First impressions: Gemini 810 + 980 diode laser

The Gemini 810 + 980 diode laser is the first dual-wavelength soft-tissue laser to be offered in the United States. It combines versatility, power, and ease of use to benefit both the user and the patient. Dr Michael Miyasaki recently brought the Gemini laser into his practice. We asked him to share his experience with us.

Ultradent describes the Gemini laser as the most powerful soft-tissue diode laser available. Has that translated into better patient care and practice benefits?

I've always been a patient user of lasers, preferring to use lower power to diminish the collateral thermal tissue damage. I think one of the big advantages of a laser is that you can brush away the tissue instead of incising chunks of it or incinerating it like many do with their electrosurgery units. This is why for simple laser gingivectomies, topical anesthetic works sufficiently; whereas, for electrosurgery and steel, I prefer to use more profound anesthesia. With a laser, I have typically used settings of 0.6 W of output in order to minimise thermal tissue damage as much as possible.

With the Gemini laser, we have an immense amount of peak power, but it is pulsed. The same average power is delivered through high spikes of power and longer cooling periods - referred to as thermal relaxation - for better tissue healing and increased patient comfort. Now, when I am in thin tissue, I can use a lower average power output and when I need to ablate thicker, more fibrous tissue, I have the power to do so without extensive tissue damage. The predictable healing is still there, but we can work faster, which patients appreciate and which impacts the practice's profitability.

Can you discuss the advantages of dual wavelength and how the Gemini laser differs from other soft-tissue lasers?

All other soft-tissue lasers in the United States offer one wavelength. Most use the 810 nm or 980 nm wavelengths. There's also a 940 nm wavelength laser that tries to take advantage of both wavelengths, but this may be a compromise that's not optimised for peak absorption by the areas to be treated.

Optimised absorption of the laser energy increases its effectiveness and provides a smoother margin when ablating tissue. The 810 nm wavelength is absorbed by pigmentation, such as haemoglobin and melanin in tissue; the 980 nm wavelength is absorbed best by water. The Gemini laser allows the user to select a single wavelength or simultaneously use the optimised absorption of pigmentation and water, having both the 810 nm and 980 nm wavelengths working at the same time. The use of both simultaneously creates a greater synergistic effect. The clever design also gives the Gemini laser 2 diodes, which work together to create a peak power of 20 W.

The Bluetooth foot pedal that comes with the Gemini laser sounds pretty cool. Does it aid in ease of use of the laser?

I have lasers that have cabled foot pedals and others that are wireless. My preference is always for a unit that is wireless. Less cable is always better in our operatories, so I appreciate not having another cable between my laser and the foot pedal. Having the foot pedal separate from the laser delivery unit makes storing and moving the Gemini laser from operatory to operatory much easier. Also, there is no interference with other wireless equipment in the office.

Can you tell us a little about the use of the laser, including its design and handling?

The Gemini laser has the WOW factor that impresses patients and clinicians with its electroluminescent display, which is big and easy to read. The voice guidance takes you through the settings in a gentle manner. The illumination at the end of the handpiece is a nice bonus, especially for a hygienist who may not have a headlight and the tips can be angled making any far corner of the mouth easily accessible. Having the numerous preset power settings and the ability to customise them makes using the laser easy, eliminating the need to remember your preferences. And should the software need to be updated, the Gemini laser can be updated through a USB connection, which I have never seen on another soft-tissue diode laser.

But mostly I have been impressed by the effectiveness of the wavelengths and power and have been amazed by how quickly procedures can be performed.

With what procedures have you used the Gemini laser?

We have used the Gemini laser to uncover our implants for impressions and it cuts quickly through thick and fibrous tissue faster than other soft-tissue diode lasers I have used. There is no interaction between the metal in the implant and the laser, although one should not leave the laser in contact with the metal for too long as that could transfer heat. Heat transfer is easily avoided by moving the laser tip in brush strokes. When it is used for gingivectomies in aesthetic cases or to expose carious root surfaces, the Gemini laser leaves the tissue cleanly cut without ragged edges or tags. I believe this is all because of the high peak power and the dual wavelengths. We don't pack cord in my practice; instead, we create the space by troughing with the Gemini laser. This also creates the haemostasis needed without waiting for a haemostatic-soaked cord. Frenectomies through fibrous tissue are quicker, too. We continue to use the laser in different situations and find that it works faster and renders a smooth soft tissue finish.

What kind of support have you received in use of the laser?

One hesitancy I've seen in dentists and hygienists about using lasers is a lack of confidence, which can be overcome with education. Ultradent and its distributor for the Gemini laser, Henry Schein, offer multiple training options. Even if you're new to lasers, you should feel comfortable integrating the Gemini laser into your practice. The installation was very easy and fast. Just make a few connections, put in some batteries and you're ready to go. Ultradent has a fantastic team who are always ready to help.

Michael A. Miyasaki, DDS is an active clinician in Sacramento, California and an educator in aesthetics, occlusion and high-tech approaches to dental care. He has used hard- and soft-tissue lasers in his practice for more than 20 years and is involved in laser education. He is the founder of Principle-Based Dentistry International and is involved in live-patient courses in his role as the Director of Education for the Pacific Aesthetic Continuum. Dr Miyasaki seeks out and educates his colleagues on techniques and equipment that can improve treatment outcomes and quality of care.