ABLS Trial Exam on Fundamental Laser Science / Tissue Interaction, Laser Safety and Dental Laser Procedures

ABLS Trial Exam for Dental Laser Practitioners

PLEASE REVIEW THESE INSTRUCTIONS CAREFULLY

This is the ABLS Trial Exam on Laser Biophysics, Tissue Interaction, Laser Safety and Dental Laser Procedures, for a total of 18 knowledge questions. This short exam will explore your knowledge with some critical questions the Board feels dental laser practitioners should know to maximize patient efficacy and safety. Your Trial Exam score will automatically show at the end.

Question 1 captures your contact information - name, location and email, but not street address or phone number.

Questions 2-7: on fundamental laser science and tissue interaction; questions 8-9: on key aspects of laser safety; and 10-19 on dental laser procedures. Question 20 asks how you think you did and for any comments.

If you are not sure of an answer, please make your best guess. You may back up to check or change any answers. However when you click the "DONE" button at the end, you cannot change your answers.

Following "DONE" your score will automatically show. 80% or higher indicates a very good understanding. There are 56 possible points for all 18 knowledge questions.

Questions with ONLY ONE right answer have circular DOTS. If you change your answer, the dot selected will change accordingly. Questions which may have MORE THAN ONE right answer will allow you to make more than one selection using the square BOXES. If you change your answer, you must click on a box to un-check it, and then click on a new box to check it.

Your information and answers will be kept confidential.

If you score below 70%, the Board suggests consideration of our certification program. Up to 28 CME units are also now available. More information is available on our website.

The Board wishes you success!

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* 1. Please provide the following information:

Your first and last name, and medical degree:

Your dental laser specialty:

Your location (city, state/province, country):

Your email address:

How did you hear about the ABLS?

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* 2. Laser light has three unique properties. Select each choice that denotes one of these properties.

high intensity

monochromatic

coherence

refractivity

spectral distribution

collimation

converging rays

phase cohesive

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* 3. To determine the length of each laser pulse and prevent the temperature of adjacent tissue from exceeding a level at which irreversible damage occurs, it is important to understand and calculate the thermal relaxation time (TRT) of the tissue that is being irradiated. The value of this time is dependent on (check any that are correct):

The heated volume of the tissue

The thermal conductivity of the tissue

The chromophore(s) being targeted

The three-dimensional shape of the heated volume

The fluence of the laser beam

The target dissipating approx. 1/2 to 2/3 of the incident thermal energey

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* 4. A Gaussian laser beam has maximum power density at the axis, and its intensity falls asymptotically toward zero with increasing radial distance from the axis, theoretically requiring an infinite distance to reach zero. Hence there is no concentric circle of finite diameter which encompasses all the radiant power of such a beam. It is, therefore, convenient to define an effective diameter: the diameter of a concentric circle within which most of the power of the beam is transmitted. In the list of statements below, check each one that is correct regarding the effective diameter:

It is the diameter of a concentric circle within which 86.3% of the total power of the beam is transmitted.

It is the diameter of the laser resonator at its midpoint.

It is the diameter of the exit aperture of the partially transmitting mirror of the laser.

It is the diameter of a concentric circle along which the power density is 13.5% of that at the center (axis) of the beam.

The average power density within the concentric circle, whose diameter is the effective diameter, is 43.2% of that at the center of the beam.

98.8% of the power of the beam is transmitted within a concentric circle whose diameter is 1.5x the effective diameter.

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* 5. When a ray of laser light strikes the first surface of living tissue, some of its intensity will be reflected from that surface. The major effect of this reflection is to diminish the intensity of the ray penetrating into the tissue. The reflectance of soft tissue is characterized by some of the statements listed below. Check each correct statement:

The reflectance of a particular tissue is the same for all wavelengths.

The reflectance of tissue is low and roughly constant from 100 to 300 nm.

The reflectance of tissue varies widely between 300 and 2,000 nm.

The color of tissue affects reflectance between 300 and 2,000 nm.

Reflectance of soft tissue is high and variable from 2,000 to 10,000 nm.

Reflectance of soft tissue is low and constant from 2,000 to 10,000 nm.

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* 6. When the beam of a continuous-wave Nd:YAG laser is delivered to tissue by a quartz fiber that does not touch the tissue, it is not very effective for vaporizing or cutting until some free carbon has formed by thermal breakdown of the tissue. However, it can be used for effective cutting of soft tissue if the distal end of the fiber is contoured into the shape of a needle with a small radius at the distal tip, or a conical tip of sapphire is attached to the distal end of the quartz fiber, and this tip is put in contact with the tissue. These terminations of the fiber enable the Nd:YAG laser to cut tissue effectively because…(check each correct statement):

the tapered tip acts as an optical funnel, concentrating the laser beam to a power density high enough to boil histologic water despite the low absorption coefficient (about 0.2/cm) at this wavelength (1,064 nm).

the sharp tip tears the tissue mechanically to perform cutting.

some of the laser light is absorbed within the distal portion of the tip, heating it to a temperature of 100 degrees C or higher, so that it heats the contacted tissue by thermal conduction and causes boiling of the histologic water.

the high power density at the distal tip causes the quartz or sapphire to become optically non-linear and to shift the wavelength to the far infrared portion of the spectrum, where the absorption coefficient is higher.

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* 7. In the list of laser types below, select the one OR two major biophysical process(es) for each type - coded by number - which are effective in soft tissue at that wavelength, and at the power densities usually employed for that laser. Processes are:

1. PhotoCHEMolysis
2. PhotoPYRolysis
3. PhotoVAPORolysis
4. PhotoPLASMolysis

CO2: 1

CO2: 2

CO2: 3

CO2: 4

KTP: 1

KTP: 2

KTP: 3

KTP: 4

Nd:YAG, s.p: 1

Nd:YAG, s.p: 2

Nd:YAG, s.p: 3

Nd:YAG, s.p: 4

Ho:YAG: 1

Ho:YAG: 2

Ho:YAG: 3

Ho:YAG: 4

Nd:YAG, c.w: 1

Nd:YAG, c.w: 2

Nd:YAG, c.w: 3

Nd:YAG, c.w: 4

Xe-Cl: 1

Xe-Cl: 2

Xe-Cl: 3

Xe-Cl: 4

Er:YAG: 1

Er:YAG: 2

Er:YAG: 3

Er:YAG: 4

dye: 1

dye: 2

dye: 3

dye: 4

Ar-F: 1

Ar-F: 2

Ar-F: 3

Ar-F: 4

ruby: 1

ruby: 2

ruby: 3

ruby: 4

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* 8. Accidental laser beam trauma to unintended targets has been a major cause of injury and death during laser surgery. In the list of four possible trauma events below, check just ONE of the options A, B, C, or D for each event to denote the relative risk of that event, with A denoting the lowest risk and D the highest risk:

perforation of hollow organs: A

perforation of hollow organs: B

perforation of hollow organs: C

perforation of hollow organs: D

injury to skin: A

injury to skin: B

injury to skin: C

injury to skin: D

injury to eyes: A

injury to eyes: B

injury to eyes: C

injury to eyes: D

injury to brain, spinal cord or nerves: A

injury to brain, spinal cord or nerves: B

injury to brain, spinal cord or nerves: C

injury to brain, spinal cord or nerves: D

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* 9. Smoke is an inevitable byproduct of surgery with any device that thermally dehydrates tissue and heats it to combustion temperatures. Denote each statement below as either true (T) or false (F) by selecting either a (T) or an (F) option for each:

(T) The products of combustion are not carcinogenic.

(F) The products of combustion are not carcinogenic.

(T) 77% of all smoke-plume particles are below 1.1 micrometer in size.

(F) 77% of all smoke-plume particles are below 1.1 micrometer in size.

(T) Inhaled particles below 1.1 micrometer in size are readily exhaled.

(F) Inhaled particles below 1.1 micrometer in size are readily exhaled.

(T) Operating-room suction at the wall is adequate to remove all laser-generated smoke plumes.

(F) Operating-room suction at the wall is adequate to remove all laser-generated smoke plumes.

(T) If all other factors are equal, the KTP laser generates more smoke during laser surgery than any other type of laser.

(F) If all other factors are equal, the KTP laser generates more smoke during laser surgery than any other type of laser.

(T) An external smoke evacuator having a capacity of 28 liters / second can evacuate 99% of a laser's smoke plume if the suction tip is held within 1.0 cm of the impact site of the laser beam.

(F) An external smoke evacuator having a capacity of 28 liters / second can evacuate 99% of a laser's smoke plume if the suction tip is held within 1.0 cm of the impact site of the laser beam.

(T) It has been demonstrated that the smoke plume from a CO2 laser vaporizing a malignant tumor contains no viable malignant cells.

(F) It has been demonstrated that the smoke plume from a CO2 laser vaporizing a malignant tumor contains no viable malignant cells.

(T) Viruses range in size from about 20 to 300 nanometers.

(F) Viruses range in size from about 20 to 300 nanometers.

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* 10. Which of the following is the most desirable type of laser-tissue interaction for an incisional procedure?

reflection

absorption

transmission

scattering

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* 11. Surgical lasers have been used for all of the following EXCEPT:

TMJ arthroscopy

hemostasis of vascular lesions

caries diagnosis

Dry Socket

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* 12. Which of the following wavelengths are preferred for root detoxification during periodontal surgery?

Nd:YAG

Diode

Erbium

CO2 (10,600 nm)

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* 13. Which of the following procedures is performed with a defocused laser beam?

papillary hyperplasia

soft tissue tuberosity reduction

assistance in torus reduction

vestibuloplasty

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* 14. Which are the correct parameters for gingival depigmentation?

small spot size and high power

small spot size and low power

large spot size and low power

large spot size and high power

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* 15. PBM lasers work by:

changing a cell in a low redox state to a high redox state

increasing ATP production of cells

dissolving the bonding between nitric oxide (NO) and cytochrome c oxidase

all of the above

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* 16. Which of the following orthodontic procedures is better served by devices other than diode lasers?

aphthous ulcer treatment

frenum removal

circumferential fiberotomy

orthodontically induced gingival hyperplasia

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* 17. The best choice of laser for TMJ arthroscopy is the:

Er:YAG

Ho:YAG

Nd:YAG

CO2

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* 18. During extraction of broken down teeth, erbium lasers are generally NOT used for:

incision and flap retraction

decontamination of the socket

sectioning of the tooth

all of the above

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* 19. Which of the following CO2 laser wavelengths is best absorbed by dental hard tissue?

10.6 microns

9.6 microns

9.3 microns

All are equally well absorbed.

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* 20. FINAL QUESTION: Thank you for taking the ABLS Trial Exam!

Please take a moment to review the information below and tell us how you think you scored. Then click DONE and see your score. A score below 75% may indicate an opportunity to improve your knowledge.

If you wish to apply, take advantage of NO application fee within 30 days (regular is $150). We NOW offer UP TO 28 AMA CME CREDIT HOURS! An Application is available at www.americanboardoflasersurgery.org. Following acceptance, candidates take the Written Examinations (online), and then sit for the Oral Examination (via web conference). The ABLS Certification provides a valuable learning experience and superior knowledge for optimum treatment parameters for dental laser procedures.

We invite you to join our unique List Serve knowledge network. It's FREE! Great opportunity to tap expertise and make new connections worldwide. Click the List Serve link on our site. Over 525 List Members and growing!

Visit www.americanboardoflasersurgery.org for more information OR email us at lasers1060@gmail.com.

Sincerely,

Edward M. Zimmerman, M.D.
President

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