Gingivoplasty w/ Cosmetic Restorations

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June 27, 2004 at 11:10 pm #2764 Reply

Benchwmer
Spectator

The free running pulsed Nd:YAG use for gingival troughing and hemostatis, has eliminated my use of sulcus packing, cords and hemostatic agents. Fiber delivered at a setting of 3.0W 20 Hz 150 usec is used for tissue retraction, gingivoplasty and gingivectomy. Impressions are taken at the same appointment of tooth preparation.

Emergency patient, initial visit, presents with fractured bicuspid

Bonding, post and core, gingivectomy, ready for impression.

Month after insertion, CAPTEK crown

Empress crowns #8,9
Before

Tissue recontoured and retracted with Nd:YAG, impression taken
Two weeks later at insertion:

Two years later

Note stability of gingival margins, no recession.
Jeff

June 28, 2004 at 4:51 am #5820 Reply

Glenn van As
Spectator

Hey Jeff: I like the second case very much and it is nice to see the 2 year follow ups. What size fiber are you using..300 or 400 micron?

How long does it take you to use the laser. Do you worry about recession or alter your settings depending on tissue type.

In addition have you tried CO2 from your Opus Duo , and if so how does it compare.

In closing , I sometimes will pack some Expasyl to distend the tissue after troughing if its tough getting a deeper impression.

THanks for sharing and yes, a dedicated soft tissue laser is better than the erbiums for troughing for crowns.

Nice cases.

Glenn

June 28, 2004 at 10:27 pm #5818 Reply

Benchwmer
Spectator

Glenn,
Hey!
The PerioLase cases were done with a 320 micron contact fiber, now I use a 360 micron fiber. I have been unable to find usable 320 fibers. Seems the qualitiy has been set for diodes, they don’t hold up w/ the peak powers of the Nd:YAG.
I attempt to treat Perio before starting cosmetic restorations. I use LANAP to treat Periodontal disease and even gingivitis. You need healthy gingiva to have predictable margins.
With all gingival troughing for impressions, I trough before tooth preparation. I do not want the diamond bur to touch the gingiva. No damage, no bleeding. Then I use Roeko Comprecaps (German), they are 3 sizes of cylandrical cotton. Just cotton, after preps, have patient bite until impression. It helps dry and retract the tissue. No chemicals. My troughing takes less than a minute per tooth.
I only have a OpusDuo Erbium, no CO2 in my unit. I didn’t see the need.
Jeff

June 30, 2004 at 3:18 am #5821 Reply

Robert Gregg DDS
Spectator

Nicely done Jeff!

Bob

July 3, 2004 at 3:26 pm #5819 Reply

Benchwmer
Spectator

Glenn,
Roeko Comprecap
Distributed by Coltene.

Jeff

(Edited by Benchwmer at 11:33 am on July 3, 2004)

May 26, 2006 at 6:58 pm #5817 Reply

Benchwmer
Spectator

Follow-up photos

Five year

3 1/2 years

This was one of my cases in Dentistry Today article May 2006, first time back to office in over 3 years.
Immediate imressions after laser GVs and laser recontouring and troughing holding up over time.
Haven’t used packing cord in any cases for over six years.
Jeff
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