Forums › Erbium Lasers › General Erbium Discussion › Amalgam removal and laser desensitization
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Glenn van AsSpectatorHi folks: A simple occlusal amalgam not that deep, but I had to try and do it without anesthetic. I used the laser for 90 seconds with a 400 micron tip at 4.8 watts and I let it run with water for that minute and a half all over.
Then I picked up a 557 fissure bur and used it to remove the amalgam and then used the laser to sterilize and disinfect the prep and get more retention.
All was done without anesthetic except for One touch topical from Patterson.
Patient was a 8 year old female , and pretty easy to work on but she felt nothing and as you can see in the 6th pic (after etch) the dentin was exposed in one area.
Just something for you to ponder.
Glenn
jetsfanSpectatorGlen,
I am unable to open any of your photos. Is there a special viewer that I need on my computer?
Jetsfan
PatricioSpectatorGlenn,
This approach is becoming my routine method of choice for small and medium amalgam removals especially on the bicuspids. I find it very successful and quick. I really appreciate your pictures they are a big help. Thanks,
Pat
Robert GreggParticipantGlenn,
What sort of change in post op sensitivity are you observing when you “Letch” (laser etch) the dentin??
I have noticed a considerable reduction, but there are times when I wonder if I need to also Letch the DEJ to be sure.
Thanks,
Bob
Glenn van AsSpectatorHi guys…of to bed gotta work in 6 hours. Had a hockey game and can never sleep afterwards.
Jetsfan, I dont think you need any viewer. What browser are you using ( I use internet explorer the most recent one) and it may be your settings on your browser.
Pat ……thanks for the kudos. Its really quite simple for me to shoot them and the magnification helps me alot to understand what is going on.
Bob……interesting you should ask. I posted a crown desensitization recently on here. The lady came in today and asked what I had done differently ( she has had quite a few crowns) and she told me that this time there wasnt much sensitivity and all the others there was. This was the one were I Letched (great great term) and then bonded overtop and Gary Griffin told me a while back that he was sure he was getting less sensitivity but I dont know if it is true or not.
Great question and I too often have to etch the dentin and then bond over it.
WHo knows………I dont think it can hurt.
Glenn
d2thdrSpectatorGlenn,
I really have been curious about this for awhile now. If one of the reasons we use a laser is to reduce/prevent the formation of micro-cracks, why are you using a carbide bur to remove amalgam?
My experience has been that carbide burs can cause micro-cracks to form. And subsequently, that has always been a question in my mind about why amalgams apparently cause teeth to crack. Mo one seems to want to admit that we caused the crack in the firstplace when we prepared the tooth.
Oh, boy. Causing controversy.
Disclaimer: I am a newbie, no actual teeth prepared in the mouth yet. And I am reading this forum from back to front so I can see where all of you started from.
If I need to be smacked, please do so freely. 🙂
Glenn van AsSpectatorNo need to smack you, you are right. I could use a diamond I guess but I tell you that most of these teeth do have cracks on them anyways.
Dennis, one thing is the laser analgesia if you get it is limited in time so you want to be quick. Fissure burs are fast and I try my best to stay on the amalgam and use a diamond at the end on the cavosurface margin.
Good question, almost eerie to revisit 2 year old cases!!
Grin
Glenn
d2thdrSpectatorGlenn,
Thanks for your answer, I understand your concept of “staying on the amalgam”, although since I have not yet prepared a tooth with the laser, I am not yet thinking like a laser dentist.
Also, as I was working my way through the erbium threads yesterday (while I wasn’t shoveling snow), I saw that “Jetsfan” posted a comment about his seeing microcracks emerge from using a diamond.
I’ll have to learn to think totally differently ASAP.
dkimmelSpectatorGlenn it really is cool going back and looking at old cases. We have all come so far with each others help.
For some time now I use this technique to remove all alloys. I do use it for all alloys even the great big ones. Those I tend to keep the laser aimed at where I think the roots are located in the soft tissue. Defocused of course.
The one minor thing I still do is keep the laser running while I take out the alloy. This has made the procedure very predictable. At first it was tough dealing with the footcontrols and holding the laser in my left hand and the drill in the right. The upper arch was always a PIA. Then you got me using the scope and I had to make a few changes in my technique. I still keep the laser and the drill going at the same time. After spending some training time with my assistant, she now holds the laser while I remove the alloy with the drill. I still control the footpedal. This has worked real well with the scope and with doing uppers without the scope.Burrs. I still use a 2-p. I like it as it is pearshaped and great for getting the alloy out of undercuts. I don’t think the burr is a big deal. Just as long as it is NEW.
d2thdr
As Glenn says as long as you are on the alloy microcracks are no problem. You got to have loops. 4 X or 6x are a must as min. Microfractures are a BIG issue in dentistry. Once you use high mag you can see it for yourself.
d2thdrSpectatorDavid
Thanks for the info. Did you get your air conditioning to crank up last night?
Currently using DFV 3.75X (I believe…or 3.5X). Gues higher power is next on the list.
Also, I wanted to add that after reading about amalgam removal on these pages, I did one Wednesday (a somple occlusal) without the laser. No anesthesia at all, just cautious removal of the restoration itself. Young woman, no pain, an occasionaly cold sensation. She was thrilled to not be numb.
You are teaching more than laser skills here.
AlbodmdSpectatorKimmel,
So for continued analgesia you aim the laser at the roots under the soft tissue?
Al B
Glenn on the roadSpectatorDennis, it is honestly amazing how important higher mags are for lasers, David recognizes this and so does one of my heroes Mark Colonna.
The 3.75 is a good start and you may find the desire to even go higher with time. Try and see how it works for the laser when you get it.All the best
Glenn
dkimmelSpectatorAl not under the softtissue!! At the softtissue where you think the roots are. Stay defocused. That is with your loops on work your way towards the tissue until you see it frosting and then backup slightly. If laser energy can get through the enamel it sure can get through the tissue.
AlbodmdSpectatorThat’s what I meant Dave. At the roots through the soft tissue. Haven’t tried that yet. Where do you aim for molars? In between the roots?
dkimmelSpectatorMAx molars the pal. root and then where I think the buccal roots are. The man. roots mostly where I think the mesial buccal roots and the distal roots are. Again the same with the ling.
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