Hi Ron,

You got the general concepts correct.

Activation = Conditioning = Hot Glass effect = minimal thermal conduction depth penetration if kept moving quickly.

Non-Activated = non-conditioned = bare fiber = 810nm wavlength emission into tissue and tissue alteration by wavelength dependant absorbtion and protein denaturing (ideally)–or by burning (not ideal).

Gated pulsed allows for refractory “cooling” but don’t get to confident about it–it warms soft tissue quickly and deep (12mm+)

Right on, Glenn….you have the technique right.  Crown or crest of tissue preparation first before BC–allows for access to the base of pocket.

I am fascinated though.

My partner Del, and I were among the first to advocate this “crest down” technique.  We were certainly the first to publish on this….and we were poo-pooed and told that pocket up was the “established” way….Oh well!
:shocked:

I guess I didn’t get the memo that crestal tissue down is now SOC!:wink:

Good luck Ron.

C ya,

Bob

Hi Ron–

Glad you reading Jeff’s book (http://www.jgma-inc.com/ for those who don’t know about it yet).  Good stuff in their, huh?

There’s just no other way to cut–MELT–fibrous tissue like a frenum or fibroma with near-infrared, unless you have VERY high peak powers in a pulsed infrared.  And with a fibroma you ALWAYS want to “lift & undermine” it, not try to vaporize the entire mass.

No, not really.  Use the activated tip to incise the internal margin of the pocket epithelium, then continue with it AS LONG AS IT CONTINUES TO REMOVE THE GOOP.  Re-condition, and try again to remove goop.  Better yet, don’t wipe off all the proteins accumulated on the fiber-optic and use that mass as your activator (hot-tip effect).  No more goop?  Then you’re done with that pass.  “More” attempts and fuss in the pocket is not better.

“Is this because of the potential for necrosis 1mm deep with an activated tip(per manni)?or just because the effect is very localized(right at the tip) when kept moving?”

The reasoning behind your thoughts and what you are asking, I think, are more to do with the fact the effects of a hot glass effect are very localized in tissue–but still VERY hot!

Thermal necrosis with the hot glass effect is very localized, unless one spends too much time on thin tissue.  But I think we are talking about pocket therapy.

EXTENDED or PERIPHERAL thermal necrosis refers to tissue that has been warmed to death (literally) beyond the zone of primary irradiation. Again, in the hot glass mode on the first pass, I don’t think we are talkin with too much concern about that.

Does that answer your questions?

Bob

Jose,

Como esta? Cada ano en Marzo me esposa e me vamos a Bolivia para trabajo in Cochabamba e Trinidad hacienda restorativa por los pobre indigenous y los chicos de la calle. Hacemos para doce anos pasado.

In my practice I am working to first assess caries risk based upon dental history, recent experience with decay, diet patterns, salivary flow, compliance with recare and oral hygiene and other items. This helps me to set a baseline number for the diagnodent reading. If I decide to treat based upon inspection, diagnodent reading and x-rays then I begin with the tooth surface with the highest number and judge from the presence or absence of decay what to do with other areas with positive readings on the diagnodent so treatment verys from patient to patient based upon the above listed risk items. I use the laser and high magnification so what ever I do to the tooth is minimal. I am sure others can expand on these comments.
Pat

Hi Ron–

My experience with diodes is that they tend to overheat (from the power supply), and they really can’t be run as long or as “hot” as a laser with an internal cooling system.

On my Soap Box, now.

I can’t be without my laser of choice. My lasers have to be there and be dependable to work for me ALL day, EVERY day. We turn our pulsed Nd:YAGs on in the morning, run them all day long, and do it again the next day–without failure or faults.

If I have 4 quads of Laser Perio Therapy scheduled at &#361,000 a quad–I HAVE to be able to count on my device working.

You should give Gordon Wilson a call in Arizona 602-667-9111. He’ll give you the straight scoop. He has both the Biolase Waterlase and the PerioLase. He has had a printer cable problem, and one “fault” issue that self-corrected when he restarted his laser several times.

Carbon dioxide and Nd:YAGs are the two work-horses laser wavelengths in science, industry, and the military. The main reasons relate to their overall utility, but importantly their longstanding history of stability and reliability.

Off my box….

“Is this a sign of things to come?”

It’s more like a tendency to occur, especially if you run them often and hard.

“Should I just request a new one since its only been in the office a couple weeks? “

No need to request a new laser. Those thermisters are the most sensitive to the excess heat from the power supply. In fact, as laser components go in those small solid state diodes, through the process of component elimination, you should get the “better-of-the-batch” as far as one with better tolerances replacing the ones that failed.

Good luck!

Bob