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  • June 28, 2005 at 12:49 pm in reply to: WaterlaseMD 700usec Pulse Duration #6823

    whitertth
    Spectator

    Al,
    Let me try and answer some of your questions….having used the MD for a while now, I can comment a little bit. As far as cutting soft tissue effectively….My best description is the feel of the cut is smooth kinda like a scalpel….Very different from the Waterlase or other erbiums…
    Hemostasis is very good and and much better than the other erbiums as well and as long as you dont get a real “bleeder” you can do alot with little to no heme…..I dont think anyone will say that it is a good hemoststically as a diode, CO2 or electrosurge…Just much better than the other erbiums because still in the presence of a real bleeded you will get some bleeding but still much better than the other erbiums.
    The tips clean easilly as with the other erbium tips…I rarely cut even soft tissue without water as there really is no need to……Hope that help..

    June 28, 2005 at 4:23 pm in reply to: WaterlaseMD 700usec Pulse Duration #6833

    Swpmn
    Spectator

    Thank you Ron.

    June 28, 2005 at 6:23 pm in reply to: Frenectomy with the chisel tip #6960

    Glenn van As
    Spectator

    Allen I totally agree with you and I have even tried the 980nm diode at high wattages with water and guess what…….still much delayed healing compared to the erbium which is fast with or without water.

    I wonder whether with water with the erbium whether the total time which is increased again will lead to delayed healing compared to just doing it without water.

    You are right that there is less bleeding but guess what, if you do the frenectomy with the chisel tip in Non contact there is alot less bleeding. Larry Kotlow was the one who taught me this and I think he is right compared to a soft tissue sharp tip in contact with the erbium for these frenectomies.

    This is a great post that you did Allen and shows a wonderful understanding of laser physics and I totally agree with you about healing. The erbium wins hands down over the diode in CW and the diode wins over the electrosurge.

    Hope that this helps

    Glenn

    June 28, 2005 at 6:26 pm in reply to: Frenectomy #9780

    Glenn van As
    Spectator

    Neat case Jeff, given the discussion of healing on these,do you have any Nd Yag frenectomies with post op pics on day 6 or so. I think that in my hands the erbium wins the healing race over the Continuous wave diode but you have both the erbium and the NdYag, I know there is less bleeding with the soft tissue NdYag but how do you feel the healing short term compares.

    For me as I posted in the erbium section the erbium wins everytime whether I use water on or off the diode laser.

    Glenn

    June 29, 2005 at 1:44 am in reply to: Frenectomy #9778

    Benchwmer
    Spectator

    Glenn,
    I have a frenectomy case on this string from Sept. 2004 comparing Nd:YAG vs. Erbium. The first post-op photos in those cases were from 7-10 days. The Erbium creates a cleaner wound, that heals quicker.
    Here is the ten day healing with Nd:YAG vs. seven days with Erbium.
    Nd:YAG 10 days
    Ahlq2404AA.jpg

    Erbium-7 days
    VanDag3304aa.jpg

    I find myself having to be more aggresive and having to relieve the tissue more using the Erbium so the frenum doesn’t re-attach. The Nd:YAG wound heals slower, but more predictably. There is no char to heal in either case.
    Jeff

    June 29, 2005 at 1:42 pm in reply to: WaterlaseMD 700usec Pulse Duration #6824

    2thlaser
    Spectator

    Ron, Al,
    Actually, I have used the MD a ton, as has Jim Jesse. When you cut with the water off in the 700ms mode, it performs very much like a diode. In fact Ron, I disagree with you about a bleeder. When I get one, I use the MD without water, very low settings with higher hz rates and can control it very very well. I don’t even get the diode out anymore. Cleaning the tips are easy, and yes, tissue clings to the tip in a dryer cut, but can be cleaned easily with a wet guaze. I only have this problem with the zirconium tips.

    Ron S…any way we can start to show some video clips on the site, maybe in the pushing the envelope section? so as to keep it easy? Just a thought.

    Mark

    June 29, 2005 at 1:57 pm in reply to: Frenectomy #9782

    Robert Gregg DDS
    Spectator

    Jeff–

    Very nice results. Expertly done.

    Try 4 watts 100Hz and 200-300 Joules per large frenum and I think you will see a cleaner wound that heals more like the erbium photo.

    Nice cases though!

    Bob

    June 29, 2005 at 2:02 pm in reply to: Facial decay sub-g, gingivectomy #5655

    Robert Gregg DDS
    Spectator

    Nice work Matt.

    How can anyone not appreciate that any other technology would not get that sort of clean result?

    E-surge? Doubt it–too dangerous to underlying bone. Radio-surg. Perhaps.

    Way to go!

    Bob

    June 29, 2005 at 2:25 pm in reply to: Frenectomy with the chisel tip #6956

    Glenn van As
    Spectator

    Interesting to read of Ron Kaminer and Mark mentioning that there is so little bleeding with the MD.

    This case wasnt done with the MD……..

    No bleeding!!

    Hmmmmmm…………..

    Glenn

    June 29, 2005 at 5:22 pm in reply to: Frenectomy with the chisel tip #6953

    Anonymous
    Spectator
    QUOTE
    Quote: from Glenn van As on 10:25 am on June 29, 2005
    Interesting to read of Ron Kaminer and Mark mentioning that there is so little bleeding with the MD.

    This case wasnt done with the MD……..

    No bleeding!!

    Hmmmmmm…………..

    Glenn

    Glenn, I’ve done some w/ my Waterlase and also had no bleeding which brings me to the following question-

    Is it the laser or how well the operator limited the erbium energy to fibrous tissue? My guess is there are less bleeders with the higher the magnification(like w/ a scope) 😉 because of better visibility during ablation.

    June 29, 2005 at 5:49 pm in reply to: WaterlaseMD 700usec Pulse Duration #6819

    Anonymous
    Spectator
    QUOTE
    Quote: from 2thlaser on 9:42 am on June 29, 2005

    Ron S…any way we can start to show some video clips on the site, maybe in the pushing the envelope section? so as to keep it easy? Just a thought.

    Mark

    Sorry, no video, just can’t fund the server space. Now if some company wanted to purchase LDf,  in exchange for a MD or Versawave, I’m sure they could afford unlimited server space…. wow.gif :biggrin:  😉 smile.gif

    Actually, anyone can put video on any server they choose and then just place the link on ldf.

    June 30, 2005 at 12:11 am in reply to: Facial decay sub-g, gingivectomy #5656

    Swpmn
    Spectator

    Matt:

    The pre-op tissue is obviously highly inflamed yet you have excellent hemostasis with minimal charring. That’s pretty cool!

    Gregg brought up the topic of electro/radiosurge. Maybe just me but I see another advantage. Clinically I seem to have better results controlling hemorrhage with minimal charring when comparing a soft tissue laser to electrosurge.

    Can you tell us more about the laser used and operating parameters such as power setting, rep rate and pulse duration?

    Nice case and large composite restoration. Even though patient has not accepted ideal treatment you’ve provided an excellent service!

    June 30, 2005 at 12:22 am in reply to: Frenectomy #9783

    Swpmn
    Spectator

    Nice frenectomy Jeff.

    Your Virginia partial probably also gave the lady an instant Lip Lift!!!

    June 30, 2005 at 1:35 am in reply to: Frenectomy with the chisel tip #6957

    Glenn van As
    Spectator

    Ron, I am not so sure that the issue is only the magnification but in addition in this case the whole thing was done out of contact on the frencectomy.

    I have never used the MD on soft tissue at the 700 microsecond pulse but I wonder how sometimes people can say it cuts smoother than any erbium laser.

    To me both the MD and the Versawave (heck even my upgraded Delight) have 50 hz settings that for me are the main reason for smoother cuts on tissue.

    I just shake my head when we get into this erbium is far better than that erbium as I have never seen something done with any laser that couldnt be done equally well by a skilled trained clinician with one of the other brands.

    As I have stated numerous times, the differences are not in how they cut but how they are packaged and marketed.

    Enough said.

    Point taken I hope

    Glenn

    June 30, 2005 at 1:38 am in reply to: Frenectomy #9781

    Glenn van As
    Spectator

    Hey Jeff, great points, I think it is interesting to note the healing from various lasers and I think that the NdYag with its high energy per pulse (like the erbium) will probably heal better than a CW diode given all the same circumstances.

    Comparing different brands within a wavelength is for me not the same in terms of amount of differences as it is comparing one wavelength to another.

    Neat idea about relapse of erbium. Not sure why that would be , I havent seen that but the operator is the same in your case on each one.

    All the best

    glenn

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