Sales soar at dental laser specialist

31 Oct 2003

As dentists begin to adopt laser techniques as an alternative to conventional drills, a small Californian firm is reaping the benefits. Jacqueline Hewett spoke to Jeffery Jones, the man at the helm of dental laser pioneer Biolase, about the company's plans.

From Opto & Laser Europe November 2003

Nearly 20 years ago, a dentist in the US began researching laser-based alternatives to the traditional dental drill. Today, this work is at the heart of Biolase, one of the fastest-growing high-tech companies in the US, with quarterly sales consistently rising by 40% year-on-year.

The 148-strong company, which is based in San Clemente, South California, owes much of its success to the development of a laser material called yttrium scandium gallium garnet (YSGG). YSGG forms the basis of Biolase's primary product, Waterlase, a dental drill that was launched in 1998 and uses a laser-energized water spray to painlessly remove tooth material.

"The YSGG is now the number-one-selling dental laser in the world, and has been for the last three years," Jeffery Jones, president of Biolase, told Opto & Laser Europe. "We have already sold thousands of Waterlase units." Fuelled by this success, Biolase is reporting a healthy profit and the company's total quarterly sales currently come in at around $10m (€8.54m). For the first six months of 2003, the firm recorded a net income of $2.4m, and saw its sales grow by 59% over the last year to reach $19.7m.

But the success of Waterlase has not caused Biolase to rest on its laurels. Its second product, LaserSmile, was introduced in 2000 and is primarily designed for tooth whitening. Last month it became the first semiconductor laser to win US Food and Drug Administration (FDA) approval to treat periodontal disease - decay in the small pocket between the tooth and gum - by laser curettage (removing the top layers of tissue).

In addition, the company increased its product portfolio in May this year when it acquired all of the laser-related assets of American Medical Technologies (AMT). For $1.83 m in cash and 307,500 shares, Biolase walked away with AMT's large portfolio of dental-laser patents, the well-known brand name of American Dental Laser, AMT's product range and many potential new customers.

"The acquisition of AMT's laser-related assets is part of our strategic growth plan for 2003 and beyond," said Jones. "Its installed base of lasers will instantly double our base of customers and give us hundreds of new prospects for our Waterlase and LaserSmile systems."

Cool, quiet and comfortable So why have the Waterlase and LaserSmile systems proved so popular? Jones has several answers, the first being that laser-based dental tools do not cause teeth to heat or vibrate in the way that a high-speed drill causes them to. This is healthier for the tooth and more comfortable for the patient. In the case of Waterlase, not only is it quiet and painless - a local anaesthetic is not required - it also makes perfectly clean cuts in both hard and soft dental tissue.

"Waterlase also has more applications than any other dental laser - in fact, more than any other medical laser. It has a tremendous number of FDA clearances," said Jones. "It allows the dentist to do things they couldn't do before or make them a lot easier."

Although Waterlase is most commonly used for hard-tissue applications such as cavity preparation, its capabilities extend much further. For instance, Jones says that Waterlase is particularly useful for crown lengthening. Sometimes when a tooth breaks, there is not enough of it left above the gum line to put a crown on. Traditionally, the options in this scenario are to pull the tooth out or to grind down the bone around the tooth, which is painful and requires several visits to the dentist. "With Waterlase, we can go around the tooth and re-contour the bone line. It's a gentle procedure and there is no pain," said Jones. "Waterlase is the only laser in the world that has any dental approvals for bone."

Unlike Waterlase, the LaserSmile does not perform hard-tissue procedures and is targeted at tooth whitening and minor soft-tissue procedures. Based on an 810 nm diode laser, it uses an arc-shaped handpiece to whiten several teeth at a time. The dentist smears a photoactivated gel over the teeth and places the handpiece over them. "Typically 15 s bursts repeated up to 10 times are required. This is the fastest whitening device that exists," claimed Jones.

Laser rivals Thanks to Waterlase and LaserSmile, the firm has two patented technologies that seem ideally suited to dentists' needs. There are, however, challengers to YSGG - the main one being Er:YAG, a laser material that emits at 2.94 µm.

"Er:YAG is readily available because it is used in dermatology and plastic surgery," said Jones. "Companies selling these products saw what Biolase was doing and began adapting their products. Despite there being several very large companies doing Er:YAG, our product has just surged past them and stayed past them."

The crucial differences between the technologies are the level of water absorption at the lasing wavelength and the tissue penetration depth of the laser light. According to Jones, water has a higher absorption at the Er:YAG lasing wavelength than YSGG. "Er:YAG has a penetration depth of about 1 µm, whereas YSGG is between 3-5 µm, and this makes a difference in how it works. If the laser light gets stopped too quickly by tissue containing water, you get zero penetration and you are going to bleed," he said.

Focusing on YSGG technology is certainly paying dividends for Biolase and Jones is optimistic about the future. "In developed countries there are close on 500 000 dentists, and with only a few thousand systems sold to date, there is a big future," he told Opto & Laser Europe. "It is going to be exciting for many years to come."

Waterlase explained At the heart of Waterlase is a pulsed laser made from an erbium chromium-doped YSGG crystal. It emits up to 6 W at 2.78 µm with a maximum pulse energy of 300 mJ. This infrared light is coupled to a specially designed handpiece through a zirconium fluoride optical fibre. During the drilling process, an air-water spray and the laser light are delivered to the surface of the tooth through the tip of the handpiece. The handpiece must be 2-3 mm from the tooth for the water and the laser to interact in an effective manner.

The system makes use of the cavitation process that takes place when water changes from a liquid into a vapour to propel the water molecules at high speed towards the tooth. "The water is actually the cutting agent," explained Jones. "You might think that it is there as a cooling agent, but it is there primarily as the cutting agent." The amount of laser power and the proportions of air and water is controlled from the Waterlase base unit. A laser-water-air mixture is used to cut hard tissue, while a laser-air mixture is used in soft-tissue procedures such as making incisions, removing gum tissue or coagulating capillaries. A red laser beam is used to align the drilling spot before switching over to the powerful infrared beam. The system enables drilling with a spot smaller than 200 µm across.