Exposing Tooth for Ortho - Laser Dentistry Forum

This topic is empty.

Viewing 14 posts - 1 through 14 (of 14 total)

Author

Posts
February 26, 2005 at 4:12 am #3286 Reply

Benchwmer
Spectator

Referal from Ortho (not my patient), sold patient’s mother on a laser surgery. 14 year old male.

Ortho wants #6 exposed and sent me a bracket to cement on and a wire.
Need a bloodless surgery, so used PerioLase, free running pulsed Nd:YAG, 3.0W 20Hz 150usec.
Exposed clinical crown of #6.

Is there anything else I needed to do? Is the only concern of the surgery placing the bracket? Are there any other tissue concerns?
Cemented on bracket and placed ligature wire.

Returned patient to Ortho for trearment.
Jeff

February 26, 2005 at 3:51 pm #9839 Reply

Glenn van As
Spectator

Hi Jeff: Nice case and thanks for sharing the photos which are excellent.

Jeff , one thing that I have learned is that the attached tissue in cases like this is vital. It must be retained if at all possible with a flap otherwise the risk is that the tooth will come into place without any attached tissue.

I will show you a case or two that I have done but the predominant theme is always to retain the attached tissue. What remains after this surgery was minimal but I would love to see the post op.

Thanks for sharing a very valuable case.

Glenn

February 26, 2005 at 4:27 pm #9835 Reply

dkimmel
Spectator

Nice use of the Nd:YAG. It will be interesting to see the post op. Glenn has point about AG.

February 27, 2005 at 1:25 am #9847 Reply

Vince C Fava
Spectator

I echo Glen’s remarks. An apically positioned FTF is the best way to go here. Great hemostasis. Thanks for sharing.

February 27, 2005 at 2:53 am #9836 Reply

Benchwmer
Spectator

Looking at the photos, I noticed that I also treated the inflamation associated with #7 with the PerioLase.
I’ll check with the Orthodontist to see if I can get some post-op photos.
Jeff

February 27, 2005 at 5:24 pm #9840 Reply

Glenn van As
Spectator

Hi Jeff: here is one I did a long time ago before Danny and others helped me realize a little bit about flaps. This is around 2 years old but it serves a purpose.

The healing was good with respect to attached tissue but my vertical inicision never healed 100% and this is how you learn. I hope that others like this.

Glenn

February 27, 2005 at 6:40 pm #9837 Reply

Benchwmer
Spectator

Glenn,
It sure was alot easier and less bloody using only the laser. The laser technique allowed for immediate cleaning. The question is will the attached gingiva come down w/ the tooth. Nice results in your case. Your need to go back and reshape the gingival contour on the lateral.
Thanks.
Jeff

March 1, 2005 at 3:16 am #9841 Reply

Glenn van As
Spectator

I agree less blood with the laser only but you have to watch AG or the perio police will nab you. The problem is that when you have the laser, everyone wants to see you fail!!

I often make sure that I take a real solid look at these cases to make sure they are ok before I use the laser on them.

I do need to recontour the lateral but he is only 16-17 so it may still shift a little (I will look when he comes home as he is a goalie playing junior hockey!)….

Take care and thanks for sharing Jeff.

Glenn

March 1, 2005 at 1:32 pm #9844 Reply

N8RV
Spectator

Interesting twist on yet another “simple” procedure that us promoted to prospective laser buyers but turns out to be a little more complicated …

How about a compromise? Could a diode or Nd:YAG be used for a bloodless, semilunar incision near the incisal edge of the tooth, reflect the miniflap, attach the bracket and allow the tissue to just sit there? Would that allow sufficient AG to form as the tooth is repositioned?

This would mean attaching the bracket instead of just sending the patient back to the orthodontist with the tooth denuded, but that shouldn’t be an insurmountable problem. Local orthodontists might trust me to glue on a bracket.

— Don

March 1, 2005 at 2:48 pm #9845 Reply

Robert Gregg DDS
Spectator

Don,

Good idea.

Your pink Periolase is calibrated and validated, pesonally, by me! With, of course your sciatica setting…….Ships out today.

Bob

March 1, 2005 at 3:07 pm #9842 Reply

Glenn van As
Spectator

I figured Don to be one of those Pink Periolase guys……..

Not that there is anything wrong with that!!

Actually, congrats Don………enjoy , hope one millennium or so to see the Periolase in Canada……

(gotta keep jabbing Del to get it done!!)

Grin

Glenn

March 2, 2005 at 12:36 am #9838 Reply

Dan Melker
Spectator

Glenn,
I looked at your case and I would dispute that it could be handled any better. You kept the AG which was critical and the end result is really about as perfect as one could get.
Super result,
Danny

March 2, 2005 at 5:27 am #9843 Reply

Glenn van As
Spectator

Thanks Danny , but I think that I could do better with keeping the vertical incision at a different spot. I actually did not use a laser here but I have cases where I have done so…….

I will post another. First off, I am a continual student and have learned TONS from you , andy, hack about flaps, perio and biology. Both Andy and Hack2 helped me in Vegas at Bob Greggs course and after the course someone asked me why I didnt do more closed flap and that I guess made me feel good because I knew it was the influence of the periodontists who have taught me to respect biology.

I know its been a long road, its still a long one, but slowly I am getting there………

By the time I get to present in Clearwater, I may actually know a thing or two!!

Grin

Cya

Glenn

March 2, 2005 at 2:46 pm #9846 Reply

Robert Gregg DDS
Spectator

Glenn,

It’s working. Del’s got a due date of the end of this month to complete GMP documentation……..then we need to call a CE MArk compliance auditor. Don’t know ETA after that, but soon. We’ll make a big announcement.

Your AG looks great too.

Bob
Author

Posts

Viewing 14 posts - 1 through 14 (of 14 total)