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  • #3295 Reply

    drnewitt
    Spectator

    This patient wanted to have me do something about her “stubby Side teeth”. She did not want her diastema changed and was not interested in veneers at this point.

    Perio readings were taken before and after ( just realized I should have taken some after tx probe shots also)

    Erbium with a 80 degree tip, no water spray, 3hz 70 mj with topical anesthesia on #12 (US&#36=7). (you can see the topical on the #22(US&#36-10). I bumped it up to 10hz, 70mj for the #22 and found she definitely felt more. Also had a little less control over contouring.

    There was a little bleeding towards the end of the treatment. She was very happy with the final result after about 10 minutes.

    Looking for suggestions and input on how I may have improved on this case.

    #9944 Reply

    drnewitt
    Spectator

    Guess it would help if you had an image to look at smile.gif

    Rach.jpg

    #9952 Reply

    Glenn van As
    Spectator

    Great case and nicely handled. I often will use 30 Hz and 30 mj or 10 hz and 50mj.

    If you lower those settings next time you may find less pain.

    Nicley handled Paul

    Glenn

    #9950 Reply

    ASI
    Spectator

    Hi Paul,

    Good result. What was the sulcular depth after the recontouring?

    A coloured probe will stand out better.

    Thanks for sharing.

    Andrew

    #9941 Reply

    drnewitt
    Spectator

    Thanks Guys

    The probing depth after tx was 1 -1.5
    Coloured probe is a great idea, it is hard to see the marks on the probe in the pic. Thanks Andrew

    I will try with the lower mj and higher Hz next time also. Thanks Glen

    #9948 Reply

    Paul – great result. I’m sure your patient is so thankful. Please do a favor and post your post-op pics when you take them. I’ve done this before on a couple patients where I impinged on the biologic width, and the tissue crept back to where it was. I’d love to see how this looks long term.

    You certainly created a lot of value for your patient. Great job!

    Kelly

    #9942 Reply

    drnewitt
    Spectator

    Regarding bio-width. what would you guys do in terms of osseous recountour to maintain it? open flap? closed? Tip? settings?

    I will get follow up pictures.

    #9947 Reply

    Paul – with respect to osseous recontouring, I would lift a flap. I think it’s the only way to know for sure that you have properly contoured the bone and placed it exactly where you want it. I would use a wider tip, like a G-series (for the Waterlase) or similar if it’s another laser. I think it’s hard to beat direct visualization, especially in the anterior esthetic zone.

    Kelly

    #9949 Reply

    whitertth
    Spectator

    Paul,
    Nice case…
    If u really want to eliminate pain with your soft tissue work..Call Doug Boudreaux at 318 6312005 and order the drkliquid…It is an unbeliveably strong topical liquid…dip a q tip in it…leave it for 5 minutes and then go to town…U will be pleased It comes in cherry for kids and mint for adults…. Doug is a compounding pharmacist and he and I developed this…We r working on some other exciting things as well..
    Disclaimer I have a very small( I Mean Very) in the product…

    #9955 Reply

    Lee Allen
    Spectator

    Hi,

    This case seems to peak my interest from the standpoint that I have a pending case that is related. It is 4 months post ortho / mouth breather case. There is definite papillary hyperplasia 6 – 11 with some delayed eruption. The patient refuses to go to the usual perio source and wants me to do it without anesthetic.

    I will call Doug Boudreaux tomorrow to see if the magic elixor will be our salvation. When you use this, is the 5 minutes a latent period before starting and how long can I expect the anesthetic to last? What about interproximal penetration? I have EMLA, also 20% Benzocaine but if you feel this is a proven better performer than these, please let me know.

    I will be using an Erbium. ( Not everyone owns a Nd:YAG.) Usually using a G-6 or a T-4. Any suggestions on an alternative tip for broad area ablation?

    #9945 Reply

    drnewitt
    Spectator

    Hi Lee

    Although I have not had the chance to use it yet I hear the chisel tip is good for broad ablation. Others on here who have used the chisel could possibly offer some comments.

    #9943 Reply

    drnewitt
    Spectator

    Well, here it is finally. My patient finally returned for some treatment and I managed to get a picture of the end result… 11 weeks later. Although the picture is at a little different angle and the teeth look slightly longer in the final shot I think it shows how things turned out fairly well.

    Looks like the right lateral tissue has come back down where as the left lateral tissue has remained stable or moved up slightly. As Kelly pointed out, there might have been more of a Bio width issue on the right lateral.

    #9940 Reply

    drnewitt
    Spectator

    Guess having the image would help smile.gif

    RachelFinal.jpgRachelFinal.jpg

    #9953 Reply

    Glenn van As
    Spectator

    Neat pictures Paul and thanks for sharing , this is how we all learn and I too have found that many times the tissue will rebound after the initial work.

    SOme may have ideas on how to prevent this.

    Gotta fly…………

    Glenn

    #9946 Reply

    emc85
    Spectator

    unless it is hyperplastic gingiva, there is no doubt there will be regrowth. you will need to reduce the bone via open flap or closed flap.

    this is for paul and glenn: go flames go!

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