I was having a lively debate with myself as I was doing a restoration today and wondered what you all would think.

I was restoring a lower second primary molar on a 7 year old that had distal decay. My assistant couldn’t get the clamp on the permanent molar so, for reasons known only to her, she put it on the tooth I was to restore. Ever up for a challenge, I thought I would just do a tunnel prep from the occlusal and see what happened. I used the erbium ( with anaesthetic, I’m still a bit cowardly about kids and anaesthetic free dentisty ) and made a nice conservative tunnel down to the caries, removed it and took a look. What I had left was a thin shell of enamel interproximately, which had not been breached, (4x loupes) with a white spot in the middle. I restored it with some Fuji IX and composite on the occlusal.

My questions are this:

Does anyone routinely leave a shell of enamel when doing restorations like this?

Will it last the required 5 years or is it doomed to replacement before the tooth exfoliates.

Is the bonding of GIC similar to this enamel as untouched enamel. What if I had used composite alone, what would the bonding be like?

Should I take assertiveness training and/or fire my assistant?

I’m sure there are a lot of different ways of dealing with this situation and I would love to hear what others have or would do.

I really respect the people who take the time to contribute to this forum, your help is greatly appreciated. Hopefully some day I will have something to contribute in return.

I am new to this forum and have joined it based on the high level rating Ron Kaminer gave it. I need to be up front telling everyone I am involved with the distribution of a low level laser and do in office chairside consulting for what I am writing about today. That is not why I have joined this forum. I am a full time practicing dentist who introduced low level laser (LLL) energy to my practice 39 plus months ago and it is the most exciting thing I have ever done in dentistry including my purchase of a hot laser prior to that. My purpose is about education of a technology that has made a huge difference in my family’s life (low level laser energy) can be useful to help heal almost anything the body needs to have healed) and then made a huge difference in my practice because I have positively impacted the health and well being of many of my sick patients.

I am trained as a prosthodontist (BU-1968) and have been practicing as a generalist since 1987 because of the state dental laws in Massachusetts. My practice is 100% adult. I have not sent a patient for pocket elimination since that time. We have had great success with non-surgical anti-microbial, microscopically monitored perio treatment prior to my purchase of an Nd:YAG early 2001. That only enhanced what I had been doing.

That is enough of my background and now I would like to know if there is any interest at all about low level lasers (LLL) on any subject from the how and why, to the practical aspect, to the differences in LLL and what to look for when purchasing one. The subjects for this or any forum can be uses of low level lasers in dentistry and there are many, in addition to what I call a separate topic about negative proprioceptive feedback to the brain otherwise known as Dental Distress Syndrome.

The following is a testimonial I received on a Thursday following an 18 year old first visit to me on Monday June 6, 2006. He had been diagnosed with CFIS, Chronic Fatigue Idiopathic Syndrome and came to me to have his amalgams removed which I did not do. I fabricated Miracle Bite Tabs™ and LLL energy to various points to allow me to adjust an oral device with the necessary muscles relaxed. This entire step took 45 minutes after a very brief 2 minute exam for Dental Distress Syndrome, and about 2 minutes for me to determine the vertical dimension of the device. The rest of the time the device was fabricated by my assistant who also held the LLL for about a total of 4 minutes at various trigger points. The family then rented an older version of the laser for ten days from the company. This unedited letter was e-mailed 4 days later last week.

Dr. Yolin,
I just wanted to give you an update on Marek. We can’t thank you enough for what you have done for him. To give you some background, Marek has not attended school due to his illness since the middle of ninth grade, and has been completing 3 courses a year through a tutor. He would have graduated high school this week if he had not gotten ill.
He started to help at his Dad’s office since January 2005 as he felt he needed to earn some pocket money. He only has been able to go in 1 day a week for 3 hours.
Since our visit Monday, Marek has said he hasn’t felt this well in so long he can’t remember. He said, “I had set the goal when Dad first hired me that I would come into work tues, wed, thurs, fri and take off sat thru mon. I haven’t been able to do that before, this week I can do it and it feels great.”
Marek also had a headache when he woke up wed morning and decided to try the laser to see if it would help. After completing the whole scan he does with the 2 wands, the headache was gone and he was ready to go to work.
We’re really confident that if things continue like this, he is going to be able to go to school this fall. I’ve been having a hard time sleeping just with the excitement that something is finally working and Marek will be able to recover and live a normal life. Every day he looks and feels better. God bless you doctor!

I would like to share one recent verbal testimonial I just heard from a pedodontist who purchased our low level laser in March at the ALD meeting. He has had a 95% success rate using one wavelength at 660nm (laser diode and not an LED) in lieu of local anesthesia on deciduous teeth. His success rate on teenage permanent teeth has been about 25% where my success in my adult practice has been about 70%. I am guessing the teenage teeth have more open unclogged tubules, wider and larger pulp chambers that require more local.

Hopefully there will be interest on this forum for the use of low level lasers in dentistry. I have found many dentists who are users of cutting lasers have no idea about cold lasers and their many uses in dentistry. We use our low level lasers ( I have two ) many times everyday. Nothing has grown my practice more or has been more exciting in my 41 years of practice. 12 years ago I downsized my practice from many square feet and shared office space to 780 square feet, 2 chairs only, low volume, reduced overhead, one hygienist, one assistant, and a receptionist. I wanted to work quietly and worry about the future later. These last 39 months have had me rent the suite next door last year so I would have room to take an associate in order to grow a sellable, alive, viable practice and reduce my office hours in order to pursue my next step in dentistry. The process has begun, the phone does not stop ringing with new patients, people are calling from all over New England and New York/New Jersey with an occasional patient from CA, CO, DC area, TX, Canada,etc. This February, the shortest month, the winter terrible, I had 52 new patient phone calls and I do not belong to any referral service. I never bothered with super internal marketing once I downsized because I had no need for it. The low level laser usage, especially its role in Dental Distress Syndrome made this all happen. I need to be able to refer to other dentists all over North America. Is there interest on this forum?