Over time you get used to doing laser dentistry and you start to take it for granted. Yesterday I got my chain jerked. I have been real lucky about not having to give anaesthia. Even with taking out alloys. It has been very predictable. So much so I just don’t think about and just get started. I have slacked off on preheating the patient as to what to expect. Slacked off on looking for excessive occlusal wear. I have just been busy and things have work great so far. Then comes Tooth #15

[img]https://www.laserdentistryforum.com/attachments/upload/IMG413717cg.JPG[/img]

[img]https://www.laserdentistryforum.com/attachments/upload/IMG413717e6.JPG[/img]

This looked like a simple alloy to remove on a 28 Y/O wt male. I did my 90 sec ER bath and then used the HP to remove the alloy. Usually I keep the laser running as I do this but #15 is way back there. He got a bit of sensitivity , so I did the 90 sec again. No deal. I try to keep the laser running at the same time as the HP but I just could not keep the tongue/cheek out of the way and still see. Not to give in , I had an assistant hold the laser and I used the HP to remove the alloy. This has worked for me predictable except for two cases. Well, now it is three cases. This was just not working.

I give him a local with polocaine. Still sensitive. I give him a PDL with septa. Still sensitive. I give him a second PDL. No problem and I can remove the alloy. This alloy was packed in tightly in undercuts and was deep with no bases. The rest was easy restorative.

I keep telling my self that laser dentistry is no different then the old fashion dentistry. Some times teeth are a PIA to get numb. This was no exception. Could I have looked at this tooth and knew ahead of time I would have a problem? Looking at his exam photo’s in hind sight I would have thought the fracture on the lingual may have been a hint. Clinicaly the crack did not go into the dentin and none of the cusps had fracture lines.
He is a bruxer/grinder. This tooth does not appear to have any real wear patterns. Decay was present. He is not blond. Still nothing to make me think I could not have done this case without the shot.
As you might quess this is causing me to run behind. I let Susan know whats up. It is then she lets me know that this is no surprise to her as he said this tooth has been sensitive. OOPs if I had just took the time to ask the patient ,I would have saved myself a great deal of time. (For those of you who may ask why this information of senstivity was not passed on to the back, lets just say some times its best not to ask the wife questions like that!!!)

It was humbling for me as I knew I could do this with- out the shot. If I had only observed the situation better and asked the correct questions ( or delegated this) , The patient would have had a better experience.