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

2. 2 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. History

3. 3 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. History

4. 4 Laser in the dentistry Laser systemIndication CO 2 – laser (10600 nm)Surgery Dioden (810 – 980 nm)Parodontology, Endodonics, Implantology, Surgery (limited) Diode (630 – 670 nm)Therapy, PDT Erbium (2780, 2940 nm)Hard fabric, Parodontology Laser systems and indications

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

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

7. 7

8. 8 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 Marketing

9. 9 Laser fiber, no kontakt Problems

10. 10 Laser fiber, in kontakt Problems

11. 11 Problems

12. 12 Problems

13. 13 Problems Problem ! – Capillary effects

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

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

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

17. 17 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 Combination

18. 18 Combination

19. 19 Laser surgery: Fibrom Surgery

20. HF oral surgery: Fibrom Surgery

21. 21 Laser surgery: Frenektomy Surgery

22. HF – oral surgery: Frenektomy

23. 23 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. Parodontology

24. 24 Parodontology

25. 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. 26 ??? Endotonics

27. 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. 28 Implantology

29. 29 LLLT LLLT: Low level laser therapy Soft 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. 30 ??? LLLT

31. 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. 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. 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. 34 Fabric Bakteria Necrosis, membrane damages Photosensitizer Laser PDT

35. 35 ??? PDT

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