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brucesownSpectatorHi there,
I typically do apicos using a scalpel for the incision. I use the laser for bone removal, because it is precise, antibacterial and possibly promotes healing. I think that MTA is probably the best material to use as it seals well and seems to have some osteogenic effect. It is, however, expensive and if you don’t have any lying around, I would suggest GIC, or I’ve even used “gasp” amalgam. Don’t have access to a CO2 laser, so can’t comment on that. My suggestion is that you try to stain the apex with methylene blue to try and find any cracks that are lurking. Most of my failures have been from cracks that I only found after the extraction. Have never heard of using tetracycline, but I do often pack with gelfoam. I don’t suppose the tetracycline will hurt, but I would worry about a foreign body reaction if there were any inert fillers in the drug. I don’t know that for a fact, but it would be my paranoid first thought unless I read a credible argument to the contrary. I don’t know what you would gain as the laser energy should probably be sufficient to decontaminate the area. Try to be as atraumatic as you can with the flap, give yourself lots of room if the lesion proves to be bigger than you thought. A little grove in the bone for the retractor to sit in will help avoid trauma caused by the retractor slipping. Suture it up tight and see the patient in a week or so. I will sometimes prescribe post op antibiotics.
I’m just a lowly GP so don’t take my word as gospel, but I have done a lot of these and they mostly work out for the good.
Best of luck.
HubertSpectatorHi Chris,
glad you joined the Opus Duo ranks. Since you have the Duo you have everything you need for performing a smooth apico. I would use the 200 micron tip for the incision (setting would be anything like soft tissue crown lenghtening). You would typically not use CO2 for that incision since you want some bleeding. I would do the incision with the straight handpiece for easier access. I would then change the tip to something like 600 micron and change setting to crown lenghtening HT (hard tissue) and go forward to cut trough the root and remove granulation tissue. You may then change to angled handpiece to prep your retro apical seal (cave lasers don’t like some GP). I seal it with Diaket which is way less expensive and does the job fine. Fill up bony defect with bio-oss, suture with 5.0 or finer and make a prescription for antibiotics and ibuprofen. Once you have ventured into making incisions with your laser, you will rarely touch a scalpell again. Oh, btw, you may clean out granulation tissue with the straight CO² and remove any char with a spoon. I really do like the versatility of my Opus for that reason, changing wavelenght is just a matter of changing handpieces. I do not get paid by OPus for saying this- but I am taking offers;-)).
Hope that helps, good luck and keep us posted
HUbert
Glenn van AsSpectatorHubert and Bruce, great replies there and that helps alot I am sure for those individuals trying to do apicos with their erbium/CO2 lasers.
Thanks for those well thought out ideas.
Glenn
Glenn van AsSpectatorNow isnt this included in your warrantee ……
Glenn
jetsfanSpectatorGlen,
I have used Atridox to fill the void before suturing. IF you have any lying around you might try this.Robert
etienneSpectatorHi Bob and others
Some feedback on this case..Unfortunately it seems as if I am going to loose #9 as well as #31. I performed endo on #9 after having persisting drainage from the sulcus area with no real change in the situation. My only explanation at this stage is a possible root fracture. #31 I fear is going to go the same way. The fracture/crack seems to deep to allow the situation to resolve. Fortunately the patient was informed right at the beginning that this might happen.
Still very disappointing though!
Take care
Etienne
cadavisSpectatorThanks for the info. I really appreciate you taking the time to help me out.
Damn, I love this site!I’m in an area where nobody else uses hard tissue lasers so we don’t have any study groups for it. Can’t wait till a few others get on the ball.
Chris
dkimmelSpectatorRod isn’t the restrictive covenant about up???
Glenn van AsSpectatorHi Robert…….I am using Osseograf sometimes with Pepgen mixed in. The logic for me is that the laser has already sterilized the space, gelfoam wont stimulate osteoblast. I think that the osseograf and pepgen is a good solution for the crypt.
Glenn
etienneSpectatorHi All
Further regarding lasers for ortho…I saw a patient last week that had a surgical mid-palatine expansion done as part of his ortho treatment. Unfortunately, he has had some bone loss associated with this procedure with associated loss of the papilla. Has anybody any experience regarding generating bone growth in such a situation? Any thoughts at all about it?
Thanks very much
Etienne
etienneSpectatorHi
This patient presented with a bad fitting bridge which I removed. At the time the tissue was flabby, bleeding and swollen.
I used my Nd:YAG at 40mJ, 80Hz in the sulcus to sterilize the sulcus and stimulate the tissue. Total lase time approximately 30 seconds.
After-
10 Days later I could take an impression to have the final bridge made. Tissue response made the job a lot easier.
Etienne
Robert Gregg DDSSpectatorThat’s a nice service Etienne.
Can you use 20 Hz on your machine?
Bob
Glenn van AsSpectatorHey that is beautiful…..tell me something…..what do you think is on the distal of the premolar at the margin. Is it calculus?
What a wonderful service and CLAP CLAP CLAP for the photos……..I LOVE IT!!
Glenn
jetsfanSpectatorGlenn,
I like your reasoning. In this case I chose atridox for 2 reasons:
I had some and this patient absolutlely refused to take antibiotics post op.Robert
davidmyloSpectatorFirst of all, I would like to express my most sincere thanks to all you guys here for the amount of precious information. I’m not using a laser yet but to me, laser definitely marks the future trend of dentistry. I’m seriously considering perchasing a laser and is in the process of gathering info and valuable opinion from laser users.
However, it seems a lot have been discused regarding waterlase and the versa wave hoya conbio laser but little has been mentioned about the kavo key laser 3.
It’s a ER:YAG solid-state laser with a feed back system claiming it can selectively remove calculus in perio pockets leaving sound root surface un-touched in perio treatments and later, with a touch-technique handpiece, can selectively remove carious dentine only leaving sound remineralisable dentine untouched during restorative treatment.
Any info or opinion welcomed. Thanks again. :confused: :biggrin:
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