Dental lasers have been available for decades,1 but only now has the technology evolved to the point where lasers can deliver both versatility and practicality to any dental practice. Understanding the different types of dental lasers and their capability is important when considering the needs of a practice. There are a variety of dental lasers with different functionalities and limitations. For example, some lasers cut only soft tissue while others will cut all tissues in the oral cavity.2 With the introduction of these all-tissue lasers, dentists now have the option of using a multi-functional tool that has distinct clinical advantages over traditional instruments, such as the drill and scalpel. Some of these advantages can include:3
• Less need for (injectable) anesthetic
• Ability to complete multi-quadrant dentistry
• Minimal bleeding
• Less need for sutures
• Less postoperative discomfort
• Faster healing times
• Increased preservation of healthy tissue (conservative dentistry)
In addition to clinical advantages, all-tissue dental lasers can also dramatically enhance the patient experience by eliminating the needle, the sound of the drill, and postoperative discomfort—the main contributors to dental phobia. Happy patients are more likely to remain your patient, come in for non-emergency dentistry, and generate referrals. Patient satisfaction is the key to a successful dental practice so it is imperative to consider the patient experience when investing in new technology.
After numerous clinical studies proved its safety,4,5 a 9.3-µm CO2 all-tissue laser (Solea, Convergent Dental, www.dentlasertip.com) was developed that is cleared for the ablation of soft, hard, and osseous tissue. This is the first and only CO2 all-tissue laser in dentistry. It enables dentists to complete various hard- and soft-tissue procedures quickly with precision and excellent clinical outcomes. The biggest advantage over traditional instruments is this laser’s ability to complete most hard-tissue cases without injectable anesthesia and most soft-tissue cases with minimal bleeding, limited need for suturing, and only topical anesthetic. If injectable anesthetic is not used, this saves time by not injecting the patient, not waiting for them to become numb, and the ability to complete other procedures in different quadrants. With minimal bleeding, visualization of the surgical field is greatly improved. Finally, the patient experience is dramatically enhanced by not using a drill or needle, and reduced postoperative pain.dental laser fibers
The following two clinical cases demonstrate this 9.3-µm CO2 all-tissue laser’s ability to complete hard-tissue procedures without anesthesia, and soft-tissue procedures with minimal bleeding, no sutures, and fast healing. Case 1 highlights the versatility of this laser, as the procedure could not be completed with a scalpel. Case 2 focuses more on the everyday procedures that most general dentists will see on a regular basis.
Case 1: Depigmentation and Gingivectomy
A 13-year-old patient presented with puberty/hormone-induced gingival hyperplasia during a consult regarding a gingivectomy. The patient’s mother asked about lightening her daughter’s “dark gums.” A six-tooth gingivectomy and gingival depigmentation was performed. The clinical objective was to remove hypertrophic tissue, expose tooth structure, and remove melanin for a more esthetic smile. Only topical anesthetic was used to complete both the gingivectomy and depigmentation. The total procedure time from start to finish was 20 minutes. The only variables that were adjusted during the procedure were the cutting speed (managed by the variable speed foot pedal), and the spot size (ie, the area of laser ablation). The 1-mm spot size was used to remove the hyperplastic tissue; the 0.25-mm spot size was used to contour the gingiva; and the 1.25-mm spot size was used for depigmentation.
With traditional tools (ie, scalpel), this procedure would have likely taken over an hour to complete compared to 20 minutes with this laser. As only topical anesthetic was used, not having to inject the patient and wait for her to become numb saved time. As no scalpel was used for the gingivectomy, there was minimal bleeding, minimal postoperative discomfort, and extremely fast healing. With traditional instruments, the depigmentation portion would have been impossible. This 9.3-µm CO2 all-tissue laser’s speed, versatility, and ease-of-use enabled this six-tooth gingivectomy and depigmentation to be completed in the same appointment slot so there was no need to reschedule or use a second appointment slot.
Case 2: Class V with Gingivectomy
The patient presented with class V buccal decay on teeth Nos. 18 through 21. The decay was subgingival, requiring a minor gingivectomy. While photos illustrate only tooth No. 20, it should be noted that all four teeth were restored during the same appointment in 35 minutes with no anesthetic. The 1-mm spot size was used throughout the procedure and the only thing that changed was the pressure on the foot pedal (ie, cutting speed). The clinician would press softer on the foot pedal for soft tissue and harder for hard tissue. This “one setting” system is advantageous as it allows full concentration on the oral cavity.
This all-tissue laser provided significant clinical benefits and notable efficiencies compared to traditional tools such as minimal bleeding and no retraction cord during the gingivectomy. This contributed to an enhanced patient experience and increased recovery time. This laser also saved time by not giving the patient an injection and not having to wait for hemostasis before restoring the teeth. This 9.3-µm CO2 all-tissue laser provides ease of use and additional timesavings because no additional instruments were required and no anesthetic was used, hence, multi-quadrant dentistry could have been performed.
All tissue dental lasers offer substantial benefits to both the dentist and the patient. Choosing the right dental laser is very individualized and based on the wants and needs of the dentist. This 9.3-µm CO2 all-tissue laser (Solea) offers dentists the ability to complete a wide range of procedures with numerous clinical advantages. While it does not completely eliminate the need for the drill, this laser’s ability to create efficiencies and increase practice growth far exceeds that of the drill or the scalpel.