2013aldpbsfcp copy - Academy of Laser Dentistry

ald2013
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Nano-oral medicine
Therapeutic biomodulating
laser care
Lawrence Kotlow DDS
340 Fuller Road
Albany, New York
12203
Website :
Lawrence Kotlow DDS
Board Certified in the Specialty of Pediatric Dentistry
Albany, New
York USA
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Photobiomodulating laser treatment described by many
different names
LLLT
Laser
Therapy
Cold Laser
Therapy
KIDDSTEETH.COM
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Soft Laser
Therapy
Magic or
Light
Therapy
Low Level
Laser
Therapy
Photo
Therapy
Anecdotal or
Real
Scientific
Laser
Biostimulation
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Science ?
Lawrence Kotlow DDS
In the USA:
Off label use
PhotoBiomodulation effects in nature and
medicine
Vitamin
DJaundice
Psoriasis
&synthesis
vitiligo
Like
photosynthesis
Neonatal
Sun
Tanning
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No heat is generated
Low Level lasers are considered by the FDA as NSR medical device that poses
NONSIGNIFICANT RISK (NSF) to patients
No FDA -IRB (Institutional Review Board) review
is required if the off label use is used to treat patients
and is not part of a research project involving humans
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Lawrence Kotlow DDS
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a
Today open your mind and begin to
think outside the box
PBM lasers used in my office
Q1000
A resonating laser (harmonizes,
soliton
wave formation) piggy backs effects)
which
combines 8 LEDs
 red and blue light and 12 Laser Diodes cluster
470-940 nm @ 3-9 joules per cycle
Mode 1= reduces pain, reduce inflammation = use with injuries
Mode 2= relaxes nervous system ,opens glands
Mode 3 = antiviral, antibacterial, immune system stimulated
2 Stimulating Lasers:
660nm InGaAIP Diode @ 50 mw 2.2 joules/min
Class
3a; acupuncture points, cycle =3 minutes
808 nm @ 500Mw GaAIAs Diode = 18 joules/minute
Class 3b invisible infrared, bone and teeth, joints

Lawrence Kotlow DDS
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Lawrence Kotlow DDS
Photobiomodulation (LLLT) in a Pediatric Dental Practice
Indirect effect: Biostimulation
Non-Surgical: does not produce heat
Visible and non-visible wavelengths
Continuous & gated pulse
Rigid tips
Hand held units :very portable
Painless
Reduced use of drugs for pain control
1. Lasers that operate using energy densities below the
threshold where irreversible changes in cells occur.
2. *Stimulates natural biological processes preventing cells from operating in
an acidic(redox) state to an alkaline state to perform optimally.
For additional peer reviewed articles
8612009 different references in
the text book written by Jan10
Turner & Lars Hode
“Laser Therapy : Clinical
Practice and Scientific
Background (2002)
-WWW.Prima –Books.com
The red and near infrared light (600nm-1000nm) commonly used in LLLT
can be produced by laser or high intensity LEDs. The intensity of LLLT lasers
and LED's is not high like a surgical laser. There is no heating effect.
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How Does PBM work ? Very briefly
•
•
•
•
(James Carroll, visit Thorlaser.com)
Uses light energy which can be absorbed in the form of photons from
both PBM and superluminous diodes to create cellular and biologial
effects in the body.
*Jan Tuner DDS Low Level lasers in dentistry pg. 263 principles & practice of laser dentistry Convissar 2010
Lawrence Kotlow DDS
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HOW PHOTOBIOSTIMULATING LASERS
WORK
(James Carroll, visit Thorlaser.com)
Power Plant of the cell where ATP is produced
Absorbed by the Mitochondria within the cell
After a traumatic cellular injury: PBM reduces what is called “oxidative
stress” ,basicly the mitochondria in damaged tissue produce “nitric oxide” that
(competitively displaces O2 ,creates Hypoxic cells) binds to the “Cytochrome c
oxidase(COX), resulting in oxidative stress, this in turn reduces ATP production.
The LLLT (red and Near-infrared , 650-1100nm range )energy is absorbed by the
cytochrome c oxidase displacing the problematic nitric oxide thus reduces this
oxidative stress and allows for increased ATP formation. Thus quicker cell repair.
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Analgesia
oral l
LLLT creating a nerve block. Higher irradiance / energy
treatments can induce an analgesic effect by disrupting fast
axonal transport in small diameter fibres, in particular
nociceptors. This temporary (reversible) inhibition of A-delta and
C fibre transmission reduces tonic peripheral nociceptive
afferent input and facilitates reorganisation of the modulation of
synaptic connections. Repeated treatments lead to a reduction
in central sensitisation.
ana
s
a
traum
gag
Procedures completed in my office
using photobiostimulation
Reducing nausea
Controls gag reflex
Reduces the need for numbing & mandibular blocks
Improved numbing when local is used
Maintaining tooth vitality after trauma
Reduces post-traumatic swelling
Improves soft tissue healing
Treatment of herpes & herpes type lesions
TMJ discomfort
Muscle trismis : releases tight muscles
Reduction in bleeding
ri
u
j
n
i
tic
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Classification: Yuan-Source point of the Large Intestine Meridian
Command Point of the head and face
Migraine
headaches
•
•
•
4-8 Joules
Between thumb and first finger
This is the main switching point for acupuncture system
Diseases of the head and face: i.e. external pathogenic headache ,congestion, swelling and nasosinusitis,
toothache in the lower jaw, trismus , swelling of the face, facial paralysis
Lawrence Kotlow DDS
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The gagger !
660nm probe,
3-4 joules one
minute at the P.6
point reduces gag
reflex in many
patients
P6- Acupressure Point is located in adults
on the anterior surface of the forearm,
approximately three finger widths down
from the first wrist crease.(children about
two+ fingers)
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Isolite placed on
patient with
gag reflex problem.
1.# Agarwal MD et al Acupuncture and ondansetron for postoperative nausea & vomiting after laparoscopic cholecystectomy Canadian Journal of
Anesthesia June 1, 2002 49:554-560
2.# Dundee JW; Yang J Jr Prolongation of the antiemetic action of P6 acupuncture by acupressure in patients having cancer chemotherapy Soc Med
(England) June 1990, 83(6) 360-3621.#
children undergoing strabismus surgery, BR.J Anaesth 1998;81:529-32
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Chinese Name: Hegu (English translation: Joining Valley)
Location: On the dorsum of the hand, between the 1st and 2nd
metacarpal bones, in the middle of the 2nd metacarpal bone on the
radial side.
Acupunture + Photobiomodulating laser treatment
P6 (Nei guan meridian point)=reduce gag reflex
Lawrence
Kotlow DDS
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3.Schlager A. et al. Laser stimulation of the acupuncture point p6 reduces post operative vomiting
in
es
sia
Lawrence Kotlow DDS
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x
Hegu- acupunture point
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Salt NACL
refle
Clinical everyday uses
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Lawrence Kotlow DDS
lge
esion
Lawrence Kotlow DDS
Lawrence Kotlow DDS
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Creating laser initiated hard tissue analgesia
with hot lasers
★
Using hot (surgical) lasers to produce
photobiostimulating effects
30 seconds to 2
minutes
Non-contact
Non-thermal
DEFUSED
LASER
ENERGY
 A photobiostimulating effect
Reduced local anesthetic
requirements
Allows for using High Speed
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handpiece
Success rate 80-90 percent
of the patients
Lawrence Kotlow DDS
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Lawrence Kotlow DDS
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Reduction in the need for a mandibular block
Photobiomodulation (LLLT) in a Pediatric
Dental Practice
Increased uptake of anesthetic agent (can22 also be used to
get rid of numbing more quickly)
Reduction of swelling if you injure a blood vessel during
injection
Lawrence Kotlow DDS
Effective patient management
Response of one child
Lawrence Kotlow DDS
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Facial Trauma
Q1000 mode A
6/4/2012
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Dental and soft tissue trauma benefits
6/4/2012
6/6/2012
6/6/2012
660 nm laser probe for 2
minutes
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Trauma to upper
anterior teeth
1.# Erickson F; ASCD J Dent Child. 1995 july-Aug; 62(4) 256-261
Anterior tooth trauma in the primary dentition: incidence, classification, treatment methods, and sequelae: a review of the literature.
2.# Andreasen JO : Endod Dent Traum, 1998;Feb;14(1) 31-44 Sequelae of trauma to primary incisors.I.Complications in the primary dentition
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Lawrence Kotlow DDS
Lawrence Kotlow DDS
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Trauma to upper anterior teeth ,
partially extruded
660 nm laser probe
for 2 minutes
Maintain tooth vitality(660nm)
 Traumatic
injury to primary teeth
many cases normal effect of trauma causes primary
teeth to devitalize in 2-6 weeks after traumatic injury.
 Laser 1 minute (day 1 and day 3) = vitality remains
 In
3 months
1 month
Initial trauma
2/15/ 2006
5 days post trauma
5/15/ 2006
3/10/ 2006
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2 years
2 months post trauma 9 mo post trauma
1/28/2008
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Lawrence Kotlow DDS
Lawrence Kotlow DDS
2 years post
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Facial trauma
14 month old infant
11/3/10
Partial avulsion of lower central incisors and fracture of
buccal plate of bone 11/3/2010
660 nm
4 j/minute
lingual & buccal
11/3/10
11/3/10
11/3/10
After suturing
2.5 days
2.5 days
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11/3/10
11/5/10
11/24/2010
19 days
11/5/10
Lawrence Kotlow DDS
Lawrence Kotlow DDS
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6 days
6 days
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Photobiomodulation (LLLT) in a Pediatric
Dental Practice
Partial avulsion of maxillary central incisor
TMJ pain & long appointments
Tooth had 660nm laser placed for 2 minutes on partially
avulsed left central incisor. This was repeated on day 4 and day
14( 4.4j)
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Directly over TMJ area
intraorally
Week two
Lawrence Kotlow
Lawrence
Kotlow DDS
DDS
Week six
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17 months
Lawrence Kotlow DDS
Mode 1, three minutes; 660 probe intraorally 1 minute
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Laser Pulp therapy
Viral & herpes like lesions
Mode 3-one minute each cheek, intraorally 660nm
probe 30 seconds on large lesions
Parent said excellent relief that night
4 days later returned almost lesion free
1.#Watanabe f, et al Usefulness of Low-Level Laser for Control of Painful
Stomatitis in Patients with Hand-Foot-and-Mouth Disease Journal of
Clinical Laser Medicine & Surgery. Dec 2003,Vol. 21, No. 6: 363-367
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Journal of laser Dentistry 2008
Lawrence Kotlow DDS
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A
Erbium'Lasers'and'Pulp'therapy
• Kimura'Y,'Yonaga'K,'Yokoyama.'
Histopathological,changes,in,the,Dental,Pulp,
Irradiated,by,Er:YAG,Laser:,A,preliminary,Report,
on,Laser,Pulpotomy.,,J'Clinical'Laser'Med'&'Surg.'
2003,21(6)345D350'
• Henson'T.'Velez'E.'Clinical'evaluation'of'pulp'
therapy'using'a'dental'lasers'unit'(an'ongoing'
study'clinical'evaluation)'San'Antonio(TX)':Univ'
Texas'Health'Science'Center'at'San'Antonio;'
2003D2007
Using'the'Erbium:YAG'laser'
(2940'nm)'for'
Pulpotomies'on'primary'teeth
Over%nine%years%of%
successful%treatments
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Pulp Therapy using the Erbium:YAG 2940 Laser
'Erbium:YAG'Lasers
•
Vol 16 No.2 Pg 75-77
Lasers'are'an'effective'alternative'for'
treating'pulps'with'the'additional'the'
benefits'of'providing'pulp'therapy'without'
the'need'to'introduce'chemicals'into'
children’s'systems.'
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
The American Academy of Pediatric
Dentistry defines a pulpotomy as when
the coronal pulp is amputated, and the
remaining vital radicular pulp tissue
surface is treated with a medicament such
as formocreosol or ferric Sulfate or with
electrocautery to preserve the radicular
pulp’s health.

Pediatric Dentistry Reference Manual: Guideline on
Pulp Therapy for Primary and Young permanent Teeth
Vol 28, No 7 2006-2008 pg 145.


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Pulpectomy
''Elimination'of'chemicals

It'has'been'demonstrated'that'small'amounts'of'
formocreosol'may'be'absorbed'and'distributed'throughout'
the'child’s'body'within'minutes'of'its'use'at'the'pulpotomy'
site.'

Pashley'EL,'Myers'DR,'Pashley'DH,'Whitford'GM.'Systemic,Distribution,of,CC
Formocreosol,from,formocreosolCtreated,pulpotomy,sites.,,J'Dental'Res'59(3):
603D608,MArch'1980
%


Pulpectomy is defined as a root canal
procedure for pulp tissue that is irreversibly
infected or necrotic due to caries or trauma
Pediatric Dentistry Reference Manual: Guideline on Pulp
Therapy for Primary and Young permanent Teeth Vol 28,
No 7 2006-2008 pg 145.
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838
Rational'for'treating'vital'and'non>vital'
pulp'exposures
Lasers&studied&for&use&as&pulp&therapy
• Studies'using'the'Nd:'YAG'lasers'have'examined'the'potential'benefits'
• The'objective'of'either'procedure'is''to'maintain,
for'pulp'therapy'and'indicate'that'the'laser'can'be'used'without'any'
detrimental'effects.''
the,tooth,or,teeth,involved,,functionally,,and,
painlessly,,without,pathology,,,until'the'primary'
tooth'(teeth)''can'normally'be'exfoliated.'
• A'permanent'tooth,'until'the'tooth'is'adequately'
developed'for'the'root'canal'completion.'
 1.'Liu'H,'Yan'MN,'Zhao'EY,'Chen'L,'Liu'HW.'Preliminary,report,on,the,effect,of,
Nd:,YAG,laser,irradiation,on,canine,tooth,pulps,.,,Chin'J'Dent'Res.'2000Dec;3(4)'
63D5
• Nd:'YAG'lasers'appear'to'be'a'successful'alternative'to'formocreosol'in'
pulp'therapy'of'primary'teeth.
 2.'Odabas'ME,'Bodur'H,'Baris'E,'Demir'C.'Clinical,,radiological,,and,
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histopathologic,evaluation,of,ND:,YAG,laser,pulpotomy,on,human,primary,teeth.,,
J'Endo,'2007'Apri;33(4):415D21
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• Carbon'Dioxide'lasers'have'also'been'shown'to'be'effective'in'treating'
pulpal'tissue'without'creating'damage'in'the'radicular'portion'of'the'
pulp.'
Pulpotomy'
Posterior(and(anterior(
pulpotomy
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Lawrence''Kotlow''DDS'''2012
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Evaluation'of'patient'
treatments'completed'
over'a'5'year'period.'
(4000'teeth)
Posterior pulpotomy w EZ-PEDO ceramic crows
• Seeing'children'by'age'1'year'hopefully'will'prevent'
most'pulpotomies'!
• Most'primary'posterior'teeth'which'require'
pulpotomies,''on'average'occur'around'4D5'years'of'
age.
• Most'of'these'teeth'will'exfoliate'or'require'removal'
at'10D11'years'of'age'
• Keeping'a'tooth'for'5'years'would'be'an'excellent'
result'in'most'instances.
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Examples%of%successful%treatment%
Erbium:YAG(laser(pulpotomies
9/3/2004
Erbium:YAG(laser(pulpotomies
2/21/2007
6/13/2007
2y.6m''
2'y''9m
9/1/2004
7/12/2004
8/22/2006
2'yrs
3y'7'm
10/30/2002
Lawrence''Kotlow''DDS'''2012
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6/1/2006
Lawrence''Kotlow''DDS'''2012
Additional(pulp(therapy
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Pulp(Therapy
5/12/2006
3yr'5mo
1/2/2003
trauma
1/9/2003
1/9/2003
8/24/2006
6/11/2007
6/11/2007
4'yr
5'mo'
4'yr
5mo'
3'yr'5mo
6/11/2003
Lawrence''Kotlow''DDS'''2012
12/5/2007
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Lawrence''Kotlow''DDS'''2012
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Post(5(years(Pulp(therapy
Five(years(of(Pulp(Therapy
10/23/2007
9/3'/2002
5'years
''2'months
8/30/2002
10/30/2007
5'years''+
5'years
''2'months
9/3%2002
10/6/2006
8/30/2002
10/30/2007
10/23/2007
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a
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Infected(non?vital(primary(
teeth((Lares(PowerLase)
5'years'
6'months
9/30/2002
3/27/2008
5'years'
6'months
9/30/2002
Initial''lesions
2'months'post'treatment
Patient'treated'with'amoxicillin'250/5cc'for'10'days
tooth'lazed'for'approximately'30'seconds'using'Er:YAG
at''20'Hz'and''80mj'with'water.''Tooth'stable'and'asymptomatic
No'sign's'of'recurrent'infection'at'this'time.'New'bone'formation.
3/27/2008
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Lawrence''Kotlow''DDS'''2012
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Deep second or third degree burn day 3-7 using laser since day 3
Day 4/ view after
24 hrs & 2nd treatment
Day 3/ 1st treatment
Day 5/ view after 48 hrs
& 3rd treatment
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Day 6 view 72 hrs & 4th
treatment
Day 7 /view after 4th
treatment
Day10 /after 5
treatments
Q1000 Photobiostimulating Laser
Lawrence Kotlow DDS 2009
Day 13 /6 laser
Day 18 after 7 laser
treatments
treatments
Approx. 4 J /min 3 minutes
Pet after tumor removal followed by dogbite
5 weeks post
burn
1 year post
burn
3/25/2010
3/25/2010
10 months
6/4/201
11/18/2010
5/9//2010
Q1000 Photobiostimulating Laser
Approx 4 J /min 3 minutes
1.5 months
Lawrence Kotlow DDS 2009
Lawrence Kotlow DDS
Cooking-oil burn 12 2009
12/28/09
Lawrence Kotlow DDS
12/30/09
2.5
56 months
Thank you for you interest and time today
1/4/10
1/4/10
2/8/2010
q1000 mode 1 and
medx
mode a
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Lawrence Kotlow DDS 2013
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