Gingivectomy with waterlase - Laser Dentistry Forum

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July 5, 2003 at 4:39 am #3299 Reply

mickey frankl
Spectator

Do you contact the gingivae directly when doing a minor gingivectomy (of gum only)?i.e does the tip actualy touch the gingivae?

July 8, 2003 at 12:32 am #9999 Reply

dkimmel
Spectator

Mickey, I also am rather new at this laser stuff. Hopefully some of the others will jump in here if I am wrong or have other ideas.
The answer is yes and no. I find at the lower power settings .25- .50 with 11%Air and no water – I often touch the tissue. It is like pealing the layers of the tissue off. Different tissue will requiring changing your settings. The more fibrous the higher the power setting and the more delicate the tissue the lower the power setting. You will know this by charring. If the tissue chars defocus and no longer touch the tissue or decrease your power and continue to wipe the tissue away.
If you defocus at these settings it will seem to take forever to remove the tissue. It will also seem to take forever if you stay at .25 wt and wipe the tissue away. I only do this if it is a small area.
If you increase your watts and increase Air and water you will get a faster removal of tissue. You will also get a greater chance of bleeding and a punched out appearence of the tissue.
I have just started doing this a little different. I now use 5.5w with 75% A and 40% W with a G4 tip defoused. Defoused is key. You do not want to touch the tissue. You want to start out at about 15mm and work into about 10mm. With maginfication you will just start to see when the tissue is being removed. I no longer get a punched out look. It is a smoother looking reduction, nice and even. It is faster as more surface area is being removed in a defoused mode. Hemostatis is the best I have had so far.
DAvid

(Edited by dkimmel at 8:34 pm on July 7, 2003)

July 8, 2003 at 1:39 am #9998 Reply

Anonymous
Guest

Ok guys,

My turn for a question (or 2).

If you are using the er,cr:YSGG and are touching tissue, are you not inside the focal point and thus defocused and doing the same thing as being defocused at a point further out from the focal point (say 1mm before vs. 1 mm past focal point)?

It seems to me that the key to Mickey’s question is -how do you want to remove the tissue- abalate or incise? and the answer to that question determines the positioning of the tip.

Finally, I’d like some input as to whether anyone seems to find their tips are less efficient after touching tissue?

July 15, 2003 at 11:41 pm #10000 Reply

dkimmel
Spectator

Ron, Funny you asked. I used at new tip this morning and was lightly touching the tissue. The next case I did , the laser just did not seem right. Stuck my new tip under the scope and nice and pitted it was. Way to soon to be pitted as much as it was.
David

July 16, 2003 at 1:13 am #10001 Reply

Patricio
Spectator

Mi 2 cents,

I agree with Ron on the question of the focal length. It would seem that defocusing at high watts irradiates a greater area of tissue with less control of tissue outcomes. The tissue being in the zone of energy divergence it could be less efficient cutting.

I find I avoid contacting the tissue and use 1.50 W 7/11 in close proximity similar to the position for cutting on the tooth. If the tissue is fibrous I may increase the Watts and w/a. I use this method for troughing and removing the pocket lining, minor gingivectomies and I rarely get any significant bleeding. I watch for bleeding and stop if I can see bleeding beginning. I think the condition of the tissue to begin with is critical to limited bleeding. Edematous and inflammed tissues will become a problem more quickly. I do get into trouble with very deep tissue reduction for root caries as there will be enough weeping to prevent proper bonding.

I agree tissue contact seems to damage the tip.

I had an interesting result today. I was working on a tunnel prep on the mesial of #15 from the buccal and began to notice the tissue making inadvertent contact with the side of the tip became red and edematous. There was no direct tip energy delivered to this area. Leaking of energy from the side of the tip?

Pat

July 16, 2003 at 4:11 am #10002 Reply

Robert Gregg DDS
Spectator

Pat–

QUOTE

I had an interesting result today. I was working on a tunnel prep on the mesial of #15 from the buccal and began to notice the tissue making inadvertent contact with the side of the tip became red and edematous. There was no direct tip energy delivered to this area. Leaking of energy from the side of the tip?

Yep. It’s got a name for it too. It’s called “lossey”.

Bob
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