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ezlase™ Soft-Tissue, Whitening, and Pain Therapy System May 2009
Why compromise on your soft-tissue laser?
Why Buy a Soft-Tissue Laser? ? ? Why buy a soft-tissue laser? • To make your patients even happier with minimally invasive dentistry, faster healing, less bleeding, and decreased post-op pain • To get rid of packing cord • Does not destroy healthy tissue like an electrosurge does • To provide your practice with extra sources of revenue Why buy a soft-tissue laser now? • To attract and retain patients with expanded service that differentiates your practice • Every day without a diode laser is a day of money lost • Surveys show patients expect you to have a laser
Why Buy an ezlase™ ? ? ? • Unmatched Combination of Power & Portability plus choice of traditional 810 nm and optimized, proprietary 940 nm. – Up to 7 Watts of power – Battery pack (sold separately) for optimal positioning and easy transport between operatories • Unmatched Versatility – Various tips sizes, all bendable, for different applications – Surgical procedures, whitening, and pain therapy all in one system • • • Pain Therapy & Relief The only dental laser with FDA clearance ( Healing? ) The Best In-Office Whitening Solution, in less than 20 minutes of treatment time The Comfort Patients Want – Comfort. Pulse™ feature can provide greater patient comfort – Minimal bleeding, swelling, or post-op pain – Reduced need for injections, sutures, hemostatic agents, and astringents • Added Revenue, Excellent Affordability – Less referring out – your patients want YOU to treat them – New procedures for additional practice revenue – No more packing cord • Training & Certification Included with Purchase
The Best Soft-Tissue Solution • 940 nm wavelength developed specifically for dental applications – Tissue does not have to be inflamed or vascular to cut well (compared to 810 nm) – Great hemostasis due to position on the absorption peaks of Hb and Hb. O 2 • Comfort. Pulse™ provides efficient cutting and greater patient comfort – Short, high-power cutting pulses with longer intervals are used for tissue thermal relaxation – Hundreds of pulse combinations • ez. Tips™ reduces chair time – – – Optically perfect every time Single-use, disposable tips can be changed in seconds No more stripping and cleaving of tips Diameters from 200 -400µm, lengths from 4 -14 mm Bendable for various procedures
From Good to Great Challenges of the Good Dental Practice ezlase™ Path to a Great Dental Practice Access and Field of Vision Minimally Invasive Gingival Recontouring • Better access and field of vision • Minimal/no bleeding without packing cord • Decreased post-op sensitivity Running out of Solutions to Persistent Perio Problems Minimally Invasive Periodontal Surgery • Sulcular debridement, laser curettage • Less recurrence of perio disease • Faster healing and decreased post-op pain No Good Solution for Patients with “Emergency” Sores Destruction of Lesions • Instant pain relief with faster healing • Simple, 5 -minute solution keeps emergencies from disrupting schedule • Treats aphthous ulcers and herpetic lesions These are just a few of the many new soft-tissue solutions that you will be able to provide to your patients!
Ezlase Procedures for Added Practice Revenue continued
Ezlase Procedures for Added Practice Revenue
Full-Mouth Whitening in. Less than 20 Minutes! • New Laser. White 20 gel and whitening handpiece (each sold separately) provide full-mouth whitening in less than 20 minutes of in-office treatment time 1 • Best whitening improvement compared to other solutions, in similar tests • Excellent results right away, and even more dramatic improvement after 24 hours • Desensitizer gel included to help reduce sensitivity if necessary • Only required training is for ezlase™ laser system 1 Does not include prep and post treatment preparation
How many have performed whitening with the ezlase?
Comparison of Treatment. Times Product Light Source Treatment Cycle* [none] 60 min LED 90 min NUPRO White Gold [none] 60 min Opalescence Xtra Boost [none] 60 min Sapphire Plasma Arc 40 min Zoom 2** Mercury Metal 45 min Laser. Smile Diode Laser 40 min ezlase 940 nm Diode Laser 20 min 35% H 2 O 2 Gel Brite. Smile * Source: ADA Professional Product Review, Vol. 3, Issue 2, Spring 2008 ** Used with the Zoom Advanced Power Light • ezlase™ and Laser. Smile are the only laser based whitening systems • Other systems utilize light, but they do not use a laser • No sun block, etc. to protect face and lips
Comparison of Efficacy Source of Charts: “Laser. Smile Tooth-Whitening System: A Study by Two Independent Clinical Sites” from The Journal of Cosmetic Dentistry, Volume 19, Number 2, Summer 2003 • As the above charts show, Laser. Smile provides approximately 9 shades of improvement , versus less than 8 shades of improvement from non-laser systems • Biolase expects the ezlase Whitening System will deliver even better whitening results compared to the Laser. Smile (see next slide) • Nevertheless, dentists are encouraged to discuss predictability and efficacy with the patient prior to the start of the whitening process: – Results may vary depending on type of stain, enamel thickness, tooth structure, and age – Teeth with deep, intrinsic staining in the grayer tones generally will not respond as well as yellow shaded teeth – Some teeth are a natural yellow shade because enamel transparency allows the color of dentin to be visualized
Laboratory Results on Hydroxyapatite Discs Total Gel Contact Time Laser Exposure Time Approximate Improvement in Shade* Laser. White 10 16. 5 min 3 min 9 Laser. White 20 5 min 13 Gel * Improvement in shade derived from "ΔE" measure, defined as a mathematical calculation of the "distance" between two colors on the CIE color space. • Laser. White 20 is approximately 44% more effective than Laser. White 10 • Laser. White 20 takes approximately 1/3 of the time compared to Laser. White 10 on hydroxyapatite discs [Note: Protocol recommends 9 min of gel contact time on teeth, but laser exposure time remains 1 min] • Less laser exposure time reduces heating effects • Note: Although these tests were not performed on teeth, enamel’s primary material is hydroxyapatite (~95%)
Clinical Results Typical results range from 6 to 12 shades of improvement on the Vita Shade Guide Brightness Scale BEFORE LASER WHITENING AFTER LASER WHITENING Results may vary depending on type of stain, enamel thickness, tooth structure, and age
Another reason for ezlase over all other whitening modalities?
Another reason for ezlase over all other whitening modalities?
Pola Office SEM of Take-Home Before and After 35%; je (8 x 30 sec. light + 5 min. exposure time) reference: 500 x reference: 8. 000 x treated: 500 x treated: 8. 000 x very strong chemical attack
Diode Laser + Gel SEM of Diode + Gel Before and After 1, 5 W cw; H 2 O 2 (30%); 2 x (60 sec. ; +120 s exposure time + 30 s rinsing) reference: 500 x reference: 8. 000 x treated: 500 x treated: 8. 000 x No visible damage
Exposure Time A long exposure time increases the risk of damage to the dental hard substance V. Cavalli, C. A. G. Arrais, M. Giannini & G. M. B. Ambrosano: Highconcentrated carbamide peroxide bleaching agents effects on enamel surface Journal of Oral Rehabilitation Volume 31 Issue 2 Page 155 - February 2004
Photobiomodulation/LLLT Bill Brown VP, International
Background • • LLLT (Low Level Laser Therapy) has been utilized in medical fields in Europe and Asia for more than 30 years with several thousand published clinical papers After resisting for many years, the FDA finally recognized the efficacy of LLLT in 2000 The American Society of Lasers in Medicine and Surgery established a section devoted to LLT and there are now a national ( NAALT) and a global ( WAALT) organization with a journal (Photomedicine and Laser Surgery) devoted to this important area of medicine. LLLT in dentistry has been found to accelerate wound healing and reduce pain, possibly by stimulating oxidative phosphorylation in mitochrondria and modulating inflammatory responses. By influencing the biological function of a variety of cell types, it is able to exert a range of several beneficial effects upon inflammation and healing. (Moritz-Oral Laser Applications)
Background • • • There is evidence that 940 nm light can trigger mast cell degranulation. Mast cells are distributed preferentially about the microvascular endothelium in skin, oral mucosa and dental pulp. Because mast cells play a pivotal role in controlling leukocyte traffic, modulation of mast cell functions by LLLT can be of considerable importance in the treatment of sites of inflammation in the oral cavity. For fibroblasts, increased proliferation, maturation and locomotion have been noted, as well as transformation to myofibroblasts, reduced productionof proinflammation prostaglandin E 2 and increased production of basic fibroblast growth factor. LLLT effects on macrophages include phagocytosis, secretion of fibroblast growth factors and fibrin resorption Lymphocytes become activated and proliferate more quickly. There is increased motility in epithelial cells.
Background • For endothelium, there is increased granulation tissue and relaxation of vascular smooth muscle • For neural tissue we have reduced synthesis of inflammatory mediators, and axonal growth with maturation and regeneration • The above listed effects are a function of various wavelengths, dosage and method of application among other parameters such as pulse characteristics, distance to tissue, speed of movement. • Recent LLLT clinical research in dentistry covers applications from movement of teeth to accelerate orthodontic treatment to bone regeneration
Clinical Research Examples 27 3/15/20 18
ezlase 940 nm Therapeutic Indications • FDA cleared indications • Temporary relief of minor muscle and joint pain and stiffness • Temporary relaxation of muscle • Temporary increase in local blood circulation • Applicable Dental Procedures • TMJ Arthralgia (treatment of the Joint) • Myofacial Pain related to TMJ (treatment of the muscle related to painful trigger point) • Muscle relaxation related to pain and muscle stiffness after dental procedures or in general(Trismus)
Temporo-Mandibular Joint Dysfunction Affects Many People • 10. 8 million people in the US suffer from TMD (NIH report); 90 % of this number are women • Very complex origin – it is the only joint in the body that is associated with a psychological element as a very high correlation with stress. • The condition is associated with pain in the joint that affects the mastication muscles. Pain can extend to the neck and the back.
Temporo-Mandibular Joint Dysfunction Conventional Treatments • Non surgical • • • Modified diet (soft food) Cold/Hot Packs Medication Injection with Steroid Occlusal mouth guards • Surgical • Arthrosynthesis (washing of the joint) • Arthroscopy/arthroplasy (removing adhesions within the joint) • Discetomy/enectomy (joint replacement surgery)
Temporo-Mandibular Joint Dysfunction Treatment Prices and Professional Organizations • Cost of Treatment – – Non- Surgical » Up to $600 for diagnosis » $500 -$1, 500 for occlusal mouth guard treatment » Follow-up cost ~ $150 per visit Surgical » ~ $2, 000 and more per procedure • Organizations with focus on TMJ – – – American Academy of Orofacial Pain (AAOP) ~ 300 members American Academy of Pain Management ~ 6, 000 members TMJ associations
ezlase 940 nm Surgical vs. Therapeutic Effects Surgical Therapeutic Surgical laser beam therapeutic laser beam Ø=0. 2 -0. 4 mm Laser Treatment Beam Size: 0. 13 cm 2 Laser Treatment Beam Size : 2. 8 cm 2 (x 20 larger than surgical tip)
What are the 4 Laser-Tissue Interactions?
ezlase 940 nm Surgical vs. Therapeutic Effects Surgical A concentrated beam of energy is delivered to tissue via a small diameter 200 -400 µm fiber tip, and upon contact tissue is vaporized and removed. Therapeutic A diffused beam of energy size 35 x 8 mm is delivered to the tissue site over a period of time. The level of laser energy is low enough to have a therapeutic effect without any tissue destruction.
ezlase 940 nm Surgical vs. Therapeutic Use Surgical • Concentrated laser energy is applied to an outer layer of the fiber tip (absorber coating produced after tip initiation). • The Process – Absorption. • The Effect - Immediate tissue vaporization and removal. Therapeutic • Diffused laser energy is transmitted through tissue to treat. The image is of an ezlase beam transmitted through tissue as it was captured by an Infrared camera. • The Process – Scattering ( or Diffusion) through tissue. • The Effect - Pain relief and improved functionality immediately post-treatment or over a few treatments.
ezlase 940 nm Therapeutic Mechanisms of Action • Increased micro-circulation in tissue • Photo-activation of inactive enzymes (catalysts) present in painful muscle cells Swollen Cell Normal Cell • Improved cellular functions through increase of ATP (fuel for the cell) production in cells
ezlase 940 nm TMD Clinical Protocol – Therapeutic Settings Method Contact Mode Power Setting (P) Power Density contact 2. 5 W 0. 89 W/cm 2 2 contact 4. 1 W 1. 46 W/cm 2 3 non-contact 5. 5 W 1. 96 W/cm 2 = 2. 80 cm 2 (35 1 8 mm) x min and up to 10 min • Settings vary depending on the type of skin and patient response • Start at the lowest recommended setting (power and exposure time), and increase as necessary • Therapeutic energies applied to any muscle or joint are measured in “Dose of energy” The formula to calculate the Dose is as follows: Dose [J] = P (W) x t (s)
ezlase 940 nm TMD Clinical Protocol – Treatment Schedule Example SUN MON TUES WED WEEK 1 Treatment 2 WEEK 2 Treatment 3 Treatment 4 WEEK 3 Treatment 5 THU FRI SAT
ezlase 940 nm TMD Clinical Treatment Protocol Temporalis Masseter • Treatment of Painful Trigger Points (Myofacial Pain) • Palpate masseter and temporalis to identify painful trigger points; mark each point with a small dot and the covered area. VAS Pain measurements for each point pre- and post. Treatment of the Joint (TMJ Arthralgia) • • • Treat the joint at the three locations provided in the image to the right
Proven Clinical Results!
Proven Clinical Results!
Proven Clinical Results!
Proven Clinical Results!
ezlase 940 nm Therapeutic Applications - Clinical Benefits • • • Progressive/immediate relief of pain Reduction in muscle tenderness and stiffness Improved functionality of the affected Improve quality of life Gentle to tissue in comparison to other alternatives such as steroid injections, or appliances such as mouth guards
EASY TO USE
Touchscreen Interface Very intuitive, and easy to use Current power settings Touch to increase power Touch to decrease power Touch to change pulse interval Touch to change pulse length Touch for continuous wave or pulsed mode Current pulse settings
Custom Presets 15 pre-sets available for customization by the clinician Touch to access or change a preset
ezlase™ Offers the Most Solutions & Most Portable Power ezlase (Biolase) Picasso (AMD) Styla (Zap) Odyssey Navigator (Ivoclar) SIROLaser (Sirona) Dio. Dent Micro 980 (Hoya) GENTLERay 980 Premium (Kavo) Maximum Power (W) 7 7 2 3 7 3. 5 7 CW, 12 pulsed Battery Power ü ü ü 810 980 980 ü ü ü Wavelength (nm) 940 810 Multiple Pulsed Modes ü ü Customizable Pre-Sets ü ü Whitening ü  Pain Therapy ü ü  Water Cooling of Tissue Wireless Foot Pedal ü ü ü Finger Switch ü ü Touchscreen Control ü Disposable Tips ü Bendable ü Various Diameters ü Various Lengths ü Key Strengths Most solutions; most portable power  Whitening is claimed, but not available at time of this printing  Whitening only for a single tooth at a time is available ü ü ü Price Power; Water Cooling ü ü Price Portable; Integrated System Portable Finger Switch
Summary of ezlase™ Specifications Category Maximum Power Output Wavelength Value Benefit 7 Watts, Continuous Wave • No other portable laser diode has more power 940 nm • Developed specifically for dental applications Pulse Length & Interval 50 µsec to 10 sec, for pulse repetition rate up to 10 KHz Size & Weight 3. 5”x 7. 0”x 2. 5”; 2 lbs Battery Pack (sold separately) ez. Tips™ Footswitch Provides power for a typical day of softtissue procedures, plus some whitening cases • Comfort. Pulse™ for efficient cutting and greater patient comfort • Hundreds of pulse combinations • Compact, and true portability • Eliminates power cord • Allows optimal placement when in use • Easy to transport between operatories Single-use, bendable, many sizes; can be • Reduces chair time changed in seconds • More choices for different procedures Wireless option • Eliminates cord • Allows optimal placement
Ordering Information –ezlase™ 940 nm Laser ezlase™ 940 nm Laser Biolase Part #: 7400001 Includes: • ezlase™ 940 nm Laser • Soft-tissue handpiece • 2 boxes of ez. Tips™ (30 tips per box) • 3 pairs of laser safety glasses • Footswitch • Power supply with cord • Set of peel-off clear covers for touchscreen
Ordering Information – ezlase™ Accessories ezlase™ Whitening Handpiece Biolase Part #: 7400022 Suggested US Retail Price: $1, 250 Laser. White 20 Whitening Gel Biolase Part #: 7400030 Suggested US Retail Price: $295 for a package of 5 kits Includes: whitening base gel, activator gel, liquid dam, desensitizer gel, applicator & brushed applicator tips, syringe caps, disposable clear cap for Whitening Handpiece ezlase™ Battery Pack Biolase Part #: 7400024 Suggested US Retail Price: $750 Delivers power for a typical day's worth of soft-tissue procedures plus 3 whitening procedures ezlase™ Wall Mount Biolase Part #: 7400023 Suggested US Retail Price: $295
Ordering Information – ez. Tips™ All tips sold in boxes of 30 Surgical Tips Biolase Part #: 7400018 Diameter & Length: 200µm, 4 mm Suggested US Retail Price: $250 Perio Tips Biolase Part #: 7400020 Diameter & Length: 300µm, 7 mm & 9 mm Suggested US Retail Price: $250 Biolase Part #: 7400017 Diameter & Length: 300µm, 4 mm Suggested US Retail Price: $250 Biolase Part #: 7400019 Diameter & Length: 400µm, 7 mm & 9 mm Suggested US Retail Price: $250 Biolase Part #: 7400016 Diameter & Length: 400µm, 4 mm Suggested US Retail Price: $250 Endo Tips Biolase Part #: 7400021 Diameter & Length: 200µm, 14 mm Suggested US Retail Price: $299
ezlase Solutions for the Top 7 Soft-Tissue Dental Challenges
ezlase™ Whitening Handpiece • Contoured to treat an entire quadrant of teeth at once, consistently, and comfortably • Ergonomically designed to fit comfortably in your hand • Elegant, small and extremely lightweight • Proprietary handpiece design ensures safety to you and your patient
Laser. White 20 Whitening Gel • Proprietary gel, chromophore engineered and designed to work with Biolase diode laser systems • Laser energy is absorbed by special particles in the gel to activate the H 2 O 2 (38% concentration, after mixing with activator gel), accelerating the whitening procedure • Desensitizer gel included to help reduce sensitivity if necessary • Each kit good for one full-mouth whitening case
How to Use ezlase ™ Whitening System Note: Listed here is just a quick summary. Please carefully follow the Instructions for Use included with the Laser. White 20 gel and ezlase™ Whitening Handpiece. 1. Apply liquid dam to the gingiva, and cure with a standard curing light 2. Mix the activator and base gels by connecting the two syringes together and pushing the gels back and forth 3. Apply a thin layer of the mixed gel with a brushed applicator tip to each quadrant of teeth 4. Ensure that the doctor, patient, and all persons in the room wear protective eyewear before starting the laser 5. Place a disposable clear plastic cap over the whitening handpiece, and place the handpiece in close proximity (~ 1 mm) to the first quadrant, without touching the gel 6. Deliver 200 Joules of laser energy at 7 Watts to the quadrant (~30 seconds), and then repeat for all quadrants 7. Repeat step 6 one more time 8. Allow the gel to remain on the teeth for 5 more minutes, then remove with high-speed suction, and flush with an air and water spray 9. Replace the brushed applicator tip with a new one, and repeat Steps 3 through 8 one more time 10. Remove liquid dam Mixing activator & base gels Liquid dam on gingiva Brushed applicator tip Applying gel to teeth Delivering laser energy Removing gel from teeth
Gel Application 1 Laser Cycle 1 Quadrant 1
Gel Application 1 Laser Cycle 1 Quadrant 2
Gel Application 1 Laser Cycle 1 Quadrant 3
Gel Application 1 Laser Cycle 1 Quadrant 4
Gel Application 1 Laser Cycle 2 Quadrant 1
Gel Application 1 Laser Cycle 2 Quadrant 2
Gel Application 1 Laser Cycle 2 Quadrant 3
Gel Application 1 Laser Cycle 2 Quadrant 4
Gel Application 1 Resting Time
Repeat Same Steps for Gel Application 2