Image of an un-initiated tip
Whether the fiber is disposable or continuous, certain procedures require either initiated or uninitiated tips; the general rule being initiated tips are used for cutting. Initiating the tip is a preparation process so the laser fiber can cause cell ablation or cutting.
How to Initiate Tip
Initiating the laser tip is the process of a photo-thermal reaction, changing the laser’s light energy to heat energy, which is why initiated tips are referred to as “hot tips”. Wattage for initiation will vary between lasers. The Pioneer lasers should be set at 1 watt on continuous mode. Once the laser is activated and firing, touch the tip or delicately drag it on both sides across blue or black articulating paper. The process can be repeated approximately three or four times to correctly initiate.
There are two ways to tell if the tip has been properly initiated. First, there will be a carbon build up on the tip and sides making the fiber darker. Remember to keep the carbonization zone small. Second, there will be clenching, an incandescent glow which at times may appear almost white. Overly clenching the tip may result in splitting the fiber ends. Shards in the fiber will act as a miniature scalpel preventing hemostasis and coagulation because it will damage small blood vessels.
When Cutting Tissue
Ideal tissue response shows little to no discoloration resulting in less residual damage and faster healing. Since the laser energy is attracted to melanin and hemoglobin, wattage should be reduced if the patient has darker soft tissue. Start with the lowest wattage setting for the procedure to begin removing tissue and work up from there as needed. If tissue charring is appearing, there is either too much power or the tip is moving too slowly across the tissue.
Needed safety procedures include filtration masks, eyewear, and plume evacuation when vaporizing soft tissue. This is a priority in any soft-tissue procedure especially in lesions procedures with potential virus or bacteria. Always have a chair-side assistant using a high volume vacuum system to assist in plume management during the procedure.
Procedure Differentiation with Un-initiated Tips
While an initiated tip is always used for a contact procedure, not all contact procedures require the tip to be initiated. Un-initiated tips use the pure light energy and are mainly used for socket treatment in addition to procedures dealing with aphthous ulcers, denture sores, or herpetic lesions. Pioneer Lasers suggest an Un-initiated tip in contact procedures for Peri-Implantitis, chronic Perio, and severe Perio cases. All procedure suggestions and presets will be in the user guide for each laser; please follow accordingly as wattage, laser mode, and time may vary per unit.
When considering adding a laser to your practice, it’s vital to become educated about procedures, preparation, maintenance, etc. Contact us for any questions regarding lasers to help determine how a diode laser can benefit your practice.