Emeril is the man! My favorite quote, “I don’t think people should be eating to live, I think people should live to eat!”.

Realistic, “wet-gloved” expectation for most of us to prep un-anesthetized patients with an Erbium laser: 50%.

That’s about what I’ve found after almost two years. The “Defocused Technique” where you bathe the tooth for 60-90 seconds at high settings helps somewhat. Others may strongly disagree with me.

Couple of examples:

This morning, preparation of #11 disto-lingual Class III composite with laser. Theoretically, this should be an easy tooth to anesthetize, right? Clinical requirement to complete restoration: 3 carpules of anesthetic.

This afternoon, Class V preps on #21 and 28. Theoretically, one would expect these preps to be sensitive and more difficult to place without local anesthesia. None was required.

My point is, just like today, placement of restorations using the laser without anesthesia is unpredictable. Many factors are involved and I believe the most important factor is the patient. Personally I believe the majority of patients who can tolerate laser composite preps are probably the same patients you could prep unanesthetized with a high speed handpiece.

Al

Hi Jeff: congrats on your purchase and tell us more about the Opus when you have a chance.

I think Lumenis who owns Opus among many lasers is having a bit of a tough time these days , so do make sure that you get everything you paid for and do have service on it if you need it.

I have played with the machine and know that it works. Let me know more about how you like it and post some pics if you can.

I went to your web site last night. Nice clean site and interesting reads.

All the best and congrats on your erbium purchase.

Glenn

Glen,
I am a Microdentistry advocate. I’ve been using air abrasion for tooth preparation, preparation for sealants, composite repairs, abfract restorations, etc for almost 10 years. When the caries spirals and spreads at the DEJ, AA is not the instrument of choice for caries removal. Air abraded dentin allows some caries excavation w/ #2 round bur in slow speed or a spoon without discomfort.
I purchased the OpusDuoE to use with AA on occlussal caries. AA is quicker in removing enamel, gaining access to caries in the dentin, then I use the laser for analgesia, to remove the carious dentin and bacterial decontamination. I am surprised how I still need that #2 round bur.
Bonding is accomplished with the 6th or 7th generation self-etching DBA, I like Kulzer’s new I-Bond, single bottle technology, w/ Gluma. No seperate acid step or rinsing. No liners (for me since 1995) No patient sensitivity.
I have the Nd:YAG for MicroPerio Surgery, now I’m using a Erbium for hard tissue microdentistry.
If I ever get back to work ( 2 feet of snow has Maryland closed down) I’ll photograph some cases.
I’m still on the way up the learning curve w/ this laser.
I will have questions. Thanks.

Ok, time for me to “chime in”. I agree with all of you, pre-verbal desensitization is the first step in successful anesthesia with the laser. Like Glenn, I ALWAYS tell them they WILL feel something. Mostly a “cold” sensation, like ice cream freeze on their tooth. Now, as many of you have heard me say, I haven’t had to anesthetize anyone since last Feb. for any routine procedures, except about 50/50 on Endo procedures. My staff really is well taught in their verbal skills to work this through prior to my walking into the operatory. Next, I re-enforce those ideas while I set up my laser and it’s settings, right in front of them. Mostly, I try to use humor, it really is the “ice breaker”. Patience, and persistance is the rule here. IF you are patient enough, and persistant, you will gain greater control over your technique, and the anesthetic effect will get better and better, I promise. DON”T RUSH INTO THE DENTIN! You will be surprised how easy it will become. I always say, if you were to wait for the anesthetic, then drill, you have that 10 min to kill. After 2 min of defocused “anethesia” with the laser, and I “chat” with the patient the whole time, guiding them through what I am doing, it is so much faster than the old methods. Another thing, don’t let your assistant keep asking, “are you ok?” every time the patient “seems” to feel something. Let the patient tell YOU. Just remind them once or twice, no need to implant into their grey matter that it SHOULD hurt. That is the old style of dentistry. We laser users are still amazed that we DON’T hurt people, at least I am. Even after a year! And what a year it’s been. I have more to share, but I got to get my son to school, and me to the office. More to come tonight!
My best to ALL of you, you all are wonderful to share in this forum together, thanks!
Mark

That’s pretty cool, Glenn. So the tip just pops right into the end of the fiber?

How much did that burned out tip set you back?

Al