Forums › Laser Treatment Tips and Techniques › Hard Tissue Procedures › For what it’s worth
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PatricioSpectatorAl and Bob have suggested that many of the teeth we numb successfully with the laser are the same teeth which may well be worked upon without the laser and no anesthesia. I feel this is true in my hands as well and toward that end I have found a bit of a short cut with some patients. When I prep the first tooth with laser anesthesia and all goes well as far as patient sensitivity I have been going to the second and third teeth with less numbing time, sometimes if the lesion is small to medium sized I may continue without any “numb time” at all and find more often than not, all goes well. I am still working on your advice, Mark – patience, patience, patience in the mean time I am using this little short cut. Pick the patient and the lesions and give it a try. I thing Al and Bob could be right.
I had a patient with a very sensitive tooth during crown seating this week. The patient kept moving and it was hard on both of us. I waved the magic laser wand over the tooth at 1.5w 11/7 for 30 seconds and this resolved the issue to tolerable limits for the patient and she appreciated it. It was nice to avoid the local anesthesia needed in the past.
Pat
2thlaserSpectatorNice tip Pat. I have been out of town, guess I should read those other posts before I chime in! Hope everyone is having a great weekend.
Mark
dkimmelSpectatorPat do you think this can be done prior to removing the temp?
DAvid
PatricioSpectatorDavid,
It seems to me Mark indicated at one point that he thought this was possible but he can comment on that point. In my case most of the temporaries I use are made from Access or Luxatemp and come off relatively easily. So I think I will pop them off and then go for the laser when needed. If you try numbing throught a temporary please post the result.
Pat
dkimmelSpectatorPat, I have 2 more weeks before I get my laser. I am like a kid X-mas eve. Trying to numb with the temp on will be one of my first things to do. (That is after I fiqure out how to turn it on.) Seems like it would be a great service to our patients.
David
SwpmnSpectatorPat:
Although I seem to have a much lower “no-anesthesia” success rate than Dr. Mark Colonna and others, I do see an improvement using Colonna’s Defocused Technique. Presently, I am running at about 58-67% without local anesthetic and this is an improvement over my previous 50% success rate based on information/training from the company.
Case in point:
Today I placed two large inciso-lingual composites on an elderly patient from the incisal all the way down to the lingual gingival. These were really “reverse” composite veneers on teeth numbers 24 and 25. I hate these because you have to decide whether to block both inferior alveolar nerves or mental nerves. Ideally these teeth should have been restored with crowns.
I educated the patient on the laser and asked for permission to place the restorations without local anesthetic. Used Colonna’s technique of bathing the teeth for 90 seconds at high power(6W or 300 mJ times 20 Hz). Patient felt nothing and was amazed at the technology.
Whether or not these restorations could have been placed with a bur I don’t know but I am starting to see improvement in no local anesthesia cases using the Defocused technique.
Al
AnonymousGuestPat,
Did you desensitize the tooth with the laser at the crown prep appointment? Was this needed in addition to that?
When you did lase the prep at the seat , was this a focused application ,or defocused?
Thanks,
PatricioSpectatorAl,
This is great news that the numbers are going up for you. When I think about the total package of laser care whether or not the teeth could have been done without anesthetic or whether the guy or gal next door is doing it that way we LD’s provide a definite advantage in patient care. When you can numb a tooth, prep it microdentally using multiple instruments, adjust the tissue or reduce the bone level, while minimizing patient discomfort and doing it faster than a speading bullet(well you get the idea) I believe patients will want this because it is a better way . I predict that within 10 years most dentists will have a laser because their patients will demand it. Those patients who know about this exceptional care are already looking for dentists who provide this service. I suppose with Glenn’s pictureswe will all be getting scopes too.
Pat
PatricioSpectatorRon,
I did not desensitize for the crown prep. I am going to try that right after I remove an impacted third molar. Actually, why not try this. It might take a a couple of renumbs depending upon how long it would take to prep the crown but with fresh burs etc. not long and of course Mark would be proud if all or part was preped with the laser.I always use the same defocused/ focused process moving in and out as the tooth tolerates without damaging the tooth though in this situation I intentional left a 1.5w frost on the prep for retention before I was done.
Pat
Glenn van AsSpectatorHi Pat: I have said many times, the reason I look every day on this forum is that I want to learn from you all.
I discovered that a microscope would allow me to see things at incredible magnfications and it allowed me to be precise and really changed the way that I did my dentistry. I was always a “watch” kind of guy but when I got the scope I realized that I was really missing the boat.
I wanted to do better work for my patients and that is why I bought the scope. From this initial desire I went to the desire to show patients and I bought video hookup for my staff and for my patients to see what I was doing.
Then I wanted to document and so the digital camera (after some terrible problems with 35mm photos) was hooked up.
ALong the way I discovered how much more comfortable I was with practicing dentistry and this was due to sitting upright .
Today I had a horrible fractured maxillary canine to take out…….piece by piece and it was on my assistants mom and I felt terrible but even though it was way way up there I could always follow the root tip at 10-16X mag and that helped with the stress of not getting it our for 45 mins.
I started showing my cases because people thought I was lying and I suddenly realized that very few people were using the combination of lasers and scopes and I do hope that with time more people will look at the combination.
I have learned an awful lot from you , Al, Ron , Mark of course, Rod and many others.
Today Rod Kurthy was teasing me on Dental town about laser assisted periodontal therapy and you know what , I am terrible at perio in my practice and something I have to do better.
My Argon is not mobile and I use it in my restorative op so I need to get a diode soon and I hope to get Continuums soon.
Until then, I will continue to post whenever possible and I want to thank you and so many others for your kind words. Its the reason I post, I never have a course to sell, or a CD , or a DVD……its just my love to teach and my hobby I guess to take photos………
Thanks Pat…….your post sure made my tough day better.
Glenn
Lee AllenSpectatorPat,
Great idea ! I have thought about doing this before but worried about the water and air on a sensitive prep. So more questions arise. How far away was the tip when you waved the magic wand? A G-4 or T-6 tip? (Bob Gregg says there are different power densities with each) Did the patient respond to the air/water and just tolerate initally? Do you think there is a difference between the reponses for molars and bi’s & anteriors?
One answer always seems to bring up more questions.
PatricioSpectatorLee,
I anticipated that the patient wouldd react to the water and air and began at some distance probable beyond a defocused range and then gradually came closer as I watched the patient’s reaction until I was just far enough away not to frost the tooth. I had warned the patient that the water might bother a little so the patient worked with me to tolerate a little sensitivity. I kept testing the senstivity by zooming in a little closer until I could frost the surface at 1.5w 11/7 using a 6mm G tip. The frost was for cementing purposes. The whole process went rather quickly 30 to 45 seconds I would say. Thanks for asking.
Pat
Lee AllenSpectatorPat,
Thanks for the tip and the reply. I can hardly wait to try it out. I hate to give anesthetics when seating since it screws up the patient’s ability to occlude normally and increases the number of followup adjustments..
Bravo!
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