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Lasertechnology + high-frequency technology
The best from 2 worlds
LASER HF
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High-frequency technology HF(also known as radio-frequency RF)
• The high-frequency technology (HF) has strictly developed since the 70s, today the devices show clear improvements compared with conventional electric surgery.
• HF is an unspectacular technology, however, it is known very well and accepted by the dentists in the surgical area.
History
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Lasertechnology
• Laser devices are often offered as omnipotent instruments and are understood by users, unfortunately, often also as those.
• Even though some applications turned out as unpracticable, the inquiry is high furthermore.
History
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Laser in the dentistry
Laser system Indication
CO2 – laser (10600 nm) Surgery
Dioden (810 – 980 nm) Parodontology, Endodonics, Implantology, Surgery (limited)
Diode (630 – 670 nm) Therapy, PDT
Erbium (2780, 2940 nm) Hard fabric, Parodontology
Laser systems and indications
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TemperatureTemperature
Drying
90 – 100 °C
Intracellularwater evaporates
Further shrinkingof fabric
Coagulation
65 – 70 °C
Collagen is convertedinto glucose
Hämostasis
Fabric changes colourgrayish / white
Fabric is shrinking
Heat
37 – 60 °C
Reversible celldamage
No visible changes
No mechanical changes
200 °C
Carbonisation
Carbonisation offabric
(grade IV)
Black colouring
Vaporisation
Fabric is evaporated
Production of smoke
400 °C +
Bases
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Differences by commercially offered dental laser devices
• Achievement: 3 – 50 W
• Moden: cw (continuouswave) / pulsed (µs – ms)
• Programs: preset / user-defined
• Design: all kinds
Marketing
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Marketing
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Laser marketing strategy
• „ Better efficiency with higher achievement !“
• „Special“ pulse-technology, to reduce thermal side effects
• On the user fitted programs
• Optimised hand pieces and fibers, tips
• Great design
• Price
Marketing
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Laser fiber, no kontakt
Problems
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Laser fiber, in kontakt
Problems
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Problems
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Problems
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Problems
Problem ! – Capillary effects
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Cuts in a pigs‘ jaw
HF / Laser
Laser: 980 nm / 3 W Fiber 200 µm in kontakt
HF: 20 W cut Needle electrode 200 µm
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HF / Laser
Laser fiber
200 µm
Mechanical strength
Mechanical strength
HF– electrode
200 µm
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HF / Laser
Beginning for the problem solution :
Laser only up to max. 3 - 4 W and mainly HF for surgery
CombinationLaser + HF = Laser HF
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Laser HF = Combination Laser + HF
• Laser for applications with low achievement
• LLLT (~ 100 mW)• aPDT (< 100 mW)• Bleaching (< 2 W)• Endodonics (< 2 W)• Parodontology (< 3 W)• Implantology(< 4 W)
• HF instead of laser for oral surgery
Combination
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Combination
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Laser surgery: Fibrom
Surgery
HF oral surgery: Fibrom
Surgery
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Laser surgery: Frenektomy
Surgery
Surgery
HF – oral surgery: Frenektomy
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Parodontology: Kill of pathogenic germs
• Access with the laser fiber like with an instrument, besides, always parallel with longitudinal of the tooth
• Irradiate of the pocket ground with only approx. 1 W (980 nm) leads to a killing of pathogenic germs.
Parodontology
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Parodontology
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Endotonics
Endodonics: Decontamination of the root canal
• Introducing the laser fiber into the root canal after preparation lege artis
• Irradiate with 1 W, besides, pull out the laser fiber under rotation of the root canal
• This procedure is repeated from 2 to 3 times, then the canal is sealed
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• ???
Endotonics
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Implantology
Implantology: Expose from implants
• The implant was put before a while and now is partial or completely covered from fabric.
• With a laser achievement of approx. 3 – 4 W the implant is exposed.
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Implantology
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LLLT
LLLT: Low level laser therapySoft laser
• The light of a soft laser (25 – 100 mW @ 660 nm) is ideal for the treatment of inflammations, aphthes and herpes.
• The time of treatment amounts between 60 and 240 seconds, besides, a surface of approx. 1 cm ² is irradiated with the laser.
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• ???
LLLT
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PDT
aPDT: Anti microbic photo-dynamic therapy
• The customary methods of the plaque control are not often sufficient – neither mechanical with instruments nor chemical (rinse, antibiotics).
• To minimise remaining risks, new methods of the selective elimination of pathogenic germs are required, these may not damage the oral flora, nevertheless.
• With the development of anti microbic, photo-dynamic therapy (aPDT) and new laser technology it is possible to inactivate micro-organisms – also at inaccessible places – without damaging the surrounding fabric.
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PDT
aPDT:Applications
• Treatment of oral carcinoms
• Anti microbic photo-dynamic therapy (aPDT)• Management of bio film• Parodontitis, Paroimplantitis• Caries prophylaxis• Caries treatment
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PDT
aPDT:Photo-dynamic therapy
Bacterial reduction about 99%
• The photo-dynamic therapy is a non-thermal inactivation induced by light of cells, micro-organisms and molecules.
• So-called “photosensitizer", colouring solutions (e.g., Toluidin blue, Methylen blue, Cyano Green, etc.) play an important role.
• The oxygen atoms in the colouring solution are activated by the laser light radiotherapy. Besides, oxygen singuletts which have a toxic effect on cells are formed.
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Fabric
Bakteria
Necrosis, membrane damages
Photosensitizer Laser
PDT
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• ???
PDT
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Disclaimer
The performed presentation was provided for internal
purposes and may not be transmitted without knowledge
by Hager & Werken GmbH & Co. KG and their written
approval and/or be changed.
The performed presentation was provided for internal
purposes and may not be transmitted without knowledge
by Hager & Werken GmbH & Co. KG and their written
approval and/or be changed.
Hager & Werken GmbH & Co. KG, [email protected]