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Surgical Lasers in Clinical Dentistry Walawander, N.; Tanweer, A.; Borisiuk, O.; Adam, K.; Kahn, J.; Arany, P.R. Oral Biology & Biomedical Engineering, University at Buffalo School of Dental Medicine. Abstract #3 Research Question What are the critical parameters of surgical lasers for optimal clinical outcomes? Introduction ● Dental lasers remain relatively uncommon in dental offices and universities despite their many benefits. ● Surgical dental lasers are a therapeutic application of light and can be divided into contact and non-contact categories. ● Dental lasers are beneficial to patients due to their concurrent photocoagulation (bloodless field) that has less pain and improves healing time due to improved visualization and reduced inadvertent tissue damage. ● Potential reasons for hesitancy are upfront costs, fear of harming patients, time investment in learning how to use them, and the unknown. Figure 1: A box diagram displaying the many uses of light in dentistry Variables ● Device Variables: Laser settings on device, manufacturers pre-sets, prior studies; ● Operator variables: hand speed, optimal pressure (contact lasers) ● Target variables: hydration (absorption & cooling), pigmentation Outcomes ● ‘Ideal’ quality of cut Effective vs Ineffective tissue separation Charring (thermal damage) ● Precision of procedure Depth and lateral extensions Materials and Methods • Three contact and two non-contact lasers were used to make incisions on five tissue types. • Ham, steak, apples, and oranges were used to represent the soft tissues of the oral cavity such as gingiva. • Egg shells were used to represent hard tissues such as enamel, dentin or cementum. • Several parameters were tested such as device (laser power, mode – pulsed vs continuous), operator (hand speed – slow, intermediate and fast, pressure – light, firm), and target (hydration, pigmentation). • The incisions using these parameters were evaluated on the basis of tissue separation, charring, and depth. • To examine operator variables, relative hand speed while using the laser was measured using a stop watch or motion sensor. Hydratio n Pigmentatio n Apple Low High Orange Medium High Ham Medium Low Steak High High Egg Shell Low Low Figure 2: Relative Hydration and Pigmentation levels of the tissues Results Part 1: Device Variables Figure 3: We used the Waterlase (Biolase) in this study and settings 1, 2 & 3 were non-ideal power parameters while 4 & 5 were ideal power parameters for various types of tissues. We observed a direct correlation of pigmentation and hydration correlated with lower power than non-pigmented, less hydrated tissues. Interestingly, the egg shell demonstrated an intermediate power parameter indicating accounting for variations in target tissue composition is critical for appropriate laser settings. Results Effect of Power Parameters 1. P-1.0W 2. P-4.0W 3. CW-4.0W 4. CW-2.0W 5. P-3.0W Figure 4: Incisions made on an orange using the Navigator Diode (810nm Ivoclar-Dentsply). Images 1, 2, and 3 show non-ideal incisions while images 4 and 5 show ideal incisions with laser power settings. Part 2: Operator Variables Figure 5: 5.0W incisions on ham using the Epic Pro (Biolase). Top - slow, Bottom - slower. Figure 6: 5.0W incisions on ham using the Epic Pro. Top - fast, Bottom - faster. Conclusion The results demonstrate that there are clear differences in ideal laser parameters and operator hand speed based on the hydration and pigmentation of target tissues. While it appears there may be some reciprocity in correlating the two major variables, attention must be paid to the clinical scenario to ensure ideal surgical outcomes. Future Directions • Quantitative assessment of operator hand speed. • Digital images analyses with NIH ImageJ to quantify charring using black pixel analysis. • Comparing contact and non-contact laser parameters discretely for surgical soft and hard tissue procedures. References 1. Pohlhaus, S. Lasers in instruments for the modern Professional Education. (2018). dentistry: practice. Minim Crest ally and invasive Oral B 2. Bryan, B. Dental laser treatment options. Bauer & Bauer Dentistry & Orthodontics. (2013). 3. Romanos GE. Diode laser soft-tissue surgery: advancements aimed at consistent cutting, improved clinical outcomes. Compend Contin Educ Dent. 2013; 34(10):752-7. 4. Fornaini C, Merigo E, Sozzi M, Rocca JP, Poli F, Selleri S, Cucinotta A. Four different diode lasers comparison on soft tissues surgery: a preliminary ex vivo study. Laser Ther. 2016 Jun 29;25(2):105-114. Acknowledgments Support for this project was provided by UB SDM start- up funds to Dr. Arany.
