honestly, I replace my tips when i dont hear the loud popping I expext to hear at 5+ watts…I know thats kinda anecdotal but it seems to work..they last alot more than three patients and they would need to come down alot in price for me to do it that way…im sure an inefficient tip contributes to heat buildup and also maybe a difficulty in anaesthetizing patients( if less enrgy is reaching the tip that would make sense to me)

Hi there folks: what do you think , should I post in Dental Town today this case and see how people react.

I am sure we will see a mixture of reaction…..people condemming me, people saying I am a butcher…..

What about it Bob?

As for your kind posts here…..

Bob, I probably dont know how to do the procedure any other way but I am going to try and get some microsurgical instruments and do a osseous procedure the same way a periodontist would try , raising a traditional flap etc, but use the laser instead of the bur.

I have a patient with a 3 unit bridge in the maxillary anterior from canine to premolar which is infringing the biologic width. Gonna shoot video and stills when I do this and raise the flap ( or maybe half of it) with a bur and half with the laser and watch the healing.

Andy I am no expert at all in perio but I am trying to see what I can do and perhaps in Canada the risk of medicolegal concerns is less than in the USA.

Andy you are very kind. I told Andrew this week, part of the reason I got the scope was because my dentistry was so average. It has taken me 5 years of working with both scopes and lasers to become proficient at extreme mags but it sure makes your job alot easier and more enjoyable when you can see.

Ron thanks for the kind words……what a funny thing. I was just thinking about how I could do this better and the thought came to me to use the chisel tip and that might plane the bone off in a bigger fashion…

The 600 micron tip isnt big enough and I might use the chisel sideways next time. See my previous posts here for a view of it. Excellent excellent post. Hoya does have one large broad tip anyways which is for flaps but I like it as it is quite broad.

I did anesthetize and it took about 10 mins extra on my 80 minute crown prep so maybe an hour and a half.

Billed out for osseous work which is fair which is what I did on the same appointment as the crown prep.

I just ask people in the perio field to look at it with an open mind. THe biggest beef so far is that the healing is with secondary intention and if I raised a flap they would like it more…….

As I always say Andrew…….

Dentists are fine with needles and drills , its the patients who dont like them.

I think I may have just infiltrated in the papilla on this one ( cant remember ) for anesthetic.

Cya

and thanks to all my friends here……its a great place to come each day and you all make it that way.

Glenn

Thanks Mickey………I think it is great if someone sees some value in the cases and its kind of like a hobbie for me posting the pics. It is relatively easy and it does create some fun for me doing them.

I dont profess to knowing it all , or even doing it all but the sharing of these cases has made me more critical of my own work and made me a better dentist I think.

Thanks for the kind words……I appreciate it.

Glenn

Hi to the two Ronnies……

With the Delight you can polish the tips if they start to break down .  It wont return them to 100% but does extend their life beyond the initial uses.

Under high magnification you can sure see when the tips are damaged.

Hope this helps…….

Cya

Glenn

Andy, at the risk of showing my ignorance, is ‘negative architecture’ periodonistese for bony defect? And if it is, and the patient is healthy, occlusion good, could you expect some natural (or laser biostimmed) remodeling to take place,  bringing about a more ‘positive architecture’?
Thanks,

Thanks Andy………I will never ever have a problem with constructive criticism of my cases. I do what I can but it is never the be all and end all. I would like to get a case that the periodontal community will look at and say hmmmm…..

I wonder in a case like what I have shown whether the lesser of two evils is a little bit of reverse negative architecture or a full flap with associated recession, full scale bone removal that is graduated, dark triangles , food entrapment and sensitivity.

Now if I were to have raised a flap and just removed bone distally with the laser , and then bring the flaps back together for primary healing one of the first issues would have been handled.

I think that I can handle tissue better than I do at present and am doing the following…

1. Got some reading material on flap designs.
2. Going to get some microsurgical instruments so that I can raise flaps with them.
3. Gonna try and get a course in flap design

I still think that many patients will prefer the laser and its non contact format to a bur for bone removal but that is personal preference.

Andy , you have already shown me more than many in the perio field by having an open mind to lasers. I respect that.

I am always open to constructive remarks and will return again to your post to see if I can improve on my cases while still retaining the laser for use of bone removal.

Perhaps then periodontists will only be able to question the role of the laser, but not the rest of the treatment.

Thanks Andy

Glenn