Forums › Laser Treatment Tips and Techniques › Hard Tissue Procedures › Laser Crown Prep Case Presentation
- This topic is empty.
-
AuthorPosts
-
SwpmnSpectatorLaser Crown Prep Case Presentation:
This afternoon I prepared tooth #19 for a porcelain fused to noble metal crown on a 30 yo male. My objective was not to duplicate what Mark Colonna is doing but simply to ascertain if some of Colonna’s technique can be incorporated into a crown prep procedure. Many people, including myself, laughed when we read his initial posts.
Profound anesthesia was established. Second photo shows my gross reduction with the Biolase Waterlase set at the 6 Watt enamel setting. Third photo depicts my prep after smoothing with a diamond in an electric handpiece. In this photo, the Waterlase was used at the 1.5 Watt soft tissue setting for gingival retraction.
Treatment time from first photo to third was 30 minutes. My objective was not speed, but simply to determine if SOME of what Mark Colonna suggested can be achieved by another dentist. I believe the patient benefitted by a 90% reduction in use of rotary instruments.
Comments, questions and ridicule will be well accepted.
Al
SwpmnSpectatorPhoto of my impression from the Laser Crown Prep Case.
If I don’t respond to questions/comments/ridicule for a few days it’s simply because I’m leaving town for Thanksgiving.
May all of us have a wonderful Thanksgiving and enjoy time with our families!!!!!
Happy Thanksgiving,
Al
2thlaserSpectatorAl, You flatter me! When you do more and more, they get faster and easier, and you ought to try, just to “do it” one without the diamond. I really like what you are doing. Great post. No, I wouldn’t laugh at you! I am sitting here smiling, knowing that you are outside the envelope, and should be proud of yourself. My initial crown preps were flukes, patient wanted them, BUT since then, I have developed the technique much further, and quicker. I am developing tips with Biolase, that should help us out too. Hopefully available soon. This is why I published the article, to stimulate, and get others to do neat things, thanks for taking it the through the steps you have with the “modified” technique. Have a GREAT and Happy Thanksgiving!
Mark
2thlaserSpectatorOh, one other comment. You CAN do these without anesthetic, and I would ascertain that you could still use the modified technique, because of the “anesthetic”effect of the laser, for a period of time after the defocusing, and intial enamel and dentin prepping. Let me know if you try it that way. I still have done all my preps without anesthetic, no one has felt anything so far. (I wish there was an icon for crossed fingers!)<—RON! Great job Al, Bravo.
Mark
Glenn van AsSpectatorAl : Many times in various formats I am accused of slandering Biolase, but I want to personally say that I love what you did.
The photos are exceptional, the treatment and dentistry sublime.
I think that a diode, Nd:yag or other dedicated soft tissue laser is a little easier to cut the tissue with for hemostasis but your impression speaks volume for your technique .
The sharing that goes on here is exceptional and the comraderie without equal…………
Congrats to you and your patient has been better served even if you dont look at the microfracture issue and only concentrate on the pulpal temperature rise with diamonds versus the laser. Perhaps long term there will be less endos doing the gross work with the laser and the finishing at low revolutions with an electric handpiece………..
My feelings are………
CLAP CLAP CLAP……..thanks for sharing.
Glenn
Robert Gregg DDSSpectatorAl–
Way to go! Nice post.
When Mark first made his post on crown preps with erbium I did NOT laugh! I’ve been around waaay too long with lasers to know better.:biggrin:
Much of what is new and interesting with lasers is both counter-intuitive and against the main-stream thinking. And even after a decade and a half of laser innovation, this is still an evolving technology. That is why those who refuse to consider the importance of clinical innovations and improvements developed by those doing it everyday–or refuse to continue to learn from others–risk becoming irrelevant themselves as they try to “poo”, “poo” and marginalize the New Guys and Gals and ideas.
I am not referring to anyone that I have seen post here. Those I refer to are too good to be seen posting here!
Glenn–GET BACK IN BED!
I’m kidding.:biggrin: Nice to see you feel good enough to share your comments and insights!
And as far as being accused of slander, I think that ‘s awefully strong language. You have been honest, forthright and honorable in putting forth your concerns and perspectives, with some restraint, I think. You have reflected the opinion of a large constituency that you have come to represent and who respect what you have to say (whether you like it or not).
Get well and get back to posting. Just don’t ever let the “bastards” get you down.;)
Bob
PatricioSpectatorA,
I strongly support the fine word forwarded to you! The wow moment for me was realizing since Mark and you can do it, it is probably possible. Which means I can’t wait for that next crown prep opportunity. Like you guy and gals I am having fun. I noticed this morning I began preping the tooth with a defocused 4W which was a step up for me and it seemed natural.Anyone taking mobile primary teeth out using the laser to “anesthetize” the soft tissue? I thought about it this morning but got cold feet.
Pat
Robert Gregg DDSSpectatorPat–
Mobile primary teeth should be a piece of cake…
Yes to soft tissue analgesia and low power to break the remaining attachments. Taper tips, a little air and Viola!
SwpmnSpectatorThanks for the reply posts!
This forum is a wonderful modality to learn and share our ideas.
Hope everyone had a nice Thanksgiving!!!!
Al
PatricioSpectatorMark,
I completed my first laser crown prep today, well almost completed one. I finished it with the usual burs etc.
I am glad I do not have my photo system operational as my tooth did not look near as nice as Al’s. Part of the tooth looked a little bit like the Rocky Mountains and I had a little trouble with estimating the depth on the facial and lingual and of course I lacked a plan of attack. It was exciting and I can see better things to come.
What are you doing to smooth out the rough and irregular surface? Is there a preferred stepwise plan of attack? Tip? Are the white pocked margins on the shoulder a problem at the lab?
I had a hypersensitive patient today. I “Anesthestized” the tooth at 6W for 45 seconds on a lower first molar and he kept jumping when the laser touched his tooth as the cervical facial (4w). Does a second “anesthetic” prep of 45 seconds usually help? It did not help in this case. Is this a time for the local anesthetic? He did better with a number 2 round bur by the way.
When I use the laser to trim back tissue around a crown prep I get white pocking on the prep margin. Is this a concern?
Any help you or anyone can give will move the mission and be appreciated.
Thanks,
Pat
2thlaserSpectatorGreat job Pat! Congrats on your boldness to move forward. I hope it was easier than you thought it would be. To answer some of your questions, the best I can…
“What are you doing to smooth out the rough and irregular surface? “
If you angle the tip, so you “shave” the tooth on very low power, around 1.25-2.25W with 40%air, 20-30%water, you can smooth it that way, which is the way I did it. You can actually see the shaving taking place. We are developing new tips to try to acheive this, but I don’t have em yet!
“Are the white pocked margins on the shoulder a problem at the lab? “
No they are not, again, lower the wattage to 1.25 or less with 30%air and 20% water to acheive margination, it was surprising how well this worked for me. The lab has had zero problems finding and getting great margination for me.
“I had a hypersensitive patient today. I “Anesthestized” the tooth at 6W for 45 seconds on a lower first molar and he kept jumping when the laser touched his tooth as the cervical facial (4w). Does a second “anesthetic” prep of 45 seconds usually help? It did not help in this case. Is this a time for the local anesthetic?”
First of all, I recommed at least 90 sec anethesia time, not 45 seconds. Also, on a cervical area, you really need not have your settings any higher than 1.25-1.75W with low air and water. It usually is a very sensitive area anyhow, lower settings usually work much better in that area. 4W in my estimation would be way too high. One of the things I have learned from Bob Gregg, Glenn Van As and Stu Rosenberg is that the lower the power you can use, the better in most cases for all procedures. I only use higher wattage when I am anesthetizing and JUST getting into the enamel on a class I or II. As far as using a local, you could have, but I think if you decrease your power settings, you would have success.
“When I use the laser to trim back tissue around a crown prep I get white pocking on the prep margin. Is this a concern?”
It can be. Make sure you are angulating your tip correctly, it is END cutting so you should not get any collateral effect if the angulation is correct. That is my experience so far. In addition, I use a T-6 tip to trough, I like it better. I can use less energy, usually .25-.5W with 11%air and 7%water, it’s only 200 microns so it’s smaller, with less chance of collateral damage even it the tip isn’t angled quite the right way.
I sure hope I have helped you see a few things. I am no expert, but I DO try a ton of things everyday. I learn more from all of you everytime I read something here, so if I can pass a tidbit along once in a while, it makes me feel like I am contributing.
BTW, I removed an amalgam yesterday, without local, did what you guys have been teaching ME, and it worked like a charm. Used the high speed, after anesthetizing, and then back to the laser to finish, the patient thought it was way cool, and then his wife came in later that day and said he couldn’t stop talking about it! How’s that for internal marketing!!! Love that laser!!
Mark
2thlaserSpectatorHere is some newer pictures of a molar crown prep I did today, all laser, no rotary instrumentation. This is the preop with large composite filling with broken distal marginal ridge.
Next are the “depth cuts” I make, which are about 1.5-2mm in depth, from the buccal over the occlusal, to the lingual.
Then, here is a picture of the occlusal table, notice the “frosting” of the composite. This all took about 10 minutes for the prep. I tried a slightly different method to create the interproximal margins this time…I will try to explain.
What I did was prep the interproximal by making a “slice” just short of the “gingival floor”, then taking a hand instrument, I broke out the thin layer that was left, and it established the initial “shoulder” of the margin. I then lowered my power to 1.25W 40%air 25%water to refine the margins and smooth the prep. Again, I don’t mind the “roughness” that some people like to smooth. I like the idea of the greater surface area I have to bond with my GI cements….Rely X.
The hard part on this prep was the MB area, where there was some root exposure, so I had to bring the margin down on that area, rather than a straight around the tooth, same level margin that I am used to fabricating. It worked great. I was in a hurry, so hopefully the pictures are ok. I just want to show you how I TRY to do this w/o rotary instrumentation. What other recommendations would you all have to improve this technique? Just wondering. Always looking to learn!
Thanks,
Mark
PatricioSpectatorMark,
You are a great help. I know I was suprised at how fast I preped with the laser and I see from the pictures I was about right in my procedure. I will add your suggestions. I suspect you will talk about this at Dana point and thought it would be good to do one or two before I get there. The desensitizing method for the cervical makes good sense and I will try this.
Completed four restorations on a three and a half year old today. No problem. Her mother was impressed.
A fellow came in because of a lost filling which was actually enamel fracture around decay. I cleaned it out with the laser and placed a temorary as we planned for a crown( another new patient arrives). As he was leaving he said his son had been to the dentist two days before and had two cavities and he wanted to know if he could bring him to our office for laser care. I won’t be high on that dentist’s list.
I find myself roughing up the abutment prior to cementation for sterilization but also for retention on short crowns. What do you think? Where is Whitefish I couldn’t spot it on a travel map? But then I just discovered that you need to click on page two and three if you want to read those messages.
Pat
Glenn van AsSpectatorNeat pics Mark……….I tell you I dont have the patience you do for doing the crown.
I will be VERY interested to see if you thoughts change once you start looking through the scope at the roughness of the preps.
I think it is great that you are doing these, did you anesthetize this one.
Thanks for sharing , by the way I changed my last lecture from the erbium not being good for crown preps to it is possible if you desire to take the time and you accept the little bit of roughness, and if not you can smooth it out with a bur.
Thanks for posting those pics……..great stuff.
Glenn
2thlaserSpectatorQUOTEQuote: from Patricio on 3:48 am on Dec. 13, 2002
Mark,I find myself roughing up the abutment prior to cementation for sterilization but also for retention on short crowns. What do you think? Where is Whitefish I couldn’t spot it on a travel map?
Pat, I think it’s great to rough up prior to cementation, remove any smear layer, and give yourself optimum retention. I do that quite often. Also, Whitefish, is in Northwest Montana, about 22 miles due west of Glacier National Park. You ought to come visit sometime!
Here is a picture of our view!
Thanks for sharing guys, this stuff is a blast! Glenn, I understand your lack of patience, BUT, I feel that it is such less trauma, for the LITTLE bit more of time it takes, and without anesthetic, which is safer, it’s worth it to me. And of course, no more cracking, and crazing…etc…you know. Just my anal thinking I guess. BTW, Global emailed me, should be seeing a scope soon! I can’t wait. Christmas is right around the corner!
Mark -
AuthorPosts