Hi Ron actually with the diode you will use BOTH activated and non activated.

First activate the tip by carbonizing some blue articulating ribbon on the tip to make it a “hot tip”. Then do the gingival curettage part of the procedure where you remove the inner wall of the pocket. This activated tip will remove the inner wall of the pocket and you will get a coagulum on the tip after20-30 secs. Keep the tip moving up and downwards and sideways in the pocket. You will get a fresh bleed when you do this and then you know you are finished with the first step.

Now cleave the fiber clean and the second part of the procedure (used to be called bacterial decontamination) now referred to as bacterial reduction takes place at different settings.

If you need further information let me know.

Glenn

Hi Ron,

You got the general concepts correct.

Activation = Conditioning = Hot Glass effect = minimal thermal conduction depth penetration if kept moving quickly.

Non-Activated = non-conditioned = bare fiber = 810nm wavlength emission into tissue and tissue alteration by wavelength dependant absorbtion and protein denaturing (ideally)–or by burning (not ideal).

Gated pulsed allows for refractory “cooling” but don’t get to confident about it–it warms soft tissue quickly and deep (12mm+)

Right on, Glenn….you have the technique right.  Crown or crest of tissue preparation first before BC–allows for access to the base of pocket.

I am fascinated though.

My partner Del, and I were among the first to advocate this “crest down” technique.  We were certainly the first to publish on this….and we were poo-pooed and told that pocket up was the “established” way….Oh well!
:shocked:

I guess I didn’t get the memo that crestal tissue down is now SOC!:wink:

Good luck Ron.

C ya,

Bob

Hi Ron–

Glad you reading Jeff’s book (http://www.jgma-inc.com/ for those who don’t know about it yet).  Good stuff in their, huh?

There’s just no other way to cut–MELT–fibrous tissue like a frenum or fibroma with near-infrared, unless you have VERY high peak powers in a pulsed infrared.  And with a fibroma you ALWAYS want to “lift & undermine” it, not try to vaporize the entire mass.

No, not really.  Use the activated tip to incise the internal margin of the pocket epithelium, then continue with it AS LONG AS IT CONTINUES TO REMOVE THE GOOP.  Re-condition, and try again to remove goop.  Better yet, don’t wipe off all the proteins accumulated on the fiber-optic and use that mass as your activator (hot-tip effect).  No more goop?  Then you’re done with that pass.  “More” attempts and fuss in the pocket is not better.

“Is this because of the potential for necrosis 1mm deep with an activated tip(per manni)?or just because the effect is very localized(right at the tip) when kept moving?”

The reasoning behind your thoughts and what you are asking, I think, are more to do with the fact the effects of a hot glass effect are very localized in tissue–but still VERY hot!

Thermal necrosis with the hot glass effect is very localized, unless one spends too much time on thin tissue.  But I think we are talking about pocket therapy.

EXTENDED or PERIPHERAL thermal necrosis refers to tissue that has been warmed to death (literally) beyond the zone of primary irradiation. Again, in the hot glass mode on the first pass, I don’t think we are talkin with too much concern about that.

Does that answer your questions?

Bob

Hey Bob, Ron, Glenn,

…have you ever played as a child “monkey in the middle” where the ball gets lobbed back and forth over your head, just out of reach….that’s what this post has been like for me (kinda). I just received the 980 Diode and have also ordered Jeff’s book (thank god).
Your knowledge amazes me.
Cheers,
Vince

Hi Vince and David,
I’ve been that monkey since I joined this forum. Great game, isn’t it?

Ron,
What settings are you using with your diode on these pockets?
I thought you’d be using your Periolase for this treatment. Do you just want to try it out?

Ken

(Edited by Kenneth Luk at 11:56 am on July 5, 2003)

Hello: Just a few comments about tip activation with the diode, and especially concerning soft tissue periodontal pocket debridement.
You always start from the gingival crest and work down to the pocket bottom. Bob Gregg, Del McCarthy and a few of the rest of us old farts were taught by ADL in 1990 to do the reverse, and it made no sense then, and makes much less now. You should first calibrate you fiber extrusion out of the handpiece to the measured pocket depth MINUS 1 mm. Then, remembering to stay on soft tissue (and more precisely on the diseased soft tissue,) move the fiber from the gingival crest down toward the apical portion of the pocket. If you think about it, you can’t easily stay on soft tissue if you start down at the apical extension of the pocket, and you must remember that there’s some depth of penetration of this wavelength beyond the contact area.
Be very careful with two things: 1) don’t over initiate (not carbonize!) your tip, paying particular attention to avoiding putting carbon on the sides. 2) please clean off as much goop as possible, especially on the sides of the fiber. Otherwise, you can just heat up your endo explorer and accomplish the same thing, which could be some unwanted collateral thermal damage. You already know that diodes only operate either continuously or with very long “pulse” durations, so the thermal relaxation can be minimal.
Use minimal power settings (I like about 0.3-0.4W. CW) and work quickly.
Then you can return to the pocket, which is now more of a pool of fresh blood, and perform bacterial reduction with a slightly higher setting (like 0.6-0-0.8W CW) moving faster, like you’re performing hemostasis, again working crown down.
You can find some articles on this by Nora Raffetto, RDH, who, although she’s one of us veteran laser users, should not be called either old or fart or both. Keep Smiling………..DON

Hi Ron: Both of my hygienists and I grew up on the pulsed Nd:YAG, and then we got our first diode, the ADT diolase when it first came out, I think about 4 or 5 years ago. That diode has only two buttons–one is CW and the other is a duty cycle of 50%, which is damn near like CW, especially when compared to pulsed Nd:YAG. So, to keep our heads on straight, we just learned to use the diode in CW, and the Nd:YAG as usual. You know that you have to work fast, but once you learn that, you can do quite well. So, pulsed diode works great for bacterial reduction, so if that’s what you learned, go for it, and you should be very successful! One thing to remember is that you’re not removing tissue when you’re preforming the procedure, rather you’re in a pool of blood and fluid. That liquid does act to disperse the heat, so CW isn’t really dangerous. The secret, of course is to get the photons to become absorbed. Hope this helps…….Keep Smilng………DON