Fast, Bloodless, and Predictable Waterlase Surgeries Every Time.  Presets Won’t Get You There...

But These Simple Adjustments Will!

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 Your Presets Aren’t Enough

If you’ve ever fired up your Waterlase for a frenum release, fibroma removal, or soft tissue contouring, and it worked perfectly one day and struggled the next, you’re not crazy.

It’s not the laser—it’s the approach.

Presets are only suggested starting points — they were never meant to cover the unique tissue differences, patient sensitivities, or your specific technique. That’s why you can’t rely on them alone.

The good news? With just a few simple tweaks, you can make every Waterlase surgery faster, cleaner, and more predictable — and I’m going to show you exactly how.

🔷 Watch The Video First, Then Use This Guide

Before diving into these details below,  STOP now & watch my 5-minute video first!   I will walk through:

✅ How pulse duration affects cutting vs. cauterizing
✅ What to listen for — that "pop" sound means something!
✅ How tip size, power, and speed work together
✅ Real-time adjustments so you can see the laser respond

This guide will reinforce and expand on what you see so you have a permanent reference whenever you need it.

🔷 The 4 Golden Rules for Waterlase Surgical Success

If you only take away one section from this guide, make it this. These four rules will give you more predictable, comfortable, and bloodless surgeries immediately:

Rule	What It Means
Use the Least Power Needed	Start low, increase only if absolutely necessary.  Less Power = Less Thermal Nucrosis, Better Healing & Patient Experience
Apply Tension	Apply tension if possibel so you know EXACTLY where to apply & focus the Laser energy.
Slow Hands Win	Slow hand movements = faster, cleaner cuts (counterintuitive but critical)
Slow Before Power	If cutting slows, slow your hand first — only increase power (Watts)  after technique adjustments

 

🔷 Anesthesia Guide — Don’t Overdo It

Most Waterlase soft tissue cases need far less anesthesia than you think, and rarely a block.  Based on how deep you need to go, here’s general guidelines ONCE you get proficient with your technique:

Tissue Depth	Power Range	Anesthesia
Less than 1mm	1W or Less	None needed
1-2mm	1.0-2.0W	Compound topical
More than 2mm	2.5W+	1/8 to 1/4 carpule

💡 Nick's Pearl: Many dentists over-numb because they assume laser = pain.   The Laser does not equal pain, heat equals pain.  The right distance, speed, and power means you can do most fibromas & frenums with just topical.

🔷 Picking the Right Tip — It Matters More Than You Think

Your tip choice directly controls how your laser interacts with the tissue.  Your initial training called this "Power Density".  You can’t use a "one-tip-fits-all" approach and expect consistent results.

Tip	Best Use
MC3	Wide, shallow cuts. Great for fibrotic tissue and better bleeding control
MZ6	Everyday workhorse for most soft tissue surgeries.  "Middle -of-the-Road" Tip
Conical (size 4 or smaller)	Precise, thin cuts—great for detail work, but higher risk of bleeding if power isn’t lowered

💡 Nick's Pearl: Dentists who struggle with bleeding almost always use too much power with too small a tip. Drop the Watts if you’re using a tiny tip.

 

🔷 Distance Control — Get Close or Pay the Price

Most dentists hold their laser WAY too far away, especially at the start.   It feels "safer" to do this.  The reality?  You’re just heating tissue without cutting, which creates pain and poor healing.

✅ Optimal distance: 0.5-1mm.  Only OnSoft Tissue & @ 1 Watt and below, softly touch the fibrotic band until release. 
✅ Get to this distance immediately — no easing in!  Why? The water spray and laser energy meet at this point. Any further and you’re not cutting and just applying heat or increasing thermal nucrosis.

 

🔷 Slow Hands, Fast Results — Hand Speed Matters

You’ve spent decades mastering your bur stroke — quick, feathering, fast.   Forget all that.  With lasers, slower is faster.

✅ The slower you move, the faster you cut.
✅ Fast Hand Speed = slow cutting, inconsistent ablation, and more thermal damage.

Try This Speed Exercise
Draw two lines 3mm apart. Move a pen between them in 2 full seconds, counting “one-one-thousand, two-one-thousand.”
Feels painfully slow? Perfect. That’s the hand speed I am talking about.

💡 Nick's Pearl: If the laser seems slow, your hand is moving too fast 99% of the time.

 

🔷 Pulse Duration & Mode — S vs H: What’s the Difference?

Waterlase gives you two pulse duration options, and you need to know when to use each:

Mode	Pulse Duration	Best Use
S Mode	700 microseconds	Vascular tissue, better hemostasis
H Mode	60 microseconds	Fibrotic tissue, faster cutting

💡 Nick’s Pearl:

• S Mode = slower, smoother, more bleeding control.
• H Mode = faster, cleaner, but less hemostasis.
• Mix & match based on tissue type. 

 

🔷 Practice Like a Pro — Weekend Homework

Before you touch a patient, practice with an apple using these settings to get familiar with the outcome.  Make a 1/2 inch line for each setting below

Watts	PPS	Mode	Notes
1	20	H	Observe cut speed, sound, cleanliness
1	30	H	Compare - what’s faster? Cleaner?
1	40	H	Feel the “pop” - this is short pulse power
1	50	H	Compare - higher PPS, less aggressive
1	75	H	See the smoother cut from higher PPS

• Repeat Above at 2 Watts
• Repeat Above at 3 Watts

Note: Most clinicians do not like to go under 20 PPS doing Soft Tissue, because the tissue cut gets "chunky" and leaves tissue tags. The lower PPS is for Hard Tissue Applications.

Now change the Mode to S & repeat ALL the above exerciser over those different parameters.

Things to pay attention to during this S Mode exercise:

• Notice no popping sound. That is because of the very long pulse duration and lower peak power per pulse is almost flowing energy continuously opposed to the H micro-pulsed mode.
• You will notice you cannot select High PPS in this mode. The Pulse durations are so long, the laser can only emit a small amount of PPS.
• You may also notice charring on the periphery of the ablation cut. This is the result of more thermal that would cauterize tissue...however, this extra energy is why it coagulates better.

Once you found your favorite setting, try the same cut exercise with chisel and conical (4 or smaller tip). Notice how they cut differently and strategically think how you could apply. For example, if you have a post ortho patient with real think and bulbous tissue on the upper arch, the chisel at higher powers and PPS would expedite festooning all that tissue.  If you used the smallest tip, this procedure would take forever! This is how you need to think going into all your surgical cases.

 

🔷 Fibromas & Frenums — Step-by-Step Technique

These procedures are where tension, tip selection, and slow movements make or break the case.

1️⃣ Apply constant tension with Addison Tissue Forceps.
2️⃣ Focus the laser on the tightest band — not the whole frenum at once.
3️⃣ Hold the laser steady, almost stopping and touching the fibotic band until it releases — don’t sweep side to side!  Just go to the next band poking out after the 1st band releases.
4️⃣ Release one band at a time. Don’t rush.
5️⃣ Always cut at 90 degrees to the tissue.

💡 Nick’s Pearl: If you feel like you’re strumming a guitar string, you’re side-loading the tip. If You Feel This, Stop Emmediately.  Remember, the laser end ciust NOT side cuts.  Focus back on the band and the distal end of the Laser tip.

 

🔷 Create A Cheat Sheet of Your Own!  But Remember,View Them As Starting Point Settings

These are just an example, fine-tune as you find settings in situations you like.

Procedure	PPS	Watts	Mode	Tip
Fibrotic Tissue	30-40	3-4	H	MC3
Vascular Tissue	40	2-3	S	MC3
Thick Gingivectomy	30-40	3.5	H	MZ6
Thin Gingivectomy	50-75	1	S	MZ6
Post-Ortho Contouring	50-75	4-6	H	MC3

 

🔷 Final Takeaways — Nick’s Top 5

✅ Presets get you started — not across the finish line.
✅ Slow = fast with Waterlase.
✅ Tension GUIDES WHERE to cut.
✅ If cutting slows, adjust your Technique 1st (Slow, Distance & Angle), then Watts.

✅ After 3-5 Seconds, If your Waterlase is not "working Like You Want", You’re 1 adjustment away from having it workEXACTLY how you want it to!

💥 Ready to Master This Faster?  Join my 2-Hour Waterlase Surgery Workshop in the link below