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Robert Gregg DDSSpectatorExcellent Etienne!
Nice job! It works……..
http://bookstore.spie.org/index.cfm?fuseaction=DetailPaper&ProductId=137376&coden
Bob
whitertthSpectatorNice job…why not try and go to the apical area as well to obliterate the lesion before filling the tooth with sealer and GP? Just a thought…..
etienneSpectatorThanks guys! The idea is to use the laser again up to the apex after shaping has been completed. This was just an emergency procedure between regular patients. I’ll post the x-ray when the endo is completed and then also try to get a follow up later on.
Take care
Etienne
PS: Sorry, there was a mistake in the original post, PD was 50usec. The fiber was 200micron.
etienneSpectatorHi Bob
Thanks for the LINK. I should have known you have done this!!! ;))
Take care
Etienne
Klye ReevesSpectatorLimited success.
I’m going from memory here. But as I recall we did about six sessions each about 5000-6000J (100usec 6.0w, 20 Hz) I bathed the dorsum, lateral, and inferior aspects of his tongue where he could feel warmth.
After a couple sessions he described it as slight improvement of the ongoing burning tongue sensation, but not eradicated. After the other sessions, he said it really did not feel any different.
So, anyway, not really anything to write home about in this case.
He’s probably due for his regualr cleaning anytime in the next few weeks and I’ll follwup and let you know if anything has changed.
etienneSpectatorHi
This patient presented with a massive periapical lesion and lots of pain.[img]https://www.laserdentistryforum.com/attachments/upload/pre-resize1.JPG[/img]
I completed the endo with the help of the Nd:YAG laser in one appointment as there was no drainage and the canals were dried completely with the laser.
[img]https://www.laserdentistryforum.com/attachments/upload/post-resize.JPG[/img]
The patient did not want as a crown as I wasn’t sure how the lesion would resolve. I sealed the access cavity with a temp. The patient only came back now, six months later with a crack mesiodistal up to the level of the bone loss. If I had placed a crown at the time the tooth would probably still be functional, now it is in the bin…
[img]https://www.laserdentistryforum.com/attachments/upload/now-resize.JPG[/img]
I found the amount of bone regeneration very interesting. The crack must have been there for a while to cause that much bone loss. With hindsight, a temporary crown would have been the answer?
Take care
Etienne(Edited by etienne at 1:54 pm on Feb. 4, 2006)
etienneSpectatorHi All
I had a very interesting case today but unfortunately have no pictures to show. I saw the patient the first time on Wednesday when she was in severe pain. She had a post crown on tooth #9 that was recemented the previous day by another dentist. On the x-ray it was clear that no endo was ever performed on that tooth. I couldn’t get the tooth numbed at all. Gave her 625mg Augmentin plus 400mg Flagyl. Came in today (Saturday) and the abscess had localized above the apex of the root. I succeeded in getting it numb. Took the tooth out and drained the abscess. I found that there was a fenestration through the buccal bone at the apex level. Lots of puss drainage! I shot my Er:YAG into the socket at 350mJ, 15Hz. Nice bleeding at that point. I then used my Nd:YAG at 100mJ 10Hz to stimulate clotting and disinfect the area. I then placed freeze dried demineralized bone into the socket and a flipper plate on top. I called the patient five hours later and she said that she had no pain at all, the anesthetic had worn off and there was no discomfort at all!
One very happy patient!
I would have preferred to place the implant immediately but thought that would be pushing things a bit in this case.Any alternative ideas on handling this?
Take care
Etienne
Robert Gregg DDSSpectatorWith hindsight, a temporary crown would have been the answer?
After having a few split molars like that of my own, I now always make a temp crown on molar endo.
Bob
Robert Gregg DDSSpectatorEtienne,
I think that you managed the case very well.
Bob
etienneSpectatorThanks Bob!
Would you have considered placing the implant immediately?
Etienne
Robert Gregg DDSSpectatorNot with a fenestration or dehiscence. But otherwise if I felt I could “nuke” the abcess, I would consider it.
Bob
cerecdocSpectatorOne suggestion I see I could make is in the realm of dentures. Instead of adjusting the denture, you have the opportunity to adjust the patient. Using the “alveoloplasty” codes and the “vestibuloplasty and frenectomy” codes is both ethical and appropriate in this area of practice.
AnonymousSpectatorQUOTEQuote: from cerecdoc on 11:21 am on Feb. 5, 2006
One suggestion I see I could make is in the realm of dentures. Instead of adjusting the denture, you have the opportunity to adjust the patient. Using the “alveoloplasty” codes and the “vestibuloplasty and frenectomy” codes is both ethical and appropriate in this area of practice.How is ‘adjusting the patient’ when you could adjust the denture ethical? :confused: :confused:
djacksonSpectatorThanks for the reply.
DJ
etienneSpectatorHi, I saw my patient for a follow up appointment today. He reported NO pain at all after his previous appointment. I prepared the canal, used the laser again and placed Ca(OH) into the canal.
This is a picture that I took today.
[img]https://www.laserdentistryforum.com/attachments/upload/Ca(OH)resize.JPG[/img]
In my opinion bone growth has started after only 6 days..what do you guys think?
Take care
Etienne -
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