Lets compare! - Laser Dentistry Forum

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July 6, 2006 at 9:11 pm #2962 Reply

dkimmel
Spectator

Since poor Allen is bored I got an idea to spark some life back into this thread.
Lets compare settings. Below is Tooth #5. It is a virgin tooth on a 25 Y/O male. There is decay on the DO. It is moderate in depth and an RCT is not indicated. Non phobic.

1. What laser would you use?
2. Will you numb the patient?
3. Will you do the 90sec. pre laser anesthic?
4. Intial settings . Tell us in focous or not in focus and how you would change your settings as you progress.
5. Tell us what setting changes you would make if the patient started to get sensitivity.
6. At what point wouuld you numb the patient?
7. Tell us also if you would use a handpiecie at any point other then to polish the filling. Also if you use any hand instrutments??

This should be interesting.

July 7, 2006 at 1:05 am #7604 Reply

dkimmel
Spectator

Ok, I’ll start.
If I used the MD: loops x6

I would not numb the patient nor do the 90 sec prelaser stuff. Instead I would use a G6 tip at 10HZ 23%water, 60% air at 2.00 Watts. Staying in focus I would start at a right angle to the marginal ridge and alblate away. If I felt I was not cutting fast enough I would bump up to 3Watt a little at a time. Too fast or getting sensitivity go defocused. Of course as I go into dentin I would just defocuse. Remembering to keep the tolet bowel prep form to keep pooling water. As I go into dentin ,if sensitvity was a problem I would change to a Z6 tip.

Once into caires if I feel the laser is stalling I will go to MArks Spoons. I don’t use a bur. I will sometimes use caresol if it is a large lesion, pretty rare to do this.

Caries gone, I use the Z-6 tip at 50HZ, 23%water,60%air at 0.5watts and start to bevel the edges of the prep. Then lastly spoon the surface to remove the molten enamel.

If I use the WAterlase: Still loops x6

Still I will not numb but will do the 90sec laser treatment. G4 tip, 6W 30%water 40% air.
Again starting at the marginal ridge. Dropping down to 2Watts averaging 3watts in focus. Changing as needed by seeing what is happening. With sensitivity I will defocus, change to a Z6 tip, drop the watts and drop the water % last. Once in dentin/caries just defocus.
Same as the MD with spoons etc. Finish the margins with just a spoon.

The Delight: loops x6

Oops to follow. Susan is calling.

July 7, 2006 at 4:44 pm #7605 Reply

dkimmel
Spectator

The Delight
Loops X6
10HZ 120mj 30 deg tip focused Then pretty much the same as with the MD .
In the dentin defocus , pretty much like with the MD.
To finish I’ll go 30Hz 50mj in contact to bevel the margins.
If I get sensitivity I will defocous, Still a probly I’ll drop to 3 HZ..

July 8, 2006 at 1:07 am #7603 Reply

Anonymous
Guest

Versawave
10/400 defocused. 10Hz.Scope 8x

1.Aim 1st from the distal toward the marginal ridge

2. then move and angle from the mesial toward the marginal ridge (best to place matrix).Remove enamel. Aim next vertically.

3.Next come from distal, again aiming at the side of the enamel rods of the occlusal table to widen out margin of prep and allow access.Stay out of dentin at this setting.

4. 10/180/10Hz. defocused to ablate or soften/hydrate caries. Focus 10/100/10Hz for caries removal then Colonna’s microspoon or round bur. Repeat until sure caries gone.

5. 10/100/10Hz (usually don’t change Hz unless soft tissue or doing laser analgesia) very defocused or slow speed round bur run over edge to create small bevel and remove inorganic byproducts.

Patient would be numbed if they preferred or I wanted to ‘move things along’ a little quicker. Also depends on if they’ve had previous laser experience.
No laser pre-analgesia.

Haven’t used my Waterlase in 6 months but NLT will repair in 9 more days. If doing with Waterlase-8x scope.
4 watts 20 Hz 90 sec.50% air water differential for laser analgesia on occlusal. Prep the same except 4 watts defocused for enamel removal the 2 watts defocused for dentin. 1.5 defocused for caries (as best as I can recall 😉 )

July 9, 2006 at 5:44 am #7606 Reply

Glenn van As
Spectator

Great stuff David and Ron……it is quiet on the laser board. A shame really. I love the advanced tips, great stuff. I dont think you need a matrix for the tooth distal to the decay as it is a porcelain crown, but the matrix and a wedge (ifyou use topical) will help prevent the tissue from getting cut as you go through.

On these at times to speed things up, if there is lateral extension into dentin , I will actually take a diamond bur and widen the enamel to get access to the decay after I use the laser for a while. I am not using as much of laser analgesia unless the patient is really antsy. Then it is helpful to get them used to water, sound and sensation.

I agree with the Versawave settings and 10/400 will move you along in enamel with whack whack whack noises but some patients cant tolerate this even in enamel. You better toilet bowl the prep though to outline your cavosurface margins best as you can, because as you near the DEJ you will find that sensitivity increases.

Ron, it looks like you are using 8X with the scope , do you realize that this will almost provide you with double the visual information that David is seeing with his 6X loupes (poor mans scope). The difference is 64X naked eye with the scope (X times Y) and 36 times the naked eye with those heavy heavy loupes.

GRIN…….

giving David a bad time…..well its late and for a treat I will post something on the board tomorrow (closed flap)……GRIN.

Cya

Glenn

July 10, 2006 at 9:40 pm #7608 Reply

Swpmn
Spectator

1. What laser would you use?
HOYA ConBio DELight 2940 Er:YAG

2. Will you numb the patient?
From your description of the patient and lesion, probably not

3. Will you do the 90sec. pre laser anesthetic?
No

4. Intial settings . Tell us in focus or not in focus and how you would change your settings as you progress.
80 degree 600um tip, 10 Hz, 210 mJoules, 1mm out of focus, air/water setting: enough to rinse and cool the site but not enough to block my vision or pool in prep. The lesion looks too large for a tunnel prep so I would make a wide outline of my perceived extent of caries at a right angle to the occlusal. Then I would drop straight down into the dento-enamel junction of the distal marginal ridge until it breaks away from the tooth. Continuing into the dentin along the long axis of the tooth, trying not to direct the laser energy towards the pulp, until caries is excavated. Switch to 30Hz 50 mJoules to smooth enamel margins and remove products of ablation. I often pre-wedge but don’t use the metal matrices much anymore while prepping.

5. Tell us what setting changes you would make if the patient started to get sensitivity.
Drop to 10Hz 125-150mJoules. If in dentin, sometimes I use 3Hz 170mJoules.

6. At what point would you numb the patient?
If above still not working and patient getting anxious.

7. Tell us also if you would use a handpiece at any point other then to polish the filling.
No.
Also if you use any hand instrutments??
Yes, spoon excavator to quickly check dentin for caries and to plane enamel margins.

Al

July 14, 2006 at 5:21 pm #7607 Reply

N8RV
Spectator

I’ll play …

I’m with Al with settings (10Hz/200mJ) using the Hoya. However, I would (and do) whip out my KaVo low speed with air/water spray and a round bur turning VERY slowly to remove the decay. I’ve had virtually NO trouble with most cases using this technique, and find it much faster than using the spoons.

If the slow speed causes discomfort, then it’s either getting pretty deep or they’re just too jumpy and I’ll then whip out my trusty syringe with Articaine and VibraJect and put them out of my misery.

I can’t thank Glenn and Mark enough for convincing me to CRANK IT DOWN!!
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