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Hi folks and a best wishes for the upcoming new year.
I am going through some old pics and seeing things that I might think are of interest.
Alot of times we have discussed things with the lasers but there havent been cases shown.
In this case there was new decay on the occlusal of a primary molar that had an occlusal amalgam in it.
Some of you have been anesthetizing the tooth in defocussed mode for 60-90 secs at high wattage (5.5-6w) with lots of water and air and then going to the amalgam.
What I did here was remove the caries first which takes that long and then go after the amalgam with a bur and once removed join the two areas up with the laser.
The laser removes the smear layer and the tooth was bonded for a composite restoration. For those that are new, the argon laser at 488 nm was used for curing.
Hope it helps solidfy once of the concepts we talk about here……….
The laser helps desensitize the tooth and alot of times you can then use a bur for amalgam removal afterwards without sensitivity.
Glenn
Hi folks this frenectomy was done on a 9 year old whom the mom is presently refusing to have orthodontics done but wanted to see how much the frenectomy will help.
Rather than arguing about it , I will do it while telling the parents that the odds are not in favour of it closing.
I then will do the ortho at 11 -12.
The keys with frenectomies is to see if the elastic tissue goes right through to the palatal and if it does you must remove the fibers.
There are two ways. Larry Kotlow uses this technique where he actually goes through the fibers from the facial troughing right through the papilla to the palatal.
I prefer to actually release the fibers on the facial and then make a small incision with the laser soft tissue tip on the palatal right down to the periosteum to release those fibers.
I use anesthetic here although some claim that EMLA is enough. I dont want to do it 2X so I use anesthetic.
One thing you can do is to blow air on the surgical site gently to see if there are still fibers remaining. With the scope I can see if I still have fibers left to remove , but often without the high mag it is tough to tell.
Once you cut through the last fibers is when the bleeding starts, sometimes I have to use the Argon laser or you can use an astrigent solution or pressure. It will often take more time to stop the bleeding than the frenectomy which takes all of 90 secs or so.
Hope this helps………..
the last two photos are of the healing and the patients are generally not taking anything except Advil at times for the first day or two.
Glenn
Here is a 2nd Frenectomy done with the method I like of making a small incision on the palatal right down to the periosteum on the palatal. This method was taught to me by Dr. Larry Finkbeiner from Colorado springs who is a periodontist who routinely uses the Argon laser for these.
The healing was uneventful and if I can find another case I will post it for you of the healing.
The settings are typically 30Hz and 80-120 mj (2.4-3.6watts) without water for the soft tissue with the pointed soft tissue tip which cuts a little cleaner and faster than a regular tip.
Magnification helps you see the fibers and prevents you from having to redo the frenectomy.
Hope this helps stimulate some debate.
These are easy and are 200 dollars per frenum so if you are interested in doing these then at least you have seen some photos.
I typically give them a bottle of Chlorhexidine and tell them to swab it with Q tips 2 times per day for 6 days and then see them on the 6th day.
I also advise them, no hot sauces, and to expect only a little discomfort, often it seems like it starts on the 3rd day once the nerve fibers start regenerating. Advil works fine for that. The laser dulls the nerve fibers (obtunds) and it really isnt too sore usually for the first couple of days and then sometimes mild discomfort for a day or two come day 3.
Hope you like it.
Glenn
oops the file didnt upload.
Here it is.
Glenn
Here is a third one that shows the healing at 8 days. Again you can see the slight bleeding when cutting the tissue on the labial.
I used a curved tip in the palate for easier positioning (its tough to get the straight soft tissue tip in the palate on a little kid).
The healing photos are at 8 days.
Glenn
