Laser Dentistry: A Path to Practice Growth
The use of lasers began in the mid-1970s in the operating room, used by surgeons for excisions. The first laser designed for dentistry appeared in 1989, and today there are 2 dozen indications for use with various dental laser devices. Clinical applications continue to increase, making the laser one of dentistry?s most exciting advances with unique patient benefits. All available laser instruments can safely and effectively perform soft-tissue excisions and incisions; however, only the erbium devices have indications for use on dental hard tissue as well as soft tissue.
Laser Dentistry: A Path to Practice Growth
Lasers provide dentists with a clinical advantage, simplifying some procedures and increasing patient comfort. They also create opportunities for practice growth.
The Clinical Advantage
Dental lasers offer several clinical advantages. They allow the clinician to reduce the amount of bacteria and other pathogens in the surgical field and in cavity preparations. In the case of soft-tissue procedures, lasers achieve very good hemostasis, reducing the need for sutures and surgical packing. Because a laser incision is more broad and irregular than that of a scalpel, the healing tissue better blends with the surrounding structures, reducing postoperative scar formation.
In addition, periodontally diseased tissue can be disinfected and detoxified with a laser. Unlike some prescribed and/or sulcularly delivered drugs, lasers can safely be used with a wide range of patients, including children and pregnant women. Patients will not experience allergic reactions, bacterial resistance, or untoward side effects with a laser.
With the good bleeding control provided by lasers, visualization of the surgical field is improved, and many laser procedures can be performed with less injectable anesthesia. In these situations, it is possible to perform more than one treatment in the same appointment. In addition, initial postoperative discomfort and swelling are reduced because of the sealing of nerves and lymphatics.
For teeth and bone, erbium lasers have a precise and beneficial effect. The surface of lased dentin and osseous tissue lacks a smear layer; moreover, it has been demonstrated that the lased enamel has a good potential for bonded restorations if they are subsequently etched with acid. These lasers have some selectivity in removing diseased tooth structure because carious lesions have much higher water content than healthy tissue. Other advantages over conventional high-speed handpiece interaction on the tooth surface include the elimination of microfractures and a reported lowering of pulpal temperature as the preparation proceeds.
4 Paths to ROI
The return on investment for a laser can be looked at in 4 ways. Lasers can simplify procedures, reduce referrals, allow for the introduction of new treatments, and create an opportunity to perform multiple procedures in a single appointment.
Compared to conventional instrumentation, several procedures can be simplified when a laser is used. For example, tissue retraction for subgingival crown or implant restorations can be performed quickly with excellent hemostasis, ensuring an accurate impression. Laser clinicians report an average savings of 10 minutes of appointment time as well as elimination of most cords and medicaments. This can be a major advantage when using modern optical impression techniques.
When using a laser, many procedures that used to be referred can be treated in the practice, based on the clinician?s experience and confidence. For example, an operculectomy can proceed with no damage to the erupting tooth, removal of fibrous tissue or commonly occurring fibromas is straightforward, and suspicious lesions can be easily biopsied and analyzed for pathology.
When procedures are kept in the practice, rather than referred to specialists, clinicians provide an invaluable service to their patients, saving them time and money. In addition, the clinician reaps the monetary and marketing benefits that will help grow the practice.
Using a laser allows clinicians to provide new treatments. Esthetic crown lengthening involving both gingival and osseous tissue removal can be done with precision and predictability. Preparing ovate pontic sites can result in more natural looking fixed prosthodontic treatment, and integrating a laser into the treatment armamentarium of periodontal disease can help to manage inflammation. These new treatments are marketing opportunities for the practice and keep it on the cutting edge.
The time saved by lasers in well-controlled bleeding and less use of injectable anesthetics allows clinicians to perform multiple procedures during a single appointment. For example, recontouring the gingival tissue during restoration of cervical carious lesions, or treating additional carious lesions in another quadrant can increase efficiency and profitability and provide better patient care.
Fees, marketing, and staff involvement are critical to successful practice integration. Many laser clinicians incrementally increase their overall charges, and almost none add a surcharge. The dental laser represents a major equipment purchase, and other expenses of supplies and education will usually require an increase in the fee schedule.
Marketing for the dental laser can range from elaborate advertisements to simple chair side explanations. Many patients are aware of lasers for other health care needs. They will appreciate the dental office?s desire to provide new technology, which in turn will increase the referral of new patients.
The attitude and involvement of the office team are critical to the successful integration of a dental laser. The clinician should make educational opportunities available, and all staff should experience care using the laser so their personal testimony can be both credible and enthusiastic.
Lasers have proven beneficial treatment options for clinicians who have adopted the technology. Attending introductory courses, seminars, and presentations, such as those at various State and National Scientific Sessions, are essential before buying. An additional resource is the Academy of Laser Dentistry (www.laserdentistry.org). As with all dental materials and instruments, the practitioner must receive proper training, become very familiar with the operating manual, and proceed within the scope of his or her practice.
Because of the varied composition of human tissue and the differing ways that energy is absorbed, there is no one perfect laser. However, patients continue to agree that the dental laser is a wonderful instrument.
Dr. Donald Coluzzi, retired from general dentistry, is a faculty member at University of California San Francisco School of Dentistry and a charter member and past president of the Academy of Laser Dentistry (www.laserdentistry.org).