Clinical Efficiency with Diode Lasers and Digital Impressions
By Dr. John Flucke
Efficiency and predictability are critical in today’s practice environment. In a busy dental practice the ability to efficiently schedule and execute means shorter appointments for the patients and less stress on the doctors and staff.
When integrating new technologies into my clinical routine, I ask myself 3 questions.
- Will I be able to expect a better result or at least the same result clinically?
- Does it increase efficiency & shorten the appointment time?
- Is the technology financially viable?
One of the technologies that answers all of these questions affirmatively is diode lasers.
Specifically for this article, I'd like to focus on diodes and digital impressions.
Market penetration of digital impression systems is currently about 20% and that is usually “the tipping point” of dental technologies that indicates a technology is around for the long haul. Over my years of working with leading edge technologies I really love it when 2 amazing pieces combine to create something that is even better than the 2 pieces accomplish separately.
Digital impression systems work best when they have a clear “line of sight” to the margin. For this reason, it is helpful to finish with either a shoulder or pronounced chamfer. These types of margins give a very clear delineation between prepared and unprepared tooth structure. However, it’s also critical to make sure that there is a clear delineation between tooth structure and the gingival margin as well.
For years, the usual way to keep the gingiva away from the margins was by packing retraction cord. While it continues to be a viable method, it does have some drawbacks, mainly in efficiency.
First of all, the cord must be placed and packed into the sulcus. This can be a time consuming and difficult depending on the clinical situation. High salivary flow, hyperactive tongues, and working in the posterior can all make the process difficult and challenging. There is also the aspect of hemostasis. Usually a cord is soaked or impregnated with some type of chemical hemostatic agent which sometimes make it harder to handle and can also have systemic complications for the patient.
Second the cord must be left in place. Most doctors prefer to leave the cord in the sulcus for 5 minutes to gain adequate retraction. This is simply chair time that is wasted and in today’s environment, patients appreciate anything that gives them less time in a dental office.
Once the 5 minutes has elapsed and the cord is removed, there is a race to scan the prep before the gingiva returns to its original contours. Oh, and placing is twice the work if the doctor likes to use a double cord technique.
For a diode laser, the doctor finishes the prep, hangs up the high speed Handpiece, and picks up the laser Handpiece. The tip of the laser is 400 microns which allows for a very thin access just below the gingival margin. When activated, the laser gently ablates a thin layer of the gingiva on the internal aspect of the gingival margin.
This creates a very thin “groove” between the tooth and the gingiva which provides more than enough room for the digital impression camera to discern the margin. This process of troughing the margin can be easily accomplished in 1-2 minutes at the most. Diodes also have a tremendous advantage in providing hemostasis. The laser literally “coagulates as it works”. This means a clean field is created at the same time as the margin is exposed.
The other advantage is that it takes a day or 2 for the ablated tissue to regrow. This means that your margins remain clear and exposed for the duration of the appointment which makes multiple unit cases much easier with lower stress. Also, laser procedures have little to no post-op pain which cannot always be said about needing to forcefully pack retraction cord.
The cost of diode lasers has dropped tremendously in the past few years which makes them an affordable and reliable option. While lasers can greatly simplify digital impressions, they can also do the same for traditional impressions. Lasers offer amazing advantages over traditional procedural options. You owe it to yourself and your patients to explore this option.