Hi Mark: Nice photos and interesting case.

I dont think I would have been inclined to save the lateral as there isnt much of a ferrule. Even the #9 has in my mind a poor prognosis, as it doesnt have much tooth structure left.

Did you say he has a partial denture or is he chewing just on the bridge?

With the above in mind I still want to mention I was pleased to see the final preps clean of decay and nice posts holes…..no chance for a rubber dam I guess ?

Neatly handled from the laser standpoint, and I will be interested to see the final result after the posts and cores.

You are a braver man than me Gungha Din!

Thanks for posting such an interesting case.

Nice pics again

Glenn

Bruce: I never posted a reply but will tell you my experiences with the Er in RCT can lead to pain if you are closer than 2 or 3 mm from the apex.

The reason is that the laser will enlarge the apex and you will get bleeding from the PDL space and bone. I know this because I have done it.

I have cleaned the canal and then used the laser and by mistake went 1mm or so from the apex and after I was done the patient mentioned they felt it and there was now blood in the canal space (I could see it in the canal and in the suction tip under high mag).

I like the laser for sterilizing as I can definitely see less debris in the canals and smoother walls after using it for 30 secs per canal but I will say that you must be careful to only go to within 2-3 mm from the apex and be very careful.

I have also checked my apical enlargement with files and found that after the erbium yag is closer than two mm it will not be the same but larger. It is irregularly shaped and not the easiest to get to an apical stop again.

There is a study supporting this that I have where the found the microleakage after using the erbium yag was very high at the apex . They shaped the canal to a #70 and then they used the laser and without going back and reshaping they filled the canal.

The erbium yag canals were leaking alot through the apex (geez I wonder why).

Anyways, the Nd Yag will not cause the enlargement of the apex like the ERbium will.

Hope that helps and like I said my opinions are from what I have seen with the microscope on cases I have treated with the laser at 16X mag or so.

If you use the erbium for disinfecting or sterilization make sure that you stay 2-3 mm away, withdraw at 2mm per second and only pulse on the upstroke , and recheck your apical diameter after using the laser with water in water filled canals (NOT BLEACH) for 30 secs per canal.

Some of that comes from Moritz work on the use of endo and lasers in ESOLA.

Cya

Glenn

mark, nice stuff…is there enough bone on the diatal of that lateral…I kinda agree with glenn that the lateral looks like a loser but is finally so what the heck…….

Mark,

What about placing a cast post (#7)with a ball attachment? Have the ring put in the partial and then add 7 to the partial( can’t think of the name of these now). Gets rid of the lateral forces on 7, no need to splint 7,8 causing a tough area to clean. root tip of 7 maintains bone. no ugly clasp on 7.

Just thinking out loud,

p.s. Mark, instruments arrived and they’re awesome. Would love to buy some more of the spoons to add to other setups.
Thanks for developing these.

Mark, That tissue looks great. Why do you like the T tips over the Gs in this type of case?
Nice photos, what type of camera?
DAvid

How wonderful! He is lucky to have a dentist with a laser like you.

Andrew

Hi David ,
I know it has been discussed before but could you be more specific about how you treated the ulcers. Time, Settings etc.
thanks,
Andy