Glenn,

Thanks once again for the kind words, my friend.

Etienne,

Nice x-rays!

You can see the effect of occlusal trauma on #18 with the apical thickening of the PDL, the wear facets on the distal (lingual?) cusp tips.

#19 has a semi-lunar bony defect in the buccal furcation area, as well as some PDL thickening. #19 also has evidence of occlusal wear as does #20. The wear has helped to decrease the force damage away from the bone, but the A-P deflective pathology is still present as per Thieleman.

Bruxism is just one of the many important indicators and a symptom of occulusal trauma.

I think I gave you the settings for your specific FRP Nd:YAG device in a previous email. Did you get that? I will look and resend.

Bob

Etienne,

Did you get a good clot at the end? Or was the tissue still bleeding? No Bleeding? No need to retreat. Just stablize the occlusion–it is an ongoing process of a year or more.

Did you fabricate a lower splint yet? Do that ASAP!

With pus and exudate I always give antibiotics–Amoxil or Augmentin 500 often combined with metronidizole 250.

Less lasing is a better therapeutic effect the larger and more involved the defect as I metioned in my email. That way you won’t lose soft tissue height.

Good luck on you both!

Bob

Etienne,

No hemostasis? repeat treatments will be necessary. Gotta get a “wet clot” for a stable fibrin seal. Need optimal laser operating parameters as we discussed in the emails.

That’s the need in order to do it one time only.

Minimal exposure on #8 like I emailed you and you should not lose the papilla. Piddle and play just for no reason and no observed benefit and you “slow-cook” and kill the soft tissue and it will recede.

Less is more in these situations.

Bob

PS: To all my Periolase friends who wondered why I was giving Etienne all the assistance w/o the benefit of a PerioLase–(what in the #&#36%^& is Bob doing?!)

Answer: To teach in the LDF environment like can be done no where else that would tolerate it by truly helping Etienne with an excellent case example of what laser perio can address and so he and others could learn that having the right answers and not the right parameters doesn’t get the controlled and optimal healing results. Technique alone does not get the results. Technology supports the technique. Technology w/o technique gets mixed even bad results.

Etienne’s patient will benefit from his efforts better than any other methodology or procedure he could offer to save these teeth–just as my many patients did–even though the optimal laser parameters/technique were not available for either of us at the respective times. The lack of optimal parameters can be compensated for if only by taking more time and effort than they might if all the right ingredients were available.

It is worth it this way? Not for practice productivity. But definately for one’s learning curve.

“You can’t see or hear this stuff enough.”