Glenn,
I’ve had mixed results.
Pretty effective using .25w 0/0 starting defocused and circling inward until pt feels it. If I can get close enough to see some surface change, then sensitivity stops in alot of cases(especially those max 1st molars w/ buccal tooth brush abrasion).
The most disappointing are those pts I’ve sent previously to the periodontist and now have 2-3 mm pockets but have to drink everything thru a straw. I’ve tried to do just a few teeth at a time but it seems the sensitivity comes from everywhere on those teeth. I think in light of the Fluoride discussion in another thread I might try some topical fluoride and lase that and see what happens.

Glenn,
A recent article by Ron Kurthy(?) sorry Ron on the spelling, states that a product like Touch and Bond will seal up the tubules and that’s it.  I have a lady coming in in the next couple of days with serious sensitivity.  I thought I would try the bonding on one side and the laser on  the other to see what results.  I have had dependable results from the laser but not necessarily complete elimination of sensitivity in all cases.  

I have noted the patient usually feels the 0.25W but saw that as a negative and backed off.  As you indicated Ron maybe this is the feedback of successful sensitivity reduction in that area.

Pat

Hey guys,
In my experience, if you do what Ron suggests, .25W with 0/0 air and water, you actually close the tubules. BUT one must start much further away, as the laser energy causes heat buildup w/o air and water. You can use a little air at times, maybe 10%,but that in itself can be sensitive to the patient. I have had great success, and without adding a bonding agent, unless it is an abfraction area, then I bond to it.

Again, most importantly, DO NOT START OUT VERY CLOSE TO THE SURFACE OF THE TOOTH. I start out 10-15mm away, and VERY SLOWLY bring the tip closer, and I ask the patient what if anything they are experiencing. I really haven’t “hurt” anyone to date doing the procedure in this manner, Ron, how bout you?
Mark

Ron
Triage has a very high F level (6 times that of Fuji 9)
Personally, I can’t see there being any benefit in hitting it with the laser. The reaction you are looking for is related to polyacrylic acid etching the enamel and creating a hybrid zone on teh surface incorporating teh Ca and Phosphates from both the tooth and the GIC, plus incorporating the F from the GIC.

The colour is pink so when you hit it with a blue light, it absorbs the photonic energy , warms up and speeds up the chemical reaction that is occuring.

The laser would only be hitting 600micron spots rather than the whole restoration. By the time you ocvered it all, it would be set all on its own. Plus the Waterlase gets its knickers in a twist on GIC’s Too much metal content I think.

Other laser applications using F have not had the complexity of what is already happening when you put GIC onto the tooth and act as an adjunct to F uptake. I doubt this would be the case with GIC’s

Just my thoughts anyway, but I could be wrong.
Cheers

Hi Guys,

Everything you all have said is consistent with our long-time clinical experiences and observations.

What we have concluded from both defocused and contact techniques is that starting defocused and NOT numb and moving and observing patient response is nearly always successful in reducng sensitivity;  whereas working numb and in contact was much more unpredictable.

Lasing “out” to “in” = 90%+ effectiveness
Lasing “in” and “on” = 50% effectiveness.

That led us to conclude emperically that dentinal hypersensitivity is BOTH a phenomenon of irritation of the odontoplastic processes AND non-occluded tubules.  Because if all we do is try to occlude the tubules, we get mixed results.  If we address the odontoplastic processes in a defocused mode, THEN move in and alter the dentin surface, we are much more effective.

But trying to get in contact on the distal CEJ or further interproximal can be real tough!  Hence incomplete treatment and results….thus the 90% rule.

The 90% Rule:

We have observed that patients cannot perceive a reduction in sensitivity unless it is reduced AT LEAST 85% to 90%.

We were able to document as much as 80% reductions in pain response PER TOOTH, but when they drank cold water or sucked in air, they perceived NO change!!!:shocked:

This led us to conclude that dentinal hypersensitivity is an ALL or NONE response.  If we don’t remove ALL of the contributing factors–we get very mixed and disappointing results.

So, what we do now is establish a baseline of response with the patient and DOCUMENT it in the chart.  What I typically do is take an air syringe and explain to the patient that I am going to make a quick air test to measure and grade their senstivity/pain on a scale between 1 and 10, with 10 being unbearable pain.  I do a sample test on the back of their hand to prepare them for how quick it will be.

Usually I get a report of 8-10.  Then I go through a defocused method as Mark and Ron described very well.  Then I re-test and record the patient’s report.  Usually they are in the 2-3 range, sometimes better.  Excellent tool for tracking results.

Now all you smart Beamers should be thinking, “Well, did we reduce sensitivity or just create analgesis/anesthesia in the teeth.  The answer is YES!  You did both.

Now the last thing to get you all as close to 100% success is to make sure that ALL occlusal trauma has been removed from the offending teeth–INCLUDING those teeth who’s gums have been amputated by the periodontist!  Don’t ignore the role of occlusal insult to the very tender pulp.

Now to get you all bright beamers thinking even more, at some point you will realize that in the use of lasers to calm pulps down, you also have an VERY sensitive instrument for PULP TESTING…….any thoughts on how?:biggrin:

Bob

PS:  Glenn–I appreciate you commnet from your periodontist, but I take exception to what your periodontist said. I have never heard anyone suggest that covering the roots with grafts is SOC.  If that were so, then why do they routinely remove tissue in “push-back” and ressective perio disease tx procedures as Ron described?  I will check the perio references I have for their SOC position paper.  I don’t think they have one!?

Here is some newer pictures of a molar crown prep I did today, all laser, no rotary instrumentation. This is the preop with large composite filling with broken distal marginal ridge.

Next are the “depth cuts” I make, which are about 1.5-2mm in depth, from the buccal over the occlusal, to the lingual.

Then, here is a picture of the occlusal table, notice the “frosting” of the composite. This all took about 10 minutes for the prep. I tried a slightly different method to create the interproximal margins this time…I will try to explain.

What I did was prep the interproximal by making a “slice” just short of the “gingival floor”, then taking a hand instrument, I broke out the thin layer that was left, and it established the initial “shoulder” of the margin. I then lowered my power to 1.25W 40%air 25%water to refine the margins and smooth the prep. Again, I don’t mind the “roughness” that some people like to smooth. I like the idea of the greater surface area I have to bond with my GI cements….Rely X.

The hard part on this prep was the MB area, where there was some root exposure, so I had to bring the margin down on that area, rather than a straight around the tooth, same level margin that I am used to fabricating. It worked great. I was in a hurry, so hopefully the pictures are ok. I just want to show you how I TRY to do this w/o rotary instrumentation. What other recommendations would you all have to improve this technique? Just wondering. Always looking to learn!
Thanks,
Mark

Neat pics Mark……….I tell you I dont have the patience you do for doing the crown.

I will be VERY interested to see if you thoughts change once you start looking through the scope at the roughness of the preps.

I think it is great that you are doing these, did you anesthetize this one.

Thanks for sharing , by the way I changed my last lecture from the erbium not being good for crown preps to it is possible if you desire to take the time and you accept the little bit of roughness, and if not you can smooth it out with a bur.

Thanks for posting those pics……..great stuff.

Glenn