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has anyone tried endo on a vital tooth without anesthetic? details please.
jetsfan

what do you think of placing topical anesthetic on pulp chamber and then using laser at low settings?
Jetsfan

Hey folks,
I haven’t posted a case in a bit, sitting here on a lazy Sunday for once…here is a case I submitted on DT about a month or so ago. No preop, BUT it was a vital tooth, on it’s way out which I did the endo with the Waterlase on.
My settings were Z-2, Z-3 tips, 34%air, 24% water 1.25W for those who like setting numbers.

I anesthetized with the normal 5.5W 80%air, 50% water for 90 sec. Opened up tooth with a G-6 tip til I got near the pulp, and then lowered my settings to 1.5W, keeping the air/water the same til I exposed the chamber. Using a small spoon, I removed the roof of the pulp chamber, then changed to the Z tips to begin to remove the chamber tissue. Once that was completed, I placed a #20 standard size K file in the canals to obtain radiographic length. Then using the Z-2 tip with the aforementioned settings, I go to about 2.5mm shy of the radiographic apex and “cleanse and shape” using the Z tips. I go back with a #25 file to make sure I still have a great apical stop, then obturate with GP, and now I am using endorez and GP with very nice results.
Sorry no preop xray (I am at home), but here is the Initial apical file:

Next is the X-ray with files in place:

Then the Waterlase with a Z-2 tip in place, 3 mm from working length:

Final fill radiograph:

Pt. really felt very little, mostly upon gaining access, just a twinge or two, but really slick to do endo with the laser. No post op discomfort as well. Really cool.
Questions, comments, and criticisms welcome…teach me!
Sincerely,
Mark

Mark – I am impressed seeing you use mostly the Waterlase on a molar. I have had good success with anteriors and premolars, but I am still using my NiTi rotary files on molars to oped the canals enough to get the Z-2 down to 2.5mm short of apex. Do you find that you are able to reach this distance on most molars without much filing first?

Great endo – the final film looks great. By the way, how are you liking the EndoREZ. I’ve been using it for ~ 2 months now – it’s great. Endo just keeps getting easier! These techniques and materials are a far cry from what I learned in dental school!

Keep up the great work!

Kelly

Here’s another I did today. Tooth #27, carious exposure on the mesial (preop xray at ins. co.)

Here is the preop Photo:

Here the access was made using a G-6 tip at 4.0W 80%air and 50% water, I made access through incisal so as not to proceed through the decay into the pulp as you will see in the xray shortly. Once I am near the exposure of the pulp, I reduce the power to 1.25W 34%air and 24%water:

Here, the #15 K file in place, it’s about 1mm short. The measurement was 25mm, the actual working length was 26mm:

Here is the working xray:

Next, place a Z-2 tip into the handpiece, and stay 3mm from the working length, settings are 1.25W 34%air 24%water, activating laser only on OUTSTROKE, circumfrentially about 8 times for 6 seconds each outstroke:

Then change to Z-3 tip and do the same…then I place a #35 file to working length, to make sure of my apical stop, and then dry the canals, and fill with Endo Rez, and a GP custom point. Here is the EndoRez placement:

And the final radiograph:

This all took me about 35 min. start to finish (without taking the time to photograph, Glenn has it easy!!)
I didn’t use any anesthetic, and as you see, the pulp was vital. Neat case, and loads of fun. The patient reported no discomfort, and was really pleased that he wasn’t numbed! He said on a scale of 1-10, it was about a 2-3 at most. Gotta love lasers!

Comments, critiques?

Thanks for letting me share here!
Mark