Erbium Frenectomy goes Awry - Laser Dentistry Forum

This topic is empty.

Viewing 3 posts - 1 through 3 (of 3 total)

Author

Posts
October 16, 2004 at 5:34 am #2976 Reply

Glenn van As
Spectator

From Dental town but wanted to show the good folks at LDF……..

Here is the case that I was mentioning to Stewart. This patient is a 40 year old patient who just recently came to see me and we noticed that a connective tissue graft is needed on the RIght maxillary central. A non carious groove with an unesthetic soft tissue contour was observed on the Left central incisor and in addition there was a very thick frenum attachment. The patient had a uncontrolled BP of 170 over 100, and recently started high BP meds to drop his BP. He didnt mention it to me until after I asked him if there was any new meds that he was on.

Probings measured 2-3 mm on the tooth with the groove. I decided at the time to remove the tissue with the Er:YAG laser positioned in a parallel fashion to the tooth to avoid iatrogenic damage to the tooth and cementum. I removed the tissue with a spoon and controlled the resulting bleeding with a hemostatic solution (Astringident). I used a 400 micron tip with a setting of 30 Hz and 45 mj without water for the gingival recontouring. I then turned the water on and used a setting of 30Hz and 60mj with the water to prep the tooth for a restoration which was placed with flowable resin (Point 4 by Kerr) and then the frenectomy was done.

It was attempted in non contact with the Chisel tip at 30Hz and 45 mj without water. It worked great until the very end when I got through the fibers and bleeding started right away. It is always the case that the bleeding starts when you cut through the last frenum fibers. I tried the diode, hemostatic agents and also the gauze with pressure, and I had to do a lower occlusal without anesthetic using the ISOLITE. I am doing some work for a new cannula from a company and cant quite show the treatment of the occlusals yet but I can tell you that it is going to look great when you see these tips. They are great.

I then turned my attention to the frenum and it still had not subsided bleeding, and then I finally got it to stop when I used the Argon laser, at arond 1.4watts Continuous Wave.

I am seeing him on Monday or Tuesday and will take a photo or two but he was asymptomatic. He is going (hopefully) to the periodontist for the graft when he gets his BP under control.

Hope that helps……….all the best.

Glenn

PS I was a little scared as it started to bleed, and even the patient picked up on that, but he was pretty good about it.!!!

Take care

Glenn

October 17, 2004 at 1:37 pm #7800 Reply

Benchwmer
Spectator

Hey Glenn,
Sorry you had problems with the case, but it’ll heal wonderfully and be successful. Good documentation.
This is an example of the problems of trying to do all procedures with one laser. This would have been an easier case on any patient, definately on this bleeder, using an Nd:YAG. You’ll see when you get that PerioLase, the advantages of fine work around papillas and teeth. I would never even think of using my OpusDuo for ginivoplasties.
Despite the heralding and promotions at the ADA meeting. There is no Swiss Army knife of lasers.
Jeff

October 17, 2004 at 1:57 pm #7801 Reply

Glenn van As
Spectator

Hi Jeff: I agree with you that a soft tissue laser was the way to go here. Good points. One thing that I will say is that the Erbium is quicker and due to less depth of penetration does seem to heal very rapidly compared to diode and argon Frenectomies which are no comparison to electrosurge surgeries.

I wanted to try the frenectomy in non contact with the chisel tip as Dr. Larry Kotlow has been doing. It was neat under the scope to see the chisel tip ablate the fibers without touching them but alas when I had to release the last fibers it was then that it started bleeding.

i have an idea for next time to combine the two of them using the soft tissue component when you need it most (right before you cut through the last fibers) and with the scope at high mag this should be possible.

For the initial portion the Erbium is awesome.

Good points Jeff, and looking forward to seeing Del and Bobs machine in Canada soon.

Glenn
Author

Posts

Viewing 3 posts - 1 through 3 (of 3 total)