Class V Composite - Laser Dentistry Forum

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June 4, 2003 at 1:06 pm #3554 Reply

Benchwmer
Spectator

I need to show that I am using my Hard Tissue laser in everday uses. I still use air abrasion on most Cl I and Class II to remove staining, remove the enamel and isolate the dentin caries, I then Lase to remove soft caries and decontaminate before restoring.
This case was done using the OpusDuoE (Erbium) laser center.
20 year old, Male. Caries on facial #28. No Local anesthetic. 10 Hz 500 mJ using 800 um tapered sapphire tip, hollow wave guide delivery.

Before

Tooth prepared, caries removed, final caries removal w/ smallest Schumacher spoon excavator. Tooth then bonded w/ I-Bond, one bottle self-etching, prime and bond, Esthet-X composite.

Final polish.
I no longer use AA on Cl V preparations.
Jeff

June 4, 2003 at 1:13 pm #12372 Reply

Benchwmer
Spectator

In the previous case I also used the OpusDuoE to remove the existing composite restoration and prepare #27 for restoration using the same laser parameters and same restorative materials. Sorry to miss that on original post.
Jeff

June 4, 2003 at 1:56 pm #12378 Reply

Robert Gregg DDS
Spectator

Thanks Jeff,

Not to be picky, but it looks like the papilla between 26-27 is a bit “unhappy”. Also looks like the mesial-incisal has a wear facet that together with some local plaque factors are giving that area fits?

Thanks for posting and letting us “pick” on you.:)

Bob

June 4, 2003 at 2:25 pm #12369 Reply

Benchwmer
Spectator

Patient is a Marine, back from Iraq with a Purple Heart. Said, lost his backpack and toothbrush for a couple of weeks. He is home for a couple of weeks to recover, then he is back to Uncle Sam. I only addressed his chief complaint, cavity on lower tooth.
I still do soft tissue laser therapy. I just posted a Nd:YAG case to even it up.
Jeff

June 4, 2003 at 11:17 pm #12379 Reply

Swpmn
Spectator

Jeff:

Thank you for sharing your case.

How do you find the hollow wave guide fiber delivery system on the Opus Erbium? Is it flexible and easy to direct the handpiece into the treatment area?

I read some information on the Opus Erbium indicating that it has a variable Pulse Duration. Is the Pulse Duration user-selectable? If not, did Opus provide some sort of chart showing what the PD is at a particular setting?

Also, I was told that Opus has certain tips for their Erbium which are very inexpensive. Have you tried these tips and if so how did you find their ablation efficiency?

Thanks,

Al

June 5, 2003 at 12:08 am #12373 Reply

Benchwmer
Spectator

I ordered the OpusDuoE at the ADA meeting last Oct, they were just showing this model. I got it in March.
It uses a hollow wave guide, it coud be a couple of inches longer, but it makes you keep it straight which gives you a truer power output. The cart has rollers and I move it inches either forward or backwards for upper arch vs. lower.
The handpiece is like a high speed in size, with removable sapphire tips, straight or tapered. I use 1000 or 800 micron for hard tissue, the small fibers 200, 400 are for soft tissue. I haven’t tried the 600 yet. They also have hollow 1300 metal tips for soft tissue.
Pulses can be set from 7-12 Hz. The foot pedal for firing can be set on variable, like your handpiece rheostat, you can decrease the Hz from your setting, by letting off the foot pedal.
I liked the ability to vary the number of pulses and tip sizes.
I’ve been using an Nd:YAG since 1999. I’m still learning uses and technique on the Erbium.
Jeff

June 5, 2003 at 5:29 am #12375 Reply

Glenn van As
Spectator

Very nice pictures Jeff…….nice service for your patient.

I am always concerned with caries still left behind.

With all the erbium lasers I hate using Caries Detector Dye and in addition there is no tactile feel for when all the caries is gone. How do you determine if all the caries in a case like this where it may appear in the prep photo like decay is still there has been removed. Do you use round burs, CDD, spoons….

Do you use GIC in the base……its something I find tough to treat with the ErYag on soft caries cases and that sometimes the caries still is present…….

Glenn

June 5, 2003 at 7:03 pm #12370 Reply

Benchwmer
Spectator

Glenn,
I use Karl Schumacher spoon excavators (#045) or a small round burr to remove the final debris and insure hard surface to bond to. These spoon excavators are so small, on a penny the excavator head only covers one number on the date. I’ll post a photo later.
I use no bases or liners (not since 1995), just a dentin bonding agent, in this case I-Bond.
Jeff

June 5, 2003 at 11:22 pm #12365 Reply

2thlaser
Spectator

Jeff,
I’d like to see those. The Spoons I developed are a bit smaller, and very sharp. Glenn can tell you more about them too. I always like to compare products. I too, LOVE spoon excavators, and hardly EVER use a bur to remove decay. After seeing what a bur does to tooth structure, I try not to use one. I have really become fairly efficient at drilless dentistry. Sometimes I am amazed. Anyhow, great post, good stuff!
Mark

June 6, 2003 at 3:04 am #12376 Reply

Glenn van As
Spectator

Hi Mark…….great talking to you today and I used your spoons today. I still like my slowspeed for decay removal verification but that is personal preference.

I still feel that with lasers it is not easy to remove the soft mushy decay but it does work well to remove the last bit of decay once the bulk has been removed with spoons, slowspeeds etc………

I will post a pedo case in a minute………

Great thread and nice talking again to you.

By the way, those of you using the lasers should really look at marks spoons…….nice stuff………

glenn

June 11, 2003 at 6:50 pm #12367 Reply

2thlaser
Spectator

Thanks Glenn,
Jeff, you spurred me on to take a picture of how small my smallest spoon is. This is the #4 spoon, titanium tipped, and man they stay sharp.

You can see they don’t even come close to covering a number on a penny! I find I can really get to the DEJ and other hard to reach areas that a laser tip can’t get to, to conserve as much tooth structure as possible…trying to complete true microdentistry as much as I can….

Thanks,
Mark

June 20, 2003 at 5:34 pm #12371 Reply

Benchwmer
Spectator

Mark,
Here is the picture I promised of the Karl Shumacher #045 spoon excavator.
They run about &#3620 apiece. I got 6+1 at the DC Meeting in March.
I use for final caries removal w/ the Erbium.

Jeff

June 20, 2003 at 9:00 pm #12368 Reply

ASI
Spectator

Hi guys,

I see this can turn into a bragging size thread. Only not how big yours is, but how small!

Jeff, what material is yours?

Andrew

June 26, 2003 at 6:05 am #12364 Reply

dkimmel
Spectator

Jeff, I am just getting around to checking out this thread. Nice case. You mentioned the Opus has a foot pedal for firing that can be set on variable. This sounds great. I love my Waterlase but !!! I am in a learning phase that I am constantly changing settings. What a pain. You constantly have to be looking up from your field of vision and doing Class 2/3 movements.
Glenn, I to liked the slowspeed for that last check for caries. That was until Marks spoons. I rarely pickup the slowspeed anymore. I just need to buy some more.
David

June 26, 2003 at 1:49 pm #12377 Reply

Glenn van As
Spectator

Hi David, it depends on the extent of decay I guess. Small ones can use Marks spoons , bigger ones I use the slowspeed.

If you want to avoid changing settings remember you can defocus to lower the impact on the tooth at the same setting and this will also prevent the Class 2/3 movements.

Take care

Glenn
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