Bridge Repair - Laser Dentistry Forum

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July 24, 2003 at 5:48 pm #2828 Reply

Anonymous
Guest

Hi all,

Retired female presented with decay on cervical buccal #20. Pt wanted to patch. No topical or local anesthectic used.

Preop

Used .75W 11%air 9%h2o for gingivectomy.

Perio probe image for RFW,azoperio, and hack2, among others 😉

Didn’t have too much of a bleeding problem until probing and then prepping the tooth – 1.5W 35/20. Went back and painted the gingiva @ .75W 0/0 which decreased the bleeding enough to get some fugi ix placed.

During finishing w/ composite instrument and explorer had a difficult time keeping things dry to see. Other than the FR nd:YAG, any suggestions for controlling this kind of bleeding?

Thanks,

July 25, 2003 at 9:42 am #6425 Reply

ASI
Spectator

Hi Ron,

Would you consider a diode laser to coagulate? Along with astringent and even retraction cord as needed to control moisture.

Would you consider an osseos reduction to gain a bit more biologic width?

Andrew

July 25, 2003 at 11:53 am #6422 Reply

Anonymous
Guest

QUOTE

from ASI on 5:42 am on July 25, 2003

Would you consider a diode laser to coagulate?

Since I did all this w/o anesthetic, I was hesitant to use diode or nd:YAG because I assumed I’d have to numb things up then. If there are parameters to do this w/o anesthesia, I hope someone will post them.

QUOTE

Along with astringent and even retraction cord as needed to control moisture. Would you consider an osseos reduction to gain a bit more biologic width?

Was concerned about contamination from astringent and bond of the G.I. I ended up applying pressure to the gingiva w/ 2 cotton tip applicators , flushing with water, having my assistant dry with a 3rd applicator , and then placing the G.I.. Once I let up on the pressure the seepage resumed. Cord would have helped.

Although my crummy photography doesn’t show it (when will I ever remember to dry the preop pics and learn how to get rid of shadows?), there was 2mm between the base of the prep and the attachment.

There were alot of things that I could have done conventionally- cord, astringent, infiltrate anesthetic w/ vasoconstrictor, application of pressure,etc.- My main interest was learning the cause (beam scatter and reflection from the tooth prep, possibly?) and seeing if there were ways to prevent it or control it better with the laser.
Thanks for the comments ,Andrew.

July 25, 2003 at 1:08 pm #6427 Reply

Benchwmer
Spectator

Ron,
You need to use the wide pulse width on your PerioLase.
Trough before hard tissue caries removal, perform GV w/ Nd:YAG 3.0W 20 Hz 150 usec, Erbium to remove caries, then Nd:YAG if needed at 3.0W 20 Hz 635 usec (or whatever your setting are at wide pulse width) for coagulation)
Use Topical and infiltrate with a couple drops of 4% Citanest before troughing and GV.
The trick is not to let the bleeding start.
This is again where I don’t understand the Hard tissue laser/BioLase mentality where you lose if you need to administer anesthetic, 2 drops of LA and the Nd:YAG would have saved you a half hour of stress w/o any cotton, hemadent, cords, etc.
Still use the Erbium for painless caries removal and tooth prep.
I find that once bleeding starts w/ the Erbium, I’m in trouble w/ hemostatis. The only time I’ve had to use Hemodent and cord in the last 4 years. Previously I’ve always prevented the problem w/ the Nd:YAG technique.
You have too many options now.
Good luck.
Jeff

July 25, 2003 at 7:43 pm #6426 Reply

BNelson
Spectator

Ron
Rather than haul out another laser for 2 secs. I just rub a little Ultradent Viscostat on and the bleeding stops in 5-10 secs. Finish everything up with the Er and place your restoration.

July 26, 2003 at 3:34 am #6424 Reply

whitertth
Spectator

Alot of the hemostatics work well but they leave that gelatinous gunk all over…try using superoxol works wonders just let it bubble up and rinse and voila….no bleeding…..see u in Jersey

July 30, 2003 at 2:04 am #6423 Reply

dkimmel
Spectator

Ron, This may sound odd but I have had better luck with the 2.75W /55w/65a defocused with the tissue removal. Far less bleeding to none.
I agree with the superoxol, nice , clean and works.
The diode is another great idea. I hear you about not wanting to use anesthic. Just got my TAC gel in today. This stuff is great. Could be a non injection option to allow cord placement or use of the diode.
DAvid
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