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PatricioSpectatorRon,
Great presentation. Great idea also. This use is one more reason to support the fact that we are working with the next generation technology.
Pat
PatricioSpectatorRon,
Absent decay in the occlusal aspect of the crack and assuming the tooth is asymptomatic I would finish as far down the crack as possible for the best possible finish line and not go looking for trouble. If trouble comes then a redo may be in order with endo etc. but in my experience these seem to work out. I feel I have successfully crowned a number of symptomatic cracked teeth eliminating the symptoms with no apparent downside. Occassionally a root canal is necessary.
Pat
Robert GreggParticipantRon-
As far as the crack goes, I would chase it a bit with the bur and the pulsed NdYAG that will be attracted to the black pigment in the crack much more than the surrounding dentin.
Even w/o the FR Nd:YAG I’d chase it a bit, then laser Er:YAG or Er: YSGG etch and bond.
Bob
P.S. Can I get upgraded from “newbie” status now? Grin;-)
Robert GreggParticipantAwesome Ron!
I was asked this past weekend if they could use a pulsed Nd:YAG to break the ligaments around the tooth and use the laser to extract.
I said, “NOPE!” You need an FR Er:YAG or YSGG for that. And that ought to work out very nicely.
And Ron, what a nice case you demonstrated that for all of us.
I’d like to encourage you to do that in more clinical situations, like ankylosed teeth.
Bob
Bob
jetsfanSpectatorRon,
I had a very similar case last week. Just finished endo thru
patients old crown. She returns two weeks later with the crown loose due to fracture subgingival, subcrestal. First I t told her that she was going to lose the tooth. I then turned to my handy dandy Waterlase and told her that I would like to try to save the tooth(root). She agreed and I then preformed a crown lengthening. I must admit there was more bleeding than I would have liked , so I used some cuttrol to control bleeding. A post was then placed with a luxacore buildup. The patient returened to my office today. I was concerned as to what I would find. She reported absolutely no swelling, and took not a single pain med. I prepared the tooth for a crown and was so excited to see how well the procedure worked out. She was naturally quite pleased. My only regret was that I took no photos.
JETSFAN
whitertthSpectatori would chase the crack as well and bond and seal…use the laser on low wattage and see where it goes..i would be at 2 watts 20/20.. than bond…good luck
ps when do i leave newbie status?
AnonymousSpectatorAt 50 posts you will become a ‘Frequent Participant’ and eventually member and advanced member and then maybe ‘unable to miss a day of posting’. Hang in there all you’ll make it 😉
lagunabbSpectatorLumenis, the parent of Opusdent, is struggling with shrinking sales and is in violation of loan covenants. The Coherent CEO just resigned from the board of directors of Lumenis suggesting that Coherent have given up on salvaging the company. I think the company has a chance of being salvaged, but it will become a much smaller company, if they sell off assets including the recent acquisitions. The status of Opusdent is very uncertain in any scenario. It is amazing how fast bad management can sink a company that was once dominant just a few years ago.
Robert Gregg DDSSpectatorHi Ray,
Happy New Year.
Good to see you again on the message boards.
Great info, as always, thanks!
Your review of recent laser company developments echoes what I have been saying for some years now–that SIZE and STOCK PRICE of a company has absolutely NO relationship to the company’s longevity in the medical or dental laser marketplace.
Longevity has more to do with the commitment of the Board of Directors to the science, technology, clinical applications, and TRAINING than any statement in the company’s SEC 10(k) filings, or advertisements claiming to be #1 in ANYTHING else.
High flying and publicly traded companies–like ADT 10 years ago–have as their first commitment the ROI to the shareholders, not the customer dentists or patients. Oh sure, they can say that customer service is necessary for their success, but that is often a means to a “liquidity event” and “exit strategy”, NOT the company mission in-and-of-itself.
It was always very frustrating to watch ADT management refuse the many suggestions and much advice we gave as their product users and trainers, and continue on a self-destructive pathway, while the company executives and stock underwriters we spoke with said–“but we must be doing it right, look at our latest quarterly sales and stock price….” “Management is so smart, look at their sales, look at their stock price, look at the number of attendees at the study club meetings……” “Who do you think you are, and what do you know….your just dentists.” OK, sure. Uh Huh….Bu Bye ADT……Bu Bye Premier…..
Guess who’s flying high now, and hasn’t shown ANY indication they have learned the lessons of ADT or Premier Laser? The arrogance, ruthlessness, exclusion, over-statements, hype over substance, false science, tactics, strategy, etc., are all the same–only worse–and on a smaller World-Wide scale. ADT had a much bigger reach in Europe, Japan, Australia as well as the US.
Like I have said for years, “When all the company’s executives, shareholders, underwriters, and private placement investors have taken their profits (or losses) and gone on to other things, us dentists who use the technology will still be using lasers (if we have made provisions) long after they are gone.”
There’s no guarantee that Millennium Dental will be around either, but I’ll still be using my digital PerioLase laser to treat my patients decades from now. What will the executives of publicly traded companies be doing months, let alone decades from now?? Where will the customers be? Can you say Premier Laser??
The effects of the next dental laser company fall-out will be painful indeed–and set laser dentistry back as much as another decade…..:(
Bob
P.S. How was your Y-Beam visit? I never got a follow-up invitation from Yossi.
lagunabbSpectatorHappy new year Bob,
I have been too busy to chat but the Lumenis situation was just too precarious not to mention to people that may be considering laser systems from different vendors. There is a book’s length story there to tell about how they started rotting from the ESC days and I feel really badly for the Coherent folks that got their pensions and careers hijacked by mismanagement (and worse). Believe it or not, a couple of buy-side analysts (on of which I think highly of) tried to convince me towards buying Lumenis stock last year. After looking at their filings and talking to some folks, I decided entered the stock as a short selling contest pick. (here is a link to the contest entries – http://www.prudentbear.com/bc_library_short_selling_home.html). It will take me an hour to explain my thoughts so remind me next time we chat if you are still interested.
I don’t share your optimism that there are currently any high flying acts in dental lasers, nor do I share your longer term pessimism that there are always spectacular crashes after take offs. Everybody is still on the landing strip tuning their engines and seeing what works and what doesn’t. Premier was still inside the hangar when they were aborted. It has been like that since the early 1990’s although the technology has improved and the Internet makes knowledge sharing much easier. Having said that I believe Biolase and Hoya are closest to take offs and I expect continuous improvements during flight. It’s too early to tell whether lessons have been learned to avoid sliding the business models into the same resting place as ADT and Lumenis or follow a path more similar to Dentsply’s. You are in a nice spot having the resources to build, use and service your own Nd:YAG and no MBA types to worry about. It is always easier for us to sit back and criticize an enterprise than to offer something that improves the system. Thanks to Ron this forum is a great step in the positive direction.
Yossi says hi. I guess he was afraid that you have designs on the dermatology market because he is not keen on the dental market. He has a few intriguing ideas about the derm market and that’s all I can tell you.
Robert GreggParticipantThanks Ray–
QUOTEI don’t share your optimism that there are currently any high flying acts in dental lasers,nor do I share your longer term pessimism that there are always spectacular crashes after take offs.I didn’t mean my comment to suggest optimism at all. This industry is in a very precarious state right now–as it has been since Pfizer, ADL, Premier, HGM all made a lot of noise in the early 1990’s.
That’s not what I said. I have never said that there are ALWAYS spectacular crashes after take offs. What I said is there will be short term profits for high flying acts (like Premier and ADT) who fail to learn the lessons of the past. But this industry needs people like me around who REMEMBER what actually happened, what was done, who did it, who got hurt and WHY.
QUOTEPremier was still inside the hangar when they were aborted.Premier was around since they were once called Pfizer Laser–and that was 1984. In May of 1997, Premier had the very first Erbium Yag laser hard tissue clearance from the FDA. They were the DARLINGS of every media outlet and Wall Street and had the dental world at their feet. But they too made horrific mistakes at the CREDIBILITY & INTEGRITY level.
You’ll have to convince me some more that they weren’t High Flyers though in the sense they had EVERY opportunity to “do it right” and BLEW IT big time going bankrupt in 1999 after 15 years in business both in medical and dental laser systems.
Designs on Derm?? Ha!!
I’m a dentist, not a derm guy. But that’s how laser engineers and manufacturers feel–very guarded, easily threatened, very suspicious, not cooperative. I could care less about the derm market. I probably have some ideas he could use and vice versa to help the other. But again, that’s the problem with this industry–no one collaborates for the benefit of the ENTIRE market. It’s only about getting one’s share of the pie at the expense of the other guy–and at the expense of the entire potentiality of the marketplace…….
I Like Yossi, he just needs to loosen up a bit…..for some people, it’s not all about the money!
Bob
jetsfanSpectatorIf you can post the various ways others use to achieve anesthesia with the laser it would be appreciated. I just am unable to predictably achueve anesthesia for restorative dentistry i.e, class I or II. Today after 1.5 min at 5.5W on a 16 year old boy, I attempted to do class I. When I reached the decay, he absolutely felt pain. I tried to anesthetize again without success. He felt low speed round burs and spoon excavator. When it came to a second tooth he wanted the needle. I wish I knew how you guys do it.
A FRUSTRATED JETSFAN
jetsfanSpectatorBTW,
I have been using this for over 1 year, have done all those procedures that have been talked about. Crown lengthening biopsies ,apico, endo extractions, but I still don’t know how to predictably anesthetize for a stupid class I. Of course , as patients begin to feel it, you go more slowy , and try different techniques. This has the effect of doubling the time to do the procedure rather than shorten the time.
JETSFAN
lagunabbSpectator“You’ll have to convince me some more that they weren’t High Flyers though in the sense they had EVERY opportunity to “do it right” and BLEW IT big time going bankrupt in 1999 after 15 years in business both in medical and dental laser systems”
I will be blunt. Pfizer Laser talked a good game but they were managerially incompetent, and up till about 1996, they were technically unproductive to put it mildly. They used the Pfizer goodwill to fund the company and that’s about it, end of story. Noticed that they had to hire in scientific talent from overseas. If it weren’t for that, they would have been technically incompetent as well. In the end, their managerial incompetence overwhelmed their newly acquired scientific talent. I understand through the grapevine that the Premier founder wants to get back in the game. Stay far away.
I dropped by WCLI on Sunday to listen to the low level laser therapy (biostimulation) talks. I was surprised by the size of the syposium.
AnonymousSpectatorFollow-up on surgical extraction. Patient only needed ibuprofin 1 day post extraction.
4 days post extraction image
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