The soft tissue diode laser is one of the most commonly used systems in modern day dental practices for most soft tissue surgical procedures.
The applications range from laser bacterial reduction, low level laser therapy, frenectomy, gingivecomy among others.
The detailed mechanism of diode laser working is beyond the scope of this write up, however, in a nutshell, it shall not be wrong to say that the initiated tip of the laser optical fibre is ultimately responsible for tissue interaction. This makes the working end an important aspect for clinical success of laser applications.
One of the most common questions among clinicians who use lasers is which tip to choose from.
Many manufacturers have many different tip sizes available for the user to choose.
200 micron, 300 microns, 400 microns , 600 microns among other various sizes are available by various manufacturers.
The three key factors which define a tip are
- the diameter of the working tip
- protective sheath and
- the working length of the tip.
Two major types of fibres available are
- Strippable fibre bundle
- Disposable fibre tips.
Most commonly reported clinical error while using laser is NOT stripping the outer protective sheath of the fibre. Before every use, the clinician must ensure the fibre has been stripped and cut efficiently and ensure is ready to use. Nowadays many manufacturers are packaging ready to use, safe and sterile, disposable tips which minimises clinical chair side time and increases efficiency.
For all dental applications 400 micron diameter fibres are most commonly used by clinicians.
Although there are many studies and articles available to assist the clinician select the right operating tip, the most important factor is the end user comfort.
The key point is the huge energy difference between tips.
- The actual cutting energy is J/cm2 (Squared)
- 1 W 400 micron =1 divided by .16 (.4x.4)= 6.25J/cm2
- 1W 300 micron= 1 divided by .09 (.3x.3) = 11.1J/cm2 -1.78 times more energy than 400 micron tip
- 1W 200 micron= 1 divided by .04 (.2x.2) = 215J/cm2 4 times as much as a 400 micron tip
Talking about the length of the fibre, many manufacturers recommend many different lengths, 5mm and 10mm being the most common ones.
One key aspect to be considered while selecting the tip is that with a smaller diameter tip and a longer length, the chances of breakage during the surgical procedure are higher, which leads to foreign body lodging into the tissue, resulting in further complications.
Most experienced clinicians recommend 400 microns and 5 mm tip, however it is the clinical judgement and experience of the clinician which the final decision is making factor.
To conclude, it would be ideal to state that One must be very aware of tip size and know if they use presets exactly what tip size the presets are for.