Forums › Laser Treatment Tips and Techniques › Hard Tissue Procedures › more operative
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whitertthSpectatorJust some more sharing of some operative dentistry…5.5 watts 90/75 round bur to finish off leathery decay and smear layer removal at 2 watts with 20/ 20 hope u guys like it!
Glenn van AsSpectatorHey I dont like it!
I LOVE IT……….nice work and I would do almost the exact same settings and exact same steps.
Nice stuff…….no anesthetic I guess.
Beautiful result……what did you restore it with.
Can I make one suggestion. Look close at the 2nd molar and you will see scatter and some laser etching of the mesial of that tooth.
My suggestion is to protect the adjacent tooth……..here is a case I did to show you what I mean.
Glenn
Glenn
Glenn van AsSpectatorBy the way that protector is called the INTERGUARD by Ultradent and is pretty thick so sometimes I have to pop it out and take a sectional matrix to get a nice contact.
The metal matrix seems to help cut faster in the box because of reflection from the metal.
Glenn
whitertthSpectatorThanks for the tip…I actually did that on an anterior tooth today…my card reader crapped out so i couldnt post it yet….I restored the tooth with kerrs point 4…seems like it does a nice job…i have restored primary teeth in the past with compoglass because of the FL. but i think it may be a crock and it dosent polish so well so i have gotten away from it …..
whitertthSpectatoris there a problem with using regular toffelmyre matrix bands as protectors?
Glenn van AsSpectatorgreat question…….there isnt a problm its just that sometimes when the contact isnt broken they are darn tough to get in
The interquards are quite firm and easier to get through.
Being thick its tough to get a good contact with the interquards from Ultradent.
Just a thought……….
Good stuff Ron and nice pics
Glenn
PatricioSpectatorHi group,
As a novice your pics are a great help as they pretty much confirm what I have been doing. A confidence builder. I have found I like to cean up with a round bur and then finish with the laser to a hard smooth surface. I do notice sometimes at that point there can be stained dentin left at the base especially with some more vertical decay uncovered by the diagnodent. Are you guys removing that as well? In the olden days I would have cut it out but thinking concervatively I have been leaving it when I am convinced it is firm.
Pat
Glenn van AsSpectatorI remove everything I can, hardly ever leave anything but I am the first to say that the laser can make it very difficult to tell what is decay and what isnt.
The water acts to rehydrate the decay and the color goes from obvious orange to dentin yellow. The only thing that helps me is the texture at high mag is much more obvious of decay. If in doubt I take a spoon…….(Hey Mark where are those spoons!!!) and check.
Caries detector give you false positives on the enamel and makes it tough to remove the color from the etched enamel.
I love small round burs for large soft areas and in addition for decay tracking laterally. Patricio you are far from a rookie here and the great thing about this forum is the general level of comraderie and interest in learning.
There is a learning curve to using the laser but seeing the cases posted here sure helps shorten that.
After 3 years of working with the laser and a scope, I have tried alot of things but people here constantly push the envelope and make it more interesting each day to practice as the cases always come outside of the box.
Keep it up, and I will post another simple case in a minute.
Glenn
AnonymousGuestQUOTEQuote: from Glenn van As on 3:02 pm on Dec. 29, 2002The water acts to rehydrate the decay and the color goes from obvious orange to dentin yellow.
GlennI’ve found that many times I think I’ve got everything and then etch (see previous post regarding difference in surface of etched vs. laser etch teeth) ) and dry only to find the discoloration. At this point I again pick up the slow speed, remove remaining decay, re-lase (word?) the area and finish. I’m also using Graemes co-cure technique more and more – figure the glass ionomer is a good thing to have there if any doubt.
dkimmelSpectatorI keep reading that Caries detector gives false postives when used with the laser. In several of the laser course at DT in Vegas this was brought up. But there was always a lower level rumble that you could tell false postives. Anyone whats up??
David
Glenn van AsSpectatorCaries detector gets all over the enamel………….I hate it.
You need to use high magnification to see the caries or tactile sense with a slowspeed bur.
THis is one concern I have with laser dentistry is that I am positive that a fair amount of decay is being left behind.
SOft mushy decay is tough to remove with the laser and in addition you will find that as the dentin rehydrates from the constant stream of water the caries become the same shade as dentin.
The textures that are different are only visable at higher mags.
Here is a case I did where you can see the false positives ( YOU HAVE TO GO HALF WAY DOWN THE PAGE TO SEE THE FALSE POSITIVES – 3RD CASE DOWN THE PAGE)
http://www.rwebstudio.com/cgi-bin/ikonboard/topic.cgi?forum=25&topic=27
Glenn
2thlaserSpectatorHi Glenn, good case. This is why I like to use the mini spoon excavators. What the laser leaves behind, I get out very easily with the spoons. Patients NEVER feel discomfort with it, and then I relase the surface at 1W or less to “sterilize” and fill. The tactile sensation that is missing using the laser is there with the use of the mini spoons. Just what I do. That’s it!
Mark
Glenn van AsSpectatorSorry Mark: I forgot about your spoons……since I ordered a set and will start using them I will take some photos when they get here.
I apologize and realized as soon as I saw your name that I had forgotten that alternative.
At present I use the slowspeed as even with high mag , I go on record as saying it is difficult to tel whether all the decay is out visually.
Glenn
jetsfanSpectatorThere is another product that I like to use. It is called cariosolv. A set of small spoons, which are shaped much like small slow speed round burs, are sold along with the cariosolv. Basically the cariosolv will softened up the carious dentin so that is can be gently removed with the spoons. I agree that it is often difficult to differentiate between carious and normal dentin. After using this I am often amazed at how much decay was present.
JETSFAN -
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