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Glenn van AsSpectatorHi folks, tomorrow I have a lady coming to my office that has a son who is 26 months old and has a severe tongue tie. He is coming from several hundred miles away and will be on Versed ( anti anxiety sedative ) when I see him.
Larry Kotlow who is a pedodontist in Albany NY has done alot of these and he has coached me a little on this one. The mom is a former hygienist and you know that can be great and also a little nerve racking.
I plan to anesthetize him (hes too old to try without) and then release it with the erbium and if necessary stop the bleeding with the Argon.
I will try ( cant promise) to get photos of the case.
Any one here done any and if so any helpful pointers………
Glenn
Robert GreggParticipantGlenn–
No need to anesthetize in our experience, especially if they are on Versed and/or that young. The release will be so quick that the anesthesia will cause more pain than the erbium–especially if you cut mid-belly of the frenum. Bleeding will be non-existant due to the fibrous nature of the tissue and small capillary diameter in connective tissue, so no need to coagulate. If you take more than 30-60 seconds, I’ll be surprised.
Good luck!!
Let me know what and how you did!!
Bob
2thlaserSpectatorQUOTEQuote: from Patricio on 3:48 am on Dec. 13, 2002
Mark,I find myself roughing up the abutment prior to cementation for sterilization but also for retention on short crowns. What do you think? Where is Whitefish I couldn’t spot it on a travel map?
Pat, I think it’s great to rough up prior to cementation, remove any smear layer, and give yourself optimum retention. I do that quite often. Also, Whitefish, is in Northwest Montana, about 22 miles due west of Glacier National Park. You ought to come visit sometime!
Here is a picture of our view!
Thanks for sharing guys, this stuff is a blast! Glenn, I understand your lack of patience, BUT, I feel that it is such less trauma, for the LITTLE bit more of time it takes, and without anesthetic, which is safer, it’s worth it to me. And of course, no more cracking, and crazing…etc…you know. Just my anal thinking I guess. BTW, Global emailed me, should be seeing a scope soon! I can’t wait. Christmas is right around the corner!
Mark
cerecdocSpectatorI’ve been here only two days, and have had a waterlase three weeks. I am very confused by what seems to be a mixing of erbium yag lasers with waterlase info. The two wavelengths and their hertz are not the same! There should be some significant differences in their performance. Or at least the settings used to get the same clean results.
What I was seeking was a forum on the waterlase, separated from forums on other, but perhaps close wavelengths. So I could perhaps participate in both, but could be assured I was not getting advice from someone with a completely different kind of machine from the one I have.
Is what I have seen these two times I have visited here a mixing of the two “camps”? Or am I just that much of a novice?
PatricioSpectatorCerecdoc,
The concepts and opportunities presented on this board are invaluable. Beyond that you make your own cup of tea at the chair. It is very clear who is using what in most cases. What are the questions you bring? What will move you forward with your machine? What experiences are you having? How are you marketing your new service? The regular posters on this site are committed to laser dentistry and willing to share their experience. They have helped me a great deal. Please join us with your thoughts.
Pat
Robert GreggParticipantWelcome to the club, Cerecdoc–
We’re ALL novices here…….I just started using lasers 12 years ago, so I’m not that much ahead of you……so we’re all learning together. Tongue firmly planted in cheek.;)
There are NO dumb questions here, and NO discrimination based on wavelengths or devices. Just opportunities to learn–thanks to Ron.
If I may be so bold as to suggest a manner and method of referring to our laser of topic and discussion? Any objections?
Too bad, here I go:
It is most accurate and descriptive to speak about our lasing MEDIUM, and power parameters, than it is to speak of the brand names of the devices we use. I’m not against marketing–knock yourselves out. But when speaking about erbiums or neodymiums or diodes, why not speak to the medium, wavelength and emission mode?
For example:
Waterlase
Medium: Er, CR:YSGG or Erbium, Chromium : Yttrium, Scandium, Gallium, Garnet.
Wavelength: 2790 nanometers or 2.8 microns for short
Emission mode: Free-running “FR” pulsed (10 to the minus 6 seconds) pulse duration = 125 microseconds
So we might refer to that as a FR pulsed ER: YSGG (2.8) with a 125 usec used at 6.0 W 20 hz and compare it to an FR Er:YAG (2.9) at 250 usec using 6.0 watts and 20–which is the Continuum DELight.
It’s not that you need a separate forum for your BRAND. It’s that we ALL need to understand the power parameters that our devices have so we can communicate and compare our results with other who may not use our exact parameters, but can adjust the discussion to their device based on sound principles of laser physics.
So let’s see. In the example above, and using the the same settings, the Er:YSGG (125 usec) would have a peak power of 2400 Watts per pulse versus 1200 Watts per pulse at the EXACT same setting for the Er:YAG (250 usec). But the longer “burn” and “forward penetration” time of the 250 usec device (2 fold), needs to be taken into consideration.
Heck, I don’t know……just my humble opinion.
Bob
(Edited by Robert Gregg at 9:45 pm on Dec. 13, 2002)
AnonymousSpectatorLarry,
Welcome to the forum.
The erbium lasers whether er:Yag or Er,Cr:YSGG are very close in their wavelengths and have similar absorption (See DentalApplications of Advanced Lasers-Manni). The effects will be similar but not identical, just as all ErCr:YSGG lasers are not identical. I believe that’s why Bob and others recommend testing the output of your machine. So one Waterlase users settings may be different from yours.Why do you believe there should be significant differences?
I think the other thing you will find is that you cannot just cookbook this stuff (which is what I thought when I started this forum). Bill Chen does amalgam removal totally different than the way Mark, Pat and I are doing them.You can use others methods to try and adapt to you and your machine, but research or question why they do what they do. I believe most of the posts are good starting points – Use them and see how you might adapt them or make them better. One of the things Bob Gregg has taught me (besides sharing alot of experience and insight) is that I need good reasons for doing what I do with the laser and the science to back it up.
As far as having a Waterlase forum, there won’t be one here,sorry. – Biolase can do that if they want and I’m sure they can afford it! My intent was to have the forum advance all laser dentistry, not just one companie’s product.
So lets hear what you’re doing well with the laser and where you’re having trouble.
I don’t believe you’ll find a better group of lasers users who are willing to share (of course I’m biased and have witnessed first hand how much I and others have moved ahead in laser knowledge and ability thanks to these guys).
Glenn van AsSpectatorHI there Larry and welcome to our forum .
I cant thank Ron enough for putting this up. I have posted alot of stuff about the Continuum laser but believe me the similarities to the Waterlase are more than the differences.
THere is so much information here from trendsetting procedures (crown preps, laser desensitization protocol ) from Mark Colonna, to the science and laser physics that are so important for understanding how lasers work that Bob Gregg provides.
I have witnessed in at least three frequent users on here a massive increase in knowledge.
Ron started this forum barely knowing the difference between his diode and his erbium, but he took a standard proficiency program with Bob Barr, he posted intelligent questions and listened to the experts like Bob Gregg and Rons knowledge about lasers has been astronomical in its increase.
In Alan I saw a skeptic get so excited because people here helped him to use his laser and learn how to use it effectively when he came here I saw a very confused and skeptical user. Recently he posted crown preps which show his mastery of the laser.
There are so many others who lurk and post here, Pat Kelly with his insightful remarks adn alot of others who escape me now but listen , question, read old posts.
Look at the pics I have posted and ask not what settings but how was this possible, what is the science behind it and soon you will realize that the settings are somewhat arbitrary and basically there are low settings for things like apthous ulcers, soft tissue removal around Class V with out anesthetic.
Medium power settings for things like frenectomies, dentin and caries removal without anesthetic, biopsies, tissue removal with anesthetic and
High power settings for enamel removal, crown preps, preps with anesthetic etc……….Keep an open mind , look and listen and you too will become very quickly a laser guru as the guys here are second to none and the best part is ……..
NO ONE CARES WHAT LASER YOU USE!!
Glenn
Glenn van AsSpectatorOh by the way the third guy who has learned a ton here from all the gurus……….
was…………….ME!
Cya
Glenn
whitertthSpectatorWhat a day…saw this patient today and (someone call me an idiot for not having a preop) but u will get the drift. Removed large composite after using mark’s anaesthesia technique, exposed vital pulp, using the waterlase at .75 dryfor a few seconds i cauterized the nerve, etched , geristore over exposure, and bonded..no pain, not even a whimper… cauterized nerve in photo..post op to follow
Glenn van AsSpectatorMarvelous pictures Ron and really cool case.
I have had very very little success with this kind of treatment. Almost every carious exposure despite my attempts to maintain the pulp have ended in endo or a very calcified canal.
Hansen a while back provided some research on his technique and it had great success. I havent been able to duplicate things.
I like the final composite, very nicely done and thanks for posting the pics and NOPE I wont call you a dummy for no preop, it happens to me all the time!
Grin
Good stuff………
Glenn
Glenn van AsSpectatorWell Bob I took your advice. What a tough case.
When the patient came in the mom was concerned alot about the little boy.
I asked the boy if he could stick out his tongue …….he could already.
I looked and saw a very thin fibrous attachment definitely from his tonque to the lingual of the incisors but not thick like I was expecting.
The little guy was on Versed but not dopy enough at all.
He started screaming ALOT just when I looked at it.
I knew that there was ZERO chance of anesthetic and it was gonna be tough.
THis is how we eventually got it done but it took 15 mins of explanation to both parents, coddling, and restraint and about 5-7 secs of actual erbium on the tongue when I finally got him held down.
I had mom lying in the chair holding him tightly to her. I had mom holding his hands so he couldnt grab me.
I had one assistant holding his legs.
One assistant holding his head still.
One assistant propping his mouth open with a Rinn instrument (she works part time in a pedo office).
I had the erbium in one hand and after playing tag trying to get the laser on the frenum , I finally had to grab his tongue without anesthetic at the frenum with a hemostat……..I never heard a scream that loud. I cut for 5 secs or so at 120 mj and 30 Hz with a laser tip and it pulled away and started to bleed the kid was so strong he pulled his head moved the prop out of his mouth and bit as hard as he could on my left index finger.
I cursed (under my breath), mom was crying , the kid was crying, (tears were welling to my eyes), my one assistant was almost in tears (she hates me grabbing tissue), dad was pacing the hallways with the little brother who started crying once the older one did.
Patients in the waiting room wondering who I was beating………..
God isnt laser dentistry fun wilthout anesthetic.
Well I almost felt guilty charging the darn 200 dollars for the 5 second job but it did take a bloody 15 minutes to get him to hold still.
I never did get another look in his mouth , he stopped bleeding pretty quickly but the little guys head was absolutely drenched.
I felt bad but given the fact that the parents drove 3-4 hours to have it done , it was completed and I hope that his speech improves………
Just wanted to give you a follow up to why I didnt get any photos!!
My advice , do the procedure when they are very young, older or when the kid is son drugged they are almost asleep.
Glenn
Lee AllenSpectatorBob,
What a useful posting on root sensitivity. I am about to venture into using a Waterlase and I learn the most from this type of posting.
A few thoughts or questions arise: I have assumed that root sensitivity must be a pulpitis. The immediate result of the laser treatment is sealing/sterilizing the tubules but the pulpitis will take a tincture of time to resolve. What are the post op results from the laser treated patients? Does the 20 to 30%remaining sensitivity decrease as the inflamation is resolved with time, and if not, does that indicate there are still areas to treat? Are the patients happy enough with the results that the residual is tolerable and they are not interested in pursuing further remedy?
I have many patients who are as anxious as I am to resolve their root sensivity and I would like to know what to expect. This helps jump start my learning process.
Thanks again.
whitertthSpectatorGlen,when has the nerve died on u ? I week after , a month 3 motnhs? I am gonna follow him every 2 weeks for a while….Monday I will post the radiograph…….
Having fun!!!
Glenn van AsSpectatorGreat question Ron…….the two cases that come to mind , I did the endos 2-3 months after the restorations were placed. One was a buccal and one a MO that come to mind.
I have two others that have had prolonged pulpal sensitivity that I am watching now and both are leaning towards the endo after the prolonged sensitivity to cold.
I have had two others where the sensitivity lessened. One was a 8 year old and the central ( traumatic fracture) discolored and vitality testing showed no pulp.
The other traumatic lateral calcified in on the pulp when the patient came back 2 years later because mom noticed the tooth getting darker and not matching the restoration……..pulp had calcified in which I thought was strange.
It just hasnt worked for me except on accidental exposures not chasing caries.
I would LOVE to hear what others are finding……in fact this is one area of using the laser that has disappointed me.
It may be something I am doing or it may be the pulp just cant respond despite our best efforts.
Who knows……..Mark? Bob? Ron?
What say ye
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