In some instances, technological innovation supports operational efficiencies; in others it has a tangible role chairside. The dental laser, received guardedly by many dental professionals, has begun to assume a greater presence in the modern practice as its clinical indications are confirmed by evidence-based research. Dental lasers such as the Nd:YAG, diode, and Er,Cr:YSGG received earliest acceptance for soft tissue applications; selection of the corresponding laser wavelength and settings enables various hard tissue procedures to be performed as well.
According to the July 2007 edition of The Journal of the American Dental Association, laser energy can also be used to eliminate bacteria in root canals. This in vitro study described the use of the laser in endodontic treatment of root canals inoculated with Enterococcus faecalis and Escherichia coli; the canals were then irradiated using either a 1- or 1.5-watt power setting. The researchers found that the laser reduced the amount of E. coli at both power settings and was also effective in eliminating E. faecalis. While citing the need for clinical studies to confirm the laboratory findings, the investigators were encouraged by the study outcomes and the promise of their laser to clean and disinfect root canals.
With the expansion of these clinical applications, dental lasers thus represent a new adjunct to the dental practice. Consequently, it is important to understand how to implement these technologies safely and efficiently in the busy practice environment.
Integrating Lasers into the Practice
The initial step is the purchase of the dental laser itself. Prior to selecting a given laser, a potential buyer should focus less on cost and instead evaluate the level of support provided by the manufacturer. Any viable dealer or manufacturer should have documented experience with laser technology, offer ongoing training in its use, and technical support sufficient to answer questions and troubleshoot any difficulties a user might encounter.
Office design and ergonomics are also relevant considerations. As the design among the lasers varies from one offering to the next, it is important to consider if the laser will be used in a single operatory, moved among several rooms, and need electrical outlets for use. Many of today’s dental lasers are designed with batteries (ie, are cord-free) and portability in mind, and understanding one’s needs prior to purchase can improve implementation thereafter.
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Adequate visualization is similarly critical to successful integration of the dental laser within the practice. Its precise cutting effect can be best evaluated by a clinician working with surgical loupes and/or a surgical operating microscope. Whereas surgical instruments enable tactile evaluation of the cutting action, the cutting action of the laser is optimally viewed under magnification.
While the body of literature documenting the performance of dental lasers through controlled trials must be increased, those using the devices empirically suggest that practice and repetition are both keys to successful use. As with any procedure, one’s prowess with the laser can be enhanced through continuing education courses and relevant hands-on experience in an in vivo environment. Procedures in posterior regions and troughing around tooth preparations for impression making, both free from the rigors of the aesthetic zone, represent ideal treatments for one to consider when searching for the right clinical indication on which to first use the laser.
The Academy of Laser Dentistry, the World Clinical Laser Institute, and related organizations offer additional instruction in laser dentistry, as do various academies and universities throughout the industry. Such course offerings enhance practitioners’ and auxiliaries’ understanding of the scientific properties of the laser as well as their clinical prowess, ensuring that users have the necessary training to harness the technology for procedures aimed at a patient’s aesthetics and wellbeing--much like the endodontic application realized by the Austrian researchers published in JADA. Others goals of implementing laser technology in daily practice include:
- Reduced pain and discomfort;
- Pocket depth reduction;
- Minimal intrasulcular bacterial activity;
- Potential increases in bone density adjacent to the root surfaces following debridement; and
- Limited to no gingival recession.
With proper training and education, the clinician can easily become adept at the use of laser technology, thus improving his or her productivity. The patient benefits of the laser system will also increase case acceptance, further augmenting the clinician’s return on investment. Emerging technologies will continue to improve the methods by which clinical procedures are performed; laser therapy is an obvious example of the many benefits that can be achieved using such cutting-edge modalities.