Dr. Lomke uses Lumenis’
OpusDuo laser system to
remove a defective composite
from the buccal aspect of a
molar
OpusDuo™ Er:YAG for Contact Thermal Mechanical Ablation of Bone
In anther significant ‘first’ in laser clearances, Lumenis Dental/OpusDent’s™ OpusDuo™ Er:YAG laser system has received approval from the US Food and Drug Administration (FDA) for contact removal of osseous tissue in oral surgical and periodontal procedures.
For close to 40 years, Lumenis has pioneered laser systems with novel applications for general dentists and oral surgeons. Now the company is going one step further. The OpusDuo, outfitted with Lumenis’ proprietary sapphire tips, enables practitioners to successfully cut bone tissue in contact mode. Granting dentists and oral surgeons the tactical feel and precision they desire while using a laser to selectively remove bone, this technology is paving the way to unparalleled clinical results.
Dr. Eric Bornstein
“This FDA approval for the ‘contact cutting’ of bone is one of the most significant milestones reached in the dental laser field,” says Dr. Eric Bornstein of Natick, MA, USA. “Used properly, the OpusDuo will allow practitioners to feel the laser handpiece make contact with the bony tissue being ablated. This represents a dramatic improvement over the the previous method of ‘point and shoot’ in a surgical field.”
Among the major clinical advantages of the Er:YAG laser for dental applications is its ability to ablate both hard and soft tissues with minimal thermal damage.
At a wavelength of 2940 nm, the Er:YAG laser has the highest specificity for water absorption of all the mid-infrared lasers. In the past, the wavelength has been specifically used for accurate ablation and cutting in different disciplines, including ophthalmology, laryngeal surgery and dermatology. Detailed histologic analyses of ablated tissue after irradiation with an Er:YAG laser have described well-defined cuts with small zones of thermal necrosis, no greater than 40 nm (40/100,000ths of a mm). In comparison, the thermal necrosis zones caused by the Er,Cr:YSGG laser system were twice as large. The unique absorption peak of Er:YAG-generated photons in water make them ideally suited for cutting mineralized biologic tissues such as natural tooth structure and bone.
One striking example of the efficacy of Er:YAG in dental surgery involves the alveolar bone, a major focus of research. To effectively cut this bone without the thermal necrosis caused by other laser systems, dental practitioners require a laser that selectively targets the chromophore of water and not the extracellular bony matrix. But alveoloplasty is not the only application. Considering the OpusDuo’s successful use in contact bone ablation, its clinical applications in oral surgical procedures include apicoectomy, periodontal bony procedures, and bone removal for extraction of partially erupted and impacted teeth.
In addition to receiving the first contact bone removal clearance from the FDA, the OpusDuo is the only dual wavelength laser system offering both Er:YAG and CO2 wavelengths in one unit. Although Er:YAG is the optimal wavelength for hard tissue procedures, including contact bone removal, CO2 is the gold standard for oral surgical, periodontal and cosmetic soft tissue procedures. With these two laser wavelengths in one unit, dental practitioners can perform the broadest array of procedures, utilizing the best available technology.
Er:YAG Irradiation Interaction with Bone – Experience Speaks
Dr. Lomke uses Lumenis’
OpusDuo laser system to
remove a defective composite
from the buccal aspect of a
molar |
Dental practitioner and Academy of Laser Dentistry (ALD) educator, Mitch Lomke, DDS, lectures on laser dentistry throughout the USA, provides clinical instruction, and teaches ALD standard proficiency courses to dentists and Registered Dental Hygienists (RDHs). Here, Dr. Lomke shares his experience using the Er:YAG laser with
LightNews.
|
Dr. Lomke explains that the unique patented internally reflective hollow waveguide delivery system is similar to that used with the carbon dioxide laser. This larger diameter hollow waveguide easily accommodates the Erbium molecule at 2940 nm, since the same technology can handle a CO2 molecule, which at 10,640 nm is more than three times the size of a molecule of Erbium.
Lumenis’ OpusDuo laser can generate up to 12 W of power to the target tissue. “All the other Erbiums try to transmit this molecule through a fiber or a ‘bundled’ fiber,” says Dr. Lomke.
These fibers are efficient for transmitting smaller diode photons at 810 to 980 nm, but not for those of Erbium. As a result, says Dr. Lomke, “The fibers are prone to breakdown and even at maximum strength, may approach only 6 W of power. This is inadequate to cut tooth structure efficiently.”
“The amount of heat generated by Er:YAG, as compared to Er,Cr:YSGG during tooth preparation, isn’t even close,” continues Dr. Lomke. The actual photothermal microevaporative explosive events that allow all Erbium lasers to cut natural tooth structure occur at double the temperature for Er,Cr:YSGG as compared to Lumenis’ OpusDuo. This is due to the higher absorption of the Er:YAG photon into tissue. “If twice the heat is needed to allow Er,Cr:YSGG to cut tooth structure, there is the potential for twice the collateral thermal damage to occur,” adds Dr. Lomke. “This is not good.”
