Magnification and the Erbium Laser - Laser Dentistry Forum

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December 18, 2002 at 4:54 am #2889 Reply

Glenn van As
Spectator

Hi guys……..reading dental town tonight the laser guys are posting.

One of the interesting things is that many users when they first start using a laser complain that it isnt cutting or that they are breaking tips.

One of the most important things in my mind is magnification. Mark uses 6X loupes, and soon a scope. I use a microscope which is often at 10-16X power, and it allows me to see beyond the water, to focus on keeping the tip at the optimum point away from the tooth to cut fast but not damage the tip prematurely. I do believe that 2.5X loupes as a minimum will really help you and that the higher the mag the easier it is to use the laser effectively.

I was looking through old photos tonight and I have literally thousands and stumbled upon this one and thought to myself this.

Without the tactile sense we all develop with handpieces in both low and high speed, lasers require much more visual clues to evaluate how we are cutting. The importance of vision for effective cutting is not related to whether you wear glasses or not.

The resolution of the human eye is 200 microns and the Continuum tips are either 400 or 600 microns, clear quartz , and have alot of water spray cooling them and they are required to be a set distance away in thin air from the tooth to cut ( with Continuum it is 0.5-1mm)…….

Hmmm………wonder why some people have trouble seeing it cut.

For those of you using loupes, tomorrow take an extracted tooth, put on the patients safety glasses and try to cut a prep. You will find yourself to be ……..slower, cutting a much bigger prep than necessary and frustrated.

i know because I had a fellow from Iran in the office trying to use the laser last week and he saw me use it on a patient under the scope ( he watched on the monitor) and then we used it without the scope……….he told me……..hmm……….it isnt cutting as fast as when you used it!!

Nothing had changed!

Heres the pic and let me know what you are using for magnification and what it has done for you.

Oh heck I am biased towards the scope and the benefits of magnification for ALL dentistry , and hopefully when Mark starts using the scope he will see the value that I see.

Take care and as I have mentioned many many times, I value your tips here and your friendship, and in this season of joy I wanted to wish you all a most happy, safe and enjoyable holiday season.

Glenn

December 18, 2002 at 4:58 am #6878 Reply

Glenn van As
Spectator

Aw darn it all the first image was too big……….here is the resized one at 640 by 480……….

Take care………
Glenn

December 18, 2002 at 12:17 pm #6881 Reply

Patricio
Spectator

Glenn,

In my own case I went from 2.0 to 3.5 mag. and fully understand what you are saying. Until you can watch it cut you cann’t optimize the cutting. For me there has been a learning curve to get the light, the scopes and the patient all at optimum distance while working. I am still having a hard time with upper teeth working in a mirror which frequently had water on it. Any suggetions for improving mirror vision. The assistant is spraying air but with other things to attend to we have periods of poor vision or obstructed vision with suction etc. Based upon your experience I imagine I will want something grander as I go forward.
Pat

December 19, 2002 at 1:16 am #6882 Reply

Swpmn
Spectator

Glenn:

No doubt. I’m convinced that magnification is absolutely essential to ablation of tooth structure with the Erbium laser. I use Designs for Vision 2.5 loupes with headlamp and probably will eventually upgrade to higher mag loupes.

Does the Continuum laser have optic illumination? I looked at the Cavilase by ADT and thought that the general idea of the 45 degree beam(vs. 90) with light illumination and offset water spray was fantastic for improving vision. Would like to see Biolase upgrade the handpiece with the same features the now dying Cavilase presented.

What do you think or did you get a chance to see the Cavilase concept? What is the beam angle from the handpiece with the Continuum as I know nothing about your laser. I know you have mentioned there are two handpieces, one straight and one contra-angled I think?

Al

December 19, 2002 at 6:51 am #6879 Reply

Glenn van As
Spectator

Hi Allen……..great to see people with an open mind……..

One of the handpieces is exactly like the biolase.

The other looks like a pen and is straight and this is the one I use because it gets the head out of the way so I can see.

There is a white aiming beam on the Erbium and the tips come in Straight, 30 degrees, and 80 degree bends and the tips come in 400 and 600 microns wide and they are making all sorts of new tips all the time (like the chisel shaped tip I am using for flaps and the endo tips.)

Here is a picture of the delivery system……..does this help at all.

Glenn

December 19, 2002 at 9:12 pm #6883 Reply

Swpmn
Spectator

Glenn:

Thanks for the photo, now I understand. Could tell from your magnified photos that your system was much different than mine but couldn’t quite get the whole image until today.

Al

December 20, 2002 at 4:52 am #6880 Reply

Glenn van As
Spectator

Hi Al………it is like a pen with different tips which I find to be better in two locations than my handpiece.

1. Buccal pits on lower molars where the cheek gets in the way as the patient tenses up and in addition with the Continuum handpiece I can come from the anterior and not get in the way of the cheek.

2. On occlusals of 2nd molars when the patient wont open up far…………

Its not often I do the occlusals but when I do the height from the tip of the laser to the head of the handpiece is much less than a bur and handpiece.

Glenn
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