Class 2s in children - Laser Dentistry Forum

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June 6, 2003 at 5:11 am #3424 Reply

Glenn van As
Spectator

HI folks: I just wanted to show you what the combination of the laser and the microscope can do for treating children.

I did this whole case on a 5 year old today without anesthetic except for topical….took around 30 mins including photos.

Primary interproximal caries were moderate in size on the primary molars, and the Erbium Yag laser was used at 30 Hz and 160 mj with 600 micron 80 degree tip on Hoya Delight laser. That would be around 4.8 watts for the Biolase folks with a tip that has a 6 after it.(600 micron)

I prepped the first primary molar with an interguard in between to show you how to protect the adjacent tooth and the final photo (enlarged) shows how the decay is visible at 16X mag with the scope. You could see the hole and in addition see which side of the contact the prep needed to go.

The concern is how to check for the fact that all decay is removed as the laser is non tactile, and I either will use high magnification ( can see if the dentin is still leathery), sharp spoons (mark colonna makes a great set of these) or a slowspeed round bur near the end because there is a little bit of desensitization that occurs after using the laser for a couple of minutes that allows for etch and slowspeeds to be used judiciously.

I filled the base with a flowable (Dyract) and Tetric Ceram overtop.

The dad was watching and they are always stunned to see what is possible now ( they watch the magnified view from the microscope, on the monitor………can hardly wait for flatscreens to come down in price) and he was very appreciative of his daughter not needing anesthetic for these teeth.

I will go out and say that you can sometimes do these in kids with a bur, but it has been my experience that although the laser may be slightly slower the sensitivity with the non contact mode of operation, the water spray to cool the tooth and the gentle popping make this a nice alternative for children.

If you want to say …….I never have a problem numbing up children……..I can do that in 7 minutes…….kids are no problem for me, then that is fine, and I wont argue with you. I will say though that many of the children I have in
my practice are great when I use the laser on them……its nice having another tool in the toolbox.

I am just here to show you a few pics ( like a coffee table book, just think of me as the Kramer of scopes and lasers then) so that those of you not using a laser might see what these preps look like.

Hope that you enjoy it……..all the best….

Glenn

June 6, 2003 at 7:23 am #11169 Reply

ASI
Spectator

Thanks, Glenn, for sharing again.

Your images are just so darn captivating to look at. I can hardly wait to do some photo posting once my scope and camaera are set up.

Best regards,

Andrew

June 6, 2003 at 1:51 pm #11176 Reply

Robert Gregg DDS
Spectator

Nice dentistry and service. No better choice for kids IMHO…

Nice pics and post as usual!

Bob

June 6, 2003 at 2:28 pm #11172 Reply

Glenn van As
Spectator

Hi Andrew…….thanks. Taking pics is a little bit of an art form and there is a learning curve to them. One part of the learning curve is moving the scope around. Another is getting used to working at the magnifications that are impressive for taking the pics at ( above 10X mag) and the final one is knowing a little bit about photography.

Eric Herbranson is a friend of mine (endodontist) in San Leandro California and he developed the Xmount adapter for the Global scope , and you can download alot of articles in PDF format for using the Xmount at

http://www.xmount.com

In addition I learned a TON from Dr. Gary Carr who is another endodontist par excellence from San Diego area.

He is the pioneer who started the scope in endo and someone I really admire.

Anyways I wanted to say thanks to Bob and you for your kind words and have a great day.

Glenn

June 6, 2003 at 5:13 pm #11168 Reply

whitertth
Spectator

Great stuff as usual buddy….. Love to watch u use that scope!!

June 6, 2003 at 8:04 pm #11173 Reply

Glenn van As
Spectator

Thanks Ron…..it really has become second nature. You know there is more pressure when you use the scope because you see so many things that bug you, decay here, a crack there, a little bit of stain or a small piece of amalgam, some calculus on your margin, a void in your composite, another canal, inadequate etch on the tooth, not enough bond, bubbles in your flowable, dips in your margins, on and on and on……….

Having said that the real joy comes when the work is done and you look at it without the scope……thats what makes me feel good……

i did it to be a better dentist and I know it has helped me alot in becoming that…..a better dentist to my patients.

Now after the fact I discovered how now I do so much more dentistry at a far earlier stage, how my back and neck feels better, how much fun it is to take video and stills and how the patients are so much better educated about the procedures we do, and finally how much more fun it is for the staff……..but if I really want to go back to why………

It was better for my patients.

Thanks Ron…….I do hope to run into some of my good friends from here someday, as this forum has been such a great source of comraderie and information.

ROn has done such a wonderful job of creating a site where there arent any egos and where sharing of our passion for lasers is first and foremost………

Well except for BOB who only wants to sell his periolase…

(JUST KIDDING BOB!!))

Cya all ……

Glenn

June 7, 2003 at 2:41 am #11178 Reply

Swpmn
Spectator

Ewww, that was a good one on Bob Gregg!!!!

I like the pic labeled:

Mark’s Spoons

Al :biggrin:

June 7, 2003 at 4:42 am #11175 Reply

Robert Gregg
Participant

Ah Yes!:biggrin:

The POWER of the VISUAL (magnified) illuminated image……..Seeing is believing, and understanding, and learning, and……..Glenn, are you sorry now you helped me with my photography??

Real world clinical photos (from a “real world” wet gloved clinician) are better than any sales campaign or advertisement a company not founded by and for clinicians can ever use to get their point across…without the hype. This is TRUE!

Do NOT leave it up to an photonic engineer to figure out the solution to a CLINICAL problem or challenge. You will be waiting for a LONG time. Some do it better than others, but if they had done it well enough, you guys might have never heard of me or Del. :shocked:

Wow! Some just might like that!! I can think of a few on Dental Town, the AAP, the…….

Bye for now……..;)

June 7, 2003 at 1:46 pm #11174 Reply

Glenn van As
Spectator

Bob : funny you should mention this but Gary Carr once told me that the key to acceptance was visual confirmation of the procedures at magnifications beyond what normal photography could shoot.

The pics get people to stop and think……hmmm..if he can photograph this and can see this……..hmmm….

Thats were the uncertainty starts for some that they will look at it further.

The guys who look for ROI, speed, proficiency, reducing learning curves and are resistant to change will then make up reasons why its not needed…..

This isnt rocket science
I dont want to see my work that close.
I have 20/20 vision
My lab doesnt even do work that close up
My back and neck are fine.
It wont work in my area
My staff wont like it.
I am ready to retire.
I am just starting my practice.

In the end , only so many people will commit to the change and the effort required to get to the point where they can take the magnified images.

The people here on this site who have bought lasers went through a similar period when committing to that technology………

Oh well, some do , some dont, ………NEXT.

And Bob, I am never sorry that I gave you a hint or two….didnt take long for you to get such nice photos. Every time someone like you or Andrew decides that the photos I post are interesting, and you decide to follow the path I have taken, it makes me feel a tiny bit better inside, like hey maybe I do know a thing or two.

Enough philosophizing……..time for my morning decaf!!

Cya

Glenn

June 7, 2003 at 3:21 pm #11177 Reply

Robert Gregg DDS
Spectator

Glenn,

I’m LOL….and watching the French Open tennis.

I hear those EXACT same objections……

Decaf!? Heck, I need caffeinated Hi Test to get going every morning…….

It’s been funny about the microscope. The first year I used it 10% of the time and then only on .55 (unless I was using it to retrieve separated intruments in endo–then up to 1.5). The 2nd year I used it 20% of the time an occasionally at .66. The 3rd year I used it 40% of the time and mostly at .66. The 4th year I used it 60% of the time at .66 and 1. Now I used it 90% of the time at 1, and feel extremely comfortable to take photos….cuz it’s sooooo easy with digital cameras!

I used to bug Ralph Klink about getting 35mm for the camera, and he said to wait until digital got better. He said I would go crazy trying to get good case documentaion with 35mm. Appears he was right. This is fun!

I REALLY do understand how STRESSFUL “Change” can be in the clinical operatory (and office in general). Everytime we bring in a new technology, there is stress involved–even though it is “positive” stress–it’s STILL stress to learn something new.

I respect those who are measured and cautious in how, what, and when they bring new stuff in so that they can get the best out of the technology for their patients.

Glenn, you can feel very good about yourself and your tireless efforts to reach, challenge, and inspire so many in the profession–inlcuding the likes of me. You will never know how much you are admired and appreciated by so many who will never consider to mention it to you.

Time for my caffeine…….

Hope to see you around the 15th. Disneyland is just down the FWY from me.

Bob

June 7, 2003 at 7:49 pm #11171 Reply

Anonymous
Inactive

Glenn,

NO flame retardant needed for posts like this. You did a tremendous service for your patient – that is the main concern – results. You used the instruments that you have very well.

I would have used other instruments simply because I have other instruments. But there is no way that anyone should argue that you should not have used a particular instrument – or did the work that you did with the instruments you used.

One thing that I try to do when doing both sides of a contact point with composite is remove one of the “dueling” bands as soon as that side is cured to reduce the thickness of my bands and increase the potential for my ring clamp to give me the interproximal pressure that I desire in my contact point.

Great work and visibility.

June 7, 2003 at 8:24 pm #11170 Reply

ASI
Spectator

Hi Bob & Glenn,

I echo the philosophy and conviction that you guys are speaking of and practising in.

I have indeed been very inspird, and contiunued to be inspired, by the images that Glenn have so kindly posted and shared with us all.

I attended Glenn’s microscope lecture at a Pacific Dental Conference some 3 years ago. The images that I saw stayed with me and made me question the work that I had been doing. How good is my really good work? Worse yet, how bad is my okay work? That bothered me and kept me thinking….

When my interest was intriqued by the capabilities and the enhanced healing of dental lasers, the combination of the “one two punch” just made so much sense.

I am but a neophyte in both the use of lasers and scopes, but am so excited by the end result of the treatment that I see from the generous sharing by all on this forum (Thanks again, Ron), that the learning curve that I face will just be part of the journey to enlightment.

My, if one doesn’t know any better, one would think this is Dental Philosophy 101.

Andrew
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