Waterlase MD as an Adjunct for Performing the Final Osteotomy?

Sorry but the concept of "hydrophotonic energy" doing almost anything useful with an erbium laser is nonsense. There is NO science that "hydrophotonic energy" can be used for sterilizing a surgical site (which can be accomplished by the direct application of the laser energy to the area) or anthing else. The only findings have been in a confined root canal where the laser energy causes bubbles in the solution which effectivel spreads and circulates the EDTA. An erbium laser is an infra-red laser that sterilizes, or ablates etc. by creating short duration, intense heat in the target tissue. Using it on the sinus is guaranteed to perforate the sinus not lift it.

When looking at an expensive piece of equipment it is important to do your due diligence. You can start on E-Bay and ask yourself "Why are there so many $85K machines for sale for $10K?" Another idea is to do a search to see what your colleagues are saying about a product. A good place to start is Dental Town.

this concept is non sense. I have used it and bought it under the perfect advertising pressure thinking it was the best tool ever. It is good for soft tissue ablation, unpredictable on hard tissue. Good adverstising tool for your clinic but you will never replace your conventional surgical tools and techniques with this one

Lasers are more suitable for lateral approach(Er-Yag or Er-Cr YCGG) because laser is selective device for opening lateral window.I use Fotona fidelis plusII and I am very happy working on bone tissue.For internal technic it could be unpredictible because it is difficult to see and feel the depth..Lasers are also very nice tools for managing periimplantitis cases(open technics)..

As a clinician who has been using the Er,Cr:YSGG laser for the past 12 years, it is obvious that the clinicians who have posted previously have never used the laser for these procedures. I have spent the past decade doing both lateral and crestal approaches using all three generations of this laser with outstanding results. First, let's dispel some of the myths about this wavelength. Erbium lasers (YAG and YSGG) are designed to be used with water. The photoacoustic effect (we no longer use the term hydrophotonics) has been evaluated ad nauseum by the Universities of Vienna and Aachen, two of the top venues for laser research in the world. Their journals are replete with the science of the interaction of both 2780 and 2940 nanometer wavelengths and the efficacy of cutting hard tissue with a LOW thermal coefficient. Second, the differential in cutting hard and soft tissue makes it ideal when approaching the Schneiderian membrane. We have surgical videos showing the membrane being pushed off of the inner boney wall as the bone/soft tissue interface is reached. I have been involved with developing some of the protocols for FDA clearance for several surgical procedures in oral implantology. You can reference some of this information in a previous Osseonews post: www.osseonews.com/lasers-role-in-implant-dentistry-an-exclusive-interview/ RJM

LANAP Dentist the last place I would look for opinions is Dental town. Bravo Robert Miller. Great post, it amazes me when people post replys on a topic that they have no knowledge of. I was glad to see your post on Lasers as you being an authority on the topic. I would love to see a review paper by you as there needs more info on this topic in journals since most clinicians have little to know knowledge of this topic.

I use the Waterlase for lateral sinus lifts with great success. It is more controlled than other instruments. I go through the cortical outlining the window and then pop it off with a chisel. I love the ErCr:YSGG for uncovering implants or removing excess soft tissue. it goes through soft tissue and bone nicely if necessary. The Waterlase is expensive, it won't replace all your other surgical instruments and I I hate the cost, but I wouldn't give it up. I think the greatest use is in cleanung up sites of recently removed teeth with PA lesions, w/ suppurate and granulomatous tissue. My immediate implant success rate in in sited after immediate extraction with use of YSGG (including Molars) is 98%+. The ones I lose are not due to the effects of the infection. The laser is brilliant in cleaning out extraction sites and performein microcorticotomies to promote faster osteogenesis.

The Dask system does the same, $150 drill using hydrolic pressure to deflect the lining to prevent preforation used it dozens of times internal and lateral with no issues. Quick and safe only side effect is possibly a little post op swelling , but no tapping through makes the patient a lot happier. Regards Peter

Hi, I am using the fidelis laser for performing osteotomies and cleaning out the extraction sockets before placing implants. For sinus procedures I find it a bit difficult to say it is great. I have to use a longer pulse length to do not perforate the membran, but then we get more heat into the tissue, which is not preferable for bone. For cutting bone you want to use very short or super short pulses. In this case you won't get heat into the bone, but a big acoustic effect I have to use very low energies not to perforate the membrane because of a great bounce against the membrane with these settings. So most times in the end fase I use a longer pulse length and a lot of water. Without the water the longer pulselength is very good for cutting soft tissue!!. Since the waterlase MD uses pulses of longer length you get the lower output energy, but more heat and you need the water not to perforate the memebrane. Still I think this heat is less then with a drill and piezotomes. The speed will be the same as with piezotomes. With too much pressure and energy on the piezotomes it is also very easy to perforate the membrane. So in the end if you look from a biological point of view the laser can be better, but from a speed point of view the drill may be the best option. For not perforating the membrane I think the lasers and piezotomes are the same.

I have not looked on the site for a long time, seeing the first few statements on the use of the laser caught my attention. Hydoaucostic effect is for real! I have published a few articles on this topic, in fact I am completing a study I have done to show how the use of a laser significantly reduced bacteria in infected sites, some of these findings will be shown during my lecture at the AAID meeting in New Orleans. I use the laser for flap reflection, block grafting, sinus lifts, tissue grafts etc. The Irbium lasers are worth there costs. Lasers do not produce peripheral heat as do the piezotomes or other surgical handpieces. Thus less collateral damage, faster healing and less pain for your patieint. If you would like to see the article you can access them on my web site:drkusek.com, click on published articles.

The best thing for the sinus approach is to elevate the membrane by fluids. It is not difficult to elevate the membrane without a rupture- even if the access in the lateral wall is only 2 mm in diameter. The membrane can be prepared almost completely and without the need of instrumentation an even over septae without rupture. The best is: even the fact that no perforation has occured can be measured and prooved. Prior to but also postimplantationem. It was currently published. Although it is in german you will understand if you just look at the pictures. http://www.zp-aktuell.de/praxis/story/sinprep-ein-vorschlag-fuer-die-optimierung-des-sinuslifts-teil-2.html

Could anybody answer me following question. If sinus membrane is lifted and maintained in a lifted position (for example by a collagenous sponge around the bottom of an inserted implants) we would expect to get natural bone inbetween the lifted sinus membrane and the sinus floor. If GBR is valid in the hights of the sinus- does realy the necessity exist for augmentation with bio-oss or dam bone ? What do you expect to be faster? Local osteoneogenesis propia or bone assmilation and reorganisation ? Wich bone will reach higher primar stability in the end? Highest primar stability could be reached by ordinary hemihydrades or even zementum- immediately. Why not hemihydrates instead of ceramics, titanium, dam bone, bovine etc graftings. Honestly speaking- what would you let be used on your own body and why?

Any thermal (laser) application to the membrane, deliberately or not, will set at least a scar. By that way it may dislodge the membrane from the sinuswall. But the density of the tissue is increased at the point of application (scar). The membrane itself gets under strain around this scar. The elasticity changes. Ventilation of the sinus will gently press the membrane on the graft. Rough grafting material may perforate therefore too. A rupture will occur as soon as you start condensing the grafting material- latest when you insert the implant. The biggest disadvantage using a laser consists in burning the vessels of the membrane in an uncontrolled maner. The proliferation of exact these vessels is needed to transform the graft in reorganized bone. Periosteal tissue doesn`t like burning either. We are lucky as far as nature cooperates- we shouldn`t create supplementary obstacles.

So many answers- only because its european ? Lack of interaction ?