Lasers , Crown Preps and BU - Laser Dentistry Forum

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November 23, 2003 at 8:07 pm #2805 Reply

Glenn van As
Spectator

Hi folks: Here is a case which I show you just for fun where lasers only played a minor role but I thought the pics were pretty cool and kinda fun.

THis is a husband of one of our former dental assistants who left after she had her two kids and we tried a pulp cap with the laser on a crown prep…….no luck. Patient needed endo when he was on holidays and the crown was temp cemented and then the other doc actually destroyed alot of the build up.

I was obturating this first molar ( surprise surprise – 4 canals , which I find all the time with the scope now) the other day and doing a buildup with a fiber post the other day and thought I would shoot some pics of the procedure.

WE use the System B in a technique taught to me by Yosi Nahmias from Ontario that first puts the plugger at 100degrees for the initial downpack and then up to 300 degrees for the final part (quick downpack). It is held in place for 8 secs and then another quick burst to separate the plug from the tip.

We use Niti pluggers from Joe Dovgan sold by Vista I think to plug the apical warm mass and then the Obtura 2 to backfill the canals.

We filled both mesial canals at the same time as there was some communication between the too and this creates greater hydraulics if you have a cone in each at the time of downpacking.

Used the erbium laser to remove the smear layer prior to bonding and placed a flowable over the Mb 1, 2 and DB canals. The palatal canal didnt get alot of backfill from the Obtura as we placed a resin post for retention of the composite core.

I then used a diode for troughing around the margin and took the impression and a post op PA.

Hope that shows how the erbium laser could be used for disinfecting the dentin and removing the smear layer and how the diode could be used for troughing.

Take care and thanks……….

Glenn

November 24, 2003 at 12:23 am #6203 Reply

vince
Spectator

Very nice Glen. What resin cement do you like to use to bond the post in place?

Awesome pics. Take care.

November 24, 2003 at 1:09 am #6206 Reply

Glenn van As
Spectator

Thanks Vince, I use Resinomer cement I think it is from Bisco which is a dual cure resin cement. I often use the Argon laser to cure the cement immediately but my Argon is down and awaiting a part so I used regular curing……..

With the Argon it is set instantly.

Take care and all the best.

Glenn

November 24, 2003 at 5:02 am #6204 Reply

ASI
Spectator

Hi Glenn,

Very nicely done. Man, that pulp chamber floor looks pristine!

Did you use a 200u fibre to decontaminate the canals? If so, are you using it routinely?

Please tell me more about System B technique.

Andrew

November 24, 2003 at 6:40 am #6207 Reply

Glenn van As
Spectator

Hi Andrew: Thanks for the feedback. I have seen guys use AA with the pulp chamber floor but I dont like the mess with the scope but it is also useful to clean the sealer off. I use a 200 or 300 micron endo tip 3 mm from the apex with water for 30 secs per canal. My tips are shot so I need some new ones (for the Erbium yag of course). There seems to be less tissue in the canal after I use it, but make sure that you keep it from the apex 3mm or you will widen the apex.

System B is sold by many people (in the USA its sold by Spartan Obtura but here in Canada it is sold by Sybron and Patterson as well I think).

Steve Buchanan started talking about it in the 90s for his vertical wave condensation technique which I have modified to try and prevent pulling out cones and to try and get a little more pressure on the downpack.

Some people prefer the Touch n Heat and Schilders old manner of sequential searing and softening of GP down to a couple of mm from the apex (usually 3-4mm) but I like the System B and the Buchanan technique that we have modified.

Lateral condensation works ok but I do get the odd accessory canal now with the warm GP that I never got with lateral………Is it important ……..who knows.

Glenn

November 25, 2003 at 1:15 am #6209 Reply

Swpmn
Spectator

Glenn:

I like the way you do your preps with the nice shoulders. Not always possible due to tooth inclination or other factors but good when we can give the technician a true cut back margin. The diode laser works great to create a trough below the margin so we get a “flash” of impression material and makes it so easy for the tech to trim the die. I can’t see as well as you but this is what I also try to emulate.

Al

November 25, 2003 at 3:09 am #6208 Reply

Stewart Rosenberg
Spectator

Beautiful case Glen and fantastic pictures. It really makes me more and more anxious to get my scope already. I’ve been borrowing one from Stefan Luger of Seiler for my courses but it’s his demo and he keeps having to take it back.

Stu

November 25, 2003 at 4:42 am #6205 Reply

Glenn van As
Spectator

Hi Allen: You know for Procera I hear a chamfer is preferable but I seem to always prepare shoulders. For an endo tooth I dont worry about the amount of tooth I take off but I tell you that its not easy to work at 10-16X mag but its harder to show you my dentistry at that mag as every little dip and fault stands out.

I like the diode for troughing compared to the erbium as I dont think shaving or planing tissue creates the ideal trough and in addition I think that the erbium is tough on inflamed interproximals (that only happens with my poor OH patients not in florida)

I am glad that you try to emulate anything that I do as before I got the scope …..NOBODY care one iota about anything I had to say , not even my wife……

Come to think of it she still doesnt care one iota.

Thanks for making my day.

Stu …thanks for the kind words. The microscope is a whole new world and the photos which for me are routine now still cause people to stop and look and say hmmm…..

Like when they can see the apical plug of GP 3-5 mm from the end of the root……it gets them to think.

Stefan is working hard to network on the net and I give him full marks for that.

The scope slows you down but it sure helps out in those tough cases of endo and restorative work when we can barely see what the heck we are doing.

Take care Stu and maybe one day I will get out your way.

I am going to be lecturing and a hands on at the DC meeting in May, and I know you are here in Vancouver lecturing on lasers for the Pacific Dental meeting but I will be in Palm Springs for the ALD meeting the same weekend.

Take care and talk to you soon.

Glenn
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