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Robert Gregg DDSSpectatorJeff,
DICOR only wore opposing teeth of you put feldspathic porcelain externally for shade.
I always used unshaded and unglazed DICOR and the abrasiveness was nearly identical to enamel.
Take a look at the pictures above. It’s the ceramic that is wearing!
I obtained my coloration from the resin cements I used. Ray Bertoloti once told me that I was the first he had heard doing that. I told him I learned it from him. He said he’d never heard of it. That was 1987…..
Bob
Robert GreggParticipantHi all,
Finally had time to post the finished endo x-ray.
[img]https://www.laserdentistryforum.com/attachments/upload/xraycomplete2.JPG[/img]
Bob
PatricioSpectatorBruce,
Check out Jon Karna’s technique on his website at http://www.karna-ddscomfordent.com for his steps to a successful anesthesia. How does this compare with what you did in this case?
Pat
Robert GreggParticipantHi All,
A case I did today using a variable pulsed Nd:YAG and a diamond.
I’ve been asked how I do osseous crown lengthening (OCL) without making a releasing flap and suturing.
This is a Coumadin patient, so you might appreciate the lack of bleeding at each step in the procedure.
[img]https://www.laserdentistryforum.com/attachments/upload/Dilleyxray.JPG[/img]
Pre-Op x-ray of Upper left 1st and 2nd molars (14 & 15)
[img]https://www.laserdentistryforum.com/attachments/upload/Dilley1.JPG[/img]
When a patient has not been seen in a LONG while, and I have “other” issues to address, as I do here–I always perform a local “Laser Periodontal Therapy”. LPT includes perio pocket measurements, as well as therapeutic treatment of the tissues. So I lased, scaled, lased tooth 14 and 15. I used a 400 micron diameter fiber, 150 usec, 4.00 watts, 20 Hz, 200 mj/p.
[img]https://www.laserdentistryforum.com/attachments/upload/Dilleyprobe2.JPG[/img]
After the teeth have been reduced for temporary crowns (yes, we charge 趚 each for them. Heck, we HOPE the patient is coming back to finish the tx with us). After decay removal, and pathologic exposures in both teeth (all 6 canals are calcified and blocked to the apex at this time). Perio probe to measure. No need to OCL
[img]https://www.laserdentistryforum.com/attachments/upload/Dilleydiode3.JPG[/img]
Appearance after using the pulsed Nd:YAG to imitate a diode laser effect.
[img]https://www.laserdentistryforum.com/attachments/upload/Dilleyprobe4.JPG[/img]
Self explanatory.
[img]https://www.laserdentistryforum.com/attachments/upload/Dilleydiamond5.JPG[/img]
Placing the 900 micron diameter diamond for reference to the tx area.
[img]https://www.laserdentistryforum.com/attachments/upload/Dilleydiamond6.JPG[/img]
Diamond cutting underway. Water and air keeps the area clear.
[img]https://www.laserdentistryforum.com/attachments/upload/Dilleyprobe7.JPG[/img]
Once I’m all finished with bone reduction, and I want hemostasis without dryness or burned edges, I switch to a longer pulse duration. In this Coumadin case I used a 400 micron diameter fiber, 650 usec, 4.00 watts, 20 Hz, 200 mj/p
Anyway, that’s how I do it. Substitute “erbium” for “diamond”, and “soft-tissue-laser-of-your-choice” for “pulsed Nd:YAG”.
How come we perform “crown lengthening” by cutting bone when we want more “biologic width”?
Bob
vinceSpectatorNice work.
Did you find “alot” of bleeding when usng the diamond. What was her INR levels at? What levels are you comfortable with using your ST laser?
Thanks, Vince
Robert Gregg DDSSpectatorThanks Vince,
Yeah, there was “quite a bit” of bleeding. Heck, I cut thru cortical and into medullary bone. Pulsed Nd:YAGs have the intensity at depth to cause a deeper zone of “injury” that is reversible, not necrosed.
Sorry, I don’t know what her INR (International Normalized Ratio) levels are at. Low = 1.5 (too thick); OK = 2.0 – 2.5; High > 4.0 (too thin).
It has never mattered in 12 years of using pulsed Nd:YAG lasers how high their INR levels are. I have NEVER had to take a patient of Coumadin (or any anti-coag tx) for ANY kind of surgery or extraction.
That’s the challenge we face as clinicians. Sometimes these paients fall into our chairs in pain and in need for treatment. Technology can help us treat them in FAR less riskier ways.
I have literally had men CRY when I told them I did not need them to be off their Coumadin AT ALL, let alone for for 3-4 days for their Laser Perio or extraction or whayever…….yet, I’ve never had a physician contact me and inquire about it, other than to tell the patient, “Oh, that’s great!”
The same goes for hemopheliacs we have treated–unlike one patient who we know died at a local university after a “simple” extraction. This is a California university who’s dean has repeatedly refused our overtures to introduce lasers into their school……. before and after the 18 year old died.
A shameful abdication of their public trust……
Bob
marc andre gagnonSpectatorI use DELight since more than a year an a half and I can say that it’s a pleasure to work with.I do more than 50 % of my day with that laser without anesthesia and it’s a relaxing to see so much people walking out of the office and smile. The new 90 degrees tip is a must for all the teeth including the molars
2thlaserSpectatorThanks Glenn,
Jeff, you spurred me on to take a picture of how small my smallest spoon is. This is the #4 spoon, titanium tipped, and man they stay sharp.
You can see they don’t even come close to covering a number on a penny! I find I can really get to the DEJ and other hard to reach areas that a laser tip can’t get to, to conserve as much tooth structure as possible…trying to complete true microdentistry as much as I can….
Thanks,
Mark
mickey franklSpectatorHow do you sterilise your laser tips?
Thanks
Mickey
jetsfanSpectatorIn answer to my own question, in the last couple of days I was keeping track of surfaces per hour. Here is what I found:
With no local I was only able to do 3-4 surfaces , albeit some deep preps,per hour. Patients do feel it often, and you go slower. Mayber you lower the settings, or try to reanesthetize with laser. Then you switch to spoons and if all else fails go to slow speed round bur. All the while the patient still feels something. For those of you who can do 6 deep surfaces, ie 3 class 2’s in an hour , God Bless you, I have tried for 1.5 years…I can’t.
SwpmnSpectatorWe clean any debris off the tip with alcohol gauze then place in a chemiclave. You just have to be careful the tips don’t get banged around or touched. A couple of perforated metal boxes came with our Waterlase and we use them to place the tips inside for sterilization(prevents any damage).
Al
SwpmnSpectatorBob:
Perhaps we should call the procedure “Width Widening”? 😉
Can the Nd:YAG not be physically used to ablate osseous structure OR would the power settings needed to cut bone cause necrosis? At 4.0 W you have to really know what you are doing with an Nd:YAG, right?
Al
ASISpectatorHi Ken,
Nice crown-tissue interface and emergence profile. Looks as though it is a natural crowned tooth.
Andrew
ASISpectatorHi All,
Could anyone provide protocol to office laser bleaching by 980nm diode?
Re:
1. bleaching product used
2. tip used
3. setting
4. duration on each tooth
5. position of tip placement to tooth
6. any other technique suggestion or recommendationThanks.
Andrew
Lee AllenSpectatorGlenn,
The immediate post op results on my patient with the internally cracked DB cusp: 3 days PO and she is without pain even to temp and chewing. Considers it a miracle and so do I. Certainly new territory for me.I am wondering if perhaps some of the CTS (cracked tooth syndrome) that I diagnose could be treated by composite restoration. In this case I did cover all the visible cracks with composite, troughing the outside and inside of the crack to fill with flowable.
Also, I am interested in the “lasing” of the crack that Allen and Mark are doing. Sounds like it is not defocused but is entered from the inside of the prep without penetrating to the outside surface. Does the presence of stain signify anything with regard to sucess, to long presence of the crack, to bacterial activity? If there is not staining, do you still lase the crack and seal with flowable internally prior to the rest of the compostie placement? Or in the end are the patient’s symptoms the driving force behind the decision to lase or not to lase.
Now I see why a picture is so valuable. 1000 word thing.
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