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18 October 2018

Seven problems — one laser solution

The decisive factor for the successful implementation of the laser in your practice — openness to new ways of carrying out standard dental procedures with a laser


practicing dentist from North Vancouver (Canada)

The purchase of the new WaterLase laser is an important event for the practitioner both from a financial point of view and in terms of training. For many people process of learning a new technology can be very difficult; sometimes it is difficult to know where to start. The decisive factor for the successful implementation of the laser in your practice — readiness to learn new techniques and openness to new ways of carrying out standard dental procedures with a laser. Put handpiece MZ5 or MZ6 on tip Gold, turn on the laser in waiting mode, pour water to get everything ready to work — and start learning how to apply the laser to these seven basic procedures. Soon you will start using the laser for other operations.


As you age and the process of gum recession due to the use of drugs and the impact of other factors, root caries is becoming a common problem in middle-aged people. In most cases, it can be treated with laser ablation of soft and hard tissues, using only application anesthesia. Of course, for dentists needles and drills — a common thing, but patients are looking for an alternative.
Performing restorations in several quadrants using a WaterLase laser with less anesthesia, while removing excess (overhanging) soft tissues and caries and conducting etching enamel with only one application anesthesia, in most cases becomes a win-win option for both the patient and the dentist.


Ablation of soft tissues: handpiece MZ6: 1,5 W, 50 Hz, water 20 %, air 20 %, mode H (if the tissue is very inflamed, mode S is used).
Ablation of hard tissues: handpiece MZ5: 0,8−2,0 W, 8−15 Hz, 1,5−2,0 W, air 40−60 %, water 60−80 %, mode H.

 Before intervention

 Immediately after intervention

Five weeks after the intervention



Frenectomy procedure, which many of us studied while studying at university, was called «Z-plasty» and included Z-shaped incision to the periosteum. Then sutures were applied to close the wound. Many patients consider this procedure is complicated due to the fact that it was seen as surgical together with the fact that for healing of primary intention sutures were used.

Introduction of lasers into soft tissue surgery opens up new possibilities, as lasers have advantages over traditional methods in that they provide an accurate and clean incision, reduce bleeding, reduce the need for sutures and reduce healing time.

Reduction of postoperative discomfort and faster healing make the use of lasers especially useful in younger patients, as well as in adolescents who need correction of the frenulum simultaneously with orthodontic treatment to close central diastema.


Without the use of local anesthetics: handpiece MZ6: 1.5 W, 20 Hz, water 12 %, air 10 %, mode H.
Using local anesthetics: handpiece MZ6: 3.0 W, 40 Hz, water 5 %, air 10 %, mode H.
Hemostasis (if possible): handpiece MZ6: 0.5 W, 50 Hz, water is turned off, air 10 %, mode S.

Before intervention

 Immediately after intervention

 Five weeks after the intervention


Traumatic fibroma (from irritation) occurs most often as a result of the reaction of submucosal tissues to injury by teeth or dentures. This inflammatory hyperplasia is the most common pathological change in the oral cavity, sent for biopsy, and is detected in 1−2 % of adults. It consists of collagen types 1 and 3 and is most often located on the lips, cheek mucosa and lateral sides of the tongue.

Fibromas of the oral cavity are usually asymptomatic, consist of dense tissue and in color do not differ much from healthy tissue if they are not ulcerated due to constant injury. Complaints of patients are often associated with biting fibroma during chewing and dissatisfaction with the appearance if they are located on the lips. With the WaterLase laser, small fibromas can be removed using only application anesthetics, and larger ones — using a few drops of local anesthetic.

Advantages of using laser include reduced bleeding, no stitches, much shorter duration of intervention and very little discomfort after the intervention. Minimum penetration depth at the wavelength of erbium-chromium laser (Er,Cr:YSG) makes this an advantage for the pathologist evaluating the sample received for histological analysis, since minimal thermal artifacts occur when using the WaterLase laser for biopsy.


Without the use of local anesthetics: handpiece MZ6: 1.5 W, 20 Hz, water 12 %, air 10 %, mode H.
Using local anesthetics: handpiece MZ6: 3.0 W, 40 Hz, water 5 %, air 10 %, mode H.
Hemostasis (if possible): handpiece MZ6: 0.5 W, 50 Hz, water is turned off, air 10 %, mode S.

 Before intervention

Immediately after intervention

 Two weeks after the intervention


Gingivectomy is the most common laser procedure on soft tissues. Removal of excess fixed keratinized tissue, after which there is enough remaining tissue is necessary for many areas of dentistry. From the point of view of orthopedics, tissue can prevent the visualization of apical caries or tubercle fractures below gingival margin. From the point of view of orthodontics, the tissue can grow inter-proximal due to the closure of diastems or poor oral healthcare. From a medical point of view, some drugs (Dilantin) can cause gum hyperplasia, and when planning indirect aesthetic restorations of the anterior group of teeth, a small correction of soft tissues can make a beautiful smile stunning by improving the «pink» component of the transformed smile. WaterLase laser can be used for fast recontouring soft tissues, bleeding is insignificant; when using all ceramic dentures recontouring of soft tissues is performed on the same day, after the completion of preparation, without requiring additional time to heal. Possibility of delicate correction of soft tissues with a WaterLase laser on the same day when the preparation is completed helps to reduce the number of visits during treatment.


Without the use of local anesthetics: handpiece MZ5: 1.5 W, 20 Hz, water 20 %, air 20 %, mode H.
Using local anesthetics: handpiece MZ5: 2.1 W, 30 Hz, water 20 %, air 20 %, mode H.

Before intervention

  During intervention

Two weeks after the intervention


Soft tissue processing for indirect restorations is traditionally carried out using retraction cord to create space for the impression material and to fix the margin position in detail. While digital methods such as intraoral scanners are gaining acceptance, traditional methods are still prevalent. When using both digital and traditional methods of fixing gingival margin, it is difficult to perform manipulations with tissue and work with retraction cord when edge is hidden under the gum. Although we would love to always leave the edge above the gums or at gingival margin level, there are times when a deep edge in the inflamed tissue can be problematic.

Lasers can be used as an additional tool in edge marking and reduce or even eliminate the need for a retraction cord.

Advantages of lasers include hemostasis, less dependence on hemostatic agents and excellent healing. With WaterLase laser for all tissues, we can ablate soft tissues as well as small amounts of bone, which can be «on the way». If left intact, this bone can cause violation of the biological width, leading to painful, erythematous and ugly-looking tissue after the final prostheses are fixed. The use of the WaterLase laser helps to significantly simplify the processing of tissues for all indirect restorations, providing laboratory assessment of margin edge, regardless of what method of fixing the preparation parts is used.


Without the use of local anesthetics: handpiece MZ5: 1,5 W, 20 Hz, water 12 %, air 10 %, mode H (if the tissue is very inflamed, mode S is used).
Using local anesthetics: handpiece MZ5: 2.0 W, 50 Hz, water 5 %, air 10 %, mode H.
Ablation of hard tissues: handpiece MZ5: 4,5 W, 50 Hz, water 90 %, air 60 %, mode H.

 Перед вмешательством

 Во время вмешательства

 Через две недели после вмешательства


Today, dentists cured many patients with painful lesions of the oral cavity, which can complicate the treatment of teeth. With the help of WaterLase laser it is can to treated lesions such as recurrent aphthous ulcers, herpetic lesions or decubitalis ulcers from removable dentures. It is important that the laser can immediately significantly reduce discomfort, but, in addition, it has been proven that the lesion heals faster due to the effects of low-intensity phototherapy. Studies have shown that after healing remission period is longer and that recurrence is likely delayed or in some cases will not occur in the same area again. Patients appreciate the care in the treatment of these lesions, and some of them will understand that the laser is their preferred method of treatment, eliminating the need for topical or systemic drugs. Combination of wavelength WaterLase 2780 nm with more deeply penetrating 940 nm diode lasers, such as EPIC or iLase, can give ideal results immediately and in the first few days after treatment.


Laser for all tissues WaterLase: handpiece MZ6: 0.25−0.5 W, 50Hz, water 0 %, air 20 %, mode H.
Diode laser EPIC 10 or iLase: 0.5−0.8 W, CW (constant impulse), new handpiece, defocusing 2−3 mm.

Before intervention

  During intervention

 Immediately after intervention


Traditional treatment of pathological gingival pockets includes resection technique of partial bone removal, which leads to the fact that the teeth look like a «breakwater at low tide». The appearance of longer teeth with healthy pockets often does not satisfy patients who find it harder to brush their teeth, have to deal with increased tooth sensitivity due to exposed roots and do not like inter-proximal «black triangles».

Regenerative methods to improve the clinical level of attached gingiva do not give positive results. Many patients are absolutely amazed to reduce pockets using laser-induced bone regeneration «bottom-up» compared to treatment «top-down» by removing pseudopockets through resection of tissue. Lasers offer a minimally invasive approach without the use of flapped techniques, as well as fewer sutures and bleeding. Postoperative period is characterized by a significantly lower number of complications, and as a result, 90 % of patients often experience a 50% reduction in pockets in cases where pathological gingival pockets were single before the operation.

REPAIR Protocol can be used for single pathological gingival pockets and generalized periodontitis. It can be used as the first attempt to save implants at initial/moderate bone loss — a problem that is increasingly observed with titanium implants.



Endodontic treatment is necessary in cases where the pulp is inflamed or infected. A common feature of many of these pulp damaging factors is that microorganisms play an important role in the emergence and development of pulp and periapical diseases. Unfortunately, it is not easy to eliminate bacteria. But lasers, unlike other modern devices, have the ability to penetrate deeper into the dentin and provide a tremendous reduction in the number of bacteria without actual direct contact.

Thanks to its pulsing high peak power, WaterLase laser provides an incredible photoacoustic flow of stimuli inside root canal, which leads to the removal of bacteria, the opening of dentin tubules and the opening of lateral canals.

WaterLase laser with radial handpiece (RFT2 RFT2 and 3), specifically designed for the canals to emit 85% of laser energy laterally and not towards the tip and greatly facilitates cleaning of canals. Laser is used for 60 seconds on each canal after traditional rotary instruments, just before obturation. Microscopic examination of the canals shows incredibly clean surfaces after laser disinfection.


Laser cleaning and shaping: handpiece RFT2: 1.25 W, 50Hz, water 10%, air 34 %, mode H.
Laser disinfection: handpiece RFT2: 0.75 W, 20 Hz, water 1 %, air 10.

Introduction of the new erbium-chromium laser (Er,Cr:YSG) of the WaterLase family for all tissues is best done by starting with the dental procedures listed in this article. After mastering these common procedures, clinician will confidently use the laser for restorations, when working on soft tissues and hard tissues. In some cases, the laser will simplify the procedure, in other cases, the advantage for your practice and for the patient will be the provision of dental care, which was not previously provided at all, or it was necessary to referral for treatment to another specialist. Don't stop using the laser — it's amazing. And the principle of «learn to walk before you start running» in laser dentistry will give more chances to successfully implement WaterLase in your practice.



Stage 1: de-epithelization of external wall of the pocket.

Stage 2: gingivectomy (if necessary).

Stage 3: de-epithelization and retraction.

Step 4: removal of plaque and root planning.

Step 5: treatment of fissures/degranulation.

Step 6: decortication of bone.

Stage 7: final treatment of fissures.

Stage 8: pressing gauze bandage 2x2.




In restorative dentistry, clinicians are often faced with the need to reduce small amounts of bone tissue to solve aesthetic or biological problems. In many cases, when tubercle is fractured subcrestally, we would like to «push» the bone apically by 1−2 mm to see if we will restore the tooth, and create an edge that is above the bone. In other cases, we see an opportunity to reduce the asymmetry of soft tissues with a smile, giving the desired shape of a thin bone over the maxillary incisors. This would improve the «pink» aesthetics combined with the «white» aesthetics that our ceramic dentures would provide.

In such cases, the laser can be used in the framework of a minimally invasive approach for bone processing by intrafissural (flapless) recontouring. When performing this technique, it is necessary to increase and carefully follow the instructions, but the laser can provide much less postoperative discomfort and reduce the healing time. Laser crown extension can provide perfect healing in two to three weeks, that is, three times faster than the traditional flapped method. The procedure ends with gingivectomy, which provides correction of soft tissues, and restoration of biological width is provided by ablation of hard tissues of the subgingival bone. This procedure can be combined with small flaps at the back to establish the biological width interproximally with just one suture to close the gingival papilla. Laser iPlus, when used for bone remodeling can greatly help in improving aesthetic appearance and function


Gingivectomy: handpiece MZ6: 1.5 W, 30 Hz, water 40 %, air 20 %, mode H.
Recontouring bone: handpiece MZ6: 2.5 W, 30 Hz, water 80 %, air 75 %, mode H.
Bone grafting: handpiece MZ6: 2.5 W, 50Hz, water 80%, air 75 %, mode H.
Tissue plasty: handpiece MZ6: 1 W, 75 Hz, water 30 %, air 30 %, mode H.

Read more
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It seems that digital technologies have begun to enter the dental practice just a while ago... And today we are already completely immersed in the digital era. The 5th Anniversary International Congress of Digital Dentistry Specialists held on 3-4 November 2018 at the Korston Club Hotel Moscow showed that the “digital” is going to stay with us for a good long while.
3 October 2018
Dental Expo 2018 ― the 44th Moscow International Dental Exhibition took place from 24 to 27 September. One of the biggest key industry shows was held at Crocus Expo Exhibition Center in Moscow. We thank event promoters, partners, and guests who took time to visit our booths. See you at Dental Salon.
17 September 2018
The mysterious word ‘Jamaica’ conjures up visions of a distant tropical island of paradise with snowy beaches and impenetrable jungle. Although there are beaches and jungle the real life is far from paradise. Jamaica is a relatively poor country with less developed healthcare industry and large percentage of very poor people. There is a fairly acute problem with dentistry: just 70 dentists per 2.8 million inhabitants. Most of dentists provide paid services only, and 80% of people can hardly afford to make use of such services. Admittedly, there are state hospitals but appointments are booked for the next few years. “Do you want to have your teeth attended? We may set up your appointment for 2020”. That is why many people are deprived of timely assistance, and volunteer missions appear to be the only solution.
9 July 2018
International Dentistry Association is an association of young dentists and students is now in its sixth year. Today IDA is represented in 16 Russian cities and 3 countries (Armenia and Jordan apart from Russia). There are over 5,500 people in the association including its members, volunteers, and activists who implement various projects of the youth organization countrywide.
20 June 2018
About the 3rd International Chamber Music Festival VIVARTE organised by the U-Art: You and Art Foundation jointly with the State Tretyakov Gallery. Six chamber music concerts were held in the Vrubel Hall. Each concert programme was associated with an exhibition of one masterpiece from the vaults of Tretyakov Gallery with descriptions from the leading gallery custodians. VIVARTE festival ended with a “musical promenade”.

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