Premolar fustration - Laser Dentistry Forum

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April 8, 2003 at 12:07 am #3502 Reply

dkimmel
Spectator

Tried to remove this alloy . Did the 90 sec. 5.5W 75A 90W on the O,B & L. Then pulled out the Highspeed and got about as far as I would expect without anesthesia. Tried another 90 sec. I repeated this 3 more times and gave up giving anesthetic. Not sure how to post the photos. Here are the links.

The rest of the story is the patient had no problem with this tooth prior . She is a 40 Y/O wt blond female. It usually takes two carpules to numb her, as it did today.
Why you ask did I even try! It was my sister in law visting for the week of spring break!!

Any ideas what I could have done different?

David

(Edited by dkimmel at 10:29 pm on April 7, 2003)

(Edited by dkimmel at 10:30 pm on April 7, 2003)

April 8, 2003 at 4:57 am #11897 Reply

BNelson
Spectator

Hi David,
As they say in the training, only 65-70% seem to get anesthesia with the laser, and that is pretty much what I have found. I know there are others out there that seem to do much better, and I am not sure how their techniques vary. I have some people that beg me to stop “anesthetizing” with the laser as it really bothers them. They request the shot! Expectation seems to help. The people that expect to be numb from the laser and aren’t overly anxious seem to do better, also. It is fun to not have to give shots and have people say how great it was when it does work, so keep on trying.
Bruce Nelson

April 8, 2003 at 1:22 pm #11882 Reply

Anonymous
Guest

David,

Anyone who needs 2 carpules to numb is going to be tough.

Couple of questions-

How did she react to the ‘bathing’?
How did you section the amalgam to remove?

The only things I could suggest to try are-
1. bathe longer
2. brand new bur-section the amalgam such that you can flake some out.Try not to create heat and minimize vibration. Once you have a small section out go real low power and bathe the dentin some more before proceding.
3. also use low power right in the sulcus ala Bill Chen

I don’t know that your results would be any different but its just a couple things to try.

April 8, 2003 at 1:44 pm #11887 Reply

dkimmel
Spectator

Thanks Ron. She had no reaction to the bathing. I pretty much did as you suggested in removing the alloy. It seemed I would work for about 20 sec on alloy removal and then bathing again.
Can you tell me more about Bill Chen and his technique?
By low power what are your settings?

I’ll try another one this afternoon.
David

April 8, 2003 at 2:36 pm #11883 Reply

Anonymous
Guest

David,
Here’s what I dug up out of my notes on Bill Chen’s technique for amalgam removal.

.25 W 15/15 into sulcus to desensitize
new bur, cut and flake out
.25W 15/15
.75 15/15
2.0W 30/30
2.5W 30/30

The other thing I forgot to mention(writing between pts) is it appearred that there may be some traumatic occlusion on that bi. Sometimes you can adjust the occlusion on the tooth at the hygiene appt and it will then be less sensitive at the subsequent operative appt.
I also have found that I can prep w/ the highspeed for the same amount of time that I bathed.

April 8, 2003 at 4:15 pm #11892 Reply

dkimmel
Spectator

Rod, Yep this patient is a clincher/grinder. Have her using an NTI. This was probably about the worst case to try this on ( just working on a relative is often the kiss of death) Then again family are always the best to practice on! Still trying to get one to let me do a flap with the laser.
Thanks Again
David

April 8, 2003 at 8:17 pm #11889 Reply

dkimmel
Spectator

It worked! Tooth #31 with a medium size occlusal alloy with a crack in the distal marginal ridge. Did the 90sec bathing just like before. This time it worked great. Bathed the tooth at least 4 more times.
When finished asked the patient 1-10 how uncomfortable. She said she felt nothing!
Today I am a happy camper!
Thanks for the help!
David

April 8, 2003 at 10:25 pm #11894 Reply

2thlaser
Spectator

OK, David, you are becoming Godlike! Great job. Always nice to hear success stories. Keep them coming.
Mark

April 8, 2003 at 10:44 pm #11890 Reply

dkimmel
Spectator

Thanks Mark but the last time someone said I was
G-dlike I ended up spending the night on the couch!
David

April 8, 2003 at 10:47 pm #11895 Reply

2thlaser
Spectator

OUCH!!!

April 11, 2003 at 3:05 am #11898 Reply

Benchwmer
Spectator

Thanks for the techniques.
I removed two 20 year old occlusal amalgams on a petrified new patient today.
Used the OpusDuoE. 800 micron sapphire tip. I vary Watts and Hz for enamel vs. dentin.
1st Maxillary molars, only the mesial pits were restored.
Removed the caries in the distal occlusal and lingual grooves, used some defocused energy trying to achieve analgesia.
Then removed the amalgams, way into dentin, recurrent caries, black stained dentin. Quartered w/ #330 bur, removed w/ spoon excavator.
Removed the caries, bonded w/ I-Bond, 3M P60/Z250 composite.
Patient said no pain, she was amazed.
It was an amazing demonstration. Thanks for the presentations.
Jeff

April 11, 2003 at 3:37 am #11884 Reply

Anonymous
Guest

Great job guys!

As I read thru several posts lately it seems that many times we do not supply all the info on what we have done or tried (I’m guilty as well ).

How about we try to standardize posts and maybe see if we can narrow down some patterns.

Patient age

Tooth number

Previous restoration (or none)

Type of tip

Power used (watts/mhz)

Focused/defocused

Time

Thanks, keep posting – everytime you do 220 some laser users learn something!

April 11, 2003 at 6:19 am #11899 Reply

Glenn van As
Spectator

Great idea Ron………this is a good way to create some standardization with our posts.

I am very very guilty of this.

I will shape up…………as its easier to improve when you know the whole story not just half of it.

Glenn

April 13, 2003 at 2:01 am #11891 Reply

dkimmel
Spectator

The fustration with this premolar at the start of the thread was a big deal for me. The second patient Tooth #31 was going to be seen the next day. This patient was allergic to all anesthetics and if numbing with the laser did not work, I was going to have a tough time. This was a long term patient of mine that had just developed an allergic reaction to the anaestheics. She is also one of the big reasons I bought the laser. I was really relived that it worked. She is also a reporter for the St. Pete Times. She showed up with a photgrapher. Since it worked it turned out fine. It could have been bad if it had not worked.
It was a great ending. Woke up this morning with a call from one of my staff. We made the front page of the Pasco section. It was a pretty good article. She left only one small thing out of the article. My name. What a hoot. I had even talked about Allen and the closest other laser to me. Sorry Allen your name did not make the article but at least she put what town you were in. So you made out a bit better then I did.
What a hoot. Well at least the laser worked!
David

April 14, 2003 at 11:58 am #11893 Reply

dkimmel
Spectator

Sort of got a Marketing plus on the deal. Sunday they put my name in the paper in the lower left hand corner. Seems they had a couple of calls asking who I was. The scoop was the editor pulled my name as he thought it was too commerical.
David
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