Lasertechnology + high-frequency technology

1. Lasertechnology + high-frequency technology The best from 2 worlds LASER HF

2. History 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.

3. History 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.

4. Laser in the dentistry Laser systems and indications

5. Bases 37 – 60 °C 65 – 70 °C Heat Coagulation Collagen is converted into glucose Hämostasis Fabric changes colour grayish / white Fabric is shrinking Reversible cell damage No visible changes No mechanical changes Temperature 90 – 100 °C 400 °C + 200 °C Drying Carbonisation Vaporisation Carbonisation of fabric (grade IV) Black colouring Fabric is evaporated Production of smoke Intracellular water evaporates Further shrinking of fabric

6. Marketing Differences by commercially offered dental laser devices • Achievement: 3 – 50 W • Moden: cw (continuouswave) / pulsed (µs – ms) • Programs: preset / user-defined • Design: all kinds

7. Marketing

8. Marketing 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

9. Problems Laser fiber, no kontakt

10. Problems Laser fiber, in kontakt

11. Problems

12. Problems

13. Problems Problem ! – Capillary effects

14. HF / Laser Cuts in a pigs‘ jaw HF: 20 W cut Needle electrode 200 µm Laser: 980 nm / 3 W Fiber 200 µm in kontakt

15. HF / Laser Laser fiber 200 µm HF– electrode 200 µm Mechanical strength Mechanical strength

16. HF / Laser CombinationLaser + HF = Laser HF Beginning for the problem solution : Laser only up to max. 3 - 4 W and mainly HF for surgery

17. Combination 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

18. Combination

19. Surgery Laser surgery: Fibrom

20. Surgery HF oral surgery: Fibrom

21. Surgery Laser surgery: Frenektomy

22. Surgery HF – oral surgery: Frenektomy

23. Parodontology 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.

24. Parodontology

25. 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

26. Endotonics • ???

27. 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.

28. Implantology

29. 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.

30. LLLT • ???

31. 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.

32. PDT aPDT: Applications • Treatment of oral carcinoms • Anti microbic photo-dynamic therapy (aPDT) • Management of bio film • Parodontitis, Paroimplantitis • Caries prophylaxis • Caries treatment

33. 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.

34. PDT Fabric Necrosis, membrane damages Bakteria Laser Photosensitizer

35. PDT • ???

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