Morita AdvErL EVO User manual

Er:YAG Laser for Dentistry
AdvErL EVO
INSTRUCTIONS FOR USE

Instructions for Use 2019-07-22
1
Thank you for purchasing the AdvErL EVO.
For optimum safety and performance, read this manual thoroughly before using the unit and pay close attention to
the warnings, cautions and notes.
Keep this manual in a handy place for ready reference.
Trademarks (™) and Registered Trademarks (®):
The name of companies, products, services, etc. used in this manual are either trademarks or registered
trademarks owned by each company.
© 2012 J. MORITA MFG. CORP.

Instructions for Use 2018-04-23
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Table of Contents
Page
PREVENT ACCIDENTS........................................................................................................................................4
DISCLAIMER ........................................................................................................................................................5
1. EQUIPMENT DESCRIPTION...........................................................................................................................6
2. PARTS IDENTIFICATION AND ACCESSORIES............................................................................................9
3. OPERATION ....................................................................................................................................................15
1) Set Laser Irradiation Conditions .......................................................................................................21
2) Laser Emission Procedure.................................................................................................................24
3) Emergency Stop ................................................................................................................................25
4) Memory.............................................................................................................................................27
5) Turn Unit Off ....................................................................................................................................32
6) Moving the Unit................................................................................................................................33
7) Make Other Settings and Check Information....................................................................................34
4. STERILIZATION, REPLACEMENT PARTS, AND STORAGE ....................................................................41
1) Cleaning (Always perform this procedure prior to sterilization) ......................................................42
2) Autoclaving (sterilization) (Always perform this procedure after cleaning and before use) ............43
1) Grease Handpiece Grips ...................................................................................................................45
2) Lens Cleaning ...................................................................................................................................46
3) Spray Water Bottle (Distilled Water for Spray) Replacement...........................................................47
5. INSTALLATION ..............................................................................................................................................50
1) Connect Water Tube..........................................................................................................................50
2) Foot Switch .......................................................................................................................................51
3) Remote Interlock...............................................................................................................................51
(1) Parts Identification.....................................................................................................................................9
(2) Accessories..............................................................................................................................................11
(3) Labels ......................................................................................................................................................13
(4) Symbols ...................................................................................................................................................14
(1) Set Up ......................................................................................................................................................15
(2) Turn the Unit On......................................................................................................................................17
(3) Handpiece and Contact Tip Attachment ..................................................................................................19
(4) Operation Procedure................................................................................................................................21
(1) Handpiece grips, Hanger, Tips and Tip stand Cleaning and Sterilization................................................42
(2) Cleaning the Main Unit ...........................................................................................................................44
(3) Maintenance ............................................................................................................................................45
(4) Storage.....................................................................................................................................................48
(5) Replacement Parts ...................................................................................................................................49
< Cautionary Remarks on Installation > .......................................................................................................50

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Page
6. MAINTENANCE, INSPECTION AND CALIBRATION ...............................................................................52
1) Outline ..............................................................................................................................................52
2) Function check (Interlock)................................................................................................................52
3) Replacement .....................................................................................................................................52
4) Other Parts ........................................................................................................................................52
5) Calibration of Laser Output ..............................................................................................................52
7. CLINICAL APPLICATIONS ...........................................................................................................................53
2.1) Tissue Interaction.............................................................................................................................53
2.2) Parameter of Laser Ablation ............................................................................................................53
6.1) General.............................................................................................................................................55
6.2) Tissue Effects of Er:YAG Laser.......................................................................................................55
6.3) Pulse Energy (Energy Level Setting: mJ)........................................................................................55
6.4) PPS (Hz) ..........................................................................................................................................55
6.5) Laser Energy Density.......................................................................................................................55
6.6) Type of Tips .....................................................................................................................................57
8. TROUBLESHOOTING....................................................................................................................................59
9. TECHNICAL DESCRIPTION .........................................................................................................................65
10. ELECTROMAGNETIC DISTURBANCES (EMD)......................................................................................67
Annual Maintenance .....................................................................................................................................52
(1) Introduction .............................................................................................................................................53
(2) Er:YAG Laser Ablation ...........................................................................................................................53
(3) Warnings and Notes.................................................................................................................................54
(4) Adverse Effects .......................................................................................................................................54
(5) AdvErL EVO INDICATIONS FOR USE ...............................................................................................54
(6) Clinical Procedure...................................................................................................................................55
Explanation of Error and Caution Messages.................................................................................................59
Troubleshooting for Problems Other than Error Messages...........................................................................62

Instructions for Use 2018-10-22
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PREVENT ACCIDENTS
Most operation and maintenance problems result from insufficient attention being paid to basic safety
precautions and not being able to foresee the possibilities of accidents. Problems and accidents are best avoided
by foreseeing the possibility of danger and operating the unit in accordance with the manufacturer’s
recommendations. First thoroughly read all precautions and instructions pertaining to safety and accident
prevention; then, operate the equipment with the utmost caution to prevent either damaging the equipment itself
or causing bodily injury.
The following symbols and expressions indicate the degree of danger and harm that could result from ignoring
the instructions they accompany:
This warns the user of the extremely serious injury or complete destruction of the
equipment as well as other property damage including the possibility of fire.
This warns the user of the possibility of extremely serious injury or complete
destruction of the equipment as well as other property damage including the
possibility of fire.
This identifies methods which must not be used or purposes which the equipment
is not suited for.
This warns the user of the possibility of mild injury or damage to the equipment.
This alerts the user of important points concerning operation or the risk of
equipment damage.
The user (e.g., healthcare facility, clinic, hospital etc.) is responsible for the management, maintenance, and use of
medical devices.
Federal law restricts this device to sale by or on the order of a dentist (valid only for U.S.A.). Only licensed
professionals who have successfully completed training should use the laser and accessories.
This equipment must not be used for any purpose other than incision, hemostasis, coagulation and
vaporization of biological tissues.

Instructions for Use 2019-07-22
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Disclaimer
•Never use this instrument for patients who have a pacemaker or an implantable cardioverter
defibrillator (ICD); it could cause these devices to operate erratically.
•Electromagnetic waves from cell phones, transceivers, and remote control devices could cause this
instrument to operate erratically. Turn off all communication devices of this type in the operating
area.
•As far as possible do not use this laser unit near or at the same time as other devices. If this cannot be
avoided, make sure both units operate properly before using them for treatment.
•J. MORITA MFG. CORP. will not be responsible for accidents, instrument damage, or bodily injury
resulting from:
(1) Repairs made by personnel not authorized by J. MORITA M F G. C O R P.
(2) Any changes, modifications, or alterations of its products.
(3) The use of products or instrument made by other manufacturers, except for those procured by
J. MORITA MFG. CORP.
(4) Maintenance or repairs using parts or components other than those specified by J. MORITA
MFG. CORP. and other than in their original condition.
(5) Operating the instrument in ways other than the operating procedures described in this manual
or resulting from the safety precautions and warnings in this manual not being observed.
(6) Workplace conditions and environment or installation conditions which do not conform to
those stated in this manual such as improper electrical power supply.
(7) Fires, earthquakes, floods, lightning, natural disasters, or acts of God.
•The useful life of the AdvErL EVO is 8 years from the date of installation provided it is regularly
and properly inspected and maintained.
•J. MORITA MFG. CORP. will supply replacement parts and be able to repair the product for a period
of 10 years after the manufacture of the product has been discontinued.

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1. Equipment Description
1. Operational Principles
The AdvErL EVO consists of a combination of 4 systems plus the laser transmission apparatus.
(1) Laser Beam Production Apparatus
1) Laser Beam Emitter System
An Er:YAG laser beam (2.94 μm) is emitted from the condenser assembly when it is excited by a flash
lamp. The laser beam emitted from the laser resonator’s mirror is partially reflected by a beam splitter,
and the sensor for the power monitor detects the output, which is then adjusted. The safety shutter
(beam shutter) opens after the Ready button has been pressed and the foot switch depressed as long as all
other operational conditions have been satisfied, and the laser beam reaches the coupler for the
transmission apparatus. At this point the laser beam is mixed with an aiming beam (650 nm) and goes
on to the hollow waveguide.
2) Electrical System
The electrical system consists of the laser power supply, the control unit, the calibrator, the touch panel
display, the key switch and the foot switch. The laser power supply is made up of a high voltage power
supply, a high voltage trigger control board, and other components. The high voltage power is used to
produce a light beam with the flash lamp.
3) Software
The software for the AdvErL EVO controls all its operations, maintains its safety, and makes sure that the
output is accurate and exact.
The Laser output conditions including output power, number of repetitions etc. is set with the various
buttons on the touch panel display. Once the unit is in its Ready condition, the laser beam is emitted by
depressing the foot switch.
Safety is constantly being monitored. If anything abnormal is detected, laser irradiation is terminated
and an error message is displayed.
4) Cooling System
The AdvErL EVO is water cooled. Water circulates to cool the unit and then the water is cooled by a
water-and-air heat exchanger. Water is stored in a tank inside the unit and circulates through the unit.
The heated water is then cooled by the heat exchanger and returns to the water tank.
(2) Hollow Waveguide and Spray System
The hollow waveguide transmits the laser beam to the contact tip attached to the end of the handpiece. There
are also water and air lines that provide spray to cool the treatment site. When the foot switch is depressed,
the laser beam, water and air are all emitted from the end of the contact tip.
Contact tips, handpiece grips, and the hollow waveguide are applied parts.
2. Biological Effects
A n E r : YA G laser emits an infrared beam with a wavelength of 2.94μm which is readily absorbed by water
contained by both hard and soft tissues. As a result, the energy of the laser beam instantly vaporizes the
water molecules in hard tooth tissue causing the tissue to crumble away.
These beams can also resect soft tissue.
3. Safety Procedures for Use of a Laser Surgical Equipment
For the safety procedures written below, use Bundled “danger plate” or “warning plate”.
(1) Safety measures to protect the eyes, skin etc
1) A serious injury will result if the laser beam directly strikes the eyes or skin. It is particularly essential to
avoid damage to eyes (such as injuring the cornea etc).
The user, patient and all other people inside the operation area must always wear Laser Safety Glasses to
protect their eyes from the laser beam.
In all testing, instruction or training situations, the laser surgeon, instructors and students also must wear
Laser Safety Glasses.

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2) When entering the operation area of this equipment, always put on the protective goggles. Furthermore,
never allow the laser beam to shine directly on the eyes even if Laser Safety Glasses are worn.
3) Regularly inspect the protective goggles to make sure there are no holes or fine cracks and make sure that
they are physically sound.
4) Before using this equipment, the user must undergo a dermatology and ophthalmology examinations.
Moreover, the user must undergo regular dermatology and ophthalmology examinations.
5) Due to the harmful effects laser beam emission can have on eyes and skin, it is necessary to undergo an
ophthalmology and dermatology examinations. There are 2 reasons for this.
1. To ascertain the state of the skin and eyes before performing laser beam emission.
2. To detect damage to eyes or skin at an early stage.
6) If the user has suspected damage to eyes or skin, they must be examined by a doctor as soon as possible.
(2) Safety measures to protect the patient
The doctor must explain to the patient all crucial points regarding treatment involving the laser surgery
equipment.
When using the laser surgery equipment, no matter what the circumstances, the doctor must always have the
patient wear Laser Safety Glasses to protect the patient’s eyes. The patient must follow the directions of the
doctor.
Do not touch any terminals of the equipment and the patient at the same time.
(3) Safety measures to protect people other than the user and the patient (observers etc)
1) The user must prohibit people other than the user and the patient from being in the area where the laser
surgery equipment is used. If it is necessary to allow a person to enter the operation area, it should be
limited to cases where the person is undertaking instruction and training.
When the user is using the laser surgery equipment, a notice stating laser surgery is in progress should be
placed where all people visiting the area will notice it such as outside the entrance of the laser surgery
room.
2) Only people recognized as authorized users may operate the equipment.
3) The user of this equipment must have complete proficiency in the operational procedures of the
equipment.
4) The user must have received comprehensive instruction and training on the hazards of laser beams.
5) Any dentists, doctors, nurses or dental hygienists who might have to enter the operation area of the
equipment must receive a comprehensive explanation on the hazards of laser beams.
6) The user of this equipment must never direct the laser beam to reflective surfaces or people other than the
patient being treated.
7) The key of the equipment’s key switch must be taken care of and kept by the person assigned that task
and when the equipment is not in use, the key must always be removed from the equipment.
8) Wear only Laser Safety Glasses that have been regularly inspected.
(4) Prevention of Laser Beam Reflection off other Equipments and Equipment
As far as possible, remove all reflective equipments from the treatment area.
Take reflection protection measures by covering items that could reflect a laser beam such as surgical
equipments and equipment with wet gauze or some other suitable material.
Look out for the possibility of the laser beam being reflected by metal objects and use surgical equipments
that have undergone processing to eliminate reflectivity.
This laser beam is dangerous to eyes, skin, mucous membranes etc. even when reflect from a diffusing
surface.
Ensure the measures to eliminate the hazard of reflected light outlined below are comprehensively followed.
1) Make sure the surgical equipments and equipment such as forceps and suction tubes have undergone
processing to prevent reflection and take all possible measures to reduce the chance of laser rays being
reflected.
2) Never perform laser beam emission on a reflective surface.
3) Take care to prevent reflection by dental prosthetics etc.
4) No one should stand behind the patient or laser surgeon.
5) When using a surgical equipment that has not undergone processing to prevent reflection, cover it with
gauze soaked with physiological saline.

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(5) Measures to prevent fire
The heat generated by the laser beam could cause significant fire damage. Make sure the laser beam will
not strike any combustible substances within the operation area.
(6) Accidental Irradiation Precautions
1) Before performing laser beam emission, living body tissue that could be exposed to laser beam
emission should be well-covered with gauze that has been soaked in a saline solution so that it
cannot be harmed by accidental laser irradiation.
2) Always carefully consider the output power and emission time required for treatment and avoid
excessive laser beam emission.
3) Both patient and laser surgeon must wear Laser Safety Glasses. If the laser beam (direct rays or
diffused rays) strikes the eyes, it could cause blindness. Even when wearing Laser Safety Glasses,
never allow the beam to strike the eyes directly.

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2. Parts Identification and Accessories
(1) Parts Identification
Main Unit
Back
Spray Water
Level Window
Touch Panel Display
Spray Water
Connector
Foot Switch
Ventilation Opening
Start Switch
Brake
Caster
Rear Handle
Hollow Waveguide
Support
Upper Tray
Handpiece
Hanger
Handpiece
Front Handle
Emergency
Stop Switch
Front Door
Hollow Waveguide
Key Switch
Circuit Protector
Power Receptacle
Remote Interlock Connector
(safety device)

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Touch Panel Display(Main panel)
PPS (pulse per second) Indicator
Shows the rate for pulsed irradiation
(Unit: PPS).
Energy Level Indicator (mJ)
Shows the energy level setting (Unit: mJ).
Memory Key
Use this to memorize and retrieve different
sets of irradiation conditions.
Water Key
Turn the spray on and off.
Ready Key
Press this to go from Stand-by mode to Ready
mode. Turns green when activated. “Ready”
changes to “Emission” when laser is being
emitted.
Information Key
Lights up when maintenance information is
required.
Spray Water Setting Key
Press this to set the water spray flow.
Air Key
Turns the tip air on and off.
(When this is turned on, the water is turned on
automatically)
Air Setting Key
Press this to set the tip air flow.
LOG Key
Press this to display the irradiation log.
(This can be shown or hidden. The factory setting
is Hidden.)
Aiming Key
Turn the aiming beam on and off.
Menu Key
Hold this down to display the Menu.

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(2) Accessories
Contact Tips
C400F (1)
C600F (1)
C800F (1)
S600T (1)
PS400TS (2)
PS600TS (1)
PS600T (1)
Keys (2) Grease Applicator (1) Laser Safety Glasses
(3 pairs) Lens Cleaner (1)
Tip Stand (1) Foot Switch (1) Remote Interlock
Connector (1) Hollow Waveguide (1)
Hollow Waveguide
Support (1) Power Cord (1) Handpiece Hanger (2) Handpiece Grips (2)
Deionized Water Tank
for Cooling, 2.5-liters
Deionization Filter
Cartridge (1) Drain Tube (1) Wheel locking device (1)

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Patient warning plate
Operator warning plate
Eye warning plate
Laser Danger plate
Operation Danger plate
Optional Tips and Parts
CF600 CS600FR135T R200T
R300T R600T P400T P600T
P400FL PS400T PS800T PS800TS
* Only for R135T, R200T and R300T
Brush PSM600T R Handpiece Grips Touch Panel Protective
Sheet

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(3) Labels
Read All Warning and Caution Labels
(inside of the device)
Rating Label

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(4) Symbols
* Some symbols may not be used.
Serial number
CE(0197) marking
Conforms with the European Directive,
93/42/EEC.
CE marking
Conforms with the European Directive,
2011/65/EU.
Manufacturer
Date of manufacture
Refer to instructions for use
Attention, consult
accompanying documents
Type B applied part
Marking of electrical
equipment in accordance with
the European Directive
2012/19/EU (WEEE)
cTUVus certification mark
(Valid only for U.S.A. and
Canada)
DANGER
No pushing
Caution
Caution: Laser Caution: High Voltage
Emergency laser stop
Optical fiber applicator
Alternating current
“ON” / “OFF” (push push)
“ON” for part of equipment “OFF” for part of equipment
Remote interlock connector,
as defined in 3.74 of
IEC60825-1
GS1 DataMatrix
This way up Fragile
Keep away from rain Temperature limitation
Authorized representative in
the European Community

Instructions for Use 2012-08-23
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3. Operation
(1) Set Up
(1) Put the unit is in position and then step on the tabs to lock
the caster brakes.
(2) Take the foot switch off its hook and place it on the floor.
(3) Turn on the circuit protector on the back of unit.
(4) Pull the handpiece hanger forward.
Hook
Caster Brakes
Circuit Protector

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•
When the unit is not in use, always take out the key and give it to the person in charge.
•Never use this laser, modify it, or calibrate it in any way other than as described in the user manual.
Inadvertent laser emission could be extremely dangerous.
•Use of controls or adjustments or performance of procedures other than those specified herein
may result in hazardous radiation exposure.
•Do not apply excessive force or stress to the hollow waveguide. Never bend in into a curve with a radius
of less than 6 cm.
•Do not let anyone go between the patient and the laser unit. Do not let personnel not involved with
the treatment stand near the laser unit.
•If an error occurs, stop using the laser unit immediately and turn it off.
•Do not put the laser unit on a surface that is not level; it could tip over. Make sure the brakes on the
casters are on.
•Never tip the laser unit more than 10°when moving it; it could tip over.
•Make sure there is enough water in the spray bottle.
•To avoid accidentally stepping on the foot switch, decide where it should be and always leave it in
exactly the same place.

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(2) Turn the Unit On
(1) Put on laser safety glasses.
(2) Put in the key and turn it to the Stand-by position.
(3) Push the Start Switch.
•The warm-up procedure will run for 20 seconds.
* The warm-up countdown number will appear in the
operation panel.
•After warm-up is completed, the LCD panel will show the
Laser Setting panel and the equipment will be in Stand-by
mode.
* If the water temperature is less than +15°C (+59°F), the
“D” interlock lamp may light up. In this case, wait for
the water to warm up.
* If the cooling water gets too warm the fan will speed up
and make a louder noise.
(4) Press the “Confirm” switch.
(5) The main panel will appear.
The settings for the Intial Memory will appear.
Initial Settings
The Initial Settings are the fifth set in Group 4 (blue tab). These
are the values set when the unit is first turned on.
These settings can be changed in the same way as all the others.
Even the name “Initial” can be changed if you like.
Start Switch

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•
A direct, reflected or scattered laser beam can cause permanent blindness. All individuals in the laser
use area must wear laser safety glasses supplied with the AdvErL EVO. The Laser safety glasses has an
OD of 3.5 (or greater) at 2.94μm. Other parts of the body should also be protected. The laser beam
can cause serious injury to the skin and eyes.
•Even if you are wearing safety glasses, never look directly into the aperture where the laser comes out;
you could be blinded by the laser. Both the main laser and the guide light are dangerous. The
safety glasses provided only temporary protection.
•Use only laser safety glasses specifically designed for the Er:YAG laser. Do not use laser safety
glasses meant for use with other types of lasers, the CO2laser, for example.