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Robert Gregg DDSSpectatorNice cases Doug and Glenn!
What I have been doing lately is using the FRP Nd:YAG (Periolase) with long pulse to lase the extraction site, place Bio-Oss to all but the coronal 1/3, allowing the thixotrophic clotting blood to squeeze around the graft material, then lase to create a barrier clot.
I will try to locate and post a case. Seems to be working well, according to Del who placed implants into these areas recently.
Bob
Robert Gregg DDSSpectatorI should add to what Jeff said about his sad Coumadin patient story.
In 15 years using a FRP Nd:YAG with at least 150usec pulse duration, I have never, ever taken a patient of Coumadin regardless of their INR.
I have an arguement with an MD who was insistent on taking the patient off for 4 days, as we were cplanning on two quads of LANAP, and I had to be firm with him and tell him how this laser works, and my experience.
To an MD that has little if any understanding of lasers, their idea is that laser just vaporize tissue.
After I made my position CLEAR, he said, “Well it’s your risk, not mine.” When everything turned out just fine with the patient, I never heard a word from the MD.
Typical…….With all the tremendous clinical outcomes like this and others (such as healing HSV-I in Chemo patients that don’t otherwise heal for weeks after chemo), I have only received one call from an MD, and that was from my Dad’s med school classmate Dr Robert Sweezy when I treated a weeping skin infection on one of his sons who is also a dental patient. Dr Sweezy was impressed enough to call, but a lifelong friend of my Dad. (Dr Sweezy of Sky Mall fame and his orthopeadic pillows).
Bob
etienneSpectatorHi Guys
This is the final x-ray after completing treatment, 21 days after seeing patient the first time, three appointments in total.
Take care
Etienne
Robert Gregg DDSSpectatorVery impressive Etienne! Hard to argue the results so soon after treatment!
Have a nice weekend with that result!
Bob
Glenn van AsSpectatorDavid, my thoughts are that if you are doing work without anesthetic (chemical) that you should try to keep the Hz below 20 (most patients cant tolerate it) and if the soft tissue work is done with anesthetic then 40-50Hz is fine.
Magnification makes all the world of difference.
Glenn
Glenn van AsSpectatorThanks Bob, just something to show that was different.
Kinda cool I thought.
Glenn
etienneSpectatorThanks Bob
Is this a private chatroom? We should actually make it open to other users as well….
Take care
Etienne
JerryDSpectatorDavid,
Looks great! Way to go!
jetsfanSpectatorI recently read a short piece on a man named Gordon Gould. Some credit him with the invention of the laser. Apparently he had a lab at Columbia University down the hall from Townes. He apparently came up with the idea first but never got a patent for it because his lawyer said he needed a prototype first.(Lawyers)! Townes many years later , in court, admitted he saw some of Gould writings. Gould eventually went on to win millions in a law suit.
Just thought this might be interesting for everyone.Robert
Glenn van AsSpectatorThought Bob, and others would enjoy this topic that appeared in the lit for me today……..cool result.
Glenn
Arch Oral Biol. 2006 Feb 2; [Epub ahead of print] Related Articles, Links
A comparison between the occluding effects of the Nd:YAG laser and the desensitising agent sensodyne on permeation through exposed dentinal tubules of endodontically treated teeth: An in vitro study.
Al-Azzawi LM, Dayem RN.
Department of Oral Pathology, College of Dentistry, University of Baghdad, Baghdad, Iraq.
OBJECTIVE: Dentine hypersensitivity may occur due to loss of covering enamel and/or loss of cementum after gingival recession, resulting in exposure of cervical dentine and patency of dentinal tubules. The effect of thermally cooled pulsed neodymium:yttrium-aluminium-garnet (Nd:YAG) laser on the permeability and structural appearance of the root canal wall was investigated in vitro. The aim of this study was to compare the occluding effect of Nd:YAG laser with that of sensodyne on exposed dentine. MATERIAL AND METHODS: Forty freshly extracted human maxillary anterior teeth were collected at random. Root canal obturations were performed using master apical file no. 60 k-type for obturated teeth. All teeth were stored in 100% humidity at 37 degrees C for 48h to allow time for the sealer to set. Dentine of 35 teeth was exposed by removing the cementum, and the remaining five teeth represented a negative control group. Specimens were examined using stereomicroscopy to show the surface topography of the dentine substrate before and after treatment with Nd:YAG laser or sensodyne. RESULTS: A double-blind technique was used when taking measurements of ink penetration (in mm) for each group. Teeth treated by Nd:YAG laser showed the least ink penetration, followed by teeth treated by sensodyne. The positive control group demonstrated complete ink penetration and the negative control group showed no ink penetration. Stereomicroscopic examination of specimens treated with Nd:YAG laser showed deposition on the dentinal surface, and specimens treated with sensodyne showed partial deposition. Untreated specimens were free of deposition and the tubules remained patent. CONCLUSION: There is no significant difference in the occluding effect of Nd:YAG laser and sensodyne toothpaste. Both treatments have a promising effect on the reduction of permeation through exposed dentinal tubules. However, the occluding effect of Nd:YAG laser occurs within seconds whereas that of sensodyne takes at least 3 weeks.
gmclaurinSpectatorI have some questions. Why did you use your Er:YAG and then your Nd:YAG and on what settings? It looks like you did not have a need to cover your bone graft, so you just placed the flipper over the site?
Did you do any biostimulation, pain meds, antibiotic? It looks great! You said that you have done this before – how did that turn out?Thanks for all the details – Gail
Robert Gregg DDSSpectatorThanks Glenn,
Yes, very interesting. The results is not much of a surprise, but the origins of the research is………
I mean, when was the last time we saw any research come from Bagdad?
Bob
Robert Gregg DDSSpectatorBump
etienneSpectatorThanks for the comment Gail
I used the Er:YAG to disinfect the site. The Nd:YAG with its deeper penetration was used to initiate clotting, biostimulate the tissue and further disinfect the site. The Er was used at 10Hz 350mJ, the Nd:YAG was used at 10hZ 100mJ if my memory serves me correctly. I have the settings at work somewhere ;)) Yes, I just placed the flipper. A membrane certainly wont hurt though. I did give the patient some pain meds, she didn’t use any though. I wasn’t taking chances with the infection so she took 1000mg Augmentin b.d. Ideally the patient should start with the AB 1 day pre-op though.The other cases turned out about the same as this one. 1 Patient removed her flipper during the first 24 hours and the graft didn’t look quite as nice as this after 48 hours. The combination of the Er and Nd:YAG seems to be quite effective.
The determing factor will be when I go in to place the implant. I’ll evaluate again in two weeks time.
Take care
Etienne
dlawlerSpectatorBob, what settings would you suggest with the Periolase to eliminate dentinal sensitivity?
David
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