Ok, I goofed,Iput Newbie on the front of the message, so I am embarrased! In front of everyone. Oh well, please forgive my ignorance in my first posting attempt here on this board. SOrry 2thdoc! However, I am willing to share with those who want to in this forum. So keep the posts coming, let’s all learn from one another!
Mark aka, Newbie 😉

You are welcome Ron. I love it when we ALL share our ideas, to help eachother get better! I go over the whole tooth, Occlusal surface, Buccal and lingual, just take the time, be patient, to use the whole minute or so to get the tooth “numb”, and then go for it. I really “Bathe” the tooth in the laser energized water to get the effect. I hope this helps!
Mark

Hi Pat,
Great to hear from you. I use 4.0, and 6.0 loupes all the time. I never use my laser without using magnification, due to the fact of the pinpoint nature of its tissue ablation. One can really see what the laser energy is doing as well as if there is any collateral “damage” it is so minimal at best. I really honestly haven’t had any!! The laser is so safe that tongue and cheeks and lips just don’t get in the way. I also have fantastically trained dental assistants who really know how to keep the field of view open for me, and when we can’t we just get out the rubber dam. Hope this helps. Keep trying and let us know how you are doing, and anything you might be doing to help US out here ok?
Thanks,
Mark

Mark:

Unfortunately I have not seen your article in Contemporary Esthetics.  Is there an online link to the article?  What issue of CE was the article published?

Mark, can you please explain in detail your technique for anesthetizing teeth with the laser?  From what I understand, you start out at a high setting like 6 Watts and bathe the tooth facial, occlusal and lingual in a “defocused” mode.  By defocused you mean that the tip is some distance away from the tooth but how far in millimeters?  What specific tip are you using, e.g., tapered vs. non-tapered?  G6 sapphire?

You then prep the tooth at 6W and 90% water and the unanesthetized patient does not feel any pain?  I have no interest in using the laser for crown preps but don’t most of the teeth you prep for crowns have a bunch of old amalgam?  What I would like to learn is your technique for successfully prepping Class I through V composites without anesthetizing the patient.

Please help the seemingly few of us out there who have been very frustrated using the laser on unanesthetized patients.

Al

Mark………great stuff. We use different lasers but I love how you brought something for everyone to try.

I will try it tomorrow with the continuum product.

HOw was the meeting in Nice, and how many attended.

Thanks for a great read.

Glenn

Thanks Mark!!!!

Today I “stole” a copy of the October CERP from an associate and plan to study your article this weekend.

Thanks for the 9-10mm info on tip distance as I was thinking 3 or 4 mm.  You believe that the G4 provides more energy.  That’s interesting as I have been using G6 tips. How do you know this, does the G4 tip ablate faster than the G6 tip?  In your hands, the G4 does not cause more sensitivity than the G6?

In regards to magnification, I use DFV 2.5 fixed loupes with a headlamp and I can see really well as I’ve had that crazy laser eye surgery!!!!  This should make Glenn happy to see that at least I’m a baby magnifier!!

Al

(Edited by Swpmn at 10:25 pm on Oct. 25, 2002)

Al: great to see that you are using magnification. I am a big believer that those tips are small, glass and you need to be close to get proper ablation. In contact and you ruin the tip, with the Continuum laser its 1/2 to 1 mm away and if you are to far away it wont cut.

I know a few things scientifically about this. First of all the resolution of the human eye is 200 microns or .2mm.
If you have two lines seperated by less than this the human eye will only see it as one. The tips are small, Continuum makes a 400 micron tip and its quartz and clear and in addition you need to hold it 0.5 mm away.

Now you realize that this is getting tough without magnification.

Sometimes guys will say to me…….its not cutting and I will smile. They are too far away and cant see it.

In addition the tactile feedback cycle is fast but primitive from a neurological standpoint. You feel the pain of your flesh on the oven before you see it smoking!

Visual feedback uses the cortex but is slower by about 5 times . That is why alot of guys are fine with a bur in contact on the tooth, they can feel and see it working their is a combination.

Now if you are in non contact mode with an erbium laser you can ONLY rely on visual feedback. There is very little tactile sensation unless you stop, touch the tooth back off and start ( which I suggest for novices is a good way of determining your distance).

Otherwise magnification really helps and Mark can vouch for the fact that with the laser, 2.5X is better than nothing. 4.0 is better than 2.5 and 6X is better than 4.0X

You are doing great and with higher mag you will find an improvement in seeing the laser cutting and in addition in knowing things like when you are through into the dentin, when there is not enough water spray, when the decay spreads laterally, when the suction is too close and suctioning up the water before it hits the tooth resulting in pain and discoloration in dentin (brown spots)

Hope all these tips help. In addition under high mag you can see when your tip is chipped and if you have high mag you can use a polishing porcelain stone to flatten off the tip and reuse it!

Just some idle ramblings but something that working at 10-16X mag has showed me.

I feel fortunate sometimes to be able to see what I do, but I tell you, I couldnt work without the scope doing laser dentistry. You really need magnfication in my opinion to make it work effectively…….

Enough rambling from me.

Glenn