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Lasers: Opinions of a Laser "Pro" Wm. Randol Womack, DDS Editorial Director, Orthotown Magazine

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Donald J. Coluzzi, DDS, a 1970 graduate of the University of Southern California School of Dentistry, is an associate clinical professor in the Department of Preventive and Restorative Dental Sciences at the University of California San Francisco School of Dentistry. He is a charter member and past president of the Academy of Laser Dentistry, and is currently the editor-in-chief of the Journal of Laser Dentistry. He has used dental lasers since early 1991. He has Advanced Proficiency in Nd:YAG and Er:YAG wavelengths. He is the 1999 recipient of the Leon Goldman Award for Clinical Excellence and the 2006 Distinguished Service Award from the Academy, a Fellow of the American College of Dentists, and a Master of the Academy of Laser Dentistry. Dr. Coluzzi has presented about lasers worldwide, co-authored two books, and published several peer reviewed articles. Orthotown Magazine asked Dr. Coluzzi about his experiences with laser use and how it fits in orthodontics.

How did you get started using lasers?
Coluzzi: In the mid 80s I started reading about lasers use in medicine I was actually the first dentist in the U.S. to use air abrasion instead of using the dental drill to remove a carious lesion and air abrasion looked like quite a good idea. I used it for a while, but I was a little disenchanted with the mess and the dust and stuff however I thought it was pretty interesting technology. I started looking at other technologies that could be utilized other than the conventional stuff that we learned in school. An oral-surgeon friend of mine had a carbon dioxide laser. He said he was using it in the operating room to remove soft tissue, and I thought, "Oh that's interesting," and I got more involved in that. He showed me a couple of cases he was working on and we played with the laser on some ham steaks. I kept following it along and then in 1987 or 1988 I read that there was going to be a laser developed for dentistry – the pulsed Nd:YAG laser, which was finally introduced in 1990. This was something I wanted to try, so I signed up for it. It was $53,000. I got it and it really changed my career. I started using it on soft tissue and I was amazed. For perio, I could contour some gingival tissue, I could remove some gingival tissue and I learned how to do troughing around crowns and things like that. I started with this technology 18 years ago and I still think it is wonderful.

There are a lot of new laser companies, new machines and new technologies. How do you see lasers going forward in dentistry?
The latest statistic I'd heard is that 12 percent of dentists around the world are using lasers. First of all its impact is slow. If approximately 90 percent of our profession is not using them, I am not sure if it is making a great impact. Last weekend I taught some introductory courses and most of the people attending were non-laser users. They said that they were amazed at the number of soft-tissue procedures that general dentists can do. So the potential impact is significant because we have another device that we should add to our toolbox that can do something quite well. Hemostasis is wonderful, the ability to disinfect a lesion that has bacterial is significant; the fact that you can do things right away, those are significant benefits to lasers. If the profession looks at those as a positive I think they will profoundly impact dentistry and orthodontics. I am excited because the price clearly has gone down for a lot of them, which will make a difference too.

Let's talk about orthodontics. Where do you see lasers being used in the orthodontic office in the future?
The management of soft-tissue in orthodontics is significant. For soft tissue, managing the gingival tissue around a tooth that you are going to put a bracket on is a big plus. Uncovering a tooth to band, especially if there is a soft-tissue flap over the top of the tooth, is a big deal. Trying to help the patient maintain his or her hygiene, like hyperplasic tissue or some areas that are inflamed, if there is a small area that needs to be dealt with at that moment the orthodontist can do that. I really see it as an adjunctive tool for the orthodontist to help soft-tissue management. If there is an issue with getting the band positioned in the right place and there is some extra tissue, the laser can certainly be utilized there. Another significant use that I can see is the management of aphthous ulcers, areas that are inflamed maybe even due to the placement of the orthodontic bracket. So that is what can be done in any orthodontic office quite straightforwardly. I have talked to a couple orthodontists who have erbium lasers, which are the hard-tissue and soft-tissue lasers, and they have actually used the erbium laser to do some osseous surgery. In concert with the surgical aspect in orthodontics you can certainly use a laser for that.

Do you think that learning how to use a laser would be easier than learning how to place TADs?
That's a great question. The answer is yes in terms of the lasers action; it is a direct result of what you do. What you see is what you get. Using a laser, you can pretty much see your result instantly. In terms of the learning curve, how do you learn? You keep repeating the procedure until you get it right. I can imagine initial trepidation of placing your first screw into the patient after you have practiced on animal tissue or something like that. The laser is easier to use as you are removing soft-tissue – you see exactly what is going on. While the laser is a sophisticated piece of scientific equipment, the interaction between it and the tissue is pretty straightforward.

When an orthodontist buys a laser, generally the company provides some sort of orientation or training. Is this training sufficient? Is something else needed?
Some of the training out there is very inadequate. Many times sales representatives parrot back something they learned somewhere else. There's a big difference between a dentist teaching a course versus a salesperson delivering the device. Unfortunately, I've seen some of the sales representatives offering the only training that is around and that, to me, is just not good enough. The best thing for a dental laser company to do would be to offer a decent course in training with the device. There is another level of training involved that understands the basics of the laser, the tissue interaction, the basics of what the laser energy is doing to the tissue and that is more of a certification course.

Some of the companies I talked with at the recent AAO meeting said, "We have a DVD but we also have an outside independent resource doctor who provides training courses through his own company and we recommend that you take that."
Quite frankly, if I sold lasers I would try to include that. I wouldn't even give the purchaser the option. I would demand that there would be a dentist-given training course for purchase. Again the training courses are generally quite good. Most of those training courses don't necessarily include certification. The DVD is something you should look at minimally and then go get some training.

What is the major benefit of laser dentistry certification over just doing a training seminar?
The certification curriculum at the Academy of Laser Dentistry (ALD) we have developed over a good number of years is very specific in the sense of giving the student the overall fundamental of lasers and how a laser operates and which laser does what for the dentist. The curriculum of the certification course is really designed for practitioners to spend considerable time on the different basics of laser energy. Making you understand what the light energy is doing to the tissue, not just, "Push this button and put it on the tissue and keep going." The interesting thing about the certification is there are some state boards that are looking at the possibility of requiring a course based on the certification process for licensure. In fact Arizona and Louisiana have a specific recommendation that you take a pretty rigorous "hands-on" course and it is based on the ALD certification process. The major benefit of certification is you get a lot of information about the basics of your laser device and then if you are also trained on that device, in my opinion, that makes you a very safe laser-practitioner.

Would you agree that the requirements for advanced certification impacting the orthodontists seem to be either present now or at least coming in the future?
Yes, I agree. I would love to see really good training and certification included with each laser sales. That would require several things. The manufacturers would have to figure out how they are going to price that. I would like everyone to say certification is desirable because we now understand what our laser does and how it works. In the orthodontic realm, if you had a diode laser and if the tissue was chronically inflamed – more white than red – the diode would have a different approach and different interaction with the tissue. If you understood that, you would have to increase the power, maybe add some water cooling to the diode. As a result of your training/certification, you are going to have an easier time managing that soft tissue instead of just pushing buttons to see what happens. The more education you have, the better your patient care is going to be. If that is going to be a requirement because of some threat or liability, then maybe that is what we need.

How would one apply for certification with the Academy of Laser Dentistry?
The application is pretty simple; you can go to the Academy's Web site, www.laserdentistry.org and apply for that. Also there are other courses for standard certification given throughout the country. After you complete standard proficiency, which is the basic level of certification, what we then have is an advance level of certification. There is also a two to two-and-a-half year program you can apply for one year after your standard is finished. Then you take a more rigorous 175 question exam. You also do an oral exam on your laser device demonstrating its features and its safety features and then you also present five clinical cases to a board and after that you achieve advanced certification which is a very elite desired level. At that point, in my opinion, you have gained significant knowledge. I would then encourage you to start teaching about it, having advanced certification means you understand a tremendous amount about lasers and how they are used in your profession.
Orthotown Magazine
November 2025
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