Mark,

Great information. I assume that you are recommending 15% air and water. Water being the important factor. Without it the “heat” is noticed.

I have been focused on water setting lately, and wonder on another subject, why we expect the water to travel the distance below tissue level to the tip when doing endo or in “zapping” a fistula. The water amount has to be too low at best and probably non existent the majority of the time at 20 Hz. A case where we are using the Erbium for effect like a NdYag. [Big picture, Bob, I know there are different absorbtions.]

Having only tried the DRK liq on myself under the tongue, it does not seem possible that one can grab the frenum and fire up the Erb. What is your take on its effectiveness?

Thanks for getting back to me on the tips and settings right away.

Mark,

Your recommendations were right on.  I saw little Mack, the 4 year old with the lingual tongue tie, and it worked better than expected.

I used my Erbium YSGG (classic) with your recommended Z-6 tip at 1.0 W with 20%water and 15% air.  The DRK liquid was applied with a cotton swab for 3 minutes on both sides of the frenum from the tongue to the attached gingiva.  On observation the attachment at the gingiva was at the mucogingival junction already so I did not ablate it, but the tongue had a tight frenum all the way to the tip with an obvious fibrous band at the crest of the frenum which blanched when stretched.

I clamped the frenum.  That was the first amazing thing.  No pain or reaction from Mack.  I just dissected the frenum from the underside of the tongue and around the hemostat avoiding the salivary gland duct. Man did it gape open when completed.  And suddenly it was done and without any, and I mean any, bleeding.   When we showed the Mom she was the happiest of all of us.  Almost to tears.

It took 10 minutes total.  Pre-op I tested his tongue reach and he could not touch my finger placed just under his vermillion border of his lower lip about at the gingival crest level.  Post op we have a reach to the mid chin button.

As recommended earlier in this post, I am relying on a motivated mother to keep him on task several times daily putting his tongue out to touch a finger placed at this spot.  I did not think that suturing would be possible given that we had tested his patience to this point.  I have had great sucess using a suture for maxillary fenectomies, but at least there is an alternative with the lower one.  New territory for me, so after 37 years of practice, I am still learning.

A very big THANK YOU to all who have given advice on this subject on this forum.  It is the only conduit for this information I have found.  Without it, the treatment and impact on the patient would have been very different.  

For that reason, we all share in the successful treatment.  :biggrin:

I wish I could convey the happiness of the mother in seeing that her son did not have to endure the recommended treatment of the Speach Pathologist and Oral Surgeon.  Truely miraculous in her eyes and grateful beyond words.

(Edited by Lee Allen at 1:30 am on April 1, 2006)

Thanks Glenn,

I am thankful for your comments.

While I am not the most adventurous with my Erbium, when success of this magnitude comes along, I wish I were 20 years younger and I would commit more resources and time to laser dentistry.

Since you asked, ideally, I would have at least 2 more: the FRP NdYAG and a diode to compliment the Erbium. Perhaps investigate a CO2. And of course light and magnification: the microscope. Ahhh.. enlightenment that comes late.

Thanks again, everyone.