Forums › Laser Treatment Tips and Techniques › Hard Tissue Procedures › class I and class 2
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jetsfanSpectatorI am curious, waterlase(Mark, Ron or anyone else) and con bio(Glen or anyone else) and opus user’s.
For a fairly deep class 1 , which is evident on xray, how long an appointment would you schedule, if it were a childs(7-16 yr old) first restoration. Now suppose it were a deep class 2 , how long for that. Suppose both were in same child, how long would that appointment be.
whitertthSpectatorI would schedule 45 minutes depending on the child and if i were doing multiple maybe an hour or hour and fifteen,,,The idea is if u are gonna do these things without anaesthesia as we get deep u will go a bit slower and maybe use alot of hand instruments( look at Mark’s Laser dental tools) so u wont be going all that fast at the end…
jetsfanSpectatorI am starting to rethink these deep ones. Yes it would be great to do it with no anesthesia, but if it takes 45 min to do a class 1, perhaps it is time to just give the injection and get it done in half the time( still using the laser).
I have Mark’s instruments, and they are great especially for those small ones. But if the hole in the tooth is huge, then we certainly don’t need microtools.
Today I had an interesting case. I have a patient who has an allergy to vibrations. That’s right vibrations, look it up.
Anyway she was referred to me because the vibration of a high speed drill can cause a severe allergic reaction, so much so that she must carry an epi pen to the dentist. So today we had to do a large class 1 under an old amalgam. I thought that I would attempt the whole thing without anesthesia and of course without a high spped handpiece.
Anesthesia was 5.25W 90/90 for 90 sec. I carefully circuscribed around the amalgam with a g6 tip at 5.25 w. I was able to remove it with a spoon and was quite pleased as no pain was felt. Now came the task of enlarging the prep and removing the decay. It got deeper and deeper and more expansive. I had to remove another amalgam on the mesial again using the same method. As I got deeper and deeper , more and more discomfort was felt. At that point I was at 2,25W 26W36A. To be absolutley certain that all the decay was removed I had to ( reluctantly succumb) and give septocaine. I finished the caries excavtion and place a composite. The procedure took way too long and I sacrificed a tip in the process. Next time I will just give the injection and get it done more quickly. I just don’t know how some of you do it.
whitertthSpectatorwhile i I have been there before as well, next time u may want to try and drop your air amd water to no more than 20/20..sometimes that can make a big difference in the apteints feeling it or not…just a thought
kellyjblodgettdmdSpectatorJetsfan –
I know where you’re coming from. I find that for most people (who aren’t allergic to vibrations – haven’t heard of that one), most cavities can be done a reasonable amount of time, especially if the “anesthesia” of defocused energy is used. However, I also find that there are that group of people who are just easier to work on if they’re numb.
One question I have been asking recently is “Are you able to bite into an ice-cream cone” to assess how sensitive their teeth are in general. I find that people who are more sensitive normally also sense the laser sooner than other patient.
Although I love doing laser dentistry, especially when I don’t have to give a shot, I am now focusing less on not giving “the shot”, and making sure that my patient has a more comfortable experience, overall. If this means giving some anesthetic, that’s okay with me.Just my two cents.
jetsfanSpectatorKB,
I agree. I think many of us (me included, got caught up in the NO NEEDLE concept that we are willing to allow our patients some “mild degree of discomfort”.I am not sure if it is for me or the patient. On the one hand the patient does appreciate it when we are done and they have no lingering numbness. In fact they often say they would prefer to do it that way again, however, I do want to be able to deliver the no needle dentistry so I go to great lenghts to achieve this. But at the same time I am under a bit of stress, wondering if and when and how much the patient is going to feel.
smileagainSpectatorKelly and Jetsfan
I have had my Waterlase for @ 6 months and the “hype” was that all operative could be done without anesthesia which I naturally tried… and was not satisfied with the level of discomfort the patient was feeling. Patients come to me because they want to be comfortable are not more impressed that they feel pain with a modern laser rather than a drill.
I too use LA when necessary and find that topical followed by Septocaine interlig infiltration is all that is usually necessary…Septocaine has made a huge difference.
Pain free dentistry is my goal and lasers are the way to go.
Best, Jerry
PatricioSpectatorHi Gang,
Some of the table talk is getting so technical I am thinking about taking a year off to go to laser tech school. But as to the time for preping I generally am driven somewhat by time. I think 6 to 8 surfaces of composite per hour and then move the time up or down depending upon the complexity and mix of restorations and the patient. I may vary the fee as well for more complex cases adding in a surface I might over look in a quick and easy case so time and effort are factors in my fee or I just tell the assistant to use a two surface fee for a difficult one surface restoration.
I too go for the simplest and most pain free experience for the patient(considering there are different kinds of pain). Since I am driven by planned time constraints I begin in the simplest and quickest manner and escalate rapidly if needed to get the job done right with the patient comfortable in the time planned. I am trying more and more intercrestal and ligajet injections using the laser as my topical (1.5w 7/11 defocused for a few seconds)and then a small amount of anesthetic in the papilla area before I go deeper. I find in many cases very little anesthesia is necessary to continue with the laser in a sensitive area. I am about to try Cavisol for gross decay removal to see what this adds to the mix. Anyone used this product?
Pat
jetsfanSpectatorPat,
I have been using carisolv for over 6 months now, with their special spoons. By and large I have a very favorable opinion of the product, especially when used with the laser and no anesthesia. One problem with the laser is that it is sometimes difficult to differentiate normal dentin from carious. Caries detector gives false positives. The cariosolv will remove carious dentin fairly easily and leave healthy dentin alone. Often , when I think I am done I go in with this product and remove a good deal more. I look forward to trying it with Mark’s spoons.
BNelsonSpectatorHi All
In response to what I think was the original question, I also plan approx 6 surfaces per hour with the Waterlase if there don’t appear to be other problems that may pop up. Today, I spent 1 1/4 hrs on a DO on 30. Same woman I did w/o LA one week prior for a 3 surface, no LA, today she wouldn’t let me get into the dentin with just the laser. Still sensitive with an interligamentous injection, and it took 2 IA with Septocaine before I could use the Waterlase to do a small! DO lesion. Don’t have a clue as to what happened. Fortunately she was the last patient of the day and wanted it done. Any ideas?
2thlaserSpectatorBruce,
How old was the patient? I find that women are more prone to sensitivity in lower molars for some reason, and that seems to be the consensus from most of the practioners I talk to. Not exactly sure why. Where was the 3 surface one you did before? Just curious.
Mark
PatricioSpectatorBruce,
Check out Jon Karna’s technique on his website at http://www.karna-ddscomfordent.com for his steps to a successful anesthesia. How does this compare with what you did in this case?
Pat
jetsfanSpectatorIn answer to my own question, in the last couple of days I was keeping track of surfaces per hour. Here is what I found:
With no local I was only able to do 3-4 surfaces , albeit some deep preps,per hour. Patients do feel it often, and you go slower. Mayber you lower the settings, or try to reanesthetize with laser. Then you switch to spoons and if all else fails go to slow speed round bur. All the while the patient still feels something. For those of you who can do 6 deep surfaces, ie 3 class 2’s in an hour , God Bless you, I have tried for 1.5 years…I can’t. -
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