Forums › Erbium Lasers › General Erbium Discussion › Frenectomy with the chisel tip
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Glenn van AsSpectatorThe Silence is deafening.
Here is a chisel tip erbium yag frenectomy.
Used 40 Hz 100mj with the chisel tip in NON CONTACT.
It is cool to see how this works and I just took the chisel and turned it the opposite way to get the fibers out in between the teeth in non contact.
In my opinion there is less bleeding in NON CONTACT than in contact. Of course anesthetic was used, no water , just air.
I have used the soft tissue tip before but it bleeds more.
This one healed nicely, patient took one advil the first day.
Hope it is interesting.
Glenn
SwpmnSpectatorYeah it is kind of dead in here but here is something that might be worth discussing:
Noticed on Dental Town Dr. van As reported an anectodotal finding that his erbium frenectomies seem to heal faster than diode frenectomies. Not real sure yet due to low numbers but possibly seeing a trend along those lines.
Have a once a week Friday or Saturday stint in a large group practice where have been transporting my 810nm diode for various procedures. Frenectomies with the diode take more time than the erbium particularly when I get down to the attachment fibers. They do seem to heal slower than the erbium frenectomies performed in my office. On the other hand they bleed less. Did one the other day where patient never bled a drop.
We have such outstanding success using the diode laser for crown/bridge retraction that I’m beginning to wonder if the diode laser is better suited for these very fine surgical applications. Since my diode laser is basically always ON, even when “pulsed(gated)”, I’m thinking the longer application time to complete the frenectomy results in a greater overall heat dose to the treatment site. Perhaps this results in more collateral damage and longer healing period. Diode setting has been Continous Wave to 10Hz Gated and 1.5-2.0 Watts with an initiated 400micron fiber.
Maybe the truly pulsed erbium with inherently high peak power and rapid cutting of high water content soft tissue results in lower overall energy dose?
Nd:YAG frenectomists wanna chime in?
Glenn van AsSpectatorAllen I totally agree with you and I have even tried the 980nm diode at high wattages with water and guess what…….still much delayed healing compared to the erbium which is fast with or without water.
I wonder whether with water with the erbium whether the total time which is increased again will lead to delayed healing compared to just doing it without water.
You are right that there is less bleeding but guess what, if you do the frenectomy with the chisel tip in Non contact there is alot less bleeding. Larry Kotlow was the one who taught me this and I think he is right compared to a soft tissue sharp tip in contact with the erbium for these frenectomies.
This is a great post that you did Allen and shows a wonderful understanding of laser physics and I totally agree with you about healing. The erbium wins hands down over the diode in CW and the diode wins over the electrosurge.
Hope that this helps
Glenn
Glenn van AsSpectatorInteresting to read of Ron Kaminer and Mark mentioning that there is so little bleeding with the MD.
This case wasnt done with the MD……..
No bleeding!!
Hmmmmmm…………..
Glenn
AnonymousGuestQUOTEQuote: from Glenn van As on 10:25 am on June 29, 2005
Interesting to read of Ron Kaminer and Mark mentioning that there is so little bleeding with the MD.This case wasnt done with the MD……..
No bleeding!!
Hmmmmmm…………..
Glenn
Glenn, I’ve done some w/ my Waterlase and also had no bleeding which brings me to the following question-
Is it the laser or how well the operator limited the erbium energy to fibrous tissue? My guess is there are less bleeders with the higher the magnification(like w/ a scope) 😉 because of better visibility during ablation.
Glenn van AsSpectatorRon, I am not so sure that the issue is only the magnification but in addition in this case the whole thing was done out of contact on the frencectomy.
I have never used the MD on soft tissue at the 700 microsecond pulse but I wonder how sometimes people can say it cuts smoother than any erbium laser.
To me both the MD and the Versawave (heck even my upgraded Delight) have 50 hz settings that for me are the main reason for smoother cuts on tissue.
I just shake my head when we get into this erbium is far better than that erbium as I have never seen something done with any laser that couldnt be done equally well by a skilled trained clinician with one of the other brands.
As I have stated numerous times, the differences are not in how they cut but how they are packaged and marketed.
Enough said.
Point taken I hope
Glenn
dkimmelSpectatorGlenn,
Very interesting. I hate plucking those fibers with the Er. What your saying is nocontact and no plucking??? Sweet.
Glenn van AsSpectatorHi David……..no plucking fibers,no bleeding and guess what, no smutz on the tip.
Hmmmm…..
Glenn
adelddsSpectatorGlenn thanks for tip. I have done 4 frenectomies in the last few days (all on children) with the chissel on 40/100. I love it. 3 had just about no bleeding, but bled for quite some time.
The tip was so clean!!!
Question: Does anybody have an ideal time in children that they propose a frenectomy?
Glenn van AsSpectatorHi there…….I am glad that you are finding the 40/100 works with the chisel tip and it is clean when there is no contact. I think that sometimes we do hit bleeders regardless of the technique (non contact with chisel tip vs contact with soft tissue tip) but that there are some advantages to the chisel and non contact.
One disadvantage with the settings I listed is that it isnt possible to use these without anesthetic. Pulse rate is too high and so is the Mj.
With respect to children, I do know that Larry Kotlow has some ideas about this. He doesnt worry about the old fear of scar tissue affecting the permanent teeth not staying together.
I also know that he likes do do the thick ones when the teeth are just erupting to give the permanents a chance to come together on their own.
I think that in the end you can do it with ortho (either before or after) or in the early mixed dentition when the teeth are just erupting. Sometimes kids arent that amenable to treatment at the earlier ages.
Great question though…….lets see what others say.
Glenn
whitertthSpectatorGlenn,
Md does not cut so well out of contact in the Soft tissue mode…one reason no bleeding for you could be the local if it has vasoconstrictor no?
all the best
adelddsSpectatorGlenn, I think you are right about doing these in the early mixed dentition stage. It seems to make more sense.
As far as the technique with 40/100 chissel; I noticed that when in non-contact mode it is hard to get that last layer to peel back just before bone. I have also noticed that some of my patients have reported more post-op pain the next day than when I used the soft tissue tip at 30/70. I would say that there is probably less bleeding with the “chissel technique” but slightly more pain. Am I possibly scorching the bone at the higher energy level? Have you had any of the same results?
Thanks,
Marc
Glenn van AsSpectatorHi Marc…….this is a rum and coke induced response so beware.
First off you ask excellent questions, they are very good indeed.
I am still experimenting with the chisel tip but remember that the footprint is so big compared to the soft tissue tip that I would hazard a guarantee that less energy is coming out of the defocussed tip that has such a large footprint compared to the soft tissue tip at 30/70 in contact.
I wonder if it takes longer or if scorching the bone is occurring. If so a couple of possiblilities to consider.
Use the contact tip (it will get smutz on it and you will bleed). Use water with the chisel tip to prevent the scorching…..’
This will take longer but is safer for the bone.
What do you think…….again I am thinking as I go here and the Bacardi has me thinking in circles. (one drink does that too me these days!!)
Cya
Glenn
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