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exhibitors 8 Pacific Dental Conference — March 17, 2016 n Of the commercially availablehard-andsoft- tissue lasers, only the LightWalker (Fotona, San Clemente, Calif.) combines two proven wavelengths, Nd:YAG and Er:YAG, with unrivaledpowerandprecisepulsecon- trol resulting in high levels of efficacy for a wide range of procedures. With this advanced level of perform- ance comes significant patient com- fort. The procedure described here has been developed to take advantage of these attributes. Snoring and sleep disordered breathing affect millions of Americans, both adults and children.1,2 The signs and symptoms are the result of partial or complete collapse of the upper airway during sleep.3 The struc- tures involved in our protocol include thesoftpalate,uvulaandthebaseofthe tongue.4 The goal of the treatment is to decrease the amount of blockage of the upper airway.5 Dentists are in a great position to help screen and in many cases treat these problems with airway manage- ment. Helping patients improve their sleep can profoundly improve their health,qualityoflifeandthewellbeing of their loved ones. The “Gold Standard” for the treat- ment of sleep disordered breathing is theCPAPtypedevice.Followingthatin 1981 was the introduction of Mandibu- lar Advancement Devices (MAD). Com- pliance with both of these treatment modalities shows a reduction in com- pliance over time and significant side effects. However, the “NIGHTLASE™ Snoring and Sleep Apnea Reduction Therapy”protocolisauniqueapproach to treatment using the Fotona Light- Walker dental laser with a propri- etary protocol and handpiece. Another positive benefit is the 24-hour-a-day improvement in airway vs. CPAP and MAD. NIGHTLASE uses the photothermal capabilities of the LightWalker laser to convert and initiate the formation of newandmoreelasticcollagen.6 Thetar- getmucosaltissuesaretheoropharynx, soft palate and uvula. The proprietary “Smooth Mode” pulse characteristics createanon-ablativeheatgenerationor “Heat Shock” that initiates the conver- sion of existing collagen to more elastic and organized forms and also initiates “neocollagenesis,” the creation of new collagen. This process results in a visible elevation of the soft palate and uvula and tightening of the oropharyngeal tissues, resulting in an improvement in the upper airway volume. The results can be seen in Figure 1. NIGHTLASE therapy is indicated for cases when the patient has been diagnosed with chronic snoring, UARS or mild to moderate sleep apnea and either cannot or chooses not to wear an applianceorCPAPdevice.Itcanalsobe used in co-therapy with those devices, allowing for lower CPAP pressures and less MAD advancement. NIGHTLASE represents a less-invasive alternative to current surgical, chemical or radio- surgical options that may require hos- pitalization, general anesthesia or soft- tissue removal. NIGHTLASE has a significant suc- cessrateinproducingapositivechange in sleep patterns. Research published by Miracki and Visintin7 has shown that it can reduce and attenuate snor- ing, and provides an effective non- invasive modality to lessen the effects of obstructive sleep apnea. As with any treatment, there are potential risks with laser treatment. However, the risks are minimal and certainly less then alternative therapies if the proto- col is followed correctly. NIGHTLASE therapy is not a permanent alteration and lasts anywhere from six to 12 months and is easily touched up at follow-up appointments.2 In 2013 we completed a pilot study that addressed only snoring with 12 patients. Twelve-month follow-up showed a 30–90 percent reduction in snoring tone and volume (Fig. 2). The lowerpercentagesweresmokers,obese patients and those with severe OSA. Follow-upstudieswithpolysonography usingHSTareinprocess,asarepharyn- gometer studies, both of which have recorded significant positive changes. A recently published pilot research study by Lee and Lee8 has shown through 3-D CT imaging the volumet- Non-surgical laser has sleep applications in dentistry ric positive changes after NIGHTLASE treatment to help support the clinical results, and the authors have follow up studies with 3-D CT, polysonography and a larger group of patients in pro- cess. We are excited to present these modern, minimally invasive and more natural treatment modalities to the dental community. Using the Light- Walker laser, we can now have another tool in our dental toolbox and offer our patients health improvements that reach beyond restorative and rehabili- tative dentistry. If the reader is curious about using the NIGHTLASE protocol or about laser dentistry in general, you can contact the manufacturer for more informa- tion. As always, we recommend a good variety of advanced educational pro- grams in dental sleep medicine to see where NIGHTLASE might fit into your patients’ treatment protocols. Financial disclosure: The author has no financial interest in the products mentioned in this article. References 1. AreportoftheNationalCommissiononSleep Disorders Research (1995) Wake Up America: ANationalSleepAlert.Washington,D.C.:U.S. GovernmentPrintingOffice. 2. Young T, Peppard PE, Gottlieb DJ (2002) Epi- demiologyofobstructivesleepapnea:apopu- lationhealthperspective.AmJRespirCritCare Med165:1217-1239. 3. Lattimore JD, Celermajer DS, Wilcox I (2003) Obstructive sleep apnea and cardiovascular disease.JAmCollCardiol41:1429-1437. 4. Courey MS, Fomin D, Smith T, Huang S, Sand- ers D, et al. (1999) Histologic and physiologic effects of electrocautery, CO2 laser and radio- frequency injury in the porcine soft palate. Laryngoscope109:1316-1319. 5. FominD,NicolaE,OliverC,FarciM,DibbernR, By Harvey S. Shiffman, DDS etal.(2007)Collagentypeanalysisinthesoft palate after surgical intervention with CO(2) laserandradiofrequencyablation.Photomed LaserSurg25:449-454. 6. Liu H, Dang Y, Wang Z, Chai X, Ren Q (2008) Laser induced collagen remodeling: a com- parativestudyinvivoonmousemodel.Lasers SurgMed40:13-19. 7. Miracki K, Vizintin Z (2013) Nonsurgical min- imally invasive Er:YAG laser snoring treat- ment.JLaserandHealthAcademy1:36-41. 8. Cameron Y. S. Lee and Cameron C. Y. Lee; Evaluationofanon-ablativeEr:YAGlaserpro- cedure to increase the oropharyngeal airway volume:Apilotstudy.DentOralCraniofacRes, 2015,Volume1(3):56-59. About the author Harvey Shiffman, DDS, is in general practice at the Laser Dental Cen- ter in Boynton Beach, Fla. He is a graduateofGeorge- town University School of Dentistry and completed a general practice resi- dency at Georgetown University Med- ical Center, with an emphasis on treat- ing medically compromised patients. Shiffman completed certification with the Academy of Laser Dentistry (ALD) in three laser systems and recently earned ALD fellowship. He uses and helps develop cutting-edge technology and has performed thousands of laser dental procedures. ShiffmanisaninstructorfortheAcad- emyofClinicalTechnologyandrecently lectured on advances in laser dentistry at the Yankee Dental Congress and the Greater New York Dental Meeting. He is an adjunct professor in the prostho- dontics department of Nova Southeast- ern College of Dental Medicine and is responsible for the development of a dental laser educational program for undergrads and dental grad students. Lightwalker Er:YAG/Nd:YAG dental laser treats snoring, sleep-disordered breathing Here at the PDC Learn more about the LightWalker Er:YAG and Nd:YAG dental laser in the National Dental Inc. booth, No. 235/237. Fig. 1: NIGHTLASE Snoring and Sleep Apnea Reduction Therapy elevates the soft palate and uvula and tightens oropharyngeal tissues to improve upper airway volume. Fig. 2: Research also documents a 30–90 percent reduction in snoring tone and volume. (Photos/Dr. Harvey Shiffman) Fig. 1 Fig. 2