Glenn:

For the gross reduction, I simply turned the tip perpendicular to the occlusal and “chopped off the top”. The tip was then turned parallel to the axial walls to strip the enamel at the DEJ – similar to stuff I’ve seen Colonna and Ben Ong present. Tricky to develop an axial taper compared to bur usage. You can see where I overtapered in some areas and underprepared the lingual axial wall.

The 30 degree DELight tip was used because there is less energy loss along this tip compared to the 80 degree tip – therefore increasing the speed of gross reduction. An awful lot of energy was applied to this tooth yet the patient experienced no symptoms of reversible pulpitis. The console energy settings reported are only marginally useful due to wide variations in erbiums. Ideally we should measure energy output at the tip. It is possible that the 30Hz setting gave me an advantage in smoothing the margins, however, I have seen Colonna and Schalter obtain smooth margins using 20Hz.

Ron K.:

I carefully timed the preparation at 20 minutes. 15 minutes for gross reduction, 5 minutes to smooth prep and refine margins. Obviously that is a lot of time for a premolar crown prep. What I was trying to do here is to see if I could obtain an acceptably smooth prep without using a diamond bur – like I have observed Colonna present in his revised technique. Another goal was to prepare the margins without inducing the soft tissue trauma which you can see was created during my first crown prep.

Mark:

Clinically, the crown appeared to have excellent marginal adaptation. Ideally, for case presentation purposes I should have exposed a bitewing radiograph. Since the crown seated perfectly with only minor occlusal adjustment, I saw no reason to justify the radiograph.

Regarding chemical anesthesia, it is simply a personal preference and allowed me to focus on developing an acceptably smooth preparation. It’s entirely plausible that this tooth could have been prepared without chemical anesthesia. We do not place chemical anesthesia for the sole purpose of using the diode for tissue retraction. The diode laser has allowed us to reduce our application of chemical anesthesia on lingual/palatal soft tissues and greatly reduce our usage of lidocaine with 1:50K epinephrine for purposes of hemostasis.

Al

Elliot:

Best question anyone has proposed.  Here is why I did it:

To demonstrate the evolution of the laser crown prep technique and prepare myself for the FUTURE

My personal assessment is that we are currently in an early, primitive and pioneering stage regarding the usage of alternative tools to prepare teeth for restorations.  As I’m sure you are already aware, patients clearly prefer the audible advantages and the lack of vibration created by the erbium lasers.  In the future, it may be possible to develop better lasers or other tools which can reduce teeth in a timely fashion.

This is not a technique which I advocate on a routine basis.  In fact, over the past two years I’ve probably done five erbium laser crown preps and this was the first one where I did not use a dental handpiece to smooth the prep.  The purpose of the case presentation was simply to show that an average general practitioner can improve on an alternative technique via listening and reading.

You aren’t stirring up the thread, what I’ve found over the last three plus years is that we learn the most by disagreeing.  Pats on the back do nothing to advance the science of dentistry.

Al