Hey Ron:

Man that ain’t no “suprise”, that’s a common problem I have!!!!!!! Due to the density of enamel(I think) it’s hard to see the extent of occlusal caries on bitewings. For some reason I often seem to be able to pick it up better on a panoramic.

Great case!!!!

Al

Ron–

Nope.

Especially since their FDA clearance and they are sold by the fiber manufacturer as single use item!

Best regards,

Bob

Hi Guys,

First, Mark, Congratulations on the recognition you have received for giving fine presentations in Dana Point.  Sorry I missed you at the Crazy Horse (I live minutes away) but since Billy Bob Brown’s invitation to me got lost in the mail–I didn’t want to crash somebody else’s party.:biggrin:   He’s a mean Rock n’ Roller isn’t he?

Al,  I feel your frustration too……that’s tough.:(   It is part of what I call the technology development curve for lasers in dentistry.

Of course you all know I think pulsed Nd:YAGs are more refined and developed after many years of use and many device itterations–now with digital technology and all.  😉

Pulsed Er, Cr :YSGG lasers  and Er:YAGs will get more stable and more damage resistant eventually, as long as there are users, proponents, and a willingness by engineers to build refinements.

Welcome back Glenn.  How was the cruise?

I do strongly feel that future maintenance costs, replacements parts, consumables should be part of the fair and full disclosure by the manufacturer to the prospective dentist customer prior to signing the order.

But to answer the question about costs and fees–I think you should keep a log or journal of your laser usage and activities, maintenance and repairs along with copies of any correspondence with the manufacturer, aside from the fee remuneration aspect.

I would generally raise my fees across the board according to the general increased level of service I can now compentantly render because of the laser benefits to patients.

Having said that, there are a few fees like LPT, crown lengthening that I increase according to my confidence in the outcome, differently than other fees.

Here’s a conversation I might have with a patient:

“I need to remove some bone underneath the tissue in order for the crown I’m going to make fit properly.  We have two choices.  1)  I can refer you to the periodontist who will pull back the tissue with a scalpel, remove the necessary bone, and close the tissue back into place using stitches.  That treatment costs about &#36650 and a couple visits to the specialist.  2)  Or I can use the laser to move the tissue without making a cut into the gums, remove the necessary bone using the laser, push the tissue back into place–no sutures are necessary.  We can do this treatment right now, without additional appointments, AND we can take the impression today for the crown.  That service runs &#36450.  What would you like to do?”

They say, “OK Doc, what’s the catch on the laser deal?  Sounds too good to be true!  Here’s my credit card.  What are you waiting for?  Let’s get going, I have an appointment in an hour I have to get to!”  

That’s when you know that you charged too little. And you thought getting &#36450 plus your crown fee was highway robbery, and they are willing to pay much more!!

As an aside, FDA Federal Law requires every manufacturer as part of “Good Manufacturing Practices” (GMPs) to log and document EVERY problem and complaint by customer and by the nature a details of the complaint–whether by phone, letter or email.

Good luck Al!

Bob

Thanks Bob, but its more like 100 registered.

I have to give credit to you and Mark, Ron K, Glenn and others who actually participate and share.Its because of that willingness to share, that more and more are registering. I was just the guy with a little internet ability who cut and pasted the site together.

I can’t imagine another place where I could have learned so much about lasers in such a short time.For that I’ll always be grateful, as I’m sure my patients will also.

I’m still a little perplexed as to why more don’t participate. If you’re a guru -show us what you do and how you do it. If you’re a rookie- ask the questions. I think its been well established that this isn’t like some other boards where you’ll be ridiculed or bashed ( if it was they’d have gotten me along time ago). There’s probably 95 other guys out there wondering the same thing you are. If you’re somewhere between guru and rookie, show or describe some successes or problems so we can work thru them together.

I’ll be happier when its 100 participating !

So come on you members who haven’t posted. Here’s your place to start- chime in and tell us if you’ve found something useful or if its a waste of time, its ok either way.
Who knows after that 1st post you may find you can’t stop 😉

Thats why I love the combo of diagnodent and the scope.

It helps alot with my old eyes.

I get alot less ……oh my that is big nowadays.

Thats a nice big case, I still like to remove all the decay but I know that I might be in the minority these days.

Glenn

Hi Mark: congrats on the kudos for your lectures at Dana Point.

Thanks for the compliments.

Read an interesting article by Hibst (sp?) today comparing the erbium yag and erbium YSGG lasers today for anesthetic, soft tissue , enamel and dentin.

It also looked at the hydrokinetic issue and without going into detail this is now the third article officially disputing the mechanism of action as being hydrokinetics.

The article was published in the winter edition of ESOLA (European Society of Oral Laser Applications) and was quite an interesting read.

Suffice it to say the results were not what Stew Rosenberg had told me about recently when comparing cutting ability in dentin, on soft tissue .

Results in enamel were the same and the mechanism of action was the same.

If anyone wants the exact quotes on the article, let me know and I will post them here.

i think that finally we are getting to the bottom of the truth with how different the erbium lasers really are.

It seems that as more evidence is coming out from our scientists that the lasers are more alike than different.

All the best and just wanted to post this before I forgot about it.

Glenn

Thanks Bob, if I knew you were just around the corner, I woulda smuggled you in! You could’ve danced on stage with us sandbaggers! Seriously though, thank you for your congratulations, I just want to teach, and learn. I always get more than I give, and that is what is important. Your very kind indeed.
Sincerely,
Mark