Page 116 – Laser Dentistry Forum

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May 3, 2003 at 5:29 am in reply to: Laser incision and drainage #10260

Glenn van As
Spectator

Hi Jerry: I use anesthetic injected around the frenum for two reasons…

1. I hate to have them have pain 1/2 way through…..you can lose their confidence.
2. It helps with hemostasis which is a problem with the erbium (it takes longer to control hemostasis than the actual cutting in most cases).

Just my two cents.

Glenn

May 3, 2003 at 11:03 am in reply to: Biolase Investment #9368

Anonymous
Spectator

#Moderation Mode

Moved here

May 3, 2003 at 11:21 am in reply to: Cracked tooth #11759

Anonymous
Spectator

QUOTE

Quote: from dkimmel on 11:08 pm on May 2, 2003
Great posting on cracks!
Glenn, I am not getting a scope! I am not getting a scope! I am not getting a scope! Well not just yet!
So much to buy to improve dentistry! So hard to budget and stay within those limits!
David

Don’t forget the perioscopy
and the Tek-Scan
and the…..
and the…
and the..

May 3, 2003 at 12:33 pm in reply to: Cracked tooth #11760

dkimmel
Spectator

Ron, I have them coming Friday to demo the perioscope!!
David

May 3, 2003 at 6:52 pm in reply to: Laser incision and drainage #10267

Robert Gregg DDS
Spectator

Hi Jerry and Glenn–

It’s raining here in So Cal–so what are YOU guys doing posting on a Saturday!?;)

For frenums I use a topical first (Sultan), then I will infil with 3% Prilocaine (Citanest) plain. pH neutral so less sting.

Since I use the pulsed Nd:YAG (hemostasis effect) at 100 usec (Short Pulse Duration for powerful punch and minimal lateral thermal injury), 4.0 watts (for rapid cutting), 100Hz for a substantial “hot glass” effect, yet this still gives me 400 watts per pulse of “forward penetration” for hemostasis and biostim–I don’t need long anesthetic duration or epi for hemostasis.

I’m not familiar with “TAC Gel”. I’m guessing topical anesthetic?

Glenn, I can’t take a noise-free, white balanced digital picture worth a tinker’s dam, but I can help you speed up your frenum cuts and not need epi!:biggrin:

As such–35mm photos later digitized:

[img]https://www.laserdentistryforum.com/attachments/upload/Slide1 frenum.JPG[/img]

Note injection sites on both sides of central frenum

[img]https://www.laserdentistryforum.com/attachments/upload/Slide2 frenum.JPG[/img]

[img]https://www.laserdentistryforum.com/attachments/upload/Slide3 frenum.JPG[/img]

[img]https://www.laserdentistryforum.com/attachments/upload/Slide4 frenum.JPG[/img]

[img]https://www.laserdentistryforum.com/attachments/upload/Slide5 frenum.JPG[/img]

[img]https://www.laserdentistryforum.com/attachments/upload/Slide6 frenum.JPG[/img]

[img]https://www.laserdentistryforum.com/attachments/upload/Slide7 frenum.JPG[/img]

It took me about 30 seconds to do this, while Dr. McCarthy was taking pictures at about 1 shot every 5 seconds or so. I then deepened the incision down to the periosteum.

The point of the photo series was the absence of black or brown char, carbon, or extensive epithelial peeling at the tissue margins–indicating a relatively “cool”, clean, and blood free wound using a FR pulse Nd:YAG.

Bob

(Edited by Robert Gregg DDS at 3:18 pm on May 3, 2003)

May 3, 2003 at 7:19 pm in reply to: Sick kid and the laser. #10821

dkimmel
Spectator

Bob, Got to play with the laser this morning. The wife had a herpatic lesion pop up this morning. I played with the air and the water remembering what you said about no need for water.
Using the water stops all discomfort. The discomfort my wife felt was along the lines of a jellyfish sting. She could deal with it but could see why a kid would not. Increasing the air from 11% helped but 20% air and no water was better.
Now for the kicker! A key word you used in your reply! DEFOCUSED!!! Gee, Stayed with the .25 W 11%A and no water started out at 20mm painting and working my way in. No discomfort!
Once you pickup the handpeice it is a reflex to just try and go at it. Defocusing and working your way in I believe is key to most laser work. Just got to remember to do it everytime!!!!
Isn’t it great to have family to learn on!!
David
David

May 3, 2003 at 7:21 pm in reply to: Laser incision and drainage #10250

smileagain
Spectator

Bob and Glenn

Thank you both for your sage advice- I’ll let you know how the
procedure turns out.

Bob- Tac Gel was mentioned of DT forum and praised to the heavens as “awesome and amazing”- so I decided to give it a
try, with what appears as very positive results. It is 20% lidocaine, 4% tetracaine, and 2% something else. I described how surprisingly well it worked to numb nerve tissue on a hot tooth and a scared patient when placed in the pulp chamber

Thanks again, Jerry

May 3, 2003 at 7:28 pm in reply to: Sick kid and the laser. #10824

Robert Gregg DDS
Spectator

Excellent David–

Defocused is the key and working your way in–as is the air to cool.

Glad it worked for you and your wife. Thanks for posting that.

Bob

May 3, 2003 at 7:42 pm in reply to: Cracked tooth #11771

Robert Gregg DDS
Spectator

Hi All,

I don’t have a lot of technology (I don’t think). I have a lot of lasers–and a Global scope.

Not much else. No AA, no digital x-rays.

I like the scope as it aids me in clinical practice, which is how I judge my purchases.

Bob

May 3, 2003 at 8:46 pm in reply to: routine class 1 #11984

smileagain
Spectator

Hi Allen W

You mentioned when you remove the last bit of decay with the spoon and you see the pulp… you then go back with the laser- what wattage/water/air settings do you use before the placement of the GI ?

With thanks, Jerry

May 3, 2003 at 9:45 pm in reply to: Laser incision and drainage #10262

Glenn van As
Spectator

Hi Bob……..neat case . The erbium photos are the same but the big difference is that there is bleeding once you get through the last fibers with the erbium whereas with the pulsed Nd Yag there isnt.

Neat stuff and yes it is cool looking on the tissue.

Way to go Bob…….

Keep trying with the photos…..what light source do you have and how old is the fiber optics.

Glenn

May 4, 2003 at 1:13 am in reply to: Laser incision and drainage #10246

dkimmel
Spectator

Jerry, that would be prilocaine.
Bob, Nice post some more!!

David

May 4, 2003 at 5:36 am in reply to: Laser incision and drainage #10252

ASI
Spectator

Nice phots, Bob.

You mentioned that Del took the photos. Was he doing them throught the scope or a SLR camera?

No charring indeed.

Andrew

May 4, 2003 at 5:10 pm in reply to: Soft Tissue Procedures #3399

Glenn van As
Spectator

Hi there folks: I kinda chuckle when I hear the reps talk about how one laser does it all. Oh yes it does cut soft tissue but how does it compare to a dedicated soft tissue laser.

Well here I did a crown prep after a post and core ( maybe the post wasnt needed but the tooth was very fragile to hold the core and I didnt want to take a chance) .

I decided to trough the distal with the best hemostatic laser ( the argon) vs the mesial with the erbium. Note how the bleeding is signficantly different on the two.

The cutting was different but the hemostasis is significantly different.

I will post the pics.

Settings for the Argon were 0.9 watts continuous wave.

For the erbium 30 Hz and 70 mj. without water.

I had to eventually control the oozing with astringident to get an impression on the erbium side.

I will post the two pictures that are key afterwards for you to have a closer look.

Hope this is interesting.

Glenn

May 4, 2003 at 5:14 pm in reply to: Soft tissue comparison #10895

Glenn van As
Spectator

Here are the magnified images……..see any difference?

Hope this settles the debate…….oh wait a minute….

The Er YSGG with the hydrokinetics cuts alot better with hemostasis than the Erbium Yag

(Nudge Nudge wink wink :>) )

Glenn
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