Thought I’d take 1 last look before leaving .

Glenn, does Hoya make long tips for your Er?

In cases where I’m pretty sure the tooth will crunch I’ve been using a long (12mm perio?) tip to remove bone interproximally. In this case  I would  remove enough  interproximal bone on the mesial to allow that tooth to rotate out toward the mesial. I would also remove just enough on the distal to get a straight elevator in and know I’m fulcruming off bone and not adjacent tooth. With the straight elevator on the distal I would use a clockwise rotation along with downward movement to elevate the tooth. Sometimes I’ll have to also just rotate the elevator on the mesial also.
I’ve done many this way now, and so far the patients all have seem to have got along with just ibuprofen or no pain meds. I also feel more comfortable doing these when I know I won’t have to go in with the high speed and if I do still break the tooth I can ‘paint’ the gingiva with the laser to eliminate that bleeding and help improve visibility.
The pictures are awesome and your patient is fortunate to have someone like you doing the work.

Thanks again for ‘filling ‘ in as admin.
Ron

Hi Pat,

Yep. Use it every day–like today–when I remove amalgam and replace with resin, regardless of the stated reason for removong the alloys in the first place.

However, I use……..yep……..you guessed it…….a pulsed Nd:YAG that is attracted to pigment (and amalgam) selectively over dentin when defocused.

Been doing that for over 12 years.

I don’t see any reason not to do it with an erbium, though……

Bob

Regarding the carious pulp exposure, it would seem that we are gambling that the bacteria are not infiltrated into the pulp chamber with caries being so close to the pulp. Radiographs are helpful but in the end without all of the soft decalicified dentine (Canadian spelling Glenn?) being removed we do not know if there has been an exposure of the pulp. My GPS of teeth does not work well enough for me to tell if I am within 2 mm of the pulp. I can guess, but will the laser sterilize the remaining layer of soft dentin well enough to predict that there will be no or little chance of pulpal infection?

Bob replied to the coagulation of an accidental exposure in a previous forum topic, that while it is more predicable with “clean” (my word) exposures, carious exposures present a more likely endo prospect.

“The laser pulp caps that work are those where the exposure is limited in diameter to smaller then the diameter of the fiber-optic you are using, and/or the area of exposure can be isolated from the main trunk of the nerve/pulp (ie a pulp horn or a small axial pin-point exposure)

Carious/bacterial exposure: don’t expect much. Try if you want, but prepare the patient for future endo.”

Hope it is OK to quote you , Bob, but I repect your opinion which seems mixed with a great deal of experience and science.

So, it would seem that a frank carious exposure has little hope of a laser fix, and a near carious exposure will be of some hope but it is a crap shoot. Maybe this is the time to evaluate the patients gambling instincts.

In my humble opinion,

Hi Glenn,

Great result so far. 3 different wavelengths working together to achieve this. How wonderful to have them at your disposal. Glenn, you’ve got all the toys I too want to practise with.

How long have you had the diodent?

Andrew

Hi Glenn,

I think it might be Glenn van As yourself.

Andrew