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

Introduction

INSTRUCTIONS:

The ABLS Trial Exam has 18 knowledge questions about critical areas which for laser practitioners. Your score will show at the end.

Question 1 asks for your name, location and email, but not street address or phone number. Your information will be kept confidential.

Questions 2-7 = laser science and tissue interaction; 8-9 = laser safety; and 10-19 = dental laser procedures.

When you click the "DONE" at the end your score will show. If you score below 75%, the Board suggests consideration of the certification process. Up to 28 AMA PRA Category 1 Credits are NOW available.

Practitioners must have a solid understanding of laser physics, tissue interaction, and safety to maximize efficacy. The ABLS Certification provides a valuable learning experience and superior knowledge of laser and light tissue interaction at the chomophore level for optimum treatment parameters. You can differentiate your practice to patients and augment manufacturer training. The ABLS is the world’s ONLY medical specialty board devoted to lasers and light-based energy devices. 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 energy

The penetration depth of the laser beam

The reaction of chemical bonds within cells to laser light

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* 4. The power density of the laser beam transmitted to the tissue is dependent on which of these factors:

A. whether the beam remains collimated
B. whether the beam is focused smaller
C. whether the beam spreads or diverges larger
D. the initial diameter of the beam
E. the wavelength of the laser

A and C

B and D

A, B and C

A, B, D and E

All of the above

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* 5. Check which statements are TRUE about the absorption of laser light relative to chromophore concentration in soft tissue:

The concentration of chromophores plays an important role in how the absorbed laser light impacts the photothermal laser-tissue interaction.

The concentration of hemoglobin is fairly constant as blood circulates throughout the body.

The most significant absorbers in tissue are hemoglobin and melanin.

The absorption coefficient for 75% water concentration in tissue depends on wavelength.

Hb concentration in blood is close to 150g/L.

Hb and HbO2 are present at maximum concentration only in whole blood inside blood vessel capillaries.

The average Hb and HbO2 absorption coefficient that affects light transport is reasonably high given a 10% average blood presence in the soft tissue in the body.

The epidermis' light transport properties are strongly affected by melanin absorption depending on volume fraction of melanosomes.

The volume fraction of melanosomes in darkly pigmented African skin is more than 10 times greater than in light Caucasian skin.

A hemangioma typically has twice the absorption of photons, and rate of heating, than surrounding tissue, assuming low melanin presence in the epidermis.

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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. Check which statements are FALSE about the biophysical processes by which lasers or light ablates or damages living tissue:

Photovaporolysis is the basic mechanism by which most surgical lasers destroy tissue. It is defined as the absorption of light by target chromophores, and the conversion of this radiant energy into thermal energy, where the resultant temperature is between 50 degrees C and 100 degrees C.

The destruction of histologic architecture by the photonic formation of a gas-like fourth state of matter, is called photothermolysis.

Photochemolysis is the rupture of inter-atomic (electronic) bonds in complex organic molecules by the photonic energy of light at all wavelengths longer than 1,064 nm.

Low-level photochemolysis is the major cause of actinic damage to the skin of persons who regularly suntan outdoors and are exposed to UV rays.

If the pressure where the laser beam impacts the tissue exceeds 760 torr (atmospheric pressure), the boiling tissular water can rise above 100 degrees C. This can result in high levels of irradiance and the accompanying photovaporolysis can cause shock waves and other explosive effects, which are largely undesirable for laser surgery.

Photopyrolysis is the destruction of tissue by heating to temperatures above 45 degrees C but below 100 degrees C.

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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

carries 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 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 70% indicates room to improve your knowledge.

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Question Title

* 1. Please provide the following information:

Question Title

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

Question Title

Question Title

* 4. The power density of the laser beam transmitted to the tissue is dependent on which of these factors: A. whether the beam remains collimatedB. whether the beam is focused smallerC. whether the beam spreads or diverges largerD. the initial diameter of the beamE. the wavelength of the laser

Question Title

* 5. Check which statements are TRUE about the absorption of laser light relative to chromophore concentration in soft tissue:

Question Title

Question Title

* 7. Check which statements are FALSE about the biophysical processes by which lasers or light ablates or damages living tissue:

Question Title

Question Title

* 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:

Question Title

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

Question Title

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

Question Title

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

Question Title

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

Question Title

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

Question Title

* 15. PBM lasers work by:

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

Question Title

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

Question Title

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

Question Title

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

Question Title

* 4. The power density of the laser beam transmitted to the tissue is dependent on which of these factors:

A. whether the beam remains collimated
B. whether the beam is focused smaller
C. whether the beam spreads or diverges larger
D. the initial diameter of the beam
E. the wavelength of the laser