Forums › Laser Treatment Tips and Techniques › Hard Tissue Procedures › Removing Temporaries
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2thlaserSpectatorI have no picture for this, BUT, when I have trouble removing temporaries, I have used the laser to remove them quite easily. I started doing this on of all people, my wife! She said it was great, no sensations whatsoever. I had a darn time removing it, this newer material and cement really attaches itself, so I just lased it in half, and using an instrument, popped it off. Anyone else ever try this? If so, how did it go for you?
Mark
Glenn van AsSpectatorIt depends on what material you are using. Obviously aluminum shells wont cut, and I wonder about polycarbonate crowns.
There are many plastic temps I am sure that will cut.
What material are you using?
Glenn
SwpmnSpectatorMark:
That’s a great idea! It can be a real pain in the ass every now and then when the assistant comes to me and says “Doc I can’t get the temp off and the patient is squirming”. Sometimes I have to numb the patient to section the temp.
If we could use the laser to do that without anesthetic that would be great! Like Glenn said, what provisional material are you using? Also what setting did you use to section with the Waterlase?
We use Luxatemp for our single units and I’m sure the Waterlase would cut it like butter. Do to the precision of the laser this would eliminate the problem where you occasionally nick the prep and give the patient a jolt with the high speed.
Al
2thlaserSpectatorAl you are right on! I use turbo temp and luxatemp, also I have cut through polycarbonate, and it works great. Usually I use 1.5-2W with 40%air and 30%water. I keep the air and water down to avoid sensitivity. I then use a Woodson instrument to “wedge” the cut area and the temp will pry right off, one half at a time. Ir really works great. Kind of like cutting through composite, real easy. Glad to see this helps you guys. What else can we do? Let’s keep this up!
Mark
dkimmelSpectatorAnyone routinely anesthesing a prep with the laser prior to cementation? Seems like it would work !
Like I posted earlier I am a soon to be newbie so be easy on me!
David
Glenn van AsSpectatorHey I never even thought of it David………
Bet Mark has………..
WHat a great idea.
Lets see what he says. My thoughts are initially the main problem might be the water on the tooth but if you use the laser on the tooth with the temporary in place then cut of the temp with the laser, you might in many cases be able to get some anesthetic type of effect.
The problem is that this effect is not a long term thing and if the crown requires alot of adjustment it may be sensitive afterwards.
Cmon Mark , give us your thoughts. ROn , Al, others what are your experiences.
I think you would use 5.5w defocussed for 90 secs all around and then afterwards cut the temp off to give the tooth a little bit of more time. I dont know what settings you would use to get the temp off , mark may know that.
Glenn
2thlaserSpectatorOk Glenn, here I go. I first reported doing this, to of all people, my wife. I anesthetized through her temporary, using the settings you specified in your post, 5.5W 80-90%air, 60-70% water for 90sec, to 2 min. Then reset the power to 1.25W 40%or so air, 20-30%water, and cut a groove in the temp, from the buccal up the occlusal and down the lingual, cutting the temp in half. Then I use a Woodson blade, and just separate the halves, and remove the temp. Very easy and painless. I like to cement crowns without anesthetic due to the proprioception that helps with adjusting occlusion when neccessary, but obviously in some cases, that’s not possible, so, the needle comes out. It really just depends on the situation, and as you all know, each and every patient and their situations are different. SO, that in mind, try it, and let us know YOUR experiences!
This is a great forum to share, we really learn that way!
Hope the above settings help.Glenn, your laser, because it’s at 30hz, delivers a tad less energy I would suspect because of the increased pulse rate, you might find you need a “tad” more power to remove the temps, it you use it at 30hz.
I usually go back and forth over the “groove” I made in the temp 2-3 times, making sure I have a large enough space to place my instrument in to separate the halves of the temporary. Also, I use a G-4 tip for this, it’s a 4mm 6 micron diameter tip.
Glenn, what is your size tip for the Conituum users to use here? It is good we are using different lasers, and can compare the two hz rates, and powers for those who have the different Erbiums, don’t you think? We must remember this in our posts, so we can help both types of users, Contiuum, and Biolase. I love it when we work together!
Mark
2thlaserSpectatorOne More Thing!
When I remove acrylic temps, I start out defocused, and when I just see the ablation of the acrylic start, I move ever so slowly towards the temp to “cut” through it, and most of the time, absolutely no laser energy affects, or “ablates” the underlying tooth structure, which is another reason why:
1. use magnification
2. it’s mostly pain/sensation free
3. learn to use the laser in the defocussed mode as well as the focused mode. Mostly, I use the tip in the focused mode only when I have to, cut tooth structure. NEVER HURRY THESE PROCEDURES, there is no reason to. It’s like cutting through composite, quick and easy. But really try to use the least amount of energy possible, it really makes this a comfortable and predictable procedure.
Mark
Glenn van AsSpectatorHi Mark: Continuum is making more and more tips for the laser as is Biolase.
At present they have……..
1. 600 micron tips (.6mm) that are 80 degrees, 30 degrees, and straight.
2. 400 micron tips (.4mm ) that are 80 degrees which cut faster at the same energy settings compared to the 600 because the power density is increased when the tip surface area is decreased. These tips are fragile.
3. They make sapphire tips and straight tips for the handpiece design which I dont use (PS I hear through the grapevine that Biolase is coming out with a pen grip). Many of you know by now that I dont use the handpiece design because I cant see around the back of the handpiece with the scope. That is why we use surgical length burs and the sides of burs (angle the handpiece) when using conventional handpieces for dentistry with the scope. The laser is end cutting so it is not as easy to use the side of a laser tip.
4. Endo tips that are 21 26 and 31 mm long and 200 and 300 microns in diameter.
5. A soft tissue tip which is a long think tip that comes to a point.
6. A chisel shaped tip for cutting flaps……….I like this one alot.
THats all that come to mind now but there are others being developed.
30Hz means that it is 30 pulses per second so if you increase the energy to its maximum on the machine it is around 6 watts.
You 6 watts would be 20 Hz and 300 mj per pulse. Not sure if it is better to have 20Hz and 300 mj or 30 Hz and 200 mj, but I know that hitting the tooth 10 extra times per second wont hurt the speed but may hurt the tooth a little more (less relaxation time) and I do think that Biolases shorter pulse duration is a good thing too.
Anyways, thats it for me…….off to hockey.
glenn
dkimmelSpectatorMark, I am so glad you posted this about temps. Had a phobic in today who broke the pontic out of a 3 unit temp. It was cemented by mistake with Fuji plus ( Another story). When I picked up the Highspeed to section it off , she got upset. Said she has always hated the THAT SOUND. With your idea in the back of my head I removed it with the laser. Best part except in one small spot it cause the Fuji to pop loose from the core.
Started out with a upset patient and ended up with a patient experiencing the laser and being very happy.
Thanks
David
Glenn van AsSpectatorGreat Story David……..what I like is how successful you are becoming with the laser. I watched on dental town and I really admire the fact that you are getting in there , and not getting discouraged by the few setbacks (removing amalgam) and just going ahead and trying different things.
Today I kept one of Ron’s ideas in my head and used both my erbium and the diode for a herpes simplex virus on the nose (underneath it) on one of my dental assistants.
Used the erbium for the surface at 3-20 Hz and 30mj without water and then the diode at 300-500 mw and 15Hz to get a deeper penetration.
Worked good I think……time will tell.
Cya
Glenn
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