Forums Erbium Lasers General Erbium Discussion What do you think?

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  • #2856 Reply

    brucesown
    Spectator

    I was having a lively debate with myself as I was doing a restoration today and wondered what you all would think.

    I was restoring a lower second primary molar on a 7 year old that had distal decay. My assistant couldn’t get the clamp on the permanent molar so, for reasons known only to her, she put it on the tooth I was to restore. Ever up for a challenge, I thought I would just do a tunnel prep from the occlusal and see what happened. I used the erbium ( with anaesthetic, I’m still a bit cowardly about kids and anaesthetic free dentisty ) and made a nice conservative tunnel down to the caries, removed it and took a look. What I had left was a thin shell of enamel interproximately, which had not been breached, (4x loupes) with a white spot in the middle. I restored it with some Fuji IX and composite on the occlusal.

    My questions are this:

    Does anyone routinely leave a shell of enamel when doing restorations like this?

    Will it last the required 5 years or is it doomed to replacement before the tooth exfoliates.

    Is the bonding of GIC similar to this enamel as untouched enamel. What if I had used composite alone, what would the bonding be like?

    Should I take assertiveness training and/or fire my assistant?

    I’m sure there are a lot of different ways of dealing with this situation and I would love to hear what others have or would do.

    I really respect the people who take the time to contribute to this forum, your help is greatly appreciated. Hopefully some day I will have something to contribute in return.

    #6590 Reply

    drnewitt
    Spectator

    I think I know what you are describing Bruce. Do you have any images?

    I have found that i have been doing a lot more tunnel type preps since I started with the laser and end up with a similar result to what you described. The trick is making sure you have good visual access to assess if you have left any caries behind, use a dye, go into the embrasure space and to get rid of the decalcified area there.

    I put a band in place before tx to ensure I am not lasing or bonding to the neighboring tooth, use Clearfill SE bond as it has one of the highest ratings for bonding to prepped enamel –> GI resin –> AesthetX occlusal (on primary teeth). If it is a permanent tooth I will only use Comp as I have read it has higher compressive strength as compared to the GI resins and less expansinon with h2o over time.

    I have followed several over the last several years and they are holding up very well. Nicest thing about it was i didn’t have to anesthetize, even on the pulp exposed ones! Trust the force Bruce, even if that force is a hydrokinetic one smile.gif

    Saving the marginal ridge will provide greater strength to that tooth in the long run. Since you are using the laser rather than the drill you will avoid introducing micro fractures into the enamel and that should allow for even more strength in that marginal ridge.

    Rubber dam, clamp whats that? Don’t fire your assistant, get an Isolite! Of course if you do decide to send her packing i am looking for an assistant for Spetember smile.gif

    P.S. anaesthetic – contact Dave Kap, he will set you straight about putting that anaesthetic in the drawer. He is a great source for info on eliminating anaesthetic.

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