Forums › Laser Treatment Tips and Techniques › Soft Tissue Procedures › apico and perio surgery
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Stewart RosenbergSpectatorHi guys,
I did two nice cases in the last two days that I thought I’d share. Unfortunately my casmera broke and the pictures are gone. (I’ve ordered a new Canon G5 but it won’t be in for 2 weeks.)
The first case was an apicoectomy on # 8 way uo under and almost into the nose with very little attached gingiva. A tough one to do. I used the waterlase for the entire procedure. Incision at .5 watts with a tapered tip and then bone removal with a g6 at 2.5 -3 watts and degranulati0n at 2.5 watts. Cut off the end of the root at 3.5 watts and prepared the apex with the same setting and placed proroot (MTA) and then sutured.
Followed with LLL therapy with the Lasersmile for 30 seconds at 3 watts with the bleaching wand on.
Saw the patient today. Zero pain, no swelling. Yesterday, mild discomfort when the anesthesia wore off . patient took 2 Advil and nothing since.
Second case was a quadrant of perio treatment . 9 mm. pockets on M and D of #4, 5 mm. on all other teeth in quadrant. Bleeding when you just look at any of the teeth. # 4 had post retained crown that came loose when I started my root planing using a cavitron, hand scalers and the perioscope. Prior to scaling i gave local anesthetic and decontaminated with the diode at 1 watt unititiated, 50% duty cycle. Followed scaling with the waterlase at 1 watt, 11% air, 15% water in all pockets. to deepithelize and remove granulation tissue. I then went back in with the diode initiated at 1 watt continuous wave and relases the pockets. We noticed a much better appearance and cessation of bleeding with the diode over what we got with the waterlase. it also seemed to degranulate better. Then I went in with the waterlase followed by the diode into the bony defects and removed all granulation tissue (aided by a sharp spoon excavator.
All bleeding had stopped and i had excellent vision into the bony defects without the need for a flap since I only had a root at that point. I placed PrefGel by Biora for 2 minutes, rinsed with sterile saline and placed emdogaine followed by freeze dried bone and Atrisorb F as a resorbable barrier membrane. Once it had hardened i caefully recemented the post and crown. Finall I lazed the buccal aspects of the attached gingiva on all teeth for a width of 5 mm from the gingival margins to help prevent reepithelization and placed arestin in all pockets except the surgical site.
Finally, 30 seconds of LLL therapy as in the other case.
JUst called patient at home. No swelling, zero discomfort. She can’t believe how comfortable she is.
I’m sorry for no before and immediately after photos but I will give an update whern appropriate. i just wanted to share the protocols and marvel once again at how wonderful the healing response of our patients is with laser therapy versus conventional means.
Stu
AnonymousGuestThanks for sharing ,Stu.
I was wondering about air/water settings on the apico?
Secondly, most of what I’ve read about biostim says its ineffective on a ‘fresh injury”. What do you think is happening doing the biostim the ‘day of’? and have you done biostim the ‘day after’?
Been trying out the G5 for a couple weeks-you’re gonna like it!
Thanks,
Stewart RosenbergSpectatorHi Ron,
Air and water settings on the apico were my standard setting for soft and hard tissue. on soft tissue incision I used 11%air and 7% water. On hard tissue I used 70% air and 40% water.
I always use biostim immediately post op to any traumatic procedure and to muscles stress during long procedures and have gotten great results. I really haven’t used it much day after. So, i really can’t comment on it with any intellegence. Maybe some others can comment. Using it immediately after, I would be reluctant to go back in next day – too soon after initial LLT. To me it makes more sense to treat before sequella occur to prevent them rather than wait until they do and then try and reduce them. So far i have been able to control swelling, pain, etc. very well in my approach but there certainly may be a better approach and i am eager to learn if there is one.
Stu
kellyjblodgettdmdSpectatorStu – Way to go! I wish I could see the pics – I’m sure they would have been great. I appreciate you sharing how and when you are using the different wavelengths of lasers. For a while, I thought I would keep my Waterlase in one op. and my Nd:YAG in the other, but as it turns out I have ended up putting both lasers in one op. and just work out of it. You can get so creative using an Er laser and a “soft tissue” laser.
I’m not familiar with PrefGel or AtrisorbF. Where could I learn more about them and what their uses are?
Thanks for giving such a detailed account of your cases. I can only imagine how thankful your patient are.
Kelly
Stewart RosenbergSpectatorThanks kelly. Prefgel comes with the Emdogain ordered from Biora USA over the internet. if you go on their website they explain it much bettwer than I can. What it does is etch the root surface for better attachment.
Atrisorb is a liquid resorbable barrier in a syringe form that hardens when sujected to moisture. Atrisorb F is the same product with tetracycline added. Agin, check their website for better and more complete info.
Stu
Stewart RosenbergSpectatorI forgot to add that I normally keep the waterlase in y op and rotate the diode thru the hygiene rooms but i find lately that it is best to keep it near me because even if i don’t use it for a procedure I have it handy for LLL therapy at the end. I alsao agree that having both options allows us to get creative and give our patients the best possible results – especially with perio.
Stu
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