Hi Folks……..I dont think I ever posted this case and if I did I apologize but here is a single appointment prep, osseous recontouring with the erbium and impression case.

The molars in the posterior had bad decay, they were endo treated and core composite buildups. Slowly with time we have been doing crowns (for financial reasons) and eventually got to the lower molar for a procera crown.

The prep was very deep on the distal and due to an open contact interproximally and food entrapment the tissue was pretty inflamed so I thought I would remove the tissue with the Argon to minimize bleeding and then use the erbium to remove bone to get a 3 mm biologic width on the distal and then take the impression if I could control bleeding afterwards with the Argon.

The soft tissue doesnt bleed much but when you get into bone with the laser there is a fair amount of bleeding.

I managed to control it and then took an impression. The insertion of the crown shows the nice healthy tissue ( 2 weeks later) and the crown was placed in .

The final radiograph shows the resulting margin……

Nice easy case with the laser to help me out. This is the kind of perio you can do with the erbium laser Mickey……osseous recontouring bone, but stay away from putting in the laser into the pocket as it wont be selective for soft tissue and there are better lasers for Laser Perdiodontal Therapy

Hope you like it………

glenn

I don’t think a blade is equal in every situation, I think it’s Better!! (lol). Honestly though, from what I have seen on this site, Glenn could do beautiful dentistry with any instrument. If I needed this work done in my mouth I would choose what was just shown. Except for the flying up to Canada part. Too cold–and our hockey teams are doing better anyway. Go Ducks!!!
Have a good weekend all.
Andy

I’m not sure about Hoya, but Biolase doesnt yet make a tip that has a wider diameterwhich would allow u to recontour bone a bit faster…. Luxar once made a wider ceramic tip for soft tissue that might be nice for more rapid bone removal…Glenn what r your thoughts about tip diameter…BTW Did u anaesthetize in this case…. also how long did it take? once again… warmest regards

Hi there folks: what do you think , should I post in Dental Town today this case and see how people react.

I am sure we will see a mixture of reaction…..people condemming me, people saying I am a butcher…..

What about it Bob?

As for your kind posts here…..

Bob, I probably dont know how to do the procedure any other way but I am going to try and get some microsurgical instruments and do a osseous procedure the same way a periodontist would try , raising a traditional flap etc, but use the laser instead of the bur.

I have a patient with a 3 unit bridge in the maxillary anterior from canine to premolar which is infringing the biologic width. Gonna shoot video and stills when I do this and raise the flap ( or maybe half of it) with a bur and half with the laser and watch the healing.

Andy I am no expert at all in perio but I am trying to see what I can do and perhaps in Canada the risk of medicolegal concerns is less than in the USA.

Andy you are very kind. I told Andrew this week, part of the reason I got the scope was because my dentistry was so average. It has taken me 5 years of working with both scopes and lasers to become proficient at extreme mags but it sure makes your job alot easier and more enjoyable when you can see.

Ron thanks for the kind words……what a funny thing. I was just thinking about how I could do this better and the thought came to me to use the chisel tip and that might plane the bone off in a bigger fashion…

The 600 micron tip isnt big enough and I might use the chisel sideways next time. See my previous posts here for a view of it. Excellent excellent post. Hoya does have one large broad tip anyways which is for flaps but I like it as it is quite broad.

I did anesthetize and it took about 10 mins extra on my 80 minute crown prep so maybe an hour and a half.

Billed out for osseous work which is fair which is what I did on the same appointment as the crown prep.

I just ask people in the perio field to look at it with an open mind. THe biggest beef so far is that the healing is with secondary intention and if I raised a flap they would like it more…….

As I always say Andrew…….

Dentists are fine with needles and drills , its the patients who dont like them.

I think I may have just infiltrated in the papilla on this one ( cant remember ) for anesthetic.

Cya

and thanks to all my friends here……its a great place to come each day and you all make it that way.

Glenn

Thanks Mickey………I think it is great if someone sees some value in the cases and its kind of like a hobbie for me posting the pics. It is relatively easy and it does create some fun for me doing them.

I dont profess to knowing it all , or even doing it all but the sharing of these cases has made me more critical of my own work and made me a better dentist I think.

Thanks for the kind words……I appreciate it.

Glenn

Andy, at the risk of showing my ignorance, is ‘negative architecture’ periodonistese for bony defect? And if it is, and the patient is healthy, occlusion good, could you expect some natural (or laser biostimmed) remodeling to take place,  bringing about a more ‘positive architecture’?
Thanks,