Osseous Recontouring Case - Laser Dentistry Forum

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February 14, 2003 at 5:19 am #2888 Reply

Glenn van As
Spectator

Hi folks: Today I had this case where a patient had fractured a maxillary lateral incisor at the gingival.

My associate did the endo and put a post in the tooth but the crown didnt fit too well and there wasnt enough tooth to put a post and core on, particularly on the buccal (more on the palatal)

I did a crown lengthening today and used the erbium to cut the flap using the unique wedge type tip that Continuum has (amazing how little hemorrhage there was) and then raised the mini flap and removed bone with a 600 micron tip with water. I then actually reduced the flap height by using the laser to reduce the edge of the tissue, and then used the Argon at 0.4w to “tissue weld” the flap back together without sutures. You heat up the tissue so it gets tacky and draw the laser across the flap.

Laser periodontist Larry Finkbeiner showed me this a long time ago and it does work if you dont have the wattage too high.

I like the final result , will see the patient for photos tomorrow and show the healing photos…….

Got it all on video.

Hope you like it…….the flap I cut with 30 Hz and 120 mj without water.

I cut the bone with water at 30 Hz and 90 mj.

Flap reapproximated with 0.4 watts Continuous

Glenn

February 14, 2003 at 5:24 am #6868 Reply

Glenn van As
Spectator

Here are the radiographs from before I started the case.

Glenn

February 15, 2003 at 12:51 am #6875 Reply

Patricio
Spectator

Glenn,
Once again these visuals are very helpful to me. Thanks for posting it.
Pat

February 15, 2003 at 3:15 am #6869 Reply

Glenn van As
Spectator

Hi Pat: here is a first for me………ONE DAY HEALING.

I was shocked, not by the healing but by the tissue height………

Its swelling I guess but who knows.

Patient had “ZERO” pain and was happy to come in today.

I will see him Tuesday again to check it out.

Glenn

February 21, 2003 at 7:10 am #6872 Reply

Glenn van As
Spectator

Hi folks: Here is the 1 week healing.

I like where the tissue is going on the buccal.

I like the way the flap healed with the “tissue welding” that went on………very cool in my opinion.

He is coming back in 6 weeks to cut of the crown and buildup and prep.

Will post those pics when he comes.

Glenn

February 21, 2003 at 2:40 pm #6866 Reply

drjingles
Spectator

Awesome case…and presentation Glenn…
where Dr. Finkbeiner be?
I remember hebelazin.com…

did you use the argon with water? or dry?
I remember he had some coaxial water spray
attached to his…

and how did you reflect?

very cool…

Lawrie

February 21, 2003 at 3:24 pm #6873 Reply

Glenn van As
Spectator

Hi Lawrie and welcome to this great forum.

I used the Argon at very low settings 0.4 w to just warm up the tissue and glue it together. I never believed it till I saw Larry do it.

He is still in Colorado Springs practicing quietly.

I reflected with a chisel shaped tip that Continuum has that really does a nice job (not as sharp) of cutting the tissue then elevated with a periosteal.

I am pleased with the healing for one week , what do you think .

Glenn

February 22, 2003 at 1:22 am #6877 Reply

Swpmn
Spectator

Cool case Glenn! Amazing healing.

Rodger Kurthy has also reported a “swelling” phenomena after crown lengthening with the Biolase Erbium – particularly with respect to the interproximal papillae.

Al

February 22, 2003 at 3:07 am #6874 Reply

Glenn van As
Spectator

Thanks Allen that is great to know because I was one worried person when I saw the 1 day healing.

With time it shrinks back down and I have the satisfaction of knowing that there is more solid tooth under the tissue.

Rod has done alot of perio and traditional crown lengthening and I want to get some small microsurgical instruments to help me raise the flap and some smaller sutures (6.0) to use. IT will make things look neater and more professional but I gotta admit the “laser welding” was pretty cool.

Grin

Glenn

February 23, 2003 at 3:56 pm #6876 Reply

Robert Gregg DDS
Spectator

Coolness to the max!

April 1, 2003 at 4:36 am #6870 Reply

Glenn van As
Spectator

Here are the pics from today where I did the crown prep.

Note how the vertical incisions healed , the pocket was 3 mm and I was able to prep the tooth and have a tooth 6mm long with a pocket after I reduced the bone.

I used the diode laser (diodent ) for the case and it worked out pretty well for the troughing today at 1 watt.

I also wanted to show you how we initiate the tip for the “hot tip” effect by using articulating paper (you can use a business card as well).

I think the case is coming along well, and hopefully you agree.

Take care.

Glenn

April 1, 2003 at 5:47 am #6867 Reply

ASI
Spectator

Hi Glenn,

Great result so far. 3 different wavelengths working together to achieve this. How wonderful to have them at your disposal. Glenn, you’ve got all the toys I too want to practise with.

How long have you had the diodent?

Andrew

April 1, 2003 at 7:13 am #6871 Reply

Glenn van As
Spectator

Hi Andrew: I had the diodent from Hoya Con Bio for 3 months about 9 months ago and then it went back.

PAC live did a hands on aesthetic course at UBC last weekend – the prep portion and then they left me a couple of diodes for a month til they need them for part 2.

I have almost finished piling up enough days for Hoya to get mine. I need a couple of more days and then I will have secured mine.

I like it, as it cuts different (less thermal damage in my opinion) than the Argon.

Thank for the kind words……….I tell you that the more I practice the more osseous cases I see coming through the door and I am starting to get very interested in purchasing small micro instruments to do the flaps.

GOnna do some more of these cases I think, as I quite enjoy them.

Cya Andrew……..

Glenn
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