Comparing Diode, Erbium, and CO₂ Soft-Tissue Dental Lasers

Overview of Dental Diode, Erbium, and Carbon Dioxide Lasers in Soft-Tissue Dental Surgery

The ADA Compares Erbium and CO₂ Lasers For Use in Soft Tissue Dentistry

According to American Dental Association (ADA) Guide on Dental Lasers, “for erbium laser wavelengths, optical absorption and coagulation depths are significantly smaller than gingival blood vessel diameters. Coagulation takes place on a relatively small spatial scale and in general – based on these particular factors – does not prevent bleeding from the blood vessels severed during tissue ablation.” Furthermore, “the optical absorption and coagulation depths for the CO₂ laser wavelengths are effective within the diameters of surface gingival blood vessels. Coagulation extends just deep enough into a severed blood vessel to stop the bleeding.” Examples of Erbium laser wavelengths include Waterlase by Biolase at 2,780 nm and LightWalker by Fotona at 2,940 nm. Examples of CO₂ laser wavelengths include LightScalpel at 10,600 nm and Solea by Convergent Dental at 9,300 nm.

Dental Diode Lasers (Hot-Tip Devices)

Near-infrared dental diode lasers circa 800-1,000 nm do not cut using a laser beam (except for in very darkly pigmented tissue). Instead, the diode laser beam heats the charred end of a fiberoptic glass tip to 500-900° Celsius. The hot glowing glass tip, then, conducts heat to the target tissue. It is an excellent coagulator, but inefficient at cutting.

“… The diode laser is basically a slow large electrosurgery …” – Gordon Christensen, DDS.

Unlike carbon dioxide and erbium lasers, dental diodes are contact thermomechanical cutting devices. Their coagulation depth depends on the degree of the diode’s glass tip charring and can range from sub-millimeter (heat propagation-driven coagulation for significantly charred tips) to multi-millimeter (photothermal radiant coagulation for poorly charred tips).

Erbium Dental Lasers

Erbium laser wavelengths circa 3,000 nm are highly energy-efficient and spatially accurate for photothermal ablation; their photothermal coagulation depths are significantly shorter than gingival blood vessel diameters. This makes erbium lasers great at cutting soft-tissue but poor at coagulating.

Carbon Dioxide (CO₂) Dental Lasers

The key to the success of soft tissue CO₂ lasers and their advantages over other dental laser wavelengths is their ability to accurately cut and efficiently coagulate the soft tissue at the same time.

CO₂ laser wavelengths circa 10,000 nm are extremely effective and spatially accurate photothermal ablation tools with exemplary coagulation ability as a result of a close match between their photothermal coagulation depths and the diameters of oral soft-tissue blood capillaries. In nonablative applications, coagulation depth can be increased for long pulses with extended heat propagation-driven coagulation depth in excess of the photothermal coagulation depth.

There are different delivery systems for CO₂ lasers: flexible fiber (LightScalpel’s proprietary system) and articulated arm (jointed metal tubes). See our infographic comparing CO₂ dental lasers side-by-side.

Other Considerations When Choosing a Dental Laser

Dental Laser Cost of Ownership

Try our dental laser ROI calculator, where you can set the laser cost per month, as well as the number of procedures you may do per month. The calculator will then returns your monthly ROI.

Cost of Disposable Tips for Dental Diodes

The initial cost of a diode laser system is fairly inexpensive, however most all diode lasers require single-use disposable tips. The average cost of a single diode laser tip is around $6. This added expense can really add up over time and cost thousands of dollars per year. LightScalpel CO₂ lasers offer tipless autoclavable handpieces.

Learn more about Dental Laser-Tissue Interaction at the American Laser Study Club

The American Laser Study Club (ALSC), offers several laser dentistry continuing education courses across the United States. The ALSC’s curriculum overcomes the known limitations of many laser dentistry courses and includes the detailed physics of soft tissue ablation and coagulation with laser and hot tip (non-laser) devices. See the ALSC’s upcoming laser dentistry courses.

Dental Laser-Tissue Interaction

In this short video review, Peter Vitruk, PhD, founder of LightScalpel and the ALSC, presents laser-tissue interaction as it applies to dental laser surgery in vascular tissue. Dr. Vitruk discusses different dental laser wavelengths’ strengths and weaknesses in soft-tissue laser surgery.

Comparing the LightScalpel CO₂ Laser to Dental Diodes

The LightScalpel is the finest instrument I have used for performing tongue and lip-tie surgeries as well as many other procedures. I use it at least four times a day. Before, we were using a diode laser and it doesn’t even compare. Before, a frenectomy would take around a minute or more. Now with the LightScalpel, it’s about 20 seconds. The moms report less pain for their babies (they eat better and are less fussy)…

Richard Baxter, DMD, MS, DABPD
Pelham, AL

CO₂ is the gold standard for laser technology, for soft tissue procedures… [diodes] are inefficient compared to the speed of CO₂… CO₂ simply cuts and ablates tissue much faster.

Alan Winner, DDS
New York, NY

Watch LightScalpel CO₂ Laser Surgeries

3 Second Tongue-Tie Release by Richard Baxter, DMD

Modified Minimal Crown Lengthening Procedure by Richard Winter, DDS

LightScalpel CO2 Laser Uses in Dentistry by Mike Shulman, DDS

Want to learn more about diode lasers and how work? Check out this article:

Hemostasis and Coagulation with Ablative Soft-Tissue Dental Lasers and Hot-Tip Devices

By Peter Vitruk, PhD, MInstP, CPhys; and Robert Levine, DDS

This article compares and contrasts the differences in hemostasis and coagulation of erbium, carbon dioxide, and diode (hot-tip) dental lasers.

Read Full Article

Further Reading

• Soft-Tissue Cutting with Hot Glass Tip Diodes – americanlaserstudyclub.org – Robert Levine, DDS; Gordon Christensen, DDS; Martin Kaplan, DMD; Richard Winter, DDS; Peter Vitruk, PhD; Robert Strauss, DDS, MD.
• Superpulse 10,600 nm CO₂ Laser Revision of Lingual Frenum Previously Released with a Diode Hot Glass Tip by Karen Wuertz, DDS; and Peter Vitruk, PhD
• Upgraded from a diode to LightScalpel by Richard Baxter, DMD
• Switching from diode to LightScalpel laser frenectomy by Molly Gunsaulis, DDS
• Laser Tissue Interaction by Peter Vitruk, PhD
• Top Ten Myths About CO₂ Dental and Surgical Lasers Used For Frenectomies by Cara Riek, DNP, RN