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SwpmnSpectatorHey Ron:
Man that ain’t no “suprise”, that’s a common problem I have!!!!!!! Due to the density of enamel(I think) it’s hard to see the extent of occlusal caries on bitewings. For some reason I often seem to be able to pick it up better on a panoramic.
Great case!!!!
Al
SwpmnSpectatorLooks good Glenn?
Hey, didn’t it hurt when you were placing the cord? How old was the patient?
Al
Robert GreggParticipantRon–
QUOTECan these be shortened or reattched to the adapter?Nope.
Especially since their FDA clearance and they are sold by the fiber manufacturer as single use item!
Best regards,
Bob
SwpmnSpectatorGlenn and Mark:
Thanks for your comments, suggestions and encouragement. Biolase is sending two new handpieces in the morning.
Mark, how about posting for us a summary of your laser maintenance lecture? Please include a description of the technique for purging water from the trunk fiber delivery system.
Thanks again guys,
Al
Robert GreggParticipantHi Guys,
First, Mark, Congratulations on the recognition you have received for giving fine presentations in Dana Point. Sorry I missed you at the Crazy Horse (I live minutes away) but since Billy Bob Brown’s invitation to me got lost in the mail–I didn’t want to crash somebody else’s party.:biggrin: He’s a mean Rock n’ Roller isn’t he?
Al, I feel your frustration too……that’s tough.:( It is part of what I call the technology development curve for lasers in dentistry.
Of course you all know I think pulsed Nd:YAGs are more refined and developed after many years of use and many device itterations–now with digital technology and all. 😉
Pulsed Er, Cr :YSGG lasers and Er:YAGs will get more stable and more damage resistant eventually, as long as there are users, proponents, and a willingness by engineers to build refinements.
Welcome back Glenn. How was the cruise?
QUOTEPerhaps we both need to keep track of the laser maintenance expenses, the number of procedures and then add some profit and charge the patients an
added laser usage fee so as to make some money and cover the expenses.What do you think, and Bob Gregg should have some ideas on this issue right!!
I do strongly feel that future maintenance costs, replacements parts, consumables should be part of the fair and full disclosure by the manufacturer to the prospective dentist customer prior to signing the order.
But to answer the question about costs and fees–I think you should keep a log or journal of your laser usage and activities, maintenance and repairs along with copies of any correspondence with the manufacturer, aside from the fee remuneration aspect.
I would generally raise my fees across the board according to the general increased level of service I can now compentantly render because of the laser benefits to patients.
Having said that, there are a few fees like LPT, crown lengthening that I increase according to my confidence in the outcome, differently than other fees.
Here’s a conversation I might have with a patient:
“I need to remove some bone underneath the tissue in order for the crown I’m going to make fit properly. We have two choices. 1) I can refer you to the periodontist who will pull back the tissue with a scalpel, remove the necessary bone, and close the tissue back into place using stitches. That treatment costs about 輪 and a couple visits to the specialist. 2) Or I can use the laser to move the tissue without making a cut into the gums, remove the necessary bone using the laser, push the tissue back into place–no sutures are necessary. We can do this treatment right now, without additional appointments, AND we can take the impression today for the crown. That service runs 蹢. What would you like to do?”
They say, “OK Doc, what’s the catch on the laser deal? Sounds too good to be true! Here’s my credit card. What are you waiting for? Let’s get going, I have an appointment in an hour I have to get to!”
That’s when you know that you charged too little. And you thought getting 蹢 plus your crown fee was highway robbery, and they are willing to pay much more!!
As an aside, FDA Federal Law requires every manufacturer as part of “Good Manufacturing Practices” (GMPs) to log and document EVERY problem and complaint by customer and by the nature a details of the complaint–whether by phone, letter or email.
Good luck Al!
Bob
Robert GreggParticipantWay to go Ron!
Bob
AnonymousSpectatorThanks Bob, but its more like 100 registered.
I have to give credit to you and Mark, Ron K, Glenn and others who actually participate and share.Its because of that willingness to share, that more and more are registering. I was just the guy with a little internet ability who cut and pasted the site together.
I can’t imagine another place where I could have learned so much about lasers in such a short time.For that I’ll always be grateful, as I’m sure my patients will also.
I’m still a little perplexed as to why more don’t participate. If you’re a guru -show us what you do and how you do it. If you’re a rookie- ask the questions. I think its been well established that this isn’t like some other boards where you’ll be ridiculed or bashed ( if it was they’d have gotten me along time ago). There’s probably 95 other guys out there wondering the same thing you are. If you’re somewhere between guru and rookie, show or describe some successes or problems so we can work thru them together.
I’ll be happier when its 100 participating !
So come on you members who haven’t posted. Here’s your place to start- chime in and tell us if you’ve found something useful or if its a waste of time, its ok either way.
Who knows after that 1st post you may find you can’t stop 😉
Glenn van AsSpectatorHi Allen: I was so tempted to use the syringe but thought I would try it knowing that bone has no pain fibers and sure enough it worked WITHOUT anesthetic and the patient said he felt nothing.
The weird part was how the loose fragment FLEW out of there. That was eery.
Thanks for the compliment.
CYa Allen
Glenn
Glenn van AsSpectatorThats why I love the combo of diagnodent and the scope.
It helps alot with my old eyes.
I get alot less ……oh my that is big nowadays.
Thats a nice big case, I still like to remove all the decay but I know that I might be in the minority these days.
Glenn
Glenn van AsSpectatorHi Allen: I dont have much problem putting silk thread in the sulcus and in addition when you use the scope you can be very very gentle.
I know its at 10 times power but I can be very very careful at high mags.
Hope that helps……..patient was around 35 years old.
I will post more of these when I have the chance.
Glenn
Glenn van AsSpectatorHi Mark: congrats on the kudos for your lectures at Dana Point.
Thanks for the compliments.
Read an interesting article by Hibst (sp?) today comparing the erbium yag and erbium YSGG lasers today for anesthetic, soft tissue , enamel and dentin.
It also looked at the hydrokinetic issue and without going into detail this is now the third article officially disputing the mechanism of action as being hydrokinetics.
The article was published in the winter edition of ESOLA (European Society of Oral Laser Applications) and was quite an interesting read.
Suffice it to say the results were not what Stew Rosenberg had told me about recently when comparing cutting ability in dentin, on soft tissue .
Results in enamel were the same and the mechanism of action was the same.
If anyone wants the exact quotes on the article, let me know and I will post them here.
i think that finally we are getting to the bottom of the truth with how different the erbium lasers really are.
It seems that as more evidence is coming out from our scientists that the lasers are more alike than different.
All the best and just wanted to post this before I forgot about it.
Glenn
whitertthSpectator“Thats a nice big case, I still like to remove all the decay but I know that I might be in the minority these days. “
Glenn, I dont follow. DO u mean stain when u say that? Is there any science to back leaving actual decay following laser enamel and dentin removal? Just curious. Hope all is well
2thlaserSpectatorThanks Bob, if I knew you were just around the corner, I woulda smuggled you in! You could’ve danced on stage with us sandbaggers! Seriously though, thank you for your congratulations, I just want to teach, and learn. I always get more than I give, and that is what is important. Your very kind indeed.
Sincerely,
Mark
Glenn van AsSpectatorHi Ron: thanks for posting.
I see these days that alot of Air Abrasion guys are saying that not all the decay needs to be removed in order for the restoration to be successful. Put GI overtop and it is solid.
I always feel guilty doing that, and feel best when the restoration is on solid tooth. There is research out there suggesting it is ok but I guess I am old school. They are paying me to get it all out so I am going to try darn hard to do it.
WIth the scope I often can see at high mag the texture of the dentin and that gives me a good idea……..is it shiny an solid or rough, leathery and not solid.
In closing I did a lecture last week on a cruise ship and one of the other guys was saying that he uses his diagnodent laser to see if there is dentinal decay present and wont bond til he gets figures around 7-10 on the meter.
Interesting idea.
Glenn
AnonymousSpectatorGlenn,
Did the guy say how he determined 7-10 on the Diagnodent in dentin was the goal as far as decay removal and bonding?
Hopefully Graeme could comment on this. -
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