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Hi Folks……..I dont think I ever posted this case and if I did I apologize but here is a single appointment prep, osseous recontouring with the erbium and impression case.
The molars in the posterior had bad decay, they were endo treated and core composite buildups. Slowly with time we have been doing crowns (for financial reasons) and eventually got to the lower molar for a procera crown.
The prep was very deep on the distal and due to an open contact interproximally and food entrapment the tissue was pretty inflamed so I thought I would remove the tissue with the Argon to minimize bleeding and then use the erbium to remove bone to get a 3 mm biologic width on the distal and then take the impression if I could control bleeding afterwards with the Argon.
The soft tissue doesnt bleed much but when you get into bone with the laser there is a fair amount of bleeding.
I managed to control it and then took an impression. The insertion of the crown shows the nice healthy tissue ( 2 weeks later) and the crown was placed in .
The final radiograph shows the resulting margin……
Nice easy case with the laser to help me out. This is the kind of perio you can do with the erbium laser Mickey……osseous recontouring bone, but stay away from putting in the laser into the pocket as it wont be selective for soft tissue and there are better lasers for Laser Perdiodontal Therapy
Hope you like it………
glenn
Hi Bob: I just wanted to point out that uncovering 4th canals is easy with the scope ( bob used it too) and here is a case not using the laser which shows this principle.
My associate did a nice endo on this tooth but I noticed a root unfilled ( the MB gutta percha isnt centered in the root meaning another canal exists) so asked him if I could look for it (hes putting a new bridge up there).
On opening it up …….I troughed with an ultrasonic tip from the MB down to the palatal and a little mesial from a line connecting the two canals.
What is interesting is that the MB2 is often located mesial to the line drawn from MB to P canals and when you uncover it, it goes first lingual and then mesial before curving back towards the MB canal……you can see this clearly on the photos.
There is ALWAYS a white line connecting the two canals as can be seen in Bobs photos and in these photos.
The SCOPE is ESSENTIAL for finding these. I found another 4th canal on a maxillary 2nd molar on thursday on a failing case and have 2-3 times found 5 canals on cases in lower molars.
THe white line is made clearer by the Nd Yag or ultrasonics so you can locate the missing canal……MAGNIFICATION IS ESSENTIAL.
Hope this non laser post helps……
Glenn
Hi Kelly,
The 320 would be easier to use in the beginning, but the 220 (200?) would definitely have greater energy density and allow you greater access deeper into the canal. But you really need to be careful and lower your energy because that is really intense.
I used a Global Surgical operating microscope, fitted with an X-mount from Global, with a Nikon CoolPix 4500 attached to that.
It has the magnification AND the coaxial illumination that allows for awesome visibility that indirect illumination alone just can’t give.
Glenn van As here is the expert on magnification & photography and can tell you lots more….
Ron,
I know what you mean. It can get VERY confusing when calculating energy density with quartz clad fiber optics.
The simple answer is I got these numbers off the ADT Pulsemaster 600 IQ energy density chart. But calculating them can be problematic.
The formula is ED = Joules divided by surface area. Surface area is Pi (3.14) times the radius squared.
So if you have a 320u fiber the surface area calculaton that was apparently used by ADT is apparently .8123. Divide 200 millijoules by .8123 = 246.21445.
Now the problem comes in when you are trying to extrapolate this to other fiber diameters, and then you find out that is does NOT correlate. The reason for this is that…..get ready…..a 320 micron fiber may not really be 320 microns in diameter. Huh?:confused:
Ok. Depending on the manufacturer specifications, there will be the quartz core diameter of say 300 microns, then a quartz coating of say 10 microns, followed with a polyimide (correct spelling) coating to protect the quartz cladding of another 10 microns. So the accurate way to calculate is using the actual CORE diameter–NOT the core diameter PLUS the resin and quartz outer layers. But is this what ADT did? I don’t know, and I need to check their numbers. Which is why I said I needed to check their numbers!?:confused:
Does that make any sense?
Thanks Glenn.
Good point. Great photos as usual!
I also use ultrasonics with various endo tips. In fact, I used the ultrasonics right after I got blocked in the last photo to trough the canal open wider. Then I went back with the Fr Nd:YAG to clean out the dentinal debris and get a clear view.
But that assumes we always know WHERE to trough. Sometimes the canal can “hide” in places unexpected, and the coloration and even the normal anatomical landmarks are missing.
The pulsed Nd:YAG has the optical capability to differentiate between different densities and chemical components of intra-pulpal materials.
So using the Fr Nd:YAG to identify, then open up the canal using instrumentation of choice (ultrasonics), then going back with the Fr Nd:YAG to clean out the dentin debris is a nice combination. That and how magnification makes it easy to view can really be an awesome enhancement.
You are very correct about the way these MB2 canals go one way, then track back another, too.
Also, ultrasonics–like rotary instruments–are “indiscriminate” hard tissue cutters. They also create a lot of debris that covers the area I am trying to view. With a pulsed Nd:YAG laser, I can remove tissue one to three pulses at a time, keep the viewing field completely free of debris, and watch the progress as it is taking place, giving me much more control, access, and visibility than even when I use ProUltra ENDO ultrasonic tips (from Tulsa Dental).
So, I love using the laser to locate, the ultrasonics tips to cut quicker, and the laser to clean out the debris from ultrasonics in an alternating fashion. Combining the two technologies together with the microscope makes for an awesome combination–and lots of fun too.
Thanks everyone for a great discussion!
Bob