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Introduction to New High Power High Dose Class IV Laser Therapy. Bruce R. Coren , DVM , MS Founder Class IV Laser Therapy. HDLT-HPLT High Dose – High Power L aser Therapy.
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Bruce R. Coren, DVM, MSFounder
Class IV Laser Therapy
It could well stand for – Latest Advance For Surgeon to Enhance
Are used to cut, coagulate, and evaporate tissues. This type of laser replaces the scalpel blade.
The TMA Laser is the only laser available on the market that was designed to accomplishboth surgical and therapeutic procedures.
High Power Therapeutic Lasers take a high amount of laser energy but instead of beam collimation you get beam divergence resulting in tissue stimulation
Increased Growth factor response within cells and tissue as a result of increased ATP and protein synthesis.
Increased metabolic activity- via increase in enzyme outputs, oxygen and nutrient availability.
Greater Tensile Strength - Surgical repaired wounds heal with greater tensile strength, including skin, tendon, ligament and fascia.
WOUND DAY 1
WOUND DAY 7 SID TX 4 WATTS-3000 JOULES
PRE-LASER AND AFTER TWO
MONTHS OF TRADITIONAL THERAPY
AFTER TWO 5 MINUTE LASER THERAPY
TREATMENTS AT 7.5 WATTS
Stabilization of cellular membrane
Lubart R, Friedman H, and Lavie R. Photobiostimulation as a function of different wavelengths. The Journal of Laser Therapy. Vol12. World Association of Laser Therapy. 2000.
Karu T. et al. Changes in absorbance on monolayer of living cells induced by laser irradiation. IEEE Journal of Selected Topics in Quantum Electronics. IEEE Lasers and Electro-Optical Society. December 2001. 7(6):982.
De Castro E Silva Jr. O, et al. Laser enhancement in hepatic regeneration for partially hepatectomized rats. Lasers in Surgery and Medicine. 2001. 29(1):73-77
Ca, Na, K Ion Changes
Cell Membrane Changes
Proton Gradient Change
Increased Leukocyte Activity
Enhanced Lymphocyte Response
of retina after laser irradiation
Class 1 Lasers
Compact Disc Players
Class 2 Lasers
Class 3a Lasers
Office Depot Laser Pointers
Class 3b Lasers
Class 4 Lasers
Laser Therapy 101
You Cannot Treat a Target That You Cannot Reach.
X-Ray Physics = Laser Physics Rule # 2
Laser Therapy 101
Overstimulation With Laser Energy Only Exists in a Petrie Dish
Laser Therapy 101
Understimulation and Lack of Penetration are the #1 Reasons for Poor Clinical Outcomes!
For a pulsed laser the energy delivery depends on the duty cycle. Duty cycle tells us what percentage of time the laser is on or actively firing. If the duty cycle is 50% then the laser at 1 watt only delivers 0.5 Joules / Second.
The shorter the wavelength, the more readily the energy is absorbed in the body.
The higher the wavelength, the deeper the penetration of photon energy.
980 nm: Low melanin, low water, low hemoglobin absorption thus an optimal wavelength to choose when designing a therapy laser for stimulating tissue at greater depths of penetration.
If you do not have sustained power density over a long enough period of time treatments may be ineffective
For purposes of penetration it is more advantageous to have one wavelength of greater power that stimulates cell metabolism and tissue regeneration at all tissues densities in its pathway
In order to do so you must saturate the superficial layers of the sponge- with enough water-energy to soak the sponge-superficial tissue structures
This it what is needed to penetrate and why it is important to deliver a high amount of laser energy/dosage on the skin
EFFECTS OF INFRARED LASER EXPOSURE IN A CELLULAR MODEL OF WOUND HEALING
Mark D. Skopin and Scott C. Molitor, Department of Bioengineering, University of Toledo, Toledo OH
Tissue LayerMax Power (mw/cm2)
Dermis Layer 182
Dermis Plexus Super. 135
2nd Dermis Layer 115
Dermis Plexus Prof. 93
Muscle Tissue 9.7
Power Setting 5 Watts, 3.0cm spot size, 980nm
This is a snapshot in time. Calculated using computer models by U of Toledo.
Translation – As laser light or energy penetrates through the body more and more energy is absorbed so by the time you start reaching deeper structures there is not enough therapeutic energy to cause adequate tissue stimulation
With a high power output the laser beam can easily penetrate deeper joints especially when compared to a class iii laser which at best only offers superficial penetration.
TMA protocols are successful because they call for delivery of significantly larger amounts of therapeutic energy than industry standard protocols.
Many other lasers are built based on economic factors or from taking laser from other markets like dentistry and converting them into weak class iv lasers
SOME COMMON CLASS IV LASERS
penetration, and each wavelength penetrates
independently, the maximum penetrating dose
is no greater than the maximum power output
of each diode. With a 50% duty cycle
penetration of each diode gets cut in half.
4. JPM = Joules Per Minute
5. CPW = Cost Per Watt
(Continuous Power Output)
Maximum power output per wavelength is one of the most important factors in favorable treatment outcome.
With multiple-wavelength lasers (2-3) beam penetration is reduced even more significantly. If a 50% duty cycle setting is paired with a three-wavelength laser, beam penetration is equal to 1/6 of the stated laser power output.
10 -15 Watt Laser Platform
20 - 30 and 60 Watt Laser Platform
In summary my recommendation is to bye the most powerful single continuous wavelength therapy laser you can afford over the next 5 years
10-15 Watt Laser Platform
20-30 and 60 Watt Laser Platform
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