waterlase - Laser Dentistry Forum

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April 8, 2003 at 11:17 pm #3427 Reply

mickey frankl
Spectator

I am thinking of buying a warelase and wondered if anyone can give their opinion as to how good this laser is compared to other makes(example Opus 20).
Can one realy do RCT with it as fast as the rep claims and with no anaesthetic?
Also how good is the Smilelase for Bleeching?
Thanks
Mickey

April 9, 2003 at 12:40 pm #11206 Reply

Anonymous
Guest

Mickey,

If you do a search you’ll find threads on most of those topics, except the endo. I think Mark C. said awhile back he had a endo case to post , but he’s been pretty busy lecturing.

Welcome to the forum!

April 9, 2003 at 7:50 pm #11220 Reply

2thlaser
Spectator

Ok everyone, here is the latest one that the Waterlase saved my butt on. This will take 2 posts to place it in, so bear with me. Patient came in with #4 fractured lingual cusp.

$fracture1.jpg$

2nd photo showing cusp removed.

$fracture2.jpg$

3rd photo showing gingival area on the lingual, with pulp horn exposure on the lingual.

$fracture3.jpg$

I ended up undercuting the amalgam with the laser and popped it out, then performed the Endo with the waterlase.
Preop Xray here.

[img]https://www.laserdentistryforum.com/attachments/upload/MVC-062F.JPG[/img]

Then place initial #15 K-files in place, and radiograph:

[img]https://www.laserdentistryforum.com/attachments/upload/MVC-063F.JPG[/img]

Then use Waterlase for complete endo Tx utilizing Z-2 through Z-3 tips, which equal to a #35-40 K-file.

$fracture4.jpg$

Here is the final radiograph of the Endo procedure.

[img]https://www.laserdentistryforum.com/attachments/upload/MVC-064F.JPG[/img]

Followed by the crown lengthening procedure after the endo was completed.

$fracture5.jpg$

I then did a build up with composite, which I didn’t get a picture of, prepped the tooth for a crown with the laser, and am seating this next week, where I will have a follow up picture for you. This was all done without anesthetic. I love my Waterlase, one visit, all the procedures, an emergency visit that MORE than made my lease payment. What do you guys think?
Mark

April 10, 2003 at 1:41 am #11208 Reply

jetsfan
Spectator

Mark,
great case!
Was the tooth non vital?
Jetsfan

April 10, 2003 at 1:53 am #11204 Reply

Anonymous
Guest

Hi Mark,

I agree, great case.

How ’bout some more ‘how to’ details on the endo?

Use of files?

How length was established?

How to maintain proper length?

Filled with?

Thanks,

April 10, 2003 at 2:01 am #11228 Reply

Glenn van As
Spectator

Neat case mark. I noticed the buccal cusp was reduced after the amalgam came out, is there something that you did to reduce it.

The radiographs are great and a very nice result. If you have an editing program place the radiographs is grayscale and the color will look much better. I edited the one radiograph to show you what it looked like after the color alteration. It took one step in ACDSee …….color 256 gray.

I applaud you for cutting back the bone and soft tissue without anesthetic on the palatal……I couldnt do that much I dont think without anesthetic.

The endo shape is nice but what did you fill the canal with. One of the problems is getting a standard shape for a GP cone with the laser. How did you shape the canal…..did you augment with rotary files.

I would love to see a radiograph of the completed case….

Neat stuff.

Glenn

April 10, 2003 at 2:14 am #11221 Reply

2thlaser
Spectator

Thank you gentlemen. First of all, the tooth WAS vital. Fresh fracture. The endo part of it….I opened the pulp chamber using normal laser settings, 3W 80%air, 50%water. Once I opened up the chamber, I power down to 1.25W, 34%air, 24%water, the endo settings, with a Z-2 tip. I find my intial length, as you see in the radiograph, with a #15 K-file. I file usually to a 20 then start with the Z-2 tip 2mm from my working length. You can see a “sharpie marker” mark on the fiber. Activate the tip only AFTER you have placed it in the canal’s, and you are slowly, for 6 seconds, activating the laser on the outstroke. NEVER activate the laser on the instroke, you WILL ledge. Do this about 8 times circumfrentially with the Z-2, then see if the Z-3 will fit to your length. Sometimes, I recheck my working length in between fibers with a 20 file again, this helps to make sure I have the proper canal shape for obturation. No need to use Hypochlorite, the Waterlase disinfects wonderfully, as does Glenn’s Er:Yag too. Then I still fill with GP, and a CaOH sealer. Some like to use EndoRez. I don’t know if I like the formaldehyde that the resins give off during setting at the apex. Most Endodontists, according to the latest surveys, are still using lateral condensation and CaOH sealers. Glenn, the final radiograph is the final fill, just so you know.

I reduced the buccal cusp with the laser, and then prepped the tooth with the laser.

Now, to reduce the bone, I use the T-4 tip with .50W, 14%air, 12%water. Low powers, with the smaller diameter tips allow me to do these procedures without anesthetic. It takes a LITTLE BIT longer, not much, but the patients love the fact they don’t have to get “shot”.

Thanks for the feedback, anything else?
Mark

April 10, 2003 at 2:19 am #11214 Reply

2thlaser
Spectator

What are you guys filling your endo with? What results are you getting, and are you using your lasers to remove the smear layer left behind by ALL other means of canal enlarging with files, or any rotary instrumentation, before obturating? Time to learn!
Mark

April 10, 2003 at 2:19 am #11205 Reply

Anonymous
Guest

How much time, start to finish?

April 10, 2003 at 2:27 am #11222 Reply

2thlaser
Spectator

The endo took about 20 minutes if that. The whole case took about 1hr 10min total time with the crown prep, endo, build up, crown lenghtening, and about &#361730.00 of the patients checkbook. No referal to the periodontist, and I can only imagine how good the tissue is going to look when I seat the permenant crown!
Mark

April 10, 2003 at 3:18 am #11232 Reply

Robert Gregg DDS
Spectator

Mark,

That’s a beautiful case, with all the erbium applications! Well done!! Clap! Clap! Clap!

I use Kerr sealer and a vertical condensation technique taught to me by Cliff Ruddle back when he gave hands-on courses in his office.

I would suggest that you re-consider using NaOCL. Studies I have seen show that while lasing alone is bactericidal, lasing to warm the NaOCL in near sterility. Same as to the smear layer.

Bob

April 10, 2003 at 3:33 am #11226 Reply

Glenn van As
Spectator

Bob I will say that you must be careful with the Continuum tips as they will degrade ( the old ones at least) in the bleach. I know because I did it and they had an aluminum coating and that broke down in the bleach as I saw little silver flakes in the tooth under the scope in the pulp chamber.

I still use bleach but not with the laser.

I use vertical condensation with Kerr EWT like Cliff as well.

We use the System B for downpack and the Obtura 2 for back fill.

I also use the erbium but not for shaping, more for cleaning and disinfecting.

Z2 and Z3 is 200 and 300 micron or #20 and #30 files I would imagine.

Nice result and mark here is the final fill adjusted in the ACDSee program.

Thanks for the interesting case…….cool stuff.

Glenn

I dont know if I am ready to shape totally the canal with the laser yet.

Buchanan says you need 30-45 mins for bleach in cases and I wonder if the laser will allow you to do them differently and faster in certain cases.

I think the Nd Yag, diode, argon etc can be used with bleach to warm it up without fear of problems but be careful with the Bleach with the erbium…….I know like I said because I did it and saw the breakdown. I dont know what kind of coating there is on the Waterlase tips so cant make a suggestion.

I concur with Mark……..only lase on the upstroke. I have had bleeding coming out of the canal after using the laser on the down stroke because it went through the apex and guess what…….My apex was enlarged.

i stay 2-3 mm from the end and lift out at around 2 mm per second and use it in the canals for around 30 secs per canal.

Cool stuff Mark.

Glenn

April 10, 2003 at 4:14 am #11215 Reply

2thlaser
Spectator

Quote:

Quote: from Glenn van As on 7:33 am on April 10, 2003
Z2 and Z3 is 200 and 300 micron or #20 and #30 files I would imagine.

Buchanan says you need 30-45 mins for bleach in cases and I wonder if the laser will allow you to do them differently and faster in certain cases.

I think the Nd Yag, diode, argon etc can be used with bleach to warm it up without fear of problems but be careful with the Bleach with the erbium…….I know like I said because I did it and saw the breakdown. I dont know what kind of coating there is on the Waterlase tips so cant make a suggestion.

I concur with Mark……..only lase on the upstroke. I have had bleeding coming out of the canal after using the laser on the down stroke because it went through the apex and guess what…….My apex was enlarged.

i stay 2-3 mm from the end and lift out at around 2 mm per second and use it in the canals for around 30 secs per canal.

/

Quote:

Glenn, thanks for the nice remarks. The radiograph you copied looks great, except it’s the initial apical working length files, not the fill, but that’s ok, I get your drift.
I have read studies that show you don’t have to use Buchannan’s 30-45 min bleach technique when using the laser because of how the smear layer is removed. I will try to find it and post it, or at least it’s source (the study that is).
And yes, the tips are 200-300 micron respectively. The Z-3 is concurrent with a 30-35 file in most cases, depending on how many times you activate the laser to enlarge the canals.
All I know is, it IS faster, easier, and my final results are better than ever. Just after dental school, I practiced in a large general practice and for 2 years I did almost nothing but the endo for everyone. I studied at that time with the endodontist next door, Dr. Marshall Smulson, who was the chairman of endo at Loyola, also where I taught in the Operative dept. I do a ton of it, and feel I have been taught, especially those 2 years after dental school, by one of the original masters. That being said, it is one of my strong points I believe in my daily practice routine, and so far, my results have been excellent. Now with the laser, it has gotten even better. Has anyone seen the SEM’s of the canal walls after exposure to Erbium laser energy? If not, I will try and post them here. Once I saw the comparisons, to the Profile Crown Down technique, the K File step back technique, and the YSGG Step back technique, I won’t do another endodontic procedure without the laser, if possible. I really do believe in what I am seeing thus far, and have done MANY cases. I am NOT an endodontist by any means, but seriously, I can’t believe the results after using the laser, in post op sensitivity (lack thereof), better fills, relieving infection, and inflamation. Amazing so far. That is my take on it. Thanks for letting me share this with you all. I hope, Glenn, you try it, enlarging that is. Let me know how you do. You guys are great, thanks for the replies!
Sincerely,
Mark

April 10, 2003 at 5:13 am #11213 Reply

whitertth
Spectator

mark great stuff….how long did the crown lengthening take? also i see pretty good hemostasis…is that a kodak moment or did u have good hemostasis throughout? Hope your jumpshot is well….

April 10, 2003 at 1:15 pm #11218 Reply

2thlaser
Spectator

Hey Ron. The crown lengthening took about 7 minutes. Not long at all. The hemostasis WAS good. Usually I get a little bit of bleeding, that I like. I will let it sit for about 5 min, let the patient bathe it in saliva, by then, it’s stopped, and I am ready for impression, build up, whatever is next. I have been lecturing so much, I haven’t played bball in over 2 months, so you would be able to pass through me like MJ at 23 y/o! BUT, that’s gonna change! SOON! Thanks.
Mark
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