血管瘤激光治疗
大约三年前与二位牙医和在一起,买了一台软组织激光(diode),叫做Picasso Lite Laser,~$1k,功能不多,不能做激光漂白,但是够用了,几乎与Electrosurg一样作用,但是激光好听,据说术后愈合快,不痛,病人好接受。Electrosurg机器比较重,固定放在一个治疗室,而激光机(Picasso Lite Laser)很轻,放在一个推车上,用时让助手取。由于嫌取激光机麻烦,使用率不高。厂家推荐为每个治疗室买一台激光机,使用率就会高。
Electrosurg切割快,激光慢,但是准确:取模尽管使用两根gingival retraction cords,偶尔取出第二根时,牙龈边缘还是阻挡牙龈沟,这时使用激光,伤口就非常漂亮了。
Picasso Lite Laser有三个settings(功能):1. Speed Mode (Surgery, Troughing, Frenectomies); 2. Super Pulse Comfort Mode (gingivectomies, Exposing implants/brackets/teeth); 3. Decontamination (Perio pockets, Aphthous ulcers, Pulpotomies)。具体病例 (为病人写的文章):止血,溃疡,助萌术,2。
Diode激光光线容易被血色素,黑色素吸收,所以可以用于治疗血管瘤,局部失水收缩(forced dehydration with induced photocoagulation)。三年来只见两例嘴唇血管瘤,第一位病人十几岁女孩,死活不肯做治疗。第二位五十来岁妇女,国内医学院毕业,她对激光治疗有些了解,没机会在国内治疗。洗牙时大胆提出治疗,她同意。图一,图二术前(海绵状型),图三,图四术后,使用Topical (no injection! 病人有些不舒服,但还能忍) and Speed mode,表面烤焦了,但是肿瘤似乎没消失,正在心急如火时,病人倒安慰得说可能需要两三次治疗才行,这样疤痕少,以前国内医生说的,是这样吗?
反正改不了大刀阔斧习惯,每次使用激光都觉得治疗过分了(以上病例)。In fact, less is better in laser dentistry。
晚上打电话给病人,她十分高兴,说“表面已经没有那么难看了,局部有些肿胀,但是由于我痛阈值高,所以不需要吃止痛药,我下个星期就可以去看你(本来预约二周)”,又打搅大伙了吗?
Peter: Thanks for the compliment. In fact do not throw away Parkell Electrosurg. It is faster, although it does not sound safe to patients. One of my assistants wants me to work faster. She does not like the idea of using soft tissue laser. Injection can be avoided if laser is used.
If you enter Picasso (sculpture, nice looking), diode laser in web search, you will find the manufacture. It has the strongest ad in the world. Your purchase price will be lower if you can persuade other classmates, such as Holly Lu, to buy together. Ask for discount. If you install the laser in every dental unit, you will become an expert in no time. 1k may not be correct, although it may be 3k. To me, there is no difference. The biggest difference is how often we use. I have not often used the laser for implant uncover or impression, which is pitiful.
Please wear protective goggles when laser is used, since pigment of our eyes loves laser beam. If you use microscope, you should buy flipperable protective glasses. I cannot use the goggles and my loopes at the same time. This is dilemma. If I want precision, I sacrifice my eyes potentially. If precision is not so critical, I wear goggles. Sometimes, I have to go back and forth with loopes and goggles.
Although the laser machine looks fancy, it is tall. It cannot be stored in my low shelf. Parkell Electrosurg is heavy, but skinny. It is easily stored in the shelf in my treatment room.
I will let you know 1800 # tomorrow if you want to. Good luck! Xin
Peter: The soft tissue laser is manufactured by AMD Lasers (American dental), 1866-999-2635.
Holly: Although the laser is called soft tissue, it is more often used for restoration. Some dentists hate to pack gingival retraction cords. With this laser, you do not have the hassle. After using topical Cetacaine, you trim the gingiva a little bit and take impression. I must not hit the point of yours. But AMD Lasers' slogan is Effective, Practical, and Affortable.
一次激光治疗后一个月,血管瘤几乎消失(图五,六),病人满意,她说结痂大约需要两三周脱落,她使用双氧水促使结痂脱落。她回来随访时,我们比较忙,没做进一步治疗,选择观察。
老汪:病人慢慢积累,开业已经八年,想做的病例前几年就想好,例如三年前买激光时,就知道它可以治疗血管瘤,三年中只遇见两例,第一例不肯做治疗,第二例是医生,回国内探亲没有机会做治疗,当她到我诊所洗牙时,被我说服了,少收钱,其实我从来没做过。这种激光在美国最便宜,三千美元,软组织激光,叫diode,我忘记是什么,您如果自己查不到,让我知道。这激光在牙科主要用途是取模前做少量牙龈切除,而不要使用gingival retraction cord。对不起,许多牙科东西,在美国重新学起,懒得去了解中文名字。谢谢让我知道您的治疗方法。不多写了,以后再聊。Xin
没有搞清楚,你的激光到底是什么,看你的文字,你用的激光,是不是我们国内称为高频电刀,你的治疗激光头接触式的还是非接触式的,你的机器是不是有一个双向的选择器,拨向一侧是烧灼,拨向另一侧是电切。看你的介绍。应该是高频电刀,不是激光。我特别喜欢新东西。你介绍的机器,我希望搞搞明白 。美国领导世界,在各个领域都是这样。diode我查了。发光二极管。汪贻静
汪医生:谢谢对激光兴趣,激光学问可能对我来说太深奥,我只会使用,知道最基本原理。Diode激光头大概是点试,需要接触,没有方向性,其实我把它当作高频电刀使用,老美叫做electrosurg,但是两者有区别,激光慢,估计组织创伤小,好像好控制,我还在摸索之中。如果我对病人说我们将使用高频电刀,他们一定吓得屁滚尿流。
真正要了解激光,只好破费,花两三千美元买一台,使用后再读些文献。如果与同学(例如老田)和买,价格就会便宜多了,三年前我们就是那样做的。厂家情况在网站解释,不好意思有的部分用英文写,如果有疑问,再联系吧。www.xinweidds.com,Professionals, Classmate,在口外专栏下,找激光血管瘤治疗。
一年半后,病人回诊所洗牙,血管瘤复发(图七),颜色比以前浅(图一,二),她要求再次治疗(图八)。
Does hemangioma have a high frequency of recurrent rate? When you perform the laser treatment, how do you determine the depth that you think is enough to remove the whole tumor? Holly Lu Tuesday, December 16, 2014 12:27 AM
I did not give local anesthetic except topical. When the patient felt a little discomfort, I stopped "burning". This type of treatment is purely trial and error. The patient is grateful with previous treatment. I do not mind doing several times until the tumor is gone. It does not take too much time. The machine is not expensive. I am afraid that laser treatment collapses venous cavitation superficially. We did not charge much for laser as long as she and her family return for prophy and scaling & root planing. In the last two years, this soft tissue laser has been a little more frequently used in gingivectomy around implants following using a liquid topical (Cetacaine). We treat chronic diseases (perio and carie) every day. Do we wish that the diseases do not recur? I do not have time to check literature about the recurrence of the hemangioma. Thanks for the interest.
Xin Wei, DDS, PhD, MS 1st edition 05/10/2013, last revision 12/16/2014