14A Clinical f DT page 13A DENTAL TRIBUNE | March 2010 form some simple procedures. I have since taken online training, as well as lecture courses, which have enhanced both my comfort level and my competency. operating tip. The units come with several presets, although after a very short time, the operator becomes so comfortable that they are rarely needed. The power and pulse settings are quickly adjusted to suit the particular patient and procedure. On a personal note, I am a dentist who does not thrive on the challenge of brand new high-tech, high-stress technology. I have tried many lasers in the past that promised to be userfriendly; they were anything but. After a short in-office demonstration of the 810 nm diode laser, I was able to pick up the handpiece and felt comfortable enough to perADS Fig. 2 Affordability Laser technology has traditionally come with a high price tag. Manufacturing costs are high and cuttingedge technology commands steep pricing. Diode lasers are less expensive to produce. Breakthrough pricing for this technology has now arrived at under $5,000. At this level, the diode laser becomes eminently affordable for the average practicing dentist. Fig. 1 Fig. 3 Why do I need this technology? The 810 nm diode laser is specifi- cally a soft-tissue laser. This wavelength is ideally suited for soft-tissue procedures because hemoglobin and melanin, both prevalent in dental soft tissues, are excellent absorbers. This provides the diode laser with broad clinical utility: it cuts precisely, coagulates, ablates or vaporizes the target tissue with less trauma, improved postoperative healing and faster recovery times.6–8 Given the incredible ease of use and its versatility in treating soft tissue, the diode laser becomes the “soft-tissue handpiece” in the dentist’s armamentarium. The dentist can use the diode laser soft-tissue handpiece to remove, refine and adjust soft tissues in the same way that the traditional dental handpiece is used on enamel and dentin. This extends the scope of practice of the general dentist to include many soft-tissue procedures. The following procedures are easy entry points for the new laser user: • Gingivectomy, haemostasis, gingival troughing for impressions The diode laser makes restorative dentistry a breeze (Picasso, AMD Lasers). Any gingival tissue that covers a tooth during preparation can be easily removed because hemostasis is simultaneously achieved. The restoration is no longer compromised due to poor gingival conditions. There is no more battling with unruly soft tissue and blood (Figs. 1–5). Excess gingival tissue can be readily managed (Figs. 5a, b) for improved restorative access to Class V preparation (ezlase, Biolase Technology). Gingival troughing prior to taking impression (Picasso, AMD LASERS) ensures an accurate impression (particularly at the all-important margins) and an improved restorative outcome. Packing cord is no longer necessary (Figs. 6, 7). Diode lasers make restorative dentistry less stressful, more predictable and more enjoyable for the dental team and the patient. • Operculectomy, excision and/or recontouring of gingival hyperplasia, frenectomy These procedures are not commonly offered or performed by the general dentist. They are examples of the expanded range of services readily added to the general practice. The dentist becomes more proactive in dealing with hyperplastic tis- sues that can increase risk of caries and periodontal disease (Figs. 8–10, courtesy of Ivoclar Vivadent). A frenectomy is now a simple and straightforward procedure (ezlase) (Fig. 10a). • Laser-assisted periodontal treatment The use of the diode laser in conjunction with routine scaling and root planing is more effective than scaling and root planing alone. It enhances the speed and extent of the patient’s gingival healing and postoperative comfort.4,5 This is accomplished through laser bacterial reduction (Picasso, AMD LASERS), debridement and biostimulation (Figs. 11, 12, courtesy of Dr. Phil Hudson). A. actinomycetemcomitans, which has been implicated in aggressive periodontitis, may also be implicated in systemic disease. It has been found in atherosclerotic plaque,9 and there has been recent data suggesting that it may be related to coronary heart disease.10 The diode laser is effective in decreasing A. actinomycetemcomitans2,4 and thereby indirectly improving the patients’ heart health. Laser education Most diode laser manufacturers provide some education to get the new user started quickly and effectively. The most comprehensive online diode laser introductory course with certification — which includes the science, safety and clinical procedures — can be found at the International Center for Laser Education, www.dentallaseredu.com (telephone, (877) 522-6863). This course provides everything necessary to get started with softtissue diode laser therapy. Advanced courses are available for more complex procedures. In conclusion The soft-tissue diode laser has become a “must have” mainstream technology for every general practice. The science, ease of use and affordability make it simple to incorporate. The laser is now the essential “soft-tissue handpiece” for the practice. In fact, there is a case for having a diode laser in each restorative and hygiene treatment room. As a result, restorative dentistry becomes easier, more predictable and less stressful. Laser therapy expands the clinical scope of a practice to include