Not all my Class 1 cases are laser - Laser Dentistry Forum

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August 4, 2003 at 5:49 pm #2979 Reply

Glenn van As
Spectator

Hi folks: I sometimes find that these types of class 1 occlusals are tough to do with the laser.

This case was one where the microscope at 10 power showed me a shadow under both mesial and distal pits and the diagnodent was at 45 so I was a little worried about how the decay might spread out as it hit the dentin.

It is very difficult to guess how wide to make your prep with the laser, and even more difficult to go back and widen the access when the decay tracks laterally. The scope is great for hinting when there is going to be a problem as the shadows jump out at you due to both the magnification and illumination.

I post this because I did use the laser at the end to disinfect the dentin, but the prep was done with high speeds primarily and the patient wanted anesthetic in this case.

How do people like Mark Colonna and others who use the laser for everything handle these types of laterally expanding lesions.

Thanks

Glenn

August 4, 2003 at 5:51 pm #7821 Reply

Glenn van As
Spectator

Missed pg 2 of the photos.

glenn

August 4, 2003 at 5:59 pm #7820 Reply

Albodmd
Spectator

Glenn,
Was the patient not a good candidate for laser anesthesia? With my limited experience, I’m doing a lot of combination of laser and high speed. As long as patient is numb, they don’t seem to mind. I could do everything in laser, but it would take a lot longer.
Regards,
Al B

August 4, 2003 at 6:13 pm #7822 Reply

Glenn van As
Spectator

Hi Albert……..the patient was very nervous and wasnt willing to try the laser without anesthetic. She was one of those patients ………you know the type, so I didnt try it.

The problem is when there is lateral expansion it is tough to do with the laser, time wise it takes alot longer.

Just want to get some advice from others.

glenn

August 4, 2003 at 11:01 pm #7817 Reply

Anonymous
Guest

QUOTE

Quote: from Glenn van As on 1:49 pm on Aug. 4, 2003

It is very difficult to guess how wide to make your prep with the laser, and even more difficult to go back and widen the access when the decay tracks laterally.

Glenn , I agree .

What I’ve been trying to do lately is prep an outline in enamel where I think the decay extends to laterally and almost have the enamel in the center of the outline collapse in. Seems I’m almost always short of where I need to be and then the prep becomes more difficult and time consuming. I think part of underestimating is due to the magnification. I tend to stay smaller because it looks like I’m opening things pretty wide with the magnification, where in reality (no magnification), often times I’d have a hard time keeping the prep that small if I were using a handpiece.
Now that I’m sitting here thinking about this, I think next time I may try some transilumination with my curing light 1st to see if it might help me estimate where I should be. Could you gain some visibilty transilluminating w/ the Argon? (just thinking out loud)

While were on the subject re:class I’s- How do you all handle those black stained fissures that seem to go forever but are too narrow for Mark’s spoons, seems like the 1/4 rounds don’t want to touch them , and if you crank up the laser you get sensitivity (not asking too much, am I)?

August 5, 2003 at 5:12 am #7818 Reply

ASI
Spectator

Hi Guys,

I still use air abrasion selectively with the combined use of laser and handpiece. For those dark stains that are tough to get out and due to being narrow and deep in nature, I find air abrasion is a nice adjunct to the other tools.

Andrew

August 5, 2003 at 2:08 pm #7823 Reply

Glenn van As
Spectator

Hi Andrew: I think AA is a good tool, but do be careful with the scope and the optics and AA damaging the objective lens. Make sure you keep the plastic cap on the bottom of the scope.

In addition I can tell you that the particles play havoc with the light source as they seem to be attracted to it and will eventually attach to the fan element in there.

Ron as for the dark spots I will often use a 1/8th or 1/16th round bur, a very small diamond or a tip of a fissureotomy bur. I dont use the laser when I see those little dark lines anymore. Takes forever. If you have opened up with a G6, then you could try a G4 to finish but honestly a bur is quicker.

Interesting idea about the opening up of the tooth the way that you are doing it. Neat idea.

I have in the past tried transillumination but mainly on teeth where I have removed the caries and wanted to see if it was all gone with the Argon. It fluoresces under the Argon if it is still left (fluoresces a orange color).

Hope that helps but in all honesty I find these occlusal lesions that I showed you to be difficult to treat without handpieces.

Glenn

August 6, 2003 at 12:15 am #7824 Reply

Patricio
Spectator

Hi All,
When I find that my laser outline is not ideal I immediately grab the electic HS. My work is laser assisted as I place more value on patient comfort, speed and staying on schedule. As for the little dark lines which do not respond to the small round bur- God forgive me but I often leave them as being less of a risk than perforation of the pulp chamber or developing a neuritis. I am satisfied that stain and infection are not always synonomous. That’s after 39 years of not having a problem with this approach. Jetsfan don’t take me literally my memory is not that good. Problems if any were certainly few. Evidence based dentistry!

Today I had a patient and completed the following with the laser: Removed a large loose composite, desensitized six lower anterior teeth, preped an abfraction, anesthetized a bicuspid and removed an MOD amalgam with a bur finishing with the laser all quickly and without anesthesia. The patient was delighted and informed me she now wants six other restortions, a frenectomy, and two Empress crowns and two veneers.

Pat

August 6, 2003 at 4:11 am #7819 Reply

ASI
Spectator

Hi All,

Thanks for the advice, Glenn.

Pat, good for you. That’s the internal marketing power of laser dentistry!

Andrew
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