Forum Replies Created
-
AuthorPosts
-
Glenn van AsSpectatorThanks Bob but I was a little surprised to see the erythema and the plaque there. its not an easy spot for an 8 year old to take care off.
I think it is healing great on the labial but feel it could have been better on the interproximal.
I post the good and the bad……….
Its still better than the electrosurge in my opinion but that is a whole other story.
Thanks Bob
Glenn
RWATSONSpectatorThanks, fellows – I obviously have more homework to do! Thanks again for shareing your info and oppinions.
Bob W.
SwpmnSpectatorBased on encouraging reports from Glenn and Rod Kurthy, today I attempted my first periodontal crown lengthening case using an Erbium(Er,Cr:YSSG) laser:
80 yo female patient presented fixed bridge #8-11 with subosseous caries palatal to #8 abutment. In reality, #8 has a poor prognosis but the patient asked me help her “buy some time” with the bridge.
After obtaining profound anesthesia(couldn’t use epinephrine) I placed the laser tip perpendicular to the long axis of the tooth and beveled the palatal gingiva down below the osseous level. Excavated caries using the laser at the palatal margin and my electric handpiece up underneath the abutment crown. I then used the laser to reduce the osseous crest 2mm palatal to my prep margin and directed the laser toward the palate to bevel the bone underneath the tissue as Rod Kurthy has suggested.
Due to hemorrhage and my inability to use epinephrine I restored the lesion with amalgam. Tried to get you guys some pictures but hemorrhage rendered the post op shots useless. However, I was able to acheive my intended clinical goals on my first attempt.
From a former “naysayer”, I now believe that the procedure is a useful adjunct to restorative dentistry. With time and better case selection I plan to improve upon the procedure. Please offer comments and constructive criticism.
Al
2thlaserSpectatorAl,
Great job. I have done quite a few myself as well. One thing you might try. When you get alot of bleeding, just give it about 5 min to “rest”, you might be surprised by what you see, and how clean the site really is. Just from my limited experience.
Mark
gwmilicichSpectatorI use the Diagnodent to diagnose and CDD to guide me regarding what I need to remove. Once you have decided to treat following DD diagnosis, clean the fissure entranc with CDD. This will remove the very extreme outer layer of tooth structure (VELOTS) This is where the pellicle becomes part of the tooth. It is a high lipid layer with gradated mineral content that increases the deep into the velots you go.
Often if you stain with CDD befoer removing this, you can get a false negative. Once it is removed, CDD with go where acid has been.In slow onset caries (most common presentation in fissures ) interprismatic enamel is lost, but macrostructure is maintained. When you place CDD, it will soak into the carious enamel, accuately identifying all the acid damaged, nonprismatic enamel that MUST be removed if you are using resin bonded restorations.
You cannot bond to carious enamel. It is non prismatic, ergo no bond, leaking seal, recurrent caries.
This use of CDD has been writen up in the peer reviewed literature, but is not well understood by most, ebcause CDD was first designed to be used on carious dentin. The fact there is another application that is even more valid seems to escape some people. Once you have used it this way, you will recognize how helpful it is.
Re using the Diagnodent. I have created a comprehensive CD on how to use it, covering the caries process, diagnosis, false positives, false negatives etc
have a look at
http://www.advancedental-ltd.com
for some more info on the CD
Regards(Edited by gwmilicich at 4:20 am on Nov. 6, 2002)
Robert Gregg DDSSpectatorAhhhh…….Yes! The Old, “Let-the-tissue-rest-laser hemostasis-technique”. Used it many times myself…..Works well in most occasions….:cool: Good tip Mark.
‘Nother technique: defocus and warm the soft tissue bleeding (not the bone!) Careful in esthetic areas until you get the feel. “Give it time.”
86
gwmilicichSpectatorI use the Diagnodent to diagnose and CDD to guide me regarding what I need to remove. Once you have decided to treat following DD diagnosis, clean the fissure entranc with CDD. This will remove the very extreme outer layer of tooth structure (VELOTS) This is where the pellicle becomes part of the tooth. It is a high lipid layer with gradated mineral content that increases the deep into the velots you go.
Often if you stain with CDD befoer removing this, you can get a false negative. Once it is removed, CDD with go where acid has been.In slow onset caries (most common presentation in fissures ) interprismatic enamel is lost, but macrostructure is maintained. When you place CDD, it will soak into the carious enamel, accuately identifying all the acid damaged, nonprismatic enamel that MUST be removed if you are using resin bonded restorations.
You cannot bond to carious enamel. It is non prismatic, ergo no bond, leaking seal, recurrent caries.
This use of CDD has been writen up in the peer reviewed literature, but is not well understood by most, ebcause CDD was first designed to be used on carious dentin. Teh fact there is another application that is even more valid seems to escape some people. Once you have used it this way, you will recognize how helpful it is.
Re using the Diagnodent
Regards(Edited by gwmilicich at 4:27 am on Nov. 6, 2002)
2thlaserSpectatorBob,
Thanks, good tip yourself, I will try that today if I have a case! Thanks,
Mark
AnonymousSpectatorHi all,
Tried something new today. 9 yr old w/ recurrent caries distal of b. Pt didn’t want to be numbed up.
Bathed tooth ~45 sec B&L Waterlase 1.75 50/50 defocused.
Removed old amalgam with high speed handpiece. Re entered tooth with laser and removed decay with laser and slow speed handpiece. Placed composite.
Sorry no pictures -my wireless intraoral cam is good enough for patient education but not alot else.Got a blurry picture – can see size of old amalgam and caries.
http://www.rwebstudio.com/preprep.JPG
Robert Gregg DDSSpectatorCooool……that’s good laser adjunctive dentistry and a great service to your patients, Ron!
Robert Gregg DDSSpectatorGraeme–nice post, good read.
Pat, very nice gesture to Jose.
Bob
2thlaserSpectatorFabulous Ron! Great job, and of course, thanks for sharing, helping us to learn great things.
Mark
AnonymousSpectatorFollow up picture day 7 (post tx) herpetic lesion.
Patient said starting with day 2 she had big improvement. The big question is – was it the laser or just time???
SwpmnSpectatorGreat idea, Ron.
Anyone have a theory on the physiological mechanism behind anesthesia using the “defocused” technique? How does the laser energy numb the tooth when we bathe for 45 secs to a minute?
Bob, can you help with your long term laser knowledge?
Al
SwpmnSpectatorLooks good Ron.
Perhaps the laser treatment at least helped relieve the patients discomfort.
Al
-
AuthorPosts