Soft-Tissue Cutting with Hot Glass Tip Diodes

Many dentists are skeptical about lasers in the age of Physics-denying “dental laser CDE”, and “dental lasers”, that are implant-melting-capable, or bright-plasma-flash-blinding, or charred-ink-on-the-glass-tip-burning, and so on. The change, however, is coming, one step and one “dental laser” at a time. The Renaissance of laser education in dentistry is driven by Physics.

Find out what American Laser Study Club members, leading dental educators and clinicians say about soft-tissue cutting with hot glass tip diodes:

Robert Levine, DDS

The review by the ALSC member Robert Levine, DDS, just published in Inside Dentistry, recognizes the hot glass charred tip nature of cutting dental diodes – “The State of the Art of Lasers”.

“For the diode lasers, their varying wavelengths will result in different levels of water absorption. These lasers have a very poor coefficient of absorption of color … Cutting with a diode laser requires activating the tip … In essence, they function as … electro-surgery units” – Robert Levine, DDS

Gordon Christensen, DDS

It is in sync with the earlier assessment by the Honorary ALSC member Gordon Christensen, DDS, in his interview by Howard Farran, DDS, of DentalTown (see video clip below).

Peter Vitruk, PhD, DABLS, ALSC Founder

Also published earlier by Howard Farran’s DentalTown, was a more technical account by the ALSC founder Peter Vitruk, PhD, DABLS, on the physics of hot tip cutting diodes, “Laser Education, Science and Safety”.

“The near-infrared wavelengths of dental diode lasers cannot photothermally ablate soft tissue, except for high-melanin-content epithelium. Instead, the near-infrared diode laser beam heats the charred distal end of its fiber optic glass tip to 500-900 degrees Celsius. The glowing hot glass tip, then, conducts heat to the soft tissue…” – Peter Vitruk, PhD, ALSC Founder, Director at American Board of Laser Surgery

Richard Winter, DDS, DABLS

Another article by the ALSC member Richard Winter, DDS, DABLS, published earlier this year in Dentistry Today, “Practical Laser Applications in General Practice”, also mentions the thermo-mechanical nature of cutting diodes.

“At diode wavelengths around 1,ooo nm, light scattering dominates the very weak absorption. When diode lasers are used, they do not cut optically. Instead, the glass tip of the diode fiber is charred and heats up to between 500°C to 900°C via heating of the char by the diode laser light. The hot charred/activated glass tip burns the soft tissue on contact. Dental diodes do not cut the tissue with photons, but with hot charred glass! The device that is closest to a diode that cuts on the same thermo mechanical principle is electrocautery. Therefore, diodes are thermal contact ablation devices and not laser wavelength-dependent precise cutting instruments.” – Richard Winter, DDS, DABLS

The American Board of Laser Surgery and Martin Kaplan, DMD, DABLS

The same physics-based assessment of cutting diodes is summarized in the position paper on soft tissue dental lasers by the American Board of Laser Surgery (ABLS)  – (the Dental Division of ABLS is headed by the ALSC member Martin Kaplan, DMD, DABLS).

“The medical efficacy of this [diode] device-tissue interface (charred hot glass surface) is highly dependent on multiple factors:

a) User’s technique and skill in controlling the effectiveness of the tip’s “initiation” (or “activation”), i.e., creating a light-absorbing char layer on the tip end;

b) Monitoring the degradation of the glass tip’s char surface which will increase the effective photo power output from the “partially transmitting” tip; the degraded char surface reduces tip temperature and leads to less ablation, an increased risk of near-IR-induced subsurface thermal-induced tissue necrosis, and mechanical tearing of the tissue by the cooler glass tip’s edges;

c) Assessing and clinically managing the biocompatibility and sterility of the char that is produced by burned ink or corkwood immediately before applying the hot tip to the soft tissue and, also, the biocompatibility of the glass and its cladding materials at 500-900°C operating temperatures;

d) Staying within the thermomechanical thresholds for any thermal gradient-induced fractures of the hot glass tip at 500-900°C operating temperatures, while considering the biocompatibility of possible fractured glass fragments;

e) User’s technique and skill in controlling hand movement and tip contact with the tissue; hot tip coagulation depth depends heavily on hand speed and tip-tissue contact duration.”

Robert Strauss, MD, DDS

An eloquent take on cutting diodes by Robert Strauss, MD, DDS, tops our list of laconic summaries of the essence of soft-tissue cutting diodes (see photo below).

Strauss version: Pasteurized, processed, diode laser stuff

Photo from the presentation by Robert A. Strauss, DDS, MD, FACS, “Lasers in Dentistry and Oral & Maxillofacial Surgery”, November 18, 2017 at Tufts University in Boston, MA.

Great minds do think alike! It feels great to have the reality of 1+1=2 returning to laser dentistry! It is time for CERP ADA and PACE AGD and ADEA to pay attention to the science-based and not opinion-based CDE.