Focus On: Laser Dentistry for the General Practice

Ron Kaminer, DDS
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Ron Kaminer, DDS, focuses on advances in laser technology relevant to the general practitioner.

Q: You have a long history of using dental lasers. How did you happen to get started using dental lasers so early in your career?

A: It’s a long story, but to summarize, I went to dental school for 5 years instead of the usual 4 years. Due to a mismatched class schedule, I ended up with some free time on most days. One of my instructors and mentors, Dr. Chuck Leibow, pushed me to do laser research. So for 2 years, I was a “lab rat,” injecting cancer cells into hamster cheek pouches and irradiating them with laser energy, then studying any changes that occurred. My research was published in a few journals, and I also presented my work at a few dental and medical meetings. When I started my private practice, I purchased my first laser, a soft-tissue CO2 laser, then I bought a hard-tissue laser, becoming one of the first dentists in the United States to use this technology. Not long after, I started teaching early adopters how to use hard-tissue lasers.

Q: Lasers have been around in dentistry for more than 30 years, but adoption still seems slow. Is that accurate?

A: I would say yes and no. If you look at it from the perspective that it has been a long time since lasers first arrived on the dental scene and that most dentists still don’t use lasers, then I would agree. On the other hand, I remember the days when I gave a lecture on lasers and there would be 10 people in the room, and now there are many more in attendance. So, in looking at it that way, interest in lasers today is very high.

Q: What procedures can you do with dental lasers on a day-to-day basis in the office?

A: Lasers are defined by their wavelength, and each wavelength is absorbed by different types of tissue. That absorption dictates the ideal way and ideal tissue type to use that laser on. For instance, diode lasers are absorbed by pigment and hemoglobin, making them great to cut soft tissue and coagulate bleeding. Er:YAG laser energy is absorbed by water and hydroxyapatite, making them great hard-tissue cutters and good soft-tissue cutters, but not great coagulators. Depending on what type of laser you have, you can perform a variety of procedures, such as basic operative dentistry (cutting both enamel and dentin), predictable troughing for crown and bridge, complex soft-tissue surgery, etc.

Q: What about newer and more advanced procedures? What’s out there right now, what’s on the horizon, and how does someone learn to perform these advanced procedures?

A: By ethically and scientifically pushing the boundaries of laser energy, new procedures have been developed and are being developed all the time. For example, there is now a treatment using an Er:YAG laser to shrink tissue on the soft palate to allow more air to pass through, thus reducing or eliminating snoring. There is also now a treatment using a laser intraorally to enhance lips and cheeks like fillers do, but without the chemicals. Using an Nd:YAG laser, a dentist can treat periodontal disease without flapping or traditional cutting. Predictable results—for example, reducing 7- to 8-mm pockets to 3 mm—can be achieved if you follow a specific technique. Lasers are also used to improve the disinfection and success of root canal treatment. And now, when indicated, we are using lasers to remove veneers and crowns atraumatically and often faster than with conventional removal methods. The bottom line is that lasers embody the term “minimally invasive dentistry.”

All of these procedures can be learned through hands-on training courses. We ran the Masters of Lasers training course for years in New York, and today, besides that program, every manufacturer runs courses on how to use its laser with detailed instructions on specific treatment protocols.

Q: Are there any new technologies in the laser world right now that excite you?
A: Traditional diode lasers used one wavelength to cut soft tissue. The newest player on the market has 2 of the most popular diode wavelengths in a tabletop, portable unit. This diode is also a super pulsed diode, so the laser can hit high energy but also quickly relax and cool off, allowing you to cut faster and more smoothly without tissue damage.
Look for new technology utilizing lasers in a healing capacity to re-emerge over the next few years. For years, lasers have been used in Europe as healing tools; however, adoption in United States has been slow for these applications. Lasers are also being used to treat the rapid rise of peri-implantitis in the United States. I would expect that manufacturers will come up with specific protocols using their lasers to treat this ever-growing problem.

Q: Do you have any final thoughts or advice to share with our readers?
A: Learn before you buy! Once you buy, get trained and trained well. Turn the laser on every morning and leave it on so that when you need to use it, the setup is a breeze. Most of all, have fun and take pride in being able to provide treatment options using this wonderful technology!

Dr. Kaminer is a 1990 graduate from the State University of New York at Buffalo School of Dental Medicine, and he maintains practices in Hewlett and Oceanside, NY. In addition to maintaining a teaching appointment at Peninsula General Hospital in Far Rockaway, NY, he is also a clinical instructor with the International College of Laser Education and director of the Masters of Lasers training program in New York. He can be reached via email at whitertth@aol.com.

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