Here is an update on a case I did a while back (9 months or so ago) where I cut a flap to expose a premolar. Really this was my first case of attempting to do some surgery with the erbium and since then we have done extractions, osseous recontouring and other flaps stuff………

I now have put these pics into JPEGs as before they were on sendpix and are long gone in terms of storage (they were kept for 1 month on the site).

I have updated the photos to show you what the case looks like now, and intend to do this more now to show you what some of the cases look like 9-12 months down the road…….and maybe in revisiting these cases we stimulate a little bit of discussion……….

Here is my original statement and photos are attached.

Hi Folks: I am glad I went into work this morning to do this case.

I have never done an exposure before , this was my first.

I feel like Mark Colonna…….well not as good looking or as smart but something close to him then.

(A Mark Colonna wannabe)

This young 14 year girl has the most crowding of any child in my entire dental career. I extracted all the first premolars and still had trouble getting some of the teeth in.

6 months into treatment one tooth is not coming in and I take a new pan , pas and an occlusal and the upper right 2nd premolar has rotated and is not coming in as it is blocked out.

I am feeling pretty sheepish and off she goes to the specialist. Well the parents are a little upset with me for not noticing the possibility before , and ask if I can do it to save them some money………enter the erbium.

Continuum has some nice new tips which are shaped like a chisel for periodontal work ( from Japan) and in addition the make a nice scalpel. After anesthetizing……( I wasnt gonna try so dont ask me why), I very quickly used the chisel tip to cut my flap. I had sounded through the tissue to feel the tooth and when I saw no bone, I thought lets just cut a window in the palate.

At this point , I notice the tooth was not really 100% formed, and a little decalcified. Not wanting to risk the erbium, I used the argon to quickly trough around the tooth ( I was worried about etching the tooth and bleeding).

Then I thought to make a better bond of the bracket to the tooth I would very lightly etch with the erbium prior to acid etch the tooth.

Some like Mark may have been content with the erbium etch to hold the bracket on……….bigger kahunas than me.

I then tied the elastic ligature to the archwire as I didnt have a chain that could fit anywhere. I have the eyelet and I usually pigtail a ligature through to bring the tooth in.

I am trying to derotate it first and then bring it down. I have done this a few times with canines before, but never exposed the tooth myself.

I asked my O/S how he stops the bleeding……..electrosurge he says………..

Oh yes the Argon laser tip is so small it assured me that the resin was set.

I know that others who have done alot of surgery will criticize certain aspects of my procedure. I ordinarily would have done the entire procedure with the Argon , but wanted to try out the new chisel tips for flaps (worked very well at 30 Hz and 100 mj without water (3W))

Ok now time for my flame retardant suit ………..

FIRE AWAY.

that way next time I will know what adjustments to make, but remember, at least I had the kahunas to try it and the photos to show it.

Grin

Glenn