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Erbium

Erbium a.k.a. “Hard Tissue Lasers” “All Tissue Lasers” “Er:YAG” or “2940” “Er, Cr:YSGG” or “2780” or “Waterlase”


Overview

Erbium lasers got off to a whirlwind start over a decade ago. However, this product never got past the early adaptor chasm and has lost some traction to the dental market place masses. Part of the reason was high cost, but perhaps the bigger reason was manufacturers in the early days marketed this as replacing the hand piece and being able to do cavities without anesthesia. Though many class I-V procedures could be done without anesthesia, it is very technique and setting sensitive to accomplish that task. To compound the problems, the early Er models frankly did not have the power or flexibility to do some of the procedures efficiently as advertised. This laser can do much more than cavity preps, is very gentle on tissue and bone as well. Today the Erbium family is more powerful and flexible and opens the door into even more procedures than ever before. These lasers cost anywhere from $40,000 – $100,000 depending on features, fiber quality, internal mechanism and training and support.

Pros

  • Versatility of procedures that this technology can do is vast.  Including existing procedures, but also new and improved endo, sleep and wrinkle reduction.
  • When used properly, is ultra conservative on tissue, bone and tooth structure which results in dramatically fast healing and positive patient experience.
  • Newer units offer vast flexibility in setting including customized pulse durations, cycles per second and increased power which greatly improved from their predecessors.
  • Increases the potential word of mouth marketing due to their unique dental experience.

Cons

  • Price is high
  • Very technique and settings focused.  Frankly, if you have poor training, you will think this laser does not work.  Proper training is paramount.  But the rewards are well worth it because of the vast amount of procedures that this laser can make easier and more conservative from past modalities.
  • It does not have the coagulation properties like the “sister” soft tissue only wavelengths.  Because of this I hear “Erbium’s do not work on soft tissue”.  That frankly is not true.  Actually they are quite fast and much more conservative than diodes, hover, they just do not coagulate as well, but does a fine job on tissue.
  • Large footprint
  • Negative image in the marketplace by the majority.  Too many sounds “too good to be true” or “the technology cannot live up to the hype” or “my buddy had one and it didn’t work”.  All those comments may be true BECAUSE OF previous generation features, quality issues and lack of training.  However, todays models are much more robust and training has improved dramatically.

Success Keys

  • Clinical Success is directly correlated to adequate training.  This is not a plug and play into your office with no training.  If you are going to invest in this technology, you MUST invest the time in the training to make it work as advertised.
  • You must be VERY close to the target tissue for these lasers to work.  Imagine you were righting using an old feather and ink well.  You would have to be as close to the tissue to draw the ink.  However, if you apply pressure, the fiber will cut NOT the laser energy and will cause bleeding.
  • Once you have it, use it.  Because of the larger footprint, many doctors do not move it from room to room and really never get to using it.
  • Try to use the least amount of power to attain your clinical objective. 

Target Tissue Keys

  • Water, Water, Water.  Before starting a procedure you must first think of how much water is in the target tissue; enamel, dentin, carries is easy to figure, but not all bone is the same consistency nor is soft tissue.
  • Er lasers also interact with HA, which helps it cut enamel, but the key is water.