November 13, 2010

Nd:YAG Biostimulation

The first time I heard of biostimulation with a laser, I too thought it was hocus pocus.  Come on, waving a defocused laser light over your body parts to help them heal, ridiculous.  After all, I’ve had a Nd:YAG for almost 18 years and never used it for anything else but a hot knife.  Or did I?  Looking back at a cheat sheet of laser settings I have taped to the side of my old Nd:YAG I have the usual setting for curettage, tissue retraction, frenectomy, hemostasis but also have tooth analgesia, and desensitization.  Had I been biostimulating the tissues without knowing it? The simple answer is an obvious YES!

Laser light is really more than meets the eye, no pun intended.  In addition to the intense heat generated with focused laser light that cuts, ablates, and coagulates tissue there is the acoustic affects that are explained better in the root canal blogs “New service to our patients: Laser Root Canals!”. There is another under appreciated laser affect on the tissue that we as dentist over look and that is called biostimulation.

Laser Therapy by Tuner and Hode

Biostimulation with a laser at 3J/cm² can increase fibroblast proliferation six-fold, stimulates osteoblasts, endothelial and angiogenesis for accelerated wound healing.  Lasers have been used to close oral-antral fistula with biostimulation.

Effect of low-power laser irradiation on cell growth and procollagen synthesis of cultured fibroblasts: Aymann Nassif Pereira DDS, MSD; Carlos de Paula Eduardo DDS, PhD; Edmir Matson DDS, PhD; Márcia Martins Marques DDS, PhD

Conservative Closure of Antro-oral Communication Stimulated with Laser Light: Graz•yna Grzesiak-Janas, Anna Janas. Journal of Clinical Laser Medicine & Surgery. August 2001, 19(4): 181-184. doi:10.1089/104454701316918934.

Biostimulation of bone marrow cells with a diode soft laser: Orhun Dörtbudak, Robert Haas, Georg Mailath-Pokorny

Direct stimulatory effect of low-intensity 670 nm laser irradiation on human endothelial cell proliferation: A.SCHINDL, H.MERWALD, L.SCHINDL,* C.KAUN† AND J.WOJTA. Departments of Dermatology (Division of Special and Environmental Dermatology) and Internal Medicine II, University of Medical School, Wa ?hringer Gu ?rtel 18–20, A-1090 Vienna, Austria *Institute for Laser Therapy, Rathausplatz 4, A-3400 Klosterneuburg, Austria.

These are just a few of the numerous studies appearing in the literature regarding biostimulation, but none of this drives this effect home as much as experiencing it first hand.  We got our new PowerLase AT in August, 2010 and began using it right away.  Our trainer was a great doctor named Ronald Schalter from Michigan, and he showed us how to do the PIPS endo “New service to our patients: Laser Root Canals!”, hard tissue cavity preparations, soft tissue surgery and then almost in passing he mentioned biostimulation.  I honestly thought to myself, “Oh boy, here comes the goofy stuff”.  He didn’t act all crazy about it, he just told me how to do it and said he even helped a lady with her paraesthesia of the lower lip after a third molar extraction with it. Hum, I thought.  So I asked will it help my tennis elbow?  “Yeah”, he answered with kind of a smirk.  I’ve got a sore toe, too.  Will it help that?  At that point he figured out I was pretty skeptical and just told me to try it.  After he left my toe and elbow were hurting about usual so I fired up the Nd:YAG laser part of the PowerLase AT and put it to work.  The first treatment I passed the laser over my elbow and toe for about 10 minutes each.  The laser light was warm and actually felt pretty good.  My elbow did feel better, but I thought it was just placebo.  However, the next day it really did feel better.  I did another 10 minute each treatment for the next 3 days and I cannot tell you how surprised I was with my pain relief.  If you still don’t believe in biostimulation by now it is because you don’t really understand the severity of my pre-op pain.  My elbow was so sore I could barely turn on the water facets.  For a dentist that is almost life threatening!   My toe had been jammed in ski boots year after year and had developed a arthritic bone bump that cause me to limp and I had a pain in my foot all night long.  My podiatrist injected the most painful steroids in the world into the joint every 4 months and said surgery was next. This surgery was going to lay me up for close to a month and cost me about $100,000.  BUT, after just 4 treatment with the Nd:YAG my elbow feels normal, and my toe doesn’t hurt at all!  That was worth the cost of the laser right there.  We will definitely be using it on our next TMD and myofacial pain cases.

I did make one mistake, I treated one of my front desk workers jammed finger and an assistants arm with the biostimulation and now every time I get it out to treatment something on myself, half my staff lines up for their aliments to be treated, too!


1. Photomed Laser Surg. 2008 Feb;26(1):37-46. Nd:YAG laser biostimulation in the treatment of bisphosphonate-associated osteonecrosis of the jaw: clinical experience in 28 cases. Vescovi PMerigo EManfredi MMeleti MFornaini CBonanini MRocca JPNammour S. Unit of Oral Pathology and Medicine, Section of Dentistry, Department of ENT/Dental/Ophthalmological and Cervico-Facial Sciences, University of Parma, Parma, Italy.

2. Lasers Med Sci. 2011 Nov;26(6):815-23. Epub 2011 Aug 2. Bisphosphonate-related osteonecrosis: laser-assisted surgical treatment or conventional surgery? Atalay BYalcin SEmes YAktas IAybar BIssever HMandel NMCetin OOncu B. Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Istanbul University, 34390, Capa-Istanbul, Turkey.

3. J Photochem Photobiol B. 2005 Oct 3;81(1):1-8. Biostimulation of dermal fibroblast by sublethal Q-switched Nd:YAG 532 nm laser: collagen remodeling and pigmentation.Poon VKHuang LBurd A.Division of Plastic and Reconstructive Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China.

4. Laryngoscope. 1987 Dec;97(12):1454-9.Biostimulative effects of Nd:YAG Q-switch dye on normal human fibroblast cultures: study of a new chemosensitizing agent for the Nd:YAG laser. Castro DJSaxton REFetterman HRCastro DJWard PH. Division of Head and Neck Surgery (Otolaryngology), UCLA School of Medicine 90024.