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today Pacific Dental Congress Mar. 18

exhibitors20 Pacific Dental Conference — March 18, 2016 n Of the commercially available hard- and soft-tissue lasers, only the Light- Walker (Fotona, San Clemente, Calif.) combines two proven wavelengths, Nd:YAG and Er:YAG, with unrivaled power and precise pulse control 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 Figs. 1–2. 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. The NIGHTLASE therapy represents a less-invasive alternative to current surgical, chemical or radiosurgical options that may require hospitaliza- tion, 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 perma- nent alteration and lasts anywhere Non-surgical laser therapy improves patients’ sleep-disordered breathing 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. The lower percentages were smokers, 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- 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. By Harvey S. Shiffman, DDS If the reader is curious about using theNIGHTLASEprotocoloraboutlaser 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: A National Sleep Alert.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. Fomin D,Nicola E,Oliver C,Farci M,Dibbern R, et al.(2007) Collagen type analysis in the soft 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. CameronY.S.LeeandCameronC.Y.Lee;Evalua- tion of a non-ablative Er:YAG laser procedure toincreasetheoropharyngealairwayvolume: A pilot study. Dent Oral Craniofac Res, 2015, Volume1(3):56-59. Harvey Shiffman, DDS, is in general practice at the Laser Dental Cen- ter in Boynton Beach, Fla. He is a graduate of Georgetown University School of Dentistry and completed a general practice residency at George- town University Medical Center, with an emphasis on treating medically com- promised patients. He also completed certification with the Academy of Laser Dentistry (ALD) in three laser systems and recently earned ALD fellowship. Shiffman is an instructor for the Acad- emy of Clinical Technology and recently lectured on laser dentistry at the Yankee Dental Congress and the Greater New York Dental Meeting. He is also an adjunct professor in the prosthodontics department of Nova Southeastern College of Dental Medicine and is responsible for the development of a dental laser educational program for undergraduates and dental graduate students. Lightwalker Er:YAG/Nd:YAG dental laser therapy produces positive change in sleep patterns Here at the PDC Learn more about the LightWalker Er:YAG and Nd:YAG dental laser in the NationalDentalInc.booth,No.235/237.  Figs. 1, 2: NIGHTLASE Snoring and Sleep Apnea Reduction Therapy results in the elevation of the soft palate and uvula and tightens oropharyngeal tissues to improve upper airway volume. The therapy lasts anywhere from six to 12 months and can be touched up at follow-up appointments. (Photos/Provided by Dr. Harvey Shiffman) Fig. 1 Fig. 2 About the author

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