an electromagnetic energy output device is disclosed for implementing procedures on hard tissue , soft tissue and osseous bone . the electro - magnetic energy level and rate output from the device can be tailored to the different dental procedures of cutting or ablating soft , hard or osseous tissue , and also for decontamination , cleaning periodontal pockets , pain reduction , and bio stimulation procedures . see pct / us2010 / 043968 and pct / us2011 / 023483 for high power treatment lasers suitable for use herewith , the disclosures of which are incorporated by reference herein in their entirety . as depicted in fig1 , a high power treatment laser beam , such as a co 2 laser beam , enters a dental hand - piece 1 on optical axis 2 . the laser beam is directed through a focusing lens 3 and two computer controlled moving optical elements 4 , 5 . the focusing lens 3 may be located ahead of or behind the optical elements 4 , 5 . an image system may be integrated into the dental hand - piece 1 , and the image system may include an imaging device 6 such as a cmos or ccd camera chip , a lens system 7 , a filter 8 and / or a focusing element such as an electro - static lens 9 . the lens system 7 can include a transfer lens and / or a variable focus lens . the variable focus lens can be used to select a suitable energy profile of the laser beam , as described below . the imaging system may be located co - linearly with the optical axis 2 of the high power treatment laser beam by reflecting light rays received from the treatment area and traveling generally along the optical axis 2 off a mirror 10 or a mirror 11 coupled to the moving optical elements 4 or 5 , respectively . regardless the location of the imaging system , the components thereof are configured such that light corresponding to the images of the area of the dental tissue being treated propagates substantially along the optical axis 2 . as a result , an operator of the laser beam can view the received images during treatment , without having to replace the treatment device with a separate imaging device or without having to position simultaneously two devices in the patients mouth — one for treatment and the other for imaging . moreover , the operator has substantially the same perspective as that of the treatment laser beam . this allows the operator to accurately monitor the effect of the laser beam precisely on the area of the dental tissue being treated during such treatment . this arrangement can also provide comfort to the patient , because the patient need not open his or her jaw so wide as to allow one access path for the treatment laser beam to the dental tissue and another viewing path , at a different angle , to the operator . in some embodiments , an optical fluorescence system is integrated into the dental hand - piece 1 . the fluorescence system generally includes an fluorescing light source ( e . g ., source of ultra - violet ( uv ) light ) that is located similarly as the imaging device 6 . the fluorescence system may use one or more of a lens system , filter , and a focusing element such that rays of substantially monochromatic light from the fluorescing source travel along the optical axis 2 to the dental region to be examined . if a certain area within that dental region is affected , e . g ., due the presence of bacteria , the light reflected from that area typically has a peak wavelength different than that of the substantially monochromatic light . those reflected light rays travel back along the optical axis 2 and may be viewed using the imaging system . the operator can analyze the received images to detect any affected areas requiring treatment . fig1 also depicts an optical element 12 that turns or reorients the optical axis 2 so as to increase the ergonometric design of the hand - piece 1 . the optical element 12 is optional , however , and embodiments in which the optical axis 2 is not turned at about 90 degrees , as shown in fig1 , are within the scope of the invention . a shroud or cover 13 may be added to the hand - piece 1 to position the hand - piece , block the illuminating light ( described below ), and / or to prevent the treatment laser beam from reaching the dental tissue substantially outside the area to be treated . the shroud 13 may also support the dental hand - piece 1 when it is positioned in a patient &# 39 ; s mouth . in some embodiments , illumination diodes or diode lasers 14 are added to the hand - piece 1 to aid the imaging system , for example , by shining light in the viewing the area of the dental tissue being treated . various light collection and focusing elements 15 ( e . g ., fresnel lenses ) may be used for collecting and guiding the light through the end opening of the hand - piece shroud 13 onto the dental tissue . in some embodiments , a marking laser 16 ( described below in detail ) is provided to provide visible light where the invisible treatment laser beam will be directed . the marking laser beam also travels along the high power treatment laser axis 2 . in some embodiments , the imaging system , the illumination system , the computer controlled optical elements 4 , 5 , and the focusing lens 3 are located in a housing , and the hand - piece 1 can be attached to the housing . if the hand - piece 1 is detached from the housing , the laser beam 50 turns off , thereby preventing accidental exposure to the laser beam . with reference to fig2 , air and water paths 17 , 18 are included in the hand - piece 1 . the air and water paths 17 , 18 are both optional . using these paths , air , water , or a mixture thereof can be used to spray , clean , or dry the tooth before , during , and / or after treatment . the air and water mixture can create a water mist that generally aids in cutting of hard dental tissue by providing cooling . air alone may be used to cut soft dental tissue or to dry or blow off dental tissue . an additional air path 19 is optionally added to provide an air flow near the opening of the hand - piece tip / shroud 13 . the air path 19 creates a curtain of pressurized air across the opening in tip / shroud 13 , blocking any water used in treatment and / or debris resulting from cutting from entering into the hand - piece and attaching to the mirror 12 . in the end portion of dental laser hand - piece 1 , the high power treatment laser beam 50 reflects off the mirror 12 and focuses at a point of focus 21 . using a converging laser beam 50 , a substantially flat mirror 12 can be used to focus the laser beam at or near the point 21 . alternatively or in addition , a multi - segment mirror or a concave mirror can be used to focus parallel or converging laser beams at the point of focus 21 . the location 21 at which the laser beam focuses , i . e ., the laser beam &# 39 ; s cutting depth with respect to the dental tissue 51 , can be adjusted over a range “ x ” 22 . though fig2 shows the point of focus 21 of the laser beam slightly above the surface 51 of the dental tissue , the point of focus 21 can be located at or below the surface 51 . adjusting the point of focus 21 of the laser beam at a distance from the surface 51 ( i . e ., above or below the surface 51 ) facilitates varying the energy density profile of the laser beam at the treatment surface 51 . thus , by adjusting the location of the point of focus 21 , a laser of a suitable energy profile can be directed to the treatment area on the dental tissue surface 51 . as depicted in fig3 , various energy distribution profiles can be generated at the treatment surface 51 . in some embodiments , using a spherical optic a gaussian energy distribution 24 is achieved and using non - spherical optics various other energy distributions such as a donut - shaped 25 distribution or a top hat 26 distribution can be achieved . using different energy distribution profiles , accuracy of treatment can be improved . for example , the gaussian profile 24 can be used to treat a relatively small affected area , while the top hat profile 26 can be used to treat a relatively large affected area . moreover , using the top hat profile 26 , laser energy can be directed more uniformly across a relatively large area , as opposed to applying significant amount of energy only to the center of the treatment area if an energy profile having a peak ( such as the gaussian profile 24 ) were used . with reference to fig4 , the high power treatment laser beam 50 passes through the focusing lens 3 and the focused beam is directed by spinning mirrors 27 , 28 . the spinning mirrors 27 , 28 are computer controlled moving optical elements 4 , 5 shown in fig1 the spinning mirrors 27 , 28 can be moved in steps such that the point of focus 21 of the treatment laser beam 50 can be moved along x and / or y directions so as to cover substantially entirely a treatment area 29 . the spinning mirrors 27 , 28 can be controlled by a positional closed loop feedback system that includes motors 30 , 31 . the motors 30 , 31 typically include a galvanometer including an actuator for adjusting positions of the spinning mirrors 27 , 28 . the positional loop associated with the motor 30 includes a sensor or position indicator 34 , an electronic position control device 32 , and the motor drive electronics 33 . a second positional control loop ( not shown ), which may utilize one or more of the components 32 - 34 , is associated with the motor 31 . though fig4 shows the dental tissue treatment area 29 as having a square shape , this is for illustrative purposes only . it should be understood that other shapes such as a triangle , polygon , circle , oval , etc ., are within the scope of the invention . as explained in detail with reference to fig6 below , in some embodiments , the treatment area 29 can be defined by the operator . the position control device 32 is provided with information about the treatment area 29 . such information may include the size and shape of the treatment area 29 . the position indicator 34 determines the relative position of the point of focus 21 of the laser beam 50 within the treatment area 29 at a particular instance . based on the relative position obtained from the position indicator 34 , the position control device 32 can determine the movement of the motor 30 during the next step of operation . these steps are determined for each of the motors 30 , 31 such that the laser beam 50 is substantially confined to the treatment area 29 , and covers , i . e ., treats the area 29 in a substantially uniform manner . thus , the positional closed - loop feedback system enables an operator to select and / or define a treatment area that approximates only the affected area of an irregular shape , and to automatically treat the entire selected and / or defined area , without substantially affecting the other portions of the unaffected dental tissue adjacent to the treatment area . with reference to fig5 , light rays from the led or laser diode light elements 14 are reflected by a collector 36 and can be collimated or focused by an optical element 15 . the collimated / focused light rays are reflected off the dental hand - piece turning mirror 12 to the focus position 21 , i . e ., the point of focus of the high power treatment laser beam 50 , as described above with reference to fig2 and 4 . the led / laser diode elements 14 can be mounted in the hand - piece 1 on a printed circuit board 37 , for example . the focusing elements 15 can be formed using , for example , an optic 38 having lenslets 39 , or a fresnel lens 40 . alternatively or in addition , the light from the elements 14 can reflect off a polished interior of the hand - piece 1 , so as to be guided to the treatment area through the opening in the tip / shroud 13 of the hand - piece 1 . as depicted in fig6 , the treatment area 29 treated by the laser beam 50 that is moved using the two spinning mirrors 27 , 28 as described above with reference to fig4 , can be a polygon 42 ( i . e ., a triangle , square , rectangle , hexagon , etc . ), a circle or oval , or any operator defined shape 43 . a user / operator may define the shape 43 as a closed area having a perimeter of short segments of length in the range about 12 μm to about 1 . 5 cm . in contrast to treating dental tissue areas of a fixed size and / or shape , such as a 4 mm × 4 mm square , defining the shape 43 as a polygon of short segments enables the operator to precisely select virtually only the affected area of the dental tissue for treatment . as described above with reference to fig4 , substantially only the selected , i . e ., affected , area can be treated by the laser beam , without unnecessarily exposing the adjacent unaffected tissue to the laser beam radiation . during treatment , the mirrors 27 , 28 and the associated positional control loops ( shown in fig4 ) are configured such that the laser pulses or a continuous power electromagnetic energy of the laser beam traces the entire treatment area 42 or 43 according to a pattern . as shown in fig6 , the tracing pattern can be a spiral pattern 41 , a raster pattern , or a random pattern 44 . when a laser beam impinges upon a spot in the treatment area 42 or 43 , a plume of tissue material may be emitted . during the next step , moving the laser beam to a randomly selected location , as shown by the pattern 44 , can avoid any interaction between the treatment laser beam and the plume , and , instead , the laser beam is directed to the tissue to be treated . prior to commencing treatment using the treatment laser beam as described above , it may be beneficial for an operator to ensure that the treatment laser beam would , in fact , impinge upon all of the treatment area in a uniform manner , and not impinge upon the tissue not to be treated . to this end , the marking laser 16 described above with reference to fig1 can be used . the marking laser 16 , e . g ., a he — ne laser , traces the treatment area 42 or 43 substantially similarly as the treatment laser beam would , because both laser beams are focused along the axis 2 , and both laser beams are directed using the system schematically shown in fig4 . the marking laser 16 , however , lacks power to ablate or adversely affect dental tissue in the area 42 or 43 , and , hence , may not inadvertently damage the dental tissue within or adjacent to the treatment area 42 or 43 . moreover , the marking laser 16 emits visible light , such as red light , so that the operator can see the tracing of the area 42 or 43 as the marking laser beam is moved , using the imaging system described above with reference to fig1 . once the operator ensures that the marking laser 16 covers substantially the entire treatment area according to the selected tracing pattern ( e . g ., patterns 41 , 44 ), and does not affect areas substantially outside the treatment area 42 or 43 , the operator can activate the treatment laser beam , and treat the area , as described above . using the marking laser 16 in combination with the computer - controlled feedback system to control the movement of laser beam , only the affected dental areas of virtually any size and shape can be treated effectively and easily , while mitigating or eliminating the risk of significant damage to the surrounding unaffected areas . fig7 shows a table identifying various system parameters such as energy densities , pulse width of the laser beam , length of a segment used to define a treatment area , etc . the ranges of the parameters , and their nominal values are also shown in the table . while the invention has been particularly shown and described with reference to specific embodiments , it will be understood by those skilled in the art that various changes in form and detail may be made therein without departing from the spirit and scope of the invention as defined by the appended claims . the scope of the invention is thus indicated by the appended claims and all changes that come within the meaning and range of equivalency of the claims are therefore intended to be embraced .
a dental tissue treatment apparatus and associated methods includes a feedback - controlled beam guidance system for directing treatment to a defined area of dental tissue .