Abfraction & Class V in Half the Time Without Anesthesia

I’m Nick Clausen, and after working with over 3,000 dentists and coaching lasers for 25+ years, I’ve seen exactly why Waterlase frustration happens — and more importantly, how to fix it fast.

 Why Class V’s Are Your Laser Sweet Spot

Dental Marketplace Stats:

• 60% of people avoid the dentist because they fear the drill and shots.
• Even among those who do visit, 83% experience anxiety.

If 60% of your community avoids the dentist because of the drill and the shot, what’s that costing your practice?"  
The good news?  You already have the solution sitting in your office — your Waterlase. You just need to unlock its full potential.

It goes without saying that fear makes it quite difficult to create a great patient experience.  Also, anxious patients are far less likely to accept proposed treatment and that is why enrollment is so difficult in dentistry.

If you’re not leveraging your Waterlase to eliminate this fear, you’re missing out on enhancing the patient experience, increasing new patient flow, and improving treatment acceptance.

When optimally utilized on Cavity preps, your Waterlase can be a powerful marketing advantage that sets you apart and creates an entirely different patient experience. Introducing a new technology, especially one as technique-sensitive as lasers, can feel overwhelming and I understand why many simply stop trying.  But with over 25 years of Laser Coaching, my goal is to simplify and make it easy to optimize.  Don't give up, you’re much closer to success than you think!

Today, I’ll walk you through how to confidently perform Class V preps and abfractions efficiently, comfortably, and without anesthesia.

The 4 Keys To Phase In Your Waterlase (Don’t Skip These!)

One of the biggest mistakes dentists make is starting with complex cases like Class II cavity preps.  Instead, follow this phased approach:

• Step 1: Start by numbing your patients for the first five cases while using the laser.
• Step 2: Start with doing anterior teeth and Class V’s without anesthesia after practicing my techniques on extracted teeth.
• Step 3: Once comfortable with Class V's, gradually transition move to small Class I’s & III's. 
• Step 4: Once comfortable with Class I's & III's, then gradually transition move to small Class II’s. 

This phased learning method keeps you on schedule, prevents frustration, and leads to fast, predictable results.

The Power of Pre-Framing Your Patient

Laser dentistry can be virtually pain-free, but every patient perceives sensation differently.  But you must pre-frame the experience properly before starting!

Essential Pre-Framing Points to Cover:

✔ Patient comfort is the priority
✔ Goal: No frozen face!
✔ Avoid words like “shot” and “drill”—even if you say “no shot,” the word shot alone can trigger fear.
✔ Explain they will feel "cold" and that’s normal.
✔ Let them know they are in control.  They simply need to raise their hand if they feel anything more than cold and you will make adjustments to make them comfortable.
✔ Keep it short and confident.

Example Script:

"What’s most important to me is that you have a great dental experience today. Our goal is for you NOT to have a frozen face. You may feel some cold, like ice cream, and that’s okay. But if you feel anything more than cold, simply raise your left hand, and I will make an adjustment to keep you comfortable. Will you do that for me?"

This simple confidence-building conversation reassures the patient they are in control and eliminates fear before you even start.

The Power Formula For Fast & Consistent Cutting

Mastering Waterlase technique is like juggling three balls—drop one, and everything falls apart. These three keys must work together for fast, efficient cutting:

1️) Distance to Target Tissue

• With traditional tools, you rely on feel and touch. With a laser, you rely on visual precision.
• Common mistake: Holding the laser too far away.  (I get it, you don’t want to hurt the patient)
• Solution: Keep the laser 1mm or less from the tissue.  The optimal working distance is 1mm.  If you go past this it will not cut tissue....period.

Laser Distance Optimization Pearl:

To find the optimal distance, move in slow 2mm increments like a sewing machine motion. This allows you to “chase the cut” and find the ideal working distance.

2️) Angle to Target Tissue

Laser energy must hit the tissue at a near-perpendicular angle to be effective. 

• If you’re not at 90° to the surface, the laser will reflect instead of cutting.
• Example:
• With a bur, you go straight into the occlusal groove and prep inside out.
• With a Class l's, the laser must be perpendicular to the incline of the cusp for efficient ablation.  That is why Class V's are easy, because you are naturally perpendicular to thinner enamel.
• Solution: Alway make sure your laser beam intersects the surface at 90°.

3️) Speed of Movement

• The slower you move, the faster the laser cuts.
• Most dentists naturally move too fast because they are trained to “feather” with a handpiece.
• “Feathering” or rapid strokes won’t work with a laser!

Exercise to Master Speed Control:

1. On a piece of paper, draw two small vertical lines about 3mm apart.
2. Hold a pen 1mm above the paper, perpendicular.
3. Move between the lines—it should take 2 full seconds while counting “One one-thousand… two one-thousand.”
4. Most dentists do this in ¼ second!  If it feels slow, that’s the correct speed.  Most likely, you have been moving WAY too fast.

Laser Speed Optimization Pearl:

"If the laser seems slow, SLOW DOWN before you power up!"

4) Not Aware of Pace & Timing

This isn’t about hand speed—it’s about how long you spend in one area before patients feel discomfort.

• Think about running your hand through a candle flame. You can do this a few times, but linger too long and it will burn.
• Laser cavity preps are the same—thermal energy buildup causes discomfort.
• Solution is a concept called Thermal Relaxation:
• Macro Pace: Limit total laser time to 2-3 minutes per tooth.
• Micro Pace: Move on after 3-5 seconds per 2-3mm area to avoid heat buildup.  If you stay in one spot for more than5 seconds you build up thermal energy.  This causes "Ouches"!

In summary we need to consider Thermal Relaxation on our initial setting and HOW LONG we apply Laser energy to the patient.  I do not like to spend more than 2-3 minutes total with the laser during a prep.  After that amount of time, go to your bur and finish the prep.  The laser analgesia is more than adequate to do this.   Most dentists aren’t aware of this timing factor, but it makes all the difference in patient comfort and efficiency.  I discuss this in MUCH greater detail in my workshop and it will greatly increase efficiency & effectiveness and allow you to have success on Class I, II & III which have thicker enamel (more power, more probability for heat) and more angles.

How & When to Adjust Your Laser Settings

Manufacturer presets are just a starting point. To get consistent results, you must learn how and when to tweak them.

• Tissue responds differently based on the amount of chromophore present (water & hydroxyapatite).
• More chromophore? Use lower power. Less chromophore? Increase power slightly.

Golden Rule of Laser Power:

Always use the least amount of power necessary to achieve your clinical objective.

Waterlase Starting Points for Class V & Abfractions:

Quick Tips:

• Use an MZ6 tip—a great all-purpose option.
• Easy to remember settings for Class V preps: 3-2-1
• 3W for enamel, 2W for dentin, 1W for caries (always at 15Hz).
• For Laser Analgesia, hold the laser 15-20mm away to let tooth get acclimated and  "numbs" the tooth before cutting.

Final Thoughts – You’re Closer to Success Than You Think!

Mastering Class V preps and abfractions without anesthesia is easier than you think—once you apply these principles:

• Pre-frame your patient properly
• Dial in the technique keys (Distance, Angle, Speed, Pacing)
• Use the least power necessary for efficient cutting

Once you master these, you’ll be ready for more advanced Waterlase procedures with predictability and speed!