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  • #3170 Reply

    Anonymous
    Guest

    Hi all,
    Recently I have seen some discussion regarding erbium users assertions that the laser allows them to prepare hard tissue faster than the highspeed handpiece. Along these lines, I’d like to start a little discussion and ask you to respond to the following:

    1. Class II preparations w/o anesthetic- faster, slower, or the same as the highspeed

    2. Class II preparations w/ anesthetic – faster, slower, or the same as the highspeed

    3. Class I preparations w/ o anesthetic- faster, slower, or the same as the highspeed

    4. Class I preparations w/ anesthetic- faster, slower, or the same as the highspeed

    5. Class III or V preparations w/o anesthetic- faster, slower, or the same as the highspeed

    6. Class III or V preparations w/ anesthetic- faster, slower, or the same as the highspeed

    7. my practice is characterized by- lots of small carious lesions just into dentin, lots of moderate to large carious lesions

    8. my level of erbium use is – 0-1 year experience, 13months- 2 years experience, 25 months- 5 years, more than 5 years

    While nowhere near scientific, I believe we can give those considering purchase a very realistic view of what they might expect an erbium to do in their practice.

    Thanks for participating!

    #9055 Reply

    Lee Allen
    Spectator

    Ron,

    My perception is:

    1.. Do not do HS w/o
    2. slower unless very small
    3 Do not do HS w/o
    4. slower
    5. Cl 5 faster, Cl 3 slower
    6. faster
    7. I see both but 30 ~ 70 mix on small to mod lesions. I think the later has increase with the onset of low fat diets.
    8. 16 months practice

    While this does express the speed issue, my choice to do the laser often has other factors like microfracture and smear layer. Even proximity to the pulp will favor the laser. Let us not forget the wow factor that the patients perceive with its use. I know that that will not quantify for your admittedly unscientific study, but I sould not help adding the other 2 cents in. I also admit that I am struggling with the “anesthesia” effect and that may skew my opinion.

    Can’t wait for the results.

    ps. I just reread your questions and I may have misinterpreted the questions 1 & 3. Were you trying to compare laser without anesthetic to the HS with anesthetic? I answered as if both were without A. which I rarely do when using a bur. The damn thing hurts!

    #9049 Reply

    Anonymous
    Guest

    Lee, I can see how those questions might be confusing. My intent was compared to the time you would spend normally using a highspeed (w/ or w/o anesthesia , whichever is the norm).

    Mine –
    1.slower
    2. same
    3. slower
    4. slower
    5. same
    6. same
    7. lots of moderate to large
    8. 20 months

    #9056 Reply

    Lee Allen
    Spectator

    Ron,

    OK then I will modify my response to include changes to 1 and 3 to both be slower.

    Thanks for the illumination.

    #9057 Reply

    Swpmn
    Spectator

    When we speak of prep time, are we talking about the time to excavate/prep the lesion OR the total time the patient is in the chair? If we are speaking of prep time, in most instances the rotary high speed will be faster.

    In my experience, Class I and II preps are much slower with an erbium laser. These are also the lesions where I have the poorest no anesthesia rate, particulary molars. In my practice it has not been chronologically/production practical to attempt no anesthesia Class I or II preps on molars.

    Class III, IV and V(V on anteriors/premolars) prep time is about the same or slower. These are the cavity preps where I have the highest no anesthesia rate. In many cases, we utilize a variable pulse rate erbium at 10 Hz. We find excellent no anesthesia rates for these Classes varying the energy setting from 150-300 mJoules. If one is able to place the composite without local anesthetic, the total chairtime with the erbium may be reduced.

    Most of the lesions we prepare with the erbium are moderate in size. I have 34 months experience with erbiums.

    As Dr. Allen pointed out, there are other reasons to utilize an erbium laser for cavity preps. The most important reasons we use the erbium is to reduce use of the high speed handpiece and to totally eliminate use of the slow speed handpiece for dentin caries excavation.

    Al

    #9053 Reply

    BNelson
    Spectator

    Hi Ron,

    If I attempt to prep a Cl II with highspeed and no anes, it’s very slow and painful, usually. I do it regularly with the Waterlase w/o and only slightly slower than with a burr.

    Cl I preps are usually small and the burr is faster, with or without anesthetic. Large Cl I are often done w/o anes and with anes time figured in, the laser is faster.

    Cl V are where the laser shines. Usually no anes with laser vs very sens with bur if not anes. I like the laser better and often have to contour the gingiva to expose the margins, and the laser is tops for that- all no anes.

    Most of my practice is small caries or big ol’ amalgams that have to be removed. Often I anes with the laser and remove the amalgam with a burr, then finish with the laser. Patients really love it if you can do that- happens approx. 80-90 % in my hands.

    I’ve been using a Waterlase for 23 months, and the Periolase for 12 months.

    Good questions and interesting to hear what experiences everyone else has. Keep up the good work!

    Smiles!

    #9052 Reply

    ASI
    Spectator

    Hi Ron,

    Overall slower with laser but more pleasant experience for patients and office staff.

    1. slower
    2. slower/same
    3. slower
    4. slower/same
    5. faster/same
    6. faster/same
    7. moderate carious lesions
    8. 9 months

    Also slower as the use of the Dental Operating Microscope makes me more picky with every step of the treatment. The more I see, the more I want to do it better.

    Cheers.

    Andrew

    #9054 Reply

    Glenn van As
    Spectator

    Here are my replies

    1. Dont use HS w/o but if I did probably equal or slightly faster for HS.
    2 HS wins
    3. Depend on depth and reading on diagnodent. Up to 30 on diagnodent ….even. Greater than 30 HS wins, but cant do much with HS beyond 30……..to sore.
    4. HS no contest.
    5.Class 3 and 5 faster with laser in Class V even in Class 3.
    6. HS wins in Class 3 but Class 5 are probably even.

    Small lesions in my practice, lots of crown and bridge and endo…….using the microscope and the diagnodent has got me doing smaller and smaller lesions earlier on.

    Erbium usage is as long as it has been FDA approved……..January 2000. 4+ years.

    Glenn

    #9050 Reply

    dkimmel
    Spectator

    Until after last week I could answer your questions easly. Now I really can not give you an answer. I have the dentist with the rosecovered sunglasses view of laser dentistry. I was talking with several dentists at the DT meeting in Vegas telling them how long it takes me do a procedure. I told them that after got things down that my time was the same. That is the time the patient was seated and dismissed was no different with or without the laser. Susan overheard me and later informed me that I was wrong. That on average it takes me 10 min longer. OOPs. Now to confuse things, I don’t think it is that simple. Today I just did a quad of fillings. 28 O, 29 O, 30 OB and 31OB . These were on a 22Y/O female. Time pt seated til dismissed was 25 min. (per Susan) This was working with a new assistant and were into dentin. No injections were given for anaesthic.
    It is also rare for me to use anaesthesia. Once I start with the laser I have only had to stop and inject once since July 2003. Of course I prescreen the patient as we discussed on another thread. The alloy removal now that I do my wierd thing has been 100% to date. It is a PIA on max molars.
    After all that Ron, I don’t know forsure. What I will start doing is timing things again. I have done this before lasers to help with scheduling and have a base line. I’ll try to also include information about anesthesia,tooth #,age of patient, settings,laser type, depth of restoration and anything else I can think of.
    There are just so many factors. At the DT meeting guys were talking about having sensitivty and difficult times in cutting. In talking to them they were using 6W . Even with the Delight there is a wide range of setting. Like Allen I use 10Hz and 200mj most of the time. All these factors make a big diffenerce.

    #9051 Reply

    Hi ,
    Hello everybody,Icame back from vacation and I’m happy to read you again

    Overall slower with laser but more pleasant experience for patients and office staff.

    1.  slower
    2.  slower/same
    3.  slower
    4.  slower/same
    5.  faster/same
    6.  faster/same
    7.  moderate carious lesions
    8.  27 months
    Even with  the Delight there is a wide range of setting. I use 10Hz and 235mj most of the time.

    mag

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