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Hi folks : heres hoping a great start for you all in 2003 both professionally with your lasers and personally with families and friends and relatives.
I just thought that it would be nice to show a failing F/S (fissure sealant) case.
I dont often put F/S in teeth anymore. Back in the mid 80s when I was in dental school we were taught if it wasnt sticky, just stained to seal it.
Not a great idea in my mind as the diagnodent show all these stained grooves are above 25-30 except in smokers. The fluoride in the toothpastes makes the enamel harder but its still decalcified and the FS doesnt stick to them.
I dont think that etching the surface and placing a sealant seals these teeth at all. In fact I think that it just acts as a food trap.
With the scope I often see at high mag shadows under the sealants when looking at them or a piece will come off and I will remove the rest and lots of times there is decay under them.
Occlusals are the hardest teeth to prep with the laser so often I will do a hybrid technique using the laser initially to anesthetize a bit, then a series of small high speed burs ( 1/4, 1/8th or 1/16th burs from Brassler) to widen the preps and remove some decay and then the laser again to remove the smear layer.
If the decay is into dentin ( it often is) the patient feels the burs if you dont use the laser sometimes.
THe laser removes the F/S very very fast, and in addition if you dont follow the grooves with the laser tip but go back and forth over the grooves perpendicular to them you get a much better result ( you flatten the cuspal slopes ) and then can get into the grooves faster.
Here is a microdental case, I usually fill them with flowables.
Happy New Year to you all , man 80+ members now.
Hey Ron it sure would be nice to have a member page with a profile, where you practice , what type of practice you have, what lasers you use , when you graduated and a photo so we could see who is a member here.
Great to put a face to the name……….
All the best.
Glenn
Here is another microdental prep where no decay was visible under the sealant when I got it off and the decay was localized to the distal pit.
Into dentin it was 3mm deep.
Flowable as well placed. I have not noticed them breaking down in the 2+ years I have been doing them this way but others may beg to differ.
I would love some feedback from Ron and others as to the value of the photos and also the layout that I am using.
i am trying to keep the size down so that I dont use up all Rons space and hope that this is suitable for all parties involved.
Glenn
I can also post it to another site Ron, like Sendpix if it is a problem.
One more for the road. I just thought I would post one last case to show you how sneaky those non cavitated lesions are.
I have mentioned that caries detector gel on erbium preps gives false positives on enamel, and is tough to remove. Here is the visual proof.
Preps are around 3mm deep and in addition flowables were used.
Glenn
