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SwpmnSpectatorDavid:
Well I hate to once again appear stupid but can you be a little bit more descriptive?
Tooth #29 is broken off or decayed to the osseous crest. Rather than surgical crown lengthening, you want to orthodontically extrude the tooth so that there is sufficient tooth structure for placement of a post/core complex with a ferrule effect? The erbium laser is being utilized to keep the soft tissue attachment off the crest of the root so that it will extrude in a shorter time?
Thanks for the clarification,
Al
dkimmelSpectatorAllen, You said that so well.
I felt that I would have to do too extensive of an osseous reduction to do this as a sx. Instead ,if I rapiedly extrude the root with elastics and cut the attachment every week, then the root extrudes and the bone does not follow. If you go slower and do not cut the fibers then the bone follows the root.
SwpmnSpectatorMan thanks for the help I didn’t know that. Learn something every day. Common to see teeth supraerupt due to lack of antagonist and the bone follow. What you are saying is during ortho extrusion if you keep the tissue attachment off the tooth there will be less or no growth of bone. If the bone followed, you would still need to perform a surgical crown lengthening for healthy biologic width around the crown?
How long is the treatment and so how long will you have to keep lasering tissue off that root? Is the root pretty long?
Al
dkimmelSpectatorShortest time has been 6 weeks. Longest time 10 weeks. I’ll post the x-ray for you.
You are right if the bone follows you have to do sx. It is still all right as you now won’t have to do osseous reduction on the other teeth.
N8RVSpectatorI posted this on DT a few days ago and thought I’d better add it here to complete the process …
Update time …
OK, now that my trusty old DELight has been successfully upgraded, I thought I’d post an update for those who might be contemplating the same.
Yeah, it speeds things up considerably. At 15Hz/400mJ, the enamel melts away probably half-again as fast as at 25Hz/260mJ (my old enamel setting). I haven’t noticed much difference in patient sensitivity — maybe patients are a bit jumpier. However, the noise level is considerably higher. At 400mJ, I really could use some ear plugs! When I drop the power for the new dentin setting (15Hz/270mJ), it sounds sooooooo quiet …
So, if you’ve been wondering if you should upgrade, that’s one man’s opinion. If Hoya will do it reasonably for you, it’s worth it. I’ve been leaning toward using some anesthetic for those patients who say, “I just don’t want to feel ANYTHING, doc!” That allows me to infiltrate a bit, use the higher settings to keep from dinking around and get the job done in a reasonable amount of time. That’s when the higher settings really make a difference.
Hope that helps,
Don
kellyjblodgettdmdSpectatorI totally agree, Al. Turning our clinical experiences in to objective findings that we can share with other dentists (especially the skeptics) is really important. That’s why I have so much respect for guys like Bob Gregg and Del McCarthy – putting their own money where thier mouths are to produce the scientific evidence that supports their clinical findings.
Unfortunately, I am long on ideas and short on cash and time! Maybe 18 years from now when I get this last baby off to college……..
I agree with you, too, Nick. Having a predictable means of producing laser anesthesia would be ideal. For the patients that don’t mind the shots, I’m still happy to give them. But for those who don’t like them, it sure is great to have an alternative!
Kelly
etienneSpectatorHi Guys
My first attempt at a laser assisted frenectomy. Any advice?
Thanks very much
Etienne
etienneSpectator
etienneSpectatorsorry, that was 10 days post op follow up.
AnonymousSpectatorHow about a few details-
wavelength?
topical?
local anesthetic?
SwpmnSpectatorEtienne:
I think you’ve done an excellent job and provided a valuable service to the patient and her/his parents.
Al
d2thdrSpectatorDon,
Thanks for the update. Haven’t gotten my upgrade yet, still waiting. But have been noticing that my effectiveness increases with every use, and I’m currently cutting enamel with 10:350.
Glenn,
I’m still getting the darn black spots occasionally that I asked about in Charlotte. They just don’t go away.
etienneSpectatorOh yes, 1064nm, 80Hz, 40mJ at the “long pulse” setting of the Deka smartfile (of which I can’t remember the exact pulse length) just at the moment.
Would you guys have been more agressive? This was done under GA as the patient needed other procedures at the same time. If something like was done in the chair, would topical only be OK or would a local aneasthetic be needed?
Thanks for the feedback!
Take care
Etienne
Glenn van AsSpectatorHi there Denis……I am off to Orlando in 5 hours, dont know if they have internet there.
Couple of things
1. When does it happen
2. Are you using high volume evacuation (could it be charring), Best is saliva ejector or isolite.
3. What settings does it happen (ie enamel settings in dentin)
4. Is your community heavily fluoridated
5. Did you check the water flow (14-18ml/min)
6. Does the patient feel it when you have the brown spot.
7. Is the water spray optimal (have you turned you water almost all the way on with the air only a litle bit).
8. Does it happen with all the tips or only a certain one (water outlet may be plugged).The thoughts I have are either it is heavily fluoridated enamel and you hit it and it gets brown.
It is charring of the dentin due to inadequate water flow.
OR it is old bond after a filling came out as this will char brown when you hit it…..dycal and GI can do it as well to a lesser degree.
Old varnish or bond will turn brown to a degree.
Hope that helps, I will be back Sunday
Glenn
d2thdrSpectatorGlenn
Sometimes I get the impression that you really don’t work much! 😉
I think it probably is the flouride issue. the enamel is usually discolored in the first place, and it’s also only a few spots. Not usually more than just a single spot or 2 on any one tooth. It also doesn’t seem to want to ablate any mor in that area either.
Water flow and tips are fine, checked regularly. No comments from the patient, and I do not believe it’s a suction thing.
Have fun with the mouse! (Mickey Mouse.) :cheesy:
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