00:00:00:00 - 00:00:28:15UnknownAll right. Well, in that case, I would like to welcome everyone to tonight's, installment of AMD's live webinars. my name is John Graber. I'm the clinical director of AMD lasers, and it's my honor to introduce and tell you a little bit about our speaker for tonight. Doctor Venkat Pandi is an alumnus by profession and has completed her postgraduate education at Rama University in India.00:00:28:15 - 00:00:57:19UnknownIn 2012, she's currently serving as a professor in the Department of Conservative Dentistry and Antibiotics at. Let's see if I get this. Matilde Mithila minority Dental College off to tell us about that. The notion she has completed her proficiency in lasers at the University of California, San Francisco and fellowship in lasers at the UCL Eastman Dental Institute in London.00:00:57:21 - 00:01:27:18UnknownAnd she is pursuing a master's in and lasers from, of all people, Sigmund Freud University in Vienna. She is the managing director of her own practice, a multi specialty, laser and dental clinic in Kanpur. She's the author of a book, Lasers and Operative Dentistry, and ended Onyx. She has close to 90 international and national publications to her credit.00:01:27:20 - 00:01:53:14UnknownShe has undergone heart tissue laser preliminary training at Advanced Center for Esthetic Dentistry in Rome. And, she's featured in various magazines as how about this, the shining star of modern dentistry. She's also interested in painting and and listens to music. And I wish I had all of her talents. Tonight. She's going to be talking about cosmetic dentistry.00:01:53:16 - 00:02:31:19UnknownAnd cosmetic dentistry is aimed to uplift the esthetic aspects of our profession. The traditional approach towards cosmetic dentistry is changing with integrate with increased integration of lasers in the field. With the current emphasis on cosmetic concerns, lasers are increasingly being used to effectively accomplish various esthetic modifications. Since many people and dentists worldwide are slowly, slowly beginning to realize the true potential of lasers in all branches of dentistry.00:02:31:21 - 00:03:15:22UnknownWe welcome Doctor Pandy on her initial presentation for AMD lasers. And, as we say in the US break the leg. It's all yours. Thank you. Thank you so much for your introduction, and I'm hardly touched about it. So today's presentation is all about esthetics and lasers. And as the introduction has already been given by Doctor Graber and little, little changes, with lasers make a living and a lasting impression on the patient itself and on the on our practice itself before, I begin to the presentation, I would just like to give you an insight of the journey, how I started using lasers in my practice.00:03:15:24 - 00:03:41:02UnknownAnd that's how Doctor Kaluza motivated me at the UCSF Dental Center to pursue my proficiency. And I was too young that time, doing my undergraduate. And I and I, I spent around six months of doing standard proficiency. And then the journey became never ending for me. Then I'm still pursuing Master's in Laser Dentistry by SFU Vienna in association with a Z.00:03:41:07 - 00:04:03:20UnknownSo that's a small journey. And the snippets which I and this happened to week Mike all the colleagues which I'm doing, we are all the batchmates with my faculty and supervisors and co supervisors. I am an accredited laser safety officer by them. So I have passed my laser safety exams with the A+ grade on 30th March 2023.00:04:04:11 - 00:04:29:14UnknownI happened to have my own practice, which is a multi specialty laser and ended on specialty practice as introduced by Doctor Graber. I am an intern on this by practice. So this is my practice and this is my team by whom I am working. We all have a woman oriented and a woman centric team, and all of them are practicing lasers with me and hygiene protocols also.00:04:29:16 - 00:04:54:14UnknownSo now I begin my presentation and as you all know, technology is improving the dental care day by day. Cosmetic procedures have increased. People are now more knowledgeable of the dental procedures. Patient comes to you by searching on your website, looking on the to Google and and just checking about your reviews so people are more knowledgeable of the procedures.00:04:54:19 - 00:05:20:02UnknownThey are all reading about the procedures and then coming to you to your practice and asking and demanding you of the same procedures. And nobody wants, painful procedures, bleeding, messy work. They are all aware of it. So before, you incorporate lasers into your practice, you should always ask certain questions to yourself. What do you know about lasers?00:05:20:02 - 00:05:48:12UnknownIt is similar to electro cautery that I've heard a lot of times that it is. It's similar to cautery. Is it similar to blade? Once you know about lasers, you know it is not. What do you want to learn about laser scanning? A practice benefit from laser technology. Would lasers help you do better dentistry? And what is holding you back from incorporating laser technology into your practice?00:05:48:14 - 00:06:13:22UnknownCan one device perform all indicated clinical procedures? What are specific procedures that the laser would perform? In my practice? Is is the technology reliable? Is it difficult to learn and operate? A dental laser device is a substantial investment in terms of equipment and training. Just flight. So these are all questions you should put up to yourself first when you are incorporating lasers into your practice, especially diodes.00:06:14:03 - 00:06:40:21UnknownThat and that's how we begin. Nobody wants to buy an all tissue laser and invest and start practicing. It's always in diode which we begin practicing with. I am sure you must be hearing all the MD webinars since a very long time, and everybody knows about lasers on this platform. So the word laser continues in, in the minds of an eye of aspects of what is described as modern, powerful, precise and innovative.00:06:41:01 - 00:07:01:00UnknownWe all know it is different. It is better and lightning quick. However, it is not a rocket science. And in one of the Ada papers it it is mentioned that it is a successful offspring out of marriage between optics and electronics. So it is better than lightning quick. But it is not a rocket science. So, do you,00:07:01:02 - 00:07:34:10UnknownAnd why should your lasers be, incorporated into esthetic practice? Why small changes leads to big impacts? Because in this changing world of fast paced communication, marketing and shared intelligence, the appearance or looks of someone or something can make or break the end result. Whether we pursue online at any hour, at any bookstore or favorite clothing, or any not a job interview, the way we look can have a major impact on the acceptance and its end result.00:07:34:21 - 00:08:02:08Unknownit has been well documented that, Looking Good can enhance your personal, professional, and economic consequences and help you get a better job. So it is now universally accepted that looking good and having a pleasing personality affects an individual's self-confidence, an image that he or she conveys. So, esthetic or cosmetic dentistry, none other than restorative general dentistry.00:08:02:20 - 00:08:38:11Unknowncompleted to a level that simply makes every attempt to mimic the biological look or the natural look. Now, we have moved from mechanical age to adhesive age in dentistry, and that has forced us as practitioners to look and view teeth in entirely a different context. Same way the profession is also seeing a change in the way gingival tissue is handled with regard to gingival sculpting, gingival plastic procedures like gingiva, ectomy and we are seeing it moving from.00:08:38:22 - 00:09:06:06Unknownsteel age or the scale age to the laser age. Now, you all know how lasers evolved way back in 1862, when James Wax Maxwell gave dynamical theory of electromagnetic field and building till Albert Einstein, where he proposed a quantum theory and where the backbone of laser started, that is, absorption and emission mechanisms to Ted Maiman, where the first ruby laser were invented.00:09:06:06 - 00:09:31:02UnknownWe have come up a long way, and it's been a long, very long journey since, lasers have been introduced in dental practice. But still, awareness of lasers is still more. An incorporation into the practice is still less as compared to the general practice. So today, I would be telling you why, leave a party of steel or the skip bullet and move to laser age.00:09:31:04 - 00:09:58:23UnknownIn esthetic dentistry. We would be looking and looking at the webinar into two broader aspects that is laser assisted multi tissue management during esthetic and restorative procedures, and laser dentistry and management of color in esthetic zone. before I, turn, I'll just give you a quick overview of the currently available dental laser wavelengths on the electromagnetic spectrum and what we are having into our practice.00:09:58:23 - 00:10:27:19UnknownWe have a plethora of, wavelengths available to us, and you can choose right from visible wavelength to invisible thermal radiations. Looking at your electromagnetic spectrum, we are working with 400 to 700 nanometers. Also today, including photo bio modulations or commonly known as low level laser therapy to invisible thermal radiation, where we can divide it into three, like near-infrared and mid infrared inside inside it.00:10:27:21 - 00:11:10:14UnknownHowever, in esthetic practice, if you look into diode practice, we are using currently, let's say wavelength from 400 to 445 for 50 nanometer, which is currently the new blue and in wavelength. And what common we are using are diodes from right from ranging from 810 to 1 064. However, 1064 becomes and at whereas other diodes can be like eight, then nine 4980 nanometers, and all current dental lasers emit either a visible light wavelength or an invisible infrared light wavelength in the portion of non-ionizing spectrum that is known as thermal radiation.00:11:10:16 - 00:11:36:02UnknownSo, you all know there are certain biological, molecules that absorb light into our, the overall tissues, which we are focusing on. And they are known as chromosomes. So what determines that? The photons, the photons coming out of the laser light would be absorbed by the target tissue is your chromosomes. And they are what they are molecules that absorb light.00:11:36:04 - 00:12:09:21UnknownAnd the rate at which chromosomes absorb light determines the absorption spectrum. For the particular laser wavelength. Why we are emphasizing on such laser wavelength and why not, all the, one of one machine is there to do all the procedures because because we have chromosomes. We have chromosomes in biological oral tissues. Like if you see diode, ranging from 812 to 9 89m, attracting Chromo four, or they are more absorbed into melanin and water interaction takes place to certain extent.00:12:09:21 - 00:12:27:23UnknownHowever, it is different for every wavelength. The the absorption coefficient becomes different. For an diag it's 1064 nanometers. And it is highly, the chromosome affinity to them is water, melanin water. And.00:12:28:00 - 00:12:52:06UnknownI'm sorry, melanin water and a little part of dentin for erbium and carbon dioxide lasers. They are termed as their high power lasers. And they are termed as, your all tissue lasers. And they are attracting chromo is, hydroxyapatite in water.00:12:52:08 - 00:13:18:13UnknownSo let us look at the absorption spectrum also for each wavelength, if we if we are talking about tonight, tonight four diodes. So and we see on the horizontal x axis wavelength in micrometers and your absorption coefficient, diode are highly absorbed in melanin in the pigments, whatever pigments the patient is having and your hemoglobin.00:13:18:13 - 00:13:42:16UnknownAnd now that can be an oxy hemoglobin or a, or a deoxy hemoglobin and a little amount in water, however, .98 that is 980 nanometers has a little peak towards water. Also. so we consider biological effect as vaporization. Also, bio diode lasers.00:13:43:09 - 00:14:02:08Unknowncoming to the most common in the versatile diode we have that is 18 nanometers. And that is AMD Picasso, which I happen to had in my practice. We, have, tips for them.00:14:02:16 - 00:14:23:19Unknownthere is an orange in the purple and a green tip, which is 400 my micron diameter used for surgery. And it comes in five and ten millimeter length. The purple tip is 300 microns. And it's useful hygiene procedures like period disinfection and same are available in five and ten millimeter length. The green tip is 200 micron diameter.00:14:23:19 - 00:14:47:22UnknownAnd it is used for procedures requiring more access and comes in 20 millimeter lip length, 200 micron can be used for Android on disinfection. The blue tip is a quadro bleaching handpiece and it is used for laser assisted handpiece. We. Today we will more focus with 400 micron diameter at its as minor surgical procedures can be very well performed with an esthetic that is laser tested.00:14:47:22 - 00:15:17:16UnknownIn-office whitening can be performed with bleaching tips, that is, a quadratic. So coming to the first one that is laser assisted multi tissue management during esthetic or restorative procedures, you can perform procedures ranging from gingiva, ectomy, soft tissue, crown lengthening for esthetics and restorative dentistry, gingival plasti for anatomy, fibro removal, molar nevus removal and tissue preparation for fixed plaster on00:15:17:18 - 00:15:50:07UnknownOrthodontic Pontic restorations. Before I, discuss anything, we should be aware of the gingival biotite and gingival biotite. it's. You all know it's a dental gingival complex. Gingival anatomy has been described and categorized either as thick and thin. Variations of those terms sometime appear in print, as you might find in some literatures and in some article, as thin gingival biotite or thick gingival biotite.00:15:50:09 - 00:16:15:13UnknownThey may be mentioning as thin scalloped gingival or thick scat. flat gingiva and current terminology is usually as thick and thin, so the thin bio type is generally less than naught point, less than 1.5 millimeter in thickness, and width is, around 3.5 to 5 millimeter, and it is characterized by narrow zone of keratinocytes, gingiva.00:16:15:15 - 00:16:44:02UnknownSo with the irregular margin surrounding the teeth with triangular anatomic rounded. Now this is a thin gingival biotite with thin okay. Write a nice tissue and a triangular anatomy of the tooth structure, whereas a thick biotite is at least two more square at nice gingival with the width of 5 to 6 millimeter around the corner of the tooth, and features a large amount of thick marginal bone and bony plates.00:16:44:04 - 00:17:12:15UnknownSo, and the, this I mentioned on the slide, other differences between the, thick and the thin. So you can, see, whereas a thin gingival biotite is usually more prone to recession, whereas the thicker biotite is more prone to pocket formation and it is more robust to and resistant to trauma, whereas a thin gingival biotite is less resistant to trauma.00:17:12:17 - 00:17:22:16UnknownI am telling you, because we would be dealing in esthetic procedures more with gingival tissue and playing in and around root.00:17:26:07 - 00:17:51:22UnknownSo the biological width is termed as, the dimensions of the soft tissue, soft tissue attachment. of of the soft tissue portion to the, dimensions of the soft tissue attachment of the soft tissue to the portion of the tooth kernel to the crystal. crystal. bone or crest. So if you look at this figure.00:17:52:21 - 00:18:01:09Unknownwe will have a first, a simple and a plain definition for it. So, but biological.00:18:01:11 - 00:18:25:12UnknownBiologic weight is defined as a dimension of the soft tissue, but which is attached to the portion of the tooth kernel to the crest of alveolar bone. Naveen and Guro in 1984 defined biological as the sum of the combined supra crystal fibers, the junctional epithelium, and the sulcus. This was over three millimeters when measured from the crest of the bone.00:18:25:14 - 00:18:52:19UnknownNow, if you look at this, we together as epithelial attachment and connective tissue attachment, which amounts to 1.07mm plus 0.97mm, is termed as biologic root and it is usually in a range. But now it is considered as 2223 more or two usually a standard is two women. So this is a diagram of the relevant anatomy and the variations of biologic width, resulting in inflammation.00:18:52:19 - 00:19:21:00UnknownOn the right side of the picture you can see the standard measurement of biologic weight is usually two women, which includes the epithelial and the connective tissue attachment, but this is uneven. So and this might lead to a little inflammation. Also this is due to inflammation also or some pocket depth also. So biologic width is really very important when you are doing procedures related to gingival gingival margins.00:19:21:02 - 00:19:49:12UnknownSo back in college in 1994 proposed biologic with increase antero posteriorly that is 1.75 to 2.0 eight millimeters. And that 15% of the restorations that impinge on the biologic width had biologic worth of less than 2.04mm. Because of the Anda and antero posterior increase in the biologic, with the clinician may want to increase the amount of tooth structure exposed when performing crown lengthening procedures.00:19:49:14 - 00:20:14:24UnknownBecker and colleague in 1997 stated that variations of gingival shallow by the distance in gingival tissue height between the facial and the proximal areas may be. If you have flat, scalloped and pronounced scalloped gingiva, you. The biologic width might have a range between 2.1mm to fluctuating 24. one millimeter. The average height difference is usually 3 to 3.5 millimeter.00:20:15:00 - 00:20:56:20UnknownAs stated by Wheeler in 1961. Now, coming to certain procedures after knowing about the biologic width and the dental gingival complex account length, and how your laser crown lengthening works. Now, if we talk about soft tissue crown lengthening, the term is used to describe as intentional removal of periodontal tissues for both esthetic improvements and a proper and a predictable placement for restoration that all we want now before starting any soft tissue crown lengthening procedures, you should address two question that is can biologic worth be maintained will attach gingival be preserved?00:20:56:22 - 00:21:22:15UnknownIs the tooth restorer bill will there be loss of support to the adjacent teeth. So if you look at this, picture of a patient coming to us within as, anesthetic looking crown, and she wants to get her crown changed just because it was an anesthetic. So we give it a we took a help of a diode laser with, go.00:21:22:17 - 00:21:48:12UnknownSo the protocol I will be telling you, and we have increased her, and we have done a soft tissue crown lengthening to give her more esthetic and pleasing look. Now, when are you using a soft tissue, crown lengthening procedure? It might help you gain access to sub gingival caries for exposing margins, to explore fractures, to develop a proper form for restoration and increasing the surface area for restoration.00:21:48:12 - 00:22:14:13UnknownAlso. And smile can be enhanced by little manipulation of this gingival contour. It was a thin gingival biotite, so we took a soft tissue crown lengthening something like this. And you should always follow a rule of golden proportion. If you are not comfortable initially with your diodes to perform soft tissue crown lengthening, you can also prepare a surgical guide or stent for determining the apical extent.00:22:14:17 - 00:22:36:17UnknownBecause you are not the doing. In osseous crown lengthening, you are only doing a soft tissue crown lengthening a 45 degree angle of laser tip use should be used to create a gingival sample with a very low voltage in power. This down. This is a golden rule. Whenever you begin your, laser practice, you never start working at a very higher power and a voltage.00:22:36:17 - 00:23:11:18UnknownYou should always begin with very low power and sweeping motion, so that your gingiva is culture. That is culturing the gingival margin. Now this here I used an diode laser with 18 nanometer in a continuous wave mode. at 1.5 average power. two region two and lengthened and gingiva. And to achieve hemostasis, now you can see, you can achieve hemostasis and you can always avoid using scalable and other procedures, and you can lengthen and you can save a badly broken down data.00:23:11:19 - 00:23:40:21UnknownAlso, you can also perform gingival plasti for gummy smile corrections. Now, this patient came to us with anesthetic looking porcelain fuzed to metal crowns with an inflamed gingiva. So our aim was both to do a conservative soft tissue crown lengthening and a better on tissue management. So that is what we did. We removed, the anesthetic looking crowns to reconstruct the gingiva according to the biologic rate.00:23:40:22 - 00:24:05:16UnknownYou should never violate to violate the biologic width. And you should be within the limits of the dental gingival complex. And with your, soft tissue laser, you can re control the gingiva, give it a break of a week and take an impression by again gingival troughing. And this is how your result changes drastically. So esthetically you can play with your, laser parameters.00:24:05:22 - 00:24:32:21UnknownThat's the laser physics and maps. And then you can achieve desirable esthetic results. Now if you look at patient often comes to a practice complaining of gummy smile. And they don't want to pursue any orthodontic procedures. They want to only pursue minimally invasive techniques which should not bleed, which should not have been that that the layman of the patient, which I'm telling you, at which I encounter in my practice.00:24:32:23 - 00:24:58:19UnknownSo here I use an average power of one board to control this. And, gingival for better esthetics. I have just did the soft tissue crown lengthening with practice. You can do it with freehand or initially you can, develop a surgical stent. Something like this. Now, this is the case which I did a week back with my, soft tissue diode that was 940 nanometer wavelength.00:24:58:21 - 00:25:26:16UnknownSo this is a, 3D surgical stent and which we have prepared. And you can ask your lab to do that. you can also get it, formulated digitally. digital scan is being taken and then, surgical template can be and according to the template, you can mark the boundaries for the patient and perform the, something like this.00:25:26:16 - 00:25:50:17UnknownAnd excessive gum show can be there due to altered passive eruption. Now this is a combination case where an orthodontic intervention should be taking place because of the bite correction. But she wasn't ready initially, so we did anesthetic down lengthening. I mark these, boundaries using my diode lasers. And then I did a soft tissue crown lengthening.00:25:50:19 - 00:26:19:04UnknownAnd after a week a healthy gingival epithelium was seen. And now she she has gained confidence in our practice. So she's going for an orthodontic intervention. So that's how your practice improves. And this is also done by your, surgical stent. And that's how a drastic change can be achieved esthetically post-operative care usually consist of gentle brushing and anti-microbial rinsing for two weeks.00:26:19:06 - 00:26:47:19UnknownWhether or not to place a surgical, dressing is again a clinician's decision. After two weeks of patient research, a return to conventional oral hygiene with soft brush, fossil color cleaning and flossing for inter proximal hygiene. now, this is a case which got published a few years back, and we did a cosmetic sculpture. for, for a patient, with a diode laser.00:26:48:10 - 00:27:15:18Unknownwe only, just, same way we increase the height from canine to canine in the esthetic zone, with the rule of golden proportion and with the help of a surgical stent. So that's how little, little changes, small changes can make a bigger impact on the patient. And that's how it was a change for her. So she she did not want, wanted to go under very fancy treatment.00:27:15:18 - 00:27:41:07UnknownSo botulinum toxin for gummy smiles or orthodontic intervention. But she was only concerned about her gum shop. So when such patients you can just convert them for your practice by little little enhancement and little little changes can lead to a bigger impact on the patient's mind. Coming to, a next, procedure, which you can perform with diode lasers in your practice, splenectomy.00:27:41:09 - 00:28:08:17UnknownNow, you all know freedom is in an atomic structure formed by fold of mucous membrane and connective tissue fibers that attach the lip and cheeks to the alveolar mucosa and gingiva, and the underlying periosteum, the free name, that encroaches on the margin of the gingiva, may interfere with plaque removal and tension on this free fleener may lead to open the sulcus, eventually leading to gingival recession and midland estima.00:28:08:19 - 00:28:38:05UnknownNow, when you perform connectome by diode, you should always know the attachment of the fibers and the attachment of the fibers. Accordingly, premium has been classified as follows like mucosal, gingival papillary and papillary penetrating mucosal the fibers are attached to the mucous gingival junction. The fibers are inserted within the target gingiva. It's the gingival fiber insertion the in the papillary and the papillary penetrating.00:28:38:05 - 00:29:06:02UnknownThe fibers extend into the inter dental papilla, whereas in the papilla penetrating fibers the fibers cross the alveolar process and extend up to the palatine papillon so clinically papillary and papillary present penetrating freedom are considered as pathologic and have been found to be associated with the loss of papilla, recession by steam, and plaque accumulation. In such cases, it is necessary to perform splenectomy for esthetic and functional reasons.00:29:06:04 - 00:29:33:05UnknownFor ectomy, the incision and relocation of the free nail attachment. Whereas connectome is a complete excision of the venom along with attachment to the underlying bone. Now, free ectomy procedures with laser are predictably successful as long as following steps are incorporated. Creation of a barrier onto the bare but still fenestration at the base of the front. Ectomy to prevent re attachment and removal of all impeding muscle fibers.00:29:33:05 - 00:29:49:17UnknownSomething like this which was causing recession for the patient. So we have removed all the fenestration at the base of the anatomy so that no fibers should be reattached. And that is how it is supposed to operatively.00:29:49:19 - 00:30:12:15UnknownNow look at this freedom. this has created di stigma and she's undergoing an orthodontic intervention. So before you want in our practice, just before bonding or activation of the, orthodontic wires, we do often ectomy the gingival biotite has to be determined as thick and thin. You should always check the tension on the phenom. And at least two women with neither.00:30:12:16 - 00:30:39:12UnknownDaddy never should be present. Complete removal of plenum insulation, which is fiber, fibrous and close to gingival margin, resulting in traction and retraction of the margins might take place. So these are the cases for laser anatomy where you remove. And these are all causes of midline distal. You should always rule out midline distemper before performing any esthetic procedures blindly like aligners or veneers.00:30:39:14 - 00:31:03:06UnknownJust remove the cause. A high renewal attachment is usually a cause for midline and estima. So that's how we do for the. This is the way laser tip is. You move the unidirectional with the tension achieved by pulling on the lip. One pass is enough to via the fiber attachment. You can use your diode settings from 1.5 to 2.5.00:31:03:06 - 00:31:28:03UnknownAverage power, very light depth, and working stroke like brush are given. You should not burn or char the tissue and the thermal damage should not be taking place. Diode fiber is placed parallel to the long axis of the tooth. It is always in contact mode with an initiated tip, and you should always have a high volume suction for it and the time, usually under local.00:31:28:03 - 00:31:50:07UnknownIt is done in the local anesthesia, and the downtime of the procedure usually is under five minutes. This is currently an offline ectomy case. that I do not take and and an esthetic case going on in my practice. It's she has a high frontal attachment with a big low. My midline is tumor. and a lot of bite issues.00:31:50:07 - 00:32:11:13UnknownAlso did her for anatomy a week back and after she had done that. This is a follow up yesterday. I have taken her to follow up. Now. She, is on a lie. sorry. This week was last month, and, this. We've done a print ectomy. And, this is, healing part of it. And she's wearing now she started to wear aligners.00:32:11:13 - 00:32:47:04UnknownThat is Invisalign. And this is a result currently, which we have a chip. She's in ongoing treatment. So, we are expecting her complete bite. Correction with her esthetic result. So you can see the drastic amount of change which take has taken place just because of the motivation which she came to. Our practice in which we gave her that after for anatomy and after everything, the relapse won't be taking place and the results would be having a bigger impact on her, coming to, color management.00:32:47:10 - 00:33:23:02Unknownas I already told you, we can use diodes for management of color in esthetic zone. That is both gingival and lip pigmentation management. Now, when we talk about gingival and lip pigmentation, usually melanin, pigmentation of the gingiva and lip is most commonly noticed in smokers, and in some ethnic groups. And patients under Mac medication like antimalarial antidepressants or minocycline, and some with those with hormonal disorders.00:33:23:04 - 00:33:48:21UnknownSo. So you can d pigment by your gingival a gingival by two methods, by an ablation method and by a non ablative technique, both by diamond. we are not talking here about normal tissue lasers. Ablation requires removal of tissue using photo thermal energy. Now we are using your diode in a contact mode. So it is also termed as vaporization.00:33:48:21 - 00:34:17:11UnknownThe process requires ablation of the surface gingival mucosal mucosa to the basal level, where melanocytes are located now near infrared diode and act ranging from 810 to 1 064 nanometer wavelengths are poorly absorbed in water, but they are very well absorbed in pigment, and initiator tips are used in contact mode. Now, you do not have to, move your fiber continuously into the capillary bed.00:34:17:11 - 00:34:37:20UnknownYou don't have to use it. And you keep touching your tip into the contact mode. Very, very, very long period of time. You just have to apply it so that the basal layer gets removed and followed by a new mucosal formation, so that the melanocytes where the basal layer is look, where the melanocytes are located, you oblate this of this gingiva.00:34:37:22 - 00:34:58:15UnknownWhereas the second technique which you can follow is a non ablative technique where the penetration of laser energy takes place and the coagulation takes place at the subsurface layer where your melanocytes are located, into the capillary bed, keeping the surface layer intact. And sometimes it is referred to as photo correlation. It is also known as laser peel.00:34:58:16 - 00:35:22:18UnknownYour laser energy is penetrated and transmitted deep into the capillary bed, and after a week you will see a revascularization. New mucosa screened form. Now, on the left hand side, this is a case which is done by a non ablative technique. she had scattered pigmentation on the maxillary segment, especially the anterior and the go cervical margins.00:35:22:20 - 00:35:50:12UnknownSo what we did was a noninvasive technique where the laser light was penetrated and transmitted deep into the capillary bed. After the week when she came back, we had speckled, gingival epithelium starting to heal. So she was worried that she had an inflammation. I told that is not an inflammation. It's amount of the laser beam. And you can take a red goes and just remove those and, dead gingival tissue which is overlying the capillary beds.00:35:50:14 - 00:36:16:22UnknownAnd after a week you will see a healthy gingival epithelium with the non ablative technique. Whereas on the right I have done an ablation technique with her because it was a dark pigmented gingiva. And she was a smoker. So after laser the pigmentation and the tissue in and the tip initiated tip and contact that was the surgical tip 300 microns and around 1.5 average power.00:36:16:24 - 00:36:45:03UnknownAnd after a month of healing, we we had no, pain, no swelling, no inflammation of the patient. So the fundamental interaction when we are doing a deep pigmentation procedure is a photo coagulation, which describes a laser tissue interaction with the target tissue component is well absorbed by the laser wavelength. And there is coagulation effect. When the temperature reaches 60 degree centigrade, hemoglobin is very well absorbed in and visible light in the end.00:36:45:03 - 00:37:13:04UnknownInfrared diodes. This photo coagulation and most commonly helpful in cases of varicose veins, nevus, venous leaks and hemangioma apart from your deep pigmentation cases. Now if you look at the left hand side this we this we have done both as ablative mechanisms 810 nanometer diode was used under local anesthesia. An initiative was used to apply the pigmented area in a sweeping motion.00:37:13:06 - 00:37:38:04UnknownAnd your, average power can range from 1.5 to 3. What, and total time of 15 minutes was utilized. Now, this is a female, which, I was telling you about, that smaller changes can lead to a little big impact. Long look at her teeth. you might be understanding that she. She requires an orthodontic correction, but she was more bothered about the gum.00:37:38:04 - 00:38:02:14UnknownSure. Which is doc? Darker than her skin tone. And when we had we we had a, assessment of a poor oral hygiene with bite corrections and a deep melanin pigmentation with a thick band of melanin all over her maxillary. Secondly, now, when you do a laser deep pigmentation in a sweeping motion, I use a brushing technique somewhat like this.00:38:02:14 - 00:38:27:20UnknownThis is 940 nanometers, which I'm using, and this is the way I brush and you keep brushing. You do not, lead to burning or churning a charring of the tissue. This is an ablative mechanism. And in in between, my assistants keep, doing high volume suction, and I keep rubbing with the wet coals so that the melanin overlying the, healthy gingival epithelium is completely removed.00:38:27:20 - 00:38:38:22UnknownThat's how we remove it.00:38:38:24 - 00:39:01:11UnknownSo once you remove it, it will look like something like this freshly after your SRP is done. That is scaling or root playing procedures. Normal oral hygiene procedures should be done a week prior or 3 to 4 days prior to the procedure performed, and this is immediately after the pigmentation with the dial. And this is after a week.00:39:01:13 - 00:39:31:13UnknownSo smaller changes does lead to bigger impacts. Anesthetics when you're using lasers. So she was happy. And now she's undergoing in orthodontic correction at our practice. So these, changes can also motivate the patient and help build confidence and trust in your practice so that you can convert the patients from an esthetic case to an orthodontic case. So these are smaller, smaller changes which you should keep in mind while doing your esthetic procedures with lasers.00:39:31:15 - 00:39:59:10UnknownNow lipstick lipstick pigmentation of peel is also done by a non ablative mechanism. As I already told you, the penetration or transmission of laser energy to the capillary bed take place where they're absorbed by chromo force, there is melanin and blood, and a laser peel is achieved and by revascularization of a new mucosa. Now here I use an 810 nanometer at two watt average power in a non ablative manner in a non-contact mode.00:39:59:10 - 00:40:28:20UnknownSo this is after 16 days of healing, a spot was present and she had an uneven lower lip. So she wanted to deep pigment her lips. Now this is a case report which I came across. It is not my case. they have done, 940 nanometer. lip deep pigmentation, by a diode. I am not very in favor of this technique, although I am a diode user.00:40:28:20 - 00:41:00:15UnknownSince past 2000. Since 1230, they have done at one watt average power. That is one, total energy of they have used and continuous wave, as I've mentioned. Now, this, this is, this looks unacceptable to me when I use the C of the one day post-operative crusting of the lips taking place. However, they are very, they have defended their article like anything.00:41:00:15 - 00:41:29:23UnknownAnd the second case, which they have done is 2.5W using specialized handpiece. this is A34 hundred micrometer tip for the pigmentation of lips. Now, this took a month of healing for, so if you compare non-relative and innovative mechanism, you should always go for a non ablative technique so that the patient does not get traumatized because, this, this is not what we trying to achieve.00:41:30:11 - 00:41:58:18Unknownthis is, as if it's burnt and scar. It might lead to deep scars also. And collateral thermal damage is really high in such cases in performing such techniques. So I just wanted to share this article because I came across while reading that you should not be performing such, Instead you should begin all tissue laser or you should prescribe patients a non ablative technique.00:41:58:20 - 00:42:25:00UnknownNow this is a case at my practice where there is Venus Lake and we use the 450 nanometer diode laser and a photo coagulation was done a non initiated and a non-contact mode you will take. And a 300 micrometer surgical tip would be taken. And you can just use it. Using a non-contact mode for 50 is highly absorbed in Milan and in pigments.00:42:25:04 - 00:42:50:23UnknownSo it just works like an individual laser, at a visible wavelength spectrum. And this, this, wig, the crusting start takes place, and this is after a week. Now, in esthetics, when you are managing a lot of things, you are managing the lip part. Also, as I already told you, we were dealing with gingival and lip pigmentation techniques.00:42:51:00 - 00:43:14:19UnknownHe. This is a boy where, he is 16 year old and we excise this, chromatic fibro more on the lip just because of lip biting habits. complete healing took back in 16 days and he did not come here anymore. Is a tech savvy person. So he WhatsApp me the picture after healing. So that's how an ablation zone was created.00:43:14:19 - 00:43:38:16UnknownThis is done in contact mode with the tip touching and this was a peduncle ated lesion with this talk at the base. So I've completely removed it from the stock. And this is how your healing takes place. This is a zone of coagulation which took place bottom. secondly you can also treat lesions in a non-contact mode with the 300 micrometer tip.00:43:38:16 - 00:44:09:02UnknownThat's an orange tip by an M.D. laser. And and heart lesions are a way, more easier to treat with laser larger than any other techniques. So, when I'm dealing with the, peels and the, management of coloring esthetics alone, I have two wavelengths, to we use I'm sharing with video 445 and 450 nanometers, can be used as one word continuous with an average power.00:44:09:02 - 00:44:33:01UnknownThe power density becomes 88W/cm square. And it is always kept away from the tissue in a do, from two women and and from in a defocus mode from tissue, the treatment time would be taking place as 40 to 60s. As you saw the case of nevus or Venus Lake on the lip that is were done on the same with the same parameters.00:44:33:03 - 00:45:10:06UnknownAnd because the absorption in melanin in and hemoglobin is higher than 18 nanometers, lower power density may produce less collateral damage. Whereas in when you're using an 18 nanometers, you can use up to 30 watt peak power to the whatever machines you are using. And average power can be as nine watt with pulse duration. you can also use a non ablative technique as two men from the folk two AMD the women from the tissue that is defocus more and 1697 what per centimeter square would be the power density.00:45:10:08 - 00:45:32:19UnknownAnd the treatment time might range from 40s to three minutes. You might end up doing more thermal damage if you, you you are using a higher peak power. However, if when you are pro while using and managing the and playing with the parameters, less amount of collateral damage takes place. 810 is a very versatile wavelength which we use in our practice.00:45:32:21 - 00:45:59:07UnknownAnd the second wavelength, which you can incorporate in your practices for 45 to for 50 nanometers. Also, the post-operative care when you were working in esthetic zone, especially in color management would be avoid smoking alcohol acidic and spicy food, gentle toothbrushing around the gingival margin. Warm salt water rinses is highly recommended. No analgesics should be prescribed.00:45:59:09 - 00:46:23:03UnknownCessation of any medication and smoking reduces the likelihood of relapse. The patient must be made aware of the possibilities of the relapse after the laser treatment of the pigmentation, the shade of the teeth may look a little darker as the gingiva returns to pink color, since there is less contrast between the normal and the soft tissue. So you should always inform this about the patient.00:46:23:05 - 00:46:47:08UnknownComing to the last part, when you are managing the color, I will not be leaving by, you in between by, only managing the gingival and the lips. We should always manage the teeth as we are dentist and we are more teeth centric. So laser assisted in-office whitening should be performed and can be performed with diode lasers.00:46:47:10 - 00:47:35:12UnknownSo you all know that there are extrinsic and intrinsic causes of stains ranging from, remnants of Nesmith membranes to using chlorhexidine in an undiluted former chromo genic bacteria to intrinsic stains ranging from hereditary disorders or staining may be located in enamel dentin, leading to dentin agenesis, imperfecta and amylose. Genesis imperfecta all fluorosis. So whatever, diagnosis you make and whatever case selection you make up for, doing an in-office whitening with the help of a diode laser, you should always have cheek retractors, a variety of cheek retractors with you twice isolate lip speckle mucosa and cheeks to avoid thermal damage or burns.00:47:35:14 - 00:47:59:00UnknownLong braided cotton rolls can be placed in the washed vestibule. Folded gauze may be placed to protect the folds of tissue. You can also have protective bill or isolation, and you have a gingival barrier. And so in a scalable manner, from papilla to papilla to protect the underlying gingival then raises a resin barrier. Material should be placed by five ten millimeters.00:47:59:00 - 00:48:27:24UnknownAnd it's cured using a curing light to avoid overheating. This is how your burial seal should be completely ready before you apply any bleach or any, gel prior to the, doing the procedure. 25 to 40% concentration. Hydrogen. Hydrogen peroxide gels are usually applied, and when heat is used, a temperature elevation of ten degree centigrade is reported, which doubles the speed of decomposition of hydrogen peroxide.00:48:28:01 - 00:48:52:12UnknownFor laser activated bleaching, the gel should contain a proper photocatalyst, which is an absorber that matches the spectrum of light used to accumulate accelerate the gel. We are already talking about chroma force, so there are no chroma force here and there is a proper photocatalyst. If you do not match the spectrum of wavelength which we are using as a laser, then it is very important to accelerate the gel.00:48:52:22 - 00:49:20:00Unknownotherwise the laser light would not be absorbed. So it is important to always use the appropriate bleaching gel with a particular laser wavelength in order to have high absorption of laser energy inside the gel. Now, when you, look at, when we do the traditional whitening with a plasma arc lamp light and a gel is without, selective laser application, your photochemical activators won't be activated and your laser light is not uniformly distributed.00:49:20:06 - 00:49:46:20UnknownSo you should make a match the photocatalyst with the proper absorption spectrum for the laser wavelength. So, the these are the variety of lasers, and we, we talk about, your diodes, ranging from all the wavelengths of your power which is being used, usually 40 milli. What to one what and to what the time of application per quadrant can range from five minutes to maximum of 15 minutes.00:49:46:20 - 00:50:11:19UnknownAnd you can light in up to 2 to 3 shades of tape. So, you can just motivate the patient for your whitening. Now these are in-office laser whitening procedures matching the spectrum of wavelength of teeth. So, this is aligned for 40 wavelength. And we, we have a laser white, available with it. And that's how the pre and the post results.00:50:11:19 - 00:50:37:13UnknownAnd this is how you isolate and put a gingival barrier across to avoid thermal bonds. Now what is the laser assisted bleaching protocol. You should always, obtain the patient's informed consent. You should always also be matching your shade using your shade tabs or spectrophotometer and documented with the clinical photograph isolate using cheek retractors, gingival barriers, and cotton rules and application of bleaching gel.00:50:37:13 - 00:51:15:22UnknownFollowing manufacturer's instructions in appropriate thickness. Irradiate tooth by tooth or per quadrant. Following the protocols after recommended interaction, you remove the gel and rinse it with water and right it to the teeth. Check for barriers and reapply the gel if needed. The clinicians, so, this is also a laser assisted bleaching protocol. So, I have told you all the esthetic procedures which you can perform with the help of a diode laser, and,00:51:15:24 - 00:51:39:09UnknownSo as a clinician, your first aim is, to check your. Hazel. Her patient should be able to diagnose and maintain a healthy dentition. Many patients desire a smile that fits the into their own criteria of esthetics. Of course, the interpretation of those concepts are widely based on individual's culture, philosophy, and personality. Thus, the practitioner should be aware of the techniques to fulfill the patient.00:51:39:09 - 00:52:10:00UnknownEsthetic demands and lasers should be at the forefront of the armamentarium. Now, I know, a short presentation, with the statics is that in future we are looking for more presentations, with the AMD, after an esthetic presentation and, telling you what I do it in my practice. and how do I make, small change and perform better impact on my patients?00:52:10:02 - 00:52:31:03UnknownI'm sure. Now you will also have a question that how would you like dentistry to be performed? You when you and your family with an outdated technology or the most advanced, comfortable technology that is available today, please use your technology to educate and motivate your patients. You should be a proactive leader in your field and integrate technology into your dental practice.00:52:31:05 - 00:52:55:15UnknownSuccessful service provider invest in technology and recognize the many benefits of being the first in line to embrace new ideologies. So it is high time to upgrade your practice. At least two diode lasers or soft tissue lasers. Thank you so much. Thank you so much for the presentation. And if you have any questions, I am free to answer those.00:52:55:17 - 00:53:21:08UnknownDoctor Pandy, you can, look at the Q&A. Yes, there are several questions which are listed there and go right ahead. Yes, I can. there is a question by Steven Corn. Is better an issue in the use of these procedures? Yes, of course. Scattering is an issue. whenever you are using a laser device and laser safety protocols should be followed.00:53:21:21 - 00:53:45:16Unknownall the laser safety goggles should be followed. You should have glass windows around it. the proper laser safety protocols should be followed. You. You cannot use a diode without any safety protocols. So and the second question which you is asked is bleaching. Do you find laser whitening result last longer than traditional. The whitening products. yes.00:53:45:16 - 00:54:17:19UnknownI especially in cases where the patient is does not have any habits of smoking or in India, we have more of tobacco chewing also. So if you have those procedure that might lead to post-operative sensitivity. So you should always inform the patient that you might have post-operative sensitivity if you are not, curbing your habits or if you have habits now, no, you practically speaking, when when we do, we perform laser in-office whitening procedures.00:54:18:00 - 00:54:39:16UnknownWe tell the patient, you don't have to smoke for at least 24 hours, but if it's a he or she is a change smoker, you cannot avoid that. So either you don't perform the procedure on such a patient, or you tell the, the post-operative complications they might have, like, extreme post-operative sensitivity. And yes, laser whitening results last longer than your whitening products.00:54:39:16 - 00:54:59:19UnknownYes. When I'm using them, the second, question a third the third question is from another user, what is the power level for treating cold sore. And the tip is initiated? No, the tip is not initiated. It is used in the non-contact mode. And the power can range from. Average power can be from point 5 to 2.00:54:59:21 - 00:55:24:20UnknownMaximum. can you speak about in the second question? another question is from Steve Marsh. Can you speak about numbing tissue before laser procedure? Gum contouring? Yes. Are all, procedures done under local anesthetic? Tesla, you can either use a leg, no cane. without an adrenaline or within a drilling procedure. Or you can use an article.00:55:24:21 - 00:55:58:14UnknownAlso, an article penetrates bone faster than your leg. No gain. And it's short acting. So you can use an article also for your, small gum contouring procedures. You should always numb them, especially if you are using, only a single tooth, a soft tissue crown landing procedure. Then you can apply a topical anesthesia to them. Then there is a question from Melisa Welty for the non for the non-contact, use of laser to remove pigmentation on the gingiva.00:55:58:16 - 00:56:26:00UnknownHow long do you hover of the hover on the pigmentation area? Melisa it's like non-contact to M.M. from the tissue in a defocused mode. You use it and you, you always, keep the tip to and from the tissue and, the time which you have asked is usually from two, 40s to one minute. Now, are there any more questions?00:56:26:05 - 00:57:01:12UnknownYes. Steven says thank you for the wonderful presentation. That's the last thank you. Well, thank you very much, doctor Penny, for your wonderful and informative presentation. And to who are still with us all, 131 folks, you will be receiving information and a short survey within the next two days from MD. Please give feedback about this webinar and you will be receiving information concerning receiving your continuing education credit.00:57:01:14 - 00:57:26:15UnknownThank you for attending tonight's webinar. I want to thank our sponsor, for providing this and all webinars on a compliment basis for our dental professionals. I think Doctor Pandi is our very first international, presenter. And I want to thank her very much on behalf of the entire group. And, we can we can leave it open to any other.00:57:26:15 - 00:57:46:11UnknownIf you'd like to post or, unmute your microphone. If you'd like to pose any other questions, we'd be delighted, to hold Doctor Pandy over a little bit more. Anyone else about any of the information given tonight?00:57:46:13 - 00:58:08:04UnknownIf not, we hope to see you again. We we try very hard to find, good and interesting topics for the evening. we thank you very much for your, your participation tonight. And hope to see you again on another Tuesday evening very shortly. Thank you so much. On behalf of AMD lasers. Good night. Thank most thank you.00:58:08:04 - 00:58:09:07UnknownThank you so much.