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CO2

CO2 a.k.a. “10,600” “9,300”


Overview

In the medical field, CO2 lasers are by far the most used laser. We have not had the market penetration in dentistry, that award goes to diodes. Cost may be a factor, but functionality is as well. These lasers are VERY fast (some say scary fast) and great for large incisions. Price has leveled and even come down a bit, but perhaps more importantly variable settings options increased and this allowed the machine to be more efficient and be dramatically “powered down” when desired. Too more conservative personalities, this laser can be a bit intimidating, especially if you are used to diodes because it is more of an “aim & shoot” technique (opposed to moving slow almost touching the tissue with diodes) and very fast. However, todays CO2 is a great soft tissue tool and though very fast, it is actually only a superficial ablation when used properly (like an Erbium) but with great coagulation properties. In addition, there have been recent advancements into the 9,300 wavelength with a mirrored hand piece that allows this laser to now operate on hard tissue and the early results seem quite impressive. These lasers cost anywhere from $35,000 – $100,000 depending on features, fiber quality, internal mechanism and training and support.

Pros

  • Fast yet conservative on tissue with great coagulation properties.
  • Great variety of spot size options.
  • Great for oral surgeons, experienced laser users and doctors looking to get into doing more surgeries and willing to dedicate the time to learn.
  • New advancements have opened the door to restorative and osseous procedures.
  • Newer units offer vast flexibility in setting including customized pulse durations, cycles per second and decreased power which greatly improved from their predecessors.
  • Newer units seem to have more ergonomically friend articulated arms and smaller and more flexible waveguides.
  • No disposable cost (some manufacturers may have a few disposables).
  • Protective eyewear required, but not special optics like all other lasers.

Cons

  • If not trained properly, the probability for collateral damage is greater with this laser than any other laser due to the longer focal length and power output.  Again not a plug and play tool!  However once you learn all the setting parameters, this laser is an exceptional tool.
  • Footprint is medium.  Most are ½ the size of an Erbium.
  • Cost (at least compared to Diodes, but can do much more)

Success Keys

  • Again training.  But different than the Erbium.  The key here is understanding technique matched with the proper setting and avoiding collateral damage.
  • When you learn and understand how to match the power in combination with Pulses Per Second, CW, Pulsed & Micro Pulsed with the proper techniques this laser is fast, effective, dry and conservative at the same time.

Target Tissue Keys

  • Even though peak absorption is HA, H2O is the key absorption characteristic you need to be thinking about in your target tissue.  As noted with Erbium’s, not all bone or soft tissue has the same water consistency and that must be considered when selecting your settings.