Dentaltown September 2016 - 107
continuing education
feature
is a process of photothermal vaporization
of intra- and extracellular water heated by
the laser light within the irradiated soft
tissue. Water vapors, rapidly steaming out
of the intensely laser-heated soft tissue, carry
cellular ashes and other byproducts of this
fast boiling and vaporization process.
Because of weak absorption (Fig. 1)
and strong scattering by the soft tissue, the
near-infrared diode and Nd:YAG laser wavelengths circa 1,000nm are highly inefficient
and spatially inaccurate photothermal laser
ablation tools.24
Diode and Nd:YAG laser wavelengths
are highly inefficient excision tools for
mucocele removal. Instead, diode's charred
and hot glass tips can be used as thermal
(i.e., non-laser) devices for soft-tissue cutting,
similar to electrocautery.
Because of strong absorption by the
soft tissue, erbium and infrared CO2 laser
wavelengths are highly efficient and spatially
accurate laser ablation tools,23,24 which makes
both erbium and CO2 laser wavelengths
highly appropriate excision tools for mucocele
removal described below. The soft-tissue
ablation threshold fluence Eth at 10,600nm
is approximately three joules per square
centimeter23 (for short pulse conditions
referred to as "superpulse," described above),
which is 1,000 times lower than at the NIR
wavelengths of diode and Nd:YAG lasers.
As Fig. 1 indicates, wavelengths circa
10,000nm are more than 1,000 times superior
to wavelengths circa 1,000nm for soft-tissue
ablation, and more than 10 times superior to
wavelengths circa 3,000nm, in regard to the
depth of soft-tissue coagulation and hemostasis.
The 10,600nm CO2 laser is highly
energy-efficient at ablating the soft tissue photothermally with very low ablation threshold
intensities. Such high-energy efficiency is due
to the extremely small volume of irradiated
tissue because of extremely short absorption
depth-around 15 micrometers.23
Photothermal coagulation
Coagulation occurs in the range of
60-100 degrees Celsius, 23 leading to a
significant reduction in bleeding (and oozing
of lymphatic liquids) on the margins of
ablated tissue during laser ablation (and
excision, or incision) procedures.
Since blood is contained within and
transported through the blood vessels,
the diameter of blood vessels B, estimated
to range from 21 to 40µm, 25 is a highly
important spatial parameter that influences
the efficiency of the photocoagulation
process. Photothermal coagulation is also
accompanied by hemostasis because of
shrinkage of the walls of blood and lymphatic
vessels, thanks to collagen shrinkage at
increased temperatures.
The coagulation depth H (for 60-100
C range below the ablation margins) was
shown23 to be proportional to the absorption
depth A- an inverse of the absorption
coefficient presented in Fig. 1-and is
also presented in Fig. 1 (for "superpulse"
conditions). The coagulation depth H
relative to the blood-vessel diameter B is
an important measure of coagulation and
hemostasis efficiency.
For H<
>B (diode laser wavelengths in Fig. 1),
optical absorption (near-IR attenuation)
and coagulation depths are significantly
greater than blood-vessel diameters; coagulation takes place over extended volumes.
Coagulation depth can be extended by
lengthening the laser pulse.
For H≥B (CO2 laser wavelengths in Fig.
1), coagulation extends just deep enough into
a severed blood vessel to stop the bleeding.
In other words, the CO2 laser's excellent
coagulation efficiency is due to the close
match between the photothermal coagulation
depth of approximately 50µm16 and oral
soft-tissue blood capillary diameters of
20-40µm.25
CO2 laser oral soft-tissue surgery
The current-generation dental CO2
laser technology features a small-footprint,
compact unit with flexible hollow-fiber beam
delivery and a variety of straight and angled
handpieces. The flexible waveguide, with its
pencil-like handpieces, allows convenient
accessibility within the oral cavity.14 The
handpieces do not use disposables; they are
autoclavable and easily adapted to switching
between incision with coagulation, superficial
ablation with coagulation, or coagulation
modalities.
Unlike electrosurgery or the diode laser,
the CO2 laser causes minimal mechanical
and thermal trauma.2,22 The CO2 laser's
ability to provide excellent hemostasis is
valuable for precise and accurate tissue
removal, improving the visibility of the
surgical field for the clinician.26
The thermal damage to the surgical site
and neighboring tissues is minimal because
"superpulse" mode minimizes the amount of
heat diffusing from the target zone.2,13,26,27
Overall, the CO2 laser is faster, simpler,
often requires no suturing, and minimizes
complications and relapses when compared
to conventional scalpel lesion removal.2
CO 2 laser surgery is a noncontact
method that reduces mechanical trauma.
In comparison with a scalpel, the CO2
laser reportedly causes less pain and discomfort in patients after oral soft-tissue
procedures.2,28,29 Postoperatively, there is
less reported swelling and edema because
the CO2 laser seals lymphatic vessels on the
margins of incision.2,13,26,27,30
Risk of infection is much lower with the
CO2 laser than with a scalpel because the
laser beam can instantly kill bacteria in its
path, which isn't possible with a scalpel.2,14
Additionally, fewer myofibroblasts with
CO2 laser surgery makes for lesser wound
contraction, and thus less scar formation,
than with scalpel surgery.2,6,12,13
Scalpel patients often take analgesics after
treatment, while patients treated with CO2
lasers often do not.2 In many cases, sutures
are not needed after CO2 laser treatment,
and the wound is left to heal by secondary
intention.2,14,31
Many clinicians have observed improved
dentaltown.com \\ SEPTEMBER 2016
107
http://www.dentaltown.com
Table of Contents for the Digital Edition of Dentaltown September 2016
On Dentaltown.com
Howard Speaks: Customer Returns—The Good Kind
Professional Courtesy: A Ton of Trouble for a Free Toothbrush
Continuing Education Update
New Products
Monthly Poll: Equipment
Implant into Root Tip?
Mandible Radiolucency Routine Pano
Handoffs
Second Opinion: To Floss or Not to Floss? That Isn’t the Question
Test Your Reading Comprehension: How well can you interpret what’s visible in dental radiographs?
Understanding Fracture Toughness
The Right Stuff: Your checklist for adopting new software technology
Electronic Health Records: Is it time to make the transition?
Permanent Help for Temporary Employees: The right practice management software can make all the difference
A Complex Restorative Case
Making Friends with Benefits: How to understand what employee perks are really worth—and which ones
Scoring the Perfect Patient Handoff
The Road to Greatness
Industry News
Product Profile: ClearCorrect
The Five Risk Factors of Improper Ergonomics
CE: Laser Mucocele Removal in Pediatric Patients
Dentally Incorrect
Dentaltown September 2016 - Intro
Dentaltown September 2016 - Cover1
Dentaltown September 2016 - Cover2
Dentaltown September 2016 - 1
Dentaltown September 2016 - 2
Dentaltown September 2016 - 3
Dentaltown September 2016 - 4
Dentaltown September 2016 - 5
Dentaltown September 2016 - 6
Dentaltown September 2016 - 7
Dentaltown September 2016 - On Dentaltown.com
Dentaltown September 2016 - 9
Dentaltown September 2016 - Howard Speaks: Customer Returns—The Good Kind
Dentaltown September 2016 - 11
Dentaltown September 2016 - 12
Dentaltown September 2016 - 13
Dentaltown September 2016 - Professional Courtesy: A Ton of Trouble for a Free Toothbrush
Dentaltown September 2016 - 15
Dentaltown September 2016 - 16
Dentaltown September 2016 - 17
Dentaltown September 2016 - Continuing Education Update
Dentaltown September 2016 - 19
Dentaltown September 2016 - 20
Dentaltown September 2016 - 21
Dentaltown September 2016 - New Products
Dentaltown September 2016 - 23
Dentaltown September 2016 - Monthly Poll: Equipment
Dentaltown September 2016 - 25
Dentaltown September 2016 - 26
Dentaltown September 2016 - 27
Dentaltown September 2016 - Implant into Root Tip?
Dentaltown September 2016 - 29
Dentaltown September 2016 - 30
Dentaltown September 2016 - 31
Dentaltown September 2016 - 32
Dentaltown September 2016 - 33
Dentaltown September 2016 - 34
Dentaltown September 2016 - 35
Dentaltown September 2016 - Mandible Radiolucency Routine Pano
Dentaltown September 2016 - 37
Dentaltown September 2016 - 38
Dentaltown September 2016 - 39
Dentaltown September 2016 - 40
Dentaltown September 2016 - 41
Dentaltown September 2016 - Handoffs
Dentaltown September 2016 - 43
Dentaltown September 2016 - 44
Dentaltown September 2016 - 45
Dentaltown September 2016 - 46
Dentaltown September 2016 - 47
Dentaltown September 2016 - Second Opinion: To Floss or Not to Floss? That Isn’t the Question
Dentaltown September 2016 - 49
Dentaltown September 2016 - Test Your Reading Comprehension: How well can you interpret what’s visible in dental radiographs?
Dentaltown September 2016 - 51
Dentaltown September 2016 - 52
Dentaltown September 2016 - 53
Dentaltown September 2016 - Understanding Fracture Toughness
Dentaltown September 2016 - 55
Dentaltown September 2016 - The Right Stuff: Your checklist for adopting new software technology
Dentaltown September 2016 - 57
Dentaltown September 2016 - 58
Dentaltown September 2016 - 59
Dentaltown September 2016 - 60
Dentaltown September 2016 - 61
Dentaltown September 2016 - Electronic Health Records: Is it time to make the transition?
Dentaltown September 2016 - 63
Dentaltown September 2016 - 64
Dentaltown September 2016 - 65
Dentaltown September 2016 - Permanent Help for Temporary Employees: The right practice management software can make all the difference
Dentaltown September 2016 - 67
Dentaltown September 2016 - A Complex Restorative Case
Dentaltown September 2016 - 69
Dentaltown September 2016 - 70
Dentaltown September 2016 - 71
Dentaltown September 2016 - 72
Dentaltown September 2016 - 73
Dentaltown September 2016 - 74
Dentaltown September 2016 - 75
Dentaltown September 2016 - Making Friends with Benefits: How to understand what employee perks are really worth—and which ones
Dentaltown September 2016 - 77
Dentaltown September 2016 - 78
Dentaltown September 2016 - 79
Dentaltown September 2016 - 80
Dentaltown September 2016 - 81
Dentaltown September 2016 - 82
Dentaltown September 2016 - 83
Dentaltown September 2016 - Scoring the Perfect Patient Handoff
Dentaltown September 2016 - 85
Dentaltown September 2016 - 86
Dentaltown September 2016 - 87
Dentaltown September 2016 - 88
Dentaltown September 2016 - 89
Dentaltown September 2016 - The Road to Greatness
Dentaltown September 2016 - 91
Dentaltown September 2016 - 92
Dentaltown September 2016 - Industry News
Dentaltown September 2016 - Product Profile: ClearCorrect
Dentaltown September 2016 - 95
Dentaltown September 2016 - 96
Dentaltown September 2016 - 97
Dentaltown September 2016 - The Five Risk Factors of Improper Ergonomics
Dentaltown September 2016 - 99
Dentaltown September 2016 - 100
Dentaltown September 2016 - 101
Dentaltown September 2016 - 102
Dentaltown September 2016 - 103
Dentaltown September 2016 - CE: Laser Mucocele Removal in Pediatric Patients
Dentaltown September 2016 - 105
Dentaltown September 2016 - 106
Dentaltown September 2016 - 107
Dentaltown September 2016 - 108
Dentaltown September 2016 - 109
Dentaltown September 2016 - 110
Dentaltown September 2016 - 111
Dentaltown September 2016 - Dentally Incorrect
Dentaltown September 2016 - Cover3
Dentaltown September 2016 - Cover4
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