People do not like having dental work done. They do not like getting stuck with a needle. They do not like feeling numb with a fat lip for hours, and they do not like the sound and feel of the “drill” in their mouths. None of this is a surprise to dentists. We know people do not like what we do, and the profession has been struggling for years to invent a way to deliver care with less fear and discomfort. If we could prepare a tooth with no needle, no pain and no whining vibrating drill it would fundamentally change the patient experience. Dental lasers have the potential to provide a pain free drill free experience, but early attempts to use lasers to prepare teeth have been limited. A new dental laser, the Solea from Convergent Dental, looks like it actually works. Solea was launched in the fall and will next be on display at the Yankee Dental Congress in Boston Jan. 29 – Feb. 2. Solea uses a CO2 laser producing a unique 9.3 micron wavelength to actually cut, or more accurately ablate the tooth. The 9.3 micron wavelength matches the peak absorption of hydroxyapatite. Other hard tissue lasers do not directly cut the tooth but energize water that then cuts the tooth surface. Michael Cataldo, the CEO of Convergent Dental tells an interesting story. In the very early days of development they invited a dentist to the lab to test the 9.3 wavelength laser. The dentist turned it on and aimed it at the tooth. After a few seconds he said, “It isn’t working.” “Doctor,” Mike said, “you have already gone right through the tooth.” The Solea engineers then developed a unique system to control the laser energy using galvos. These are computer controlled motors that move tiny mirrors inside the handpiece. The mirrors manipulate the beam thousands of times per second, creating patterns that are perfect for whatever tissue you are cutting, enamel, dentin or soft tissue. They call this CAP, Computer Aided Preparation. The system uses a variable speed foot control very similar to what we use now with conventional handpieces. The harder you press the faster it cuts. The device has FDA approval for both hard and soft tissue ablation. It has been beta tested in several dental offices with varying levels of laser experience. I had the opportunity to visit Dr. David Fantarella at his office in North Haven, Conn. He is a good test site as he has experience with other lasers, and his undergraduate degree is in physics which gives him a better understanding of how lasers actually work. Two of his patients allowed me to observe their treatment. First he did a simple class two prep removing enamel, dentin and decay in seconds with no anesthesia. He then did a soft tissue case removing and contouring the gingiva around a crown prep with deep sub gingival margins, again with no anesthesia. The clinical process looked relatively easy, but even more significantly, the patients reported no pain and offered that they much prefer the laser to conventional tooth preparation with a handpiece and burr. Solea cannot be used to remove old alloys or cut off crowns but it can remove composites and prepare onlays. It is a well-known but not well understood property of certain lasers that they produce an anesthetic effect. Not everyone can have laser tooth preparation without anesthesia but so far the vast majority, more than 90%, do not require anesthesia. The Solea laser does most of the work, but does not completely eliminate the need for a handpiece. Early users are reporting that they use a conventional handpiece for 10 - 15% of their prep. However, because of the laser anesthetic effect, even then the patient does not need to get numb. In any case it is safe to Say Solea delivers a significantly different patient experience. Solea is the first high tech device to use digital technology to enhance tooth preparation. It could be the first step to total digital dentistry where we design the prep with a computer and let the machine actually do the work. Whatever happens, the future is coming and it will be amazing!