Post LLLT Ulceration - Laser Dentistry Forum

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August 21, 2003 at 1:59 am #2936 Reply

drlam
Spectator

Hi Folks,

I have a waterlase and I’ve started using it for what they called “LLLT “for my patients against bad breath.

My settings are 0.25 Watt /11% Air /0% Water. I lased the gingival sulcus for about 20 seconds per tooth.

It was so far so good until last week. Two of my patients that had been treated with the said “LLLT” procedure showed up yesterday claiming that they suffered from severe buccal mucosal ulceration. Clinical inpection revealed linear ulceration along of the bottoms of the buccal vestibulules just apical to the two first molars, about 1.5 mm long on one patient. The other patient had similar ulcerations but were located only on areas around upper right first molar and lower left incisor.

Do anyone of you have any clue why and how it happened?

Sincerely,
Wai

August 21, 2003 at 2:29 am #7347 Reply

Anonymous
Guest

Wai
Have you had your pk settings checked. You should be able to do .25W 0%air/ 0%water and get colser than 2 mm to your hand w/o it feeling hot. I just had mine reset.Could be things were just too hot.

August 21, 2003 at 9:21 pm #7355 Reply

Robert Gregg DDS
Spectator

Hello Wai,

I’ve only heard of “LLLT” in reference to “Low Level Laser Therapy” in using lasers for biostimulation.

Your mention of LLLT here suggests an intended direct effect on the offending tissues (e.g. sulfer producing anaerobes like p. Gingivalis).

What is the source of this protocol and what does LLLT supposed to be an acronym for?

I think the use of air in a pocket could be the source of some ulcerations due to an air embolism.

Let us know how your patients respond.

Good luck.

Bob

August 22, 2003 at 3:10 am #7349 Reply

drlam
Spectator

Hi Ron and Bob,

Thank you for your response.

So according to Don, it was the setting “11% Air ” that went wrong. As for heat generation, I really had no idea because the patients I treated didn’t tell me anything like that to me at all.

I think I misused the term “LLLT” for the sulcular debridement procedure I did on my patients.

The two patients I mentioned that came up with the severe ulceration actually had their symptoms subsided in about a week. And for one of them, because by the time she showed up she was still feeling pain, I treated her with the Laser Smile ( Biolase), 1.5 w for 20sec, then 1.7w for another 20sec( 2mm from the ulcerated surface). She immediately had most of the pain relieved.

Question:
Is it a better option to use diode laser ( Laser Smile) for sulcular debridement?

Take care,
Wai

August 22, 2003 at 4:53 pm #7356 Reply

Robert Gregg DDS
Spectator

OK Wai,

I’m with you now.

QUOTE

Question:
Is it a better option to use diode laser ( Laser Smile) for sulcular debridement?

Yes. It’s an entire level of magnitude better than erbium for SD.

And better yet by a similar order of magnitude of desireable tissue response (and control over deliterious effects) is a free-running pulsed Nd:YAG.

Glad your patient are doing much better. Wheew!

Bob

August 24, 2003 at 4:02 am #7350 Reply

drlam
Spectator

Thanks Bob,

I appreciate your prompt response, though I don’t really know what a free-running pulsed Nd:YAG is.

Take care,
Wai

August 24, 2003 at 1:20 pm #7348 Reply

Anonymous
Guest

Wai, follow this link for info-
Periolase from Millennium Dental

August 27, 2003 at 3:04 am #7351 Reply

drlam
Spectator

Ron,
Thanks!

Wai

August 30, 2003 at 12:06 pm #7354 Reply

moguldoc
Spectator

hi,

I’m new to waterlase. (1 week). My rep/trainer taught me to use close to those settings (.25W,15%AIR/15%H20) in the sulcus for anesthsia effect. From the sounds of it I’m dancing on the fringe of a post op problem. Any suggestions?

September 28, 2003 at 5:18 am #7352 Reply

drlam
Spectator

Hello David,
Sorry! I havn’t visit this forum for a while.
From my experience, I don’t think your setting can achieve any anesthetic effect on your patient’s teeth. What I heard from the waterlase guys is 5.5W 60%Air 90%Water, bathing the tooth for about a minute. I tried a few times before and found it not very effective. Any other suggestions?

September 29, 2003 at 2:53 pm #7353 Reply

marc andre gagnon
Spectator

hello Wai
I’m a diode 980 user since more than 2 years and I can assure you than I have very good results for sulcus debridement with that wavelenght.
You can do curetage with the diode 980 without anesthesic in most of the cases because of the use of water .You can see case like yours with better results at http://www.biolitec-us.com
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