Man, it’s been a long time since I’ve been here to the LDF. And I have no idea why…

Well, my ortho referral is returning the favor and referring me a tongue-tie release. I have not done one yet and I’m going to consult with the parent and child on Thursday. I figured I should bone up a little bit before I see them. I don’t even have a fee in place yet and what ADA code is this? Any suggestions for a fee…N8RV (Don) and Ron you are reasonably close geographically…any siggestions from you?

I will be taking pictures, so I’ll post some on Thursday evening.

I have been using the TAC gel (alone) with mixed results and am thinking I will probably add some local after the TAC gel.

How does placing a suture at the superior aspect of the incision prevent re-attachment? I’m planning on using 4.0 gut since it’s all I have.

I’m eager to do this treatment finally – almost 2 years into DELight ownership.

BTW, I used the chisel tip.

Thanks, Glenn.

I used the chisel tip in non-contact mode 45 Hz/55 mJ with air/without water. I was about 1-4 mm from the tissue throughout the treatment.

I started getting a little concerned about the size of the dissection when I reviewed this thread after completing the procedure. The other dissections look so small. Does anyone think it looks too aggressive?

BTW, this is an 11 year old girl who was referred to me by my main ortho referral with complaints (by mom) of speech impairment, inability to keep her lips moist and trouble swallowing pills. My orthodontist attended a lecture I gave to our local Young Dentist group last November. I am going to devote some more effort to getting the word out about this treatment to my other orthodontists and pedodontists. The laser really shines on these! (no pun intended!)

I spoke to mom about 30 minutes ago and the patient is a little uncomfortable but doing well. She has eaten lunch and dinner and has just taken her first dose of OTC pain meds. Treatment was performed at 10:30am today and mom said there has been ZERO bleeding all day. NOT ONE DROP!!! Amazing….

Seeing a few of Glenn’s laser-assisted extraction cases inspired me to try one myself.  This patient is my assistant’s husband.  He was in the military and this tooth was neglected following a RCT.  He came in with gross decay on the distal and an abscess on the distal root.  The re-treat was completed and this tooth fractured about 6 weeks following the re-treat.

(Pic 1)  I initially went in to explore the fracture.  I was fairly certain it was hopeless, and it was, as it turned out.  The tooth was fractured along the buccal aspect of both buccal orifices from mesial to distal.  I decided to extract this tooth surgically exclusively using the DELight for access and bone removal.

Pic 2
After anesthesia, I used the DELight (45Hz, 55mJ +H2O, no air) to sever the gingival attachment.  The buccal section was removed with tissue forceps.  I gave in and removed the remaining Cavit temporary with the handpiece.

Pic 3
So I could have access to the pulpal floor I used the laser to remove the palatal axial wall of enamel (by angling the laser to cut palatal to buccal @ the CEJ) (20Hz, 400mJ)  After removing the palatal wall I gained easy access to the pulpal floor.  I sectioned the pulpal floor from mesial to distal and between the buccal roots.  (20Hz, 400mJ).  When I was able to visualize bleeding in the section I knew I was through the floor.

Pic 5
A straight elevator was used to luxate the buccal roots.  They all but jumped out.  Very little force was used due to the perfect purchase I had between the roots.  I then used the laser to sever the palatal gingival attachment and removed bone around the palatal root (20Hz, 200mJ).  Now I had a solid purchase on the palatal and buccal aspect of the palatal root, so I used the Rongeurs to twist the palatal root out, again, with minimal exertion.

I am very pleased with the result of this treatment.  It went better than I could’ve hoped.  There was very little bleeding (notice the pics) and minimal tissue damage or bony expansion.  I was prepared to lay a flap, section with the HP and suture it closed.  What a difference!  The total treatment time after anesthesia time was 45 minutes, including pics.  Neat use for the laser!!  Thanks so much to all on the forum who posted cases like this.  I would never have thought to use my laser like this.  What a great service for the patient.  Comments are appreciated, good or bad!!

(Edited by drkdds at 9:05 pm on Feb. 21, 2006)

(Edited by drkdds at 9:17 pm on Feb. 21, 2006)

Thanks, Glenn.  Coming from you that means ALOT!

By the way, I used a 600nm 80 degree tip to cut the palatal axial wall.  I then switched to a 400nm 80 degree tip for the sub-gingival and pulpal floor sectioning.  Getting the correct angulaton to access the mesial portion of the tooth was a challenge.  I found myself thinking about the 90 degree handpiece and chisel tip, but I just didn’t want to get up out of my chair.  My 400nm tip did get beat up a bit, though.

I look forward, as always, to seeing your case, Glenn.

Are you, or is anyone here, going to the Townie Gathering Las Vegas in March?

(Edited by drkdds at 9:10 pm on Feb. 21, 2006)

Hi Jeff,

My wife Kate and I had a great time at the MDT clinicians meeting and enjoyed meeting you.

I may have already asked you which AA machine you use but cannot remember. I have an old Kreativ Mach V or IV but find it takes up too much room now that I am using my erbium and periolase daily. My ops are way too small and I have no plans on moving ( don’t know where I am going to put the cerec machine at this point.)

AA in rear cabinets sounds doable.

Bruce