Hi David,

Wow! Quite a series of events. Nothing that most of us have not seen before but certainly maybe not all at one appointment . That unit coming off the wall is a new one though. Better that than some overhead mounted equipment.

I feel your angst, David. Have a glass of wine and a good laugh.

Cheers,

Andrew

Hey David,

Andrew’s right. That’s one to have glass of wine over……..would you like some cheese with that whine?:cheesy:

You know, with all our talk about the PerioLase for, well, perio, not a lot of discussion is made about its ability to remove that sort of decay using the short 100usec PD. Not a reason to buy one, in my opinion, but it would be there to assit in this sort of decay removal and clinical challenge.

Bob

Dave:

Funny story, I’ve got tons like:

When we set a patient’s bib on fire during an endo procedure; a giant Florida roach slowly crawled across the wall while I held an impression and the patient watched(the roach); lost a Peeso reamer in a female patients’ brassierre(found at the local hospital’s radiology unit); when the control unit on my fancy new electric handpiece blew up like a Fourth of July firework complete with smoke; or my all time favorite when I released a teenage girl from the operatory, she fainted in the hall and then her twin sister promptly fainted and collapsed right on top of her!!!!

But back to your findings, why is it that sometimes it seems that caries is the most difficult thing to remove with the erbium? Is that why slow speed burs and spoons are often recommended? Particulary on Class I and II lesions it seems at times I have difficulty with complete caries excavation. OR, do you think it really matters? Can we remove the majority of the caries, avoid a pulp exposure, properly bond the restoration and still be OK? I’ve changed my tune a bit lately and may be leaning toward the latter view.

Dr. Gregg’s point regarding the Nd:YAG is noteworthy. He once guided me on the removal of pigmented dentin lesions with the Periolase. Literally “pig-mented”;)

Anyone else having success using an Nd:YAG to excavate dark, pigmented carious lesions?

Al

Great questions, Al.
Could it be that the  caries is more difficult to remove because the leathery or rubberlike caries absorbs some of the ‘explosion’ from vaporization and then you don’t get the same efficiency in ablation as you would with ‘hard’  enamel or dentin? You know, eric’s ‘for every action there is an  equal and opposite reaction’ ( enamel gives a harder wall to recoil against -just guessing, of course). I think the spoons and round burs are just a matter of convienence and speed.

As far as total caries removal, I think as Glass Ionomers become more popular there will be a change of thinking in this area, especially if ozone pans out.

Finally, I’ve never bothered to use my nd:YAG for the pigmented dentin lesions. Just too many other ways to do the same thing w/o using a second laser.

Ron:

Thanks for your thoughts – that’s a good theory. Soft tissue is “soft” and wouldn’t provide much recoil either, yet it seems to ablate fairly efficiently with the erbium. Is that simply because it has a high water content?

Perhaps it’s not the caries itself that is difficult to remove with erbium but more related to depth and type of preparation. Particularly with the Class I we are shooting a laser beam into a “toilet bowl”, so maybe the irrigation water pools and absorbs most of the erbium energy? Maybe Dr. Gregg can help us here.

Are you using ozone therapy? I have some cases going on two years where not all caries was removed yet the patients are coming in for recalls without symptoms or clinical/radiographic findings. In many of these cases Vitrebond glass ionomer/resin has been placed over the incompletely excavated caries, others I’ve “self-etched” with Clearfil SE and then overlayed with flowable composite. Seems like I’ve heard there is some research showing it may not always be necessary to completely excavate caries.

Thanks for your input regarding the Periolase Nd:YAG for pigmented caries removal. Any thought on using an uninitiated, defocused 810-830 diode fiber not to remove but to disinfect or perhaps “carmelize” pigmented caries??

Al

Ron,

“Finally, I’ve never bothered to use my nd:YAG for the pigmented dentin lesions. Just too many other ways to do the same thing w/o using a second laser. “

Number of ways? Yes.

Quality of result? Hmmmm……

What about increased dentin bond strength post FRP Nd:YAG caries removal/dentin etch?

Bob

Is there something that shows a better bond than what’s obtained using an erbium to remove the smear layer after use of a spoon or round bur?