Great stuff David and Ron……it is quiet on the laser board. A shame really. I love the advanced tips, great stuff. I dont think you need a matrix for the tooth distal to the decay as it is a porcelain crown, but the matrix and a wedge (ifyou use topical) will help prevent the tissue from getting cut as you go through.

On these at times to speed things up, if there is lateral extension into dentin , I will actually take a diamond bur and widen the enamel to get access to the decay after I use the laser for a while. I am not using as much of laser analgesia unless the patient is really antsy. Then it is helpful to get them used to water, sound and sensation.

I agree with the Versawave settings and 10/400 will move you along in enamel with whack whack whack noises but some patients cant tolerate this even in enamel. You better toilet bowl the prep though to outline your cavosurface margins best as you can, because as you near the DEJ you will find that sensitivity increases.

Ron, it looks like you are using 8X with the scope , do you realize that this will almost provide you with double the visual information that David is seeing with his 6X loupes (poor mans scope). The difference is 64X naked eye with the scope (X times Y) and 36 times the naked eye with those heavy heavy loupes.

GRIN…….

giving David a bad time…..well its late and for a treat I will post something on the board tomorrow (closed flap)……GRIN.

Cya

Glenn

1. What laser would you use?
HOYA ConBio DELight 2940 Er:YAG

2. Will you numb the patient?
From your description of the patient and lesion, probably not

3. Will you do the 90sec. pre laser anesthetic?
No

4. Intial settings . Tell us in focus or not in focus and how you would change your settings as you progress.
80 degree 600um tip, 10 Hz, 210 mJoules, 1mm out of focus, air/water setting: enough to rinse and cool the site but not enough to block my vision or pool in prep. The lesion looks too large for a tunnel prep so I would make a wide outline of my perceived extent of caries at a right angle to the occlusal. Then I would drop straight down into the dento-enamel junction of the distal marginal ridge until it breaks away from the tooth. Continuing into the dentin along the long axis of the tooth, trying not to direct the laser energy towards the pulp, until caries is excavated. Switch to 30Hz 50 mJoules to smooth enamel margins and remove products of ablation. I often pre-wedge but don’t use the metal matrices much anymore while prepping.

5. Tell us what setting changes you would make if the patient started to get sensitivity.
Drop to 10Hz 125-150mJoules. If in dentin, sometimes I use 3Hz 170mJoules.

6. At what point would you numb the patient?
If above still not working and patient getting anxious.

7. Tell us also if you would use a handpiece at any point other then to polish the filling.
No.
Also if you use any hand instrutments??
Yes, spoon excavator to quickly check dentin for caries and to plane enamel margins.

Al

Nice, but I would have been far more aggresive with either the laser or just plain cold steel and sunshine. See articles by Tim Hempton. Good stuff on thid type of treatment.

Nice case Matt. And difficult too.
I maybe would have Lanaped it first and then did some tissue re-sculpting for any areas that needed to be touched up later. I have had similar cases ( not as sever as yours however) where Lanap alone let most of the “air” out of the puffy papillas. You just need to be carefull with the  marginal gingiva areas as they have a tendancy of getting over-cooked a bit and later receeding. Nice case. Thanks for sharing.
Nice composites BTW!

Dino

The extra info does help. I thought it was a delayed passive eruption case or medicinally induced hyperplasia. If it just plain old poor OH then great job anyway. Make this patient some custom thicker clear flexible trays and give her some peroxide. 10% carbamide variety.

<a href="http://www.learnlasers.com/certification/fellowship.php

David,

” target=”_blank”>http://www.learnlasers.com/certification/fellowship.php

David,

You need to present a few cases, 2-3, and be able to discuss them without much proctoring. Real easy for you, you already know all this stuff….website above to guide you. Call me if you have any questions!! Come to Montana dude!! No Beavers here!;)

Mark