Forums › Erbium Lasers › General Erbium Discussion › Laser Dentin Disinfection on deep prep
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Glenn van AsSpectatorHi folks: Again nothing mind boggling just something to consider.
This was my last patient tonight ( around 3 hours ago).
All photos shot through the scope with preop and postop radiographs digitized by taking my Nikon 990 and shooting the film on a viewbox with macro mode.
Photos edited with text in ACDSee 5.0 ( a nice little program in my opinion)
This patient had alot of decay under the amalgam which was visible on the lingual of the MO amalgam in the preop photos.
I removed the amalgam and noted alot of decay and in addition a void on the MO composite on the 2nd molar.
I have often said that the scope allows you to visualize decay and know when you are on solid tooth structure and when you arent.
I put some caries detector gel in this case to see what it would say.
WHen I got the last bits of decay out with a slow speed the pulp was very very close and visible at high mag with the scope.
no direct exposure but right there…….
I used the erbium yag hard tissue laser to try and disinfect the remaining areas close to the pulp.
Covered it with Dyract Flow Glass Ionomer. Then a flowable and finally a hybrid tetric ceram.
It worked out great but time will tell on whether the pulp will turn irreversible pulpitis on us.
Just to show you another use for the lasers in deep preps to try and disinfect the deepest areas with minimal preps.
The post op film shows the restorations.
Glenn
Here is the link
http://www.sendpix.com/albums/021030/2247510000066676d506106ffa0a5a/
Robert Gregg DDSSpectatorGlenn–
Nice post, GREAT pictures!
I was dying to use the FR Nd:YAG to get the final decay out….;)
I didn’t see any pulp tissues. Was that thin dentin, or was there an actual dry opening there?
Bob
Glenn van AsSpectatorHi Bob……..it was very thin dentin there. No pulp but it was very thin.
The Erbium worked fine for the last little bit. i wasnt aware that Nd:Yag could take out dentinal caries. I thought it was able to take out stained enamel caries.
I dont know if this will work……..time will tell.
Cya
Glenn
Glenn van AsSpectatorHi Bob……..it was very thin dentin there. No pulp but it was very thin.
The Erbium worked fine for the last little bit. i wasnt aware that Nd:Yag could take out dentinal caries. I thought it was able to take out stained enamel caries.
I dont know if this will work……..time will tell.
Cya
Glenn
AnonymousGuestQUOTEQuote: from Glenn van As on 1:46 am on Oct. 31, 2002I put some caries detector gel in this case to see what it would say.
Glenn,
I don’t remember where I heard or read this (Graeme Milicich perhaps-I’ll check my cd’s at the office)and I’m not being critical in the least, but on lased teeth I remember something about caries indicator dye giving false positives on lased teeth.
I’ve stayed away from doing this- anyone else familiar with this line of thinking?
Love the pictures, wish I had a scope to see like that!
Thanks to all you guys for the posts-I’m learning alot
Robert Gregg DDSSpectatorHi Glenn,
QUOTEI wasnt aware that Nd:Yag could take out dentinal caries. I thought it was able to take out stained enamel caries.Heck yeah!! Pulsed Nd:YAG cuts dentin very well, as well as removes caries very well and very selectively–leaving behind healthy enamel and dentin. It can act as a very good “caries detector” that way. It is a good dentin bacterial decontamonator and desensitiser as well.
As few examples:
Contact pulsed Nd:YAG ablation of human dentin: ablation rates and tissue effects
Harris, David M., Univ. of Illinois College of Dentistry; Yessik, Michael J., Incisive Technologies, Inc.
Publication:Proc. SPIE Vol. 2128, p. 409-415, Laser Surgery: Advanced Characterization, Therapeutics, and Systems IV, R. Rox Anderson; Ed.
Publication Date:9/1994Abstract:
Dentin from freshly extracted human teeth was exposed to flashlamp pumped Nd:YAG pulses (100 microsecond(s) duration, 50 – 200 mJ/pulse) delivered through a flat cut fiberoptic in contact with the dentin surface. Ablation depth and volume were measured optically and confirmed with electron microscope morphometrics. Ablation depth increased with force applied at the fiber tip up to 5 – 10 g. Above this ablation depths were insensitive to applied force. Craters made in dental stone were deeper and narrower than those made in normal dentin. Ablation depths per pulse and volumes per pulse decrease as the number of pulses increase. This is more prominent for 200 mJ pulses. At 60 mJ the ablation depths are the same from 10 to 100 Hz repetition rates, although qualitative changes (collateral damage) are greater at higher repetition rates. A progressive increase in collateral damage is seen from the 1st through the 200th pulse.
Histologic and SEM evaluation of caries removal and restoration in enamel and dentin using a pulsed fiber optic delivered Nd:YAG laser
White, Joel M., Goodis, Harold E., Kudler, Joel J., Eakle, W. S., Univ. of California/San Francisco School of Dentistry; Neev, Joseph, Beckman Laser Institute and Medical Clinic
Publication:Proc. SPIE Vol. 2128, p. 439-452, Laser Surgery: Advanced Characterization, Therapeutics, and Systems IV, R. Rox Anderson; Ed.
Publication Date:9/1994Abstract:
The pulsed Nd:YAG laser has been proposed as an alternative to the dental handpiece for caries removal in enamel and dentin. The purpose of this study was to systematically evaluate, in vitro, the process of caries removal and restoration in enamel and dentin. The effectiveness of this device was investigated utilizing scanning electron microscopy to determine the behavior of dentin after laser treatment of artificially created carious lesions in dentin. Histologic sections of extracted teeth after laser treatment and restoration demonstrated successful caries removal and restoration using the pulsed fiber optic delivered Nd:YAG laser as compared to both high and low speed rotary instrumentation. The adjacent enamel and dentin were unaffected by the laser irradiation although slight carbonization was seen on the dentin surface. Thermocouples placed in the pulp chamber during caries removal confirmed previous studies that showed laser parameters up to 1 W and 10 Hz being the same as conventional caries removal in the amount of heat generated which reaches the pulp. The addition of air/water coolant decreased pulpal temperature.
Bacterial” target=”_blank”>http://spie.org/scripts….cterial reduction and dentin microhardness after treatment by a pulsed fiber optic delivered Nd:YAG laser
Goodis, Harold E., White, Joel M., Marshall, Sally J., Marshall, Grayson W., Univ. of California/San Francisco School of Dentistry
Publication:Proc. SPIE Vol. 2128, p. 431-438, Laser Surgery: Advanced Characterization, Therapeutics, and Systems IV, R. Rox Anderson; Ed.
Publication Date:9/1994Abstract:
The purpose of this study was to determine the microhardness and extent of bacterial reduction of contaminated dentin following pulsed fiber optic delivered Nd:YAG laser exposure. Knoop hardness was determined before and after laser exposures from 0.3 to 3.0 W and repetition rates of 10 to 30 Hz. Half the sections were covered with an organic black pigment before laser exposure to evaluate the use of the pigment as an initiator to increase laser absorbance on the surface. Repeated measures design was employed to determine the microhardness of cut and polished dentin sections. Additional dentin sections were sterilized by gamma irradiation and then inoculated with B. subtilis, E. coli or B. stearothermophilus. The contaminated sections were exposed to contact delivered Nd:YAG laser. Cultures were obtained from the dentin surfaces and the colony forming units counted. Increased microhardness was found for all laser treatments above the physical modification. Bacterial reduction was obtained but complete sterilization was not.
Glenn van AsSpectatorThanks Bob……..great to see the science behind it. Interesting how Higher Hz produced more collateral damage.
I think it is safe to say that the erbium is more selective for removal of tooth structure than the Nd Yag but it is nice to know that the Nd Yag will remove tooth structure
Ron , I know from looking at the dentin that there was still caries left as it wasnt smooth or shiny but still had that roughened look. It may be that the caries detector gives false positives on dentin as well as enamel but I know it was still carious. Interesting enough, the patient had no pain before the restoration was done, but it sure was nice to be able to show him both live and afterwards with the photos what was done with the tooth and how deep the caries was.
Patients never come back and say ……hey that tooth you worked on is darn sore and it wasnt before.
I dont know if the laser helps prevent endos, Hansen says it does. I know it wont hurt in deep preps.
Thanks for the kind words and practicing with the scope makes dentistry fun indeed.
Glenn
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