Glenn:

Wow that’s a big one! Go ahead and forward:

dral@clearwatersmiles.com

Al

Glenn:

I think you did an outstanding job and this is a perfect case for crown lengthening using the Erbium. This case will heal very nicely – I would just be scared to take the impression same day if patient expects an esthetic margin.

Rodger Kurthy in California is doing a lot of crown lengthening with the Biolase Erbium and I have been bugging him to publish/post cases like this so we can learn. Rod says he takes impression same day and they turn out beautiful.

I like the way you are now posting cases on the Forum rather than the former link method with clickable thumbnails. I can click on and save your “collage” .jpegs – makes it a lot easier to follow the case!!!!

Al

Thanks Pat for your reply

You answered many of my questions and painted a very nice visual picture

Jerry Rosenfeld DDS
Avon, CT

A question from a new user, Is the burnt orange dentin always decay, even though it may feel hard to the explorer? I find that Dentin tends to discolor while prepping. So I have been using spoons and slow speeds to remove this.

Having a spare trunk fiber sounds like a great idea…what do they cost, or do I want to know?!

Mike

Hi Bob: AT high mag if there isnt enough water flow then you will get charring in the dentin. It could be your suction is to close, your laser trough that you cut is to narrow and water cant get down it or that the water on your laser isnt up high enough.

Others here can give you settings. Without the tactile feel of the slowspeeds its tough to tell sometimes if all the decay is out with vision.

High mag helps, some people use slowspeeds (me) or caries detector gels (not me – gets all over the enamel etching and is tough to clean up) or sharp spoons like Mark has for removing the decay.

I can tell you that at high mag the mushy dentin that is carious gets transparent with all the water and it is tougher to see if the decay is still there.

Often I etch the tooth and see the leathery dentin at high mag and then realize there is decay still left.

Hope that helps somewhat

Glenn

Mike,
Everyone in the room should have protective eye wear(PEW). Besides doc and assistant we also give them to mom, sis, and aunt Susie when they’re in the Tx room.

Depending on the PEW they can distort color. The glasses that came with my diode are rose colored and affect color of tissue. I had some filters made for my loupes and they are a slight yellow color (for the diode, green for the erbium- PEW are wavelength dependant) and there is very little distortion. Probably a greater problem with the hard tissue Tx is that there is hydrating(lasing)/dehydrating(drying prep) of dentin and the caries and this makes it difficult to determine caries. Sometimes you think you have all the caries out and then etch or dry the tooth only to find there is more decay there. Tactile sense seems to be the surest way to determine if all the decay is gone.

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