Forums › Erbium Lasers › General Erbium Discussion › Soft tissue recontouring with the Erbium Yag
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Glenn van AsSpectatorHi folks: When I had a couple of days with David Hornbrook in Costa Rica I got to see him lecture on using the erbium to sculpt tissue prior to veneers. It was a really good presentation and “stoked” my interest in trying some more stuff.
Here is a case I started today and what I am trying to do is “widen” the zenith on the Gingival height of contour as the teeth are quite V shaped and I wanted to make them more U shaped. The tissue was inflamed a little as well.
I used the 400 micron tip on these 3-4 mm probing areas to sculpt and shave the tissue prior to the veneer preps. THe settings were around 30 Hz and 30-40 mj without water in non contact or very light contact.
After I planed and shaved the tissue away, I used the chisel tips at higher settings (bigger footprint) of around 30hz and 60 mj without water to “debulk” or reduce the papilla. This is what I picture skin resurfacing to look like as I reduce the thickness of epithelium and flatten the papilla so they dont look so thick.
I did the preps then and the veneers (after taking the impression) and will follow the case up. I reduced the lower incisors quite a bit today to help with the occlusion. I had a waxup done today for the provisionals.
Hope its interesting and do you think I would get eaten alive on DT, as I am not in the mood to do so!!
Glenn
mickey franklSpectatorHi Glen
Great result.
Never new the papila can be thinned out,but it is always worth checking out your posts because one will always learn something from you.
Would love to see post op after a week.
Thanks for posting
Mickey
Glenn van AsSpectatorThanks Mickey…….gotta get some sleep now Work is in 7 hours.
I am glad that I have something to benefit those like yourself who are passionate and committed to laser dentistry.
I have often mentioned that there are a couple of reasons why I am able to do some of these things. One is the scope. It allows me an ability to precisely treat certain things that I would never have the confidence to treat previously. Another is that I live in Canada which is not so litigious yet, a third is that I have been using the laser for 5 years so I have learned a few things from my many mistakes along the way. Finally, working with Hoya and documenting these cases has caused me to go back and review alot of my cases and see now what I did wrong and my dentistry has improved I think. I am no longer focussed on restorative dentistry per se, but alot of advanced cases using the laser to help solve the daily problems I either referred previously, or didnt even realize existed (ie Biologic Width).
You know what, come to think of it, before the lasers I wouldnt have even thought to look at the tissue heights or Gingival Height of Contour and Zeniths like I did here.
its just something that I thought might be interesting, and I thought I would play a little today to see if I could improve more so on the esthetic outcome. I think it helped a little but the final result will tell the story.
Take care Mickey and your kind words really are thoughtful and most appreciated. Thanks and I will post the post op in a week or so.
Glenn
Dan MelkerSpectatorGlenn,
Beautiful sculpting of the tissue. Tough case because of the rotation of the teeht. Great cosmetic contours to the tissue. Very pleasing to the eye. Too many do not sculpt the contours of the tissue enough and the teeth appear flat and not contoured at the tooth tissue interface,.
This is the work of an artist!
Thanks,
Danny
Glenn van AsSpectatorHi Danny: humbly I say thanks for such a nice endorsement. The key is to make sure that you are not infringing upon BW. The probings were normal but there was some pseudo pocketing where the tissue was inflamed interproximally to 4mm. That is where almost all of the sculpting happened.
This is not easy to do with the diode, as you cant shave the tooth. You have to connect the dots in the diode case to do this and sometimes its tough to know how much to take off in an area. The diode can do a gingivectomy easily enough but its not very easy to debulk the papillae. This is very easy to do with the erbium just by its mechanism of action.
I think that the shaving of tissue or sculpting is something that could be used effectively in a peridodontists office as I am not sure if you have anything to help you withthis.
I actually had a lingual tongue tie+ frenectomy yesterday on a 6 year old boy. He was great but at the end I noticed some little tags on his tongue right where the lingual tongue tie attached. I was able to shave them off with the chisel tip to a smooth finish.
Its neat really, and as for the cosmetics, I just find I can shave a little , take a look, shave a little more etc, until I get the result that I am happy with.
Hope that helps and thanks, but periodontally I am much more conscious of not doing anything negative since you and hack2 posted about biology .
Cya
Glenn
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