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cadavisSpectatorDoes anyone know if there is a chisel tip that will fit the Opus Duo handpieces?? I know there is one for the DELight, are they interchangable?
BenchwmerSpectatorOpus largest tip is 1300 micron.
No chisel type tips.
Tips are not interchangable between manufacturers.
Jeff
Glenn van AsSpectatorTHanks for the kind remarks Etienne, it was a first attempt and something designed to help out people out there who didnt have anything to go by. Its amazing the places I have shipped them including USA , Israel, Japan, Europe (all over) and Africa just a few off the top of my head.
I hope it helps but dont be afraid to bug me if you need help and I for one admire what you are doing with lasers and scopes to help your patient. You should be darn proud of what you are attempting to do.
Kudos to you and do keep me informed. Its a neat case.
Glenn
Glenn van AsSpectatorFound this on pubmed where I occasionally look to see what is new in laser research…..suggesting that deeper penetrating wavelengths (diode , Nd Yag ) may have a greater effect on the dentin due to heat generation and affect perhaps the tensile bond strength of dentin.
I have always said that a diode or soft tissue laser cant do much damage to a tooth. Do I worry now?
I personally dont think so but here is the abstract.
Glenn
Photomed Laser Surg. 2005 Jun;23(3):278-83. Related Articles, Links
Effects of laser irradiation on tensile strength of bovine dentin.
Tonami K, Takahashi H, Kato J, Nakano F, Nishimura F, Takagi Y, Kurosaki N.
Oral Diagnosis and General Dentistry, Dental Hospital, Tokyo Medical and Dental University, Tokyo, Japan. ken1.gend@tmd.ac.jp
OBJECTIVE: The purpose of the present study was to investigate the tensile strengths of dentin after laser irradiation using three kinds of dental lasers to elucidate the laser-irradiation effect on dentin properties. BACKGROUND DATA: Different kinds of laser devices have been developed in dentistry. The characteristics of each laser are determined by its original wavelength; however, one common feature is to generate heat in irradiated tissues, and such heat possibly affects dentin collagen, which contributes to tensile strength of the tissues. MATERIALS AND METHODS: Er:YAG, CO2, and diode (GaAlAs) lasers were used to irradiate bovine dentin. Subsequently, tensile test specimens were made from the irradiated dentin and tensile tests were conducted. The tensile strengths were analyzed using the paired-t test and Weibull analysis. Irradiated dentin was also observed transversally using light microscopy. RESULTS: The tensile strengths of the lased dentin and the control group for the Er:YAG, CO2, and diode lasers were 73.1 and 78.5, 70.3 and 74.3, and 64.3 and 71.0 MPa, respectively. The tensile strength of the dentin had a tendency to decrease with laser irradiation. Weibull analysis indicated that the laser influence was different among the three kinds of laser apparatuses and seemed to correspond to the depths the laser beam reached, which were suggested by light microscopy observation. CONCLUSION: Laser irradiation could possibly decrease dentin tensile strength, which suggests the importance of careful use of laser for hard tissue treatment, considering its energy-transforming characteristics.
Robert Gregg DDSSpectatorGlenn,
Thanks once again for the kind words, my friend.
Etienne,
Nice x-rays!
You can see the effect of occlusal trauma on #18 with the apical thickening of the PDL, the wear facets on the distal (lingual?) cusp tips.
#19 has a semi-lunar bony defect in the buccal furcation area, as well as some PDL thickening. #19 also has evidence of occlusal wear as does #20. The wear has helped to decrease the force damage away from the bone, but the A-P deflective pathology is still present as per Thieleman.
Bruxism is just one of the many important indicators and a symptom of occulusal trauma.
I think I gave you the settings for your specific FRP Nd:YAG device in a previous email. Did you get that? I will look and resend.
Bob
Robert Gregg DDSSpectatorHey Glenn,
I know from years of previous research with Nd:YAG that dentin tensile strength is increased.
I can’t speak to any diode studies, but I would not think it likely, especially since I don’t know anyone who is directly irradiating dentin as we do with FRP Nd:YAG.
I’d chaulk this one up to academic curiosity………or the “A-Files” for wierd and unexplained phenomenons!
Bob
Glenn van AsSpectatorBob, it is interesting how so much of the research on certain wavelengths keeps coming out of the same camps. For instance Aoki and his group does a ton of the research on Er:YAG lasers.
I think that one of the problem with many of the studies (for example microleakage studies for Er:YAG lasers) that the researchers have zero idea of what settings to use that are clinically relevant. They rely on the companies supporting the study to tell them. THe reps dont know what is going on in the real world either in alot of cases.
That is why so much of the research is useless at times in these early stages and so conflicting in nature. Now I have noticed that recently more microleakage studies are being done with Er:YAG lasers but many fire away with huge energy settings (ie enamel settings) on the enamel and then dont acid etch and compare to acid etched.
Meanwhile in the real world those of us using the lasers have figured out that bevels need to be at much much lower settings and we either scrape the eneamel with a spoon or air abrade, diamond scrape etc the margins.
Why cant researchers ask real world clinicians to look at the design (M and M) of their studies to make them more clinically relevant to us. I know that Hack amongst other things taught me to look more closely at the M and M – in so many cases it just has very little clinical relevance to how we are doing things in the real world.
I actually like the literature search that I do every few months. I read the abstracts, occasionally get an article for download (got one yesterday on diodes and periodontal therapy) and read it to find out if there is clinical science to back up what I am doing in the real world.
It shows how far the pioneers in this field are out there, when we are 2-3 years ahead of the researchers trying things out. Its also amazing how many times the research eventually shows that the stuff we bantered around on LDF and to a lesser extent on DT helped solve problems and that eventually the research backed up our claims.
For Er:YAG eventually a study will compare power settings on enamel and look at microleakage……guess what they will find.
Largest microleakage will occur with higher energy settings.
Lowest will occur with caries or less settings , slightly defocussed with scraping of enamel or AA on the enamel to remove loose prisms.
Its just a shame that we as clinicians have such a good idea how to do a relevant study but the researchers in their ivory towers keep missing the mark that clinicians have figured out a LONG time ago.
All the best
Glenn
etienneSpectatorHi Bob
Thanks! This is the Durr Vistascan, I am quite happy with it. You sure see a lot on these x-rays! Nice diagnosis!Yep, thanks very much, you did send me the settings. I saw the patient on Saturday and used the settings that you provided. I spoke to her today and she sounds fine. I have arranged to see her again in 4weeks time (she lives 4 hours by car away, so it is kinda difficult). When do you re-treat and how long apart?
Thanks Bob, I really appreciate your effort!!
Take care
Etienne
PS: Do you ever use antibiotics during these cases? There was quite a bit of puss drainage from the #8 area..
SwpmnSpectatorDavid:
Which sections gave the 0.0W reading and which gave the 0.4W reading? The pilot study would seem to indicate that the majority of the Er:YAG energy is absorbed a short distance into tooth structure.
How about we do our own unscientific, double-unblind, in vivo pilot study? I’ll volunteer to be the patient. Do you have a pulp tester?
I still have a handful of mostly unrestored premolar and anterior teeth. We could pulp test my teeth to establish baseline viability levels. You would then irradiate the teeth using your specified protocol with Er:YAG or Er,Cr:YSGG. Then we would apply the pulp test post-irradiation and compare numbers.
Glenn van AsSpectatorWill this be a double blind (you both blindfolded), clinically randomized, (neither of you knows any of the testers), long term (multiple evening sessions), university provided (young college students hosting the event), being done under the careful scrutiny of your neighbourhood HOOTERS.
If so who is funding the study………CAN I??
Grin
Glenn
Robert Gregg DDSSpectatorEtienne,
Did you get a good clot at the end? Or was the tissue still bleeding? No Bleeding? No need to retreat. Just stablize the occlusion–it is an ongoing process of a year or more.
Did you fabricate a lower splint yet? Do that ASAP!
With pus and exudate I always give antibiotics–Amoxil or Augmentin 500 often combined with metronidizole 250.
Less lasing is a better therapeutic effect the larger and more involved the defect as I metioned in my email. That way you won’t lose soft tissue height.
Good luck on you both!
Bob
Robert Gregg DDSSpectatorGlenn,
I know what you mean.
It is the nature of acdemicians to feel that clinicians have nothing to contribute. It is their bias on the heirarchy of evidence that all discoveries stem first from basic science instead of an observed clinical phenomenon. I’ve been seeing it just as you so eloquently described for the 15 years I’ve been using lasers
Early adopters have been pretty good at adjusting their intra-operative parameters and getting around some manufacturer originated deficiencies in dosimetries.
Why do they (academicians) listen so intently to the operating parameters that a PhD came up with on extracted teeth or dead cow tongue?!
They need a Glenn van As or Ron Kaminer, or a Mark Colonna or an Eric Bornstein. Sometimes they listen, but usually only after considerable time has passed and they are so many frustrations with the manufacturer (and academically “researched”) recommended settings.
Look at Nd:YAG and perio. The entire WORLD of lasers experts–save but a few like George Romonos–decided years ago (thanks in part to poor research desgin and execution by the UMKC studies and irrational negative bias of Zachariasen and Dederich) that Nd:YAG was the worst wavelength for perio. A dangerous Nylad Laser 35 with 800 usec and fixed 50 Hz didn’t help (again manufacturer-based and designed parameters)
Del and I just said, “How can they be so sure of their conclusions and be so emphatically wrong?”
So much of what Del and I have done, and continue to do with respect to science and research, is to overcome the ingrained negative conclusions by those in academia and research about Nd:YAG and perio.
All that could be much less if university investigators would partner with clincians like we have done with Prof Yukna and is research team.
Arrogance and exaggerated self-importance by academic researchers prevents many from partnership, from my humble observations. And often when it does happen, the university researcher wants to take all the glory and dismiss their clinical partners. We went through that as well early on with someone we thought was trustworthy. Not Ray Yukna. It’s been a great partnership that continues to benefit both entities.
Bob
etienneSpectatorHi Bob
Thanks for your reply. Still bleeding at the end unfortunately. Does that mean that I will have to retreat? I had the lower splint done today and I gave antibiotics as well.What do you normally expect in the papil area of a large defect like we have here surrounding #8?
Thanks again for your time!
Take care
Etienne
dkimmelSpectatorAllen, Glenn has me thinking. How about lets see if we can get some of the Hooters girls to volunteer for the study. We can then blindfold them to help with the vality of the study. Let talk about at the meeting Tuesday night.
Robert Gregg DDSSpectatorEtienne,
No hemostasis? repeat treatments will be necessary. Gotta get a “wet clot” for a stable fibrin seal. Need optimal laser operating parameters as we discussed in the emails.
That’s the need in order to do it one time only.
Minimal exposure on #8 like I emailed you and you should not lose the papilla. Piddle and play just for no reason and no observed benefit and you “slow-cook” and kill the soft tissue and it will recede.
Less is more in these situations.
Bob
PS: To all my Periolase friends who wondered why I was giving Etienne all the assistance w/o the benefit of a PerioLase–(what in the #$%^& is Bob doing?!)
Answer: To teach in the LDF environment like can be done no where else that would tolerate it by truly helping Etienne with an excellent case example of what laser perio can address and so he and others could learn that having the right answers and not the right parameters doesn’t get the controlled and optimal healing results. Technique alone does not get the results. Technology supports the technique. Technology w/o technique gets mixed even bad results.
Etienne’s patient will benefit from his efforts better than any other methodology or procedure he could offer to save these teeth–just as my many patients did–even though the optimal laser parameters/technique were not available for either of us at the respective times. The lack of optimal parameters can be compensated for if only by taking more time and effort than they might if all the right ingredients were available.
It is worth it this way? Not for practice productivity. But definately for one’s learning curve.
“You can’t see or hear this stuff enough.”
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