Forums › Laser Treatment Tips and Techniques › Soft Tissue Procedures › Tx of Herpetic Lesion
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AnonymousGuestHi all,
Yesterday tried to tx a herpetic lesion that patient had had for about 7 days .Patient was txing with peroxide.
Used diode 3W ,50/50 ,nonactivated tip out of contact.Started tip 4-5mm away from tissue and circled and cross hatched down to 1mm from tissue. Tx time approx 5 min. At finish tissue no longer showed vesicles and appeared to have shrunk.
Below is image from day after tx.
http://rwebstudio.com/day1.jpg
Expected more resolution, any suggestions?
Thanks
SwpmnSpectatorRon:
Interesting case. I’ve treated a few large, intraoral apthous lesions with the Biolase Erbium and there did seem to be some relief of discomfort for the patient. I do not have a diode and also have not attempted to treat a herpetic lesion.
So basically my comments aren’t any help but I found your case interesting.
Al
Glenn van AsSpectatorGreat post Ron
couple of things…….all lasers will work on Apthous ulcers and you did the right thing with your diode. It is deeper penetrating then the erbium but I often will use the erbium as it doesnt hurt as much ( not CW).
If you use the erbium dont use water and it is a more superficial on the outside of the lesion.
Did the lesion hurt the next day or was there less pain.
I can send you some photos of what the erbium lesion looks like after it is done.
Glenn
Glenn van AsSpectatorHere is a link to some photos I just put up on sendpix.
No water and usually 3-10Hz ( not possible with biolase) and 50-80 mj, with no water, just out of contact.
Keep air blowing on tissue to keep it cool. It “numbs up after a while”
Biolase has only 20Hz
so keep it at a low setting for energy.
<a href="http://www.sendpix.com/albums/021029/214811000001620e036e17481406e4/
Cya
Glenn” target=”_blank”>http://www.sendpix.com/albums….p>Glenn
AnonymousGuestQUOTEQuote: from Glenn van As on 12:31 am on Oct. 30, 2002Did the lesion hurt the next day or was there less pain.
No pain, although the patient wasn’t really concerned with pain to begin with. 1 week I’ll have another picture.
I guess my big question is- before tx , lots of vesicles- right after tx the lesion showed no signs of vesicles(sorry ,don’t have a good picture) but yet the next day vesicles are present, was this lesion just ‘blossoming’ again or would I have been better off using EMLA and the diode in contact?
Thanks for your comments,
Glenn van AsSpectatorHi Ron ……….I know that it is defocussed and with the diode to get the energy deeper into the tissue.
Perhaps using the Erbium the next day would have helped.
Rob Gregg might have a better idea.
i think you did good but I would have changed something on day 2. You got the erbium , use it next time and see. I like certain things about the erbium ( like the Nd Yag it is pulsed) and you can do alot of work without anesthetic.
Glenn
Robert Gregg DDSSpectatorHi Ron and Glenn–
You did just fine Ron. There’s not a whole lot you’re going to do with a 7 day old lesion through biostim.
What you will do is some biomodulation and accelerated wound healing, and pain relief if there was any.
Glenn’s right about the surface effects with the erbium–that is, it will help alter and modify the surface. Stop ozzing, prevent secondary infections, kill the virus.
The best idea is to catch these lesions in the prodrome phase and prevent their manifestation in the first place.
The general idea is to avoid creating a new wound–ie a BURN. But that doesn’t mean a surface alteration with erbium is out of order. That’s OK. CO2 is OK in that way too, for example.
Bob
PS If the vesicles show up the next day–do it again. Use BOTH wavelengths to get the max benefit of both the deep penetrator and the surface modifier.
I’ve been using the FR Nd:YAG on my torn tendon every day for 5 weeks (feels goooood!). So lase until pathology goes bye-bye.
(Edited by Robert Gregg DDS at 2:03 am on Oct. 31, 2002)
AnonymousGuestFollow up picture day 7 (post tx) herpetic lesion.
Patient said starting with day 2 she had big improvement. The big question is – was it the laser or just time???
SwpmnSpectatorLooks good Ron.
Perhaps the laser treatment at least helped relieve the patients discomfort.
Al
Robert Gregg DDSSpectatorRon–
I agree with Al.
The laser made ALL the difference in this case.
That 7 day result looks like a regular heal at 14 days.
The laser did the job and you did a tremendous service.
Believe it–and charge for it next time!!
Bob
AnonymousGuestAnother herpetic lesion treated yesterday-
EMLA 3minutes
Waterlase .75W 11/7 treatment time approximately 90 seconds starting defocused and then moving in to just out of contact with tissue. Unfortunately no before picture but it was full size vesicles.Todays picture about 90 % improvement.No pain, no discomfort.[img]https://www.laserdentistryforum.com/attachments/upload/cold.JPG[/img]
AnonymousGuestHere’s another er,cr:YSGG .75W 7 air ,no h2o, EMLA topical.
Preop picture
Immediately after TX
24 hours later
(dark spots in 24 hour are artifact,n0 charring present)No pain or discomfort at 24 hour mark.
Will post again in 1 week. Its interesting that this pt had lesion area of # 8 about 3 weeks ago- no recurrence there but rather the new spot.
AnonymousGuest1week followup- lesion gone , slight cracking from winter dryness but overall good result
Robert GreggParticipantHi Ron,
Excellent case management.
No need for ELMA as you adjust your distance to tissue based on patient response You want them to feel some warmth at first. Gives you and the patient some feedback.
Spend more time–say around 3-5 minutes. Be patient, be thorough, be done with it!
Bob
AnonymousGuestBob,
Re:greater distance / more time
My question then is if least amount of energy to get the job done is the ideal , why not use the EMLA and decrease the time? (I understand further distance will affect how much energy is absorbed- so in this case how do you calculate which way is really using the ‘least energy’?)
Thanks, -
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