ezlase™ soft-tissue, whitening, and pain therapy system may 2009

ezlase™ Soft-Tissue, Whitening, and Pain Therapy SystemMay 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

– ComfortPulse™ 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

SOFT-TISSUE PROCEDURES

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 HbO2

• ComfortPulse™ 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

• ezTips™ 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

WHITENING

Full-Mouth Whitening in Less than 20 Minutes!

• New LaserWhite20 gel and whitening handpiece (each sold separately) provide full-mouth whitening in less than 20 minutes of in-office treatment time1

• 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 TreatmentTimes

Product Light Source Treatment Cycle*

35% H2O2 Gel [none] 60 min

BriteSmile LED 90 min

NUPRO White Gold [none] 60 min

Opalescence Xtra Boost [none] 60 min

Sapphire Plasma Arc 40 min

Zoom2** Mercury Metal 45 min

LaserSmile Diode Laser 40 min

ezlase 940 nm Diode Laser 20 min* Source: ADA Professional Product Review, Vol. 3, Issue 2, Spring 2008

** Used with the Zoom Advanced Power Light

• ezlase™ and LaserSmile 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

• As the above charts show, LaserSmile 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 LaserSmile (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

Source of Charts: “LaserSmile Tooth-Whitening System: A Study by Two Independent Clinical Sites” from The Journal of Cosmetic Dentistry, Volume 19, Number 2, Summer 2003

Laboratory Results on Hydroxyapatite Discs

GelTotal Gel

Contact TimeLaser Exposure

TimeApproximate Improvement in

Shade*

LaserWhite10 16.5 min 3 min 9

LaserWhite20 5 min 1 min 13

* Improvement in shade derived from "ΔE" measure, defined as a mathematical calculation of the "distance" between two colors on the CIE color space.

• LaserWhite20 is approximately 44% more effective than LaserWhite10• LaserWhite20 takes approximately 1/3 of the time compared to LaserWhite10 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

Results may vary depending on type of stain,enamel thickness, tooth structure, and age

BEFORE LASER WHITENING AFTER LASER WHITENING

Another reason for ezlase over all other whitening modalities?

35%; je (8 x 30 sec. light + 5 min. exposure time)

reference: 500x reference: 8.000x

treated: 500x treated: 8.000x

very strong chemical attack

Pola OfficeSEM of Take-Home Before and After

No visible damage

1,5W cw; H2O2 (30%); 2x (60 sec.; +120s exposure time + 30s rinsing)

Diode Laser + Gel

treated: 500x treated: 8.000x

reference: 500x reference: 8.000x

SEM of Diode + Gel Before and After

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: High-concentrated carbamide peroxide bleaching agents effects on enamel surface Journal of Oral Rehabilitation

Volume 31 Issue 2 Page 155 - February 2004

PAIN THERAPY

Photobiomodulation/LLLT

Bill BrownVP, 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 pro-inflammation prostaglandin E2 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

04/19/23

27

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

Ø=0.2-0.4 mm

Laser Treatment Beam Size : 2.8 cm2

(x20 larger than surgical tip)

Laser Treatment Beam Size: 0.13 cm2

Surgical Therapeutic

Surgical laser beam

therapeutic laser beam

What are the 4 Laser-Tissue Interactions?

ezlase 940 nm

Surgical vs. Therapeutic Effects

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.

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.

Surgical Therapeutic

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

Normal Cell• Improved cellular functions through

increase of ATP (fuel for the cell) production in cells

Swollen Cell

ezlase 940 nm

TMD Clinical Protocol – Therapeutic Settings

Method Contact Mode Power Setting (P) Power Density

1 contact 2.5 W 0.89 W/cm2

2 contact 4.1 W 1.46 W/cm2

3 non-contact 5.5 W 1.96 W/cm2

• Laser Coverage Area = 2.80 cm2 (35 x 8 mm)• Exposure Time (t) = 1 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)

Treatment 1 Treatment 2

MON TUES WED THU FRI SATSUN

WEEK 1

WEEK 2

WEEK 3

ezlase 940 nm

TMD Clinical Protocol – Treatment Schedule Example

Treatment 3 Treatment 4

Treatment 5

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!

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

Current power settings

Touch to increase power

Touch to decrease power

Very intuitive, and easy to use

Current pulse settings

Touch to change pulse length

Touch to change pulse interval

Touch for continuous wave or pulsed mode

Custom Presets

Touch to access or change a pre-set

15 pre-sets available for customization by the clinician

COMPARISONS

ezlase™ Offers the Most Solutions & Most Portable Powerezlase

(Biolase)Picasso(AMD)

Styla(Zap)

Odyssey Navigator(Ivoclar)

SIROLaser(Sirona)

DioDent Micro 980

(Hoya)

GENTLERay 980 Premium

(Kavo)

Maximum Power (W) 7 7 2 3 7 3.5 7 CW, 12 pulsed

Battery Power

Wavelength (nm) 940 810 810 810 980 980 980

Multiple Pulsed Modes

Customizable Pulsed Modes

Customizable Pre-Sets

Whitening [1] [2]

Pain Therapy

Water Cooling of Tissue

Wireless Foot Pedal

Finger Switch

Touchscreen Control

Disposable Tips

Bendable

Various Diameters

Various Lengths

Key Strengths Most solutions; most portable power Price Portable; Integrated

System Portable Finger Switch Price Power; Water Cooling

[1] Whitening is claimed, but not available at time of this printing[2] Whitening only for a single tooth at a time is available

Summary of ezlase™ Specifications

Category Value Benefit

Maximum Power Output 7 Watts, Continuous Wave • No other portable laser diode has more power

Wavelength 940 nm • Developed specifically for dental applications

Pulse Length & Interval

50 µsec to 10 sec, for pulse repetition rate up to 10 KHz

• ComfortPulse™ for efficient cutting and greater patient comfort

• Hundreds of pulse combinations

Size & Weight 3.5”x7.0”x2.5”; 2 lbs • Compact, and true portability

Battery Pack(sold separately)

Provides power for a typical day of soft-tissue procedures, plus some whitening

cases

• Eliminates power cord• Allows optimal placement when in use• Easy to transport between operatories

ezTips™ Single-use, bendable, many sizes; can be changed in seconds

• Reduces chair time• More choices for different procedures

Footswitch Wireless option• Eliminates cord• Allows optimal placement

ORDERING INFORMATION

Ordering Information – ezlase™ 940nm Laserezlase™ 940 nm Laser

Biolase Part #: 7400001

Includes:• ezlase™ 940nm Laser• Soft-tissue handpiece• 2 boxes of ezTips™ (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™ Accessoriesezlase™ Whitening Handpiece

Biolase Part #: 7400022Suggested US Retail Price: $1,250

LaserWhite20 Whitening Gel

Biolase Part #: 7400030Suggested US Retail Price: $295 for a package of 5 kitsIncludes: 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 #: 7400024Suggested US Retail Price: $750Delivers power for a typical day's worth of soft-tissue procedures plus 3 whitening procedures

ezlase™ Wall Mount

Biolase Part #: 7400023Suggested US Retail Price: $295

Ordering Information – ezTips™

Surgical Tips

Biolase Part #: 7400018Diameter & Length: 200µm, 4mmSuggested US Retail Price: $250



Perio Tips

Biolase Part #: 7400020Diameter & Length: 300µm, 7mm & 9mmSuggested US Retail Price: $250

Biolase Part #: 7400019Diameter & Length: 400µm, 7mm & 9mmSuggested US Retail Price: $250

Endo Tips


All tips sold in boxes of 30

Thank You.

APPENDIX

ezlase Solutions for the Top 7 Soft-Tissue Dental ChallengesProcedure Clinical Images Challenge Solution

Uncovering Unerupted Tooth

Pre-op Post-op

Referral/Pt. Compliance Local Anesthetic Extended Treatment Time Improper Bracket Location Post-op Sensitivity

In-office Procedure Topical Anesthetic Accelerated Treatment Proper Bracket Location Decreased Post-op Sensitivity

Frenectomy

Referral/Pt. Compliance Local Anesthetic Zone of Necrosis Sutures Post-op Discomfort

In-office Procedure Topical Anesthetic Minimal Collateral Tissue Damage No Sutures/Laser Band-aid Minimal Post-op Discomfort

Gingival Recontouring & Hyperplastic Tissue

Pre-op Post-op

Referral/Pt. Compliance Biologic Width Violation/Flap Zone of Necrosis Extended Treatment Time Post-op Discomfort

In-office Procedure Minimally Invasive Minimal Collateral Tissue Damage Accelerated Treatment Minimal Post-op Discomfort

Laser Curettage / Sulcular Debridement

Recurrent Perio after SRP Referral Flap Surgery Impaired Access & Field of Vision Extended Treatment Time Post-op Discomfort

Decreased Occurrence In-office Procedure Minimally Invasive Improved Access & Field of Vision Faster Healing Minimal Post-op Discomfort

Troughing for C&B Impressions

Pre-op Impression

Packing Cord Extended Treatment Time Impression Re-takes Post-op Discomfort

No Cord Required Accelerated Treatment Decreased Impression Re-takes Minimal Post-op Discomfort

Aphthous Ulcers & Herpetic Lesions

Aphthous Ulcer Herpetic Lesion

Rx Prolonged Discomfort Extended Healing Time

N/A Immediate Pain Relief Reduced Healing Time

Operculectomy

Pre-op Post-op

Referral/Pt. Compliance Caries Local Anesthetic Zone of Necrosis Sutures Post-op Discomfort

In-office Procedure Prevent Caries Topical Anesthetic Minimal Collateral Tissue Damage No Sutures/Laser Band-aid Minimal Post-op Discomfort

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

LaserWhite20 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 H2O2 (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 SystemNote: Listed here is just a quick summary. Please carefully follow the Instructions for Use included with the LaserWhite20 gel and ezlase™ Whitening Handpiece.1.Apply liquid dam to the gingiva, and cure with a standard curing light2.Mix the activator and base gels by connecting the two syringes together and pushing the gels back and forth3.Apply a thin layer of the mixed gel with a brushed applicator tip to each quadrant of teeth4.Ensure that the doctor, patient, and all persons in the room wear protective eyewear before starting the laser5.Place a disposable clear plastic cap over the whitening handpiece, and place the handpiece in close proximity (~ 1mm) to the first quadrant, without touching the gel6.Deliver 200 Joules of laser energy at 7 Watts to the quadrant (~30 seconds), and then repeat for all quadrants7.Repeat step 6 one more time8.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 spray9.Replace the brushed applicator tip with a new one, and repeat Steps 3 through 8 one more time10.Remove liquid dam

Liquid dam on gingiva

Mixing activator & base gels

Brushed applicator tip Applying gel to

teethDelivering laser energy

Removing gel from teeth

Gel Application 1Laser Cycle 1Quadrant 1

Gel Application 1Resting Time

Repeat Same Steps for Gel Application 2

ezlase™ soft-tissue, whitening, and pain therapy system may 2009

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