by William Thompson, DDS
It was my own doubt that spurred my interest in and involvement with lasers. Quixotic claims about their infinite uses had made me skeptical. At the 1999 California Dental Association meeting, my main goal was to investigate the various hard-tissue lasers. Those I evaluated included Premier Laser, Biolase, and Continuum Biomedical.
I selected the erbium laser from Continuum. The performance and possible applications of these erbium lasers made the decision to venture into this new technology an easy one and .3 its impact on various aspects of my dental practice has been extraordinary. Lasers provide an amazing alternative to conventional restorative dentistry; their use can eliminate the need for local anesthetics as well as the noise and vibration that comes with conventional handpieces.
The benefits
Incorporating an erbium laser into your practice benefits four crucial areas:
- patients
- staff
- doctor
- the practice itself.
Patient benefits
Laser use often eliminates the need for local anesthesia on routine restorative procedures, which is an immeasurable benefit for patients. Laser treatment decreases the sensory assaults associated with injections and drilling. Less pain increases patient satisfaction. Patients also benefit from atraumatic and minimally invasive operative procedures.Laser use also results in increased preservation of sound tooth structure and enhanced tooth fracture resistance through adhesive restorative procedures. The results are cosmetically beautiful.
Scientific studies utilizing scanning electron microscopy show that laser use eliminates the smear layer. The remaining surface is free of bacterial contamination and residue from lubricants associated with high-speed handpieces. In short, the tooth preparation is ideal in every way for the use of modern direct resin restoratives, which enhances the quality of the restoration.
Another patient benefit is the possibility of multi-quadrant treatment. The patient can have treatment finished in fewer appointments. Additionally, patients truly enjoy leaving the office with little or no motor or sensory impairment.
Staff benefits
A very interesting benefit and one that I did not foresee relates to my staff. Their exposure to the new technology generated an initial interest that grew into real excitement. Their enthusiasm includes a real sense of pride in being a part of something very unique and special. We all feel we have something interesting and beneficial to offer. We enjoy sharing the miracle of this technology with others, even when we're not actively using it during an appointment.
Doctor benefits
I have found that the doctor benefits in several ways. First, there is a renewed or expanded excitement for clinical care that is directly related to the adoption of the laser. Anticipating the application of the laser clinically and patient's responses to it makes going to work exciting. Minimizing anesthetic injections results in happier patients and therefore less stress for the doctor.
My involvement with the Academy of Laser Dentistry has also been a real and stimulating benefit. Innovative people who enjoy sharing with others abound. They have provided not only a vehicle for learning and certification but also a congenial group who shares a common enthusiasm.
Practice benefits
The practice has benefited in many ways. Most evident was our productivity, chiefly the hourly rate of production. We actually can treat more surfaces per hour! For example, you may have a patient who requires anesthesia for the replacement of an amalgam restoration. While waiting for anesthesia, you may be able to treat one or more teeth in that quadrant or different quadrants.
Laser use shortens the duration of certain procedures, allowing the practitioner to schedule them in conjunction with other procedures —a crown prep, for example. After giving anesthesia, you can perform one or two short laser procedures while waiting for the other patient's anesthesia to take effect.
What you have just accomplished is converting a procedure that normally takes a considerable amount of time — an injection, plus waiting for it to take effect — and has very low production (especially if a single surface restoration) to a procedure that adds to the already favorable production earned from a crown. I used to grumble in the past when I had to do just one class V restoration. Now, I happily do these procedures; the reduced time now makes good hourly production great.
Some procedures do take longer with the laser, depending on the size of the preparation. The clinician should also allow some extra time when first utilizing a laser. Experience will increase performance efficiency.
Many procedures, however, require far less time. For example, if a patient has class V caries or perhaps a failing buccal crown margin, the procedure can take almost the same amount of time as placing a sealant. There is no injection or waiting for anesthesia. We now treat all defects needing sealant with the laser, which eliminates all plaque and debris, ensures a good bond, and which further enhances quality. If we find decay during this process, it can be quickly removed by continuing the preparation with the laser and placing a composite, further enhancing efficiency.
The production rate also is affected in several indirect ways. Referrals almost always increase, which brings an influx of patients needing significant restorative treatment. Some of those will be people who have avoided the usual process of restorative care and now appear, hoping for a better alternative.
Our practice has generated a different identity and increased visibility within the community. Providing state of the art, high-tech dentistry has justified an overall increase in fees, not simply those associated with the laser. In fact, we explain that we charge the same whether we use laser or conventional treatment. We have easily reached our financial goals over the last two years; as a result, I've had the privilege of rewarding my staff with some special trips and cruises — another benefit that they richly deserve!
The popularity of laser surgery and other procedures in dermatology, ophthalmology, and plastic surgery has made the public enthusiastic about laser use in dentistry. Steady refinement from manufacturers has resulted in lasers that perform with admirable clinical ease and efficiency.
Presently, I have added other lasers for soft tissue procedures, notably the Twilite by Biolase, as well as the Diagnodent by Kavo for laser-assisted diagnostics.
My involvement in the field has increased exponentially. I'm now pursuing educator status in the Academy of Laser Dentistry. My skepticism has been replaced with evangelism; I want to "spread the gospel" and help train new users in the safe and effective operation of this new technology.
I believe any dental practitioner who chooses to become involved will be likewise rewarded. Investigate for yourselves these amazing devices and see if you think the same benefits can be yours.
