Hi Newbie,
  I just returned from France and the World Clinical Laser Institute meeting, and I chatted with Bill Chen about our differing ways of “anesthetizing” teeth. I have not tried his way before, and am going to, but the way I use my Waterlase, it works. From the crown/veneer preps to the regular ole class I-V’s. The only time I start lower is usually on an abfraction area, that is already sensitive. I also have heard that Bill Grieder in Florida always uses 6W as well. It would be a good study to see what is more or less effective. Like I said, I have had very good, no, great success using this method. I haven’t used anesthetic on any patient I have used the Laser on in the last 8 months. So far so good.
Regards,
Mark

Mark, enjoyed the article.
Just tried using the laser, higher settings 1st , defocused. Can’t believe how much faster things went with no discomfort. Did 30 occl , moderately deep,1/3 width of tooth.Patient didn’t even blink.
THANKYOU!
When you use the laser defocused for the ‘anesthetic’ effect do you just go over the area to be prepped or over the whole tooth( i.e.,if prepping occlusal do you go over the B&L defocused)?

Hi friends,

I am beginning to understand better. I have been starting slowly al la Chen on the first tooth and then I have been going to higher power on subsequent teeth with no negative response from the patient. I do defocus and come in slowly but have little trouble.

Are you genrally working under high magnification for efficiency or is this not so necessary at higher power? I find the tip action to be a little bit of a loose canon in many situations ie. patients who move a little – lips, cheeks, tongue as well as difficult angles to reach which seem to require a lower setting for control. Any suggestions?

Pat

Thanks Mark,
I turned up the energy today and defocused as suggested. Due to your support I was more confident and things went well. I have been using 3.5 mag at all times and will consider more as I get used to them. I sure enjoy the light and wonder how I ever was able to see well in the old days. They are great for watching the electric handpiece at work as well. It has helped me learn the rate of speed and force for best efficency.
thanks again,
Pat

Hi Al,
The article is in the latest, October issue, of CERP. The link unfortunately is not in service. It would be [url=”http://www.dentallearning.com.”%5Dwww.dentallearning.com.%5B/url%5D Actually, for the detail you give on my technique for anethetizing teeth, is right on. I usually use, my favorite, G-4 tip, sometimes a G-6, but mostly a G-4 because of more energy available from that tip. I keep the tip about 9-10 mm above the tooth structure, making sure I am not creating any “white” spots on the enamel, because if I am, I am too close. One can readily see these if they are wearing loupes. I stress the magnification issue, like Glenn, because what we are doing for the most part is true microdentistry.
I stay at 6W for about a minute or so, and gradually ease, patiently, into the area I want to start ablating, because with a G-4 tip, you can start ablating as far as 4-5 mm distance. As I gradually enter the enamel, and start seeing the dentin exposed, the tooth is getting more and more laser energy through the hydrokinetics, and getting more “numb” as I go. Once I get into the decay, if the patient is not feeling it, I keep going without changing the power level, if they are just beginning to feel it, I drop the power down to comfortable levels, usually 3.25-4W 40%air and water. It really does go fast. I really feel that being patient during the “bathing” process is so important. Take that minute or so. The alternative is using anesthetic, waiting 10 min or so, then using the drill, etc…and I don’t want to do that. It really is so quick this way, at least for me. As far as crowns are concerned, if they have amalgam, yes, conventional methods apply, but if composite, or fractured virgin teeth, I use the laser, WITHOUT anesthetic. I haven’t had to use anesthetic yet for any crown or veneer prep so far. I hope this helps! Anytime I can help just let me know, and the same, if you have any handy tricks up your sleeve, let us all know, it would be great for us all to continue to share and learn from one another!
Mark

Glenn,
As always, thanks. I am humbled, believe me. Nice was great, really attended well, by over 10 different countries. The lectures were awesome, and there is some wonderful new procedures being done with Erbium lasers. There were over 150 dentists/staff there in attendance with virtually no one missing meetings/lectures. It was so refreshing to have such a wonderful forum to present new and intriguing ideas. I just absolutely enjoy when we all share and learn from eachother. This laser dentisty we are all doing, is so incredible, and the responses from our patients, physically and mentally is so rewarding. I sure hope this catches on, it should. It is our responsibility to help this happen, Continuum, Biolase, whatever works in ones hands, we need to teach ourselves, and those who are new what we know. I thank you especially for all you have shared with your microscope, and your laser cases. All are incredibly educational for us all. Thanks Glenn.
Mark

Al,
 Thanks, hope you enjoy the article. The G-4 tip is shorter, and generates a bit more energy,and does cut a bit faster, and if not careful, yes, one can cause a bit of sensitivity with it, which is why I defocus for such a long time before slllooowwwly bringing it into a more focused mode to ablate. I love the shorter tip, and have had great results with it. All of my crown and veneer preps have been with that tip, I change to the G-6 tip for interproximal margination on molar crowns, due to the longer  length of the tip to get to that marginal area. That’s about it. Hope this helps.
I gaurantee Glenn will be happy that you are using magnification. He really is at the top of our class, scopes and lasers, we can learn alot from him. I hope you check out some of his cases he places on the web, they have been great. Have a great weekend.
Mark