Forums › Laser Treatment Tips and Techniques › Hard Tissue Procedures › Periodontal Crown Lengthening
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SwpmnSpectatorBased on encouraging reports from Glenn and Rod Kurthy, today I attempted my first periodontal crown lengthening case using an Erbium(Er,Cr:YSSG) laser:
80 yo female patient presented fixed bridge #8-11 with subosseous caries palatal to #8 abutment. In reality, #8 has a poor prognosis but the patient asked me help her “buy some time” with the bridge.
After obtaining profound anesthesia(couldn’t use epinephrine) I placed the laser tip perpendicular to the long axis of the tooth and beveled the palatal gingiva down below the osseous level. Excavated caries using the laser at the palatal margin and my electric handpiece up underneath the abutment crown. I then used the laser to reduce the osseous crest 2mm palatal to my prep margin and directed the laser toward the palate to bevel the bone underneath the tissue as Rod Kurthy has suggested.
Due to hemorrhage and my inability to use epinephrine I restored the lesion with amalgam. Tried to get you guys some pictures but hemorrhage rendered the post op shots useless. However, I was able to acheive my intended clinical goals on my first attempt.
From a former “naysayer”, I now believe that the procedure is a useful adjunct to restorative dentistry. With time and better case selection I plan to improve upon the procedure. Please offer comments and constructive criticism.
Al
2thlaserSpectatorAl,
Great job. I have done quite a few myself as well. One thing you might try. When you get alot of bleeding, just give it about 5 min to “rest”, you might be surprised by what you see, and how clean the site really is. Just from my limited experience.
Mark
Robert Gregg DDSSpectatorAhhhh…….Yes! The Old, “Let-the-tissue-rest-laser hemostasis-technique”. Used it many times myself…..Works well in most occasions….:cool: Good tip Mark.
‘Nother technique: defocus and warm the soft tissue bleeding (not the bone!) Careful in esthetic areas until you get the feel. “Give it time.”
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2thlaserSpectatorBob,
Thanks, good tip yourself, I will try that today if I have a case! Thanks,
Mark
PatricioSpectatorAl et al,
I was reading recently in the those patients with root caries where deminished saliva is a factor that there is a case for placing the restorative cervical margin within the sulcus to help reduce plaque accumulation and recurrent decay. Initially removing soft tissue but not bone, if possible, so the tissue will rebound and cover a portion of the restoration margin. I have no experience with this but am trying to develop a better strategy against reinfection and am wondering what you think.
Say ya to da UP a,
Pat
SwpmnSpectatorPat:
The gingival sulcus is full of bacteria and we all see recurrent decay at the margins of subgingival restorations. Other than esthetics, personally I believe there is no advantage to a subgingival margin. In posterior regions and where patient education allows, we place many crowns with supragingival margins.
I believe this allows the educated patient to cleanse the margin and also allows full exposure to fluoride. If the margin is subgingival it cannot be cleaned by the patient.
Al
PatricioSpectatorAl,
Your idea has always been my thinking and is what I have done over the years but root caries is a bit unique and we do not seem as a profession to have over come this devestation in the decay prone patient so I am trying to be open to new research. Thanks for all your comments on the board.
Pat
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