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2thlaserSpectator‘spell corrected version!;)”
Have either of you guys tried a Svedopter? I used to use one in dental school, 20 years ago, when I didn’t have a dental assistant. I just ordered a new one, and it is invaluable to keep the tongue out of the way, as well as suction at the same time. If placed gently and correctly, even if they are not anesthetized, it is comfortable. Just a thought. Glenn, how do you post photos to sendpix?
Al, how has it been going with the Waterlase?
Mark
SwpmnSpectatorGlenn:
Haven’t tried my tongue depressor technique on unanesthetized patient, probably tastes like crap!
An older(oops, more experienced) female associate showed me how to place a 2 X 2 gauze deep in the lingual vestibule then place the end of the tongue depressor against the mandible(on the 2 X 2) and fulcrum the tongue away. Tongue sticks to the “popsicle stick”.
This would probably hurt a patient who wasn’t numb but I’ve found quite useful for lingual cervical caries and lingual margins of second molar crown preps. Also has taken a great deal of stress off my left arm when I prep #18 and my assistant’s left arm on #31!!!
Works much better than trying to retract with a dental mirror or high volume evac.
Al
RWATSONSpectatorThanks, AL and Glen – I’m learning some things allready.
Being a newby is HARD!
What are the ‘expected’ expenses that add up to several thousand $$ a year – is it the ‘fiber’ or some sort of alignment/adjustment, or what?
And, if I am going to have to put that amount of $$ into keeping it running well, perhaps there is no real saveings to buying an older model for say 10 or 15 k less. I might well have to put that much into it to keep it up to snuff, right? Or is my reasoning incorrect??As for space, I think I could handle a cart as large as a ‘big’ desktop, but what I am worried about is that ‘fiber’ geting banged around in a busy office.
Way too mucy to think aobut..
PS: i got an estimate from a 3rd party for a MilliniumI at around 30k w a one yr warrenty – does that sound fair?
PPS: any books or journals you guys would recommend as reading to get background learning?
SwpmnSpectatorBob:
Realize that everyone using the Erbium for hard tissue treatment is a “newbie”. We are not the “pioneers” of laser dentistry but we ARE the very small percentage of dentists using Erbium lasers for cavity preps in a day to day, “wet gloved” clinical situation.
Many things can go wrong with the laser. With my laser, have experienced problems with the laser rod, the pump chamber and the flashlamp. When the thing breaks, it’s very expensive to repair. I have blown two trunk fibers – the “hose” which delivers the laser energy to the handpiece.
Biolase offers what they call a “bumper to bumper” yearly maintenance contract. The present cost is 񘴘. Be sure to read your contract carefully and ask a lot of questions, e.g., Is the trunk fiber covered? If you do not purchase the maintenance contract, I can tell you the cost to repair your laser may be a lot more than 񘴘.
Bob, in my opinion, 30K for an old Millenium I with a one year warranty is quite steep.
Al
AnonymousSpectatorQUOTEQuote: from RWATSON on 6:57 pm on Oct. 30, 2002PPS: any books or journals you guys would recommend as reading to get background learning?
Dental Clinics of North America Oct. 2000 44:4 Laser and Light Amplification in Dentistry (check ebay-got mine for ů.00)
Dental Applications of Advanced Lasers -Manni
SwpmnSpectatorFollowing are a few ideas I’ve gleaned from my own mistakes and from discussions with laser technicians:
1) Never allow the laser to contact a metal substrate. Do not allow the laser to contact amalgam or the margin of a PFM crown, e.g., don’t attempt to prepare a Class V restoration under a PFM crown with recurrent caries.
2) Be very careful when removing old bases underneath amalgam. Some old bases contain metals for radiopacity, if you see “sparking”, discontinue laser usage and pick up the high or slow speed handpiece.
3) Do not use “powdered gloves” with a laser. Cornstarch can damage the laser. I got rid of powdered gloves years ago because my staff could always tell where my hands hand been, ha ha ha!!!!
4) After you finish your procedure, make sure to purge all water out of the laser delivery system by switching the water button to “OFF”. Leaving water in the delivery system can cause problems.
5) Likewise, minimize the exposure of the laser system to sunlight. The sun will heat up the laser and may cause problems with any water which remains in the delivery system. I place this idea here because in my operatories, the wall which the patient faces is all glass.
My points may be obvious to experienced users but may be beneficial to others. Feel free to disagree with my comments and add your own ideas.
Al
Glenn van AsSpectatorHi Ron ……….I know that it is defocussed and with the diode to get the energy deeper into the tissue.
Perhaps using the Erbium the next day would have helped.
Rob Gregg might have a better idea.
i think you did good but I would have changed something on day 2. You got the erbium , use it next time and see. I like certain things about the erbium ( like the Nd Yag it is pulsed) and you can do alot of work without anesthetic.
Glenn
Glenn van AsSpectatorHI there ………join the Academy of Laser Dentistry and take a standard proficiency 2 day course.
In my opinion (keep in mind I own a continuum laser) that 30K for a old millenium 1 is ridiculously high.
I know that you can get a brand new erbium yag from Continuum lasers which is very very similar to the Biolase for 36K. You can get a hard tissue erbium yag and a seperate soft tissue diode laser from them in a package deal for 44K.
I think the Millenium 2 new is 45 K .
Join the ALD and get back orders of their Wavelengths magazine which has all kinds of cool cases.
Be aware of what the laser can and cant do.
Its not a panacea for all and remember that cutting with light is always slower whether in soft tissue or hard tissue than cutting with the handpiece.
I will post a case tonight where I feel the laser helped me sterilize a very deep prep.
It was an adjunct not a replacement.
Its a phenomenal and I mean phenomenal marketing tool
Check out some of the cases I have posted and see what is possible.
Glenn
Glenn van AsSpectatorHi Al: I have done lots of Class V restorations with success under PFM crowns and with magnification you can be very selective in only touching tooth structure and not the crown. If you touch metal the tip will degrade faster but if you stay on tooth it is fine.
Old base will spark especially CaOh and you can do it with a high speed or low speed.
Interesting idea about the powdered gloves……I havent noticed this, but could save myself alot of embarrassment without the powder.
I love the anatomical right and left gloves (Baxter) for restorative and could never go to the cheapies, they bother my hands.
With the Continuum laser I never purge, and only replace the filter once per year.
Biolase I think has more upkeep on their product. I have replace tips, filter packs and a foot pedal….thats it in almost 3 years of use.
My laser sits right next to the glass windows and never had a problem. I hear you must be careful moving the biolase but I never have had a problem with my continuum laser.
I think that some of your posts may be intended for certain lasers but I will keep them in mind for future reference.
Glenn
Glenn van AsSpectatorHi folks: Again nothing mind boggling just something to consider.
This was my last patient tonight ( around 3 hours ago).
All photos shot through the scope with preop and postop radiographs digitized by taking my Nikon 990 and shooting the film on a viewbox with macro mode.
Photos edited with text in ACDSee 5.0 ( a nice little program in my opinion)
This patient had alot of decay under the amalgam which was visible on the lingual of the MO amalgam in the preop photos.
I removed the amalgam and noted alot of decay and in addition a void on the MO composite on the 2nd molar.
I have often said that the scope allows you to visualize decay and know when you are on solid tooth structure and when you arent.
I put some caries detector gel in this case to see what it would say.
WHen I got the last bits of decay out with a slow speed the pulp was very very close and visible at high mag with the scope.
no direct exposure but right there…….
I used the erbium yag hard tissue laser to try and disinfect the remaining areas close to the pulp.
Covered it with Dyract Flow Glass Ionomer. Then a flowable and finally a hybrid tetric ceram.
It worked out great but time will tell on whether the pulp will turn irreversible pulpitis on us.
Just to show you another use for the lasers in deep preps to try and disinfect the deepest areas with minimal preps.
The post op film shows the restorations.
Glenn
Here is the link
http://www.sendpix.com/albums/021030/2247510000066676d506106ffa0a5a/
Robert Gregg DDSSpectatorHi Ron and Glenn–
You did just fine Ron. There’s not a whole lot you’re going to do with a 7 day old lesion through biostim.
What you will do is some biomodulation and accelerated wound healing, and pain relief if there was any.
Glenn’s right about the surface effects with the erbium–that is, it will help alter and modify the surface. Stop ozzing, prevent secondary infections, kill the virus.
The best idea is to catch these lesions in the prodrome phase and prevent their manifestation in the first place.
The general idea is to avoid creating a new wound–ie a BURN. But that doesn’t mean a surface alteration with erbium is out of order. That’s OK. CO2 is OK in that way too, for example.
Bob
PS If the vesicles show up the next day–do it again. Use BOTH wavelengths to get the max benefit of both the deep penetrator and the surface modifier.
I’ve been using the FR Nd:YAG on my torn tendon every day for 5 weeks (feels goooood!). So lase until pathology goes bye-bye.
(Edited by Robert Gregg DDS at 2:03 am on Oct. 31, 2002)
Robert Gregg DDSSpectatorBob,
Buy the newest laser technology, not last decade’s White Elephant.
Biolase erbiums are fussy enough as they are–without buying their old technolgy. The engineers have solved many problems in the Waterlase II design that could not be properly addressed in the Waterlase I. Some things will always be problematic in the first design.
Bob
PS–There is a reason I don’t refer to the Biolase Waterlase as the Millennium ANYTHING……;)
http://www.millenniumdental.com
(Edited by Robert Gregg DDS at 2:17 am on Oct. 31, 2002)
Robert Gregg DDSSpectatorGlenn–
Nice post, GREAT pictures!
I was dying to use the FR Nd:YAG to get the final decay out….;)
I didn’t see any pulp tissues. Was that thin dentin, or was there an actual dry opening there?
Bob
Glenn van AsSpectatorHi Bob……..it was very thin dentin there. No pulp but it was very thin.
The Erbium worked fine for the last little bit. i wasnt aware that Nd:Yag could take out dentinal caries. I thought it was able to take out stained enamel caries.
I dont know if this will work……..time will tell.
Cya
Glenn
Glenn van AsSpectatorHi Bob……..it was very thin dentin there. No pulp but it was very thin.
The Erbium worked fine for the last little bit. i wasnt aware that Nd:Yag could take out dentinal caries. I thought it was able to take out stained enamel caries.
I dont know if this will work……..time will tell.
Cya
Glenn
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