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ePaper created 2016-07-29, 16:53:04 | version 1.38.0
| industry 16 laser 2 2016 within a tissue mass, in a uniform and predictable manner, has been lacking. Several problems complicate the adoption of a standardised protocol. While the biostimulatory ef- fect of laser energy is experienced on a cellular level, the energy is applied macroscopically to large vol- umes of tissue in a non-uniform manner. As energy passes through tissue, part of it is absorbed so each successive depth of cells is irradiated differently. Beers law is usually used to define this relationship. However, this is inadequate since the dominant form of interaction at wavelengths between 600 nm and 1,400 nmisscattering.22 Thus,asenergyenterstissue, its density decreases rapidly. TheoutputofmostclinicallasersisGaussianinspa- tialprofile.Therefore,cellsdirectlyinthecentreofthe beamareirradiatedataveryhighfluence,whilethose on the periphery of the incident beam receive a very low dose. As a result, cells at the beam centre may be overstimulated far above the scientifically recom- mended range of 3–10 J/cm2 and inhibited while those on the periphery receive insufficient cellular energy to produce any effect. Furthercomplicatingstandardisationistheissueof beam divergence. Fibre-delivered laser energy exits the fibre with a significant divergence, usually on the order of 8 degrees. The applied energy is, therefore, distributed over an increasing area as the tip-to- tissue distance increases, dramatically affecting en- ergydensityatthecellularlevel.Atcurrentlyreported beam divergences, energy density can be diminished by90percentwithonly3millimetresoftip-to-tissue distance. This makes the repeatable application of an appropriate energy density extremely technique- sensitive and operator-sensitive. As a result of these problems, a handpiece was de- veloped that provides homogeneous irradiation over a 1 cm2 surface with a constant irradiation area (spot size) irrespective of the tip-to-tissue distance (from 10 to 100 mm) from the target tissue. With the intro- ductionofthisnewflat-tophandpiece,14 itisnowpos- sible to irradiate a target surface with a homogenous energy density, using relatively high-power densities, in less time and without risk of significant thermal damage. This would make the application repeatable and not operator-sensitive,14, 23 a significant step for- ward in standardisation of treatment parameters. The aim of this study is to present, through a series of clinical cases, a preliminary report on the dental andmedicalapplicationsofanewflat-tophandpiece used in conjunction with an Nd:YAG laser according to the therapeutic protocols described in Benedicen- ti’s textbook.24 Fig. 14 Fig. 16 Fig. 13 Fig. 15 Fig. 13: Fracture of an implant and missing teeth from 12 to 22. Figs. 14–17: A regenerative procedure with bone substitute. Fig. 17 22016