Forums › Laser Treatment Tips and Techniques › Soft Tissue Procedures › "Closed" crown lenghtening
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socalsamSpectatorguys,
these types of situations are all too frequent in my office. My best success has been with Tenure bonding agent and corepaste from denmat. The tenure is self cure as is the core paste. use your post of choice ( I try to stay away from metal, too many fractures) and you will get a great build up that is rock solid.
make sure you have an adequate ferrule effect and get enough of the natural tooth structure.
rhenkelddsSpectatorI am a new Waterlase user, and have been trying just about any procedure that I can read about and implement in my office. When doing a laser crown lengthening, is there any issues with leaving a negative boney architecture interproximally when doing this with the laser. Traditonal surgery(flap and ostectomy) suggest blending all the bone contours so no depressions are evident. From what I have seen, from other laser users, is that a more conservative laser crown lengthening is much more selective in nature and does not require as much bone or soft tissue removal.
Is it considered acceptable to use a G6 tip in the col area,remove the tissue and two mm of bone and then call it a day, or should we reflect a flap and use the laser to remove and contour bone and then replace the tissue.
RodSpectatorBob,
Usually, when this is the case, you’ve got plenty of access to that interproximal area from the occlusal. Make sure you’ve already done your basic crown prep. All you need to do is angle the laser tip through the interproximal, coming from the occlusal, and point it a little buccally to ‘ramp’ the bone removal to the buccal, and then, if needed, do the same thing for the lingual.
Only once have I needed to be so aggressive in this that I’ve needed a suture in the papillas because they were undermined too much.
Rod
(Edited by Rod at 1:29 pm on Mar. 23, 2003)
Andrew SatlinSpectatorBob,
Laser dentistry is very new to me but as a periodontist I can tell you that if aggressive ostectomy is required, particularly in the interproximal area, conventional flap surgery is indicated. As you mentioned, it is important not to leave negative architecture. Also, don’t forget to evaluate root morphology, root proximety, length of root trunk/location of furcation and overall thickness of the periodontium. I firmly believe that lasers are have important roles in the future of dentistry. We still should not throw out the basic rules we learned about proper oral health.Andy
RodSpectatorAndy,
Your last statement is a VERY important one, and I’d like to echo it again. I too have found that there are some that feel that because we’re using a laser, we can overcome some of the restrictions of the basics we’ve dealt with for years. And in some narrow applications this will be true.
However it’s important for new laser users to understand that the laser is simply a new instrument, but most often the same ‘rules’ do apply.
You seem very interested in lasers — do you own one yet? If so, which one, and if not, what sort are you thinking about and why?
Rod
Andrew SatlinSpectatorHi Rod-
I sort of always have been interested in Lasers for periodontal therapy. I am a periodontist. Used a CO2 in my residency but was never really impressed.
I recently purchased the PerioLase from Millennium. Still evaluating my results. Very much enjoying the procedures. Trying to learn as much as possible. I call Bob and Del about twice a week to ask about settings and techniques and stuff.Andy
Glenn van AsSpectatorAndy , I want to congratulate you for having an open mind. It is unfortunate that more periodontists dont open their mind to the possibilities of lasers in their practice.
I recognize that perio is steeped in the tradition of double blind , randomized , long term clinical trials for almost anything to become standard in their regimen and that literature review is very very important in your field, but it seems that many are interested in not even opening up their mind to change.
As an aside I find that the endodontic community has accepted better than any discipline change and technology in their discipline (microscopes, digital radiography, Niti instrumentation, apex locators, warm gutta percha obturation are all examples of high tech in their discipline).
Not all periodontists are this way…….Dr. Larry Finkbeiner is a periodontist in Colorado Springs who taught me how to use the Argon laser 4+ years ago, but I know that he was ostracized for his ideas on pocket reduction therapy even after providing his own study from his practice showing a 40% reduction in pocket depth on 1300 + pockets.
I am delighted to see you using the laser and hope that with time more periodontists will find out about the benefits of laser assisted periodontal therapy and include them in their practice.
Thanks again for posting your history and nice to have you aboard.
Glenn
RodSpectatorYes, VERY nice to have you aboard Andy!
Rod
Andrew SatlinSpectatorThanks Glenn and Rod
Yes, periodontists are a funny bunch. I have a read alot of liturature and have been largely unimpressed. I am a clinician. I believe in safety and efficacy. If lasers do the job, I am in favor. It certainly won’t be the first time I have disaggreed with the AAP’s position.Andy
Robert Gregg DDSSpectatorHey Andy–
Nice to see your posts with Rod!
To All:
Andy deserves a lot of credit for having more than an open mind, but for the personal and professional integrity to look for better ways to help his patients.
Andy is not certain yet on laser perio for gum disease treatment–he needs to evaluate his results over many patients and several months–and that’s just fine with us. Every practictioner needs to evaluate the results of ANY modality in the context of their own circumstances and situations. If it works for them, their patients and staff–great! If not, it doesn’t necessarily condemn the procedure, it just better defines the role a new procedure may or may not have for the clincian.
I took courses in implants for a while when they were just coming ou in 1984-5. Found they just didn’t interest me. I couldn’t “relate” to them. Del on the other hand–having great 3-D spatial relations–LOVES to place them.
Anyway, Andy and his patients are going forward with guarded optimism.
My personal opinion is that Andy and his patients are going to do really well with laser perio–and I’ve told him so–because he is willing to call, or come by and talk about his cases, or special situations or laser settings, etc.
Just like Rod said, we don’t have all the answers. But if we can work together in the best interests of our patients to better understand, then I think we all come out (oot in Candian) ahead.–grin for Glenn
Thanks for participating Andy. Talk with you soon!
Bob
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