COMPREHENSIVE BROCHURE. doctor-smile.com AM NI I12.1

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1 COMPREHENSIVE BROCHURE doctor-smile.com AM NI I12.1

2 2 INTRODUCTION Laser technology represents an evolution of medical techniques and an indispensable daily support to the traditional dental practice because it offers patients more comfortable and faster treatments, with less injections and less pain compared to conventional tools. The Wiser dental laser is a surgical device designed for a wide variety of oral soft tissue procedures. The Wiser laser utilizes a solid state diode as a semiconductor source of invisible infrared radiation. The energy is delivered to the treatment site via flexible fibre, connected at one end to the laser source and the other end to the handpiece. Various types of bendable autoclavable tips are available for different applications. The device is activated directly from the handpiece through the Sensa-touch. The Wiser laser is battery powered and can be used without the power cable inserted. BENEFITS OF THE DIODE LASER COMPARED TO CONVENTIONAL TECHNIQUES The extreme tolerability of the treatment can reduce the need for anaesthesia in most operations. This assures a better relationship with the patients, especially the odontophobic and children. The laser is a less invasive method compared with the conventional techniques, offering little cell destruction and virtually no bleeding thanks to its haemostatic properties. The laser has a strong power against bacteria thus encouraging decontamination and anti-inflammatory action while using it. The treatment with the laser requires a reduced number of sessions, and a shorter chair time for most applications. BENEFITS FOR THE DENTIST BENEFITS FOR PATIENTS Distinguishes your practice and increments revenue Precise incision, excision, ablation Quality of work Excellent visibility in oral cavity Reduces stress Greater through-put of patients Greater efficiency Versatile tool for many application Minimal or no bleeding No swelling, faster healing Reduced post-operative infection Minimal or no anaesthesia Minimal pain, inconvenience Less chair time, less anxiety Whitening single visit procedure High quality treatment Less time predictable result May be used during pregnancy and pacemaker cases

3 3 CONTENTS INTRODUCTION... 2 the benefits of diode lasers WHAT IS A LASER?... 4 laser light laser components LASER-TISSUE INTERACTION... 5 parameters effects on tissue why 980nm APPLICATIONS... 8 soft tissue surgery periodontics endodontics implantology therapy whitening TEN REASONS TO CHOOSE WISER I. Wiser is II. portable III. SensaTouch handpiece IV. chargeable V. interchangeable tips VI. flat top handpiece VII. TOP Tissue Optimized Pulsing VIII. SoftTouch keypad IX. user interface basic and advanced X. made in Italy ABOUT DOCTOR SMILE on-line resources academic partners technical service training courses our laser tutors SPECIFICATIONS... 19

4 nm LASER LIGHT WHAT IS A LASER? The LASER (acronym of Light Amplification by the Stimulated Emission of Radiation) is a special instrument that can be applied in many different fields. Lasers have specific features that make them different from ordinary sources of light: MONOCHROMATIC: a light bulb emits many different wavelength whereas a laser will emit photons at a single wavelength, so that it s application is very specific and the interaction selective. COHERENT: all photons in the laser beam travel with the same space and time undulation. POLARIZED: all photons in the laser beam travel in the same direction. Compared to other sources of light, the laser is monochromatic, coherent and polarized. LASER COMPONENTS To stimulate the emission of light with these characteristics, three elements are necessary: 1. an ACTIVE MATERIAL (the Wiser uses a diode semi-conductor) capable of producing photons with a specific wavelength and increase their energy at each passage. 2. a SOURCE OF ENERGY, such as a lamp or electricity, also known as optical pump, that can increase the energy of each photon so that stimulated emission may occur. 3. an OPTICAL CAVITY: an arrangement of mirrors that can perfectly line up each electron until they reach the energy and coherence necessary to become a laser beam

5 5 LASER-TISSUE INTERACTION Biological tissue interacts with laser light mainly by absorbing its energy, but other important phenomena must be taken into account: DIFFUSION: energy will be dispersed in the tissue in the form of heat and will not contribute to the main effect of laser such as ablation or vaporization. It is important to evaluate its effects in the areas surrounding the point of application of the laser beam. With the diode laser diffusion of energy is predominant and generally involves the penetration of heat between 2 and 8mm into the tissue. TRASMISSION: energy that passes through tissues without any interaction. It is important to evaluate the underlying presence of other materials that may instead absorb the laser beam. ABSORPTION: energy that induces a transformation in the tissue, mainly through its change into heat. Chromophores are materials capable of absorbing the energy of specific wavelengths. In the oral cavity water, hydroxyapatite, hemoglobin and melanin are the main elements that can absorb laser energy. Since biological tissue is composed 80-90% of water, the 980nm wavelength of the diode laser is very effective on soft tissue: effective vaporization occurs with very little heat diffusion in the surrounding area. Also small blood vessels are perfectly coagulated. The absorption of laser energy by a tissue depends on factors linked to the laser beam: wavelength laser emission mode (pulsed or continuous) time of exposure power density and on factors linked to the tissue: degree of vascularization tissue tension presence of chromophores optical and thermal conductivity Photo-thermal effects on tissue according to the temperature reached: C Vasodilatation and endothelial damage C Enzyme activity stops protein denaturation. Collagen is more resistant. Increase in blood viscosity. 80 C Perivascular and intraparietal collagen shrinks. 100 C Vaporization of interstitial and intracellular fluids.

6 6 VARIABLES The main laser tissue interaction consists in the transformation of radiant energy into thermal energy. In order to obtain the desired effects on biological tissue, it is possible to increase or decrease the energy distribution by modifying these variables: POWER - W (watt) the total power of the laser beam can be increased or decreased. TIME: exposure time to laser light for each treatment. POWER DENSITY W/cm 2 it is the amount of power in the laser beam divided by the area of the beam on the irradiated surface. With the same power emission, as the size of the laser spot decreases, the power density increases. As the surface increases the power density on that area will decrease. This will radically change the effect: with the same energy but with different power densities it is possible cut, coagulate or biostimulate. If using a focused laser it will be possible to concentrate all the energy in a small area. When a laser is unfocused the irradiated surface is greater. EMISSION MODE laser emission can be continuous or pulsed. Continuous wave emission means that laser energy is delivered without interruptions. This mode is ideal for quick incisions and no bleeding. Pulsed emission creates a succession of laser pulses separated by pauses. In the pulsed mode the average power emission is therefore lower than the peak power created by each pulse, proportionally to the ratio emission time Ton/pause Toff. The pulsed mode is not as fast in cutting procedures but it can avoid the charring of tissue, since it allows time for the tissue to cool off in between pulses. This cooling-off time is a very important aspect of what is referred to as THERMAL RELAXATION TIME. FREQUENCY: - Hz (Hertz) - measures the number of pulses per second. The combination of frequency and Ton Toff values characterized pulsed emission. This leads to two important clinical advantages: 1. during the Toff interval, the heat accumulated in the tissue can dissipate (thermal relaxation). 2. during surgical procedure less anesthetic will be necessary.

7 7 EFFECTS All of the variables mentioned above lead to different effects on biological tissue: VAPOURIZATION, ABLATION, CUTTING these effects require high levels of energy usually emitted by focused lasers. Pulsed emission mode can avoid excessive heat build-up on the surrounding tissue. DECONTAMINATION - BIOSTIMULATION PHOTO COAGULATION these effects occur with less energy over a wider surface (low power density), so that more heat is transferred to the tissue, using continuous or extended pulses. WHY 980 nm Soft tissue contains a high percentage of water. For this reason the 980nm wavelength is the most effective for laser ablation, since water has an absorption peak at 980nm. Hemoglobin is also an important component for optimal coagulation, hemostasis and no charring. Its absorption peak is at 810nm, but since it absorbs 8 times less than water at the 980nm peak, for direct ablation, rather than cutting from secondary heating, 980nm is the most effective wavelength.

8 8 URGERY APPLICATIONS SOFT TISSUE SURGERY The 980 nm diode laser can be used for numerous soft tissue procedures including gingival hyperplasia, tooth exposure and hyperpigmentation. Additionally, there is a range of gingival adaptation procedures, both to allow restorative procedures and to allow access to restorative margins during restorative procedures. The laser energy will act primarily as a means of incision, excision or ablation, with advantages over the scalpel such as no or minimal bleeding, no sutures, less chance for infection of the wound. When possible, any laser surgical procedure in and around the gingival cuff should seek to preserve a biological width (the zones of connective and epithelial tissues attached to the tooth), minimum 3 mm in depth, which will help to maintain gingival margin stability, alveolar bone height and health and prevent overgrowth. When an incision is made with a scalpel blade small blood vessels are cut in the skin and the layer of tissue just under the skin. Normally they are taken care of by clamping the cutting with hemostasis, cauterizing, or holding gauze sponges on them until they stop. All of these procedures take time, which means the surgery takes longer and there is more post operatively swelling. The laser beam is a highly effective coagulator of small blood vessels. Less bleeding during surgery means less anaesthetic time and faster recovery time. The 980 nm wavelength diode laser transverses the epithelium and penetrates 2 6 mm into the tissue. When laser cutting is in progress, small blood and lymphatic vessels are sealed due to the generated heat, thereby reducing or eliminating bleeding and edema. Denatured proteins within tissue and plasma are the source of the layer termed "coagulum", which is formed because of laser action and serves to protect the wound from bacterial or frictional action. Clinically, during hours post-surgery, this layer becomes hydrated from saliva, swells and eventually disintegrates to later reveal an early healing bed of new tissue. The reduction in pain is a result of the unique characteristics of the laser beam as it cuts the tissue, preventing the raw ends that are characteristic of scalpel blades. Whenever an incision is made in tissue with either a scalpel blade or scissors inflammation is started in the affected tissue. This inflammation is a result of interaction with the circulatory and lymphatic systems. Because the laser beam effectively cauterizes the lymphatic system there is much less post-operative swelling. This makes the patient much more comfortable while it is convalescing from surgery. Moreover, the laser beam radiation operates at a temperature that makes it highly effective at killing bacteria that have the potential to cause an infection. This is particularly important in areas where it is difficult to prevent bacteria from contaminating the surgical site. Applications include the removal of fibromata, labial and lingual frenectomies, small hemangiomata, mucocele, denture granulomata, treatment of nonerosive lichen planus, aphthae and herpes lesions.

9 9 PERIODONTICS The main use for the 980nm dental diode laser in the periodontal therapy is the removal of diseased pocket lining epithelium and disinfection of periodontal pockets. Optic systems with μm fiber diameters enable extremely easy access into the periodontal pocket. After hard and soft deposits have been removed through scaling and/or root-planing, the pocket architecture is re-assessed, with emphasis on the depth. With regard to the disinfection of periodontal pockets, studies have shown the effectiveness of diode laser in eliminating bacteria commonly implicated in periodontal disease and bone loss. IMPLANTOLOGY In implantology, the 980 nm dental diode laser can be used for second stage implant recovery and the treatment of periimplantitis. In second stage implant recovery care must be exercised to avoid contact with the implant body. Soft tissue ablation leads to precise and predictable healing and the procedure can usually be performed with the use of a topical anesthetic. The advantages of using a diode laser to perform this procedure are easier visual access to the cover screw due to hemostasis and the production of the protective coagulum to aid in healing and patient comfort. Peri-implantitis is described as one of the most important causes of implant loss and is not restricted to any one type of implant design or construction. It can be recognized as a rapidly progressive failure of osseo-integration, in which the production of bacterial toxins leads to inflammatory change and bone loss. Always, an assessment must be made to determine the causative factors associated with the condition (infection, implant overloading, occlusion and other local, systemic and life-style factors), to establish whether the implant can be saved. Curettage of granulation tissue is especially important. Research has shown that a diode laser can be used to perform the procedure with the added bonus of disinfecting the treated area ENDODONTICS In endodontics, published papers indicate the effectiveness of the diode laser root canal treatment (disinfection of the root canal. The fine diameters of optic fibers ( μm) enable effective delivery of laser light to the root canal to help with reduction of bacterial contamination. The antibacterial effect observed reaches over 1 mm deep into the dentin, surpassing the effective range of chemical disinfectants, such as NaOCl and displaying moderate effectiveness against Enterococcus faecalis even in the deeper layers of dentin. Root canal treatment is currently performed using a combination of hand and rotary instruments to remove the soft tissue, cleanse the root canal space and shape the space to receive the obtruding material, usually gutta-percha. Laser energy, when added to root canal procedures, exhibits a great list of advantages. Lasers can reduce the quantity of micro organisms in canal. The walls of the prepared

10 canal space contain tubular openings that harbour organisms, and the preparation itself causes the formation of a layer of debris (smear layer) composed of organisms and tooth substances. Laser energy can remove the smear layer as well as dentin from the canal wall and will melt and resolidify the dentin to close the tubular openings. The laser also may aid in welding tooth-like materials to the resolidified walls, resulting in denser root canal packing. Root canal spaces are rarely straight and more often are curved. thanks to the elastic properties of the fibre, laser probes can clean the space throughout root canal length and can follow the curvatures in a tooth root, cleaning all the area. 10 THERAPY DESENSITIZATION Many attempts have been made to treat dental hypersensitivity by sealing exposed dentinal tubules, primarily using fluoride preparations, strontium chloride, and hydroxyapitite. However, these treatment methods have the disadvantage that the preparation is effective only for a limited period of time and must be applied repeatedly, at short intervals. The laser has been shown to have an excellent sealing effect on hypersensitive dentinal surfaces. The patients suffering from dentinal hypersensitivity have normally a higher number of dentinal tubules open and their diameter are larger. Compared to conventional fluoridation, combined laser irradiation and fluoridation was shown to be effective in the treatment of hypersensitive dental necks and dies. A shown in many studies, patient treated with laser feel complete freedom from pain. The success rate in the laser therapy is effective more than 96.5%. Moreover, examinations of irradiated teeth under the scanning electron microscope still revealed complete closure of the dentinal tubules four and six months after laser treatment. On the base of the results of many tests, laser can be recommended as an ideal tool for desensitization of dental necks and die. CANKER SORES/COLD SORES The pain and discomfort of aphteous ulcers (cancker sores) and herpetic lesions (cold sores) can be stopped in only a few minutes of laser treatment. The energy of the laser destroys the viruses and helps speed up the healing process. BIOSTIMULATION / ATM THERAPY Laser biostimulation is a safe and effective way to heal trismus disorder and other painful oral conditions, especially after surgery. Pain relief with laser therapy is effective, fast and drug free. Therapeutic indications of diode lasers include TMJ arthralgia (treatment of the joint); myofacial pain related to TMJ (treatment of the muscle related to painful trigger points); and muscle relaxation (related to pain and muscle stiffness after dental procedures or in general). The therapeutic mechanisms of action of diode lasers include increased microcirculation in tissue, photo-activation of inactive enzymes, improved cellular function, and increased ATP production.

11 11 WHITENING The laser is undoubtedly the fastest and most effective way to achieve naturally white teeth. The laser light is used to activate a special whitening gel that can also be used on sensitive teeth, without discomfort. The LSW whitening system The LWS TiO 2 Bleaching Gel was developed by a cooperation between Vienna Dental School and Vienna University of Technology under the direction of two professors, Dr. Johann Wernisch and Dr. Andreas Moritz. They focused their attention on creating a product with high bleaching efficiency combined with very high protection of the dental enamel. Why titanium dioxide? TiO 2 (Titanium dioxide) is an effective photocatalytic pigment mixed in the powder which provides a natural whiteness and acts a physical blocker of light avoiding unwanted increase of heating to the elements, so that it can be used even on patients with dentinal sensitivity. The Doctor Smile LWS laser bleaching systems offer many advantages: * Excellent results in less than one hour * no overheating * No damage to the pulp * No side effects * No anaesthesia required * Long term whitening effect * Proven results over all other methods * Pain-free treatment

12 12 10 REASONS TO CHOOSE WISER LASER I. WISER IS Wiser is a third generation diode laser. Its superior technology is designed to fulfill the needs of a busy dental practice. Fiber and handpiece are integrated, so there is no need to prepare them before starting. Specific interchangeable and autoclavable tips are applied directly to the handpiece. The handpiece has a built-in SensaTouch trigger area: there is no need for pedals and wires. Wiser is also chargeable so it does not need to be connected to the power supply during use. It can be therefore moved from one chair to the other without the fuss of cables and sockets. IL MANIPOLO SENSATOUCH II. PORTABLE Wiser is designed for maximum portability and freedom of movement during operation: it does not require any cables so it can be easily moved from one chair to the other, and operation can begin instantly. Wiser is chargeable, no power cables are necessary during use. Wiser s hand piece has a built-in finger switch, the SensaTouch area on the handpiece, so it is not necessary to connect a pedal to the laser. III. SENSATOUCH HANDPIECE The SensaTouch trigger area on the WISER handpiece start laser emission with a slight pressure. Its sensitivity eliminates any strain on the finger and hand of the operator, resulting in better precision and less stress. The Sensa-Touch area sensitivity can be set through the menu to high, medium or low values. It is therefore not necessary to connect a pedal to the laser.

13 13 IV. CHARGEABLE The WISER laser can operate without being plugged into the power socket thanks to the patented Super Cap capacitor system. This capacitor and the internal rechargeable batteries guarantee the functioning of the system and the power supply when used in the wireless mode. POWER SOURCE SYMBOL CAPACITOR Patented Super Cap system STORAGE BATTERY Type: 4 AA 1,2V 2000mAH rechargeable FUNCTION Powers laser beam Powers basic laser functions and software CHARGE TIME 1,5 minutes 10 hours V. INTERCHANGEABLE TIPS Wiser s fibre and handpiece are integrated into the laser body. To change the size and diameter of the laser spot, specific colour coded tips are applied to the end of the handpiece. Tips are reusable and autoclavable. The can be shaped according to specific operating needs. Intra and extra oral biostimulation accessories are also available. TREATMENT ENDODONTICS PERIODONTICS SURGERY IMPLANTOLOGY THERAPY COLOUR BLUE YELLOW GREEN WHITE BLACK WHITENING GRAY FLAT TOP(optional) BIOTIP (optional) GRAY GRAY

14 14 VI. FLAT TOP HANDPIECE Did you know that you can treat many painful extra-oral conditions with your Antalgic therapy and biostimulation is now possible with great effectiveness with the AB2799 FLAT TOP handpiece. The handpiece was created thanks to the collaboration with Prof. A. Benedicenti, author of the comprehensive Atlas of Laser Therapy (teamwork media ed.) in which many therapeutic uses of the laser are described. The handpiece guarantees a constant and optimal amount of energy absorption over a 1 cm 2 area for an easy application of the clinical protocols. The handpiece can be held at a variable distance from the treated surface (up to 1m the energy does not vary) without varying the energy output but must not be held in direct contact with the skin. Headaches, herpes, sinusitis, arthritis, arthrosis, trigeminal neuralgia, TMJ disorder, tennis elbow and many other painful conditions can be treated effectively with different cycles of applications in specific areas. VII. TISSUE OPTIMIZED PULSING Wiser is equipped with TOP Tissue Optimized Pulsing. TOP allows fast and effective cutting and removal on all soft tissue types (granulation, fibrous, normal) and reduces thermal damage thanks to special pulse modes that include adequate thermal relaxation time. VIII. SOFTTOUCH KEY PAD Design and functionality: the soft touch key pad does not have prominent buttons, for perfect cleanliness and beauty, and fast treatment selection.

15 15 IX. USER INTERFACE WISER can be used in the basic or advanced mode. The BASIC mode allows fast and direct selection of preset treatments, whereas in the ADVANCED mode it is possible to access a more complete list of treatments and modify single parameters. BASIC MODE The BASIC mode is designed to simplify and speed up laser treatments. It shows a list of the most commonly used preset treatments. The main screen will show and indication of the power setting, the application time, and suggest the tip colour code. Each preset parameter is based on bibliographic indications and on clinical studies carried out by eminent doctors specialized in laser dentistry (Prof. G. Rey, Prof. S. Benedicenti, etc.). The basic mode allows dentists approaching laser dentistry for the first time to operate in complete safety, without having to worry about each parameter setting. Fast access to the TOP system is available for treatment of granulation tissue, fibrous or normal tissue, each with a specific parameter for power and pulse type.

16 16 ADVANCED MODE In the ADVANCED mode each treatment category is subdivided into specific procedures with specific parameter settings. The preset treatments are therefore greater in number and more specific in the application. In the advanced mode it is possible to modify any one of the single laser parameters, once the user has acquired the necessary confidence with the laser. The main screen will show the value of each parameter in detail: power, timer, pulse type with Ton and Toff values, frequency, average power and the suggested tip colour code. X. MADE IN ITALY Wiser laser is a medical device designed and produced entirely in Italy by LAMBDA SpA. LAMBDA is an Italian company located near Venice, that manufactures and commercializes hi-tech devices worldwide. Wiser laser is certified FDA, CE, KFDA, GOST, SFDA ecc. Labs, offices and a showroom are located on our 5000m 2 premises, alongside the Doctor Smile Training Center, a place dedicated to training doctors from every country on the benefits of laser dentistry.

17 17 ABOUT DOCTOR SMILE Not only lasers: Doctor Smile organizes seminars and training courses developed to offer an elevated standard of scientific and clinical support. All of our knowledge is at your disposal! ON-LINE RESOURCES Visit regularly to keep up to date on all the news regarding our products, events, and training courses. The site contains downloadable material such as brochures, data sheets, clinical studies and more, so that your patients and colleagues can get to know laser dentistry. The Doctor Smile You Tube channel offers clinical and product videos. Follow us on Facebook: always up to date on the latest events and news! PARTNERSHIPS Doctor Smile works in partnership with many universities and research centers word wide. Doctors and academics actively participate in the development of our products for dentistry and aesthetics, in order to offer you the best technology and the most up to date clinical information. SERVICE Our products signify trust and professionalism. As direct producers we assure immediate, efficient assistance. Technicians and specialized engineers regularly carry out system diagnosis and check ups to keep your Doctor Smile laser in a perfect working condition. The service team is at your disposal: service@lambdaspa.com skype name: service.lambda

18 18 EDUCATIONAL Doctor Smile organizes training courses for those who wish to learn the basics of laser dentistry and for those who wish to enhance their expertise on the clinical applications of laser dentistry. Doctor Smile collaborates with professional laser educators that work with lasers on a daily basis. Our courses are articulated in two parts: in depth technical and theoretical lectures and hands-on live case studies on patients. Visit to get to know our laser tutors and to find the training course nearest to you. OUR LASER TUTORS Dr. GIANLUIGI CACCIANIGA Italy Dr. JIHAD HABLI Lebanon Dr. BENITO CAPOBIANCO Italy Dr. SARMAS EVANGELOS Greece Dr. ROLAND MALEKI Germany Dr. ALEX MATHEWS India Dr. STEFANO SALMINI- STURLI Italy Dr. SHIN-NAN HSIEH China Dr. AMR HOSNY Egypt Dr. VLADIMIR ŠČIGEL Czech Republic

19 19 SPECIFICATIONS Model name/ certification code Laser source Wavelength Frequency Max power Mode Fibre/ Tips Handpiece Pedal Size / weight Medical / Laser class Operation Voltage Doctor Smile WISER / LA3D diode 980 nm Up to 25 khz 7 W (0,10 W to 7 W in 100mW steps) Continuous (CW) or Pulsed Modes (MP, SP, SSP); customizable modes integrated fibre with variable autoclavable tips for specific application Standard with SensaTouch finger switch Whitening Arch Biostimulation Lens Optional 8 x 18 x 6-8 cm (w x h x d) / less than 1 kg II B / IV Vac info@doctor-smile.com

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