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2thlaserSpectatorBy Bob, I think you hit on it. If you look at the preop photo, there is a small abfraction area. This tooth takes a little bit of a hit in protrusive. Maybe that is why?! I will definitely make notes of this as I continue.
Al, I like the roughness of the prep, I feel it gives me much more surface area for the bonding of the veneer. Also, I asked Ross Nash about that, being that he really seems to know about veneers, and he agreed with me, BUT I would like to see a study done of how the internal stresses interiorly affect the tooth upon light polymerization of the cement under the veneer. I can only say that in ALL cases I have done, there is absolutely NO post op sensitivity, unlike when I used a high speed and a diamond for the same preps. Thanks everyone!!!
Mark
SwpmnSpectatorMark:
I wasn’t giving you a hard time about the roughness of the prep, we’ve already discussed that and I’m fine with it. My composite and buildup preps with the laser are rough as hell.
Mostly I was interested in your ideas about could the laser have been used to anesthetize any accessory palatal nerves which may have resulted in your inability to numb tooth #10 on the disto facial?
Al
2thlaserSpectatorI agree with you Al. I will try the anesthetic the way you do it. It sounds like a GREAT way to do that!!! You guys always help me out! Thanks.
Mark
2thlaserSpectatorAl,
This is fantastic. I can’t wait to try it! Very cool! I wish I’d of tried it on the veneer patient, but next time!!!I will, if I have to, great post.
Mark
AnonymousSpectatorNice job ,Al
Did you apply any topical at all?
Anybody applying topical and lasing that for infiltrations?
Just wondering.Mark, did you try low level right down the PDL in that area?
SwpmnSpectatorOk, Ron, yeah you busted me and I can’t stand not being honest:
EMLA was applied for 30 seconds prior to lasing the area.
Al
AnonymousSpectatorAl, it’s still good to know. I’ll give it a try. (Water / Air Settings?)
I was hoping you and our California friends weren’t going to say that you needed 70 degrees and sunshine to make it work, because if that were so, Mark, Pat and I would only be able to use the technique a few months a year.:biggrin:
Glenn van AsSpectatorHi Ron……this is great stuff……..
I think your web site is proving very useful for users of all lasers and want to compliment the users here for their desire to help others learn new techniques.
Great stuff Allen and I for one am proud that a skeptic and an owner like you were has become such a proponent for lasers as you have.
Kudos to you all.
Glenn
(took my happy pills just now after posting on dental town first ……sheesh.)
Glenn
Glenn van AsSpectatorHi folks……got a little time to post a simple occlusal.
My discoveries with using the laser for Class 1 small fissure caries are as follows. It is not as fast or as accurate as small burs, and not as fast as AA.
Having said that, I like using the laser for anesthetic to help with the burs.
The difficulty lies in when you anticipate a small lesion either with diagodent or visual inspection and then find out the decay hits the DEJ and spreads laterally. IT is tough to enlarge the preps without a bur. THe enamel settings cause sensitivity in dentin.
To combat this I generally use a wider 600 micron tip and create a little bit of a wider prep in the enamel and then use a 400 micron tip once the initial portion is done. If there is lateral spread at the DEJ viewed under the scope then we will widen it with a bur. The first part of the laser helps with anesthetic if the decay reaches the dentin but occasionally I will use a fissureotomy bur or small 1/8th or 1/16th bur to open the grooves (Brassler 003 or 004 burs).
This case was a fissuresealant failure (god I hate sealants) and then it was a little brown groove testing 40 on the diagnodent.
Opened it up and look at the decay at the DEJ, widened with burs and then caries detector gel. Note the false positives on enamel.
I remove the last bit of decay with a small slowspeed round bur and use the laser at the end to remove the smear layer.
Flowables used to fill it often dyract flow (GI) in the base.
Graeme Milicich knows alot more about Fuji glass ionomers than me though.
I just wanted to show you one of the difficulties with the laser in treating fissure caries in my hands and how I have developed this hybrid technique to still work on these types without anesthetic.
This case was an upper 2nd molar treated without anesthetic and can be located here……….
http://www.sendpix.com/albums/021115/0922360000003319575fd2345f07ad/
Hope it is somewhat insightful to the difficulties of lasers in small Class I fissure caries. It works great to anesthetize and to remove the smear layer.
Use the “toilet bowl prep” of widening the top part before you take out the crap in the center……my term.
Glenn
2thlaserSpectatorGlenn, Nice case. Couple of curiosity questions though. How hard/easy is it to work on those upper 2nd molars with a scope ( I don’t have one, thinking of course of getting one) compared to using loupes? What is your learning curve, for say, someone like me, a newbie with a scope, to learn how to use it properly? Lastly,
How short of a tip is on your laser? I use a 4mm length tip, and find that I can angle my handpiece to reach most of that later spreading stuff, and when I can’t, I either widen the prep a bit with the laser (cause as you know I, it’s my own thing, try to not use rotary instruments), or succumb to using, like you, a 1/8 small round bur in my slow speed. Just trying to learn a bit. Thanks, how was Arizona?
Mark
2thlaserSpectatorCorrection “lateral spreading stuff…”, typed too fast!;)
joegarciaarSpectatorDear Pat:
You are welcome in Buenos Aires.
My wife (my colleague and partner) and I will have much I please to receive them and to accompany them in their visit.
Todo es cuestion de planificarlo. Aunque esten de vacaciones tambien podrian visitar nuestra oficina, conocer a nuestro staff, nuestos ´´toys´´ (con los que disfrutamos nuestro trabajo diario).
Sorry this forum is in Englishs. The rest if it seems to you goes by private mail and in Spanish.
Best regards.
Jose Garcia
Buenos Aires, Argentina
Glenn van AsSpectatorMark…….you know what I admire most about you other than your pushing the envelope with crown preps. (did you get my private email thanking you for the article you sent me……I read it all and was impressed by the relative smoothness of the preps actually).
The thing I admire is your professional nature in asking pointed and well thought out questions.
Mark, until recently I had forgotten what the most difficult teeth to see with loupes are and it is the upper 2nd and 3rd molars. You block out the light with your head trying to see, you crane over at ridiculous angles to see and still cant manage to get a clear view particularly in decreased opening cases.
With the scope the hardest teeth to see are the lower first molars and 2nd premolars. Its the angle you view with the scope.
You need to use indirect mirrors alot with the scope ( even in the lower arch) but if you are used to using mirrors then it is easy easy to see the last teeth. I have very small mirrors I use at high mag to view things.
I have cases which show me prepping MO and even DOs at times on third molars.
I will post in a minute a case I did where I restored a lesion which was on the DB line angle of the maxillary left third molar which was subgingival. I did it with anesthetic at the patients request and I didnt shoot a photo until the prep was done.
In closing Mark, there are many factors associated with the learning curve and they are as follows…..I know the answers in your case but for others.
1. Do you use magnification now.
2. How long have you used them.
3. What magnifications do you use now.
4. When you want to look at the linqual of the lower left molar, how do you view it? Do you move yourself or do you move the patient .
5. Do you use mirrors routinely? ( for both arches or only the maxilla)
6. Do you trim your own dies under a scope.
7 Did you use a microscope lots in the past such as in an undergraduate microbiology program.If you practice standup dentistry , dont use mirrors, never have used magnification, dont ever move the patient or the mirrors and only move yourself to see, never have used a microscope then the learning curve is going to be steep and long.(PErhaps a year)
If you are committed to change, have some of the features above then you may find your learning curve to be as short as a month.
I was routinely using the microscope for most procedures at around 3 months and I had only used 2.5X mag routinely and only mirrors in the maxillary arch.
The documentation is second to none.
Finally with the scope you have to learn to move the handpiece out of the way to see. The scope will otherwise see the back of the handpiece so I like the Continuum laser handpiece which is like a pen. If you have a long tip on the laser then it is irrelevant ( I use alot of surgical length burs to move the handpiece out of the way of viewing.)
I hope this gives you some insight into using a scope.
You can always come to my office for free and watch, or combine it with a course that I am giving. I am doing one in December (7th ) at the University of British Columbia and one in March 5-8th ( not sure of the exact date) at the provincial dental meeting in Vancouver. These are both lectures with hands on workshops.
Let me know if I can be of any help.
Glenn
Glenn van AsSpectatorFor mark…….here is the view on the DB of the third molar.
No preop as only afterwards did I think of clicking a photo to show the ability to see.
Glenn
http://www.sendpix.com/albums/021115/17041400000197419c341922fb4178/
SwpmnSpectatorRon, was overcast here when I tried the palatal technique:
Air/Water was 65/55%.
Glenn, you aren’t the only one that is happy. My main problem was there were serious problems with my laser(and like I’ve said b4 think this was the case when the laser was delivered). Once I got the laser fixed it works great!!!!!
Al
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