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2thdocSpectatorHow detailed a consent form do you use?
List alternate Tx?
Tx details?
Possible negative outcomes?Have one you’d like to share?
Thanks
ncdocSpectatorI am a frustrated Waterlase user at the present time.
We have been using the Biolase Waterlase for 3 months with mixed success.
I have noticed that the laser will “cycle” for lack of a better term. What I mean is that it seems to almost rev up and down slightly during continuous use. Almost like an idling car sometimes will. My partner and I have had many people complain of “electric shocks” and we are trying to figure out if this phenomenon may be the cause. We have talked to several other dentists using the laser and I think, have pretty much eliminated most other likely causes. Our air and H2O settings are default for the machine and we have tried a variety of power settings. Our machine did have a contaminated water supply (internal) for sometime, but that has been replaced. Just wondering if anyone else has had any experience with this.Thanks.
2thdocSpectatorWhen you say ‘recycled’ what is it they’ve done? Has the fiber and handpiece been replaced?When I first got mine I was having trouble with what I called arcing-little flashes that caused dicomfort even when I was sure I hadn’t contacted metal. replacement of the fiber and handpiece solved this. Can you post the settings your using? Maybe we can help more.
ncdocSpectatorWell, Waterlase basically replaced the entire water system inside the box. It had become contaminated somehow and was not filtering right. also the power was very low. After we had this fixed the power was great. I can cut through steel with the thing (jk), but I am still having some problems with the “electric shock” thing. My partner has used it on me for 2 occlusal restorations on 18 and 31. Pain free until dentin and then “wow”. felt like when I had my veneers placed without anesthetic. lots of sensitivity. He cut through the enamel on the default 4.00 power setting (H2o at 55% and 65%Air) As soon as he hit dentin he went down to 3.25, but basically it didnt cut well here so a slowspeed was used to excavate decay. Here are the settings as we are currently using:
1. 6.00 90%Air 75%H20
2. 4.00 65%Air 55%H20
3. 1.50 11%Air 10%H20
4. 0.75 11%Air 0% H20Anybody that has suggestions please let me know. I am planning on putting a call into Keith at Waterlase today to discuss the option of getting a New Waterlase. We are just tired of hurting people.
Christian
2thdocSpectatorI’m not an expert but here’s what I’ve been doing.
1.5W 20/20 20 seconds
1.75 W 20/20 20 seconds
2.00W 20/20 20 seconds
keep progessing up to 3.25 W for B or Ling (4.50 for occl with more air and h2o) remove necessary enamel. Once thru enamel I again cut down to the 1.75-2.00 range for removing dentin/caries . This seems to ‘condition the tooth enough that I can then remove all decay with a small sharp round bur and the patient doesn’t have discomfort. When done with round bur I again run the laser thru the prep, then restore.
ncdocSpectatorare you starting out with that low of a setting at first to remove enamel? if so, doesn’t it take a long time? one of the reasons we bought the laser was to be more efficient and waste less time (with anesthetic, etc.) time is money as they say.
2thdocSpectatorThe lower settings won’t remove enamel . My understanding is the lower settings ‘condition’ the tooth-maybe starting to block the pain pathways. I also think the gradual increase keeps the higher setting from feeling quite as forceful to the patient. As far as speed , at this point I definitely spend longer prepping with the laser-sometimes it seems like an eternity- but when I actually check the clock, class III & class V’s I do just as quick or quicker as when I need to use the handpiece and anesthesia. Class II’s take slightly longer and Class I’s take a lot longer. I guess I bought my laser for different reasons- less need for anesthetic, able to offer different services, increased bond strength,ability to do more conservative (micro) dentistry thus perserving more tooth structure, and of course the WOW factor.
Robert GreggParticipantHere’s one that i have used over the years:
Consent and Authorization for Treatment with the Dental Laser
1.I understand that Dental Lasers marketed and sold in the United States have been cleared for marketing by the Food and Drug Administration (FDA) for use in dentistry.
2.I understand that Doctor __________ and Doctor __________ have been trained extensively in the use of Dental Lasers by the best universities, academies and experts that teach this information.
3.I have been presented with the laser treatment plan and fees-for-treatment. I have been informed of other methods of treatment and the alternatives. The expected results and risks (even the remote chance of death) of the proposed treatment (and/or no treatment) have been explained to me.
4.I understand there is no guarantee of success or permanence of the treatment.
5.I understand that dental conditions in my mouth can change and alter the proposed treatment plan.
6.I understand that any time teeth are manipulated, whether by a mechanical drill or laser, there is always the possibility and risk that Root Canal Therapy may be necessary. I realize that in spite of the observation of every reasonable precaution — prior nerve damage, infection, or tooth trauma may have pre-existed in the tooth.
7.I understand that anytime that soft tissue is manipulated, whether by traditional dental technology, or laser dentistry, there is always a possibility and risk of unexpected and undesirable side effects.
8.I understand that “high technology” dentistry, including laser therapy, may be considered “investigational” or “experimental” and may not be reimbursed by some insurance companies, and I must anticipate paying 100% of any such treatment.
9.I have read and agreed to the foregoing. I have had the opportunity to ask treatment related questions and have been advised of the risks and benefits of treatment, including the use of local anesthesia and dental lasers.
11.I, ______________________________________, authorize the performance, upon myself, of dental treatment using dental lasers, which treatment will be performed by Robert H. Gregg, D.D.S. or Delwin K. McCarthy, D.D.S.
Patient Signature, _________________________________________________Date, _______________
Witness, ________________________________________________
PatricioSpectatorMy machine is working fine. Second one after six months with a lemon. I have experienced the shock but I believe it only happens when a focused energy is directed begins to cut rapidly into the dentin. With magnification I watch the enamel melt away and open the prep so I can work down the sides of the decayed area . If it is narrow and deep I use the 1/4 round to remove the dark tissue(love that round bur). I have also gone from a macho 6w to a much more conservative number (3-4) and increased wattage as necessary. I find I can not cut at speed without magnification where I can easily watch the enamel melt away. Keep the tip moving and do not allow it to drill a hole into the dentin.
I find if I work up slowly on the watts(.25 then 1.50) on the inexperienced patient I can do almost anything on the second or third tooth.
Pat
Robert GreggParticipantWell, I realized I didn’t even post to my own post….
Both the Pulsemaster and the PerioLase are free-running pulsed Nd:YAG solid-state lasers and were designed by the same designer and engineer, Mike Yessik and Rick Thompson. ADT purchased the rights to the Pulsemaster in 1994 when their OEM deal with Sunrise went sour, while Millennium Dental Technologies (a company I co-founded with Dr. Del McCarthy) worked with Rick and Mike in January of 2000 to design from scratch a pulsed Nd:YAG laser with 21st Century technologies and to our specifications and our input to the clinical needs of end-users–novice and expert alike. As an aside–We formed MDT when we couldn’t get manufacturers interested enough in our findings regarding the importance of pulse duration or lasers for their importance in periodontal therapy (not hygiene curettage)–hence the name we coined “PerioLase” cuz no one else was obcessed about lasers for perio like we were.
PulseMaster 600 IQ
1. Analog power supply, multiple analog capacitors, free-running pulsed Nd:YAG laser.
2. 6.00 Watts; 20-200 mj per pulse energy; 10-200 Hz
3. 10″W x 19″D x 29″ H
4. 75 lbs.
5. Single 100 microsecond pulse duration
6. Power: 110-120 VAC, 50/60 Hz, 10 Amps
7. Touch pad
8. Pre-sets for power and repetition rate.PerioLase MVP-7
1. Digital power supply, single digital capacitor, free-running pulsed Nd:YAG laser.
2. 6.00 Watts; 20-300mj per pulse energy; 10-100 Hz
3. 11″ W x 16.5″ D x 24.5″ H (with Cart)
4. 45 lbs.
5. “Multi Variable Pulse” (MVP)–7 user selectable pulse durations: 100, 150, 250, 350, 450, 550, 650 microseconds (for variable clinical needs both hard and soft tissue)
6. Power: (Digital power supply)110-120 VAC, 50/60 Hz, 10 Amps, Single phase; 200-240 VAC, 50 Hz, 2 Amps
7. Touch Screen
8. 3 presets for each pulse duration (21 total)
9. Procedure driven menu selection
10. Printer (upper left of device face)
11. Internal Molectron Power Meter (below fiber port)
12. Cart with storage bin
13. Continuous Fluence display in Joules (of total energy used during procedure)Del and I realized in 1993-94 that another parameter beside wavelength, power and repetition rate was necessary to control bleeding without charring and the delayed healing that goes with it. Varying the pulse duration to be “longer” than 100-150 usecs was the answer. But long pulse is not good for hard tissue (selective caries removal, dentin etching, calcified canal opening, etc) like 100 usecs is……
It’s the same with erbium. We realized when using experimental erbiums in beginning in 1990-1997 (Kavo in Germany, then P-Optics in California) that another parameter besides wavelength, power, and repetition rate (Hz) was needed for RAPID and SMOOTH cutting of crown preps without injury to the pulp (the electro-mallet effect for those who did gold foils).
You could accurately say that the PerioLase is the next generation of the Pulsemaster having been prototyped by the same designer and engineer….so we must think very highly of the Pulsemaster!
AnonymousKeymasterJust did my first ‘training’ on the diode. Biolase rep recommended using an activated tip.Treated 2 pockets with activated tip and continuous wave.
Last night got Manni’s book (thanks for the suggestion Bob) and went thru it kind of quickly.From what I gathered an unactivated tip seems to make sense in the Tx of perio pockets because you get some action away from the tip whereas an activated tip the action is at the tip so I would have to contact all the areas I wanted to TX. Also instead of CW, pulsed or gated would be better because of the refractory period. I know Bob recommended these things in another post but I want to make sure I’m understanding the rational for this. Is my understandiing correct? Comments?Thanks,
Glenn van AsSpectatorRobert………excellent letter of consent. I have printed it out if that is ok with you.
Its great to see how someone with your experience is able to not only share tips for usage but also to help share things like this consent form.
Great stuff.
Glenn
Glenn van AsSpectatorHi Ron actually with the diode you will use BOTH activated and non activated.
First activate the tip by carbonizing some blue articulating ribbon on the tip to make it a “hot tip”. Then do the gingival curettage part of the procedure where you remove the inner wall of the pocket. This activated tip will remove the inner wall of the pocket and you will get a coagulum on the tip after20-30 secs. Keep the tip moving up and downwards and sideways in the pocket. You will get a fresh bleed when you do this and then you know you are finished with the first step.
Now cleave the fiber clean and the second part of the procedure (used to be called bacterial decontamination) now referred to as bacterial reduction takes place at different settings.
If you need further information let me know.
Glenn
Robert GreggParticipantGlenn–Why…..thank you…….thank you very much (in my best Elvis voice), now that’ll be โ bucks:biggrin:
I appreciate the kind words, and always happy to share whatever I can. Glad you like it! You and any clinician have my blessings for their personal use of it.
Manufacturers and lecturers should use with permission and acknowledgement–that has not always been the case, unfortunately.
AnonymousKeymasterQUOTEQuote: from Glenn van As on 11:30 am on Sep. 20, 2002
Hi Ron actually with the diode you will use BOTH activated and non activated.First activate the tip by carbonizing some blue articulating ribbon on the tip to make it a “hot tip”. Then do the gingival curettage part of the procedure where you remove the inner wall of the pocket. This activated tip will remove the inner wall of the pocket and you will get a coagulum on the tip after20-30 secs. Keep the tip moving up and downwards and sideways in the pocket. You will get a fresh bleed when you do this and then you know you are finished with the first step.
Now cleave the fiber clean and the second part of the procedure (used to be called bacterial decontamination) now referred to as bacterial reduction takes place at different settings.
If you need further information let me know.
Glenn
Glenn, thanks for the reply.I appreciate yours and Bob’s patience with all my questions.
Why not do decontamination with the unactivated tip 1st and then activate the tip and do the curretage? Wouldn’t this decrease the bacteria and not expose the newly lased inner wall of tissue to as great amount of bacteria?
What about pulsed vs. continuous?Thanks again,
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