Implant seat with hard tissue laser - Laser Dentistry Forum

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December 3, 2003 at 3:26 pm #3344 Reply

Glenn van As
Spectator

Here is something I did yesterday and I am rushing of to work so I will be quick……

The implant seat appointment was yesterday and the patient felt the tightening down of the abutment so she wanted anesthetic.

I used the 400 micron tip to remove tissue 2X.

Once to get the abutment to fit without blanching in the hole, and the second time to get tissue of the margin of the abutment for the crown to seat.

I was careful to remove the inner tissue so it will regrow, and I will show you this in healing photos when she returns in two weeks.

30 Hz and 70 mj with a little water for fun…….

No fears for me with working around metal, is this something that should be avoided for the Biolase users, not sure if it is or not but dont want to get myself into trouble for posting something that might cause problems in the future with fibers etc……

Glenn

December 3, 2003 at 3:45 pm #10399 Reply

Robert Gregg DDS
Spectator

Saweet! Very nice Glenn!

I don’t what I like better, the case or the documentation…..

Great case and photos. Nice collage.

Bob

December 3, 2003 at 5:47 pm #10392 Reply

marc andre gagnon
Spectator

Very nice Glenn!

Great case and photos.

December 3, 2003 at 7:27 pm #10391 Reply

kellyjblodgettdmd
Spectator

Glenn – Great case! You must have the fastest trigger finger around to take so many photos. Thank you for sharing this case. I just used my Er laser this morning to remove some tissue around an implant abutment that was in the way of seating the crown completely. It’s so wonderful to be able to remove tissue when you need to quickly, effectively, and without anesthesia. Don’t the patients just love it!?!

Keep up the great work!

Kelly

December 3, 2003 at 8:35 pm #10393 Reply

ASI
Spectator

Hi Glenn,

Good presentation of progress of treatment as usual. What kind of implant is that?

Thanks for sharing again.

Andrew

December 4, 2003 at 2:55 am #10401 Reply

Swpmn
Spectator

QUOTE

No fears for me with working around metal, is this something that should be avoided for the Biolase users, not sure if it is or not but dont want to get myself into trouble for posting something that might cause problems in the future with fibers etc……

Glenn

Glenn:

Excellent use of the erbium to remove soft tissue which many times creeps over implants after we remove the healing abutment and prevents full seating of the restorative abutment. I’ve also carefully used the 810 nm diode laser for this procedure without anesthetic at low energy settings and had no problems.

In reference to the Waterlase question I’ve used it many times for this procedure and never had a problem. I don’t think it is metal in general that caused some of the early failures with the Waterlase trunk fiber but certain types of alloys or old metal containing bases/composites which resulted in a “flashback”. Have irradiatated titanium implants and stainless steel matrix bands and never had a problem. I suspect that some of my early failures could be related to accidental irradiation of dental amalgam, certain types of old liners/bases/composites and possibly when trying to repair marginal caries on some types of non-high noble metal crowns.

Wish we had a better understanding of what alloys might result in damage to an erbium laser system. Looking around for some wood to knock on(and hoping I don’t jinx myself) but we are rapidly approaching one year without any type of system or trunk fiber failure on the Waterlase.

Al

December 4, 2003 at 8:51 am #10396 Reply

Kenneth Luk
Spectator

Hi guys,
Havn’t posted any pictures for a long time!
I’ve been using 980 ( High fluency) to remove the soft tissue around the implant.
I place composite around the try-in abutment to build up the emergence profile and then cut the core.
Then I make the temp acrylic crown.
Imps were taken on the implant for final abutment and crown; one with the themp crown cemented in place for the technician to see how I want the emergence profile.
Sorry, no pre-op photo.

Male:60
Fractured upper left central incisor
Immediate loading with Sterioss.
Patient was happy and dores not want to improve on the contour and surface characteristics.

(Edited by Kenneth Luk at 3:52 am on Dec. 4, 2003)

(Edited by Kenneth Luk at 3:56 am on Dec. 4, 2003)

December 4, 2003 at 2:26 pm #10394 Reply

Glenn van As
Spectator

Nice job……..if you ever do get a chance take a little off the right central and lateral for the Gingival Height of contour and they will be the same height across the front four.

Nice result though on what are the trickiest ones to restore…..

All the best

Glenn

December 4, 2003 at 2:40 pm #10397 Reply

Kenneth Luk
Spectator

Thanks Glenn,
I’d really want to restore all the poor class V s.
It’ll take me some time to convince him on the cosmetics side though.
His lip line is pretty low, so I didn’t think he’d be bothered with the recontouring.
Ken

December 4, 2003 at 3:25 pm #10400 Reply

Robert Gregg DDS
Spectator

Nice job Ken……

Bob

December 5, 2003 at 5:18 am #10395 Reply

Glenn van As
Spectator

Hi guys……..by the way I didnt answer your questions and posts in my rush this morning……

Bob and Marc Andre…..thanks for the kind words, the esthetics, as has been pointed out on Dental town are far from perfect and it is something to improve on. The Collage is easier for me to do than perhaps the esthetics!!

Kelly, its the easiest thing with the scope to take these pictures , no setting up the camera, just click away……its actually a shame if you dont take pictures.

The patients do love the ability to use the laser without anesthetic and the lasers offer you so many opportunities to just make your life easier. Hopefully with these cases I post , some people who lurk here will gain an understanding of how a laser could impact their practice.

Andrew….thanks for your friendship and posting your kind thoughts.

Al: I agree, with the 810 nm diode you can pulse the laser at fast settings and get a nice result. I worry about the depth of penetration of soft tissue lasers and the heat generated. It might affect the bone or soft tissue more or affect the implant. The erbium is faster with these and also will not penetrate so deeply. Of course there is the bleeding phenomena. I can do more without anesthetic with the erbiums than the diodes which the patients find “hotter” primarily because of the short pulse duration of the erbiums and the tissue relaxation time……..between pulses.

The 980 nm diode has fast pulse times (.01 secs on and off at its fastest) and in addition with the water spray seems to be able to be used at higher wattages without charring.

Neither here nor there, just the prinicpal of be careful around implants with soft tissue laser without water…….

The fast pulse durations of the Nd Yag make it similar I would imagine to the erbium…..Bob and Ron can comment on that.

BOb do you have a case you can show??

Ken…..nice photos you showed and a really nice result……I like the custom abutment and the resulting lack of shine through on the crown. Gosh we get picky looking at pictures which are much more magnified than what most people work at…..

For those of you who want to improve your dentistry, take pictures…….you will be stunned at what you see …….

AFTER THE FACT OF COURSE!!

thanks for the constructive remarks.

Glenn

December 5, 2003 at 4:46 pm #10398 Reply

Kenneth Luk
Spectator

Hi Glenn,

Yes, we can be so critical with the work on the photos without realising the tooth has been magnified so many times. That shows how the kind of fine services you’re providing to your patients.

The custom abutment (try-in abutment with composite build up) is a temp for the acrylic temp crown and for the soft tissue to recontour leaving the ‘final crown fit ‘ easier two weeks after imp.
I hope I’ve not got you confused.
Ken
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