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Hi folks: its been painfully quiet in here for a while. Here is a case I did a couple of weeks ago and thought it might be interesting.
This is a yong 13 year old female with alot of crowding. Treatment included extraction of all permanent 1st premolars and the primary tooth on the upper left at the same time.
I have posted some preop radiographs and then when I extracted the primary molar I heard the tell tale “CLICK” which occurs at the same time as the crown is removed. It is typically followed by some short four letter words uttered quietly or thought loudly.
In this case given the orthodontics are being done the primary root had to be visualized (its great to have a scope), and then removed.
The erbium laser was chosen to create the osseous laser trough around the root so that a root tip elevator can be inserted and the root removed. Settings were water on, 40Hz and 110 mj or so. Not much air at all.
I then removed the 9mm root and decided to help the tooth along a little by using the diode to remove the overlying tissue (follicular tissue) and allow this tooth to come in faster and I used the diode to remove the tissue. Settings were 1.0w CW. Light air and water stream. The diode was used in contact as was the erbium.
I like the diode for coagulation in these cases as well. Maybe not quite as nice as Dr. Bobs NdYAG (cant speak from experience though) but it works.
Hope it creates some discussion, we cant have figured it all out in under 3 years can we??
Glenn
Nice case Glenn. The erbiums work well for this type of conservative extraction assistance. Sometimes these seemingly simple deciduous tooth extractions can be a real PIA can’t they?
Great job on placing tip and trough on the palatal side and not adjacent to the adult premolar. If we place the erbium tip on the side adjacent to the premolar we could have easily nicked up the adult tooth.
Seeing a few of Glenn’s laser-assisted extraction cases inspired me to try one myself. This patient is my assistant’s husband. He was in the military and this tooth was neglected following a RCT. He came in with gross decay on the distal and an abscess on the distal root. The re-treat was completed and this tooth fractured about 6 weeks following the re-treat.
(Pic 1) I initially went in to explore the fracture. I was fairly certain it was hopeless, and it was, as it turned out. The tooth was fractured along the buccal aspect of both buccal orifices from mesial to distal. I decided to extract this tooth surgically exclusively using the DELight for access and bone removal.
Pic 2
After anesthesia, I used the DELight (45Hz, 55mJ +H2O, no air) to sever the gingival attachment. The buccal section was removed with tissue forceps. I gave in and removed the remaining Cavit temporary with the handpiece.
Pic 3
So I could have access to the pulpal floor I used the laser to remove the palatal axial wall of enamel (by angling the laser to cut palatal to buccal @ the CEJ) (20Hz, 400mJ) After removing the palatal wall I gained easy access to the pulpal floor. I sectioned the pulpal floor from mesial to distal and between the buccal roots. (20Hz, 400mJ). When I was able to visualize bleeding in the section I knew I was through the floor.
Pic 5
A straight elevator was used to luxate the buccal roots. They all but jumped out. Very little force was used due to the perfect purchase I had between the roots. I then used the laser to sever the palatal gingival attachment and removed bone around the palatal root (20Hz, 200mJ). Now I had a solid purchase on the palatal and buccal aspect of the palatal root, so I used the Rongeurs to twist the palatal root out, again, with minimal exertion.
I am very pleased with the result of this treatment. It went better than I could’ve hoped. There was very little bleeding (notice the pics) and minimal tissue damage or bony expansion. I was prepared to lay a flap, section with the HP and suture it closed. What a difference! The total treatment time after anesthesia time was 45 minutes, including pics. Neat use for the laser!! Thanks so much to all on the forum who posted cases like this. I would never have thought to use my laser like this. What a great service for the patient. Comments are appreciated, good or bad!!
(Edited by drkdds at 9:05 pm on Feb. 21, 2006)
(Edited by drkdds at 9:17 pm on Feb. 21, 2006)
Hi Doug……..its been too long for me since I have posted here. I saw Rons sig and felt guilty…..darn it all.
Its 2 am and I am in Vegas starting a lecture tomorrow and I cant sleep.
Here is that case I did the other day.
The original bridge from the premolar (2nd ) to the canine fractured and the patient doesnt want implants. I tried to salvage the canine, doing an endo on a completed calcified tooth, some crown lengthening and then it came in like this. I took and impression for a Procera Zirconium post that I cemented with Resin (after using the ErYAG laser to remove the smear layer).
The crown on the first molar was removed (yikes) and then the 2nd premolar was extracted ala Dougs case. I used a 4oo micron tip at 25 Hz and 200 mj with H20 to create a small trough……..crack , crack , crack. A little more troughing and presto mundo, out comes the root.
Placed in some Osseograf and put a piece of gauze over the osseograf til I took the temp and relined it. Didnt want all the extraction preservation material going all over the place. Will leave the temp in for 3 months and then will do an ovate pontic on both teeth that are missing.
The temp bridge is in place……..hope its interesting.
Glenn and PS its too late and to tiring for text , so just follow along….
Boy some of the socket photos through the scope showed RIGHT down to the bottom of the socket….talk about no bleeding!!…what a cool shot. Put that in at the end for you.
glenn
