Dental Tribune Italian Edition

24 Speciale Laser Tribune Italian Edition - Maggio 2014 The diode laser as an electrosurgery replacement Glenn A. van As, BSc, DMD Introduction In 2008, Dr. Gordon Christensen wrote an article in JADA comparing the soft tissue cutting abilities of di- ode lasers to those of electrosurgery (radiosurgery) units.1 In comparing these two technologies against each other, he found that both dental la- sers and the less expensive electro- surgery units have advantages and disadvantages, and he summarized with several key points: 1. Although, there was consider- able overlap in their uses and both technologies were effec- tive, Christensen found that di- ode lasers were able to be used around metal (amalgam and gold) as well as with dental im- plants. 2. He stated that lasers did not harm dental hard tissues (bone) or soft tissues (pulp), and that the clinician could use the laser with less anesthetic, and finally he mentioned that lasers were antimicrobial (antibacterial). 3. The acceptance and use of lasers, especially the diode laser, was increasing in dentistry, and that lasers attract patients because of their recognized and accepted role within the field of medicine (LASIK eye surgery). 4. Electrosurgery units were “far less expensive than the least expensive diode lasers” and he questioned whether “the advan- tages of the diode laser were sig- nificant enough to compensate for the additional cost”. There are two basic types of electro- surgical units that can be purchased in dentistry: - Monopolar, in which a single electrode exists and the current travels from the unit down a sin- gle wire to the surgical site. The patient must be grounded with a pad placed behind the patient’s back (a part of the procedure that many patients may que- stion). Heat is produced when the electrode contacts the tissue, and due to pain that is produced, anesthetic must be used. - Bipolar, in which two electrodes are placed in very close proxi- mity to each other. Bipolar units are more expensive than diode lasers and the electrical current flows from one electrode to the other, thus eliminating the need for a grounding pad. Bipolar units, because of the two wires, create less of a precise cut than the monopolar or diode laser. Although electrosurgical units are inexpensive, require no safe- ty glasses and can remove large amounts of tissue quickly, diode lasers have become much more common in dental operatories in the four years since Christensen’s article was published. The primary reasons for their increased popular- ity are that diode lasers have a small footprint, are reliable and durable lasers, and are portable. Where a few short years ago, diode lasers could cost in the range of $ 10,000 to $ 15,000, they are now cost effective and can be purchased for less than $ 2,500. Advantages of diode lasers over electrosurgery Ability to work around metals intraorally Diode lasers in the range of 810- 1,064 nm are well absorbed in he- moglobin, melanin (pigment) and to some degree water (Fig. 1). These mid infrared dental wavelengths in the absorption spectrum offer the dental clinician the ability to ablate soft tissues precisely while con- trolling hemostasis, providing the clinician with an excellent view of the surgical site with a reduced re- liance on sutures. Diode lasers have features that make them attractive as mentioned earlier, but they also have several advantages in function over electrosurgical units2 (Table 1). Perhaps the greatest benefit of these lasers is that they allow the clini- cian to work safely around metals. The literature has shown that mo- nopolar electrosurge units can acci- dentally create catastrophic results when touching metal intraorally. Published reports have shown that contact for very short periods of time with the electrode of a monop- olar electrosurgical unit can cause >> pagina 25 Fig. 1 - Absorption curve of various tissue components shows diode lasers to be well absorbed in melanin (pigment), hemoglobin and to some degree water (Images/ Provided by Glenn A. van As, BSc, DMD). Fig. 2 - Gingival hyperplasia around orthodontic appliances. Fig. 3 - Immediate post-op after diode laser gingivectomy completed. Fig. 4 - Eight-day healing of soft tissue around brackets. Fig. 5 - Diode laser for second-stage implant uncovery in edentulous maxilla. Table 1 - Comparison of diode laser versus monopolar electrosurgery units.