Hi Everybody,

Here’s a case I had to deal with today on an uxpected basis.  Patient had a C/C of sore gums.  At first I used air and vacuum (to cool and for comfort) Fr Nd:YAG at 3.00 watts, 20 Hz and 100 usec pulse duration without local anesthetic.

[img]https://www.laserdentistryforum.com/attachments/upload/Eva1.JPG[/img]

After giving Lidocaine 2% with Epi 1:50,000 I tried again at a higher wattage but same PD of 100 usec.  No such luck in getting hemostasis.

[img]https://www.laserdentistryforum.com/attachments/upload/Eva2.JPG[/img]

After anesthesia, I used a long pulse duration setting of 650 microseconds.  Since I had disrupted the tissue and capillary vessels (opening them up), it took a little more effort and energy to get the area to calm down.

This is the kind of control over the tissue and bleeding that is possible when one can vary the pulse duration of a near infrared pulsed laser.  Note the lack of char, zone of coagulation, or epithelial peeling.  No post op recession for this patient………

[img]https://www.laserdentistryforum.com/attachments/upload/Eva4.JPG[/img]

Starting off using a longer pulse duration on hemorrhagic tissues avoids disrupting the tissue and
vessels with high peak powers of short PD (1500 watts per pulse), and getting immediate hemostasis, thus saving time & less irradiation exposure to tissue, i.e. proper “Light Dose”.  Less chance of thermal injury to tissue that way through economy of energy.

May 22, 2003

This is the missing Pre-Op x-ray showing the defective restoration.

This is the 7 day post-op.  NOTE:  Any recession or loss of tissue height? 

Bob

(Edited by Robert Gregg at 4:38 pm on May 22, 2003)

No reason to buy a pulsed Nd:YAG for the following reasons, but if you have one, here’s how you can use it for selctive removal of hard tissue components.

Pulsed Nd:YAGs with high peak powers of 3000 watts per pulse at 100 usec and 10 Hz are highly absorbed in calcium containing hard tissue and pigmented decay.

Very nice selective removal of dentinal debris, (without water or air, and defocused at a distance of 4-6 mm.

Yeah, I saw the fracture line on the DL. And so would the pulsed Nd:YAG too–see the next image for an even better demo of that through enamel and dentin.

I don’t have the greatest cleave in the world, but I do have a very high energy density to transmitt through enamel and reach dentin on the other side with enough intensity to have absorption on decay on the other side.

Self explanatory

Almost ready for impression for IPS-EMPRESS after I remove the decalcified enamel on the mesial and the fracture line on the DL margin[/b]

This making any sense to anyone??

Bob

Greetings All,

I will post the pictures when I get to the office later today, as I had planned to do yesterday. Del and I have a lecture today and I’ll have some time to upload the images.

In the mean time, some may want to see the reaction I got on Dental Town while trying to show and share the technical applications for plused Nd:YAG.

Instead I got grief over the necessity of care–something I never tried to address in the first place.

Thanks to Ron Schalter who made a much appreciated supporting post and made my technical point–it was about what the 1064 laser could and couldn’t do.

And thanks to David Kimmel who hit the nail on the head (borrowing from “Doctor Ed’s” hammer analogy) when he also posted and made a very important point about aggresive carious lesions in the elderly due to medications, dry mouth, poor saliva flow, and the inability to detect carious invasion into dentin using radiographs.

The caries extended 3mm into dentin! Talk about being surprised! I was expecting the stain to blow out and be left with healthy enamel. It started out as a simple case of stain removal–one reason I didn’t charge the patient is because I didn’t prepare her for the fee in advance. Oops. But again, that wasn’t the point I was trying to make….I wasn’t trying to make a statement about these sorts of class I situations. There’s the Congress of Microdentistry, Kim Kutsch, Stu Rosenberg, and others to make that case.

Anyway, thanks or the support, guys, it’s greatly appreciated.

Now I know what Glenn van As means about the hostility to technology and his previous clinical posts on Dental Town!!! Geez, just trying to share technical capabilities and some differnt ways of solving clinical problems and some of those people get TWISTED about it!

and

http://www.dentaltown.com/idealbb/view.asp?sessionID={DC5AF088-EE75-477D-A1D6-81103B24213A}&topicID=16692″ target=”_blank”>http://www.dentaltown.com/gold….

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