Dental Tribune U.S.Edition No.2, 2017

a18 COmmENTAR Y Dental Tribune U.S. Edition | February 2017 Hard-tissue laser systems: Is the future now? By David L. Hoexter, DMD, FaCD, FiCD Editor in Chief A greater number of dentists may soon be ready to start us- ing hard-tissue lasers in the preparation of teeth and re- shaping of bone. The technology prom- ises to be more precise, lead to more esthetic results and, hopefully, be more economical as well. Restoring the natural dentition has been one of the cornerstones of dentistry. Historically, GV Black was the first to use hand chisels to shape his design prepara- tion for restorations. A foot-pedaled drill with special burrs followed. Belt-driven handpieces with drilling apparatus came next, along with a high-pitched whir- ring sound. Although the belt helped the practical achievement, the irritating and annoying sound hurt the dentist’s ear and escalated patient fear and anxiety. The high-speed handpiece helped ease strain on the practitioner’s hand and seemed to make things better for patients, but the whirring sound sim- ply evoked a variation in the fear. Lasers have made remarkable strides to elimi- nate the annoying sounds, but initially the technology was limited primarily to soft-tissue work. Different power sources are utilized for different fields. Today, hard-tissue lasers are becoming more accessible and practical. Recently, in an exhibitor booth at a major dental meeting, I was amazed by a laser system used for hard-tissue procedures. Early on, hard-tissue lasers used in dentistry would typically cause bone or dentin to become dried or desiccated and then crumble. Pulpal reactions were also re- ported. Use could result in patient dis- comfort and pain. Many practitioners avoided the technology. Also with the early generations of the technology, some questionable claims were made about some hard-tissue achievements. I tried some of those ear- Ad DaviD L. HoExTER, DMD, FiCD, FaCD, is director of the International Acade- my for Dental Facial Esthetics and a clinical professor in periodontics and im- plantology at Temple University, Philadelphia. He is a diplomate in the Inter- national Congress of Oral Implantologists, the American Society of Osseointegration and the American Board of Aesthetic Dentistry. He lectures throughout the world and has published nationally and internationally. He has been awarded 12 fellowships, including FACD, FICD and Pierre Fauchard. He has a practice in New York City limited to periodontics, implantology and esthetic surgery. Contact him at (212) 355-0004 or drdavidlh@gmail.com. lier products and found the ones I used to be expensive and ineffective. Their pounding, pulsating, loud noises — along with streams of water — seemed to achieve little if anything for the patient. Application seemed limited to Class V restorations. The disappointment of some these ear- ly products dulled many practitioners’ hope and expectations for the use of lasers with hard-tissue procedures. But things are far different now! Testing in the exhibit hall One example I recently learned about is Light Instruments’ LiteTouch Er:YAG la- ser system, which was launched in the U.S. last year by AMD Lasers. It is a water- cooled laser that enables clinicians to shape osseous structure as well as the tooth as desired, without causing pathol- ogy, while achieving desired goals. Once the practitioner acquires the abil- ity to use the tip’s apex rather than the side of the filament, as many are accus- tomed to do with a burr, the artistic abili- ties of the practitioner promise to soar with this technology’s possibilities. I immediately see the possibilities with a restorative preparation. With this laser, the micro-groove caused by the burr on the cavo surface of the tooth will no lon- ger be there. Then, perhaps, the micro- seepage of such a groove’s margins will no longer be present. This means the restorations shouldn’t leak or wear out at the restoration’s “margins-less” seepage, resulting in longer-lasting restorations and improved service for our patients. The advantages of using a laser on hard tissue are enormous. To begin with, the laser is silent. The annoying and fear- provoking sounds of many high-speed, air-driven handpieces and the whirring, chilling noise of many belt-driven hand- pieces disappear. Using a hard-tissue laser, the resulting margins of a tooth preparation in restor- ative dentistry are sharp and might pre- vent micro-leakage. The resulting longer- lasting restorations further justify the technology as economical and practical. I encourage you to try one at a dental meeting where physical booths are pres- ent, and let me know if you agree that the future is now. ” FLOSSING, page A16 the need for additional visits when sub- mitting a claim. Giving us a little wiggle room for oral-health assessment human- izes the health care provider. It adds value to our diagnostic abilities. It allows us to emphasize the mouth/body connection to the patient. If we’ve assessed that the patient presents with at least 30 percent of his or her gingivae exhibiting moder- ate to severe inflammation, the code can then be correctly used. When The New York Times reporter called me to do research on Esther’s life, the initial questions were about Esther’s classic dental-hygiene textbook. The 12 editions in multiple languages are im- pressive enough on their own. So I tried to steer the reporter away from the text, hoping the tribute might focus more on the wonderful, energetic woman Esther was. When Esther was 89, she was out on a Chicago dance floor at a Hu Friedy party at 10 p.m. The rest of us, decades younger, were yawning into our decaf. I can see why someone who isn’t a hy- gienist would wonder why people would stand in line for two hours for an auto- graph from a professor. This is what made Esther so special and unique. She really was our True North. Esther was our link to another era. A liv- ing, breathing connection to the begin- ning of our profession. The rest of us can only pray that, in time, the shadows of our own professional reputations stand bigger than ourselves. I’ve been collecting lithographs for 30 years. Stumbling upon Sorel’s “The Last Flossing” around the same time that Es- ther passed away led me to believe that divine provenance had met divine provi- dence. Considering Sorel’s nontheism, I’m not so sure he would agree. But then, he’s not a hygienist. More online For more information on the updated dental hygiene code, visit DiGangi’s web- site, www.DentalCodeology.com. Find “The Purple Guide: Developing Your Clinical Hygiene Career” on Gut- kowski’s site, www.rdhpurpleguide.com. At press time, a signed print of Sorel’s “The Last Flossing” could be seen for sale at www.chrisbeetles.com/gallery/cartoon/ last-flossing.html.

Dental Tribune U.S.Edition No.2, 2017

Pages Overview