Hey Jeff: excellent example of how the erbium cutting of tissue for gingivectomy would differ in angulation of tip compared to soft tissue lasers. Great Point.

Nice photos and thanks for sharing.

Interesting that with the Erbium hollow waveguide that what starts out as 6 watts (500 mj 12Hz) ends up as 2 watts.

Now is this loss because of bending the hollow wave guide or is there some other issue I am not aware of.

Do you think it happens similarly with restorations. What settings would you use for occlusal enamel.

In closing I got a chance to cut with the Opus at the ALD and enjoyed it and learned some things that I like and a few I dont. All in all it was very enjoyable to see how the Opus cut under the scope and I thank Rick for helping bring the laser into the meeting.

Thanks in advance and nice photos of two great frenectomies…….thanks for posting.

Glenn

As a Periodontist learning about lasers I still look at tissue. In the case with the mand. frenectomy I would suggest doing a soft tissue graft on #24. Removing the frenum will not correct the gingival problem.
As far as the  GV on the centrals and lateral I think BW considerations should have taken place. To create a long lasting result I think osseous recontouring would be necessary.
Again, I know this is a laser forum and hope that these comments are not taken the wrong way. Treating the patient with a laser is great though I think we should still keep biologic principles in mind.
Thanks,
Danny

(Edited by Dan Melker at 9:19 am on April 25, 2004)

Nice post Jeff and nicely done case.

glenn

Ron,
I answered your question in about 5 paragraphs and have no clue where it went. Briefly, the tooth is in labial version. This simply means that the root is in the position where the bone would be. Correcting the occlusion will not correct the lack of bone nor connective tissue in the area.
Benefits of connective tissue are:
1. avascular-prevents bacterial infiltration
2. dense connective tissue-prevents toothbrush causing recession.
Mucosal tissue has none of the above characteristics.
Choices of treatment:
1. Subepithelial graft-root coverage
2. Submarginal graft-increased connective on bone.
When there is recession and lack of connective bound down to act as a barrier, I always recommend soft tissue procedures.
I could spend hrs. showing you continued recession on teeth left untreated. Then I could show hrs. of treated teeth. Objectively, there is absolutely no comparison in long term health. Soft tissue treatment is so successful it is not funny. To date I have treated over 7,500 teeth and have probaly 7,490 successes. I am sure others have the same degree of success. I only tell you this because this is far and away the most successful long lasting procedure I do.
I would treat the above patient 100 out of 100 times.
Thanks,
Danny

(Edited by Dan Melker at 4:14 pm on April 25, 2004)

(Edited by Dan Melker at 4:16 pm on April 25, 2004)

Jeff,
I cannot argue about bad perio or bad rest. dentistry. I do not think we are comparing apples to apples.
Let’s start with the frenectomy on mand. anterior. #24 has recession and the patient is young. the tooth is in labial version, this there is a very thin labial plate of bone if we are lucky. I would venture to say that there is miminal if any attahed tissue on #24. Probe the buccal sulcus, then probe the outer portion from coronal tissue to mucogingival junction. I will bet the #’s equal each other. Therefore there is not attached connective tissue bound down to either root surface or bone. After 29 yrs. of seeing these areas break down I would recommend a soft tissue procedure.
As far as the maxillary, let your 6 month followup be the judge. Let’s learn.
I believe in the laser even though I do not own one. Lasers will not cure all our problems. I will be happy to send you cases where proper periodontal procedures produced the ideal outcome with no root sensitivity, long teeth, black triangles, etc. occurred. These are advanced perio-rest cases.
Do not forget basic BIOLOGIC prin. when using your laser. I am not sure who your Periodontists are but frankly none of the above concerns of yours have never been a problem for me.
Let’s all learn. I would be very happy also to send you altered passive or active eruption cases for your evaluation. Similar to your case shown above. It may be a real eye opener for you. I love to learn and love to share, that is why I am here.
Danny
THIS case belongs with the FRENECTOMY TOPIC BY JEFF
Thanks
(Edited by Dan Melker at 5:30 pm on April 25, 2004)

(Edited by Dan Melker at 5:35 pm on April 25, 2004)

Ron,
No question the problem was caused by labial position of the tooth as well as possible secondary occlusal trauma. Look at the wear of the incisal edge.
Look closely at your two green lines. If you look at the gingival one you can still see red tissue below the line. If you probe to the mucogingival junction you will get a #. If you then probe from green line to green line you will get a second #. They will be about the same. Therefore you have really minimal or no attached connective tissue.
The above benefits of connective tissue are the reasons to do soft tissue procedures. Over the last 17 years I have been doing subepithelial  grafts. By and large they are where they were when I placed them. Some over 5-7mm. of reason covering the entire root. This is far from unusual. Actually quite the norm.
Connective tissue again by being avascular and dense is a great barrier and protects the underlying structures.
I found a slide from 1975. I will mail it with the other material. The followup is 1978. You can tell from the dates on the slides. Which way would you like tobe after 3 yrs. Also notice the change in papilla height between 24 and 25. You can be the judge. What some 29 yrs. ago. If people would learn from other peoples successes and failures it would make their lives so much easier.
This is really a simple case for an attached tissue procedure especially with the patients age. By the way I did multiple grafts on my son bfore ortho, so yes Jeff I would want one in my mouth if necessary. Also covered up an exposed root(#11) on my wife. She likes it, very cosmetic.
Danny

(Edited by Dan Melker at 7:03 pm on April 25, 2004)