I initially investigated incorporating a laser into my practice early in 2008. I am a periodontist, and as you may or may not know, there is a general lack of laser awareness in the periodontal community. It is a complex issue that will be addressed separately.
I decided to research lasers independently. I read countless studies, spoke to laser users around the world, attended seminars, and even had various lasers in my practice to evaluate. My goal was to get a laser that would best assist me with periodontal procedures, regeneration, hard tissue grafting, cosmetic surgeries, implant dentistry, extractions and the occasional treatment of pathological lesions. With regards to periodontal treatment, the laser had to be kind to diseased cementum.
A diode laser is very nice – but it is not meant to be a workhorse. Its uses are limited. The remaining options were: CO2, Nd:YAG, Er:YAG and YSGG.
Based on my findings, the CO2 would not suit my needs. CO2 is not designed for hard tissue, and it can char tissues if not used properly. Healthy root surfaces can literally melt.
Here’s where things get interesting. The Periolase Nd:YAG laser, manufactured by Millenium, is loaded with all sorts of fantastic claims. There are 100’s of dentists out there who are believers in the LANAP procedure, a proprietary treatment protocol. There are other Nd:YAG manufacturers, but Millenium is the “big guns”. I opted out of this laser. I will address all of the Periolase’s shortcomings in a separate, probably controversial, post. I am looking forward to intelligent comments and a scholarly discussion.
The most intriguing lasers, in my mind, were the Er:YAG, manufactured by several companies; and the Er,Cr:YSGG, a.k.a. Waterlase MD, manufactured exclusively by Biolase who holds the patent. The Erbium lasers generate much less heat than the other dental lasers. Both the Er:YAG and YSGG have very similar wavelengths and probably only differ slightly based on machine settings and calibration. The Waterlase has a greater variety of interchangeable tips for various procedures.
Numerous studies clearly show that the Erbium lasers are safe when used on roots and cementum. They ablate tissue effectively without a char. They are also FDA cleared for cutting bone and teeth. The YSGG was the choice that I made, for my practice, for my patients.
Having used it now for many months and seeing the results and patient experiences, I felt obligated to share my journey. In the coming months, I will document dozens of studies and provide insightful commentary from the perspective of a periodontist. My hope is to make the dental community more aware of the benefits of laser dentistry. Dentistry must move forward with better patient care. This is my contribution.
Mark Schlesinger, DDS
Diplomate, American Board of Periodontology
President, NY Academy of Collaborative Dentistry
Clinical Assistant Professor, NYU College of Dentistry