Alan, I have to agree with everything said thus far. I’ll also add that education is lacking here. I’m not saying that to insult you, but to agree with your experience. Been there, done that.

I, too, had a DELight on a trial basis and it was less than satisfactory. Honestly, I didn’t have a clue. I’d seen a demo by the rep and been to a presentation by Dr. Don Wilson, but it’s just not the same. No replacement for education and experience.

If you’re serious about incorporating a hard-tissue laser into your practice, take an introductory laser course sponsored by one of the manufacturers. Yeah, you’ll get a bellyfull of hype, but you’ll also learn what you need to know about how lasers work (and don’t) and get a basic understanding of how to use a laser safely on your patients.

I’m rather cautious, so I wasn’t about to start lasing my patients without adequate training. That’s just me. Some just grab it like a handpiece and start zapping away. Regardless, you’ll soon discover exactly what Glenn said about case selection is true. I’m only now starting to develop a feel about when I’ll be successful and when to leave it in the corner.

Hope that helps,

Don

Hi Alan,
Re: 980 nm
You are using far too long pd.
Try 0.05sOn/0.05sOff 10W.
I’ve been using 0.02s On/ 0.03s Off with 6-8W.
You should use water to irrigate while cutting!
Are you using a 400 fiber ?
Do you have the irrigating handpiece ?
It should be cutting very finely without any charring, NOT electrosurge!
Regards,
Ken

Pamela, one of the absolute keys is to have higher levels of magnification. I honestly mean this because so many times if someone is using 2.5X loupes if they bump up in mag then they see the laser – tissue interaction much better.

Next off, dont be afraid to take the LVI course or come out to Nash Institute (next course is in March and is rapidly filling up) where you can learn some little tips to make your life easier.

Make sure the water flow is 14-22ml /min and if not turn your air down on your unit (or nearly off).

As for troughing, the erbium laser is not the best choice for this procedure. If its all you have fine, it can do some troughing but you must be cautious as it will
1. Cause more bleeding than a diode or NdYag
2. Nick the margins on your prep.
3. In my opinion not give as nice a trough as a dedicated soft tissue laser.

If I was doing it with the erbium I would use the 400 micron tip (you may have to order one) and only put it around 1/2 of the tip (around 1.25 mm) into the sulcus with no water on, and settings of 30 Hz and 30-50 mj with the angulation of the tip parallel to the long axis of the tooth. Again high mag helps minimize damage to bone, underlying cementum etc, and structures you dont want to nick.

If you arent using anaesthetic for this procedure (maybe one area where the erbium would be better than the diode) then the settings above may be too high and you might have to drop back to 20Hz and 30-50 mj with a 400 micron tip.

Hope that helps and dont be afraid to come to one of the training sessions, your experiences in the first month are VERY common, so thanks for sharing them, because others are finding the same.

Glenn

Hi Pamela, see if you can beg or borrow a higher set of loupes and see if it makes a difference to the effectiveness of your cutting. Heck if you come to Nash Institute (next course is March 11 and 12th I think) then Designs for Visions and Global microscopes will be there and you can see first hand how higher powers might impact your ability to use the laser.

Don Wilson and I provide most of the instruction there and feel free to sign up (phone hoya and Kimberly Coleman if you want at 510 445 4554 I thik is her number)…….

If you cant make it thats ok but try to see if you can borrow a 4.5 or something like that and see if you can see more effectively the tip.

Its amazing how many docs have told me that the single best thing they did to help them cut better with the laser was increase their magnification.

Our resident hero Ron Schalter I think started with 2.5 and moved to a higher set of loupes and now a scope.

Thanks for you kind words and in another 2-4 weeks you will be over the learning curve and excited about treating cases without any anaesthesia on a regular basis.

Hope that helps and welcome to LDF!!

Glenn

Thanks alot Mark……..I hope that your office is coming along nicely and that the scope issue is getting resolved. Email me if you still havent heard anything and I will get on the phone again tomorrow to the president.

As for the kind words thanks alot and to be honest with you I have been very busy lately trying to get some cases together so maybe soon I will post one or two for the board here.

Hope all is well and Pam try to see if you can get a set of higher powered loupes to try for a day or two.

Glenn

Hi Alan

I have had my laser almost 2 years now and had gone through some similar frustrations as you did. It did take some time but now I am able to treat with the Er without much difficulty. I still pick up the anesthetic for some patients as I just know they are not going to tolerate any sensation. And in some cases the enamal is very tough to get through but there are techniques. As to your original post:

“”the kid is 11, huge cavity (DOL) on a 75 (retained, no premolar)…after trying to treat him with the laser at 25Hz/255mj, with laser analgesia , i had to lower it to 200mj, then to 175 and gave up …needle and drill…50 mins for this treatment…””

Those settings are pretty high to begin with. 6.37 watts is a lot to be using on a huge cavity, especially if you are just removing caries. It is best to start low and go higher rather than high and then turn it down.

I have had great success in cases like you described above by starting at 20hz/70mj (1.4W) then scaling up to 20hz/170mj (3.4W). I always place topical around the gingivae to allow for matrix placement also. I will also use a hand held rotary, and round burr and spoons to remove bulk decay.

Some things you might want to look at as far as your laser goes, if you are not already.

– check the air pressure on the back of the unit is about 25-30

– get a measuring cup and timer set for 1 min and get your water flow to about 12-14ml / min. ( on my unit it is 3/4 turn counterclockwise for air and 2 turns counterclockwise for water – but every unit is different so check yours.)

– check that the tip is clear and transmitting light well. ( i hold mine towards my view box and look under magnification – (I polish mine up with brassler porc. discs if they are dull looking.)

– make sure high speed suction is not taking all your water away during proceedure.

– don’t get to close to target tissue when treating as you will limit water flow and may build up heat and sensitivity. (a little easier to do with higher magnification)

– cut perpendicular to target tissue ( if you have the laser at any other angle to the enamal you will find it tough to get through) and if you place the tip right over a groove without angle you may not get enough water flow into the groove and create enough heat to produce sensitivity. Mark C has some pics on this forum of that technique.

– keep the tip moving over the target tissue rather than holding stationary. (a little easier to do with higher magnification)

– get patients to give you a left hand signal if sensation is more than they are comfortable with, and then lower the mj to get comfort.

– don’t give up! it will come.