Bilateral mandibular surgical extraction

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January 27, 2004 at 9:12 pm #3505 Reply

ASI
Spectator

Hi People,

Here is a case of a bilateral mandibular surgical extraction of bony impacted wisdom teeth that was assisted by the erbium laser. Incision was at 30Hz 95mJ wet down to the periosteum and the osseous resection was up to 25Hz 240mJ wet.

It was a chance to try different settings and at different working distances to see the optimal ablation on bone and tooth. The optimal osseous ablation distance was at near tip contact and as expected the optimal tooth ablation distance was at about 0.75mm.

Each tooth was eventually sectioned with a surgical bur to keep the osseous exposure to a minimal. Prior to closure with 5-0 vicryl sutures, the erbium was used at 30Hz 95mJ wet at a distance of 10mm over the site.

The patient had mild to moderate discomfort for a couple of days and had no swelling nor bruising. In fact she was at her part-time job by the 3rd day.

Suggestions please.

Andrew

January 28, 2004 at 12:37 am #11924 Reply

emc85
Spectator

very clean procedure…taking lasers to the max!

it is good to see you push the envelope. i am not sure i would have used a laser for extractions, but it is amazing what skilled laser dentists can do. i am still using mine exclusively for restorative and soft tissue treatments.

good work

January 28, 2004 at 12:43 am #11928 Reply

Robert Gregg DDS
Spectator

Oustanding Andrew!

A+++

Bob

January 28, 2004 at 3:33 am #11929 Reply

Swpmn
Spectator

Andrew:

Nice case!!!!

I don’t do impactions but we have found our erbium lasers to be outstanding tools for routine extractions.

Being mindful of air emphysema erbium lasers can be utilized with copious water irrigation at very high energy levels to cut deeply into the periodontal ligament. An elevator may then be placed into the space for luxation and this also facilitates deep sub-osseous placement of the forceps for rotation of the offending tooth.

Al

January 28, 2004 at 7:12 am #11922 Reply

drnewitt
Spectator

Nice case Andrew!
looks like a good one for say… a case presentation.

Overall how do you like the use of the erbium for incision in the 3rd molar area Vs. blade? Easier access? Do you do anything to your air setting and what tip did you use?

January 28, 2004 at 7:39 am #11925 Reply

ASI
Spectator

Thanks to all for the kind comments.

The benefits in using the erbium were mostly to reduce the osseous debris generated with a surgical bur, to get away from the vibration of the handpiece on bone, the ease of access with the 80 degree 600u tip, the decontamination of the site as treatment progresses, and if anything, there may be less air and water blasting at the surgical site than a handpiece.

It definitely took longer but it was much less invasive, and the patient almost enjoyed the visit.

Cheers,

Andrew

January 28, 2004 at 8:50 pm #11923 Reply

drnewitt
Spectator

Hi Andrew

Wish I had some pictures but I don’t for this case. I used settings similar to your above. 30hz, 95Mj, with water and using the Hoya handpiece. Access was very limited with this 18 soft tissue impaction but the laser removed the tissue, without bleeding!, in about 45 seconds. (about 1mm or less from tissue). Pumped it up to 30hz, 160Mj for osseous removal for purchase point on buccal. tooth came out with a cryer in about 30 seconds.
was very exciting for both myself and the patient as the 28 was removed with scalple and drill last year by another dentist.
only real concern going around the tooth was that he would move a little and break off the laser tip.
thanks for the motivation and setting suggestions above.

What would most of you charge for a case like this? fee guide or above due to laser use?

January 29, 2004 at 7:24 am #11927 Reply

Glenn van As
Spectator

Andrew: Nice presentation and great pics. I think that for me the greatest things about using the erbium and the scope for extractions are:

1. Visibility around the handpiece – second to none, with a 400 micron tip I can get very very deep in a socket and still see what I am doing because of the design of the handpiece.

2. Lack of ablation material……..very important that the bone and tissue dont obscure your view.

3. Sterilize (less risk of post op infection).

4. No vibrations …..patients love this and find it much more palatable without the whine and vibrations of the drill.

I can get a nice trough very deep on a broken root tip without resorting to a long shank bur and the trough is much much smaller than using a 1557 on the tooth.

Now it takes longer and at times can remove far less tooth but I still often like to try it.

Kudos to you for a beautiful case and 5.0 sutures…….

CLAP CLAP CLAP……and I am standing as I type!!

Glenn

January 30, 2004 at 10:05 pm #11926 Reply

ASI
Spectator

Glen,

Thank you so kindly for your positive input. Coming from you is especially meaningful as you are the one who really inspired me to follow in your mode of operation in the implementation of the laser and scope. What I had said at the Midwinter intro was from the heart.

Cheers,

Andrew
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