Forums › Erbium Lasers › General Erbium Discussion › First go at it not too succesful
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d2thdrSpectatorI’m a new DELight user also, and tried my first restorations today. I think my patient was too young (14 yr old black male), and I had stars in my eyes seeing all these little interproximal lesion that are perfect for tunnel preps (11 of them).
We did get 2 done, ML’s on #8 & 9. Analgesia with 30 and 200mj, for 2 minutes. Actually only used the Dentin setting of 20 @160 for the preps. He rated sensation at a 4/100. Pretty good I thought. Did the miniscule restorations (loved the prep sizes) and moved to the others.
Here’s where I ran into trouble. Tried the same analgesia. Moved in at 20 & 300 and thought I prepared the enamel fairly well. But as I tried to go under the distal marginal ridge, the kid got sensitive, we backed off , moved to dentin setting (20 @ 160), and made little to no progress. This went on for awhile, and I realized I wasn’t really cutting much.
So I bailed out because I didn’t want this to become a situation where I saw how far I could get him to push himself down into the chair. We can do these later, so I really don’t want to use injection and drill.
Tear me a new one, I need help!!
(Sorry to make this technically a double post, but wanted it to be seen.)
2thlaserSpectatorMurph,
Forgive me, I forgot, what magnification are you using? That MIGHT be the first thing to address…as you can/can’t see the tip appropriately distanced from the target…Mark
d2thdrSpectatorHello Mark
They are DFV 3.5 or 3.75. I don’t remember which. Just moved up a year ago.
I was probably trying to do too much, because I still got 2 done easily.
dkimmelSpectatorDennis,
Just part of the journey. This is what I did when I first got my lasers. I picked a non production time, for me this was Friday mornings. I had my assistant come in and work we me. We picked patiients of my practice that needed work done that had $ problems. They also had to be nice people that just needed a break. I explained to them I was learning how to use the laser and I would do thier work at NC. That it would take a little longer but I would make sure they where comfortable. I booked extra time with these patients so there was no stress to hurry up. I could take my time playing with the laser and getting feedback from the patient. In my case most of my patients are older. I would tend to start off with patients 30 Y/O or older. Wait on kids and teenagers until you are ready. The patients that I worked with during my learning phase became Raving Fans of the LAser and my practice. I got to learn more then I ever would have if I had tried to do this in a regular day.
When you work on these patients. Vary your setting to see the different albation rates. Make sure you are using loops. 4x min 6 x is better.Try analgesia at 20 HZ 220mj. Determine how far to be from the area you are working on by first bringing the laser close to the soft tissue until you see albation. Then backup about 1mm. Use that as your defocused distance.
Beware of water pooling in small preps but also make sure you are getting enough water in the prep area. Watch how the water comes out of the tip of the Delight.
When a patient begins to feel something your options are:
1. Backup and renumb with the laser.
2. Vary your HZ
3. Vary mj.
4. Vary your distance to the site
5. Clear the site with a spoonI tend to backup first, working at a more defocused distance. Usually I will then bump down to 10HZ. I work alot at 10HZ and 100-160 mj. Sometimes I try 30HZ and 60mj and work the mj backup.
The key is seeing what you are doing and playing with the settings. That and taking the time to get comfortable with the laser.
Hope that helps.
AnonymousGuestDennis,
DAvid has given you some good advice. I’d add 2 things. 1.Watch your assistants positioning of her suction tip- if too close -not enough water and you get sensitivity, if too far away the water pools and the laser stalls in the pooled water. We will often just use the ‘straw’ type suction and catch the water in the posterior.
2. it’s really not a sin to numb people up, especially as you are just beginning to visualize where the laser needs to be to ablate efficiently. By using some local for awhile on your more difficult cases or where you have time limitations,you will have 1 less thing to worry about. As you become more comfortable, then add in the laser anesthesia for the more difficult cases.Hope that helps,
d2thdrSpectatorDave and Ron,
Thanks for the comments. I was trying to accomplish too much, too fast.
And Ron, the comment about numbing is well received. However, because this kid has soooooo many lesions, I would like to spare him having to have his work done conventionally. No need to make another dental cripple out of him.
I’ll just wait til I’m better at it.
N8RVSpectatorDennis, I already gave you all my sage (!) advice on DT, but one more thing to check …
Be sure to check the water output of your laser. As I recall, my first unit was set up with a pretty meager water output. It was adjusted to about 15ml/min and things went much better.
Also, as Ron said, be sure your assistant isn’t sucking away all the water! I keep an eye on that and am surprised how many times I see the stream of water curving toward the suction and not even touching the tooth while I’m doing the defocused preparation of the tooth. I’ll look at my assistant and she’ll have that, “What?” look on her face. Sheesh.
— Don
d2thdrSpectatorI think we were OK with the suction. Used an Isolite for the posterior.
I’ll check the output ASAP.
For the time being, I’m taking Dave’s advice, and backing off a little. Schedule for extra time in non-productive time frames. Going to try on some older individuals.
Thanks for the help and encouragement.
d2thdrSpectatorJust finished checking the water supply. Where it was set, only got 8 ml/min. So I opened it up all the way in the control box, and ended up with 8.5 ml/min.
Is there another adjustment? Am I missing something?
dkimmelSpectatorMake the phone call Hoya. Something is not right.
jaynelsonSpectatorI just check the water spray on my DELight. At max, it’s close to 10ml/min. In the manual, it says to go 2/3 max for spray of 5-10ml/minute. Is this not enough?
Thanks!
JayJay Nelson
Lutz, FL
d2thdrSpectatorHere’s an update, please chime in if you think there is still a problem here.
Talked to my Hoya rep, and he suggested turning the ait al the way off, and then measure the water flow. Went well, producing 22ml in a minute. He then suggested turning up the air until I reached my desired water flow. So I got it to 15ml/min but the air is only on about 1/3 of a turn.
Does anyone think there is a problem running on this small a volume of airflow, if I can still turn the air valve about 3 full turns.
Inquiring minds want to know.
I posted this on Dentaltown too, for maximum exposure.
jaynelsonSpectatorDennis,
Tech support told me the same thing and mine has the exact same water measurements. I’m also anxious to hear what the DELight gurus say
Jay Nelson
Lutz, FL
d2thdrSpectatorDoes misery love company or what!!
Going to try mine on some gingival contouring here in a few minutes. Patient will be anesthetized, so should be a good patient to work on.
Glenn van AsSpectatorI know that the air and water compete for the same canula so it doesnt surprise me to hear that you are only getting that small amount of water.
Interesting though how they told you to test the water flow because I had never heard that method and that is very ingenius.
I learned something to be honest with you.
Check out now if you get less sensitivity. You know what (I never change the air water flow)!!
Grin
Glenn
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