Lasertechnology + high-frequency technology

The best from 2 worlds

LASER HF

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High-frequency technology HF(also known as radio-frequency RF)

• The high-frequency technology (HF) has strictly developed since the 70s, today the devices show clear improvements compared with conventional electric surgery.

• HF is an unspectacular technology, however, it is known very well and accepted by the dentists in the surgical area.

History

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Lasertechnology

• Laser devices are often offered as omnipotent instruments and are understood by users, unfortunately, often also as those.

• Even though some applications turned out as unpracticable, the inquiry is high furthermore.

History

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Laser in the dentistry

Laser system Indication

CO2 – laser (10600 nm) Surgery

Dioden (810 – 980 nm) Parodontology, Endodonics, Implantology, Surgery (limited)

Diode (630 – 670 nm) Therapy, PDT

Erbium (2780, 2940 nm) Hard fabric, Parodontology

Laser systems and indications

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TemperatureTemperature

Drying

90 – 100 °C

Intracellularwater evaporates

Further shrinkingof fabric

Coagulation

65 – 70 °C

Collagen is convertedinto glucose

Hämostasis

Fabric changes colourgrayish / white

Fabric is shrinking

Heat

37 – 60 °C

Reversible celldamage

No visible changes

No mechanical changes

200 °C

Carbonisation

Carbonisation offabric

(grade IV)

Black colouring

Vaporisation

Fabric is evaporated

Production of smoke

400 °C +

Bases

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Differences by commercially offered dental laser devices

• Achievement: 3 – 50 W

• Moden: cw (continuouswave) / pulsed (µs – ms)

• Programs: preset / user-defined

• Design: all kinds

Marketing

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Marketing

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Laser marketing strategy

• „ Better efficiency with higher achievement !“

• „Special“ pulse-technology, to reduce thermal side effects

• On the user fitted programs

• Optimised hand pieces and fibers, tips

• Great design

• Price

Marketing

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Laser fiber, no kontakt

Problems

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Laser fiber, in kontakt

Problems

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Problems

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Problems

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Problems

Problem ! – Capillary effects

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Cuts in a pigs‘ jaw

HF / Laser

Laser: 980 nm / 3 W Fiber 200 µm in kontakt

HF: 20 W cut Needle electrode 200 µm

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HF / Laser

Laser fiber

200 µm

Mechanical strength

Mechanical strength

HF– electrode

200 µm

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HF / Laser

Beginning for the problem solution :

Laser only up to max. 3 - 4 W and mainly HF for surgery

CombinationLaser + HF = Laser HF

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Laser HF = Combination Laser + HF

• Laser for applications with low achievement

• LLLT (~ 100 mW)• aPDT (< 100 mW)• Bleaching (< 2 W)• Endodonics (< 2 W)• Parodontology (< 3 W)• Implantology(< 4 W)

• HF instead of laser for oral surgery

Combination

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Combination

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Laser surgery: Fibrom

Surgery

HF oral surgery: Fibrom

Surgery

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Laser surgery: Frenektomy

Surgery

Surgery

HF – oral surgery: Frenektomy

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Parodontology: Kill of pathogenic germs

• Access with the laser fiber like with an instrument, besides, always parallel with longitudinal of the tooth

• Irradiate of the pocket ground with only approx. 1 W (980 nm) leads to a killing of pathogenic germs.

Parodontology

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Parodontology

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Endotonics

Endodonics: Decontamination of the root canal

• Introducing the laser fiber into the root canal after preparation lege artis

• Irradiate with 1 W, besides, pull out the laser fiber under rotation of the root canal

• This procedure is repeated from 2 to 3 times, then the canal is sealed

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• ???

Endotonics

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Implantology

Implantology: Expose from implants

• The implant was put before a while and now is partial or completely covered from fabric.

• With a laser achievement of approx. 3 – 4 W the implant is exposed.

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Implantology

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LLLT

LLLT: Low level laser therapySoft laser

• The light of a soft laser (25 – 100 mW @ 660 nm) is ideal for the treatment of inflammations, aphthes and herpes.

• The time of treatment amounts between 60 and 240 seconds, besides, a surface of approx. 1 cm ² is irradiated with the laser.

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• ???

LLLT

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PDT

aPDT: Anti microbic photo-dynamic therapy

• The customary methods of the plaque control are not often sufficient – neither mechanical with instruments nor chemical (rinse, antibiotics).

• To minimise remaining risks, new methods of the selective elimination of pathogenic germs are required, these may not damage the oral flora, nevertheless.

• With the development of anti microbic, photo-dynamic therapy (aPDT) and new laser technology it is possible to inactivate micro-organisms – also at inaccessible places – without damaging the surrounding fabric.

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PDT

aPDT:Applications

• Treatment of oral carcinoms

• Anti microbic photo-dynamic therapy (aPDT)• Management of bio film• Parodontitis, Paroimplantitis• Caries prophylaxis• Caries treatment

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PDT

aPDT:Photo-dynamic therapy

Bacterial reduction about 99%

• The photo-dynamic therapy is a non-thermal inactivation induced by light of cells, micro-organisms and molecules.

• So-called “photosensitizer", colouring solutions (e.g., Toluidin blue, Methylen blue, Cyano Green, etc.) play an important role.

• The oxygen atoms in the colouring solution are activated by the laser light radiotherapy. Besides, oxygen singuletts which have a toxic effect on cells are formed.

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Fabric

Bakteria

Necrosis, membrane damages

Photosensitizer Laser

PDT

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• ???

PDT

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Disclaimer

The performed presentation was provided for internal

purposes and may not be transmitted without knowledge

by Hager & Werken GmbH & Co. KG and their written

approval and/or be changed.

The performed presentation was provided for internal

purposes and may not be transmitted without knowledge

by Hager & Werken GmbH & Co. KG and their written

approval and/or be changed.

Hager & Werken GmbH & Co. KG, Duisburginfo@hagerwerken.de