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PatricioSpectatorThanks to all for your helpful comments. I enjoyed the article from out friend from Montana. I look forward to preping a tooth in the near future.
I was thinking today how nice it is to anesthetise with the laser and then to use the electric hing and the slow speed as needed. With rare discomfort felt by the patient. I get a kick out of asking how it went and they all say that laser is great. They do not even know I used a drill since the familiar high speed whine is gone.
I notice at 1.5 w I am getting brown spots am I using to little water? At this point I do not remember the preset but it is the standard set by the Biolase tech. I also notice with the high magnification the depth of field is less obvious so I find myself reaching for the slow speed so I can feel what I am doing. Does confidence build with time as to the depth of field? Again thanks for all the help.
Pat
PatricioSpectatorAl et al,
I was reading recently in the those patients with root caries where deminished saliva is a factor that there is a case for placing the restorative cervical margin within the sulcus to help reduce plaque accumulation and recurrent decay. Initially removing soft tissue but not bone, if possible, so the tissue will rebound and cover a portion of the restoration margin. I have no experience with this but am trying to develop a better strategy against reinfection and am wondering what you think.
Say ya to da UP a,
Pat
SwpmnSpectatorPat:
The gingival sulcus is full of bacteria and we all see recurrent decay at the margins of subgingival restorations. Other than esthetics, personally I believe there is no advantage to a subgingival margin. In posterior regions and where patient education allows, we place many crowns with supragingival margins.
I believe this allows the educated patient to cleanse the margin and also allows full exposure to fluoride. If the margin is subgingival it cannot be cleaned by the patient.
Al
Glenn van AsSpectatorGraeme great to have you here. Tell me after all your work with microdentistry, scopes. air abrasion, fissureotomy burs and now lasers, where do you find the role of hard tissue lasers in microdentistry to fit in.
I know that you like air abrasion ( I am leery when using a scope) but am interested to hear of your experiences in using the laser for early caries intervention.
I have been using a hybrid technique sometimes with fissureotomy burs or small 1/8th or 1/16th burs to open up the grooves and then the laser to remove decay into dentin………
Just one approach I use and not always in every case.
How about you………
Glenn
Glenn van AsSpectatorHi Pat….what magnification are you using.
Brown stain is typically when it occurs in the dentin…….
1. Suction to close to the laser tip (water not hitting tooth)
2. Water spray inadequate and therefore increase water.
3. To small a trough (using a small tip ) and creating a narrow channel that the water cant get into the trough.THe problem is that brown is not enough water to cool the tooth and then its YEOWWWW!!!!!!!!!!!!!!!!!
The closeness of the high volume suction has not been discussed but on video I can show that if you are too close then you get brown spots and the water doesnt hit the tooth…….just goes up the suction.
The microscope helps with this and in addition with the monitor hooked up to the video , my assistant can see it and quickly moves back before the patient starts getting uncomfortable.
I will say that I dont think the magnfication is responsible for the problem with seeing decay. The water rehydrates the tooth and suddenly the decay doesnt look orange. I often use small round burs in large decayed areas to confirm decay removal and in addition it is difficult to remove soft mushy decay with the laser.
I use a sharp spoon or a small round bur most times without pain. I use the laser afterwards to remove the smear layer and make sure the dentin is decontaminated (perhaps the correct term is bacterial reduced), and the smear layer is gone.
Hope that helps, I am off to Scottsdale for the weekend to lecture at the inaugral Congress of Microscope Enhanced Dentistry meeting.
Cya next week.
Glenn
2thlaserSpectatorFirst of all, thanks Pat. Second of all, thanks Glenn for your reply, it’s right on. Third of all, thanks Ron, I did a amalgam removal, without anesthesia today as well. Only difference is I used 6w for my usual 1min to 90 sec first, then used the high speed to remove the amalgam, went back to the laser to remove decay and prepare tooth for composite restoration (it was a class I), and it was very easy. My assistant gave me a high five, she’s been wanting me to do this for some time now, your post made me do it! Thanks! Al, as far as the mechanism of action, there is really no sure fire way to find out how it is done, BUT the theory is the reduction of the sodium/potassium pump near the odontoblast/pulp interface. It seems like that makes sense, and at the WCLI in Nice, we discussed it for some time, but no one could really figure a way to really “test” this theory. It sure would be interesting to see what goes on histologically, physiologically at that exact area when defocused laser energy is applied like we do. Anyhow, great posts everyone, let’s keep learning!
Mark
gwmilicichSpectatorGlen
I have not found the laser that good for fissure microdentistry
1. Even with 400micron saphire tips it doesn’t cut as fine as AA.
2. It is not as selective as AA
3. It gets hung up on stained fissures
4. It is slower that AA in the fissuresI use AA to do initial entry and disection of carious fissure enamel. If it turns to custard and I am into reaonable dentin caries, I use the laser. Interestingly, the parallel H2O airabrasion has slightly less sensitivity cutting dentin compared to the laser. They cut at about the same speed.
Regarding using AA around the scope. I have not had any problems. I have got a protective cap over the main lens that I can remove and wash when needed. Dry AA doesn’t affect it at all. I make the mess with the laser and llH2O AA.
Robert Gregg DDSSpectatorRon–
I agree with Al.
The laser made ALL the difference in this case.
That 7 day result looks like a regular heal at 14 days.
The laser did the job and you did a tremendous service.
Believe it–and charge for it next time!!
Bob
joegarciaarSpectatorI am deciding the purchase of a diode. My dealer offers to me Biolitec’s 980nm (Ceralas D) including bleaching handpiece in $ 19.500. I will be thankful advise on the equipment and its price to me.
Thanks for your help!
joegarciaarSpectatorGraeme:
Impeccable technique.
We followed a procedure similar although we do not even have a defined protocol.
Thanks for your participation
Jose Garcia
Buenos Aires, Argentina
AnonymousKeymasterMark,
Glad the amalgam removal was easy (I was ready to high five everbody in my office also). I assume with the 6W that this was a permanent tooth? Do you stay as high with your settings for primary teeth?
2thlaserSpectatorYes Ron, it was #18. As far as deciduous teeth, I start out defocused at 5W, and then drop to 3W or less before I start any ablation activity. They are so easy to work on, and I notice how children rarely feel anything at all with the waterlase.
Thanks,
Mark
AnonymousKeymasterHi all,
In the last 2 days I’ve had pt’s back for followup decomtamination with the diode. 1 week ago we did de-epithel. @ 1.0 CW (post molars, did get removal of tissue- clear to slightly white in color- remaining tissue looked normal in color after procedure) ,followed by decont. 1.8 50 duty cycle pulsed (some areas fresh bleed ,but not all). Tx about 15 sec per tooth surface. Didn’t notice any charring or discolorization while doing procedure. Applied vitamin e and gave pt some to apply the next day at home.Today both pt’s complained of sore gums . Did decontam today at 1.6 50 pulsed, no anesthesia, ~50% of areas showed bleed . No complaint during the procedure but pt said tetracycle irrigant we used after was very sensitive(probably cold h2o).
Am I on track here and seeing normal 1 week later or can you offer suggestions?
Thanks
PatricioSpectatorGlen,
Thanks very much for your reply. I am using Zeiss 3.5 with a light. The suction things feels right and I will watch the HVS. I notice the water is 7% so it would not take much to deflect the water.Today I had a gentleman who had lost half of a large class II on #19. I Bathed the tooth at 1.5w for 30 seconds and entered the exposed area to deepen the anesthesia then I drilled out the rest of the amalgam and finished with the laser. What a joy to send this patient out the door in short order and without the numb jaw. He felt a small pain at one point when I hit bottom under the amalgam but he felt the trade off was well worth it. Thanks to you guys I am gaining more confidence at the higher power. I notice if I watch the body language and switch to the round bur to clean the area when some sensation is developing comfort seems to settle back in and I can begin again with the laser and maybe reduce powere a little if I wish just avoiding the now preped sensitive area.
Ron, The video you set up is now up on my web site. It does take about 20 seconds to load at 56K. I will put a note there so the viewer knows what to expect. I am getting patients who find us in the phone book but are sold by our web site. We are tracking every new patient and finding several sources. One of the best is a lady who just decided t make us her project.
Pat
PatricioSpectatorAl,
Your idea has always been my thinking and is what I have done over the years but root caries is a bit unique and we do not seem as a profession to have over come this devestation in the decay prone patient so I am trying to be open to new research. Thanks for all your comments on the board.
Pat
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