CO2 v. Diode in Soft Tissue Surgery

I’ll admit - my dental education was pretty lacking in laser knowledge. But when you’re told you’re certified in something from your trusted educational institution, you tend to believe it. So the last year of my life has been eye-opening in terms of what I did not know regarding lasers.

So let’s talk about lasers. In layman’s terms, a laser is a beam of light created by some really cool physics. By definition, a surgical laser is a beam of light that can cut tissue.

Two of the popular lasers you may hear about in the world of frenectomies are the diode (~1µm wavelength) and the CO2 (~10µm wavelength). I won’t belabor the physics (that I’m still learning about myself), but the take home message is that when you shoot the laser light of these two wavelengths at soft tissue, very different things happen.

• A CO2 light focuses on water and ignores red (blood). Since about 70% of our tissue is made of water, aiming a CO2 light at soft tissue will result in a cut.

• A diode light ignores water and focuses on red (blood): this is great for coagulation, but it simply does not cut.

So how are people using a diode for cutting?

The beam of light on a diode laser is sent through a glass optical fiber. The tip of this glass fiber is blackened with ink to actually stop the laser light from exiting. When the laser light is absorbed by the black tip, it heats up to over 1000°F. When a diode is used for soft tissue cutting, it is not a laser - it is using laser technology to heat a glass tip. It is a fancy hot glass knife.

I used to use a diode for frenectomies. I was well trained - I did a good job with that tool. But I had been completely misled about what a diode is. There is too much unnecessary collateral heat damage with a diode for a frenectomy procedure.

If you want a soft tissue surgical procedure done by a laser, choose a CO2. If you want a soft tissue surgical procedure done by a hot tip cautery tool, choose a diode.