ezlase™ Soft-Tissue, Whitening, and Pain Therapy System

1. ezlase™ Soft-Tissue, Whitening, and Pain Therapy System May 2009

2. Why compromise on your soft-tissue laser?

3. Why Buy a Soft-Tissue Laser??? Why buy a soft-tissue laser? • To make your patients even happier with minimally invasive dentistry, faster healing, less bleeding, and decreased post-op pain • To get rid of packing cord • Does not destroy healthy tissue like an electrosurge does • To provide your practice with extra sources of revenue Why buy a soft-tissue laser now? • To attract and retain patients with expanded service that differentiates your practice • Every day without a diode laser is a day of money lost • Surveys show patients expect you to have a laser

4. Why Buy an ezlase™ ??? • Unmatched Combination of Power & Portability plus choice of traditional 810 nm and optimized, proprietary 940 nm. • Up to 7 Watts of power • Battery pack (sold separately) for optimal positioning and easy transport between operatories • Unmatched Versatility • Various tips sizes, all bendable, for different applications • Surgical procedures, whitening, and pain therapy all in one system • Pain Therapy & Relief The only dental laser with FDA clearance ( Healing?) • The Best In-Office Whitening Solution, in less than 20 minutes of treatment time • The Comfort Patients Want • ComfortPulse™ feature can provide greater patient comfort • Minimal bleeding, swelling, or post-op pain • Reduced need for injections, sutures, hemostatic agents, and astringents • Added Revenue, Excellent Affordability • Less referring out – your patients want YOU to treat them • New procedures for additional practice revenue • No more packing cord • Training & Certification Included with Purchase

5. Soft-tissue procedures

6. The Best Soft-Tissue Solution • 940 nm wavelength developed specifically for dental applications • Tissue does not have to be inflamed or vascular to cut well (compared to 810 nm) • Great hemostasis due to position on the absorption peaks of Hb and HbO2 • ComfortPulse™ provides efficient cutting and greater patient comfort • Short, high-power cutting pulses with longer intervals are used for tissue thermal relaxation • Hundreds of pulse combinations • ezTips™ reduces chair time • Optically perfect every time • Single-use, disposable tips can be changed in seconds • No more stripping and cleaving of tips • Diameters from 200-400µm, lengths from 4-14 mm • Bendable for various procedures

7. From Good to Great These are just a few of the many new soft-tissue solutions that you will be able to provide to your patients!

8. Ezlase Procedures for Added Practice Revenue continued

9. Ezlase Procedures for Added Practice Revenue

10. whitening

11. Full-Mouth Whitening in Less than 20 Minutes! • New LaserWhite20 gel and whitening handpiece (each sold separately) provide full-mouth whitening in less than 20 minutes of in-office treatment time1 • Best whitening improvement compared to other solutions, in similar tests • Excellent results right away, and even more dramatic improvement after 24 hours • Desensitizer gel included to help reduce sensitivity if necessary • Only required training is for ezlase™ laser system 1 Does not include prep and post treatment preparation

12. How many have performed whitening with the ezlase?

13. Comparison of TreatmentTimes * Source: ADA Professional Product Review, Vol. 3, Issue 2, Spring 2008 ** Used with the Zoom Advanced Power Light • ezlase™ and LaserSmile are the onlylaser based whitening systems • Other systems utilize light, but they do not use a laser • No sun block, etc. to protect face and lips

14. Comparison of Efficacy • As the above charts show, LaserSmile provides approximately 9 shades of improvement, versus less than 8 shades of improvement from non-laser systems • Biolase expects the ezlase Whitening System will deliver even better whitening results compared to the LaserSmile (see next slide) • Nevertheless, dentists are encouraged to discuss predictability and efficacy with the patient prior to the start of the whitening process: • Results may vary depending on type of stain, enamel thickness, tooth structure, and age • Teeth with deep, intrinsic staining in the grayer tones generally will not respond as well as yellow shaded teeth • Some teeth are a natural yellow shade because enamel transparency allows the color of dentin to be visualized Source of Charts: “LaserSmile Tooth-Whitening System: A Study by Two Independent Clinical Sites” from The Journal of Cosmetic Dentistry, Volume 19, Number 2, Summer 2003

15. Laboratory Results on Hydroxyapatite Discs * Improvement in shade derived from "ΔE" measure, defined as a mathematical calculation of the "distance" between two colors on the CIE color space. • LaserWhite20 is approximately 44% more effective than LaserWhite10 • LaserWhite20 takes approximately 1/3 of the time compared to LaserWhite10 on hydroxyapatite discs • [Note: Protocol recommends 9 min of gel contact time on teeth, but laser exposure time remains 1 min] • Less laser exposure time reduces heating effects • Note: Although these tests were not performed on teeth, enamel’s primary material is hydroxyapatite (~95%)

16. Clinical Results Typical results range from 6 to 12 shades of improvement on the Vita Shade Guide Brightness Scale BEFORE LASER WHITENING AFTER LASER WHITENING Results may vary depending on type of stain, enamel thickness, tooth structure, and age

17. Another reason for ezlase over all other whitening modalities?

18. Another reason for ezlase over all other whitening modalities?

19. Pola Office SEM of Take-Home Before and After 35%; je (8 x 30 sec. light + 5 min. exposure time) reference: 500x reference: 8.000x treated: 500x treated: 8.000x very strong chemical attack

20. Diode Laser + Gel SEM of Diode + Gel Before and After 1,5W cw; H2O2 (30%); 2x (60 sec.; +120s exposure time + 30s rinsing) reference: 500x reference: 8.000x treated: 500x treated: 8.000x No visible damage

21. Exposure Time V. Cavalli, C. A. G. Arrais, M. Giannini & G. M. B. Ambrosano:High-concentrated carbamide peroxide bleaching agents effects on enamel surface Journal of Oral Rehabilitation Volume 31 Issue 2 Page 155 - February 2004 A long exposure time increases the risk of damage to the dental hard substance

22. Pain therapy

23. Bill Brown VP, International

24. Background • LLLT (Low Level Laser Therapy) has been utilized in medical fields in Europe and Asia for more than 30 years with several thousand published clinical papers • After resisting for many years, the FDA finally recognized the efficacy of LLLT in 2000 • The American Society of Lasers in Medicine and Surgery established a section devoted to LLT and there are now a national ( NAALT) and a global ( WAALT) organization with a journal (Photomedicine and Laser Surgery) devoted to this important area of medicine. • LLLT in dentistry has been found to accelerate wound healing and reduce pain, possibly by stimulating oxidative phosphorylation in mitochrondria and modulating inflammatory responses. By influencing the biological function of a variety of cell types, it is able to exert a range of several beneficial effects upon inflammation and healing. (Moritz-Oral Laser Applications)

25. Background • There is evidence that 940 nm light can trigger mast cell degranulation. Mast cells are distributed preferentially about the microvascular endothelium in skin, oral mucosa and dental pulp. • Because mast cells play a pivotal role in controlling leukocyte traffic, modulation of mast cell functions by LLLT can be of considerable importance in the treatment of sites of inflammation in the oral cavity. • For fibroblasts, increased proliferation, maturation and locomotion have been noted, as well as transformation to myofibroblasts, reduced productionof pro-inflammation prostaglandin E2 and increased production of basic fibroblast growth factor. • LLLT effects on macrophages include phagocytosis, secretion of fibroblast growth factors and fibrin resorption • Lymphocytes become activated and proliferate more quickly. There is increased motility in epithelial cells.

26. Background • For endothelium, there is increased granulation tissue and relaxation of vascular smooth muscle • For neural tissue we have reduced synthesis of inflammatory mediators, and axonal growth with maturation and regeneration • The above listed effects are a function of various wavelengths, dosage and method of application among other parameters such as pulse characteristics, distance to tissue, speed of movement. • Recent LLLT clinical research in dentistry covers applications from movement of teeth to accelerate orthodontic treatment to bone regeneration

27. Clinical Research Examples

29. ezlase 940 nmTherapeutic Indications • FDA cleared indications • Temporary relief of minor muscle and joint pain and stiffness • Temporary relaxation of muscle • Temporary increase in local blood circulation • Applicable Dental Procedures • TMJ Arthralgia (treatment of the Joint) • Myofacial Pain related to TMJ (treatment of the muscle related to painful trigger point) • Muscle relaxation related to pain and muscle stiffness after dental procedures or in general(Trismus)

30. Temporo-Mandibular Joint Dysfunction Affects Many People • 10.8 million people in the US suffer from TMD (NIH report); 90 % of this number are women • Very complex origin – it is the only joint in the body that is associated with a psychological element as a very high correlation with stress. • The condition is associated with pain in the joint that affects the mastication muscles. Pain can extend to the neck and the back.

31. Temporo-Mandibular Joint Dysfunction Conventional Treatments • Non surgical • Modified diet (soft food) • Cold/Hot Packs • Medication • Injection with Steroid • Occlusal mouth guards • Surgical • Arthrosynthesis (washing of the joint) • Arthroscopy/arthroplasy (removing adhesions within the joint) • Discetomy/enectomy (joint replacement surgery)

32. Temporo-Mandibular Joint Dysfunction Treatment Prices and Professional Organizations • Cost of Treatment • Non- Surgical • Up to $600 for diagnosis • $500-$1,500 for occlusal mouth guard treatment • Follow-up cost ~ $150 per visit • Surgical • ~ $2,000 and more per procedure • Organizations with focus on TMJ • American Academy of Orofacial Pain (AAOP) ~ 300 members • American Academy of Pain Management ~ 6,000 members • TMJ associations

33. ezlase 940 nm Surgical vs. Therapeutic Effects Surgical Therapeutic Surgical laser beam therapeutic laser beam Ø=0.2-0.4 mm Laser Treatment Beam Size : 2.8 cm2 (x20 larger than surgical tip) Laser Treatment Beam Size: 0.13 cm2

34. What are the 4 Laser-Tissue Interactions?

35. ezlase 940 nm Surgical vs. Therapeutic Effects Surgical Therapeutic A diffused beam of energy size 35 x 8 mm is delivered to the tissue site over a period of time. The level of laser energy is low enough to have a therapeutic effect without any tissue destruction. A concentrated beam of energy is delivered to tissue via a small diameter 200-400 µm fiber tip, and upon contact tissue is vaporized and removed.

36. ezlase 940 nm Surgical vs. Therapeutic Use Surgical Therapeutic Diffused laser energy is transmitted through tissue to treat. The image is of an ezlase beam transmitted through tissue as it was captured by an Infrared camera. The Process – Scattering ( or Diffusion) through tissue. The Effect - Pain relief and improved functionality immediately post-treatment or over a few treatments. • Concentrated laser energy is applied to an outer layer of the fiber tip (absorber coating produced after tip initiation). • The Process – Absorption. • The Effect - Immediate tissue vaporization and removal.

37. ezlase 940 nm Therapeutic Mechanisms of Action • Increased micro-circulation in tissue • Photo-activation of inactive enzymes (catalysts) present in painful muscle cells Normal Cell • Improved cellular functions through increase of ATP (fuel for the cell) production in cells Swollen Cell

38. ezlase 940 nm TMD Clinical Protocol – Therapeutic Settings • Laser Coverage Area = 2.80 cm2 (35 x 8 mm) • Exposure Time (t) = 1 min and up to 10 min • Settings vary depending on the type of skin and patient response • Start at the lowest recommended setting (power and exposure time), and increase as necessary • Therapeutic energies applied to any muscle or joint are measured in “Dose of energy” • The formula to calculate the Dose is as follows: Dose [J] = P (W) x t (s)

39. ezlase 940 nm TMD Clinical Protocol – Treatment Schedule Example SUN MON TUES WED THU FRI SAT Treatment 1 Treatment 2 WEEK 1 Treatment 3 Treatment 4 WEEK 2 Treatment 5 WEEK 3

40. ezlase 940 nm TMD Clinical Treatment Protocol Temporalis Masseter • Treatment of Painful Trigger Points (Myofacial Pain) • Palpate masseter and temporalis to identify painful trigger points; mark each point with a small dot and the covered area. • VAS Pain measurements for each point pre- and post- • Treatment of the Joint (TMJ Arthralgia) • Treat the joint at the three locations provided in the image to the right

41. Proven Clinical Results!

42. Proven Clinical Results!

43. Proven Clinical Results!

44. Proven Clinical Results!

45. ezlase 940 nm Therapeutic Applications - Clinical Benefits • Progressive/immediate relief of pain • Reduction in muscle tenderness and stiffness • Improved functionality of the affected • Improve quality of life • Gentle to tissue in comparison to other alternatives such as steroid injections, or appliances such as mouth guards

46. Q & A

47. Easy to use

48. Touchscreen Interface Very intuitive, and easy to use Current power settings Touch to increase power Touch to decrease power Touch to change pulse interval Touch to change pulse length Touch for continuous wave or pulsed mode Current pulse settings

49. Custom Presets 15 pre-sets available for customization by the clinician Touch to access or change a pre-set

50. comparisons