Forums › Laser Treatment Tips and Techniques › Soft Tissue Procedures › perio with warelase
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Glenn van AsSpectatorThanks Andy………I will never ever have a problem with constructive criticism of my cases. I do what I can but it is never the be all and end all. I would like to get a case that the periodontal community will look at and say hmmmm…..
I wonder in a case like what I have shown whether the lesser of two evils is a little bit of reverse negative architecture or a full flap with associated recession, full scale bone removal that is graduated, dark triangles , food entrapment and sensitivity.
Now if I were to have raised a flap and just removed bone distally with the laser , and then bring the flaps back together for primary healing one of the first issues would have been handled.
I think that I can handle tissue better than I do at present and am doing the following…
1. Got some reading material on flap designs.
2. Going to get some microsurgical instruments so that I can raise flaps with them.
3. Gonna try and get a course in flap designI still think that many patients will prefer the laser and its non contact format to a bur for bone removal but that is personal preference.
Andy , you have already shown me more than many in the perio field by having an open mind to lasers. I respect that.
I am always open to constructive remarks and will return again to your post to see if I can improve on my cases while still retaining the laser for use of bone removal.
Perhaps then periodontists will only be able to question the role of the laser, but not the rest of the treatment.
Thanks Andy
Glenn
Andrew SatlinSpectatorHi Ron,
A healthy periodontium is described as having “positive architecture” when the interproximal bone is coronal to the buccal and lingual bone. The goal of osseous recontouring is to restore this ideal architecture to a periodontium in which bone loss has caused negative boney architecture. This will result in pocket elimination for long term maintenance. So yes, boney defects can be described as negative arcitecture in a localized respect.Glenn — Your points are excellent. In fact they are among the main reasons I have gotten involved in laser treatment. In many situations, I felt that the “side effects” ( root exposure, sensitivity, black triangles, removal of healthy supporting bone) were too severe to warrent conventional surgical treatment. I commend you on your quest to learn more about periodontal microsurgery. It will certainly help you and your patients depending on their specific needs.
Talk to you all later.
Andy
BNelsonSpectatorGlenn,
Fantastic case and I love the quality of the pictures. Do you have your power settings to share with us?
Glenn van AsSpectatorHI Bruce….thanks
I use the Argon most times at CW around 1.0 watts.
You can use it higher but then you need to put the laser in pulsed mode 0.2 secs on and off.
For the erbium I use the 600 micron tip most times if it is a big area to lase……maybe gonna start using the chisel tip which has a larger surface area for the bone relief.
I typically will use water on, and use 30Hz and 100 mj or so. You can use more. I wonder whether we should use high settings. As long as the water is on, I dont know if there will be any damage…….
What do you think.
Thanks again Bruce for the kind words.
Its all just me trying things and then posting it for discussion to see how it can be improved. Slowly but surely I am getting a little bit better at using the laser through the magnification, the tips from so many, and trial and error. Its the nature of the beast and I guess why the call it the practice of dentistry, not the perfection of dentistry.
Cya
Glenn
Andrew SatlinSpectatorHey Ron,
I realized that I only answered half of your question.
Re: Natural or laser stimulated remodeling. I would say around a restorative margin no. In fact I think if anything, it would lose attachment in the direction of a boney defect due to the proximety of the restorative margin which is difficult or impossible to keep plaque free. Also, the defect we were originally discussing was surgically induced. These behave differently as well.In regular plaque induced perio defects–we will see. That is regeneration.
The final point is that patients, as you have probably seen, can tolerate a certain degree of negative arch. as well as different biologic widths. It is hard to use these specific rules when each patients tolerance is so different.
talk to you later
Andy -
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