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Clinical General Dentistry

Harvey Shiffman, DDS, is in general practice at the Laser Dental Center in Boynton Beach, Fla. (Photo: Provided by Dr. Harvey Shiffman)
Oct 10, 2016 | General Dentistry USA

Non-surgical laser has sleep applications

by Harvey S. Shiffman, DDS

Of the commercially available hard- and soft-tissue lasers, only the LightWalker (Fotona, San Clemente, Calif.) combines two proven wavelengths, Nd:YAG and Er:YAG, with unrivaled power and precise pulse control resulting in high levels of efficacy for a wide range of procedures. With this advanced level of performance comes significant patient comfort.

The procedure described here has been developed to take advantage of these attributes. Snoring and sleep disordered breathing affect millions of Americans, both adults and children.[1,2] The signs and symptoms are the result of partial or complete collapse of the upper airway during sleep.[3 ]The structures involved in our protocol include the soft palate, uvula and the base of the tongue.[4] The goal of the treatment is to decrease the amount of blockage of the upper airway.[5]

Dentists are in a great position to help screen and in many cases treat these problems with airway management. Helping patients improve their sleep can profoundly improve their health, quality of life and well-being of their loved ones.

The “Gold Standard” for the treatment of sleep disordered breathing is the CPAP type device. Following that in 1981 was the introduction of Mandibular Advancement Devices (MAD). Compliance with both of these treatment modalities shows a reduction in compliance over time and significant side effects. However, the “NIGHTLASE Snoring and Sleep Apnea Reduction Therapy” protocol is a unique approach to treatment using the Fotona LightWalker dental laser with a proprietary protocol and handpiece. Another positive benefit is the 24-hour-a-day improvement in airway vs. CPAP and MAD.

NIGHTLASE uses the photothermal capabilities of the LightWalker laser to convert and initiate the formation of new and more elastic collagen.[6] The target mucosal tissues are the oropharynx, soft palate and uvula. The proprietary “Smooth Mode” pulse characteristics create a non-ablative heat generation or “Heat Shock” that initiates the conversion of existing collagen to more elastic and organized forms and also initiates “neocollagenesis,” the creation of new collagen.

This process results in a visible elevation of the soft palate and uvula and tightening of the oropharyngeal tissues, resulting in an improvement in the upper airway volume. The results can be seen in Figures 1 and 2.

NIGHTLASE therapy is indicated for cases when the patient has been diagnosed with chronic snoring, UARS or mild to moderate sleep apnea and either cannot or chooses not to wear an appliance or CPAP device. It can also be used in co-therapy with those devices, allowing for lower CPAP pressures and less MAD advancement. NIGHTLASE represents a less-invasive alternative to current surgical, chemical or radiosurgical options that may require hospitalization, general anesthesia or soft-tissue removal.

NIGHTLASE has a significant success rate in producing a positive change in sleep patterns. Research published by Miracki and Visintin[7] has shown that it can reduce and attenuate snoring, and provides an effective non-invasive modality to lessen the effects of obstructive sleep apnea. As with any treatment, there are potential risks with laser treatment. However, the risks are minimal and certainly less then alternative therapies if the protocol is followed correctly. NIGHTLASE therapy is not a permanent alteration and lasts anywhere from six to 12 months and is easily touched up at follow-up appointments.[2]

In 2013 we completed a pilot study that addressed only snoring with 12 patients. Twelve-month follow-up showed a 30–90 percent reduction in snoring tone and volume (Fig. 3). The lower percentages were smokers, obese patients and those with severe OSA. Follow-up studies with polysonography using HST are in process, as are pharyngometer studies, both of which have recorded significant positive changes.

A recently published pilot research study by Lee and Lee[8] has shown through 3-D CT imaging the volumetric positive changes after NIGHTLASE treatment to help support the clinical results, and the authors have follow up studies with 3-D CT, polysonography and a larger group of patients in process.

We are excited to present these modern, minimally invasive and more natural treatment modalities to the dental community. Using the LightWalker laser, we can now have another tool in our dental toolbox and offer our patients health improvements that reach beyond restorative and rehabilitative dentistry.

If the reader is curious about using the NIGHTLASE protocol or about laser dentistry in general, you can contact the manufacturer for more information. As always, we recommend a good variety of advanced educational programs in dental sleep medicine to see where NIGHTLASE might fit into your patients’ treatment protocols.

This article was published in Dental Tribune Canada Edition, Vol. 10, No. 2, April 2016 issue. A list of references is available from the publisher. Financial disclosure: The author has no financial interest in the products mentioned in this article.

 

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DT U.S. No. 7, 2017

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