Download our “Brain Booklet” Learn the Helios Value Proposition

Clinical Utility

The diode laser is a production tool with which a practitioner may accomplish two kinds of better and more productive dentistry.

Soft tissue surgery A diode is able to remove diseased and extraneous tissue quickly and with little pain and blood or thermal damage. Using traditional cutting methods, such removals would be difficult. Eliminating extraneous tissue is more useful than one might first think. Crown troughing, for example, lets you get rid of cord packing, a time-consuming procedure that patients hate .

LAPT  The diode’s benefits lie in combating pocket biofilm infection and stimulating epithelial healing. In a standard LAPT sequence, the laser is useful at two stages. First, after pocket depth evaluation, a diode can selectively dissect the epithelium and denature diseased tissue and biofilm. This stage also opens sulcus for SRP access. Second, after SRP, the diode can finish debriding the pocket and coagulate the epithelium.

For both soft tissue removal and LAPT, the diode’s overall utility lies in:

• Cutting quickly and cleanly to reduce procedure time.
• Limiting thermal damage to surrounding soft tissue and not harming bone.
• Balancing between cutting and coagulation to reduce bleeding.
• Acting as a bactericide and stimulating local tissue growth. 

Helios Tissue Optimized Pusling®

Operational Efficiency

Diode laser efficiencies are firmly based on power and pulsing. As emission power increases, the pulsing regime gains flexibility. With more total power, pulsing briefly surges laser energy to the tissue and then lets it rest. The power-rest balance changes by tissue biotype. In advanced pulsing regimes, such as Helios Tissue Optimized Pulsing®, tissue biotype is the primary emission consideration.

Compare, for example, diode cutting with electro-surge. A diode requires 1/5 the amount of energy as electro-surge to do an equivalent amount of work. Moreover, diode collateral damage is limited to about 25µ. With electro-surge, damage ranges to 250µ. A diode wounds soft tissues just 10% that of electro-surge. And, in addition to cutting better, a diode laser can kill up to 95% of all bacteria at the surgical site and also stimulate soft tissue regeneration.

Financial Performance

In the present economy, financial performance, or ROI, comes to equal clinical utility in the dental equipment market. Our laser educator, Dr. Michael Swick, provides the basic data for diode laser financial performance.

It is clear that a month of standard soft tissue surgery and LAPT will bring in revenue exceeding the price of the laser.

In sum, the value proposition is the heart of a laser demo. Proposition subject matter should permeate the demo’s formal stages: intro, presentation and mini-training. Visual aids, especially charts and graphs, aid in presenting value.

Next up: laser demo mini-training. 

As we’ve seen in Good Demo Part 1, success begins when the laser rep finds common ground with the practitioner. Once a connection is established, the laser may come to the fore in presentation. The laser presentation provides the foundation the hands-on training component. Both rep and practitioner may be eager to go to the final hands-on part of the demo. However, if the rep has the right pitch and materials, the presentation can provide real insight.

Presenting a Diode Dental Laser in 2012

In 2012, a laser presentation needs to play out a bit differently than, say, five years ago. We’ve been through a major recession; people are more sober about the reasons for buying. In the last five years, the practice at hand may have suffered a drop in patient volume or visits per patient. The practitioner may be looking to grow on fewer patients in a more complex setting.

Such a dentist may have asked for a demo because he/she has heard good things about soft tissue laser dentistry–that lasers are a relatively inexpensive means to expand treatment offerings and gain management efficiencies. The concepts of interest are clinical utility, operational efficiency and financial performance.

The current environment has therefore diminished the value of “we love ourselves” presentations. Practitioners in all medical fields want more than feature comparisons of one laser to the competition. Best to keep it simple with utility, efficiency and performance.

Printed information sheets can give important demo information and help the practitioner to remember it. Two pieces of literature make for a concrete presentation and good take-home notes:

Dental Laser Demo Outline

The outline serves as a working guide and also as the practitioner’s record of the event. The outline is a good place to indicate the manufacturer’s dental laser timeline and accomplishments, as well as presenting the course of the session. In talking  about the manufacturer’s accomplishments, the rep can also indicate what the future might bring, generally, in terms of technology introductions. 

Download the Helios Wiser Demo Outline

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Dental Laser Demo Chart

The chart provides basic information and ready answers for basic questions:

• Why is this manufacturer or brand special—what has it accomplished in laser dentistry?
• Why is this laser special—what will it do for me?
• What comes with the package? 
• How do I get trained?

Download the Helios Wiser Demo Chart

The Demo Chart can be arranged to aid in presenting the three basic concepts: utility, efficiency, and performance. In the next post, I’ll consider these topics individually.

Dr. Michael D. Swick instructing Dr. Dennis Garrow on the Helios Laser HL5, October 2010. Photo by Mark Cartwright, Helios Laser.

Think “laser demo“ and a common event comes to mind. A dental practitioner invites a laser rep into the office for an hour or so. The rep makes a formal presentation and then holds a mini hands-on laser training session.

Time is a critical factor. An hour is brief for presenting the laser and hands-on. It is also a short time for absorbing a lot of information and making critical judgments. In this compressed context, which are the factors that leave rep and practitioner feeling satisfied? The following is posed from the rep’s perspective, but is a practitioner’s guide to the course of a demo.

Let’s step beyond the event sequence to see the laser demo as a simple equation. On one side, the dental practitioner has, so to speak, a brief chance to bring a laser “home.” On the other side, the laser rep has the chance to present at home. At home, a demo proceeds with two currents.

Competing Interests

A demo necessarily plays out on divergent interests of the laser rep (my chance to sell this laser) and the practitioner (give me information about this one laser). The rep usually assumes that this home demo will be one among others and that this one must therefore become the point of reference for any others.

Unfortunately, the assumed absent competitor becomes a complicating third party. Now, “home” becomes a place of negotiation in which rep and practitioner struggle to get needs met around an ill-defined competing interest. Under competing interests, each side works somewhat independent to get needs met.

Common Ground

There is a way to dispel the competitive aspect during the demo’s introductory exchange. Here, both parties seek to establish common ground upon which to simplify the equation. The common ground is a mutual understanding of the practitioner’s level of laser knowledge and practical goals for this particular demo.

The reasons to establish common ground are simple. If the rep does not know the practitioner knowledge level, he/she risks presenting too high or too low. With the practitioner’s goals unarticulated, the rep risk’s some amount of demo irrelevance. Alternatively, if common ground is achieved, the assumed third party tends to leave the equation and the demo can flow more collaboratively.

Common ground can emerge quickly if the rep asks the right questions, politely yet persistently, and if the practitioner replies forthrightly, even if revealing ignorance on the subject.

Diode Laser Common Ground

Establishing diode laser knowledge is easily broached with simple questions: “Have you ever taken a Laser Intro course.” If a Laser Intro course is in hand: “Are you familiar with the diode wavelengths and with the concept of pulsing?” “Do you know what it means to initiate a diode tip?”

Regarding practitioner goals, the rep must proceed discretely. Here is one approach. “A diode laser is a production tool for removing unwanted tissue. The laser’s added advantage is that it coagulates (less blood), seals nerve endings (less pain) and stimulates healing. The diode would replace your current production tool (scalpel or electro-surge). “Which is you present soft tissue cutting instrument?”

This is not a loaded question and it gets the practitioner to think in concrete terms about laser dentistry. In breaking the ice with the concreteness of the production tool issue, it is easy to ask the practitioner’s goals for this particular demo.

With common ground in hand, the demo may proceed on greater certainty and, more likely, without the pesky third party.

What are your ideas on the nature of a successful laser demo?

Florida Probe periodontal pocket depth diagnostic chart

In Phoenix, I had the pleasure of meeting Florida Probe’s Ron Joos (pronounced Joess), VP for global sales. Ron introduced me to the Florida Probe (FP), which began as a perio pocket depth research instrument in 1987, and has been marketed as a clinical diagnostic instrument since 1991.

The Florida Probe

At base, FP is a computerized sensor/procedure for periodontal probing and charting. FP’s real strength lies in diagnosing perio disease in the patient’s presence and in presenting treatment options.

As Ron explained the procedure, FP’s ability to present laser periodontal therapy became clear. But let’s start at the beginning. FP has three basic clinical utilities; information about each is available on the Florida Probe website:

• Relative to manual probing, FP quickly and precisely measures pocket depth and recession.
• As a semi-automated procedure, FP enables the hygienist probe and chart without assistance.
• FP creates an informative pocket depth chart which easily integrates with practice management software.

On these three features, FP plays into Sixth Wave machine efficiencies, including automated controls and the integration of diverse medical datasets.

Of greatest value, FP provides an objective third party to help the patient understand perio disease and accept therapy. That’s where the patient and the practice benefit. This is also where laser periodontal therapy comes in.

Using an operatory monitor, FP displays a pocket depth chart and tells the patient about the diagnosis in progress. As FP helps the hygienist chart pocket depth, site by site, the patient sees, hears, and feels (slightly) the process. Monitor presentation helps make the diagnosis real and concrete.

The best part is that the monitor, as a third party, delivers the diagnosis and the call for treatment. Relieved from presenting the diagnosis, the hygienist can better explain the results and suggest treatment options. In such conversations, the patient more easily takes in the diagnosis and takes ownership of the disease—and is more likely to consider treatment proposals.

Florida Probe and Laser Periodontal Therapy

Florida Probe expanded screen display

The FP patient experience can draw on laser periodontal therapy in three ways:

1) In-diagnosis call-out warnings.
As the FP procedure encounters perio sites needing treatment, an alert is vocally called out. A phrase such as “Laser periodontal therapy suggested” can be part of the call-out.

2) Laser Periodontal Therapy Map.
Immediately after the diagnosis, while patient still is in chair, the monitor displays a diagnosis chart. The chart can then be transformed into a treatment map for laser periodontal therapy, and then printed as a patient take-away.

3) Laser Periodontal Therapy Video.
The time to propose laser periodontal therapy comes while the patient is still in the chair. FP can help by launching a laser perio therapy video. Having heard the diagnosis and seen the laser treatment map, the patient now gets a short introduction to laser therapy.

FP’s beauty is that it sets up the patient and hygienist to discuss the case at hand. Working of the FP presentation, the patient and practitioner build a lesson in dental education. As FP can introduce laser periodontal therapy as a treatment option, the lesson now aims toward results. Such small-scale collaborative lessons in laser dentistry education will create the environment for good laser dentistry.

As laser dentistry advances and globalizes, the means for buying dental lasers diversifies faster than the means for getting good training. Take diode dental lasers as an example. No matter the location, a practitioner may purchase a diode online or through a local dealer for a few to several thousand dollars, and diode prices continue to drop.

Gaining proficiency on that laser, nevertheless, usually means travel to a group training venue, and the cost of assembling training groups is rising. In this environment, the time and expense for dental laser training can resemble the price of the laser itself. In the ideal world this cost ratio should not matter, but it does.

Online telecommunications platforms, such as Skype and GoToMeeting, offer means for rich multimedia communications. Are there ways to use online telecommunications for long distance laser dentistry training?

Dr. Swick training for Helios Laser

Voyager Laser Training™

Helios is experimenting with Voyager Laser Training™ (VLT) which can extend personalized dental laser training to the global level. VLT sets up an online long-distance one-on-one, hands-on session between a qualified laser practitioner and a veteran laser trainer. Our trainer is Michael D. Swick, DMD. 

VLT is oriented toward the practitioner who owns a laser and desires more clinical proficiency. The trainee should be proficient on safety, laser-tissue interaction, system operation, etc. He/she should also have experience enough to define needs addressable in a two-hour session.

To the trainee’s location, Helios ships a Web-ready digital video mini-studio. The package includes a laptop holding the data and programs needed for an online clinical hands-on session as well as instructions for preparing the studio, simulation materials, and Internet link. Dr. Swick’s studio setup makes use of his proprietary teaching aids.

On the surface, VLT enables the trainer to make a virtual distant office visit to deliver knowledge to the trainee, somewhat akin to a physician’s house call. However, we strive for more give-and-take. Helios encourages the collaborative element found more often between a personal health trainer and trainee. With VLT, Helios encourages the trainee to take equal charge of the session. We ask the trainee to prepare goals and questions for Dr. Swick’s pre-session review.
While still in experimental stage, our hopes for VLT process have been met. It seems that in preparing to bring Dr. Swick into a distant home office, the trainee takes an active role in building successful one-on-one conditions.

VLT is one experiment to use telecommunications for niche training. It is our attempt to diversify manufacturer-based laser education using emergent resources.

Learn more about Voyager Laser Training™

Laser Tech Efficiencies

Dental lasers are now present in great variety and with significant specializations, miniaturizations, and falling prices. The trends are the result of efficiencies inherent to tech development of any kind. At first glance, the education/training side of laser dentistry seems distanced from tech efficiencies. Yes, we use PowerPoint and video and sometimes distribute presentations online. Yet education/training still seems highly dependent upon traditional—and costly—face-to-face group gatherings and print literature.

Laser Dentistry Training Efficiencies

A common complaint is that manufacturers have decoupled training from product. Only the highest priced lasers now include significant training in the base price. Yes, it has become difficult to include face-to-face training in base diode sales packages. Nevertheless, I do not believe that diode manufacturers value training any less. We are tending to deliver education in more specialized and less costly ways. Manufacturer-based laser education thus makes more use of technological efficiencies. And because it is proprietary, manufacturer-based training is less visible than meeting-associated professional programs.

Helios Laser Tech and Training

Helios is one of more than a dozen manufacturers selling diode lasers in theUS. The ways in which Helios Laser develops education programs may shed light on diode manufacturer-based training generally.

Helios collaborates with laser veteran, Michael D. Swick, DMD, to develop emission regimes and the training to make them clinically effective and safe, and financially rewarding. We offer three face-to-face courses with Dr. Swick: Helios Laser Intro and two proficiency courses. Helios Initial Certification (7 CEU) is directed toward Helios practitioners. Helios Standard Proficiency (14 CEU) aids any practitioner in obtaining ALD Standard Proficiency.

Helios Laser Online

The Helios Laser online education program supports traditional course offerings by breaking them into specialized segments for Web distribution. There are ebooks on therapeutic effectiveness and financial performance [View sidebar ebooks]. There are three categories of videos:

• Product setup manuals and videos, including basic safety and security.
• All aspects of laser tissue interaction.
• Vignettes of common procedures.

Finally, Voyager Laser Training is our means to deliver face-to-face hands-on training to remote locations. With VLT, Helios sends a complete mini digital video studio to the practitioner. The apparatus provides all needed for a Skype-driven two-hour intensive hands-on session with Dr. Swick.

Helios Laser Online aims to bring tech efficiencies to laser education in parallel with traditional coursework. Online tech helps us tailor training to individual customers at relatively low cost. Nevertheless, Helios Laser Online represents a substantial commitment of resources

All the diode manufacturers and working in the same general direction. Among all such efforts, one finds a substantial commitment to diode laser education and training. Yes, face-to-face instruction is decoupling from the laser sales package. Nevertheless, the traditional courses are still available and the content is now offered in diversifying forms and prices. Laser Dentistry Training Efficiencies are making for better education programs. 

Elements of an answer may be found in The Sixth Wave: How to Succeed in a Resource-Limited World, by James Bradfield Moody and Bianca Nogrady. Random House Australia (2010).

Moody and Nogrady argue that innovation arrives and ebbs in waves and that we can count five waves since the Industrial Revolution. The first three related to motive power: water, steam, and electrification. The fourth related to the mass production of goods. The fifth wave, during which many of us grew up, developed on advanced information and communications processing technologies. Each wave has transformed society and economy.

As an invention, the laser came from advances of the electrification and mass production waves. Issuing directly from digital telecommunications technology, diode dental lasers are firmly rooted in the fifth wave. The fifth wave made lasers a commonly available product. The fifth wave also produced innovator and early adopter dentists. These very specific personality types essentially developed laser dentistry.

The fifth wave is now fading. Why? Through the first five waves, economic growth depended upon resource consumption inadvertently tied with the production of waste materials. Our world now has skyrocketing consumer numbers competing for dwindling resources upon greater waste loads. Consumption-based growth brings diminishing returns.

The sixth wave aims to decouple growth from the resource/waste cycle and focus on efficiently processing renewable resources. The sixth wave also looks directly at human capital and information as primary resources. The sixth wave will transform dental lasers and laser dentistry in three fundamental ways.

Machine Efficiencies. We can see dental laser innovations coming to integrate human capital and diverse information sets. These include personalized and automated laser controls, integrated information on tissue condition and patient medical history, and algorithm-generated emission parameters.

Online Collaboration. As laser use increases, laser practitioners become more diverse and widespread. The new practitioners may have fewer personal ties and comprise less innovative personality types. Nevertheless, using online resources, newer practitioners have more means to interact and more information to interact upon. Online collaboration will change the ways we learn about and train for laser dentistry. Education will become more collaborative and more resource-efficient. While face-to-face forums may diminish, educational telecommunications strategies will greatly improve.

Measurement. The sixth wave rides on the ability to measure everything and to process and compare data sets endlessly. We will have better indicators for the value and cost of equipment and protocols. Much information, now wasted, will be found valuable.

It seems evident that sixth wave advances will push laser dentistry to greater efficacy based on real evidence. The trend can be seen presently in the attempts to understand laser effectiveness in perio and endo, those areas in which promise has been touted, but results have been hard to demonstrate. Service to patients has suffered some in the process. However, current research to understand therapeutic effectiveness now covers a global practitioners collaborating on sixth wave tenets.

Welcome to sixth wave laser dentistry!

Periodontal laser debridement. Courtesy, Lambda Scientifica.

In 2012, it is time reconsider dental hygienists and laser use, an issue that I’ll call the hygienist-laser relationship. There are a number of relationship components, including clinical utility, operational efficiencies, return on investment, and state regulations. Clinical utility is the most important component and it is subject to active scientific experimentation. In later posts, I’ll examine research on the therapeutic effectiveness of laser debridement, decontamination and new attachment. Perhaps it is reasonable to begin at the other, more concrete end of the spectrum: which state dental boards have approved laser use for licensed hygienists and what is the character of the approvals?

State dental board positions on the hygienist-laser relationship are not easily understood for two reasons.

1) The US has 50 independently operating dental boards without common or even parallel means for publishing positions. Dental board statements must be investigated state-by-state and the results are usually difficult to compare.

2) Answering the unitary question of approval/disapproval is not enough. For those boards which have approved laser use for hygienists, approval often has specific directives. Some examples:

•    Range of acceptable treatments (e.g., debridement, decontamination, and new attachment);
•    Scope of required training (e.g., didactic versus hands-on) and supervision level;
•    Sange of laser equipment limitations (e.g., restricting to low-level “non-cutting” outputs).

The best hygienist-laser research I have found comes from Lisa Dowst-Mayo, RDH. In 2008, Ms. Dowst-Mayo published Dental Lasers and the Dental Hygienist. RDH Magazine, vol 28, issue 6. The piece ended with a stepwise list of state board positions. The nature of the list indicates that state boards, as of 2008, were considering the hygienist-laser relationship in several ways:

a) Approval with significant directives (5): Arizona, California, Colorado, Idaho, and Nevada.

b) Approval without significant directives (17): Arizona, Delaware, District of Columbia, Indiana, Kentucky, Maine, Michigan, Missouri, Montana, North Dakota, Nebraska, New Mexico, New York, Oklahoma, Oregon, South Dakota, and Washington.

c) Disapproval with explanation (11): Alabama, Arkansas, Florida, Georgia, Iowa, Illinois, Ohio, Pennsylvania, Texas, Utah, and West Virginia.

d) Disapproval without explanation (16): Connecticut, Louisiana, Maryland, Massachusetts, Minnesota, Mississippi, North Carolina, New Hampshire, New Jersey, Rhode Island, South Carolina, Tennessee, Vermont, Virginia, Wisconsin, and Wyoming.

e) Boards which have, apparently, explicitly not considered the question (2): Hawaii and Kansas

I’ll be updating this information in future posts. It will be interesting to see the movement in boards being petitioned to approve a hygienist-laser relationship. I’ll be pleased to take in relevant information. 

Founded in 2011 by four dental laser veterans, Laser Education International (LEI) is blazing a new path in laser dentistry. The self-selected group, from 17 countries, is gathering to produce and distribute the best available information regarding dental lasers and their effective use, especially in general practices. LEI desires to pool veteran resources and keep administration minimal. I will report on LEI work as it becomes available. 

The LEI website is under construction. From it, some critical information can be abstracted:

LEI Goals
  – Keep collective knowledge on the cutting edge of dental laser research and clinical application.
  – Publish articles, teach courses, give seminars and present on-line learning opportunities.
  – Help dental professionals safely and efficiently integrate lasers into clinical practice.
  – Provide an unbiased source of evidence-based laser information. 

Member-Contributed Articles
  – Laser-Tissue Interaction. By Michael D. Swick, DMD (10 pp)
  – An Overview of Lasers in Dentistry, 2011. By Donald J. Coluzzi (19 pp)
  – Soft Tissue Applications of Lasers for the General Dentist. By David M. Roshkind (6 pp)

Reading List, by Donald J. Coluzzi
    Category (number of references)
      Journals (1) (Photomedicine and Laser Surgery)
      Textbooks [with publisher website links] (9)
      DVDs and Videos (1)
      Laser Institute of America publications (5)
      Peer reviewed articles on:
        Comparing modalities and wavelengths (21)
        Dental laser fundamentals (13)
        Wavelength (40)
        Photobiomodulation and photo-activated disinfection (15)

2012 Forum
On Feb 24 and 25^th 2012, Laser Education International gathered in Breckenridge CO, for its first annual forum, The topic:  “ … the state of lasers in in periodontics and endodontics: from history to technique and science.”

Organizing committee: Donald Coluzzi, Steven Parker, David Roshkind, Wayne Selting, and Michael Swick.
The proceedings were recorded and there are plans to publish.

For each of the two panels:
Assigned moderators were to present introductory comments and then lead following group discussion.
Goals: 1) develop a consensus on current treatment modalities; 2) decide on the merits of writing a position paper.
Dr. Swick was to serve as laser-tissue interaction advisor on both panels.

Panel 1: Phase one periodontal therapy. Coluzzi and Parker, moderators, for discussion covering:
  – debridement: rood surface, soft tissue and peri-implant
  – pathogen reduction via high power or PDT 
  – new attachment procedures

Panel 2: Endodontics. De Moor and Benedicenti, moderators, for discussion covering:
  – dentin hypersensitivity 
  – pulp capping
  – pulpotomy/pulpectomy
  – canal access, preparation, shaping
  – canal disinfection
  – apicoectomy
  – PIPS

The forum has just ended. I await a statement on whether or not the forum attendees will author position papers on lasers in perio and endo. 

The Journal of Clinical Dentistry has published its first issue for 2012. The lead article: “In Vitro Evaluation of the Spectra Early Caries Detection System.” The authors (Maria Graye, Kenneth Markowitz, Maxine Strickland, Gerald Guzy, Mary Burke, and Milton Houpi) comprise a private practice pedodontist and five faculty members from the University of Medicine and Dentistry of New Jersey.

The evaluation finds that Spectra is a useful adjunct for detecting, assessing, and monitoring enamel demineralization and caries progression. Kathy Kincade, Editor in Chief at Dr. Biscuspid, has provided a timely review, summarized herein.

Using 41 extracted molars, the research compared Spectra and radiographic caries expression on occlusal surfaces. Caries progression was classified using the International Caries Detection and Assessment System (ICDAS).

Air Techniques Spectra caries detection aid

Radiography found that 9 of the 41 occlusal surfaces showed signs of decay. Spectra replicated these results. Moreover, high ICDAS scores were associated with higher Spectra readings. Spectra readings thus add significant information to relatively low sensitivity/high specificity radiographic results. Using Spectra along with radiography, the clinician may identify smaller lesion progressions. Spectra also detected in detected dentin caries better than radiography alone.

In sum, “When used in conjunction with visual and radiographic examination, the Spectra is an effective means of analyzing the occlusal surface of molars and is well-suited to detecting early stages of the caries process. The Spectra can detect areas of enamel demineralization and dentin decay, as well as create a continuous scale that represents the full extent of the caries process.”

We reiterate that Spectra provides simple, dependable, early caries detection and supports a minimally invasive treatment approach. The color imagery makes caries progression more clear and allows for more focused treatment options. Spectra is safe, user-friendly and patient-friendly.

Dental Tech Today features products and protocols that can help practitioners achieve better patient care, clinical efficiencies, and significant returns on investment. Dental lasers are among the products, but the concept reaches to include many technologies for disease-focused, minimally-invasive dental diagnosis and treatment.