LightScalpel Laser in Periodontics – The Physics Explained

Dozens of articles and studies have been published on the use of diode, Nd:YAG, and erbium lasers in scaling and root planning for the treatment of periodontitis. The JADA has published a systematic review and meta-analyses. These all note that the use of diode, Nd:YAG, and erbium lasers, have a chance of bias, the results are inconsistent, and they offer minimal to no benefit.^[1]

Case Studies and Reports Using LightScalpel and 10,600 nm CO₂ lasers in the treatment of periodontitis and periimplantitis using sulcular debridement

In the case study, “SuperPulse 10.6 µm CO₂ laser-assisted, closed flap treatment of peri-implantitis” by lead author, Eric Linden, DDS, he discusses how the LightScalpel laser works in the periodontal pocket. Dr. Linden details his clinically efficient CO₂ laser-assisted, closed flap peri-implantitis treatment protocol. Using this treatment protocol in a single session resulted in reduced pocket depths, diminished bleeding, and improved tissue health.^[2]

In another case study by lead author Dr. Linden, “Implant-safe settings for SuperPulse 10,600 nm CO₂ laser-assisted, closed flap peri-implantitis treatment“. He discusses how the LightScalpel’s 10,600 nm wavelength is uniquely safe to use around implants. The LightScalpel laser increases the implant temperature by only about one-tenth as much as a diode.^[3]

In an in vitro study by lead author Charles M. Cobb, DDS, MS, PhD, “Effectiveness of a super-pulsed CO₂ laser for removal of biofilm from three different types of implant surfaces: an in vitro study“, he specifies how biofilms can be vaporized off of implant surfaces. The LightScalpel in SuperPulse may provide a predictable method of surface decontamination in the treatment of peri-implantitis.^[4]

In the article “The Use of CO₂ Laser in the Treatment of Peri-implantitis“, lead author George Romanos, DDS, PhD, indicates that the CO₂ laser “deserves consideration as an efficacious treatment modality.”^[5]

Videos demonstrating the LightScalpel being used in periodontal treatments

This video by Ben Sutter, DDS, illustrates the technique of using the LightScalpel CO₂ laser in sulcular debridement (starts at time marker 5:12).

This video by Mike Shulman, DDS, shows before and after x-ray images for 3 successful periimplantitis treatment cases.

In another video, Dr. Shullman shares a couple of his implant cases.

Demonstrating the Physics of How LightScalpel’s Perio-Tip Works

LightScalpel has a special tip attachment designed for periodontal pocket sulcular debridement simply called the “Perio-Tip.”

Laser ablation perpendicular to soft-tissue

This first video shows the good old way of laser light directed at soft-tissue the usual way i.e. perpendicular to the tissue. The power level is set very low. There is only very superficial ablation and coagulation taking place.

Laser ablation parallel to soft-tissue

This video shows the same tip used when oriented parallel to the tissue. The same superficial ablation and coagulation take place like in the perpendicular video.

Laser ablation parallel to hard-tissue

This video uses the same laser tip, but on hard tissue. The tip is orientated so the tip is parallel to the hard-tissue and it illustrates that hard-tissue is not being impacted by the laser energy.

Laser sulcular debridement simulation

This video simulates the Perio-Tip being used in the sulcular pocket to illustrate that the hard-tissue surface is not being affected while the soft-tissue surface is being ablated and coagulated.

Laser ablation parallel to soft-tissue underwater

This video illustrates that the Perio-Tip can operate in a liquid environment (a slow air purge is maintained through the laser tip in order to keep any backstream of laser plume or liquids.

Laser coagulation of blood

This video illustrates that the LightScalpel CO₂ laser can effectively coagulate blood if needed.

References

1. Smiley CJ, Tracy SL, Abt E, Michalowicz BS, John MT, Gunsolley J, Cobb CM, Rossmann J, Harrel SK, Forrest JL, Hujoel PP, Noraian KW, Greenwell H, Frantsve-Hawley J, Estrich C, Hanson N. Systematic review and meta-analysis on the nonsurgical treatment of chronic periodontitis by means of scaling and root planing with or without adjuncts. J Am Dent Assoc. 2015 Jul;146(7):508-24.e5. doi: 10.1016/j.adaj.2015.01.028. PMID: 26113099.
2. Linden E, Vitruk P. SuperPulse 10.6 µm CO₂ laser-assisted, closed flap treatment of peri-implantitis. Implant Practice US. 2015: 8(4):30-34.
3. Linden E, Vitruk P. Implant-safe settings for SuperPulse 10,600 nm CO₂ laser-assisted, closed flap peri-implantitis treatment. Implant Practice US. 2015: 8(6):1-4.
4. Cobb C, Vitruk P. Effectiveness of a super pulsed CO₂ laser for removal of biofilm from three different types of implant surfaces: an in vitro study. Implant Practice US. 2015;8(3):20-28.
5. Romanos G, Ko HH, Froum S, Tarnow D. The use of CO(2) laser in the treatment of peri-implantitis. Photomed Laser Surg. 2009 Jun;27(3):381-6. doi: 10.1089/pho.2008.2280. PMID: 19569952.