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PatricioSpectatorGlenn,
We moved the suction a little to see if that would reduce the brown spots during preparation at 1.5w. while doing incisal edges etc. This definitely helped. I have also increased the water from 7% to 12-15% and this seems to have the same effect.
Pat
PatricioSpectatorGlenn,
I meant to mention the local primary TV station call today and spend at least an hour filming all around our office. They called because of our Rembrandt one hour whitening service. I have turned some of those who have responded to this add (non patients of record) into laser patients for the replacement of anterior restorations following whitening. Cross pollenation! The first health spot featuring the laser by this TV canel is on my web site thanks to Ron.
Pat
SwpmnSpectatorSam:
Congratulations on your purchase of the Waterlase! You will find it a useful adjunct to your armamentarium. In my practice, we have eliminated use of the slow speed handpiece for caries removal. My patients love that!
Sam, I want to present a case from today that I believe was successful only due to my communications with Mark Colonna:
70 yo female presented with Class V caries on the facial of tooth #6. Patient expressed to my assistant that the lesion was very sensitive. I explained to the patient that we now have a laser for placement of restorations and asked for her permission to attempt the restoration without anesthesia. At a 10mm distance, “bathed” the facial and incisal edge of the tooth with a G6 tapered tip for one minute at the 4W setting. Reduced the beam setting to 3.25W, moved in slowly and then as the patient felt nothing, rapidly removed enamel and caries. Treatment time from patient seating to polish/dismissal was 15 minutes. We were “swamped” with emergencies today and it helped a lot not to have to use anesthesia. The lady was amazed by the laser.
We’ve only used the Colonna “long-distance defocused” technique for two weeks but I can tell you we already see a difference in our ability to place restorations without anesthesia.
Al
SwpmnSpectatorBob and Ron:
Thanks for the theory on laser anesthesia with the defocused technique. Whatever the mechanism, although I’ve only used two weeks, seems to work.
Ron, do you know if LR Eversole is Lawrence or Larry Eversole? I trained under a Larry Eversole at the University of Florida from 1985-89. Dr. Eversole was an Oral Pathologist.
Al
AnonymousSpectatorQUOTEQuote: from Swpmn on 10:57 pm on Nov. 11, 2002Ron, do you know if LR Eversole is Lawrence or Larry Eversole? I trained under a Larry Eversole at the University of Florida from 1985-89. Dr. Eversole was an Oral Pathologist.
Al
Al, I don’t know if he is or not. So I guess I can’t help that way.
I’m glad the ‘amalgam removal’ and Marks suggestions have been helpful. That was the whole intent of this site – sharing as we learn.
2thlaserSpectatorHey Pat,
If you don’t mind. I would recommend that if you are cutting enamel and or dentin, I would use at minimum 24% water. This really helps cut, clean, and I can assure you, no charring, and you can even keep your suction tip a bit closer. Hope this helps.
Mark
2thlaserSpectatorRon,
I second Al’s accolades on this message board. I learn everyday somebody posts here. From Bob, to Glenn, to you, to Al, Pat, and now I am sure I WILL forget a name or two, but thanks to all. This is what so invigorates me for OUR profession. Thanks to all you pioneers!!
Mark
socalsamSpectatorAllen,
thanks so much for the post. I am really excited about defocusing anesthesia. I know we dont know the mechanism but any studies out there to indicate that this is a safe technique, meaning that we are not permanently frying the pulp.
Glad to be a part of this laser group.
AnonymousSpectatorQUOTEQuote: from socalsam on 11:43 am on Nov. 12, 2002
Allen,thanks so much for the post. I am really excited about defocusing anesthesia. I know we dont know the mechanism but any studies out there to indicate that this is a safe technique, meaning that we are not permanently frying the pulp.
Glad to be a part of this laser group.
Sam , how ’bout this one-
Pulpal thermal responses to an erbium,chromium: YSGG pulsed laser hydrokinetic system.
Rizoiu I, Kohanghadosh F, Kimmel AI, Eversole LR.
UCLA School of Dentistry, USA.Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998 Aug;86(2):220-3
RESULTS: Pulpal temperatures associated with the hydrokinetic system either showed no change or decreased by up to 2 degrees C. Wet bur preparations resulted in a 3 degrees to 4 degrees C rise. With dry bur preparations, a 14 degrees C rise in temperature was recorded.Does that mean you can’t fry the pulp,.I’ll bet you can w/o enough h20 or air.
Glad your part of the group-welcome!
PatricioSpectatorToday I noticed I had progressed up the learning curve. I completed two DO’s on a young adult female who was sensitive to the slightest effort. When I could see my frustration mounting I asked for the ligajet al la Jon Karna after having bathed the tissue at 1.5w and followed his suggestions. This patient felt nothing beyond the slight sensation of a prick and I was able to prep as usual. My confidence in the process felt good and she was very grateful for my interest in her comfort during this process. I noticed today when I come up against some interproximal tissue which was in the way. I just removed it. The removal is becoming second nature. I think there is hope I will master this thing after all. I did look at molar today which I know Mark would have preped but I was not ready for that one yet.
Pat
2thlaserSpectatorPat,
Congrats, good job. Climbing the learning curve is fun actually. Can you tell me what John Karna taught you? I think I get it, but maybe you can describe it for those of us who haven’t done that method yet. Sounds great.
Thanks in advance!
Mark
SwpmnSpectatorThat’s great Pat!
Perhaps your use of the laser anesthetized the area enough so that the patient did not feel the PDL injection?
What teeth needed the DO’s? What needle length, gauge and what specific anesthetic did you use for the PDL injection?
Al
AnonymousSpectatorQUOTEQuote: from Patricio on 9:36 pm on Nov. 12, 2002
and I was able to prep as usual.http://www.karna-ddscomfordent.com/
With the laser or highspeed?
Ditto Al & Marks questions
Robert Gregg DDSSpectatorHi Ron,
I agree. Posts can be misinterpretated. Thanks for your explaination. What should I edit??
And thanks for your kind words.
I hate to sound like an “old-guy” when I respond to the posts of new laser users. But sometimes the stuff that I know and do that comes second nature to me, the stuff I don’t even think about anymore, the things I expect others must surely know is not what others know or understand at all!
I’m not such a sour-puss or Big Head that I ask questions of people just to “nail” them. If I am going to take up my time to be involved in a discussion at all, I’m asking questions with sincerity.
I know that you appreciate my main concern: justifying (not merely doing something) because some “expert” suggested it, especially now that there is a plethora of research, clinical case studies, abstracts that has been done with nearly every laser that you can imagine. Anecdotes are fine. But I won’t justify–as a reason to experiment on patients or buy a laser–on anecdotes alone. Combined with other information–OK.
One thing that is always an undercurrent with lasers: We are the fringe of our profession. We’re Orphans. So are medical laser practitioners. After investing so much time, energy, money into this field, I want this technology to flourish in our profession, not be subject to ridicule and scorn.
I remember when I first got my pulsed Nd:YAG laser in 1990. A lot of press had been whipped up about using the laser for “curettage”. The perio people were furious. A periodontist by the name of Bernard Gantes, DDS. MS from the Long Beach Calif. area wrote a letter that he sent out to all the dentists in my area disparaging this laser for any perio except cutting frenums or whatever. I ran into him at a dental society meeting. In a question not unlike what I asked of you he barked, “What are you trying to accomplish when you perform laser curettage?!” I didn’t have any clue, or rationale, or concept of what I might be doing. But I managed to say, “Trying to maintain my patients’ perio condition.” I guess he was either too angry to pursue the question, thought I was too ignorant (I was of perio then) or I made a good come-back he couldn’t respond to because he just turned and walked away.
Talk about people who want to “nail” you it is certain periodontists!! See President’s Newsletter and the responses, as well as the other newsletters attached. <a href="http://www.calperio.com/calperio/csp.nsf/vpages/News?OpenDocument
They” target=”_blank”>http://www.calperio.com/calperi….
They are lying in wait to ask you what your justification for using lasers in the perio pocket might be. We have a lot more data, rationale, and scientific justification than we did when Gantes questioned me. That’s where I was coming from when I asked you those questions.
Your friend,
Bob
AnonymousSpectatorBob,
Can you recommend research sources ,besides PubMed?
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