Diode Laser Workshop - Academy of Laser Dentistry

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Diode Laser Workshop. John J. Graeber DMD MALD MAGD FICD. East Hanover, New Jersey [email protected] Dr. John Graeber ...

Diode  Laser  Workshop   John  J.  Graeber  DMD  MALD  MAGD  FICD   East  Hanover,  New  Jersey   [email protected]  

Dr.  John  Graeber  

AppreicaDon   AMD  Lasers     Biolase   Dental  Photonics   Helios  Lasers   IvoclarVivadent   Sirona   SpectraLase   Zila  (Discus  lasers)    

Dr.  John  Graeber  

Disclosure   r John Graeber DMD has had the following relations and affiliations: Lecturer, Trainer: HOYA ConBio, American Medical Technologies, BioLase Technology, IvoclarVivadent, Opus, and Air-Techniques. Free Equipment: Dental Photonics Air Techniques, American Medical Technologies, BioLase Technology. Discounted Equipment: HOYA ConBio,

Dr.  John  Graeber  

SoN  Tissue  Pathology    

Clear  understanding  of  pathological  lesion  

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Fully  trained  with  convenDonal  approaches  

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Surgical  plan    

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Laser  appropriateness    

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Use  Physical  or  visual  surgical  guides  

ContaindicaDons:  GraN  HarvesDng  

Post  operaDve  management  

Dr.  John  Graeber  

Surgical  Principles    

So#  Tissue:  

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Clean  Field:  Chlorhexidine  

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WYSIWYG  

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Tissue  Tension  

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No  charring  

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No  Scalpel,  Suture,  bleeding     Don’t  mix  techniques  

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Second  intenDon  healing  

Dr.  John  Graeber  

SuggesDons    

Carrot  simulates  fibrous  Dssue  

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Tomato  simulates  granulaDon  Dssue  

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AYempt  each  of  the  procedures  on  Pig    Jaws  using  different  devices  

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Follow  procedure  list  and    power  suggesDons.  

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Fibroma  removal  on  tongue  papillae  

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AddiDonal  power  required:  Cold  Jaws  and  Bloodless  specimens  

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Ask  manufacturer’s  reps  for  assistance  first/se\ngs/photoiniDaDon  

Dr.  John  Graeber  

Stripping/Cleaving  Video  CommonaliDes  

Dr.  John  Graeber  

       

A  well  cleaved  fiber  end   Dr.  John  Graeber  

Fiber  Maintenance………………………  

Dr.  John  Graeber  

A  well  cleaved  fiber  end  

Cleaving……………………………….    

"Micro-­‐scalpel"  created  from  an  bad  cleave  and  an  improper  break  of   the  fiber:    Cause:    Heavy  Pressure.    (SILENT  SCRATCH)  

Shard

Dr.  John  Graeber  

Dr.  John  Graeber  

A  poorly  cleaved  fiber  

Dr.  John  Graeber  

Poorly  cleaved  fiber  aiming  beam  

Dr.  John  Graeber  

Burned  ?p  –  needs  cleaving  

OpDcal  Purity   Necessary  for  Photonic  Transmission   From  fiber  to  Target  Tissue  

Dr.  John  Graeber  

OpDcally  pure    Good  Cleave  

Poor  cleave  

Leads  to  Loss  of  Fluence  and     PotenDal  Physical  Tissue  Damage  

Dr.  John  Graeber  

Incident  Angle  must  be  Perpendicular  to  target  Dssue  

Figure  4-­‐2  Diagram  showing  anatomic  landmarks  of  the  gingiva.  

Dr.  John  Graeber  

Downloaded  from:  Carranza’s  Clinical  Periodontology  (on  30  April  2007  02:33  AM)   ©  2007  Elsevier    

Photo  IniDaDon    

Low  Power  devices  require  “priming  the  Pump”  

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Follow  each  Manufacturer’s  recommendaDons  

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Would  occur  with  Dssue  ablaDon  

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“Wears  off”    Repeat  as  ablaDon  slows  down  

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One  touch  technique  

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Thick  arDculaDng  Paper  has  most  ink  available  

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Avoid  Mylar  arDculaDng  papers  

Dr.  John  Graeber  

Dr.  John  Graeber  

Safety  glasses  stay  with  devices  

Dr.  John  Graeber  

        Use  appropriate  safety  eyewear.    Photo-­‐iniDate  fiber  acc.  to  Mfgr  DirecDons    Cold  animal  models  may  require  up  to  twice  the  power  se\ngs  than  for     live  specimens;  use  the  lowest  se\ng  to  achieve    treatment  objecDve  with   minimal  charring  of  the  Dssue.       ____    Cut  thru  carrot  slice  across  the  grain  1.0-­‐2.0w  cw       ____    Pierce  the  tomato  surface  mulDply,1.0  W  PW       ____    make  incision  into  pig  tongue  3mm  deep  1  inch  long-­‐  use  tension  and   short  strokes  (4-­‐5mm)  1.0-­‐2.0  w  cw       ____    Excise  a  piece  of  tongue  using  hemostat  for  tension  1.0-­‐2.0  W  CW       ____    PracDce  laser  decontaminaDon  of  any  deep  pocket  1w  pw  or  cw       ____  Ablate  interproximal  papilla    0.8-­‐1.2w    cw       ____    excise  enDre  papilla,  bevel  edges  to  finish    0.8-­‐1.2  w  cw  

Dr.  John  Graeber  

      ____    perform  full  gingivectomy  at  proper  bevel  0.8-­‐1.2w    cw       ____    lase  uncovered  clean  root  structure  0.8-­‐1.2w       ____    create  trough  for  impression  where  gingival  Dssue  is  thick  0.8-­‐  1.5      w  on   mulDple  teeth       ____    create  ovate  ponDc  area  on  rugae  of  palate  1.0-­‐  1.5w    use  All  ablaDon  and  double  incision  techniques       ____    prepare  a  full  thickness  flap  around  one  tooth  1.0-­‐1.5  W  CW       ____    frenectomy  –  use  hemostat  for  tension  1.0-­‐1.5  W  cw       ____    Perform  a  distal  wedge  procedure  on  maxilla  1.0-­‐2.0W  CW       ____    Excise  a  plug  of  Dssue  for  an  implant  in  edentulous  area  0.8-­‐1.2W  cw   ____    Degranulate  a  “defect”  under  the  full  thickness  flap  1.0-­‐2.0w  cw   ____    lase  clean  tooth  structure  0.8-­‐1.2  w    (  there  should  be  no  absorbDon  )  

Dr.  John  Graeber  

Dr.  John  Graeber  

Thank  You   for  ParDcipaDng   John  J.  Graeber  DMD   [email protected]  

Dr.  John  Graeber