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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