Forums › Laser Treatment Tips and Techniques › Hard Tissue Procedures › Microdentistry
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2thlaserSpectatorHere’s another case I did today, utilizing a “slot”prep technique taught to me by Stu Rosenberg, Kim Kutsch, and Bob Barr. I really feel this is a service to the patient. On the occlual surface there were NO diagnodent readings. On the x-ray, there was mesial decay (don’t have the xray to post, you’ll have to trust me here!). I really tried to keep the marginal ridge intact, and with the pinpoint accuracy of the laser, this is really fast and easy. I started out the normal way, 5.5W, 80%air, 50%water, (BTW, we have found that a 30%differential between water to air ratio seems to work the absolute best for speed of preps), for 90 sec. Then at 5.5W, I enter the enamel to about 1/2 way down the proximal surface, then change to 3W to finish the box, keeping the same air/water settings. Then I cleaned out decay using the small #4 microspoon excavator, and then on 1.25W went back to fine tune the prep prior to placing the composite resin restoration. This is the first interproximal restoration for this patient, low caries rate, and YES, we WILL be replacing that terrible amalgam on #3 in the near future!!!! We used no anesthetic, he felt NOTHING. They usually don’t with slot preps on molars. Here are the pictures…sigh…I need a scope, just don’t have the money for one yet!
This is so fast and easy, less than 20 min in and out. (of course this took about a half an hour as I stopped to take the pictures.) But I thought it was a good example of how to use the laser to preserve tooth structure.
Thanks!
Mark
dkimmelSpectatorMark, Nice! What did you matrix with. I have found some times that the prep is so small That I can not matrix without opening the slot up larger then the caries.
Where did you find that little spoon?
DAvid
2thlaserSpectatorDavid,
I use those disposable matrix’s, I don’t know the name of them offhand. The little spoons are something I developed as a kit of microdental instruments. You can find them at http://www.laserdentaltools.com Stu will have some for you to try at his course. I love em. I selfishly made them for myself, then others saw them, asked for them, now my wife runs that little venture. So far, we have been really busy with it all, thanks for asking.
Mark
Glenn van AsSpectatorNice pics Mark and remember if you get a scope the procedure isnt slowed down at all after you learn how to use the scope as the pics are shot WHILE you are working so for instance the osseous recontouring that I do tomorrow a.m. is for one hour with post core buildup and probably crown prep if I have time.
I will post the pics tomorrow or perhaps this is a good one to video and put up on the web site.
WOuld people like to see streaming video of the procedure as Ron has offered to do this. If so I will edit the video from the scope and send it to Ron next week.
WHat say ye?
Glenn
Glenn van AsSpectatorP.S. I almost forgot……..cool case Mark, what about protecting the adjacent tooth from the beginning and for those that dont own the microinstruments that Mark has……….ORDER A SET.
I did and honestly I am going to use his instruments for all my comps. If you dont believe me, ask Mark for my emails which were unsolicited but his
Felts, spoons, pluggers and burnishers are fantastic .The spoons really are a cool shape.
Try em………..you will like em.
Glenn
ASISpectatorHi Glenn & Mark,
Would love to see the streaming video, Glenn.
I met Tannis, the new rep for Biolase, today. I understand that Mark might be coming to Vancouver to give a course on Waterlase soon.
Glenn, Tannis claims that the Delight shuts itself down every 3 minutes. Is that so? It also doesn’t cut as fast as the Waterlase and doesn’t coagulate as well. What do you say? Are these all sales pitch stuff, Glenn?
All you guys are tireless in your effort to share your knowledge and experience. What a wonderful atmosphere!
Andrew
Robert Gregg DDSSpectatorHi Andrew–
Glenn will give us all an earfull in a bit, but let me tell you as a someone with no bias as to either erbium–
I used the DELight on an extracted tooth recently–in fact, right after Stu Rosenberg did at the ALD Hoya ConBio booth in Florida. It didn’t shut down at all in continuous use by either Stu or me in over 30 minutes of playing around.
Both Stu and I were impressed at how fast the ConBio cut–and Stu has since publically said so on Dental Town.
And as far as coagulation–it is the same.
Geez! Tell Tannis to clean up her marketing act. We don’t need “used car” sales tactics in this field. We have had too much of that over the last 12 years.
I told Rick Shock the same thing in Florida when he tried to claim the Waterlase can do perio like PerioLase MVP-7.:angry:
Misrepresentations, mischaracterizations, hype, style over substance, claims over science are the sorts of things that hurt the credibility of the ENTIRE laser industry when even one company engages in it, if it is as prolific as some Biolase reps have done it.
I speak to Waterlase owners every week who feel they were under trained and mis-led.:sad: They still like their Waterlase, but they wish the company reps had been more honest and sincere. They would still have bought w/o the lies…..
Bob
Speaking as a laser clincian for 12+ years and owner/user of MANY different company lasers (Excel, ADL, ADT, LaserMEd, NIIC, Sharplan/OpusDent, MDT, Sunrise, Biolase); as well as co-founder of Millennium Dental Technologies.
[url]http://www[/url]. millenniumdental.com
(Edited by Robert Gregg DDS at 6:53 am on April 12, 2003)
SwpmnSpectatorHey folks,
Lean real close to your monitor and you can almost hear a roar – yes, the roar of thunderous applause as Dr. Bob Gregg just laser-guided a bomb right into the Bull’s Eye of the target area!!!!!
Congratulations Dr. Gregg!!!!!!
Al
AnonymousGuestI posted this under the Gerenal Erbium Forum but thought it might also be good here ( I’m still one of those who are happy with their Waterlase )
Interesting abstract-
Pulsed erbium laser ablation of hard dental tissue: the effects of atomized water spray versus water surface film
Freiberg, Robert J., IMC Associates; Cozean, Colette D., ENO Vision, LLC
Publication: Proc. SPIE Vol. 4610, p. 74-84, Lasers in Dentistry VIII, Peter Rechmann; Daniel Fried; Thomas Hennig; Eds.
Publication Date: 6/2002
Abstract:
It has been established that the ability of erbium lasers to ablate hard dental tissue is due primarily to the laser- initiated subsurface expansion of the interstitial water trapped within the enamel and that by maintaining a thin film of water on the surface of the tooth, the efficiency of the laser ablation is enhanced. It has recently been suggested that a more aggressive ablative mechanism, designated as a hydrokinetic effect, occurs when atomized water droplets, introduced between the erbium laser and the surface of the tooth, are accelerated in the laser’s field and impact the tooth’s surface. It is the objective of this study to determine if the proposed hydrokinetic effect exists and to establish its contribution to the dental hard tissue ablation process. Two commercially available dental laser systems were employed in the hard tissue ablation studies. One system employed a water irrigation system in which the water was applied directly to the tooth, forming a thin film of water on the tooth’s surface. The other system employed pressurized air and water to create an atomized mist of water droplets between the laser hand piece and the tooth. The ablative properties of the two lasers were studied upon hard inorganic materials, which were void of any water content, as well as dental enamel, which contained interstitial water within its crystalline structure. In each case the erbium laser beam was moved across the surface of the target material at a constant velocity. When exposing material void of any water content, no ablation of the surfaces was observed with either laser system. In contrast, when the irrigated dental enamel was exposed to the laser radiation, a linear groove was formed in the enamel surface. The volume of ablated dental tissue associated with each irrigation method was measured and plotted as a function of the energy within the laser pulse. Both dental laser systems exhibited similar enamel ablation rates and comparable ablated surface characteristics. The results of the study suggest that, although the manner in which the water irrigation was introduced differed, the mechanism by which the enamel was removed appeared basically the same for both dental laser systems, namely rapid subsurface expansion of the interstitially trapped water. It is the conclusion of this study that if the proposed hydrokinetic effect exists, it is not effective on hard materials, which are void of water, and it does not contribute in any significant degree in the ablation of dental enamel.
Glenn van AsSpectatorAndrew: I think that you might want to look at the posts here again on the web site regarding Biolase vs Continuum (Hoya Con Bio) and decide which one that you want to get.
I have some set opinions based on my experiences but will tell you that the Biolase machine works and is perhaps a little sexier, the Hoya Con Bio laser is not as well marketed but is very stable.
Both are used by various people here and I dont think either one has an advantage with respect to speed of cutting. THe both cut by the same mechanisms mainly H20 particles absorbing the laser energy and expanding and as they do ablating a piece of tooth.
Which one you get has to do with price , reliability, stability, training , support and whether you prefer the delivery options with the Con Bio or the Biolase.
Sales reps are sales reps and they all will say anything to get the sale. Its their job, and mine is to say ask for both to come in and do a demo and remember to ask about warranties, and in addition TRAINING.
I have a bias toward hoya con bio, and you know that I do but dont expect to have one laser cut really fast compared to the other.
It just isnt so, and as for soft tissue……..check out the cases and you will see that the laser cuts.
I did a osseous recontouring on a patient today with anesthetic and it bled but was controllable for the post and core buildup. Gonna send that one to Ron for posting on the web site.
ALl the best…………
(Hey Allen did I stay civilized?))
GrinGlenn
Glenn van AsSpectatorHey Ron ……..is there an echo in here……….
I have been saying that for a while.
Biolase does an excellent job marketing their product and Imean it……….they do a wonderful job.
The company is very aggressive in getting FDA approvals.
They throw great parties, and are Number 1 in sales.
It doesnt work on hydrokinetics………
The Hoya Con Bio cuts soft tissue very very nicely and with minimal bleeding.
IT cuts similarly to the Biolase in enamel.
THe Hoya is extemely stable. For those that doubt me , privately email me and I will give you a list of 6 people to phone, email etc. who have both the Waterlase and the Hoya Con Bio in their office and they can tell you which one they prefer.
Ask Bill Greider about his preferences and why.
Glenn
ASISpectatorHi All,
Thanks for the input. Just what I needed to confirm my thoughts about the matter.
Tannis is a lady by the way. Not that it makes a difference in truthful representation.
Thanks and regards to all.
Andrew
2thlaserSpectatorGlenn, FYI, I talked to Keith about the remarks of the rep, so he is aware. I feel that the ConBio unit is a very good laser, especially after talking to Stu, and his experiences with the new unit. Let’s just stop bashing eachother, and companies, and just learn what we can do clinically here. I really don’t care what each laser company does, I agree Biolase has had some training problems, BUT, in their defense, they are working that problem out. I think the meeting between you and Keith has gone a long way towards some of that. This post is really directed towards everyone….Let’s just get about the business of teaching eachother. That is what is important here, that is “the laser guided bomb that hits the target for me”!!! Have a great weekend everyone.
Mark
Glenn van AsSpectatorHi Mark: Dont misunderstand me, in that I really wasnt pointing any fingers at anyone with respect to training or what any rep says.
I have mentioned numerous times that any rep be it Continuum , Biolase , Opus Dent or any of the soft tissue laser companies will try to take advantage of any opportunity to promote their product or tear down the other. ITs human nature.
Andrew as for the 3 minute thing and turning off that is erroneous. The unit goes into standby if you dont press down on the foot pedal for 3 minute it will automatically go off. If you use it continuous or even intermittent in that time it will not shut off. Its a safety measure.
Finally, I am beyond bickering with Keith or Biolase , in fact I got an email from Keith yesterday laughing about the t-shirt that he gave me because i sent him the photos and i promised to buy him a beer in Anaheim.
We agree to disagree on certain issues but remain mutually respectful of the role each plays in the laser field.
All the best Mark……….editing my videos today.
Glenn
AnonymousGuestThought Microdentistry might be a good place for this-
http://www.cda-adc.ca/jcda/vol-69/issue-1/25.pdf
From Jan.2003
I was wondering if anyone was using this approach for Class II’s since it seems like 1 way to leave a stronger tooth and also maybe avoid some of the Class II laser prep sensitivity problems (that I have anyway)?
Thoughts?
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