Page 86 – Laser Dentistry Forum

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March 20, 2003 at 5:15 am in reply to: Nd:YAG questions #5856

lagunabb
Spectator

Bob,
Sorry I have such a thick skull and forgot so much of what you showed me. I am a poor student and will have to drop by once again to do a makeup session. The 320 um fiber translates to 250 J/cm2 per pulse at your settings for pigmented caries removal.

I don’t think you are trying to tell me that the enamel-laser interaction is wavelength independent? I am stuck on Dr Fried’s point that 1064 um is not well absorbed in hydroxyapatite and water so laser energy is transmitted until it is absorbed by other tissue underneath. I am hearing that from your clinical observations that it does not seem to matter even at 250 J/cm2. Sounds like there is a need for additional experiments at 1064 um of the type that Dr Fried conducted on Ho:YAG.

March 20, 2003 at 5:25 am in reply to: Trunk Fiber #9227

BNelson
Spectator

Hi All,
This is my first post here. I’ve had my Waterlase since 7/2002 and the trunk fiber burned 2-3 months later. At the Dana Point meeting I asked the tech support people about it and they assured me that it was most likely a bad fiber. It did scorch the mirror in two handpieces, which they said was to be expected. I had switched handpieces assuming it was the problem and ended up needing two handpieces and a new trunk fiber. Kept y down for 3 days waiting for parts, but OK since.

March 20, 2003 at 2:40 pm in reply to: Tx of Herpetic Lesion #10750

drTommyU
Spectator

Hi everyone. A first timer here.
How do you guys bill such tx, apthous or herpetic lesion, to the ins. ? Have you had any rejections ? Thanks

March 20, 2003 at 10:00 pm in reply to: Periodontal treatment #10187

Robert Gregg
Participant

Hi David,

How funny!:biggrin:

Yes that was a slip of the “o”. Some folks just may hold one or all of these guys in such high esteem!!

We may never live it down if you go now and tell them I referred to them as “gods”.

Bob

March 20, 2003 at 10:06 pm in reply to: Tx of Herpetic Lesion #10772

Robert Gregg
Participant

Hi TU,

I just bill the patient out as an office visit, usually. Since it is a small fee of say &#3650-75 (more if more involved), they often pay on the spot, and insurance is a secondary issue to the treatment need.

But we make sure we make to FA’s before we begin treatment. That’s always the part where disciplpine with yourself and the front desk is needed to get the FA’s agreed to, since removing and/or treating those lesions are relatively quick and painless.

That’s how we handle it, and try to get people to save their benefits for other needed stuff, or tell them it is a non-reimbursable procedure, and they will often elect to pay cash. Nice way to save on insurance headaches.

But I haven’t looked at the new CDT-4.

Bob

March 20, 2003 at 10:14 pm in reply to: Nd:YAG questions #5862

Robert Gregg
Participant

Ray,

I may be the “thick head” here! I was trying to understand the experiment……

QUOTE

I don’t think you are trying to tell me that the enamel-laser interaction is wavelength independent?

No, not in this instance. But I think I see where the confusion may be.

The Fr Nd:YAG, even at the power densities of 250 J/cm2–and thanks for that calculation–will PASS through dentin if not in focal contact with it. So that means if I am on enamel and ablating away a organic plug, the interaction will stop once the pigment is gone, or the fiber comes within the focal spot of the underlying dentin. But simply irradiating dentin through enamel will not result in damage to the underlying dentin–not in vivo in human teeth anyway.

Too bad the dental researchers don’t use J/mm2 since it is more meanigful than J/cm2 and more to our scale.

Bob

March 21, 2003 at 2:49 am in reply to: Periodontal treatment #10181

BNelson
Spectator

Hi All,
I have to agree with you all on Bob and Del’s Nd:Yag. I just finished a great 3 days in Cerritos with both of them learning to use my new MVP-7. So much to learn, and I was thinking about a diode after the Biolase meeting. Glad I met Bob first, as this laser seems to do a whole lot more a lot better.
Ron- As far has the erbium and hard tissue, I picked up a handful of extracted teeth from the oral surgeon and spend a few afternoons playing with those. Sure helps if you haven’t tried it.

Best regards,
Bruce

March 21, 2003 at 5:01 am in reply to: Trunk Fiber #9260

Swpmn
Spectator

For me, it’s upsetting to view the posts by newgen and BNelson. Problems with the system you are using are commonplace. Read the forums and talk to other users.

There is a serious problem with the trunk fiber delivery system and mirrored handpieces.

Little or nothing is stated regarding maintenance and absolutely nothing about how to pay for maintenance after the one year “warranty”.

If you attempt to remove an old, brown colored composite be careful and watch for white “sparking” from the Erbium. The Erbium laser will not react or “arc” off of commonly used stainless steel composite matrices.

Al

March 21, 2003 at 3:33 pm in reply to: Nd:YAG questions #5857

lagunabb
Spectator

Thanks Bob, I think I get it. The beam is scattered and so is the energy when it passes through the enamel. In the experiments, Dr. Fried used polished and flat bovine samples and that could mean less scattering than a vital tooth where the caries is located in a concave shaped depression. Sort of like sending a beam through a concave lense and scattering the beam. Your comments on patients’ reaction to Ho:YAG does indicate some difference in interaction between Ho and Nd:YAGs, so it’s still probably worthwhile to run the equivalent experiments (Fried et al) for Nd:YAGs.

Thanks again for the helpful comments.

March 22, 2003 at 8:05 am in reply to: Periodontal treatment #10194

Rod
Spectator

Ron,

I also have heard great things about the Periolase, but I’ve got a question for you regarding the diode. Are you unhappy with the results, or are the results less than you’d hoped for?

The results I’m seeing with my diode are blowing me away. Of course, the laser is simply one of the tools I’m using. But you seem very disappointed with the diode. Why?

Rod

March 22, 2003 at 8:19 am in reply to: Tx of Herpetic Lesion #10779

Rod
Spectator

Lotsa great stuff on this thread. I’d just like to comment that I also use both the erbium and diode on both herpetic and apthous ulcer lesions. Different depths of penetration and surface effect.

They work wonders.

Rod

March 22, 2003 at 8:29 am in reply to: Soft Tissue Procedures #3350

Rod
Spectator

This is a case I did this morning. I posted it because the patient is a dentist and recognizable Townie. I’ll ask him if he minds me giving his name.

Please note that he ALREADY had a periodontist do cosmetic contouring/crown lengthening, and the first photo of his smile was taken this morning before we started (this is AFTER the periodontist’s handywork). The periodontist told him that this is the best he could do without flapping and osseous.

You can see this was not the case. This was done by laser. A new sulcus was created also with the Biolase LaserSmile diode laser. I used a thin small instrument to create the sulcus about 1.5-2 mm depth, and then used the laser at 1watt continuous, dragging through the ‘new’ sulcus of each tooth. (this will inhibit re-growth of the tissue)

You can imagine that if I only ‘contoured’ up the gingival margin and left it that way, we’d have a blunt, THICK marginal gingiva. Therefore note that after the contouring, the gingiva was ‘thinned/festooned’.

You don’t see a post-op of his smile because he was numb after the procedure and his ‘smile’ looked stupid 😉

Think this looks painful? Think again. This case was desensitized (similar to what we’d do to treat a canker sore) with the laser. Here’s an email I just got from this Townie patient:

“you wanted to know so you can tell patiens so heres the scoop as of ..well its 1:30 and ZERO PAIN and numbness totally worn off,,,

rite when i left office i DID HAVE some very mild discomfort for about an hour but that passed …i did place rembrandt junk on gums too which helped earlier…but rite now i am touching gums and zero pain!!!! and my wife couldnt belive how good an dlonger my teeth look

great job doc and enjoy your weekend”

(Edited by Rod at 3:31 am on Mar. 22, 2003)

(Edited by Rod at 3:34 am on Mar. 22, 2003)

March 22, 2003 at 2:31 pm in reply to: Periodontal treatment #10173

Anonymous
Spectator

Rod,
Since August I am now on my 3rd machine. I’ve had to reschedule patients and explain time and time again why we have to postpone tx. This last time I was without the laser for a week. We’ve also had 3 fibers separate at the connector (where the fiber attaches to the machine- the metal connector separates in 2) Its hard to get healing from the bottom up if you can’t do the followup because the machine is down.

Biolase is very cooperative in helping to straighten things out but its just frustrating. I also didn’t get an answer from them about whether my year warranty starts over with the delivery of the 3rd machine.

I’ve also been disappointed in the whitening (I didn’t buy it for that though) -limited results and some cases of very sensitive teeth. Seems everyone needs to follow up with trays.

I have thought the diode is great for cases like the one you just posted and for perio when pockets are in the 5-6 mm range. Greater than that and my results have been less than I expected. I also think its a pain going back and decomtaminating time and time again. 9 mm pocket gets revisited 6 times.

I guess as I begin to understand more of the physics involved I worry more about how hot the activated tip is and collateral damage.

The diode has made me put a lot more clench marks in my biteguard than the Waterlase ever has 😉

March 23, 2003 at 12:42 am in reply to: Periodontal treatment #10197

Swpmn
Spectator

Ron:

That is quite disappointing regarding the mechanical problems with your Diode. “Ah feel your pain” on a different system.

Interesting that you aren’t particularly impressed with the Diode bleaching. Many people, e.g. John Kanca, feel there is no light or laser effect on “in-office” bleaching. We’ve had good initial results with Ultradent Opalescence Xtra Boost(no light/laser) but also see the need for follow up with “take home” trays.

I’d like to learn more about Diode/Nd: YAG lasers for treatment of periodontitis as my interests have only been with the Erbium for hard tissue treatment. Couple of questions:

1) Is there a body of scientific evidence which shows a significant difference between treating periodontitis with root planing vs. root planing combined with Diode or Nd: YAG laser?

2) Within those studies, is there evidence that attachment loss greater than the 5-6 mm pockets you mentioned can be successfully treated without surgery and by using Diode or Nd: YAG lasers?

Anyone else that is in the know feel free to respond and help educate me.

Al

March 23, 2003 at 1:10 am in reply to: Periodontal treatment #10174

Anonymous
Spectator

Well Al ,

Here’s 1 –

Lasers Surg Med 1998;22(5):302-11 Related Articles, Links

Treatment of periodontal pockets with a diode laser.

Moritz A, Schoop U, Goharkhay K, Schauer P, Doertbudak O, Wernisch J, Sperr W.

Department of Conservative Dentistry, Dental School of the University of Vienna, Austria.

BACKGROUND AND OBJECTIVE: The aim of this study is to examine the long-term effect of diode laser therapy on periodontal pockets with regard to its bactericidal abilities and the improvement of periodontal condition. STUDY DESIGN/MATERIALS AND METHODS: Fifty patients were randomly subdivided into two groups (laser-group and control-group) and microbiologic samples were collected. There have been six appointments for 6 months following an exact treatment scheme. After evaluating periodontal indices (bleeding on probing, Quigley-Hein) including pocket depths and instruction of patients in oral hygiene and scaling therapy of all patients, the deepest pockets of each quadrant of the laser-group’s patients were microbiologically examined. Afterwards, all teeth were treated with the diode laser. The control-group received the same treatment but instead of laser therapy were rinsed with H2O2. Each appointment also included a hygienic check-up. After 6 months the final values of the periodontal indices and further microbiologic samples were measured. The total bacterial count as well as specific bacteria, such as Actinobacillus actinomycetemcomitans, Prevotella intermedia, and Porphyromonas gingivalis, were assessed semiquantitatively. RESULTS: The bacterial reduction with diode laser therapy was significantly better than in the control group. The index of bleeding on probing improved in 96.9% in the laser-group, whereas only 66.7% in the control group. Pocket depths could be more reduced in the laser group than in the control group. CONCLUSION: The diode laser reveals a bactericidal effect and helps to reduce inflammation in the periodontal pockets in addition to scaling. The diode laser therapy, in combination with scaling, supports healing of the periodontal pockets through eliminating bacteria.

Publication Types:
Clinical Trial
Randomized Controlled Trial

PMID: 9671997 [PubMed – indexed for MEDLINE]

Of course you might want to consult the expert also known as – rfw in the DT active cases, right Bob G? :biggrin:
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