Forums › Laser Treatment Tips and Techniques › Hard Tissue Procedures › Amalgam preps
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brucesownSpectatorI realize that I am probably a throwback in this forum, but I occasionally use ***gasp*** amalgam in restoring teeth. I still like to use the laser for all the advantages it provides, but has anyone had any experiences for good or bad with amalgam in laser preps. It may just be my relative inexperience with the laser, but the line angles and cavosurface margins are just not as smooth. I suspect retention is pretty good as long as you pay a bit of attention to Black’s priciples but I worry about the margins staying sealed if there are small bits of relatively unsupported amalgam. I use sharp hand instruments to finish the margins but they still are less sharp than a carbide. What do y’all think?
kellyjblodgettdmdSpectatorMy thought: ’86 the amalgam and GV Black prep designs. One of the main reasons to use an Erbium laser is to help save tooth structure. The prep design for any retentive amalgam prep is far from conservative. My suggestion: Drop the alloy and switch to the co-cure technique using Auto-cure glass ionomers, such as Fuji IX and composite over the top. Or if you don’t care about the color, just squirt in some Miricle Mix. At least this would create a bond to the tooth and creat a hyper-mineralized zone between the tooth and the glass ionomer.
Just out of curiousity, why would you choose to use amalgam considering all the other restorative materials available today. And just to clarify, I pass no judgement on anyone using it. I just feel that to use it you have to take away healthy tooth which isn’t my goal.
Thanks for the post!
Kelly
arrowsmithSpectatorBruce,
In my experience, alloy is not ideally suited for laser cavity preparations . . . . it’s like putting a square in a hole meant for a circle. Alloy gets its strength from bulk; one of the main advantages of the erbium is to remove little amounts of tooth structure which simply doesn’t support the required reduction of tooth needed for alloy.
I realize that amalgam can be way easier to manipulate, especially if that has been your material of choice for years. However, now that I use adhesive bonding techniques like what Kelly suggested, I’ve found that it is more predictable and easier than placing alloy.My two cents worth anyway . . .
aaroN
djjafishSpectatorbruce
because of isolation problems with some kids, i opt for alloy–it just works. my approach is to laser the tooth and then refine the prep with either a 330 in the high speed or a sharp round bur in the contra angle. i still get the anesthetic affect from the laser. the kids are happy. i don’t feel bad about that at all if i have to pull out a “drill” once in a while. that just the way it is sometimes.
dave
SwpmnSpectatorQUOTEI realize that I am probably a throwback in this forum, but I occasionally use ***gasp*** amalgam in restoring teeth. I still like to use the laser for all the advantages it provides, but has anyone had any experiences for good or bad with amalgam in laser preps. It may just be my relative inexperience with the laser, but the line angles and cavosurface margins are just not as smooth. I suspect retention is pretty good as long as you pay a bit of attention to Black’s priciples but I worry about the margins staying sealed if there are small bits of relatively unsupported amalgam. I use sharp hand instruments to finish the margins but they still are less sharp than a carbide. What do y’all think?I’ve placed many Class V amalgams on elderly patients using erbium lasers for preparation. Last month did a recall exam and my very first “Laser Amalgam” from May 2001 was doing just fine.
It’s easy to change the angle of the erbium laser tip and create an undercut for amalgam retention. If you have a variable pulse rate erbium, smooth the cavosurface margins by switching to a high Hertz rate(30-50) and low energy (85-100 milliJoule) setting. Then go in with your hand instrument to plane the margins.
Regards,
Al
brucesownSpectatorThank you everyone for your thoughtful replies. I appreciate greatly that you will take time to answer a newbie question.
Kelly, I agree that amalgam is a far from ideal material. There are basically two instances where I will dust off the amalgamator. The first is if I have minimal cooperation and poor moisture control. I see a lot of special needs people. GI would be a good choice too, but I guess that you go back to what you know will work in times of stress.
The other time is, believe it or not, when people actually request it. Amalgam fees are much lower around here and inspite of it all some people actually want it. If they know their options and make a decision I will generally go along with people’s wishs. Having said that, I can not count how many times I have done a minimally invasive resin on a kid and charged the amalgam fee just because I don’t think they should suffer because their parents can’t see the light. Bad business I know, but I can look at myself in the mirror.Having said all that, amalgam is a very small percentage of the practice. It was just a question that popped into my head as I was working the other day.
Anyway, that’s my two cents.
kellyjblodgettdmdSpectatorBruce – you bring up a good point regarding insurance reimbursement. We all practice in “real-world” practices where we have to consider the financial ramifications of the treatment we provide for our patients. Fortunately, in the U.S. anyway, now there is no differentiation between amalgams and composites, so I just charge the same for both. That way the patient can decide what they want based on material properties, not cost. It has worked pretty well.
Thanks for being involved in the posting, Bruce. It’s always great having new folks speaking their voice. I find that’s why I learn so much coming here!
Kelly
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