Forum Replies Created
-
AuthorPosts
-
AnonymousSpectatorPatient presented with crown done 3 yrs ago by another local dentist. History of crown coming loose and being recemented. 6 months ago dentist placed a ‘few’ pins and cemented with what looked like composite. Came loose again and patient superglued.
[img]https://www.laserdentistryforum.com/attachments/upload/xray1.JPG[/img]
Told pt I suspected either the post was loose again or fractured. Turns out the post was fractured. Told patient saving the tooth was probably hopeless but I’d like to try and remove the post .
Set Waterlase at 2.25 30/30 6mm tip and proceeded to remove composite from around the post. Parelleled laser to post and moved in a circular motion. Got down to about 1 mm of post left in composite and still couldn’t budge the thing. Explained to pt that with the depth we were at we could continue but the root would be too weak to hold another post. Pt decided to ext and 3 unit bridge.[img]https://www.laserdentistryforum.com/attachments/upload/post1.JPG[/img]
Long story short , I wasn’t successful but found it to be an interesting approach due to the lasers end cutting which I assumed should minimize the chance of lateral perforation. AND… I didn’t fry the tip doing it
2thlaserSpectatorGood try Ron. Boy I had a tough one today too! did a laser root canal on a broken #7, came out great, but what a job to restore. Is there a way we can post our photos on this board also?
Mark
AnonymousSpectatorQUOTEQuote: from 2thlaser on 5:38 pm on Nov. 13, 2002
Is there a way we can post our photos on this board also?
MarkWorking on that. Downloaded a hack and thought I had it working . Note quite there yet. Hopefully soon.
PatricioSpectatorMarK, Al, and Ron,
Thanks for your interest and encouragement. Please see Jon Karna’s website http://www.karna-ddscomfordent.com/ He has a slide show and complete details. I preped with the laser #4 and #19 using the same anesthesia method on both teeth. 30 guage needle and lidocaine. If he has taken his instructions down I will post them.
It occurred to me today what you have probably tried. I will begin “anesthetizing” teeth with the laser when I expect to begin by using the high speed to remove the old amalgam. I have long treated many people without anesthetic for routine care. It seems the older they are the easier this is. I can see now this can be a larger group with the addition of the laser to anesthetize.
On the down side. I had one of those large cavities entirely under the gum tissue on the lingual of #2. I dug a deep hole with the laser 1.5w my favorite wave length it seems and was able to see and access the area but could not stop the tissue weeping enough to restore the prep. I placed a seditive filling and rescheduled after healing. Any suggestions beyond another 20K investment. I guess I could have brought out my electrosurg. I did not think of that at the time.
Off to California tomorrow to see what liberals look like. May stop in at the Biolase factory. Anyone thinking about attending the January meeting at Dana Point?
Pat
PatricioSpectatorJose,
I will be intouch about a possible trip to you beautiful city in the spring or early summer. I shall wait until I have time to type some of it in Spanish for practice.Pat
2thlaserSpectatorPat,
Two things, first, try to use only .50-.75w with 11%air and 7%water to remove tissue. It’ll be a tad slower, but worth it. Also, you will get a little bleeding, you can do a couple of things after tissue reduction, one, do nothing, wait 3-4 min, then go back in, bleeding usually stops. Second, you might try to go back over what you reduced with .25W no water or air, defocused, and “frost” the tissue, that can stop bleeding as well. Don’t give up, you can stop bleeding, just use lower power, and wait sometimes, you might be surprised!
I will be at Dana Point, I am speaking, and I would LOVE to meet you! I love those meetings!
Hope this helps.
Regards,
Mark
gwmilicichSpectatorQUOTEQuote: from Patricio on 9:19 pm on Nov. 13, 2002
MarK, Al, and Ron,I dug a deep hole with the laser 1.5w my favorite wave length it seems and was able to see and access the area but could not stop the tissue weeping enough to restore the prep. I placed a seditive filling and rescheduled after healing. Any suggestions beyond another 20K investment.
I have had the same issues with deep subgingival caries. All I do is run the laser around the gingival crevice to trough it, as per crown troughing, and pack a cord with Ultradent gel on it. Instant haemostasis, plus excellent viusalization and access.
I don’t get hung up on trying to make the laser do everything. It is great for heaps of things, and OK for lots of other stuff as long as you accept you may need other adjuncts to complete Tx. I thought 1cm of retraction cord was a reasonable alternative to a �+ Diode (yep, that is what they cost in NZ)
Cheers
Robert Gregg DDSSpectatorHi Ron–
I can’t quote in RED!
QUOTEHer’e what I’m basing my thinking on;
In the Dental Clinics of NA there is a review of several studies regarding laser de-epithelialization and enhanced guided tissue regeneration. The procedures involved an initial flap procedure and repeated de-epi to prevent down growth of the epithelium thus getting healing from the bottom up rather than top down trying to avoid a long junctional epithelium attachment.
I think I will skip the charring and external de-epi thoughOK, This is a good start. But let’s not ingore the charing and the external de-epi though. You may want to turn down the settings, or use a gated pulse. Alternatively, you may want to try creating a hot-glass effect for the first pass, then turn down the power and pulse.
I like the references you listed to give a rationale for laser pocket use. It’s a good start. You want to be able to explain/justify to patients, non-laser peers, state-boards, plantiff’s lawyers, peer review committees, etc.
QUOTESo to kind of sunmmarize-
1.deepithelialization to remove inflamed tissue
2.decomtamination (each successive appt 1mm shorter) to zap he bugs, not disturb the healing in the bottom most area to help heal bottom up for better chance of reattachment instead of just a long junctional epithelium
3. no reprobing for 6 mths so as to not disturb new attachment formationYou didn’t mention if you used anesthesia or not. It’s harder to remove all the pathologic proteins and epithelium and bugs in one treatment without profound anesthesia to get a good clean & kill-rate. But you will need to be careful in learning your safe and effective laser dosimetry, maybe, before you can do that.
As a rule, the only reason to re-enter the pocket after initial treatment, is if there is bleeding, inflammation or re-current disease–not for “decontamination” unless there was a reason for killing the bugs first appointment.
With diodes, a re-entry protocol may indeed be required. But if you can avoid it, your results will be better. Wounds don’t like to be picked at or stirred up. They want to be left alone to heal. (Just ask my ankle!)
Best kept secret in laser dental research:
http://www.spie.org/app/Publications/index.cfm?fuseaction=advsearch
But have you seen this one??
<a href="http://spie.org/scripts/abstract.pl?bibcode=2002SPIE%2e4610%2e%2e%2e49H&page=1&qs=spie
Bob” target=”_blank”>http://spie.org/scripts….e
Bob
Robert Gregg DDSSpectatorNice attempt Ron–
Now,
Believe it or not, we’ve been using pulsed Nd:YAGs with the tough quartz glass fiber-optic you all use with the diodes to remove cement around silver points and posts. The misnomer is that pulsed Nd:YAGs are soft tissue only. They were first developed for hard tissue.
We really have several laser in one device–just can’t cut preps like Mark is doing.
Just an FYI.
Bob
Robert Gregg DDSSpectatorHi Al–
QUOTE…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.His name is Lewis Eversole, and he is an oral path at UOP now. Used to be at UCLA.
Bob
2thlaserSpectatorHere is a case on #10 I did this morning. Funny thing, this is the first time I couldn’t get the tooth totally “numb” using any technique, only on the disto-buccal near the gingival margin. Everywhere else the patient felt nothing. Thoughts? I would love to learn why this was “spotty” anesthesia. Thanks everyone.
Mark
2thlaserSpectatorI tried to upload photos, but it didn’t work Ron. Here is the site to get to them of the above post.
photos.yahoo.com/toothlaser. Let me know ifyou guys can see them!
Mark
SwpmnSpectatorMark, pics came through great on Yahoo! Looks like a good prep just still looks rough to me but if it’s working great!!!!
Spotty anesthesia happens to me also and is hard to explain. Perhaps some patients have different nerves which innervate different regions of a tooth. I see this fairly often on mandib molars. All the signs show profound anesthesia yet there will be one area of the tooth where you have trouble completing the prep.
Every now and then have trouble with profound anesthesia for preps on max first molars, premolars AND on teeth #7 and #10. When I anesthetize the palate in these situations, no more pain!!!!
What if you tried using the Waterlase with a defocused technique to disrupt or “anesthetize” the nasopalatine or the palate directly gingival to #10 in this case? Might be worth a try. Used the Waterlase this morning to “anesthetize” palate prior to giving greater palatine injection. Worked great!!!!!
Al
P.S. Edit: In the second and third paragraphs of this post I’m referring to “caine” anesthesia, did not want that to get confused with “laser” anesthesia
(Edited by Swpmn at 5:07 pm on Nov. 14, 2002)
(Edited by Swpmn at 5:12 pm on Nov. 14, 2002)
Robert Gregg DDSSpectatorTo All–
I think there are several reasons for the laser anesthetic effect.
But one thing I have noticed–and I’d like your feedback–is that I have found occlusal trauma will cause teeth that I have numbed to not have complete anesthesia. A posterior hit and slide into the anteriors will upset those teeth. Molars, of course, can exceed their physiologic load tolerances.
Just something to think about. See if you notice a correlation as I have.
Al–That’s great to hear about the numbing of the GP nerve!
Bob
SwpmnSpectatorRobert Gregg suggested using the Erbium to “pre-anesthetize” the palate prior to giving a greater palatine injection with “caine” anesthetic:
This morning we were prepping a bridge from #1 to #6 and extracting #3. Got my preps and buildups all done and got ready to anesthetize palate for the extraction. I’m thinking, hmm, this is a good case to try using the Erbium to “numb” the palate like Bob Gregg had suggested in an earlier post. Then I’m also thinking this isn’t such a good idea since my office manager had said “Doctor Williams, you know he(patient) has spent � in your office this year?”.
Used a G6 tip with Waterlase at 4W setting and 10mm distance(high energy defocused Colonna technique). Lasered the area for 30 seconds(timed) and got in a few white “dings” on the tissue indicating when I got too close(made for nice “bull’s-eye”, he he). Injected 0.25 carpule of Septocaine and watched patient’s eyes and body language. Eyes did not change and he didn’t even flinch. Asked patient if that bothered him and he said “Not at all”.
Although only first attempt, the idea did seem to work. Could have just been a “tough” patient. On the other hand, perhaps the Erbium can temporarily disrupt or “anesthetize” palatal tissue and nerves.
Time will tell.
Al
-
AuthorPosts