Color would be a good idea, however, since laser light is specific to color, that might be why we see either clear sapphire tips, or the brownish color of the disposable tips like the Z’s we have. Good question, we ought to ask. Thanks for the tip on the sealer, and for the kind words on this case. If anyone has any other thoughts on how to do this better, let me know. I know I could’ve used the diode for the soft tissue, just that I get so used to the Er that I don’t opt for the diode that often. I was thinking of that today as I was getting ready to head to the office. Thanks again.
Mark

Mark, Did I read your thread correctly? You removed an alloy with the laser. I realized One cusp was gone and the alloy was not vaporized .
Great case. Does your Waterlase have a delay on starting the water at low water %. ? Like 14% and lower.
David

Mark,
Sorry to harp on this but I hope you would clarify one more thing for me. You said you reanesth. then entered with z2 at 1.25W. Does this mean that you entered with the z2 before you got your working length with the 1 5 file. If so how far down are you going with z2 , and is the purpose of the inital entry with z2 before 15 file for anesth. Just trying to understand. Thanks for your patience.
JETSFAN

Mark,

I read with enthusiasm your posts on this endo case. Great job! What a pleasure it is to see the renewed excitement with lasers in dentistry.

I don’t want my comments to dampen your excitement or your desire to try new and varied techniques that will expand the knowledge of lasers in dentistry – but, there are a couple of technical concerns that might be considered when using an Erbium laser as the last instrument on the internal walls of the root canal. In the August 2002 issue of Journal of Clinical Laser Medicine & Surgery an article was published that I believe would be of interest here. The article, on page 215, is titled “Effect of Nd:YAG and Er:YAG Lasers on the Sealing of Root Canal Fillings.” The study was performed in Brazil so the translation is missing a couple of words along the way but you can get the drift of the message. I have included a few of the salient points and would be happy to send you a copy of the entire article if you request.

In the interest of better lasers in dentistry…

ABSTRACT

Objective: The ability of the laser irradiation to promote the cleaning and disinfection of the radicular canal system has become this type of treatment in a viable and real alternative in endodontics. The purpose of this study was to evaluate the apical marginal sealing of root canal fillings after the irradiation with the laser of Nd:YAG or of Er:YAG. Materials and Methods: Forty-two human, extracted single-rooted teeth had their crowns sectioned and the root canals prepared with a no. 70 K-file. Then, they were dried and divided into three groups according to canal wall treatment: group 1: the canals were filled with EDTA for 3 min, followed by irrigation with 1% sodium hypochlorite solution; group 2: the canal walls were irradiated with Nd:YAG laser; and group 3: the canal walls were irradiated with Er:YAG laser. Afterwards, the root canals were obturated by the lateral condensation technique. The roots were externally waterproof, except in the apical foramen and immerged in 2% methylene blue aqueous solution during 48 hours. Results: The results showed that the largest infiltrations happened in the group 3-Er:YAG (7.3 mm), proceeded by the group I-EDTA (1.6 mm) and by the group 2-Nd:YAG (0.6 mm). The group Er:YAG differed statistically of the others (p < 0.05). Conclusion: It was concluded that the Er:YAG laser intracanal irradiation previously to the root canal filling must be used with caution until future research is define the best parameters for it's use.

(A piece of the) DISCUSSION

The results of this research shows that group 3 (Er:YAG) presented higher mean and statistically significant infiltration levels, when compared to the levels of the other groups (Table I and Fig. 3).
It was expected that a lower infiltration degree would be observed with the use of Er:YAG laser, since it promotes exposition of the dentin tubules, removal of the smear layer, with increase of dentin permeability.10,11 These observations would justify a better marginal sealing of the root canal obturations after the use of this laser.
Although the Er:YAG laser does not promote the melting of the dentin neither the closure of the dentinal tubules, it causes a reduction on the dentin layer due to the ablation process, forming craters and consequently a rough surface with great irregularity as described by DostAlovd et al.,12 who observed a decrease of the dentin layer in cavity preparation with the use of Er:YAG laser. Besides that, during the ablation process, the dentin is not vaporized, and can be dislodged to other areas, including to the apical region, making more difficult the adherence of the obturation material to the root canals walls.

Address reprint requests to:
Dr. Marcia Carneiro Valera
Av. Dr. Francisco José Longo, 777
Faculdade de Odontologia de São José dos Campos-UNESP
Caixa Postal 314
Sã José dos Campos, SP, Brazil
CEP 12201-970
E-mail: mcvalera@iconet.com.br

Again – I appreciate your enthusiasm for lasers!! I wish we had had these resources available to us 14 years ago when I started. What a benefit they are and how much faster we will learn and better our procedures will be as we learn together “Lasers in Dentistry.”

Delwin McCarthy

Thanks Del, and Glenn. I agree with Glenn on this one. I also note that ALL my results with the ER:YSGG and endo have been fantastic.
Jetsfan, I go into the tooth to do a “pulpotomy” with the laser, and to get adequate pulp removal and anesthesia prior to placing the file to it’s determined working length, then go back and use the z tips as beforementioned. Hope that helps.

Del, one more thing. I always double check my apical integrity to my working length prior to obturation. I know I have no blockages, and the irrigation is excellent. Just my observations. I know of others using scopes (Glenn not included because I don’t know of how he is performing the endo procedures) and seeing that after using the YSGG laser, no dentinal debris remains at the apex at high powers. Again, just our observations.
One last thing Del, WELCOME to the board!!! You and Bob are so great at making us all think out of the box. Thank you for your contributions here, and to laser dentistry in general. It is because of men like you and Bob, we are doing what we are today with lasers in dentistry.
Sincerely,
Mark

Thanks Bob,

Here is the final cementation of the crown from the previously posted case. This is focused on the lingual tissue to show normalcy and healing of the laser crown lengthening procedure.

I really feel we are doing a wonderful service to these patients, and to be able to have such great results is so rewarding. Obviously, we will follow these cases, and take xrays and photos over the years to see how our results fare long term, but so far, what I have seen, is fanatastic.
Thanks everyone.
Mark

Glenn, see previous post in this thread, the whole slew of pictures, including the surgery, minus the buildup are there. Thanks
Mark