Class V operative - Laser Dentistry Forum

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December 29, 2002 at 8:45 pm #3507 Reply

Glenn van As
Spectator

Hi folks: Here is a Class V abfractive lesion and boy these are a joy to do with any erbium.

You can remove tissue on the labial without anesthetic with water off (air if needed on the Biolase) and if you get one tip out of this , its to buy some silk cord (silk thread) and place it in the crevice prior to removing the tissue and it acts to help you in two ways.

It protects the deeper structures that are beyond 1mm like pockets, bone and especially cementum.

In addition it provides a visual marker for you to lase to and doesnt really get too damaged by the laser.

The composite was a little light. Use water with hard tissue removal and a little higher settings.

Soft tissue was 30 Hz and 30-50mj (.9-1.5 watts) with no water at all (you can use air if you want)

Hard tissue was 30Hz and 50-70 mj (1.5-2.1 watts) with water starting defocussed if you want.

I will post a case where I didnt use cord, didnt take caution with the cementum and show you my mistakes in a sec.

Glenn

Please tell me if these pics help you at all.

By the way……..no anesthetic with this one.

December 29, 2002 at 8:47 pm #11966 Reply

Glenn van As
Spectator

The photos are in 4 per page so read them as follows

A B E F I J
C D G H K L

Sorry for the confusion but its the way the forum reads the pages.

I will have to stick to one page………

Glenn

December 29, 2002 at 9:04 pm #11960 Reply

Anonymous
Guest

Glenn, I moved the images . If you upload 1 picture and then hit your space bar and then upload the next picture they will fall in line 1 below the next.

Is the blanching just from the cord or initial softtissue tx with the laser?

December 29, 2002 at 9:12 pm #11967 Reply

Glenn van As
Spectator

Ron very perceptive……..it is just from the cord. The scope allows you to very gently place the silk cord in with a probe without anesthetic and you get some blanching.

No laser treatment , gosh you are perceptive.

Thanks for helping me out.

Your brilliant.

Glenn

December 29, 2002 at 11:58 pm #11961 Reply

whitertth
Spectator

Glenn…great case… i am still using hurriseal before my bonding agent…I find it really works to eliminate sensitivity….Do u use any wetting agents prior to bonding?

December 30, 2002 at 2:43 am #11968 Reply

Glenn van As
Spectator

Hi Ron……..no I dont use any wetting agents , I was going to ask you on the value of hurricane to the bonding process.

I do notice less of my Class Vs coming out since using the laser. The enamel etch and the opening of tubules I think makes for a better bond.

No research , just an opinion.

I also find less Class 4s falling out with the laser.

Glenn

December 30, 2002 at 2:58 am #11964 Reply

wkarhan
Spectator

I know this is a laser forum but I was impressed by the intraoral photos. Which microscope did you use to take the photos?

December 30, 2002 at 9:30 am #11969 Reply

Glenn van As
Spectator

Hi Wade……its the Global microscope.

Here are a couple of pics of me using it and one of some etching prior to a Class IV going in.

Glenn

[img]https://www.laserdentistryforum.com/attachments/upload/Xmount.JPG[/img]

[img]https://www.laserdentistryforum.com/attachments/upload/Class 4.JPG[/img]

December 30, 2002 at 2:24 pm #11962 Reply

whitertth
Spectator

I seem to get no sensitivity since using hurriseal…so i have become a junkie of the stuff…it so cheap as well…. so i etch, hurriseal, lightly dry off, bonding agent and then bond….Happy New Year

December 30, 2002 at 8:19 pm #11963 Reply

whitertth
Spectator

some more fun stuff..Class V , no anaesthesia, removed some tissue as well..and restored with cosmedents Renamel flowable Note the white laser bandaid done at the end to help healing and provide some hemostasis…Hope u like….

December 31, 2002 at 1:24 am #11972 Reply

Patricio
Spectator

Glenn,
At 3.5 mag and .75 – 1.5 W I have not noticed the ditching of the cementum do you feel this effect is the rule and if so does it appear to be left exposed or covered by the restoration in the typical case?

The scope picture was fun for me to see. If my hair color was a little closer to yours I would find a way to include it in my practice. I will give it some it thought they probably sell to white haired guys too.

On the beginners end I completed most of an inlay prep with the laser today after numbing the tooth with the laser and removing the resident amalgam with the electic HP.

I had a belglass crown debond at the tooth inteface so I used the laser at 1.5w to reprepare(roughen) the tooth surface, clean and sterilize, then etch, and recemented the crown. No local needed.

Preped an MO on #17 and could not get adaquate numbing at 5.5w for 60 plus seconds so used the ligaject on the mesial interproximal(small amount of local to assist) and in 30 seconds I was in business. The tissues was numb from the laser and the patient felt nothing. As I get better at assessing the possible, the patients body language, time available etc. I see my bag of tricks expanding. Great fun.

Pat

December 31, 2002 at 2:42 am #11971 Reply

Glenn van As
Spectator

Hi Pat: I think that my errors were caused by the soft tissue tip, not being careful enough with the positioning of the tip when cutting ( I now try to stay parallel to the tooth instead of perpendicular when trimming the tissue away). In the typical case I dont have it now.

The scope is a fun thing and it allows me to actually remove the patient from the equation by focussing 100% of my attention on the operating field. It eliminates the patient who makes faces from interrupting my concentration and I leave this area to my assistants.

The scope is fun , but there is a big learning curve to it.

I havent done many inlay preps with the laser so kudos to you. and there are no laws against using intralig or even intraosseous if the patient is not comfortable.

Good stuff .

Ron nice case, nicely prepped and restored.

Great stuff.

Glenn

December 31, 2002 at 3:25 am #11973 Reply

Swpmn
Spectator

Nice cases Glenn and Ron Kaminer.

Thanks for sharing!!!!!

Al

December 31, 2002 at 10:39 pm #11965 Reply

2thlaser
Spectator

Man you guys, I have been off vacationing over the holidays, and here you are all teaching without me! I feel left out! Just kidding. Great stuff. I get back to work on Thursday, and have tons to share when I get back. I hope everyone had a great holiday season. Excellent cases!
Mark

December 31, 2002 at 11:54 pm #11970 Reply

Glenn van As
Spectator

Hi mark: We are going on without Ya but I am just passing the time til you get back and start showing of veneers, full mouth reconstructions, endo , perio and a little bit of other disciplines using the laser!!

Take care have a safe and happy new years Mark.

Glenn
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