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Soft Tissue Lasers Practical Applications and Results Michael Koceja, DDS Camas, Washington, USA

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Page 1: Soft Tissue Laser

Soft Tissue


Practical Applications

and Results

Michael Koceja, DDS

Camas, Washington, USA

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What is Everyday


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How can we improve the

Dental care we provide to

our patients on a daily


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How is Dentistry changing?

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- Technology is improving Dental care

- Cosmetic procedures are increasing

- People are more knowledgeable of

Dental procedures

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What is your view of how

dentistry is progressing?

Are you seeing more patients?

Are you providing more services?

How do you perceive Technology?

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Some Questions to Ask

• Is your practice successful?

Was incorporating technology part of your


• When would be a better time to

incorporate technology that differentiates

your practice and positions your practice

for the future?

• How can we provide better care to our


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How could you make your practice

more successful?

• See more patients

• Do more procedures on each patient

• Have more fun

• Provide better care for your patients

• Try new technologies

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With Technology

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What type of laser is right for you?

- Er,Cr:YSGG

- Nd:YAG

- Er:YAG

- Diode

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Questions to Ask

• Fact: Lasers have become a part of dentistry

• What do you know about Lasers?

• What do you want to learn?

• Can your practice benefit from Laser


• Would Lasers help you do better dentistry?

• What is holding you back from incorporating

Laser Technology into your practice?

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More questions to ask?

• What does a dentist expect laser

technology to do for their practice?

• How can we tailor laser technology to our

office and practice style?

• How can we educate our patients?

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What makes a Dentist


• Training

• Training

• Training

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What makes a Laser Dentist


• Training

• Training

• Training

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Laser Technology

• This is Different

• This is Better

• This is not Rocket Science

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The meaning of LASER

• L = light

• A = amplification by

• S = stimulated

• E = emission of

• R = radiation

First postulated by Albert Einstein

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Absorption Rates

• Different lasers are absorbed at varying rates in

specific tissue types

• Main targets of the ErCrYSGG and ErYAG is

water and hydroxyapatite

• Main targets of diode lasers is melanin and


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Stimulated Emission in Lasers

High Voltage Power Supply

cathode anode

100% Reflective Mirror 98% Reflective Mirror


Medium in the


Beam output

= atoms

The atoms of the active medium

are stimulated to emit light

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Laser Safety

• ANZI Z136.3-1988, OSHA, Laser safety office

• Wavelength specific eyewear

• Know you NOHD

• Difference from radiography

• Always use the lowest power necessary

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Energy, Pulse Menu, ezlaseTM

7.00 W

1.40 W

9.40 J

0.05 ms0.20 ms


3 pages, 15 pre-sets

Beep – 3 levels

Aiming – 5 levels

©2008 Michael Koceja DDS, Inc. No unauthorized reproduction. All rights reserved.

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Tissue Effects

• To get an overall effect on tissues, all of

the following factors come into play:

1. Power density (watts per cm squared)

2. Cooling of tissue

3. Duration of exposure to laser

4. Specific wavelength

5. Emission mode

6. Tissue characteristics

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What can you

utilize a soft

tissue laser for?

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Soft Tissue Indications

• Hemostasis

• Crown troughing

• Sulcular debridement

• Gingivectomy/gingivoplasty

• Frenectomy/frenotomy

• Implant recovery

• Excisional/incisional biopsies

• Aphthous Ulcer

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Soft Tissue Indications

• Extremely beneficial in treating

subgingival decay

• TMJ treatment and pain management


• Whitening

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Non Surgical




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Clinical Studies

Perio Articles and Implant Uncovering Article

1. Yeh S, Jain, Andreana S. Using a diode laser to uncover dental implants in

second – stage – surgery. Gen Dent 2005 ; 53: 414 – 417.

2. V. I Haraszthy et al., “ Microbiological Effects of Diode Laser Treatment of

Periodontal Pockets” J Dent Res 85( Spec Iss A): 1163, 2006.

3. J. Sanz et al., “A Diode Laser as an Adjunct to Periodontal Surgery” J Dent Res

88 ( Spec Iss A): 847,2009.

4. S. G Ciancio et al., “ Clinical Effects Of Diode Laser Treatment on Wound

Healing” J Dent Res 85

(Spec Iss A): 2183,2006.

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Utilizing Lasers in Dental Hygiene

Combined with scaling and root planing

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Benefits of Laser Periodontal treatment

• Non surgical treatment

• Higher Patient acceptance

• Motivates your Patients to become part of

their treatment

• Increased hygiene production

Better Results

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Lasers can

differentiate your Practice

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• Do procedures you haven’t done

in the past

• Do procedures in office that you

may not be able to refer

• Do procedures better and more

comfortable for your patient than

the Dentist next door

• Increases patient referrals

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Diode vs. Electrosurgery

• Can use diode around metal

• Has zone of necrosis only 3-5 cells deep

• Perio applications

• Whitens teeth

• Desensitizes teeth

• Herpetic and aphthous ulcer treatment

• Marketing benefits

©2008 Michael Koceja DDS, Inc. No unauthorized reproduction. All rights reserved.

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• To do better Dentistry everyday

• Better Dentistry equates to more

productive use of time

• Better use time equates to

greater efficiency

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• To change the perception of


• Changing the education process

for your patients

• Change their lives

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• To provide the best in cutting

edge technology available for


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• To change your office and

invigorate your staff

• Show them the benefits of laser


• Improving the overall general

health of your patients

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• Into multiple procedures per

patient everyday

• Increase procedures per


• Increase efficiency

• Your staff must be part of

incorporating this technology

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Into all aspects of

“Everyday Dentistry”

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Ortho Induced


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Tooth Exposure For

Bracket Placement

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Restorative Indications

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Existing Denture Patients

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• The laser that fits your needs.

• There are numerous lasers


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• Pain management treatment into

your practice

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LLLT Low Level Laser Therapy

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• FDA cleared indications

• Temporary relief of minor muscle and joint pain and stiffness

• Temporary relaxation of muscle

• Temporary increase in local blood circulation

• Applicable Dental Procedures

• TMJ Arthralgia (treatment of the Joint)

• Myofacial Pain related to TMJ (treatment of the muscle related to painful trigger point)

• Muscle relaxation related to pain and muscle stiffness after dental procedures or in general

ezlase 940 nm Therapeutic Indications

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ezlase 940 nm

Surgical vs. Therapeutic Effects

A concentrated beam of energy is delivered to

tissue via a small diameter 200-400 µm fiber tip,

and upon contact tissue is vaporized and


A diffused beam of energy size 35 x 8 mm is

delivered to the tissue site over a period of

time. The level of laser energy is low enough

to have a therapeutic effect without any tissue


Surgical Therapeutic

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• Increased micro-circulation in tissue

• Photo-activation of inactive enzymes

(catalysts) present in painful muscle cells

Normal Cell

• Improved cellular functions through

increase of ATP (fuel for the cell) production

in cells

ezlase 940 nm

Therapeutic Mechanisms of


Swollen Cell

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ezlase 940 nm

TMJ Clinical Protocol –

Therapeutic Settings

Method Contact Mode Power Setting (P) Power Density

1 contact 2.0 - 2.5 W 0.71 - 0.89 W/cm2

2 Contact/non-contact 4.0 - 4.5 W 1.43 - 1.61 W/cm2

3 non-contact 5.0 - 5.5 W 1.79 – 1.96 W/cm2

• Laser Coverage Area = 2.80 cm2 (35 x 8 mm)

• Exposure Time (t) = 1 min and up to 10 min

• Settings vary depending on the type of skin and patient response

• Start at the lowest recommended setting (power and exposure time), and increase as necessary

• Therapeutic energies applied to any muscle or joint are measured in “Dose of energy”

The formula to calculate the Dose is as follows: Dose [J] = P (W) x t (s)

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ezlase 940 nm

TMJ Clinical Treatment Protocol



• Treatment of Painful Trigger Points (Myofacial Pain)

• Palpate masseter and temporalis to identify painful trigger points; mark each point with a small

dot and the covered area.

• VAS Pain measurements for each point pre- and post-

• Treatment of the Joint (TMJ Arthralgia)

• Treat the joint at the three locations provided in the image to the right

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• Progressive/immediate relief of pain

• Reduction in muscle tenderness and


• Improved functionality of the affected

• Improve quality of life

• Gentle to tissue in comparison to other

alternatives such as steroid injections, or

appliances such as mouth guards

ezlase 940 nm

Therapeutic Applications -

Clinical Benefits

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In Office Whitening

• 12 shades

• No Sensitivity

• Works every time

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Laser Whitening

• Differences from past in-office whitening

• Advantages of laser application

» Time

» Penetration

» Tissue Interaction

• Advantages to patient

» Time

» Sensitivity

» Results

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• How would you like dentistry performed on

you and your family?

• With outdated technology or with the most

advanced, comfortable technology that is

available today?

• Use technology to educate and motivate your


Provide a higher quality of care

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Thank You

For your time and attention

Michael Koceja DDS


[email protected]