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Robert GreggParticipantHi Ron,
You got the general concepts correct.
Activation = Conditioning = Hot Glass effect = minimal thermal conduction depth penetration if kept moving quickly.
Non-Activated = non-conditioned = bare fiber = 810nm wavlength emission into tissue and tissue alteration by wavelength dependant absorbtion and protein denaturing (ideally)–or by burning (not ideal).
Gated pulsed allows for refractory “cooling” but don’t get to confident about it–it warms soft tissue quickly and deep (12mm+)
Right on, Glenn….you have the technique right. Crown or crest of tissue preparation first before BC–allows for access to the base of pocket.
I am fascinated though.
My partner Del, and I were among the first to advocate this “crest down” technique. We were certainly the first to publish on this….and we were poo-pooed and told that pocket up was the “established” way….Oh well!
:shocked:I guess I didn’t get the memo that crestal tissue down is now SOC!:wink:
Good luck Ron.
C ya,
Bob
AnonymousSpectatorDid some more reading, so of course , some more questions.
Bob, you stated in another post that activated tip should be used on fibrous tissue.
So with an Activated tip – use more for incision (gingivectomy) than treating the goop in the pocket. Is this because of the potential for necrosis 1mm deep with an activated tip(per manni)?or just because the effect is very localized(right at the tip) when kept moving?
Glenn, in your other post you referred to using an activated tip-was this to do a reverse gingivectomy?
Thanks
Robert GreggParticipantHi Ron–
Glad you reading Jeff’s book (http://www.jgma-inc.com/ for those who don’t know about it yet). Good stuff in their, huh?
QUOTEBob, you stated in another post that activated tip should be used on fibrous tissue.There’s just no other way to cut–MELT–fibrous tissue like a frenum or fibroma with near-infrared, unless you have VERY high peak powers in a pulsed infrared. And with a fibroma you ALWAYS want to “lift & undermine” it, not try to vaporize the entire mass.
QUOTESo with an Activated tip – use more for incision (gingivectomy) than treating the goop in the pocket.No, not really. Use the activated tip to incise the internal margin of the pocket epithelium, then continue with it AS LONG AS IT CONTINUES TO REMOVE THE GOOP. Re-condition, and try again to remove goop. Better yet, don’t wipe off all the proteins accumulated on the fiber-optic and use that mass as your activator (hot-tip effect). No more goop? Then you’re done with that pass. “More” attempts and fuss in the pocket is not better.
“Is this because of the potential for necrosis 1mm deep with an activated tip(per manni)?or just because the effect is very localized(right at the tip) when kept moving?”
The reasoning behind your thoughts and what you are asking, I think, are more to do with the fact the effects of a hot glass effect are very localized in tissue–but still VERY hot!
Thermal necrosis with the hot glass effect is very localized, unless one spends too much time on thin tissue. But I think we are talking about pocket therapy.
EXTENDED or PERIPHERAL thermal necrosis refers to tissue that has been warmed to death (literally) beyond the zone of primary irradiation. Again, in the hot glass mode on the first pass, I don’t think we are talkin with too much concern about that.
Does that answer your questions?
Bob
AnonymousSpectatorYes , its starting to come together. Can I reserve the right to more questions later?
joegarciaarSpectatorIn my ofice we used both methods of diagnosis with surprising results. Not yet we have an established protocol. Can somebody give its experience us on this subject?
Thanks for your help!
2thdocSpectatorI think Graeme can elaborate more , but caries indicator dye isn’t accurate on a lased tooth.
PatricioSpectatorHow long does the desensitization of hypersensitive teeth last. (0.25w x 30-40 seconds)? Is it somewhat predictable. Can we offer the patient a service which when effective at the time will last for weeks or months?
Pat
PatricioSpectatorI was reading an article today which I may have ripped out of Compendium Mag. which indicated dye will stain a number of things beside infection and is not recommended as a diagnostic tool for decay.
joegarciaarSpectatorPat:
I use both elements for diagnosis, but not yet I have known as it would be the best method. The caries detector produces false positives, as it happens to the Diagnodent, is necessary to evaluate clinically. We need to develop a protocol.
You could give some information me?
Thanks for your help!
AnonymousSpectatorWell, went to use my Twilite for the fifth time today (2 previous perio uses and 2 bleaching) and all I get is a thermister error.Informed it must be returned for service. Anyone else run into this? Is this a sign of things to come?Should I just request a new one since its only been in the office a couple weeks?
PatricioSpectatorJose,
Como esta? Cada ano en Marzo me esposa e me vamos a Bolivia para trabajo in Cochabamba e Trinidad hacienda restorativa por los pobre indigenous y los chicos de la calle. Hacemos para doce anos pasado.
In my practice I am working to first assess caries risk based upon dental history, recent experience with decay, diet patterns, salivary flow, compliance with recare and oral hygiene and other items. This helps me to set a baseline number for the diagnodent reading. If I decide to treat based upon inspection, diagnodent reading and x-rays then I begin with the tooth surface with the highest number and judge from the presence or absence of decay what to do with other areas with positive readings on the diagnodent so treatment verys from patient to patient based upon the above listed risk items. I use the laser and high magnification so what ever I do to the tooth is minimal. I am sure others can expand on these comments.
Pat
AnonymousSpectatorCalled Biolase-Fed Ex was at my office in 2 hours picking up the laser for service and a loaner arrived 22 hours later. Impressed with the service!
Robert Gregg DDSSpectatorHi Ron–
My experience with diodes is that they tend to overheat (from the power supply), and they really can’t be run as long or as “hot” as a laser with an internal cooling system.
On my Soap Box, now.
I can’t be without my laser of choice. My lasers have to be there and be dependable to work for me ALL day, EVERY day. We turn our pulsed Nd:YAGs on in the morning, run them all day long, and do it again the next day–without failure or faults.
If I have 4 quads of Laser Perio Therapy scheduled at ũ,000 a quad–I HAVE to be able to count on my device working.
You should give Gordon Wilson a call in Arizona 602-667-9111. He’ll give you the straight scoop. He has both the Biolase Waterlase and the PerioLase. He has had a printer cable problem, and one “fault” issue that self-corrected when he restarted his laser several times.
Carbon dioxide and Nd:YAGs are the two work-horses laser wavelengths in science, industry, and the military. The main reasons relate to their overall utility, but importantly their longstanding history of stability and reliability.
Off my box….
“Is this a sign of things to come?”
It’s more like a tendency to occur, especially if you run them often and hard.
“Should I just request a new one since its only been in the office a couple weeks? “
No need to request a new laser. Those thermisters are the most sensitive to the excess heat from the power supply. In fact, as laser components go in those small solid state diodes, through the process of component elimination, you should get the “better-of-the-batch” as far as one with better tolerances replacing the ones that failed.
Good luck!
Bob
Robert Gregg DDSSpectatorDear Pat–
It is “light dose” dependent. Depending on whether you are in “contact” or defocused. My goal would be to be defocused to get the effect, not in contact, as we learned it is both a problem of open tubules AND hyper-polarized dentinal tubules. So just glazing the surface is not enough.
It also depends on surface are of the effected area involved.
Often with dentinal hypersensitivity, you can “chart” a reduction in areas that have no response to stimuli, but the patient doesn’t perceive that there is any change in sensitivity. So, the “take-away” is that you need to chart the effected area in your notes (using an air syringe and short puffs). Rate sensitivity on a scale of 1 to 10–record it!
Done properly, it last for years–decades even. My tooth is going on 13 years (and it is still vital thank you).
It is very predictable, once you find the best settings and approach with your individual device settings.
You should charge as you would to place a restoration on a Class V.
Keep us posted,
Bob
(Edited by Robert Gregg DDS at 2:10 am on Oct. 4, 2002)
AnonymousSpectatorWas supposed to take a standard proficiency class last weekend but my daughter made homecoming court so I had to cancel. Are there any classes coming up? Recommendations of who to take the class through?Interested in diode and erbium
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