Been playing around with the C6 tips more and more. They have an interesting “footprint” that changes as you defocus the beam. It goes from a focused zone, and as you move away from the surface, the main energy distribution becomes like a doughnut. This helps prevent central overheating and whitespots. Move out a bit further and the beam diverges quite rapidly. This effect is beneficial if you want a wide footprint for certain effects. Here is a soft tissue application of the C6 tip utilizing its defocused, wide footprint.

This case is only simple stuff, but it helps make a difference. Had this patient in today with subgingival caries. A real “potty mouth.” Can’t get him to clean his teeth any better than this!!! Been beating my head against that wall for 10 years. He won’t make the connection between cleaning his teeth properly, and avoiding making regular contributions to my retirement fund!!

The buccal gingival tissue was very thick and rolled and covered most of the lesion. So I used a C6 tip at 1.5W 7%W 11%A in a defocused mode to utilize the wide footprint of the C6 defocused beam to contour the tissue for access.

It was incredibly effective in ablating away the full width of the tissue (about 1.2mm wide) without creating the potholes in tissue that the G6 tip tends to create because of its more focused beam. Normally, I would have used a 750 micron tip and still had a bit of difficulty dealing with the width of tissue in one sweep.

Once the height was established, I reduced the power to 0.75W 7%W 11%A and did an internal reverse bevel gingivectomy with a focused C6 tip. This thinned the thickness of the tissue and gave better access without reducing the height any further. It will also allow the tissue to collapse back onto the tooth and create a thinner gingival architecture, which hopefully will reduce plaque accumulation in this site. (one can only hope!!)

IMHO, there was sufficient attached gingival to make this treatment option viable. Repositioned sliding flaps etc would not be indicated in this mouth!!!! Cost being the major player, plus potential healing issues due to the poor oral hygiene. Eating into the attached gingiva might not be the perfect periodontal approach, but sometimes our options are limited by other patient factors.

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Initial contouring. Cord and astringident used to establish a dry field (crevicular exudate more than bleeding)

Composite placed

Cord removed and composite polished (Optibond and Gradia Direct)

If I had tried to do this with a G6 tip, the energy footprint would have been narrower and it would not have covered the entire width of the gingival tissue. It would have still got the job done, but would have taken more time and would have not been as smooth. This doesn’t look very wide on the crest in the photos because I have removed about 3/4mm of width with the internal bevel gingivectomy. I don’t think I could have done this with a scalpel or electrosurgery. It only took 2 minutes to establish a clear operating field for this restoration.

There was an intersting string recently where a keen user commented that laser dentists were “better.” I don’t think that is what was really meant in the heat of the enthusiasm. I think this little case is what was being alluded to. The laser can let you personally do “better dentistry” compared to what you would have personally acheived without having it at your disposal.

Every day I do little things without thinking about it, and then realize how much I have integrated the laser into my treatment protocols without realizing just how dependant on it I have become.

If you haven’t got any of the new C6 tips, get one and take it for a spin.
Cheers

(Edited by Graeme Milicich at 5:27 pm on Oct. 20, 2004)