MIR • July 26, 2012 138 0
One of the most common fears of the modern person is a visit to the dentist’s office. Dental drilling machine, pain, skyrocketing prices. Today all these fears are treated with new technologies. Photonics is engaged in design and introduction to the domestic market of fundamentally new medical laser systems for soft and hard tissue surgery.
The correspondent of MIR (Young Innovative Russia) site met with Igor Shugailov, Chief Medical Advisor of the Skolkovo resident company (biomedical technologies cluster), President of Laser Stomatology Association of Russia, and Anna Zelenkova, PR-Director.
What was happening in the area of laser equipment before new technologies have appeared?
Igor Shugailov: The way everybody was following earlier is perceived as a dead end now. You see, a certain technological limit has been reached. In particular, until recently hydrokinetic dentistry lasers have been applied, in the first turn, for odontotrypy to replace dental drilling machines. That is why, for a long time there was racing for maximum power. High-power lasers were created. With great disadvantages, as we can understand now. First, they are awfully bulky and costly. Second, they require very delicate maintenance. In case of any defects or faults, they require a qualified specialist and considerable expenses. All that has led to the fact that only a small number of clinics have the possibility to operate such devices.
And diode lasers are cheaper, they are more reliable. So far they are limited only to soft tissue surgery. But it’s only a temporary limitation.
What is the main advantage of the new technology?
Igor Shugailov: When laser radiation leaves the fiber tip, then sole optical power with the help of which tissue can be cut is not enough, as the depth of diode laser penetration is great: 1 to 1.5 mm and more. That is why, all that power is dispersed in tissue. In addition, tissue can be heated up intensely but not cut. But when we touch the tissue, then there occurs the fiber tip carbonization. This process is called fiber tip initialization. The optical power flow cannot leave the fiber any more, it is concentrated on this carbon film, and then the tip incandesces. Thus, it can be initialized in tissues but, since it became clear, the initialization has been done before the operation. One takes a burnt cork or mat-surface black paper, touches it with the fiber tip, switches on laser, an even carbon film covers the fiber tip and it incandesces. And this is here that thermal power starts working.
What is the problem of the method?
Igor Shugailov: Well, when you cut tissues with laser, a laser scalpel – incandesced fiber tip – meets various tissue types on its way. Among them are fibrous tissues, muscular and fatty tissues, blood vessels. Each tissue type has its coefficient of power adsorption. Therefore, even if the laser scalpel moves smoothly, it turns out that in one point the tissue is “underburnt”, in another “overburnt”. Besides, it is impossible to insert scalpel absolutely evenly! A surgeon is not a robot. It results in uneven incision depth. On the second thought, it is a serious trauma for an organism. Despite that, laser treatment wounds are healed faster, postoperative pains and postoperative edema are significantly less.
All diode lasers in the world operate by the same principle. In fact, it is an incandesced fiber tip. They differ only in design, output power, wavelength and some other parameters. The rest is all the same. That's exactly why the new generation of diode lasers has been created, namely, the universal stLase platform, with the help of which operations can be made on soft tissues, by excluding all those drawbacks connected with uncontrolled tissue coagulation.
What is the area of stLase application?
Igor Shugailov: Its application is primarily planned for dentistry, in particular, for operations in maxillofacilal area and for a number of other diagnostic and treatment procedures. For example, for treatment of periodontitis the majority of the adult population of the planet suffers from. With such disease, the organism starts rejecting own tissues that may lead to teeth loss. The reason for it is poor oral hygiene, congenital disturbance of occlusion or its disturbance as a result of poor quality dental prostheses – crowns or fillings.
StLase, like other diode lasers, is also applicable for any other operative interventions: among them is general surgery, as well as urology, cosmetology, and ENT-surgery. Qualitative indicators of such lasers increase constantly. For the last 5–7 years, there was a great progression in this area. No exhibition in Russia, Europe or USA is held without new modification of the devices.
StLase implements a new technology: initialization of the fiber tip with the help of nanocarbonization. A thin even nanocarbon film is applied under the computer control. Nanocarbonization of the tip fulfills two functions:
1. Heats up the fiber tip and converts from wavelength of 970 Nm, which goes rather deeply into the tissue, to radiation from 4,000 to 11,000 Nm, which is absorbed by water in panniculus. As a result, all converted optical power is absorbed by panniculus. Besides, the surgeon has tactile link with the scalpel and incision speed is not less than the one of СО2 laser.
2. stLase ensures feedback, that is, laser cuts and at the same time analyses and maintains the preset temperature in the operative field. Thus, on the laser display, we set up not power but temperature in tissues, being optimal for such operation. It provides for reduction in operative intervention injury potential. High precision and speed of incisions ensure all the positive effects for the patient.
In the near future, an attachment will be introduced to stLase, which will convert it into erbium laser that will enable the dentist to make operations on hard tooth tissues, maxillary bones and mineralized dental deposits. Such upgrade will be available to every stLase owner, as it will not involve changes in the patient reception technology, existing in a given dentist’s office: the attachment does not alter the laser dimensions, and low-level cost will promote wide and fast practical application.
Who holds the palm of victory in the area of laser equipment development now?
Igor Shugailov: Cut-edging design efforts are made by our physicists. If you take a Western company dealing with laser medicine, be sure that our physicists work there. An example is not far to seek. So, the author of the thermo-optical surgery used in stLase, Gregory Altshuler is Senior Vice-President for science and technology of one of the largest American companies in the sphere of laser medicine – Palomar. He is a LITMO graduate, the author of about a hundred of patents. Thanks to him, the world laser medicine has made a groundbreaking breakthrough. The Vice-President of the American company, BioLase, the largest in the world in hydrokinetic dentistry laser sales volumes, is also a Soviet scientist – Dmitry Butusov. There are a lot of similar examples.
How has the company received its first investments and what comprises its joint work with Skolkovo?
Anna Zelenkova: Photonics joined the project for laser design at the stage when only the first prototype of stLase system had been developed. The project attracted investments of Maxwell Biotech Venture Fund, an RVC portfolio fund, and RVC Seed Fund. Expert commissions of these two funds saw the technology potential and were the first to invest into the design. After that the company became a resident of Skolkovo Fund and applied for a grant for designing the next model of the device for work with hard tissues.
Are there specialists in Russia to operate such devices?
Igor Shugailov: There are specialists of such level but not many of them – engineers, physicists. As for dentists, it is planned to train them to operate the device. Retraining everybody is a very long process. It is necessary to create remote training methods: video films, clips, trainings for doctors to learn to master the device independently. And when take the exams in person.
What is the case with serial production?
Igor Shugailov: In future, it is planned to tailor production of stLase in Russia. From the point of view of cost, it is more profitable. It is complicated for Western companies to compete with the Russian producers of diode lasers in the Russian market. Some of our producers give a warranty period for their equipment up to 60 months! An enormous period. Our fiber is of the same quality but costs considerably lower. Unfortunately, people have still preserved prejudice to the Russian medical equipment. But it will be overcome.
In your opinion, how will this technological line develop further?
Igor Shugailov: I think, and my colleagues will agree with me that modern dentistry must restore not only beauty and high functionality of the dentition but make reconstruction of face aesthetics in general. I would like to say that dentists should be given an opportunity to perform procedures, enabling complex rehabilitation of patients.
If a dental clinic uses laser equipment, it should not limit itself only to teeth. The dentist must have a possibility, as an example, for eradicating lines that have been formed in the patient’s face as a result of disturbance of occlusion. It is for the benefit of both the patient and the doctor. By the way, modern dentist equipment, such as stLase, allows doing it. This concept will be outspoken at the forthcoming congress on September 18 to be held in Moscow. A medical aesthetics course for dentists already exists in the New-York University. It is necessary to develop a new standard of work for the Russian dentists as well.
Does the experience of foreign colleagues you meet help you in any way?
Igor Shugailov: There can’t be excessive experience. Recently, a review was published of an American author who analyzed several thousand publications of international specialists. The subject of the analysis were results of laser application at periodontitis treatment. The following conclusion has been made: actually there are no proven advantages of laser application during treatment that would be confirmed by evidence-based medicine. It is clear that this is a biased article but it is not less interesting. Doctors who have knowledge and experience in application of laser technologies in treatment of such disease, know well that it is not the case! But specialists who do not know well or do not have work experience in laser dentistry are brought to a nonplus by such research. In fact, the number of publications based on objective criteria prove high efficiency and safety of application of laser technologies in dentistry is just not large.
And if there are only few fair publications, as you say, then how do you exchange experience with your colleagues?
Igor Shugailov: We organize congresses. When there is a visible result. We succeed in holding these events only as often as once in 2 years. On September 18, for example, we are holding a congress jointly with the Americans and will show what was before and what we have today. And also what a specialist can expect in the sphere of application of laser technologies in diagnostics and treatment of dental diseases in the nearest future.
The first laser was created in the Soviet Union in 1960 by Soviet scientists, Alexander Prokhorov and Nikolay Basov. Dentists and cardiac surgeons were the first to apply it in practical medicine. The author of thermo-optical surgery implemented with the help of equipment of Photonics is Gregory Altshuler
Specially for MIR site.