Ron:

That’s pretty cool, thanks for sharing.

How old was the patient?

Al

Hi Group,

With all these positve comments about the MVP-7 I am getting a little nervous about my visit to see Bob in a couple of weeks. At one point I was thinking,”Well maybe half a loaf is better than no loaf at all.” Now that I see some are soured on the Biolase diode I am rethinking the plan. Maybe I will wear old clothes and shoes with holes in the toes when I travel up the coast of CA. Hey Bob do I need to take laser physics before we come?

Pat

Rod,
Could you say a little more on how you created the new sulcus with the thin instrument?  Did you remove bone with your laser?  Will you anticipate some recession from the festooning as the tissues heal?

Pat

Hi Ron,

Nice case and thanks for sharing.

Hey Al–am I the only one old enough to remember that decay has a “bacteria free zone” in the last 2mm near the pulp and that decay like this was treated with a “indirect” pulp cap using Ca(OH)2 (because decay was left behind) in order to obtain secondary dentin of the remaining soft stuff.  Then a few months later, the ZOE was removed and a “final” restoration was then placed after a calcium bridge had formed.:confused:

Admittedly, I have never done this, but isn’t this “New Think” really “Old Think”:confused:

Bob

Ron: gosh it is hard for me to let go of old ideas.

I really like your treatment…clap clap clap

Great photos and a nice result. Boy have I got a cool case coming soon that I dont even think our poster boy Mark Colonna has done.

Cant tell you yet but you are gonna flip when I do it.

I really wonder about bonding onto soft decay as some propose. It looks bad on radiographs and in general I hate it .

In this case you sure did a nice service to the patient.

I also wonder sometimes when the lesion is as undermined as yours was if there is a value to going back and widening the enamel up with a high speed diamond to prevent the weakened enamel from breaking.

Who knows but great clear photos.

Glenn

Al, whenever possible I remove all decay. When I think we will have an exposure I tell the patient we can do a couple of things( before even starting restorative procedure).

1. proceed and remove all decay, expose the nerve and be assured the will need RCT

2. get as close as possible to the nerve w/o exposing , place calcium hydroxide and then GI to try and get the tooth to use its natural defense mechanism to build up secondary dentin. they are also told that this tooth still may need endo.

3. direct  pulp cap
Very few opt for endo right off the bat. I very rarely will do a direct pulp cap anymore due to high failure rate in my hands. I have done a couple since the laser and so far, so good. Over several years I’ve had more teeth treated as number 2 not go on to endo than have gone on to endo. If it works you’re a hero for avoiding an endo and if it doesn’t the patient is still happy you tried to avoid endo for them. I think the key is to get them involved in your thinking process so they understand what you are trying to do for them.

Ron : I looked back at your case again, and really want to congratulate you for your fine treatment.

I think I would have done the DO on the premolar and the MO on the 2nd molar at the same time (they are dentinal) and checked to see if either proximal surface on the tooth you restored was involved. I just find so often with the scope that the first molar will have a cavitation not visible on the radiographs but present all the same .

1 year from now you are gonna have to do it anyways.

What is your feeling on this.

Thanks again.

HIgh caries rate in this individual.

Oh ya ……the little stain in the distal groove is something I will open up as well under the scope as it is often decay.

Again, dont get me wrong…….I LOVE WHAT YOU DID, just trying to provoke some more discussion on a nicely handled case.

glenn