Forums › Erbium Lasers › General Erbium Discussion › Back to Basics
- This topic is empty.
-
AuthorPosts
-
Glenn van AsSpectatorHi folks : Havent posted much lately ( kinda burnt out) but sat down and wanted to post a couple of cases from today. Here is one simple one done without anesthetic.
Patients love not having a numb lip and I was able to use the modified Colonna technique ( modified for Delight) to 6 w with water for 120 secs on each tooth and then use a 600 micron tip at 30 Hz and 140-160 mj for the left canine and a 400 micron tip at similar settings (thats alot of energy) without any problem.
On the first one I did a small amount of soft tissue trimming without anesthetic at 20-30 Hz , and 30 mj non contact to get the tissue back at the gingiva.
I was pleased to get this done without anesthetic……..its possible with some patients and not with others.
Hope you like this one.
Glenn
Glenn van AsSpectatorHere is a 2nd case I did on the little 4 year old I had in last week , other side.
No anesthetic, used the Isolite again for retraction. High energy, with almost a pulp exposure for the bigger decayed tooth.
Used Fuji 9 in the base and flowable over top.
Mom asked me about the material today, dont think dad was too happy with Fl in tooth from last time.
Take care but another biggie without anesthetic.
Glenn
Glenn van AsSpectatorOk here is the final case I am going to show from today.
Patient came in with bombed out lower right first molar.
I used the laser to section the roots and to trough around the roots to relieve tissue and bone and get solid tooth to apply an elevator to get the roots out.
I was able to avoid a flap and sutures, and elevated the tooth out quite easily. Used a 600 micron tip with water and only a little air at 30 hz and 140 mj and then switched to a 400 micron tip to get deeper into the sectioning and to remove tissue and bone circumferentially to remove the tooth. Patient like the non tactile, non contact manner of bone relief with the laser ( doesnt sound as bad either) and I like that afterwards there isnt alot of bone debris in the socket.
Do you have to use a laser ……..nah.
But if you have an Erbium Yag or Erbium Cr YSGG, you can do these for the patient and the healing seems to be great and also the laser sterilizes in the socket.
I placed a temp bridge for the patient who was not willing to go with an implant.
Glenn
drnewittSpectatorNice cases Glen, I especially like the surgical case.
I have had a few kids in over the last week with much smaller preps than you showed and they seem to be feeling the laser a lot. using settings of 30hz |160mj with 30 degree tip. Am also finding that I am not getting through the enaml very easily on some of these primaries. Is that more common than not?
Glenn van AsSpectatorHi Paul: Yes some kids will feel it but make sure that you do desensitize for a full 2 mins at the highest setting possible.
Kids enamel is pretty quick to cut through, check the tip and make sure it is still ok and not chipped.
Make sure you have enough water going to the site.
Remember to angle the tip perpendicular to the enamel rods ala Mark Colonna to cut through. Kids enamel (deciduous) is easier to cut through than adults but if you are to slow work for a minute and then use the handpiece.
Glenn
dkimmelSpectatorGlen, Nice to see you posting cases again.
Have you tried using lower Hz and more mj? Like 10hz and say 200-300 mj?
DAvid
Glenn van AsSpectatorHi David: I like to have the multiple Hz settings that are faster especially with anesthetic. WIthout it , I could see the benefit. I will say this though that my laser only goes to 240 mj for enamel……..
Did the Opus guys get you thinking?
Glenn
Glenn van AsSpectatorHere is another case I did today……..the two premolars in the lower right quadrant. The first I did a quick core buildup for a crown as there was facial decay and placed in a resin ( wasnt concerned about color as patient going to have crown), and then had to extract 2nd premolar with huge facial decay (first photo).
It broke – so what else is new. With the laser we tried to get enough tooth exposed to use the forceps on it on the mesial and distal………..no luck
More bone later taken away with 400 micron tip and 30 Hz and 140 mj.
Finally got a purchase point on mesial and out it popped.
The papilla between the two premolars was torn so I place one suture (3.0) looks like a tug of war rope. Got my Hartzell microperio instruments and will be getting smaller opthalmic needles and sutures that are 6.0 soon.
Until then this is the best I can do…..placed Gelfoam and let patient go……
Just to show you what is possible.
Glenn
ASISpectatorHi Glenn,
Another super application of the erbium laser.
It never ceases to amaze me how the tissue looks immediately afterwards as though noticeable healing is already evident.
Thanks for sharing again.
Andrew
-
AuthorPosts