Veneers and Lasers - Laser Dentistry Forum

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May 28, 2003 at 6:46 am #2815 Reply

Glenn van As
Spectator

Hi folks…….gotta sleep but here is a case finished today.

The preps were done (4 veneers ) due to mottling. Patient had some attrition on the incisal edge leading to a shorter tooth by a mm, and in addition had problems with gingival height of contours so I did some erbium recontouring with the erbium after probing on the right side and may have taken a half mm more than I wanted ( I find it harder to control at times the erbium for soft tissue) and on the left side I did the ARgon (soft tissue laser)

Erbium was around 80 mj and 30 Hz (with anesthetic and no water) and the Argon at 0.2 secs duration and pulse of .7-.8 watts 0.2 secs off.

The insert was done today and the patient was pleased with shape and color. I was pleased with fit and length was longer, due to me trimming tissue and perhaps adding 0.5 mm on incisal (patient having NG made as we speak to control grinding)

Hope it is interesting…….todays insert was 2 weeks after preps……

gotta sleep…..cya later.

Glenn

May 28, 2003 at 6:28 pm #6308 Reply

whitertth
Spectator

nice result….. would u get less ( brown charring) if u used a little water with the erbium? just curious?

May 28, 2003 at 11:51 pm #6313 Reply

Swpmn
Spectator

But what about the BIOLOGIC WIDTH??

Oh, ok, I see the yellow and black probe!!!!(Covering my mouth to hide the snickering)

Looks real nice. What kind of veneer is that, i.e, pressed ceramic or feldspathic?

The Argon gingivectomy appears more surgically precise. However, it appears you used a 30 degree tip with your Er:YAG which is about 600 microns. How would the Erbium gingivectomy compare if you had used the straight, conical soft tissue tip?

Furthermore, how would the gingivectomy on #9 compare if it had been performed with the following lasers(and variations within each category):

1) CO2
2) Diode
3) Nd:YAG

Thanks,

Al

P.S. Dr. Gregg and all others please feel free to chime in and help me with the last question in this post

May 29, 2003 at 5:46 am #6310 Reply

ASI
Spectator

Hey Glenn,

Another good case treated and posted.

Is a frenectomy almost necessary? Do you think it may tug on #11 and cause further apical pull on the gingiva?

Andrew

May 29, 2003 at 5:54 am #6307 Reply

mickey frankl
Spectator

Nice case

Please can you photogragh the scope and camera so we can see what you are using to get these amazing top quality photograghic results

Thanks

Mickey

May 29, 2003 at 6:00 am #6309 Reply

2thlaser
Spectator

Again, nice case Glenn. I really think I ought to come up and show you how to prep these veneers with the laser, it’s so darn easy, and in my hands at least, fast. You could do the whole thing with the lasers you have. I really like the work. I will post a few more I have done after I get back from lecturing in Napa this week. Kudos!
Mark

May 29, 2003 at 2:51 pm #6312 Reply

Robert Gregg DDS
Spectator

Glenn,

Never, ever tired of you or what you post! This forum thrives because of what you contribute.

Al, to answer your question:

1. CO2 would be awkward since it is a “free-beam” and harder to control around the CEJ. You’d need to use a metal instrument to shield the tooth from the beam. The clinical result would be similar to the erbium since they are both absorbed in collagen.

2. The diode would probably be hotter and cause some additional (1mm) recession.

3. The Fr Nd:YAG would look pretty much like what Glenn shows with the Argon (but Glenn is an expert with the Argon!)

The deal with the pulsed Nd:YAG is that it is much more “forgiving” to the operator than other lasers that are used in a “hot-glass” effect because the free-running pulses with high peak powers are then interrupted to tissue to allow some thermal relaxation, while subsequently delivering high peak powers (say 400 watts per pulse) on the next pulse delivery.

Bob

P.S. BEAUTIFUL dentistry Glenn.

(Edited by Robert Gregg DDS at 10:55 am on May 29, 2003)

May 31, 2003 at 2:21 pm #6311 Reply

Glenn van As
Spectator

Hi Guys….sorry for the delay in replying…..absolutely exhausted and had a couple of lectures to do. 600 emails later…….phew.

Anyways Ron, you can try to use water with the laser for soft tissue but I always turn mine off. If you were to leave it on I would only use a very very small amount. I have never done that because with the Hoya Delight the water know is not controlled by % like on the Waterlase. Next time, I will check it out by making only a very small spray come out. I like doing it without water, but your idea is valid. Remember though I am showing these cases at high mag and any case may look a little charred at these mags…..Good question though.

Al: thanks……they were pressed ceramic Empress veneers. I dont like the conical tip for the shaping of soft tissue , it cuts more like a knife. Great for frenectomies, for soft tissue biopsies but when I have used it for Class V I notched the root surface. If I was smart maybe the 400 micron tip would have been a little better to cut with. I think you need a tip with a cylindrical flat face to shave or plane the tissue with the erbium for sculpting. I really wasnt very good in this one on the erbium side in sculpting. Shows my errors.

Diode and Nd Yag would have looked as nice……(Nd Yag better if you are Bob!! GRIN)….

CO2 would char more.

Andrew …..great seeing you yesterday, have fun with the new laser and be patient even in your skilled hands there is a learning curve. Find out what you like doing with it and focus on that………

I agree with you that the frenectomy should have been done…..perfectly good idea. I missed on that one but will post another case in a minute that I finished this week where the frenectomy was done.

I might advise her to do it at the post op check…..thanks for pointing that out. These are the reasons I post things (not to be a holier than thou ) but I learn things and get ideas from others and see my work in a different light. I do become more critical as I look for the errors alot and in addition it is making me a better dentist. For the new people on this forum, dont be scared to ask a question even if it seems trivial and please post cases, because we all learn and you will too.

Hi Mickey…….I have included a picture of the scope in action so that you can see how we do things. One interesting thing is that with the microscope I literally am working and ask my assistant to press the shutter, so it is really easy to document these cases. I dont have to stop…..pick up the camera , get all focussed and then shoot….its easier and of course the magnfication is unsurpassed. It was a fluke that we got to this point with documentation , really the development of digital cameras and their ability to photograph without flashes in low light (increase ISO) helped amazingly , combined with new light sources…….

Hope that helps you Mickey and thanks for the kind words.

Bob, ……..thanks, coming from you with your knowledge of lasers that is very kind. Reading you post I thought to myself that yes the Nd Yag because it is pulsed is probably a good laser for beginners to use as it is more forgiving. Good point.

I sure hope to try the laser out one of these days. For those in Canada, Bob will soon be able to ship to Canada (talked to Chris Schmidt from the laser institute for Canada yesterday) and so you should be able to buy it soon.

I will post another case of 4 crowns that I am really proud of in a flash………

thanks guys………all nice comments.

Glenn
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