Hi Ray,

Am I Dr. Fried or Bob?? Or are you really me??:confused::biggrin:

Good questions.

One answer to the question about pulsed Nd:YAGs and caries and dentin removal is the pulse duration needs to be short (e.g 100 usec) to minimize lateral thermal burn. (Didn’t I show you 7 different pulse duration on an extracted root when you were here?)

The Lares laser has a pulse duration of 150 usec at the shortest–which is OK for caries removal, just not as good as 100 usec–less lateral thermal damage.

The Fr, Nd:YAG will NOT removal HEALTHY enamel. But it will remove diseased enamel, decalcified enamel and healthy dentin. Which is actually a neat thing when you think about it as a clincian. We can undermine the enamel that’s healthy, and not damage it, we can prep VERY thin area of DEJ (like incisals of lower anteriors), while removing decayed or even healthy dentin. Not many tools in my dental tool box can do that as selectively as a pulse 60 microns deep at a time!!

We NEVER use Fr, Nd:YAGs to prep under water. We use water only after the prep is completed to remove any discoloration from the plasma deposits on the tooth surface (carbon). Don’t see any problems in regards to fracturing or crazing with the FR Nd:YAG on vital tooth structure. The pulse preps are very clean.

Since I have a 2.1 micron Fr, Ho:YAG, (150 usec, 5-10 Hz, up to 500 mj/pulse) I can tell you I have been disappointed with its hard tissue capabilities. It just doesn’t absorb on dentin or pigmented caries much at all. But man does it heat up the vital tooth. Patients do NOT like it even when theya re numb!!

I question his conclusions. But I would need to know what his parameters of operation.

We typically use 2.5 Watts 10 Hz 250 mj/pulse at 100 usec, no H2O. What were Fried’s parameters?

Bob

Hello Dr. Fried,

Welcome to the forum.

I enjoyed your presentation on P-OCT in Florida.

My Fr, Nd:YAG colleagues and I have been using them for caries removal, dentin prepping, dentin etching, etc for over 12 years without any adverse effects.

Our personal observations are we obtain better bonds to dentin when we etch with Fr, Nd:YAGs.

Fr, Ho;YAGs aren’t good on hard tissue even at 500 mj/pulse.

The reason many of us like the Fr, Nd:YAGs over Erbium in certain cases for hard tissue, is its ability to selectively remove only the organic plug, stain, caries, or dentin. Many times this means we do not have to prep the enamel, thereby conserving maximum tooth structure.

Erbiums are great for enamel preparations, and do so quickly without any thermal injury or fracturing to surrounding tooth, to be sure. It’s just I don’t always want to remove or etch or prep enamel, especially if I only want to determine if the decay remains in enamel.

Or maybe I just want to remove smoker’s stain or calculus from the pits and fissures. Easy to do with Fr, Nd:YAG.

Very useful diagnostic aid until Lantis makes P-OCT available.

Bob

Glenn,

Nice case! CLAP, CLAP, CLAP!

Can’t tell if the 1st molar needs endo, or is just hitting hard?

Bob

Hey Todd,

Welcome to Ron’s forum!!

Thanks for the very kind words.

It was great to hang with you in Florida. Glad you made the decision to go forward with your PerioLase purchase. But I think you will find just how unbelievably valuable the PerioLase for LPT will be, the training you will get, the support, as well as all the other 101 things a pulsed Nd:YAG can do, including hard tissue stuff.

Thanks again and see you soon.

Bob

Hi David,
I would second the recommendation of getting some training from Bob Barr and Gloria, see http://www.rwebstudio.com/cgi-bin….topic=5
The simple version of Tx is
scale/rt plane then-
1. treat quadrant with deepest pocket 1st
2. activated tip used to deepithelialize 1mm short of pocket depth
3. decontaminate pocket ,placement of tetracycline
4. 1 week later- do #2 followed by #3 in new quadrant and return to 1st quadrant to decontaminate again 1mm shorter than previous tx.
Occlusal adjustment as necessary.
Rule of thumb is pocket depth minus 3=# of treatments
7mm pocket will be revisited 4 times.
The de-epi is done w/ activated tip continous w/ local
The decontam is done w/ nonactivated tip , pulsed /no local
We’ve got nice results 6mm and less. Often resolve to 2’s and 3’s. Not been doing it long enough for xray’s to check bone.

That being said, from my investigation and time spent w/ Bob G., I think his Periolase MVP-7 offers a much better result, with less patient time and retreatment. I’ll probably be selling my diode when the MVP-7 arrives  , so if you know anyone who’s interested ….?

Hope that helps,

Ron:

Ha ha ha!!!! I got a good chuckle out of the last paragraph in your post. Sounds a lot like some of the frustrations I post with my Erbium. Actually it’s not really funny but that’s why we are here – to learn from one another.

Keep us informed on your experiences with the Nd: YAG once it arrives.

Al

Sorry David,

I was referring to the Periolase MVP-7 that Bob Gregg and Del  have developed.

http://www.millenniumdental.com/main.html

Didn’t mean to be confusing,I was kind of poking fun at myself because, if this forum was here last July and if I had done better research and investigation before buying my Twilite, I’m sure I would only have a Waterlase and Periolase MVP-7 and no diode. Instead I’ll have all 3.

Sounds like you’re going to be learning some great things, from some great people.

Be sure to share with the rest of us later,