Forums › Laser Treatment Tips and Techniques › Hard Tissue Procedures › endo baby endo!
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whitertthSpectatorpatient came in today with swelling,and pain in max canine …anaesthetized tooth with waterlase using Bill Chen’s (turtle) technique, Tooth was non vital but painful to percussion… accessed using a t-4 tip ..instrumented to a 20 file then used 2, 3 , and 4 hundred micron fiber with waterlase….tooth was 28 mm long..went back with 25 file and it slid smoothely in and out. Used a 1 and 2 peeso then back with 300 micron fiber and filled…no anaesthetic, no pain and patient was thrilled. what would u do differently?
PatricioSpectatorRon,
Great step forward. I have dabbled with the endo stuff but have not followed through to completion. Today I did open a hot molar which the patient found painful to the presssure of his tongue without any problems. I used no anesthetic. This was a step forward for me.
I keep thinking, boy am I having fun. Thanks for the pictures.Pat
whitertthSpectatorsorry some are reversed..i was kinda excited to post them and didnt check to seeif i had them all the same way
2thlaserSpectatorNot much Ron, as far as doing something differently. We each have our own way of adding the laser to our tx. Your way seemed to work great. Sometimes I use the Waterlase for complete enlargement, sometimes I don’t, it just is so case selective, like anything else with the laser. Good job, well done!
Mark
whitertthSpectatorIn a recent conversation with Bill Chen , he actually suggested that I instrument the canal to 25 file first then use the endo fibers to complete…I just extrapolated on what he suggested
BNelsonSpectatorI often shape the canal with the Ultradent AET system and finish sterilizing the canals with the Waterlase. Strangely, in two cases lately, after no feeling ( the tooth is anesthetized) when I use the laser 3mm from apex, the patient complains that they feel it and it is uncomfortable. Any ideas why? I assume that if many of you do the entire procedure without anesthetic, this shouldn’t be a problem?
whitertthSpectatorpossible if u have a water delay in your sysem and are firing pure laser energy down the canal they could conceivably feel it..also is your setting set at 1.25 watts with about a 14/8 air water ratio… Shouldnt be any more wattage than that…..anyone else?
Robert Gregg DDSSpectatorHey Bruce,
Did you then try your Nd:YAG to see if it caused the same discomfort? Say at 100 usecs 2.5 W 15 Hz and the canal wet with NaOCL…
Bob
(Edited by Robert Gregg DDS at 10:15 am on April 28, 2003)
BNelsonSpectatorHi Bob
As you guessed, the Nd:YAG didn’t have the same effect. Some of the canals need the 200m tip to get down the canal, and the 320 doesn’t make it. I have been trying more to instrument the middle and upper 1/3s with the Er. And yes, there is always liquid in the canals and the energy is .5-.75w. I did another today and the lady felt the Er but not the file at the apex. NaoCl and the Nd worked wonderfully on the anterior tooth with the draining infection.
Glenn van AsSpectatorBruce: I never posted a reply but will tell you my experiences with the Er in RCT can lead to pain if you are closer than 2 or 3 mm from the apex.
The reason is that the laser will enlarge the apex and you will get bleeding from the PDL space and bone. I know this because I have done it.
I have cleaned the canal and then used the laser and by mistake went 1mm or so from the apex and after I was done the patient mentioned they felt it and there was now blood in the canal space (I could see it in the canal and in the suction tip under high mag).
I like the laser for sterilizing as I can definitely see less debris in the canals and smoother walls after using it for 30 secs per canal but I will say that you must be careful to only go to within 2-3 mm from the apex and be very careful.
I have also checked my apical enlargement with files and found that after the erbium yag is closer than two mm it will not be the same but larger. It is irregularly shaped and not the easiest to get to an apical stop again.
There is a study supporting this that I have where the found the microleakage after using the erbium yag was very high at the apex . They shaped the canal to a #70 and then they used the laser and without going back and reshaping they filled the canal.
The erbium yag canals were leaking alot through the apex (geez I wonder why).
Anyways, the Nd Yag will not cause the enlargement of the apex like the ERbium will.
Hope that helps and like I said my opinions are from what I have seen with the microscope on cases I have treated with the laser at 16X mag or so.
If you use the erbium for disinfecting or sterilization make sure that you stay 2-3 mm away, withdraw at 2mm per second and only pulse on the upstroke , and recheck your apical diameter after using the laser with water in water filled canals (NOT BLEACH) for 30 secs per canal.
Some of that comes from Moritz work on the use of endo and lasers in ESOLA.
Cya
Glenn
dkimmelSpectatorAnyone finding doing access a bit tricky. It could be that down here in Fl the 80 Y/O have small pulp chambers. Seems I am a bit more gun shy then I am with the high speed. It could be that I am using the high speed dry and with the laser the water makes it tough to see. Guess a scope would help but my wife/front desk person would shoot me! Do you think there is an advantage to the T tips over the Gs in this case?
Someone mentioned water delay. It appears the latest waterlase have a time delay if the water is below 14%. Canbe a Pain. I have been told a fix is on the way. So if you have a delay in your water at low %s give them a call!
David
BNelsonSpectatorGlenn,
Thanks for the input. I have been using the technique Dr. Chen suggested and staying 2-3 mm from the apex, but sometimes I get some sensitivity. Guess I’ll go back to the old files, seems to have worked just fine for the last 25 years, and sterilize with the Nd:yag. Appreciate the info on the opening of the apex with the Er. That is why I have always finished the apex with a file. -
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