A challange??
A call to action??
You are correct in things are not the same as 4 years ago…

This is a tough time of year though to ask. One very busy last day of the year for me tomorrow…

I’ll have to get back to you in Jan….

David

I shouldn’t have posted that last post. I think I “jinxed” myself. We finally had ONE person this week we had to drag out the syringe for……so we could do it the “old fashioned way”.

Seriously…..going 2 months between failures isn’t so bad!

Dan

Paul……..you are on.  I will begin to post the small stuff.  The stuff everyone buys a laser for and then moves on.  I will start by saying that for the most part I use the laser for restorative dentistry in the following situation.

1. Pedo (kids are great with the laser) especially the interproximal back to back lesions on the primary molars.
Great to do without anesthetic but you have to develop soft touch on the tissue with matrices and topicals work great for that.

2. Adults

Class 1 and 2s that are small (ie less than 40 on the diagnodent) and only Class 2s where the patient is adamant that they want it done with the laser.  ITs slower and I charge more for it.

Anterior Class 3, 4 and all Class Vs are great with it.  Its not a panacea for all but I tell you , patients love it when it works.

You need to use resins or GI for these preps as they are rougher, so amalgam is not possible.

I will post some “beginner ” stuff or bread and butter stuff over the Xmas season as time permits.

Hope this helps you but many buy the laser in the hope of being faster, being able to do tons without anesthetic but as my good friends Kimmel, Williams and McNamara say, the key is to success without anesthetic is patient selection and trial and error gives you some idea as to what will work without anesthetic and what wont.

One change in settings that has occurred over the years has been a gradual reduction for enamel ablation from Higher Hz rates (pulses per second ) to lower Hz.  In the old days most of us would use 30Hz on the Delight and on the old Waterlase it was always 20Hz as that was the only setting.  Alot of Opus users were able to penetrate enamel at 10Hz and very high energy per pulse (the Opus Principle or the Jackhammer (high hertz) vs the Sledge Hammer (low hz) effect).

Effectively this did a couple of things.  It gave more time between pulses for tissue relaxation and each pulse was at a huge energy compared to the old days.  More chance of success in decreasing sensitivity during the preps.  

In addition another change I have seen is in the bevels on Class Vs, 2s etc at the cavosurface margins.

More and more people are using lower energy settings and higher Hz for a smoother cut that doesnt give such a big ablation crater per pulse.  What these big ablation craters did was decrease bond strength leading to staining at the enamel margins so people now use say 40-50 Hz and 30-40mj which gives a smoother margin and better bonding.  I will scrape the margins with a spoon, some use a diamond , others AA.

One last suggestion for someone looking into lasers.  Make sure that you are using good magnification for laser dentistry.  Loupes above 4.5X make it far easier for the hard tissue lasers and to a lesser degree soft tissue lasers to see what you are doing.  Hard tissue lasers depend far less on tactile ability than do other aspects of dentistry.  You dont feel what you are doing , but you must see what you are doing.

Hope that starts you off on the right path.

Glenn

Here is one case where I did some Class Vs

Diode used at 0.8w pulsed with TAC topical.
Erbium for preps on Abfractive lesions (patient wouldnt go for grafts and it was sensitive).  50 Hz and 30-40 mj on enamel for bevel.
Point 4 opaque flowable for material.

Simple, no anesthetic laser preps.

Glenn

(Edited by Glenn van As at 2:36 pm on Dec. 22, 2005)

(Edited by Glenn van As at 2:38 pm on Dec. 22, 2005)

Hi Glenn!!

When you say osseous now you do mean open… right?

With sutures and sensitive roots and black triangles?

Why not just extract and place implants?

That seems to be the reputation most of us periodontists have been accused of lately.

Pardon the sarcasm, I have just been reading alot of anti – periodontist posting recently on this forum and I find it a bit alienating for those of us who enjoy being here.

Truth is I would love to see your cases when you get a chance to post them.

andy

Hey Glenn,

I am sorry if it sounded like I was accusing you in any way. That was not my intention. In fact I applaud you for educating yourself in both open and closed surgical procedures. As you know I feel both are appropriate on a case by case basis.

I suppose CT grafts and implants are somewhat more rewarding than the conventional osseous surgery but I believe perio treatment is still very much focused on regeneration. Hence, my personal interest in the periolase.

Anyway, Best regards to you and your family for the Holidays.

Sincerely,

Andy