The process of selecting the ideal disposable tip and when and how to best initiate that tip can sometimes be confusing to the new user.
Picasso lasers come standard with a multi-tip handpiece which is a fiber optic bundle that carries the laser energy from the front of the laser to the surgical site.
Many diodes have a strippable fiber that each time after you use it, you must remove off the insulation (strip the fiber), as well as cut it clean and sharp (cleave the fiber). However, many clinicians prefer the simplicity and ease of single use tips from AMD, where the tip is simply removed from the package having already been stripped, cleaved, and ready to go.
Another benefit of these single use tips is they come pre-bent at an angle of around 60 degrees but because of the metal cannula that extends from the plastic sleeve, one is able to bend the tip over your thumb to an angle of 90 degrees. Often for certain procedures this is of benefit when working in certain areas where access is difficult (posterior teeth where crown troughing is required with limited inter-occlusal opening). If the clinician prefers a straight tip, they can also straighten the metal cannula which is advantageous for working in anterior areas of the mouth.
It is very important to make sure that a gap does not exist in the connection of the disposable tip to the Multi tip handpiece. The connection between the plastic sleeve and the metal portion of the handpiece must be firm (no gap). There is an audible “click” when the tip is inserted on the hand-piece all the way. If this connection is not tight then energy can be lost at this point and then the clinician will require greater energy to complete the given task.
There is one additional tip that can be connected to the multi-tip handpiece and that is the Bleaching handpiece which is not single use. The Bleaching Handpiece should only be used with the 7 watt Picasso+ when providing laser bleaching to patients. The Picasso Lite+ (3w) laser cannot provide enough energy to the tip to be effective for laser bleaching.
Initiating the tip Now after selecting the tip that you wish to use, one must consider whether to INITIATE the tip or not.
"The simple rule is that any time that you wish to be in contact with tissue and ablate it, the tip must be initiated"
The process of initiating the tip will concentrate the laser energy in the tip essentially making it a “hot tip”. The monochromatic laser light is turned into heat and hence this process is called a photo-thermal reaction.
The heat that is generated causes a localised zone of vaporisation, surrounded by zones of carbonization (try to keep this char zone as small as possible), coagulation and hyperthermia. The higher the settings, typically the faster the vaporisation, but the greater these other zones of unwanted lateral thermal damage may be. In keeping with the Academy of Laser Dentistry’s most current guidelines, which “advise the use of the lowest average fluence to avoid risks of excessive heat complications whenever possible,” Of course total treatment time must also be kept in mind in trying to minimise the collateral thermal damage that can be created by prolonged exposure to laser energy through settings that are not above the ablation threshold required for vaporisation.
After selecting the appropriate single use disposable tip
Select single piece of blue articulating ribbon.
Set the laser at 0.5 watts
Touch the tip to the articulating paper first then step on foot pedal for ONE second.
Repeat 8 times or more. The tip should glow an incandescent orange when stepping on the foot pedal (like a candle flame)
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