Dual pulse-width medical laser with presets
Contents
1. JOVIYSALNI JOS INOO H31VM JOYLNOD 3571 009 ctu 089 929 0 9 S99 TINO SOVINSINI o z _ JOuNOONV _ 099 30H1NOO u31VM IND 3109 089 201409 31V dau u3MOd 7 TINO 3519 859 103109 43571 9 sMunosxs Loto AMOWSI LN3NVIWiH3d 208 Slasaud 069 ASOWSW 1 cis SNDISOM 0 9 HOSS32OMd S09 U S Patent Jun 28 2011 Sheet 8 of 8 US 7 970 030 B2 810 PREPARE ACCESS TO PULP CHAMBER USING G6 TIP AND PRESETS FOR CUTTING ENAMEL AND DENTIN REMOVE CORONAL PORTION OF INFECTED ue NECTOTIC PULP USING G6 FIBER TIP 830 PERFORM INITIAL INSTRUMENTATION 840 PERFORM LASER ROOT CANAL ENLARGEMENT 850 MEASURE WORKING LENGTH 860 ENLARGE ROOT CANAL USING Z2 FIBER TIP 870 ENLARGE ROOT CANAL USING Z3 FIBER TIP 880 ENLARGE ROOT CANAL USING Z4 FIBER TIP FIG 10 US 7 970 030 B2 1 DUAL PULSE WIDTH MEDICAL LASER WITH PRESETS CROSS REFERENCE TO RELATED APPLICATIONS This application is a continuation in part of U S applica tion Ser No 11 191 594 filed Jul 27 2005 now U S Pat No 7 630 420 and entitled DUAL PULSE WIDTH MEDICAL LASER the entire contents of which are incorporated herein by reference U S application Ser No 11 191 594 claims the benefit of U S Provisional Application No 60 591 933 filed Jul 27 2004 and entitled DUAL PULSE WIDTH MEDI CAL LASER the en2. 12 A method of using a power supply to generate dual pulse outputs for an electromagnetic energy output device the method comprising Providing a plurality of high voltage outputs from the power supply including at least a first voltage of about 200 500 volts and a second voltage of about 1200 1500 volts and Providing a plurality of pulse forming networks having capacitors of about 30 70 uF and 300 600 uF and induc tors of about 30 70 uH and 800 1200 uH wherein the plurality of high voltage outputs drives the plurality of pulse forming networks with signals differing in one or more of duration and power 13 The method of claim 10 wherein the providing of a plurality of high voltage outputs is performed by providing only two high voltage outputs 14 The method of claim 10 wherein the providing of a plurality of pulse forming networks is performed by provid ing only two pulse forming networks 15 The method as set forth in claim 10 further comprising providing a laser pumping source capable of being pumped by the plurality of pulse forming networks 16 The method as set forth in claim 12 wherein the method comprises cutting tissue US 7 970 030 B2 19 17 The method as set forth in claim 12 wherein the elec tromagnetic energy output device is a laser that is pumped by the power supply 18 An apparatus comprising a device having a single power supply capable of supplying a first high potential output at a first
3. PATENT DOCUMENTS 3 051 905 A 8 1962 Haynes 3 051 906 8 1962 327 105 3 515 988 A 6 1970 315 240 3 578 986 A 5 1971 McGuffin et al 327 397 3 679 863 7 1972 Houldcroft et al 3 679 998 A 7 1972 Dahlinger 3 711 725 1 1973 Johannessen 307 108 3 914 648 A 10 1975 Friedman et al 3 991 296 A 11 1976 Kojima et al 4 005 333 1 1977 Nichols Continued FOREIGN PATENT DOCUMENTS DE 3840126 5 1990 Continued OTHER PUBLICATIONS Cook Pulse Forming Network Investigation Aug 1975 Thesis at Texas Tech University Continued Primary Examiner Jessica T Stultz Assistant Examiner Joshua King 74 Attorney Agent or Firm Stout Uxa Buyan amp Mullins LLP 57 ABSTRACT A medical laser device is described that generates a laser beam controllable with presets as to pulse duration pulse repetition rate power and energy per pulse The device also provides presets with respect to water and air outputs Para metric values for power pulse duration pulse repetition rate and energy per pulse as well as for water and air settings may be programmed by an end user and stored as presets 20 Claims 8 Drawing Sheets 165 175 US 7 970 030 B2 Page2 4 087 705 4 276 518 4 550 275 4 724 299 4 770 811 4 826 431 4 862 888 4 908 030 4 910 438 4 913 142 4 931 047 4 985 027 5 086 378 5 092 773 5 092 864 5 102 410 5 151 029 5 199 870 5 221 561
4. in view of this disclosure or suggested by the incorporated Waterlase User Manual c f Tables 2 6 and related text In modified implementations in the context of the present pro cedure either of the two modes can be combined in any sequence or proportion to include for example long pulse mode cutting followed by short pulse mode cutting visa versa and or treatments using long pulses interspersed in short pulse mode pulse sequences and or short pulses inter spersed in long pulse mode pulse sequences 20 25 30 35 40 45 50 55 60 65 16 Apicoectomy Procedures During cutting of gingival tissue in an apicoectomy proce dure as described in Appendix C of the incorporated Water lase amp User Manual bleeding of the gingival tissue may be attenuated or treated by switching to long pulse mode e g via the end user activating a preset or manually which for example may configure the cutter to a power of about 1 2 W a pulse repetition rate of about 40 50 Hz an energy per pulse of about 20 40 mJ a water setting of about 0 and an air setting of about 10 2096 and or to combinations of values as disclosed in Table 4 of the incorporated Waterlase amp User Manual Short pulse mode procedures as set forth in a section of Appendix C discussing apicoectomy procedures may be enabled using presets With reference to the apicoectomy procedure set forth in Appendix C ofthe incorporated Water lase amp User Manu
5. 5 237 331 5 242 454 5 263 950 5 267 856 5 313 481 5 318 562 5 334 019 5 374 266 5 388 988 5 401 171 5 409 376 5 498 935 5 552 675 5 554 172 5 570 182 5 611 797 5 694 046 5 723 864 5 729 562 5 741 247 5 755 751 5 764 672 5 785 521 5 820 627 5 825 958 5 828 803 5 869 805 6 080 148 6 083 218 6 106 516 6 118 521 6 193 711 6 223 987 6 231 567 6 254 597 6 288 499 6 315 772 6 350 123 6 389 193 6 449 301 6 512 782 6 561 803 6 567 582 6 669 685 6 701 181 6 878 899 U S PATENT DOCUMENTS gt a lt 0 gt gt gt gt 0 gt lt dt td 2 2 5 1978 6 1981 10 1985 2 1988 9 1988 5 1989 9 1989 3 1990 3 1990 4 1990 6 1990 1 1991 2 1992 3 1992 3 1992 4 1992 9 1992 4 1993 6 1993 8 1993 9 1993 11 1993 12 1993 5 1994 6 1994 8 1994 12 1994 2 1995 3 1995 4 1995 3 1996 9 1996 9 1996 10 1996 3 1997 12 1997 3 1998 3 1998 4 1998 5 1998 6 1998 7 1998 10 1998 10 1998 10 1998 2 1999 6 2000 7 2000 8 2000 9 2000 2 2001 5 2001 5 2001 7 2001 9 2001 11 2001 2 2002 5 2002 9 2002 1 2003 5 2003 5 2003 12 2003 3 2004 4 2005 Barnes Ferguson O Loughlin Hammeke Myers Fujimura et al Yessik Linkow et al Farnsworth Kittrell et al Broadwin et al Dressel Prince Levy Hayes et al Dressel Levy Steiner et al Flicstein et al
6. FIG 1 is a flow diagram describing an implementation of the method of the present invention FIG 2 is a schematic diagram illustrating an embodiment of a dual pulse width flashlamp driving circuit according to the present invention FIG 3 is a plot depicting short long and mixed electro magnetic energy pulses generated by the dual pulse width flashlamp driving circuit shown in FIG 2 in accordance with various aspects of the present invention FIG 4 is a pictorial diagram ofa delivery system capable of transmitting electromagnetic energy to a treatment site in according to an exemplary embodiment the present invention FIG 5 is a partial cut away diagram of a handpiece tip in accordance with an exemplary implementation of the present invention FIG 5a is a detailed illustration of an embodiment of a chamber for mixing spray air and spray water in the hand piece tip of FIG 5 FIG 6 is a cross sectional view of the handpiece tip of FIG 4 taken along line 6 6 in accordance with an aspect of the present invention FIG 7 is across sectional diagram ofa handpiece tip taken along line 7 7 in FIG 4 according to another aspect of the present invention FIG 8 is a flow diagram summarizing an implementation of a method of modifying and saving specified values as presets in accordance with the present invention FIG 9 is a block diagram of an embodiment of a medical electromagnetic energy controller capable of modifying and saving
7. Waterlase amp User Manual may include or be preceded by a modification of surfaces e g side wall surfaces of the root canal using for example the Waterlase amp in long pulse mode to modify e g close exposed tubule structures or openings The cutter which may comprise for example a Waterlase device may be set e g by the end user activating a preset or manually to a power of about 1 5 2 W a pulse repetition rate of about 30 Hz an energy per pulse of about 50 mJ a water setting of about 20 and an air setting of abut 40 Surfaces of the root canal may then be modified using a protocol similar to that of steps 840 880 For example Z2 Z3 and or Z4 output fiber tips can be successively used for about 5 10 upward strokes each wherein for example each upward stroke involves about 5 seconds of lasing and wherein the downward strokes do not entail lasing In another embodiment the long pulse proce dure may use only a Z4 output fiber tip to the exclusion ofthe Z2 and Z3 output fiber tips Modification of Prepared Cavity Surfaces cavity is first prepared using for example a short pulse mode wherein for example the parameters which may be any of those known to those skilled in the art or suggested in the incorporated Waterlase amp User Manual may be recalled for the procedure using a preset or manually in combination with techniques suggested in the incorporated Waterlase User Manual c f Tables 2 6 and related
8. bonding if a caries is present for example on or just below the gum line on the outer root surface the cutter e g Waterlase may be imple mented to remove the carious tissue in a short pulse mode Short pulse mode parameters generally known to those skilled in the art or suggested by the incorporated Waterlase User Manual may be used According to an exemplary embodiment the parameters are recalled for the procedure viaa preset or manually using techniques suggested in for example Tables 2 6 and related text of the incorporated Waterlase amp User Manual After preparation of the cavity on the outer root surface but before filling thereof the prepared cavity surface may be modified to for example enhance bonding properties The cutter e g Waterlase may be set e g by the end user activating a preset or manually to a long pulse mode and to the settings disclosed in the preceding section entitled Modification of Prepared Cavity Surfaces and surfaces of the prepared cavity may then be modified using a circular motion covering pertinent bonding surfaces for an exemplary time of 5 15 seconds In modified embodi ments the short mode and long mode pulse procedures may be swapped in time or combined 2 Desensitizing or Otherwise Treating the Outer Root Surface For desensitizing or otherwise treating the outer root sur face to the extent exposed the output fiber tip can be posi tioned and activated about 2 5 millime
9. first switching transistor 120 for example an insulated gate bipolar tran sistor IGBT and a first inductor 125 The first capacitor 115 is connected between the first high voltage output 110 and ground The first high voltage output 110 further is con nected to the first inductor 125 through the first switching transistor 120 and the flashlamp 150 is electrically connected between the first inductor 125 and ground The first pulse forming network 101 and the second pulse forming network 102 may be similar in form to a circuit such as that shown in FIG 3 of the above referenced U S application Ser No 11 033 032 entitled ELECTROMAGNETIC ENERGY DIS TRIBUTIONS FOR ELECTROMAGNETICALLY INDUCED MECHANICAL CUTTING The second pulse forming network 102 which is similar in form to the first pulse forming network 101 comprises a second capacitor 135 a second switching transistor 140 and a second inductor 145 The second high voltage output 130 is applied to a terminal of the second capacitor 135 which has another ter minal connected to ground The second high voltage output 130 also is coupled through a second switching transistor 140 to the second inductor 145 which is connected to the flashlamp 150 In typical embodiments of the dual pulse width analog flashlamp driving circuit 100 first and second capacitors 115 and 135 may assume values of respectively about 30 micro farads uF to about 70 uF with an exemplary value being ab
10. in combination with any part s of the present invention according to this disclosure that those ofthe patents and the knowledge and judgment of one skilled in the art U S Pat Nos 5 741 247 5 785 521 5 968 037 6 086 367 6 231 567 6 254 597 6 288 499 6 350 123 6 389 193 6 544 256 6 561 803 6 567 582 6 610 053 6 616 447 6 616 451 6 669 685 6 744 790 and 6 821 272 For example output optical energy distributions from the flashlamp 150 of the illustrated embodiment of the present invention may be useful for optimizing or maximizing a cutting effect of an electro magnetic energy source such as a laser that is driven by the flashlamp 150 The electromagnetic energy output can be directed for example into fluid e g an atomized distribu tion of fluid particles above a target surface An apparatus for directing electromagnetic energy into an atomized distribu tion of fluid particles above a target surface is disclosed in the above referenced U S Pat No 5 574 247 The long and or short pulses can impart large amounts of energy into the fluid e g atomized fluid particles which preferably comprises water to thereby expand the fluid e g fluid particles and apply disruptive e g mechanical cutting forces to the target surface In view of the foregoing it will be understood by those skilled in the art that the methods ofthe present invention can facilitate operation of electromagnetic energy devices and in particu
11. of the present invention FIG 7 is a cross sectional diagram taken through a housing portion 335 of the electromagnetic energy handpiece tip 245 of FIG 5 The illustrated embodiment depicts an output fiber tip 255 surrounded by a tip ferrule or sleeve 345 and option ally glue that fills a cavity 350 around the output fiber tip 255 to hold the output fiber tip 255 in place The housing portion 335 may comprise tip waveguides 325 circularly disposed about the output fiber tip 255 that may receive illumination light from the second mirror 320 FIG 5 and direct the illumination light to a target as described above In certain embodiments a plurality of fluid outputs 380 may be dis posed in the housing portion 335 of the handpiece tip 245 the fluid outputs 380 being configured to direct for example a mixture of air and water to a target A detailed illustration of an embodiment of a chamber for mixing spray air and spray water in the handpiece tip 245 is shown in FIG 5a As illustrated the mixing chamber com prises an air intake 370 connected to for example tubing not shown that connects to and receives air from a spray air connection in the connector 240 FIG 2 Similarly a water intake 375 may connect to tubing also not shown that con nects to and receives water from a spray water connection in the connector 240 FIG 4 The air intake 370 and the water intake 375 which may have circular cross sections about 250 um in dia
12. presets according to the present invention and FIG 10 is a flow diagram outlining a root canal clinical protocol wherein presets may be used in accordance with an exemplary implementation of the present invention DETAILED DESCRIPTION OF THE INVENTION Reference will now be made in detail to the presently preferred embodiments of the invention examples of which are illustrated in the accompanying drawings Wherever pos sible the same or similar reference numbers are used in the drawings and the description to refer to the same or like parts It should be noted that the drawings are in simplified form and are not to precise scale In reference to the disclosure herein for purposes of convenience and clarity only directional terms such as top bottom left right up down over above below beneath rear and front are used with respect to the accompanying drawings Such directional terms should not be construed to limit the scope of the invention in any manner 40 45 55 65 4 Although the disclosure herein refers to certain illustrated embodiments it is to be understood that these embodiments are presented by way of example and not by way of limitation The intent of the following detailed description although discussing exemplary embodiments is to be construed to cover all modifications alternatives and equivalents of the embodiments as may fall within the spirit and scope of the invention as defined by the append
13. text of the incorpo rated Waterlase User Manual or otherwise known to those skilled in the art After preparation of the cavity but before filling thereof the prepared cavity surface may be modified to for example enhance bonding properties The cutter e g Waterlase may be set e g by the end user activating a preset or manually to a power of about 2 5 3 W a pulse repetition rate of about 30 Hz an energy per pulse of about 80 100 mJ a water setting of about 10 1596 and an air setting of abut 25 30 Surfaces ofthe prepared cavity may then modified using a circular motion covering all bonding sur faces for a time of for example 5 15 sec Modification of Outer Root Surfaces at or Below Gum Line Outer root surfaces can be modified using a long pulse mode to perform at least one of 1 modifying a prepared cavity surface to enhance bonding and 2 desensitizing or otherwise treating the outer root surface Either of these operations can be implemented by setting e g via the end user activating a preset or manually the cutter e g Water lase to for example a power of about 3 a pulse repeti US 7 970 030 B2 15 tion rate of about 30 40 Hz an energy per pulse of about 80 100 mJ a water setting of about 15 2096 and an air setting of about 4096 1 Modifying a Prepared Cavity Surface to Enhance Bond ing For operations on outer root surfaces involving modifying a prepared cavity surface to enhance
14. to one embodiment treatment electromagnetic energy 305 is received by an internal waveguide such as treatment fiber 300 and is directed toward a first mirror 315 disposed in the distal portion 250 of the electromagnetic energy handpiece 220 whence reflected electromagnetic energy is directed toward the output fiber tip 255 Electromagnetic energy received by the output fiber tip 255 may be directed toward a target e g a treatment surface The output fiber tip 255 may be encased ina tip ferrule or sleeve 345 that together with the output fiber tip 255 forms a removable interchangeable unit asis described more fully in U S Provisional Application No 60 610 757 filed Sep 17 2004 and entitled OUTPUT ATTACHMENTS CODED FOR USE WITH ELECTRO MAGNETIC ENERGY PROCEDURAL DEVICE the entire contents of which are incorporated herein by reference to the extent compatible or modifiable by one skilled in the art to be compatible with any aspect or modified aspect of the present invention FIG 6 is a cross sectional diagram of a portion of an embodiment ofthe handpiece tip 245 the cross section being taken along a line 6 6 of FIG 5 The electromagnetic energy fiber 300 may carry electromagnetic energy that is directed toward first mirror 315 as already described According to another embodiment additional fibers such as illumination fibers 400 may carry another form of electromagnetic energy such as visible light blue light and the like
15. which electro magnetic energy may be directed toward a second mirror 320 FIG 5 whence the electromagnetic energy is directed toward a plurality oftip waveguides 325 FIG 5 disposed in a housing 335 as is more particularly described below with reference to FIG 7 Another implementation of the present invention receives reflected light from a target surface a first portion 330 of the reflected light being received from the output fiber tip 255 and a second portion ofthe reflected light not shown being received from the plurality of tip 20 25 30 35 40 45 50 55 65 8 waveguides 325 The reflected light including the first por tion 330 may be received by second mirror 320 which directs the reflected light to feedback fibers 405 FIG 6 disposed in an interior ofthe handpiece tip 245 The feedback fibers 405 may transmit the reflected light to the electromag netic energy base unit 230 where the reflected light can be analyzed as is described for example in U S application Ser No 11 203 677 filed Aug 12 2005 and entitled LASER HANDPIECE ARCHITECTURE AND METHODS and U S application Ser No 11 203 399 filed Aug 12 2005 and entitled CARIES DETECTION USING TIMING DIFFER ENTIALS BETWEEN EXCITATION AND RETURN PULSES the entire contents of both which are incorporated herein by reference to the extent compatible or modifiable by one skilled in the art to be compatible with any aspect or modified aspect
16. 513 515 520 525 and 530 for example by pressing up down buttons corresponding to respective values for pulse duration repetition rate pulse energy water setting and air setting After the values e g one or more ofthe values have been entered an embodiment of an electromagnetic energy hous ing such as laser housing 230 FIG 4 then stores the entered preset values in response to an end user pressing and holding the selected preset button at step 535 while waiting at step 540 for an audible notification e g a beep that the 20 40 45 50 55 65 10 entered preset value or values have been stored Until a beep is heard e g abouttwo to three seconds in one embodiment the end user continues to hold the selected preset button at step 545 and to wait for the audible indication After the audible indication is heard the implementation continues at step 550 with a decision which may be made by the end user as to whether more presets to be stored If more presets are to be stored then the implementation of the method can repeat commencing at step 505 When for example all pre sets have been stored the implementation of the method terminates at step 555 Presets once stored can be recalled for example according to a medical procedure to be per formed by pressing a preset number button on the user inter face according to an illustrative embodiment Returning to Table 1 the percent air setting
17. 690 may be connected to the user input panel 700 which may have disposed thereon a plurality of preset buttons 695 a SELECT button 720 an increment but ton 715 a decrement button 725 anda speaker 735 A function display strip 705 such as a liquid crystal display LCD may display a function chosen according to the SELECT button 720 and a numerical parameter value may be displayed in a value display strip 710 When an end user input is received on user communication line 690 the user interface 685 may communicate information between the user input panel 700 and the processor 605 For example the processor 605 may execute the user interface control instruction sequence 730 that minimally may cause the processor 605 to update a display such as a message presented in the function display strip 705 and or a value presented in the value display strip 710 according to the end user input In particular the user interface control instruction sequence 730 further may cause the processor 605 to interact with the user interface 685 for example to modify and store preset values 620 according to un 0 5 30 40 45 65 12 inputs provided by the end user The user interface control instruction sequence 730 further may cause the processor 605 to activate the speaker 735 Referring again to FIG 8 and with continued reference to FIG 9 an end user may for example modify and store a set of preset values The end user may
18. 7 OTHER PUBLICATIONS Cook Pulse Forming Network Investigation Aug 1975 Thesis at Texas Tech University Supplementary European Search Report EP 05711358 PCT US2005 000852 mailed Feb 8 2010 International Search Report Jun 30 2008 PCT US08 05 1963 International Search Report May 23 2008 PCT US08 05 1967 International Search Report amp Written Opinion Sep 2 2005 PCT US05 00849 International Search Report amp Written Opinion Jul 31 2006 PCT US06 00989 International Search Report amp Written Opinion Oct 25 2006 PCT US05 28891 International Search Report Dec 10 1998 PCT US98 12357 Written Opinion Apr 15 1999 PCT US98 12357 European Search Report Jun 6 2005 EP 05 07 5231 Partial European Search Report Apr 6 2000 EP 98 92 9060 T S Fahlen Efficient Quarter Joule KrF Laser with Corona Prelonization IEEE Journal of Quantum Electronics vol QE 15 No 5 pp 311 312 May 5 1979 Bernard Grob Basic Electronics Glencoe division of Macmillan McGraw Hill pp 690 681 1989 New Laser Matter Interaction Concept to Enhance Tissue Cutting Efficiency by Ioana M Rizoiu and Larry G DeShazer published in SPIE col 2134A Laser Tissue Interaction V 1994 309 Rizoiu Ioana and Levy Guy C Efficiency of Bone Ablation with an Nd YAG Laser Beam Delivered with a Cooling Spray SPIE vol 1882 Laser Tissue Interaction IV 1993 pp 316 321 Rizoiu Ioana and Levy Guy C
19. 8 um may be driven with the architec ture of this circuit Parameters of the first and second pulse forming networks may be adjusted to produce respectively pulses having relatively short and long durations In a typical embodiment relatively short pulses having durations of for example about 140 microseconds us are produced by the first pulse forming network and relatively long pulses having durations of for example about 400 us are produced by the second pulse forming network Repetition rates forthe pulses may range for example from about 1 to 50 pulses second US 7 970 030 B2 5 partial schematic diagram of an embodiment of a dual pulse width analog flashlamp driving circuit 100 according to the present invention is shown in FIG 2 comprising a high voltage power supply 105 capable of producing dual i e respective first and second high voltage outputs 110 and 130 using methods known to those skilled in the art The illus trated embodiment of the dual pulse width analog flashlamp driving circuit 100 further comprises a first pulse forming network 101 and a second pulse forming network 102 con nected to respective first and second high voltage outputs 110 and 130 First and second pulse forming networks 101 and 102 are further connected to a flashlamp 150 that may func tion as a pumping source for a laser not shown The first pulse forming network 101 in the illustrated embodiment comprises a first capacitor 115 a
20. Henderson et al Gundlach et al L Esperance Jr Wolbarsht et al Cook et al Levy et al Goldsmith et al Kataoka et al Goisser et al Paghdiwala Murphy McMahan et al Lemelson Horner et al Nathel et al George Hillerich et al Atkinson et al Birx et al Rizoiu et al Eckhouse Ukita et al Rizoiu et al Rosen et al Gollihar et al Eckhouse Beyer et al Damasco et al Chou Massengill Jung et al Connors et al Knowles et al Rizoiu et al Rizoiu et al Rizoiu et al Marchitto et al Rizoiu et al Kimmel et al Wu et al Hsia et al Rizoiu et al Rizoiu et al Rizoiu et al Tang et al Smart 6 902 290 B2 6 2005 Watts et al 7 097 639 8 2006 Almeida 7 415 050 B2 8 2008 Rizoiu et al 2002 0149324 Al 10 2002 Rizoiu et al 2003 0069567 4 2003 Eckhouse et al 606 9 2003 0100824 5 2003 Warren et al 2003 0227953 12 2003 Hsiaetal 372 53 2005 0137655 6 2005 2005 0143792 6 2005 Jay 2006 0020309 1 2006 Altshuler et al FOREIGN PATENT DOCUMENTS DE 4138468 3 1993 EP 0181199 5 1986 EP 0912833 9 1986 EP 0454312 A2 10 1991 EP 0454312 A3 10 1991 EP 96 41657 12 1995 GB 2 023 330 12 1979 GB 2297610 8 1996 JP 5945092 3 1984 JP 5200045 A 8 1993 JP 5506601 A 9 1993 JP 11511386 A 10 1999 JP 200301465 1 2003 JP 2003070722 A 3 2003 WO 9004358 A1 5 1990 WO 97 07928 A3 3 1997 WO 9707928 3 1997 WO 97 45165 4 199
21. Morphological Changes of Dentin and Enamel after Ablation with an Experimental Laser System SPIE vol 2128 pp 282 288 cited by examiner U S Patent Jun 28 2011 Sheet 1 of 8 US 7 970 030 B2 PROVIDE FIRST HIGH VOLTAGE OUTPUT FROM n HVPS CAPABLE OF DRIVING FIRST PFN PROVIDE SECOND HIGH VOLTAGE OUTPUT FROM HVPS CAPABLE OF DRIVING SECOND PFN PROVIDE LASER PUMPING SOURCE GENERATE LASER PULSE HAVING FIRST DURATION GENERATE LASER PULSE HAVING SECOND DURATION FIG 1 15 25 30 U S Patent Jun 28 2011 Sheet 2 of 8 US 7 970 030 B2 175 Hi Voltage LU Power 150 Supply P time P b time P N f f c time FIG 3 U S Patent Jun 28 2011 Sheet 3 of 8 US 7 970 030 B2 FIG 4 U S Patent Jun 28 2011 Sheet 4 of 8 US 7 970 030 B2 U S Patent Jun 28 2011 Sheet 5 of 8 US 7 970 030 B2 246 400 405 300 400 405 U S Patent Jun 28 2011 Sheet 6 of 8 US 7 970 030 B2 500 505 ENTER POWER SETTING PRESS AND HOLD BUTTON FOR SELECTED PRESET CONTINUE TO HOLD 510 513 515 520 525 530 535 540 AUDIBLE INDICATION 550 MORE PRESETS 555 FIG 8 US 7 970 030 B2 Sheet 7 of 8 Jun 28 2011 U S Patent su ozz 199188 SLL mor 902 012 6000 Gel 002 S69 069 6 Sis S89 39959344 SJOVAYSLNI
22. a pulse duration e g a long pulse mode having pulse durations selectable or variable from about 650 to about 1000 us or a short pulse mode having a pulse duration of about 140 us such as a currently active pulse duration as a parameter and further can store one or more additional parameters from a group including power in watts W pulse repetition rate in hertz Hz energy per pulse in millijoules mJ water setting 96 and air setting 99 FIG 8 is a flow diagram summarizing an implementation of a method of modifying and saving predetermined or pre ferred values as presets The illustrated implementation com mences at step 500 and can continue by selecting a preset number at step 505 after which a power setting can be entered atstep 510 According to one embodiment a user interface on an electromagnetic energy base unit comprises a plurality of buttons including preset buttons and a display whereby an end user as distinguished from a manufacturer or technician may select a preset by pressing a button associated with the selected preset A power setting which may relate for example to an emitted power level of an electromagnetic energy e g laser beam may be entered by pressing buttons e g power up down buttons on the keypad in a manner known to those skilled in the art Similarly values for one or more of pulse duration repetition rate pulse energy water setting and air setting may be entered at respective steps
23. a2 United States Patent Rizoiu et al US007970030B2 US 7 970 030 B2 Jun 28 2011 10 Patent No 45 Date of Patent 54 75 73 21 22 65 63 60 51 52 58 DUAL PULSE WIDTH MEDICAL LASER WITH PRESETS Inventors Ioana M Rizoiu San Clemente CA US Dmitri Boutoussov Dana Point CA US Assignee Biolase Technology Inc Irvine CA US Notice Subject to any disclaimer the term of this patent is extended or adjusted under 35 U S C 154 b by 183 days Appl No 12 368 266 Filed Feb 9 2009 Prior Publication Data US 2009 0141752 A1 Jun 4 2009 Related U S Application Data Continuation in part of application No 11 191 594 filed on Jul 27 2005 now Pat No 7 630 420 which is a continuation in part of application No 11 033 032 filed on Jan 11 2005 now abandoned which is a continuation in part of application No 11 203 400 filed on Aug 12 2005 now abandoned Provisional application No 60 591 933 filed on Jul 27 2004 provisional application No 60 601 415 filed on Aug 13 2004 Int Cl HOIS 3 00 2006 01 US 372 38 04 372 38 06 372 25 372 30 372 31 372 38 02 372 70 606 10 606 11 Field of Classification Search 372 38 06 372 38 04 25 30 31 38 02 70 606 10 606 11 See application file for complete search history 100 CN Hi Voltage Power Supply 56 References Cited U S
24. al as modified by the disclosure herein other implementations may comprise either of the two 1 long and short pulse soft tissue cutting modes being used or combined in any sequence or proportion to include for example short pulse mode cutting followed by long pulse mode cutting visa versa and or treatments using long pulses interspersed in short pulse mode pulse sequences and or short pulses interspersed in long pulse mode pulse sequences This disclosure can be extended to other soft tissue procedures such as frenectomies As an example of an api coectomy procedure a first preset can be activated by the end user to facilitate short pulse mode incising cutting followed by the end user activating a second preset to facilitate a long pulse mode treatment which may induce for example reduced bleeding cutting or coagulation via lasing the tissue for about 5 10 seconds whereby the operation may continue with additional switches to or between one or more ofthe two i e long pulse and short pulse cutting modes Corresponding or related structure and methods described in the following patents assigned to BioLase Technology Inc are incorporated herein by reference in their entireties wherein such incorporation includes corresponding or related structure and modifications thereof in the following patents which may be 1 operable with 11 modified by one skilled in theart to beoperable with and or iii implemented used with or
25. and or the decrement button 725 until a desired value for power is displayed in the value display strip 710 The end user may again press the SELECT button 720 to change the content of the function display strip 705 to for example PUL DUR indication for example of an electro magnetic energy pulse duration according to step 513 of FIG 8 Again the user interface instruction sequence 730 may cause the processor 605 to present in the value display strip 710 a value currently stored for electromagnetic energy pulse duration according to the selected preset The end user then may adjust the value displayed in the display strip 710 by pressing the increment and decrement buttons 715 and 725 in a manner similar to that already described The end user may continue to initiate updating of param eter values for selected preset numbers according to for example steps 515 520 525 and 530 of FIG 8 The user interface control instruction sequence 730 may cause the processor 605 to store updated parameter values in for example working memory 610 When the end user completes updating desired parameter values the end user may press and hold the selected one of the preset buttons 695 The user interface control instruction sequence 730 may cause the processor 605 to execute a timing instruction sequence not shown thereby waiting for about 2 to 3 seconds after which time interval the user instruction control instruction sequence 7730 may cause the
26. and the percent water setting set forth therein may be directed to one or more fluid outputs cf 380 of FIGS 5 5a and 7 at pressures ranging from about 5 pounds per square inch psi to about 60 psi and at flow rates ranging from about 0 5 liters minute to about 20 liters minute A liquid e g water may be directed to one or more ofthe fluid outputs 380 at pressures ranging from about 5 psi to about 60 psi and at flow rates ranging from about 2 milli liters ml minute to about 100 ml minute In other embodi ments the air flow rate can go as low as about 0 001 liters minute and or the liquid flow rate can go as low as about 0 001 ml minute In certain implementations a water flow rate through a water line disposed in the electromagnetic energy hand piece may be about 84 ml minute e g 100 and an air flow rate through an air line of the electromagnetic energy handpiece 220 FIG 4 may be about 13 liters minute e g 100 These values may be understood in reference to such flow rates or to other flow rates suggested in the incor porated Waterlase amp User Manual or otherwise known to those skilled in the art in the same context In accordance with an aspect of the present invention the storing of one or more combinations of values in whole or in part as presets may enable an end user to switch among the presets for example during an operation thereby permitting the end user to quickly and reliably accomplish multiple proc
27. ces present issues such as limited pulse repetition rates relatively expensive driving circuitry somewhat rectangular rather than bell shaped current pulse shapes and relatively numerous voluminous and or heavy capacitors While the invention has been described in the context of first and second pulse forming networks it is to be under stood that greater numbers of pulse forming networks each similar to the first and second pulse forming networks but being constructed for generating pulses of different lengths are also contemplated Moreover while the invention has been described in the context of using a single power supply to generate two pulse outputs for an electromagnetic energy output device implementations ofthe present invention using three or more pulse forming networks may comprise a single power supply or may comprise a number of power supplies that is less than the number of pulse forming networks Additionally other combinations omissions substitutions and modifications will be apparent to the skilled artisan in view ofthe disclosure herein Accordingly the present inven tion is not intended to be limited by the disclosed embodi ments but is to be defined by reference to the appended claims What is claimed is 1 method of using a power supply to generate dual pulse outputs for an electromagnetic energy output device the method comprising providing a first high voltage output of about 1200 1500 volts fro
28. ct use of the various output attachments at varying times in a given operation or procedure An embodiment of the present invention may include a visual indication of color codes or topography codes indicative of and corresponding to output tips having a color pattern various attachments being used at various times as is more fully described in the above referenced U S Provi sional Application No 60 610 757 filed Sep 17 2004 entitled OUTPUT ATTACHMENTS CODED FOR USE WITH ELECTROMAGNETIC ENERGY PROCEDURAL DEVICE Inthe context ofimplementing part or all of steps 1 8 ofthe root canal clinical protocol described in Appendix C of the incorporated Waterlase amp User Manual which steps corre spond to steps 810 880 of FIG 10 a first display on for example an electromagnetic energy base unit 230 FIG 4 may instruct that the end user prepare access to the pulp chamber at step 810 using a G6 output fiber tip at a setting manual or preset of operating parameters appropriate for cutting enamel and dentin For example presets 1 and 2 as presented in Table 1 above may be used to prepare access to the pulp chamber The first display or a subsequent display may instruct that the end user then use the same output fiber tip at step 820 to remove the coronal portion of the infected necrotic pulp at an appropriate setting of operating param eters According to one embodiment the operating param eters may be preset The same or a subsequent di
29. ction sequence 630 an electromagnetic energy e g laser control instruction sequence 635 a water control instruction sequence 655 an air control instruction sequence 660 and a user interface control instruction sequence 730 The electro magnetic energy control instruction sequence 635 may com prise as examples a power control instruction sequence 640 a pulse duration control instruction sequence 638 a repetition rate control instruction sequence 645 and a pulse energy control instruction sequence 650 The permanent memory 625 in this and other embodiments may have stored therein additional instruction sequences related for example to elec tromagnetic energy handpiece functions tangential to or out side of the immediate scope of the present invention For example the permanent memory 625 may contain an instruc tion sequence that controls electromagnetic energy pulse shape according to an end user input as well as similar types of instruction sequences related to operation of medical elec tromagnetic energy e g laser systems The executive instruction sequence 630 minimally may cause the processor 605 to schedule and coordinate the aforementioned instruc tion sequences as well as additional instruction sequences not described herein According to an exemplary mode of operation the embodi ment of FIG 9 receives an input from an end user i e an end user input on a user communication line 690 The user communication line
30. d using a cutter such a Waterlase device are elucidated for various operations wherein short pulse modes may be used for some procedures of a given operation and long pulse modes may be used for other procedures of the operation These examples include modification of root canal surfaces modification of prepared cavity surfaces modifica tion of root surfaces at or below the gum line including modifying a prepared cavity surface to enhance bonding and further including desensitizing or otherwise treating an outer root surface and apicoectomy procedures Modification of Root Canal Surfaces Appendix C ofthe incorporated Waterlase amp User Manual describes a root canal clinical protocol that is abstracted in FIG 10 Operating parameters for the procedure as delin eated in the incorporated Waterlase User Manual e g power pulse repetition rate energy per pulse water percent age and or air percentage and as another option pulse dura tion may be entered manually or may be recalled using a preset such as a preset presented above in Table 1 In accordance with an aspect of the present invention a monitor that may form part of the electromagnetic energy base unit 230 FIG 4 may instruct use of various output attachments such as output fiber tips According to an exem plary implementation various output attachments are embodied in the form of output fiber tips identified as G6 Z2 73 and the like The monitor may instru
31. ed claims It is to be under stood and appreciated that the process steps and structures described herein do not cover a complete architecture and process flow for operation of electromagnetic energy e g laser devices The present invention may be practiced in conjunction with various structures and techniques that are conventionally used in the art and only so much of the com monly practiced items are included herein as are necessary to provide an understanding of the present invention The present invention has applicability in the field of electromag netic treatment devices in general For illustrative purposes however the following description pertains to a medical laser device and a method of operating the medical laser device to perform tissue treatments and surgical functions Referring more particularly to the drawings FIG 1 is a flow diagram describing an implementation of the method of the present invention This implementation of the method provides a first high voltage output from a high voltage power supply HVPS at step 10 The first high voltage output is capable of driving a first pulse forming network PFN A second high voltage output from the HVPS is provided at step 15 The second high voltage output is capable of driving a second pulse forming network An exemplary embodiment of the high voltage outputs described herein can provide about 1500 volts from the first high voltage output and about 500 volts from the seco
32. edures of a given operation Efficiency may be increased along with accuracy such as in the context of relatively com plex operations that implement combinations of short pulse mode procedures and long pulse mode procedures FIG 9 is a block diagram of an exemplary embodiment of a medical electromagnetic energy e g laser controller 600 capable of modifying and saving presets according to an aspect of the present invention The illustrated embodiment which may be disposed for example in an electromagnetic energy base unit 230 FIG 4 comprises a processor 605 e g a microprocessor working memory 610 nonvolatile memory 615 permanent memory 625 and a user interface 685 The embodiment further comprises an electromagnetic energy e g laser control interface 670 a water control interface 675 and an air control interface 680 The aforemen tioned elements of the embodiment are interconnected by a system bus 665 that facilitates communication among the elements The illustrated embodiment further comprises a user input panel 700 In some embodiments the processor 605 the working memory 610 e g random access memory RAM the nonvolatile memory 615 the permanent memory 625 and other system elements such as a clock not shown may be implemented on a single microcontroller chip as an application specific integrated circuit ASIC In other embodiments the electromagnetic energy control inter face 670 the water control inter
33. electromagnetic energy pulses according to a typical mode of un 0 jak 5 20 25 30 40 45 50 55 65 6 operation of the illustrated embodiment A user input 170 which may comprise for example a switch on a electromag netic energy housing or handset not shown may specify parameters e g user adjustable parameters such as pulse duration and or pulse repetition rate In certain embodiments additional switching transistors 121 and 141 shown in phan tom in FIG 2 may be provided in order to increase current capacity of the first and second pulse forming networks 101 and 102 A relatively short current pulse 175 may be produced by the first pulse forming network 101 in the embodiment ofthe dual pulse width analog flashlamp driving circuit 100 illus trated in FIG 2 The second pulse forming network 102 may produce a relatively long current pulse 180 with parameters chosen substantially as described herein FIG 3 isa chart illustrating three exemplary chains a b c of electromagnetic energy pulses capable of being produced by an electromagnetic energy e g laser device driven by a dual pulse width circuit according to the present invention such as a dual pulse width analog flashlamp driving circuit 100 shown in FIG 2 Chain a illustrates electromagnetic energy such as laser energy generated according to relatively long pulses Chain b illustrates relatively short pulses of electromagnetic ener
34. face 675 the air control interface 680 and user interface 685 further may be imple mented on the same chip In yet other embodiments the latter US 7 970 030 B2 11 four elements may be implemented on a companion chip to the microcontroller chip These and other equivalent imple mentations are contemplated by the present invention The nonvolatile memory 615 may be configured to have stored therein presets 620 The illustrated embodiment com prises four presets identified as 1 2 3 and 4 Default or pre programmed values for the presets 620 may be stored in nonvolatile memory 615 at a time of manufacture of the medical electromagnetic energy controller 600 However because they are stored in nonvolatile memory 615 which can be altered values of the presets can be changed under end user control Once changed the stored preset values are retained in the nonvolatile memory 615 which is capable of maintaining integrity of stored data even in an absence of electrical power being supplied to the medical electromag netic energy controller 600 The permanent memory 625 which may be programmed at a time of manufacture of an ASIC for example may have instruction sequences stored therein that may when executed by the processor 605 cause the medical electromagnetic energy controller 600 to perform functions according to the present invention These instruction sequences in the illus trated embodiment can include an executive instru
35. gy such as laser energy and chain c depicts a mixture of relatively long and short pulses An end user such as a dentist or physician as distinguished from a manufacturer or technician may select a type of pulse chain to be produced using for example a user input 170 FIG 2 Long pulses generated by the embodiment illustrated in FIG 2 may be used to achieve an objective of cutting tissue with good hemostasis no bleeding and no charring of a cut surface Conversely short pulses generated by the same embodiment may provide for cutting with bleeding in order to promote post operative healing In another application short pulses may be employed in the cutting of hard tissue e g tooth enamel dentin bone while long pulses may be used in cutting soft tissue e g periodontal mucosa liver kidney and to perform thermal modifications Examples of long pulse and short pulse applications are described in for example the above referenced U S Provisional Application No 60 601 415 entitled DUAL PULSE WIDTH MEDICAL LASER WITH PRESETS and U S application Ser No 11 033 032 entitled ELECTROMAGNETIC ENERGY DIS TRIBUTIONS FOR ELECTROMAGNETICALLY INDUCED MECHANICAL CUTTING According to cer tain implementations of the present invention use of the methods and apparatus described herein are not restricted to medical or dental applications alone and similar methods and apparatus contemplated by the present invention may be applied in
36. industrial applications such as for removing and shaping semiconductor materials FIG 415 pictorial diagram ofa delivery system capable of transferring electromagnetic e g laser energy to a treat ment site The illustrated embodiment comprises an electro magnetic energy e g laser handpiece 220 that connects to an electromagnetic energy e g laser base unit 230 using a linking element 225 The linking element 225 may comprise a conduit 235 which may include one or more electromag netic energy e g laser conduits or fibers tubing for air tubing for water and the like The linking element 225 further may comprise a connector 240 that joins the conduit 235 to the electromagnetic energy base unit 230 The connector 240 may be an identification connector as is described more fully in U S application Ser No 11 192 334 filed Jul 27 2005 and entitled IDENTIFICATION CONNECTOR FOR A MEDICAL LASER HANDPIECE the entire contents of which are incorporated herein by reference to the extent com US 7 970 030 B2 7 patible or modifiable by one skilled in the art to be compatible with any aspect or modified aspect of the present invention The electromagnetic energy handpiece 20 may comprise an elongate portion 222 and a handpiece tip 245 the elongate portion 222 having disposed therein a plurality of optical fibers that may connect to or that are the same as the optical fibers included in the conduit 235 A proximal 1 re
37. lar examples medical laser devices exhibiting a capa bility of producing laser pulses having a plurality of pulse US 7 970 030 B2 17 durations The above described embodiments have been pro vided by way of example and the present invention is not limited to these examples Multiple variations and modifica tionto the disclosed embodiments will occur to the extent not mutually exclusive to those skilled in the art upon consider ation of the foregoing description For example a pumping circuit comprising a plurality e g more than two of high voltage outputs and correspond ing pulse forming networks e g for generating three or more outputs of varying pulse width is contemplated by the present invention The present invention may be used with or constructed to implement different electromagnetic energy pulse durations and varying amounts of fluid e g water streams sprays or mists in the context of for example Erbium types of lasers for facilitating for example multiple treatment or cutting effects such as hemostatic type and bleeding type tissue cutting effects For example a wave length of about 3 um and pulse durations of 50 us and 1000 us may be implemented to provide first and second cutting effects as desired The present invention may also be used or constructed with capacitor charging power supplies in the generation of pulses having variable duration keeping in mind that such modifi cations may in some instan
38. latively nearer to the electromagnetic energy base unit 230 portion 221 and a distal relatively further from the electromag netic energy base unit 230 portion 250 may be disposed at respective proximal and distal ends of the electromagnetic energy handpiece 220 The distal portion 250 has protruding therefrom an output fiber tip 255 that is described below in more detail with reference to FIG 5 As illustrated the link ing element 225 has a first end 226 and a second end 227 First end 226 couples to a receptacle 232 of the electromagnetic energy base unit 230 Second end 227 couples to the proximal portion 221 of the electromagnetic energy handpiece 220 The connector 240 may connect mechanically to the electro magnetic energy base unit 230 with a threaded connection to the receptacle 232 FIG 5 is a partial cut away diagram of a handpiece tip 245 cf FIG 4 that couples with the electromagnetic energy base unit 230 through the linking element 225 and the elongate portion 222 of the electromagnetic energy handpiece 220 The illustrated embodiment which is enclosed by an outer surface 246 may receive power or treatment electromagnetic e g laser energy from the electromagnetic energy base unit 230 Typically the treatment electromagnetic energy is trans mitted through a waveguide such as treatment fiber 300 disposed in the elongate portion 222 and the handpiece tip 245 as described below with reference to FIG 6 According
39. m the power supply the first high voltage output being capable of driving a first pulse forming network that has a capacitor of about 30 70 uF and inductor of about 30 70 uH and is configured to generate a first pulse output and providing a second high voltage output of about 200 500 volts from the power supply the second high voltage output being capable of driving a second pulse forming network that has a capacitor of about 300 600 uF and an inductor of about 800 1200 uH and is configured to generate a second pulse output 2 The method as set forth in claim 1 further comprising providing a pumping source capable of being pumped by at least one of an output from the first pulse forming network and an output from the second pulse forming network wherein the providing of a second high voltage output com 20 25 30 35 40 45 50 55 60 65 18 prises providing a second high voltage output configured to generate a second pulse output differing from the first pulse output in one or more of duration and power 3 The method as set forth in claim 2 further comprising generating a pulse having a first duration by pumping the pumping source with the first pulse output and generating a pulse having a second duration by pumping the pumping source with the second pulse output 4 The method as set forth in claim 3 further comprising generating a plurality of pulses by repetitively pumping the pumping source
40. meter join at an angle 365 that may approximate 110 in a typical embodiment Mixing may occur or begin to occur in a neighborhood where the air intake 370 and water intake 375 join and a spray e g atomized mixture 385 of water and air may be ejected through a fluid output 380 The embodiment illustrated in FIG 7 depicts three fluid outputs 380 These fluid outputs may for example correspond to comprise parts of or comprise substantially all of any ofthe fluid outputs described in U S application Ser No 11 042 824 filed Jan 24 2005 and entitled ELECTROMAGNETI CALLY INDUCED CUTTER AND METHOD the entire contents of which are incorporated herein by reference to the extent compatible or modifiable by one skilled in the art to be compatible with any aspect or modified aspect of the present invention The fluid outputs 380 may as illustrated in FIGS 4 and 7 have a circular cross section measuring about 350 um in diameter One aspect of the present invention as outlined in User Manual for a Waterlase All Tissue Laser for Dentistry ref erenced herein as the incorporated Waterlase User Manual the entire contents of which are incorporated herein by reference includes programmed parameter values referred to herein as presets the presets being applicable to various surgical procedures Presets may be programmed at a time of manufacture of a device in which case the presets may be referred to as pre programmed presets Alte
41. nd high voltage output A pumping source such as a laser pumping source is further provided at step 20 according to the implementation In a representative embodiment the laser pumping source can comprise a flashlamp capable of stimulating emission of coherent light by a laser device such as for example an Er YSGG or Er Cr YSGG solid state laser At step 25 of the implementation an electromagnetic energy e g laser pulse having a first duration i e width is generated by pumping the laser pumping source with the first pulse forming network output Similarly at step 30 a laser pulse having a second duration may be generated by pumping the laser pumping source with the second pulse forming network output An example ofa circuit capable of driving a flashlamp from first and second high voltage outputs is described below with reference to FIG 2 A relatively detailed implementation of the circuit of FIG 2 is disclosed in FIGS 2p and 3p of U S Provisional Application No 60 591 933 filed Jul 27 2004 and entitled DUAL PULSE WIDTH MEDICAL LASER the entire contents of which are incorporated herein by reference to the extent compatible or modifiable by one skilled in the art to be compatible with any aspect or modified aspect of the present invention An Er YSGG or Er Cr YSGG solid state laser which is capable of generating electromagnetic energy having a wavelength in a range of about 2 70 microns to 2 80 um typically 2 7
42. or relevant for example in grafting applications Prior art methods of generating these first and second effects can include employing distinctly different devices for each type of tissue cutting Some prior art methods of per forming first and second effect procedures may include employing systems capable of generating different wave lengths of electromagnetic energy For example wavelengths of about 1 and about 3 um may be generated using and Erbium type lasers respectively Overhead time and effort that may be required in switching between two medical devices can be disadvantages of this approach Extra time and attendant discomfort from a point of view of a patient under going such procedures may represent additional disadvan tages A need exists in the prior art for laser devices capable of rapidly and efficiently transitioning between varying charac teristics or modes of operation to facilitate for example different desired cutting effects or procedures such as for facilitating both hemostatic type and bleeding type tissue cutting effects SUMMARY OF THE INVENTION An exemplary implementation of the method present invention addresses these needs by providing first and second high voltage outputs from a single power supply A laser pumping source e g a flashlamp also can be provided the laser pumping source being capable of exciting a laser that may be used for cutting tissue The first and second high voltage
43. out 50 uF and about 300 uF to about 600 uF with an exemplary value being about 400 uF First and second capaci tors may receive respective first and second high voltage outputs 110 and 130 The first high voltage output 110 in an illustrative embodiment has a value ranging from about 1200 volts to about 1500 volts at an impedance level capable of charging the first capacitor 115 at a rate of about 1500 Joules per second J s The second high voltage output 130 in the embodiment may range from about 200 volts to about 500 volts at an impedance level capable of charging the second capacitor 135 at a rate of about 1 J s The first inductor 125 may comprise an inductance of about 30 microhenries uH to about 70 uH such as a solid core inductor having a rated inductance of about 50 uH in an exemplary embodiment The second inductor 145 may comprise an inductance of about 800 uH to about 1200 uH such as a solid core inductor having aninductance of about 1 millihenry mH The flashlamp 150 may comprise a 450 to 900 torr source such as a 700 torr source Control signals 155 and 160 from a control device 165 may be applied to terminals of transistors 120 and 140 in order to enable operation of the first pulse forming network 101 or the second pulse forming network 102 Enabling the first pulse forming network 101 may generate relatively short electromagnetic energy pulses and enabling the second pulse forming network 102 may generate relatively long
44. outputs drive respective first and second pulse form ing networks capable of generating respective first and sec ond pulse outputs that pump the laser pumping source according to the exemplary implementation of the method Pulses produced by the first pulse forming network may be relatively short and pulses produced by the second pulse forming network may be relatively long Another embodiment ofthe present invention comprises an electromagnetic energy emitting device which according to an exemplary embodiment may comprise a medical laser device wherein the electromagnetic energy emitting device is capable of emitting a sequence of electromagnetic pulses having first durations and second durations wherein the elec tromagnetic energy emitting device is adapted to store pre sets specifying combinations of electromagnetic pulses hav ing first durations and second durations and wherein the apparatus is capable of cutting tissue One embodiment ofthe medical electromagnetic energy device can comprise a con troller capable of storing presets which may include param eters that control operation of the medical electromagnetic energy device Examples of parameters that may be stored as presets can include power pulse duration pulse repetition rate energy per pulse a water setting and an air setting Another embodiment of the medical electromagnetic energy device can include a user input panel through which a user can modify and save prese
45. potential level and a second high potential output at a second potential level the first potential level being higher than the second potential level a pumping source a first pulse forming network having a capacitor of about 30 70 uF and an inductor of about 30 70 uH and being capable of receiving the first high potential output the first pulse forming network further being capable of driving the pumping source with a first signal and 20 a second pulse forming network having a capacitor of about 300 600 uF and an inductor of about 800 1200 uH and being capable of receiving the second high potential output the second pulse forming network further being capable of driving the pumping source with a signal differing from the first signal in one or more of duration and power 19 The apparatus as set forth in claim 18 wherein the device is a laser device and the pumping source is a laser 10 pumping source 20 The apparatus as set forth in claim 19 wherein the device is constructed to facilitate cutting of tissue
46. processor to move the updated parameter values to nonvolatile memory 615 andto update content ofthe selected one of the stored presets 620 The user interface control instruction sequence 730 then may cause the proces sor 605 to transmit an audible signal e g a beep to the speaker 735 Several operations are now described that involve combi nations of short pulse procedures and long pulse mode pro cedures In many cases for a given operation values for some or all parameters e g power pulse repetition rate etc may be different for short pulse mode procedure as compared to values for long pulse mode procedures Although the opera US 7 970 030 B2 13 tions outlined below are described in a context of a cutter such as a Waterlase device operating in distinct short pulse cf FIG 3 5 and long pulse cf FIG 3 a modes at differ ent times it should be understood that modified but not necessarily interchangeable implementations can include long pulses interspersed in short pulse mode pulse sequences and or can include short pulses interspersed in long pulse mode pulse sequences For example one or more ofthe below long pulse mode procedures of a given operation may as an alternative to a long pulse mode pulse sequence of only long pulses implement a long pulse mode pulse sequence com prising a plurality of alternating long and short pulses cf FIG 3 c Inthe examples that follow operations that may be implemente
47. rnatively or additionally presets may be generated or modified and US 7 970 030 B2 9 stored by an end user Table 2 ofthe incorporated Waterlase User Manual is reproduced herein as Table 1 and includes examples of pre programmed presets for general hard and soft tissue procedures TABLE 1 Suggested Presets for General Hard and Soft Tissue Procedures Rep Energy Water Air Preset Power Rate Perpulse Setting Setting Procedure Watts Hz mJ 1 Enamel Cutting 6 0 20 300 75 90 2 Dentin Cutting 4 0 20 200 55 65 3 Soft Tissue 1 5 20 75 a 11 Cutting thin tissue small incisions 4 Soft Tissue 0 75 20 37 5 0 11 Coagulation According to exemplary embodiments a plurality of pre sets e g programmed settings for one or more of power repetition rate pulse duration pulse energy and settings for air and water as shown in Table 1 may be established Although not shown in the table an aspect of the present invention comprises the inclusion of pulse duration as one of the presets The plurality of presets may be generated at a time of manufacture and stored in the electromagnetic energy base unit 230 FIG 4 In addition to the pre programmed preset values for general hard and soft tissue procedures set forth in Table 1 combinations of customized values of parameters can be stored in the electromagnetic energy base unit 230 as new presets According to one implementation ofthe present invention each preset can store
48. select a present number at step 505 and may press one of the plurality of preset buttons 695 on the user input panel 700 The user interface 685 may receive an input according to the selected preset number on user communication line 690 The user interface 685 further may communicate with the processor 605 according to the end user input The processor 605 may execute the user inter face control instruction sequence 730 that minimally may cause the processor 605 to update content of the function display strip 705 and the value display strip 710 according to information received from the user interface 685 Similar interactions between the processor 605 and the user input panel 700 may occur according to the user interface control instruction sequence 730 as will be understood by those skilled in the art Subsequent to selecting a preset number at step 505 the end user may press the SELECT button 720 on the user input panel 700 until for example a POWER indi cation is observed in the function display strip 705 according to step 510 of FIG 8 The end user then may enter a power setting by for example observing a numerical value corre sponding to a currently active power setting in the value display strip 710 and pressing the increment button 715 to thereby increase the power setting The end user also may decrease the power setting by pressing the decrement button 725 In either case the end user may continue to press the increment button 715
49. splay may instruct that the end user perform initial instrumentation using a Z2 output fiber tip at step 830 using an appropriate 20 25 30 35 40 45 50 55 60 65 14 setting manual or preset of operating parameters The same or subsequent displays may instruct the end user then to perform for example laser root canal enlargement at step 840 using a Z2 output fiber tip A similar display or displays may instruct the end user to measure working length using a Z2 output fiber tip at step 850 and to enlarge the root canal at step 860 using the Z2 output fiber tip At step 870 the end user may be instructed by the same or subsequent displays to enlarge the root canal using a Z3 output fiber tip The same or subse quent displays then may instruct the end user to enlarge the root canal using a Z4 output fiber tip at step 880 of the preceding displays further may instruct the end user to use appropriate operating parameter settings e g manual or pre set values for electromagnetic energy e g laser power pulse duration pulse repetition rate pulse energy and set tings for water and air Steps 810 880 of the root canal clinical protocol described in FIG 10 may be performed in whole or in part with for example a short pulse mode wherein the parameters for steps 840 880 may be recalled for the operation using a pre set A before and or after irrigation step cf step 9 in Appen dix C of the incorporated
50. tec tures have existed in the prior art A solid state laser system for example generally comprises a laser rod for emitting coherent light and a source for stimulating the laser rod to emit the coherent light Flashlamps are typically used as stimulation sources for middle infrared lasers between 2 5 microns um and 3 5 um such as Er Cr YSGG and Er YAG laser systems The flashlamp is driven by a flashlamp current which comprises a predetermined pulse shape and a prede termined frequency The flashlamp current drives the flashlamp at the predeter mined frequency to thereby produce an output flashlamp light distribution having substantially the same frequency as the flashlamp current This output flashlamp light distribution from the flashlamp drives the laser rod to produce coherent light at substantially the same predetermined frequency as the flashlamp current Medical applications such as those requiring the excision of soft human tissue may in some instances require or benefit from two opposite tissue effects The first effect may relate to laser cutting of tissue with controlled hemostasis minimal to no bleeding and attenuated or eliminated charring of cut surfaces The second effect may relate to laser cutting with bleeding in order for example to stimulate post operative 20 25 30 35 40 45 50 55 60 65 2 healing when tissue is brought together The second effect can be particularly important
51. ters mm from the surface depending on sensitivity Lasing can be applied using a circular motion making sure the patient does not feel pain In a particular example lasing may be initiated with the output fiber tip about 5 mm from the surface and while lasing with a circular motion the output fiber tip may be brought closer and closer to a distance of about 2 3 mm from the surface while making sure the patient does not feel pain An 575 output fiber tip manufactured by BioLase Technology Inc of San Clemente Calif may be used and the lasing application time to treat the exposed root surface may be about 30 60 seconds To the extent an outer root surface to be treated is not exposed obstructing gum tissue may be removed in a long pulse mode by setting e g via the end user activating a preset or manually the cutter e g Waterlase to for example a power of about 1 2 W a pulse repetition rate of about 40 50 Hz an energy per pulse of about 20 40 mJ water setting of about 096 and an air setting of about 10 2096 In another embodiment the cutter may be implemented in a short pulse mode wherein as with the long pulse mode implementation parameters known or apparent to those skilled inthe art in view ofthis disclosure or suggested by the incorporated Waterlase User Manual cf Tables 2 6 and related text may be recalled for the procedure via a preset or manually using techniques known to those skilled in the art
52. tire contents of which are incorporated herein by reference U S application Ser No 11 191 594 is a continuation in part of U S application Ser No 11 033 032 filed Jan 11 2005 now abandoned and entitled ELECTRO MAGNETIC ENERGY DISTRIBUTIONS FOR ELEC TROMAGNETICALLY INDUCED DISRUPTIVE CUT TING the entire contents of which are incorporated herein by reference This application is also a continuation in part of U S application Ser No 11 203 400 filed Aug 12 2005 now abandoned and entitled DUAL PULSE WIDTH MEDICAL LASER WITH PRESETS the entire contents of which are incorporated herein by reference U S application Ser No 11 203 400 claims the benefit ofU S Provisional Application No 60 601 415 filed Aug 13 2004 and entitled DUAL PULSE WIDTH MEDICAL LASER WITH PRESETS the entire contents of which are incorporated herein by reference U S application Ser No 11 203 400 is a continuation in part of U S application Ser No 11 033 032 filed Jan 11 2005 now abandoned and entitled ELECTROMAGNETIC ENERGY DISTRIBUTIONS FOR ELECTROMAGNETI CALLY INDUCED DISRUPTIVE CUTTING the entire contents of which are incorporated herein by reference BACKGROUND OF THE INVENTION 1 Field of the Invention The present invention relates generally to electromagnetic energy emitting devices and more particularly to pulsed medical treatment laser devices 2 Description of Related Art A variety of electromagnetic energy generating archi
53. ts While the apparatus and method has or will be described for the sake of grammatical fluidity with functional explana tions it is to be expressly understood that the claims unless expressly formulated under 35 U S C 112 are not to be construed as necessarily limited in any way by the construc tion of means or steps limitations but are to be accorded the full scope of the meaning and equivalents of the definition provided by the claims under the judicial doctrine of equiva lents and in the case where the claims are expressly formu US 7 970 030 B2 3 lated under 35 U S C 112 are to be accorded full statutory equivalents under 35 U S C 112 Any feature or combination of features described herein are included within the scope of the present invention pro vided that the features included in any such combination are not mutually inconsistent as will be apparent from the con text this specification and the knowledge ofone skilled in the art For purposes of summarizing the present invention cer tain aspects advantages and novel features of the present invention are described herein Of course it is to be under stood that not necessarily all such aspects advantages or features will be embodied in any particular embodiment of the present invention Additional advantages and aspects of the present invention are apparent in the following detailed description and claims that follow BRIEF DESCRIPTION OF THE FIGURES
54. with the first pulse output 5 The method as set forth in claim 3 further comprising generating a plurality of pulses by repetitively pumping the laser pumping source with the second pulse output 6 The method as set forth in claim 3 further comprising generating a plurality of pulses each pulse having one of a first duration generated by pumping the laser pumping source with the first pulse output and a second duration generated by pumping the laser pumping source with the second pulse output 7 The method as set forth in claim 6 further comprising receiving a control input from an end user and controlling the generating of pulses according to the con trol input 8 The method as set forth in claim 3 wherein the generating of a pulse having a first duration comprises generating a pulse having a duration of about 50 micro seconds and the generating of a pulse having a second duration com prises generating a pulse having duration of about 1000 microseconds 9 The method as set forth in claim 1 wherein the providing of a first high voltage output comprises viding a voltage of about 1500 volts and the providing of a second high voltage output comprises providing a voltage of about 500 volts 10 The method as set forth in claim 1 wherein the method comprises cutting tissue 11 The method as set forth in claim 1 wherein the elec tromagnetic energy output device is a laser that is pumped by the power supply
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