Soft tissue reduction - Laser Dentistry Forum

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September 2, 2004 at 3:55 pm #3355 Reply

kellyjblodgettdmd
Spectator

Two days ago a woman came in who was irritated with the stability of her denture. The story of how she ended up in a denture is too long to tell, but anyway, she hates the denture. We’re now treatment planning her for some implants.

Roughly where #14 used to be, she has a large bulbous mass of fibrous tissue. The area was grafted more than 5 years ago after #14 was exo’d due to sinus perf. To gain more predictable stability, we discussed decreasing the thickness of the tissue mass. She agreed.

Anyway, I chose to do the bulk reduction w/ YSGG laser, C6 tip (9mm) at 2.5W (45/20) for quick reduction, then coagulate the wound w/ the Periolase with the long pulse width (650usec) in a defocused mode, roughly 1cm away @ 20Hz, and 180mJ/pulse. She agreed to come back 24 hours later for a post-op pic.

At her post-op visit, she reported having no pain at all. A very happy patient. I think this illustrates the benefit of utilizing multiple wavelengths to obtain optimal results and patient comfort.

Kelly

September 3, 2004 at 7:25 am #10490 Reply

Glenn van As
Spectator

I like it, you know the Delight soft tissue tip is very similar in design to the tip you used. Love how the Nd Yag instantly clots the tissue. Bob Gregg is coming to Vancouver in two weeks tomorrow to lecture. I am thrilled and honoured to be with him and hope to at least keep the audience somewhat awake after lunch and after his riveting speech in the morning.

SHould be fun again to see Bob in action with the Periolase…. It will be simply DELIGHTFUL.

Well done Kelly, did the tissue go in for biopsy. Did you use anaesthetic at all if so how much. One other thing, I did some soft tissue reduction today (videotaped it) at different settings and sure enough it did start bleeding more once I used the water. It keeps the smutz down, the smell down as well but there is more bleeding with the water ( I did part without and part with the water). If you have the instant clotting of the Nd Yag its fine but is that sore at all (the long pulse duration) without anesthetic.

Glenn

September 3, 2004 at 2:23 pm #10492 Reply

Robert Gregg DDS
Spectator

Kelly,

Nice case combo!

Nice spread in Doctors of Dentistry too!

Glenn, thanks for the kind words. I’m looking forward to the Vancover presentaion. I’ve got some new “warts and all” clinical stuff to show the good, bad, and ugly of laser perio. Also have that case that you collaged for me. I have photos after opening it up for all to see–Danny Melker inspired!

With your caliber of presentation prowess, you have nothing to worry about. I’ll just be your warm-up…..

See ya!

Bob

September 3, 2004 at 6:51 pm #10491 Reply

Glenn van As
Spectator

SHould be fun…….I will post the erbium CL case in a minute, its 84 pics long in 21 collages so I am reducing size and editing at present. It will change the way CL with the laser is viewed I think.

Glenn

September 13, 2004 at 5:18 am #10489 Reply

kellyjblodgettdmd
Spectator

Glenn – sorry so long on the response. I’ve been in Maui celebrating my 10yr. anniversary – Just got back this morning.

The story of this tissue lump is a bit odd. The patient had #14 extracted about 7yrs. ago. She had virtually no sinus, and when the tooth was extracted the sinus floor came out. Of course, she was a smoker, so the graft placed over the site failed. It took a mongo tissue graft to finally close the sucker, and there is still little to no bone under the graft. She then had a bridge from #11-15 and the tissue underneath became hypertrophic to fill the “hygenic” pontic space. Once the remaining teeth were extracted for the immediate denture, the tissue just sat there. I didn’t send it to the lab, although the option was given to the patient.

She asked for anesthetic, so I gladly gave her 0.5 carps of Septocaine. Amazingly, this woman wouldn’t even come to see us unless we had the nitrous on full blast for the first three years I treated her, but over the last six months she has become really comfortable at our office (You can really bond taking out all of a person’s teeth!).

It would be very easy to coagulate at this distance even if the patient hadn’t had the local injection.

Hope this answers your questions. Talk to you soon.

Kelly
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