Hi there folks: As I get more comfortable with the erbium for osseous recontouring, I find that I am looking more and more at biologic width issues and making sure I have enough when I didnt before primarily because of the ease of doing this.

In this case this premolar (maxillary) broke and was patched up by my dad who put a couple of pins in.

I had to remove the restorations and pins and then get some more solid tooth structure on the palatal so I used the erbium to remove tissue (30 Hz and 100 mj without water) and then 30 Hz and 130 mj with water for the bone with a 600 micron tip. I think if Hoya Con Bio had a big 1 mm or 1000 micron tip I would use it here so maybe it is something I will talk to them about , a big stubby tip for bone removal.

In addition, we troughed to control hemostasis with the diode that I have in the office at present. I then proceeded to take the impression on the same day.

Now I hear that in the USA that certain dental plans will not pay for the osseous if the crown prep is done the same day. Ridiculous I think but that is something you need to discuss with the patient…….

I took the impression and was pleased with the result and then placed a provisional on the tooth ( my Dental assistant did)

I will post the final shots when I do it for this case and tell you how long the healing took etc and focus in on the palatal to see about recession. I may try and get the patient back in 6 weeks to look at healing as well.

I sent one of my cases to the periodontist here in town for her to look at …….no reply.

I wish people would at least have an open mind to these procedures as I honestly havent had any complications yet but I guess if I will then I will adjust my settings.

One thing I wondered about was the possibility of air emphysemas with the air on cases where you blow out the attachment and bone. I had some bubbles on this case at the gingiva so I think it might be an idea to keep the air low with the bone reduction.

What do you think?

How about taking the impressions on the same day.

Rod taught me the marketing value of this and how you must explain to your patients what a service you are doing to be able to do the reduction of bone at the same time as you take the impression.

What feelings do you have on this and other ideas.

In closing, I am constantly trying to push the envelope on using the erbium as I get more comfortable with simple restorations and other soft tissue procedures with it.

How are you using the erbium lasers in your offices?

Glenn

Hi there: one last case I did this week with the erbium laser…….

THis lady fractured off the premolar and it was decayed and unrestorable (no rads here sorry).

We sent her to the periodontist for a consult re implants but she just couldnt get herself to do it so we opted to do a bridge instead.

I used the laser at 30Hz and 80 mj with water and a 600 micron tip for the core buildup of the posterior abutment which had an endo done through a very old crown.

Then after both preps were done we used the diode to trough and then used the erbium laser with water at 30 Hz and 130 mj to remove bone around the root fragment and then got the root out after the bone relief was done.

A couple of things……I was hoping to get it out in one piece with the forceps but it broke but a little more relief with the laser and I was able to elevate the tooth out of the socket with a small root tip (micro elevator). No flap or sutures required.

I then thought……….well it isnt in a area where it is highly esthetic……lets see if we can get an impression.

It worked so what the heck we went with it.

I then had a custom waxup from the lab (no time for me to do this at night ……) and then we made a suck down template in coping material of a pour of the waxup and used this to make a custom fitting provisional.

I had placed gelfoam in the socket prior to the impression to coagulate and to prevent provisional material and also impression material going down the socket.

Now in this case , it was the first time for me using the diode since I got it back and I couldnt get it working right (my stupidity) so there was some trouble troughing and I did pour more energy into the tissue than needed ( it took longer at 1.0 watts then it should have)……..but we got it sorted out after this case.

I mention this because the patient came back the next day with the temp off and the tissue was inflamed a little and I suspect it may recede a little but time will tell.

It was also a little sore that night but she had never had a tooth removed so this might account for some of the pain and the preps, but I think the laser also didnt help.

I will post the final images when I seat the bridge.

All the best……..just experimenting to see what works and what doesnt……with respect to tissue recession.

I hope that my cases help a little to stimulate you to see what is possible and that my mistakes help you in preventing to make the same ones…….lord knows I make enough of them.

Just ask Bob……..

Glenn

Tried to remove this alloy . Did the 90 sec. 5.5W 75A 90W on the O,B & L. Then pulled out the Highspeed and got about as far as I would expect without anesthesia. Tried another 90 sec. I repeated this 3 more times  and gave up giving anesthetic. Not sure how to post the photos. Here are the links.

The rest of the story is the patient had no problem with this tooth prior . She is a 40 Y/O wt  blond female. It usually takes two carpules to numb her, as it did today.
Why you ask did I even try! It was my sister in law visting for the week of spring break!!

Any ideas what I could have done different?

David

(Edited by dkimmel at 10:29 pm on April 7, 2003)

(Edited by dkimmel at 10:30 pm on April 7, 2003)