- This topic is empty.
-
Hi folks: I took some time to go to Danny’s great surgical perio restorative course with Bill Strupp and it really was fun to be there. I think I learned some stuff as well.
Hack2 , Andy and Danny have preached surgery with or without lasers in an open flap environment and here is a case I did today that required osseous surgery. I have the three of them to thank for any successes and of course me to blame for any mistakes.
In this particular case (having seen some of Bill Strupps work) I am trying to do more quadrant type work. I did an MO on the 2nd molar and a DO on the premolar with direct resins. Then in Dannys course I learned to temporize first so I then prepped the first molar and this tooth had the need for osseous on both the mesial and mesial buccal line angle of the tooth.
If its multiple surfaces or multiple teeth I find visualization with open flap and the laser for surgical bone removal to be the way to go. After prepping the tooth for the crown you could see how deep the mesial was so I used a diode at 1.1w Continous Wave to get some hemostasis and then made a provisional crown. I flapped the case with a microsurgical blade and proceeded to raise a fairly minimal flap. (The endodontics for this case was done by my associate who has since left but did a decent job not perhaps getting to the end of the distal root quite perfectly).
Osseous took place first on the MB root, then on the DB root and finally on the Straight Mesial which was more difficult from an access standpoint. I used a chisel tip at 30 Hz and 140 mj and 40 Hz and 115 mj. The 400 micron tip with alot of water at 50 Hz and 30-40 mj. This smaller tip has the propensity to create vertical defects if not used at very low settings. It will pluck the bone. I use hand instruments to remove bone fragments and finally if you want you can try ultrasonics to remove tissue or bone adhering to the root.
I closed the case with 5-0 vicryl sutures interupted (Hollywood sutures as Danny likes to call them) and then cemented the temp with ZnPO4 because I didnt have Durelon or the cement Danny prefers (Darn it all forgot which one that is).
It took me 2.5 hours to do the whole case and I know its a long time but I needed time to think it all through.
I hope that its of interest and again I can handle some constructive criticism on anything you see that I should have done better. The buccal was easier to do then the mesial which was tough to create the parabolic ,and flowing contours that Danny likes.
Anyways, hope its interesting.
Glenn
I like what you’re doing..and I’m not sure I want to see my cases mag’d that high.
One comment-DB of the molar-I’m sure you smoothed it in a later photo, but notice what the end cut of the chisel tip creates in that area that you smoothed out later. A little divot-may be easier to smooth is out with something that is not solely end cutting…..you’re doing very nice work however. As I said, I’m not sure I want to mag my work that high
Hi Lee: I am constantly changing my ideas based on what I find closed flap going to open, and open flap plus what Danny and Lookin4t and also Andy advise.
In general for open flap
Chisel tip is first at 40Hz and 110 mj or for higher energy 30Hz and 140mj with lots of water , and little or no air.
Chisel tip is 400 by 1200 microns (I think) or its 400 by 800. I think it is the former not the latter.
For the 600 micron tip 50Hz and 50mj or 40Hz and 60-70mj or 30Hz and 70-90mj
For the 400 micron tip 50Hz and 30 mj, 30Hz and 50 mj.
HOpe that helps and check out these 2 week healing photos of the case I did above when I took out the sutures on Monday.
Glenn
