Class 1 and amalgam removal - Laser Dentistry Forum

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December 31, 2002 at 5:07 pm #2884 Reply

Glenn van As
Spectator

Hi folks and a best wishes for the upcoming new year.

I am going through some old pics and seeing things that I might think are of interest.

Alot of times we have discussed things with the lasers but there havent been cases shown.

In this case there was new decay on the occlusal of a primary molar that had an occlusal amalgam in it.

Some of you have been anesthetizing the tooth in defocussed mode for 60-90 secs at high wattage (5.5-6w) with lots of water and air and then going to the amalgam.

What I did here was remove the caries first which takes that long and then go after the amalgam with a bur and once removed join the two areas up with the laser.

The laser removes the smear layer and the tooth was bonded for a composite restoration. For those that are new, the argon laser at 488 nm was used for curing.

Hope it helps solidfy once of the concepts we talk about here……….

The laser helps desensitize the tooth and alot of times you can then use a bur for amalgam removal afterwards without sensitivity.

Glenn

December 31, 2002 at 10:00 pm #6801 Reply

Swpmn
Spectator

Glenn:

Cool case, use the laser first to remove caries and desensitize the tooth then use bur to remove amalgam.

What bonding system are you using to place your composites? I notice that you always etch with phosphoric after your laser preps. Are you placing a flowable for first layer?

Since April of this year, I have been prepping carious virgin teeth only with the laser then placing Clearfil SE Bond with no phosphoric acid etch. I place a flowable composite first on my posteriors, currently using DE-MARK from Cosmedent.

Patients are cycling through recalls, reporting virtually no sensitivity and composites look great.

Al

December 31, 2002 at 11:52 pm #6798 Reply

Glenn van As
Spectator

Allen: your questions are always so astute.

Thanks for the kind words by the way.

I still dont feel comfortable using SE bond because the local bonding guru told me about the possible failures of 6th and 7th generation (no etch) bonding systems which he termed as fine on dentin , not fine on enamel.

I think the laser etch probably is enough but old things die hard for me.

I use a 5th generation bonding agent , Prime and Bond NT (one bottle bond) after I etch.

I am not in the majority anymore when I look at polls. There are alot of people doing exactly what you are doing.

Don Coluzzi whom I really respect is doing exactly what you are doing with Clearfill SE bond.

He loves it too.

I often use flowables in the base like tetric flow and then hybrids like Tetric Ceram. Some times in kids I will use Dyract Flow and Dyract.

Thanks for the compliments. ALot of the tiny preps are only possible to treat with the flowables.

I thought the pics were good on that one so that is why I posted it.

Happy New Years to you All

Glenn

January 1, 2003 at 12:26 am #6799 Reply

Patricio
Spectator

Al and group,
I have been wondering when I prep with the laser and leave a roughened surface what additional value the etching adds. So far I am using clearfil SE but am trying the new stuff I think it is called Simple?? which is a little different. I notice Glenn is really roughing up the occlusal margin and it looks like maybe a bevel has resulted. What are others doing?
Pat

January 1, 2003 at 12:50 am #6803 Reply

Swpmn
Spectator

Glenn:

Thanks for your input on bonding after laser preps.

Read my post on Dental Town under “Feeling Great About my Waterlase”. It’s actually a serious post about my experience with soft tissue surgery but I threw in some humor to try and break the ice.

Al

January 1, 2003 at 1:06 am #6802 Reply

Swpmn
Spectator

Pat:

I think Glenn posted on Dental Town research results which show about 90% bonding of laser only enamel etch compared to phosphoric acid. When you also etch laser treated enamel with phosphoric the bonding strength is increased by about 30% over phosphoric etch alone. Personally I think when we get above 20 MPa bonding strength the differences are clinically insignificant.

You are using John Kanca’s Simplicity product, right? How is it working for you so far? I’m quite interested in the product.

Here, I use the Waterlase to strongly etch the axial occlusal margins on a posterior tooth but try not to create a bevel. I’m concerned that composite on beveled posterior occlusal margins may fracture over time.

Al

January 1, 2003 at 11:22 pm #6800 Reply

Patricio
Spectator

Al,
Thanks for your comments. Yes I am using the Simplicity. So far I have had to learn to clean the prep with alcohol without flooding the patient’s mouth. The sponges privided hold way to much but I have it down now. The self etch liquid is clear and a little more difficult to see on the bracket table vs the Clearfil. The resin is much thiner and only requires 5 to 8 seconds prior to curing so that is a plus. The idea was to develop a thinner resin interface so I would say this is a success. There should be virtually no pooling of the resin. I have been using the Rembrandt Saphire light for curing with complete success. In most cases we use 3 seconds for each application. This makes for a smooth flowing procedure without 20 second delays.
Pat
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