Ok last case for a couple of days……..gotta finish a lecture due on Thursday.

Here is the lowdown on the case where magnification and lasers helped me but the scope really helped. Look at this case closely as I think that alot of times these are the little things that the scope helps me with.

Upper first molar needs a crown. No decay noted on radiographs but a large amalgam that the patient wants out and a full coverage restoration.

On interproximal on the distal note the decay that is visible at 16X power.

look how tough it is to see at 2.5X power compared to 16X power.

Next the prep was completed and initially I noticed how deep the mesial amalgam was and got under it and noted decay there as well and so I removed the old amalgam and there was alot of decay there on the mesial.

Removed it with a round bur and was getting very very close to the pulp so I decided to use the erbium laser so that if I got an exposure it is at least sterile. No exposure. I used Mark Colonnas cool spoons for the deep part and it worked great

Then I noticed small decay on the distal surface of the adjacent 2nd premolar, which when prepped was 3mm deep and quite wide but I didnt have to break the marginal ridge and that keeps the tooth much stronger. Its tough to spot the decay without a scope and very tough to use a 1/8th round bur to clean it out.

Flowable was used to fill that proximal preparation.

Next I noticed the marginal tissue below the prep wa oozing so I needed to control the bleeding prior to filling the prep on the premolar and in order to get a good impression.

I then used the Argon laser (green wavelength to cut the tissue and trough around the crown. The microscope gives me great control over this part of the process and allows me to minimalize the trauma to the tissue.

Afterwards I used a diamond bur to refine the preps at 16X power to make sure the margins were equiginigival or slightly subgingival to the laser troughing.

There is no hiding if your impression isnt good enough for the lab. Bubbles , tears, missed margins jump out at you at 10X-16X power and the temp is easier to trim and refine the occlusal with the scope.

I hope this laser + scope case shows you that the microscope isnt just for endo……..oh sure there is a learning curve, heck there is one for the lasers, but its well worth it when little things get spotted like in this case.

Photos will be in two parts…………40 pics in total.

Glenn

PS this case took me 1 hr and 15 minutes from beginning to end including the photos and I had to do the temp and everything myself as my main assistant is on holidays in Mexico.

Cya gotta go sleep.

Glenn

[img]https://www.laserdentistryforum.com/attachments/upload/Resize of Pg 1 of crown pre_p1.JPG[/img]

Hi Mike
I would have to say that the laser will pay for itself. The wow factor is incredible, especially with Mom’s and their kids. I also have the diode laser for soft tissue and I have to admit that I am not using it as much as I should, but am getting more into it. If you are thinking about that, you may want to check into the ConBio (Delight and Diodent lasers) as they gave me quite a great deal when I bought them together.

Nice meeting you at theDT meeting – Good luck!

Janet

I am having a “silly” problem. When I have the insert for my loupes (for the Erbium) I cannot control the fogging. I don’t have this problem with the loupes alone. Advice?

Could this be just the initial excitement of using the laser? It should resolve with time!!
David