Geez, Glenn, don’t mention me and I’ll abide by what you ask:
“First off Ron thanks for your thoughtful and thorough response. As always you have created a civil and professional post and it keeps in line with the overall scope of the LDF. “
I think you need to take a good hard look at the rest of what you wrote here and see if it’s consistent with the first paragraph. It doesn’t bother me at all, but it’s two faces of one argument with what follows IMO.
“I want to lead off by saying that I really appreciate all the efforts of Danny and to a lesser degree Hack in trying to teach us periodontal principles in application to laser technology. I have learned alot from their posts and particularly Dannys great photographed anterior crown lengthening cases and posterior cases of root reshaping. “
I spent a considerable amount of time showing you how to make a vertical, not splitting papillas, bringing the data you asked for. Perhaps your anger has clouded what used to be a good relationship..at least as I perceived it. I had recommended people to see you speak….and would likely still do so as you and Mark Colonna are the only two speakers I’ve seen on erbiums in restorative dentistry that have good info to share even if I don’t agree with all of it (yeah, I’ve heard you speak Glenn). Sorry it’s come to this Glenn.
“Second off, I have seen many many anterior cases posted on Dental town which are beautiful from Danny. I have yet to see a single periodontist post a case of interproximal bone relief in posterior teeth. Why is this?
I suspect that not many dentists do refer in these cases although it happens often with posterior crown preps when the interproximal amalgams approach bone. So what are the general dentists doing – are they referring patients. I can tell you the one patient I referred to the periodontist for interproximal bone recontouring ended up with significant sensitivity to cold and also a large posterior triangle without any papilla so that things could be gradualized out. In addition I have 3 patients in my practice who have gone through osseous recontouring in one quadrant and have repeatedly told me that they will not go back for the other 3 quadrants of “non invasive ” periodontal surgery. It is the reality that most patients dont want surgery.”
Ummm…maybe we don’t take pictures of that because it is routine and not exciting in any way, shape or form. We also don’t have as many to shoot as violation of biologic width is rampant and not often referred. If you like I could dig those photos up, but then you would have to have a dialogue with me, and that seems to incense you (even a small simple, sentence). It would also require a bit of my time, and apparently, I haven’t been that useful to you or anyone else and my time is valuable to me. The reason is not patient comfort as much as you would like to believe. Perhaps your bias is leading you to an incorrect conclusion. I would agree that most people don’t want surgery…I’d also tell you I’ve worked on several that had no trouble coming back for more later after they realized how easy it was. Of course, throwing in osseous surgery is not apples to apples is it? A straight forward single tooth crown lengthening on that tooth equals no need for vicodin, and probably no advil in that part of the mouth. I also have no idea how your guys are doing osseous. If they are in the grand school of ultimate positive architecture….it ain’t easy on the patients. There are other modes of treatment to consider as opposed to one size fits all therapy. Could you maybe stick to crown lengthening as that was the discussion topic?
“Heck I have a huge kidney stone in my right kidney, (perhaps accounting partially for my testiness these days) and I dont want to have surgery on it…..do anything you can to break it up without having surgery. Just the word creates some angst for me. Do Danny and Hack do wonderful surgery ……YES, but patients dont love having to have it done. “
In a comparison of post-op photos, crown lengthening in my hands seems to heal faster than in yours. Have you seen any of mine or Danny’s patients that you can make that statement from? Are you sure your patients “love” interproximal denudement as done here. Bob Gregg suggested my patients may like me and don’t always give me the straight scoop, I imagine that applies regardless of the tool. As always individual mileage on a procedure varies from one to the next. I just happened to go to a New Year’s party that featured two of my crown lengthening patients that went on and on without solicitation of how it didn’t hurt at all. I’m sure I can find some that say the opposite however. In any event, the pissing contest here is pointless..two opinions, both will be right at one point or another. I place a bit higher value elsewhere.
“WHy is it that the initial dentist just drilled down with a bur, didnt worry about
1. Biologic Width
2. Getting a solid margin on tooth structure.
3. Removing all the decay.
I have a feeling that this is the norm. I see it on my endo forum that I belong too, the specialists (endo) were discussing how to restore a tooth which had deep decay subgingival and the consensus was to take a bur and remove bone and tissue.- all done closed flap. “
That was one in the mid-80s..you’re doing it with a laser now, but it looks much nicer to the tissue with the laser than the bur. Perhaps Canada doesn’t reflect my area. There is also a difference with new tech on hemostasis, ability to get impression, etc.
“I have yet to see ANY posterior cases posted showing interproximal treatment done, especially with the magnificiation and detail that I am trying to show.”
I’m not sure what you’re trying to prove here besides your value as a result of your effort. Was that the point?
“I think that sometimes that these difficult cases are a compromise no matter what you do. You can flap and graudualize bone creating iatrogenic root recession and sensitivity on adjacent teeth with a large dark interproximal space. You can in addition extract as many periodontists in my area are doing for ANY questionable teeth and put in the all mighty titanium. I do restore implant abutments in my practice but my first goal is always to try and retain what is there.”
This is not a difficult case though is it? I would agree minimize the compromise can be a good catch phrase. If it’s the mesial of a first premolar and it’s deep, the titanium isn’t always a bad idea. Why criticize one technology while using another? Are they both not viable? Saving teeth with a compromise versus extracting is always an interesting debate-taken on a case by case basis. I can’t see this one as an extraction, nor did I call for it.
“Next off it is difficult to determine in this case how much bone was removed because of the angle and the difficulty in showing this and the PA does you no justice because the buccal and lingual papillary bone areas are still at the same heights. The only clue is if you look at the impressions and as stated before you get some idea of the roll of impression material into this area.”
PAs aren’t appropriate to look at here, the BWs are..as I pointed out at DT. You are 100% correct.
“In reflecting a flap in this area and removing bone it would be a difficult case because of the root proximity of the mesial root of the molar to the distal of the premolar. Perhaps the best insight I had from someone on DT, was to have considered extrusion which I dont do often simply because of the time necessary to complete the extrusion but it is a viable alternative in this case. “
Looking at the BW, the roots aren’t that close are they? In a tight space, you can use a beavertail ultrasonic to remove bone, a sugarman file, etc. You can also smooth up the root when you get done if you abuse anything if you have a flap. In this case, a flap is more likely to have more bone coverage with tissue at the finish if that matters….and given what some people do with straight line incisions..it doesn’t matter that much I guess.
“I to be honest had forgotten this case but was surprised that it was brought back up again by Hack2, looking4t etc and I was wondering why after a month he suddenly posts on this again with a short terse reply obviously intended to do nothing but stir the hornets nest, and he is surprised that I stand up for myself, but that is ok.”
There was nothing terse, just short. I’ve also made no secret here of my ID at DT..and many here know me by name or even personally. I waited a month to respond to anything you posted in deference to what appeared to be unjustified anger that lead you into a post that you did that was clearly ONLY meant as a personal attack. Perhaps you’re forgetting your conduct and in context, I can’t see where your anger is justified. I think a short reply to stimulate discussion can be more effective than a long one. Hardly anyone outside of you or Ron will read this whole thing. That post was meant to stimulate thought as to what you’re doing with the architecture and what that can mean. I will readily concede in some cases, a small compromise is acceptable-I do it myself. I wouldn’t view a 3mm crater as a small one though. In this case, it is unlikely to be where you think it is IMO.
“I post cases here for everyone to learn and do so realizing that not everyone will agree with my treatment, in fact I often learn from the constructive criticism that is levelled at it. Danny has taught me alot.”
And you went after him pretty good for quite awhile and said he wasn’t being constructive, just abusive. I think there’s a lesson in there somewhere. By exclusion, you are suggesting I post to cause trouble, not to learn. That is complete BS and inconsistent with my actions.
“I also realize that some people have such a built in negativity towards a technology or a treatment that they belittle anything done with it.”
That is inaccurate, unfair, and in a vein that can’t be supported by my actions. Belittling something would mean attacking it for the purpose of attacking it…to wit, with no basis in fact. I have yet to see where your concern is when you look at trench formation, crater formation,and negative architecture. I see criticism of conventional crown lengthening, but when done conventionally with a laser it seems to take on a new meaning to you. Perhaps you are as biased against older methodologies as you think I am against new ones. I guess I should throw out my implants, PRP, fibrin glue, digital X-rays, stacks of journals, T1 line to connect the offices, paperless office, etc. just to prove you correct.
“Do I go onto the Cerec forum and dish the technology, nah……..not my way.”
I have not dished the technology in this thread-the application of it requires deeper thinking IMO. It was said without heat or any hint of a personal attack…that came in your reply. Apparently a more lengthy reply would have assuaged your hurt feelings, but I honestly didn’t see it as rude. Given that perception is reality, the only thing I can offer is my apology that it was not meant taht way. I wanted to know what you thought you did. I am of the opinion you removed much less bone than you thought, a vertical BW would be useful post-operatively, and that in some cases, as I have said now TWICE, minimizing the compromise is something that is perfectly fine. In addition, I could link to the old thread on closed versus open and see if the numbers are the same now. It apparently isnt’ just me. Are you going to respond to them the same way? Are they “dishing” new technology when they say it?
“If someone wants to continually be negative about a technology that is fine but if you do so in a forum where almost all the people own or are interested in laser technology then I figure I have the right to defend myself.”
If someone tells me they won’t be responding to me, then respond in a self-styled personal attack after commenting how nice things have been set-up here, I will likely choose to respond. As pointed out, it was not the technology, but the application of it. Erbiums are fine and may be better for some things. People are interested in lasers here..all the more reason to consider from a different view what is being done. If everyone is thinking the same, then someone isn’t thinking. In this case, IMO, you removed much less bone than you estimated, are little close on biologic widht, but will likely end up OK due to the fact that there hasn’t been as much compromise as you estimated (third time).
Now, I sent a private message to you last night…if you want to continue this, you can continue it in private, or by yourself, I’ve said all I will say and refused to get sucked in by you calling me out again. If you genuinely want a respone, you let me know…otherwise I will show you, Ron, and the message board as set up my respect by not posting to you. You have more to contribute on erbiums than I have to contribute on general biology. When I have a professional difference of opinion on something that doesn’t make the other guy a bad person or even a bad dentist for that matter. Bad ethics make a bad dentist-every time IMO. The rest is person by person…just like they view me. Apparently, it isn’t quite the same for you-it’s more personal. It is not a weakness, just a difference in how we think that I will try to be cognizant of if we have any future interactions. I will endeavor per your request to avoid them.
(Edited by lookin4t at 3:22 pm on Jan. 8, 2005)
} You know, with patients like these, it’s no wonder we’re so busy. Look at all those old restorations!