Hi Ron: nicely done, I bet the patient was very happy.

It seems as OH was an issue due to the inflamed tissue on the maxillary anteriors and also the decalcification on the right lateral

I blew up your image and had a look at it and although it got pixelated, it seemed to suggest that there was some etching on the centrals near the gingivectomy. Particularly on the right central.

I always caution people that this can be caused even by .75W with erbium lasers if you angle the tip towards the tooth.

What positiion did you hold the tip and did you shave the tissue back or cut it of in one chunk. Shaving it back you might avoid etching the tooth. Cutting it in one chunk will necessitate that you position the tip towards the tooth and then will cut the tooth.

Dont get me wrong…….I think it is a wonderful result but in my mind for large gingivectomies the soft tissue lasers offer peace of mind with respect to non etching of tooth structure and with better control of hemostasis in these inflamed tissue cases like post ortho or gingival hyperplasia due to drugs.

THanks for posting a very nice result, and have a look at the full sized pictures of the gingival aspect of the centrals to see if there is etching of the surface……

THanks for sharing and its a great case.

Glenn

Looks real nice Ron.

How did you apply the EMLA?  Just dry tissue then paint on and or did you do something like soak a cotton roll or gauze in EMLA and let it sit up there for 6 minutes?

Al

(Edited by Swpmn at 1:47 pm on Aug. 14, 2003)

Again Ron , let me re- emphasize how nice a result it was. DOnt think for a minute that I am criticizing you.

I know that by now you are an expert , but neophytes might now realize that this can happen. This is like the discussion that is occuring on Dental town with respect to the Waterlase being used for perio pocket reduction.

I am just not a big fan of this wavelength ( or any erbium) being used as a panacea. Waterflow from the laser is cool , but I do think that the soft tissue wavelengths have a place in the practice of dentistry and am posting a case as we speak of a fibroma removal on the lateral aspect of the tongue.

I could have done it very very fast with the erbium but the concern of hemostasis is a very real one and I was worried it might bleed horrifically.

You are a master Ron with the erbium but I worry that the neophyte using the laser may get ALOT of etching if they angle the tip at a perpendicular angle to the facial aspect of the tooth or even a 45 degree angle.

Nice case with EMLA only…..

Congrats again on a fine result, and I just wanted to emphasize to use caution with the erbium around tooth structure ( ie pockets or gingivectomies ) as inadvertant damage to adjacent tissues is possible as the erbium wavelength is not selective for tissue only like the soft tissue lasers are.

Glenn

Ron, Nice! You are using .75W with 15a/8w. I expect that this was in contact? Have you tried this at any higher settings in a defoucsed mode. I have been trying about 2W with 60a/30w as defoused. Hemostatus seems good ( except on the thin tissue) and it appears easier to thin. I can do a larger area and seem to have more control and the patients feel nothing.
Glenn you are killing me with the scope!
DAvid