Dental Tribune Canada Edition No.2, 2016

. . A12 INDUSTRY Dental Tribune Canada Edition | April 2016 Of the commercially available hard- and soft-tissue lasers, only the LightWalker (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 pro- cedures. With this advanced level of perform- ance comes significant patient comfort. The procedure described here has been developed to take advantage of these at- tributes. 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 structures involved in our protocol include the soft palate, uvula and the base of the 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 management. Helping patients improve their sleep can profoundly improve their health, quality of life and well-being of their loved ones. The “Gold Standard” for the treat- ment of sleep disordered breathing is the CPAP type device. Following that in 1981 was the introduction of Mandibular Advancement Devices (MAD). Compli- ance with both of these treatment mo- dalities shows a reduction in compliance over time and significant side effects. However, the “NIGHTLASE™ Snoring and Sleep Apnea Reduction Therapy” protocol is a unique approach to treat- ment using the Fotona LightWalker den- tal laser with a proprietary protocol and handpiece. Another positive benefit is the 24-hour-a-day improvement in air- way vs. CPAP and MAD. NIGHTLASE uses the photothermal capabilities of the LightWalker laser to convert and initiate the formation of new and more elastic collagen.6 The tar- get mucosal tissues are the oropharynx, soft palate and uvula. The proprietary “Smooth Mode” pulse characteristics create a non-ablative heat generation or “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 eleva- tion of the soft palate and uvula and tightening of the oropharyngeal tissues, resulting in an improvement in the up- per airway volume. The results can be seen in Figure 1. NIGHTLASE therapy is indicated for cases when the patient has been diag- nosed with chronic snoring, UARS or mild to moderate sleep apnea and either cannot or chooses not to wear an appli- ance or CPAP device. It can also be used in co-therapy with those devices, allowing for lower CPAP pressures and less MAD advancement. NIGHTLASE represents a less-invasive alternative to current sur- gical, chemical or radiosurgical options that may require hospitalization, general anesthesia or soft-tissue removal. NIGHTLASE has a significant success rate in producing a positive change in sleep patterns. Research published by Miracki and Visintin7 has shown that it can reduce and attenuate snoring, and provides an effective non-invasive mo- dality to lessen the effects of obstruct- ive sleep apnea. As with any treatment, there are potential risks with laser treat- ment. However, the risks are minimal and certainly less then alternative ther- apies if the protocol 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 lower percentages were smokers, obese patients and those with severe OSA. Follow-up studies with polysonography using HST are in pro- cess, as are pharyngometer studies, both of which have recorded significant posi- tive changes. A recently published pilot research study by Lee and Lee8 has shown through 3-D CT imaging the volumetric 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 process. We are excited to present these mod- Non-surgical laser has sleep applications ern, minimally invasive and more nat- ural treatment modalities to the dental community. Using the LightWalker laser, we can now have another tool in our den- tal toolbox and offer our patients health improvements that reach beyond restor- ative and rehabilitative dentistry. If the reader is curious about using the NIGHTLASE protocol or about laser dentistry in general, you can contact the manufacturer for more information. As always, we recommend a good variety of advanced educational programs in den- tal sleep medicine to see where NIGHT- LASE might fit into your patients’ treat- ment protocols. Financial disclosure: The author has no financial interest in the products men- tioned in this article. References 1. A report of the National Commission on Sleep Disorders Research (1995) Wake Up America:ANationalSleepAlert.Washington, D.C.: U. S. Government Printing Office. 2. Young T, Peppard PE, Gottlieb DJ (2002) Epi- demiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 165: 1217-1239. 3. Lattimore JD, Celermajer DS, Wilcox I (2003) Obstructive sleep apnea and cardiovascular disease. J Am Coll Cardiol 41: 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 radiofrequency injury in the porcine soft pal- ate. Laryngoscope 109:1316-1319. 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) laser and radiofrequency ablation. Photomed Laser Surg 25: 449-454. By Harvey S. Shiffman, DDS 6. Liu H, Dang Y, Wang Z, Chai X, Ren Q (2008) Laser induced collagen remodeling: a com- parative study in vivo on mouse model. Lasers Surg Med 40: 13-19. 7. Miracki K, Vizintin Z (2013) Nonsurgical min- imally invasive Er:YAG laser snoring treat- ment. J Laser and Health Academy 1:36-41. 8. Cameron Y. S. Lee and Cameron C. Y. Lee; Evaluationofanon-ablativeEr:YAGlaserpro- ceduretoincreasetheoropharyngealairway volume: A pilot study. Dent Oral Craniofac Res, 2015, Volume 1(3): 56-59. About the author Harvey Shiffman, DDS, is in general practice at the Laser Dental Center in Boynton Beach, Fla. He is a graduate of Georgetown Univer- sity School of Dent- istry and completed a general practice residency at George- town University Medical Center, with an emphasis on treating medically compromised patients. Shiffman com- pleted certification with the Academy of Laser Dentistry (ALD) in three laser systems and recently earned ALD fellowship. He uses and helps de- velop cutting-edge technology and has performed thousands of laser dental procedures. Shiffman is an instructor for the Academy of Clinical Technol- ogy and recently lectured on advances in laser dentistry at the Yankee Dental Congress and the Greater New York Dental Meeting. He is an adjunct pro- fessor in the prosthodontics depart- ment of Nova Southeastern 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 Fig. 1: NIGHTLASE Snoring and Sleep Apnea Reduction Therapy elevates the soft palate and uvula and tightens oropharyn- geal tissues to improve upper airway volume. Photos and chart/ Provided by Dr. Harvey Shiffman Fig. 2: Research also documents a 30–90 percent reduction in snoring tone and volume. Fig. 1 Fig. 2 ODA BOOTH 516

Dental Tribune Canada Edition No.2, 2016

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