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  • April 14, 2006 at 6:35 am in reply to: Surgical2 #5507

    etienne
    Spectator

    Hi Bob
    Thanks for your note. I recall a picture that I saw of a case that you used the Nd:YAG alone to initiate clotting and that sure seemed like it created a very nice “scaffold” for healing.

    I have not been able to get that kind of results. I still lose alveolar height when not using some kind of augmentation material. The demineralised freeze dried bone works OK but it is not ideal. Last night I did my first case with PRP after doing my normal laser procedure. The idea is to limit interventions at a later stage by trying to optimize the site at time of extraction.

    The PRP product I used is actually a very interesting product. It is something bought of the shelf that is actually manufactured for use by the medical guys and has a shelf life of 3 years. They claim that the growth factors stay viable all this time…

    Would be interesting to see how it turns out.

    Take care
    Etienne

    April 14, 2006 at 3:49 pm in reply to: Versawave and Upgrading the Delight #7769

    Glenn van As
    Spectator

    I can relate to you a story from last years (2005) ALD where I did a hands on demo with the scope and the laser. I was cutting a tooth and afterwards a lady literally came running up to the front and asked me what laser I was using because it was so much faster than hers.

    I of course jokingly asked her if she had a Biolase unit….she did.

    Then I told her that the problem wasnt the machine but he magnification that she was using. She told me as a pedodontist that she didnt need mag, and I told her that as a laser user she did!

    SHe went and purchased a 2.5X mag loupes from Designs for Vision and came back smiling and said her laser was cutting 2x as fast now.

    Its really true, the magnification is essential for the lower settings. Its something I knew a long time ago and when you cut at 12X mag like Mark is doing, you know EXACTLY whether the tip is in the ideal vertical position in non contact mode as you can evaluate the laser tissue interaction ideally.

    One other story. I was teaching an evening course with David Hornbrook in San Diego and I got to talking to one doc about his diode. He mentioned that he was finding it so slow to cut unless he got alot of charring.

    I asked him for his settings for troughing……..

    He told me 2.5 Watts , Continuous Wave…….

    YIKES…..

    Next question, what mag are you using as a cosmetic dentists?

    Answer…….

    NONE….my eyes are still 20/20……..

    I give up!

    Grin

    Glenn

    April 16, 2006 at 3:10 pm in reply to: Surgical2 #5521

    Robert Gregg DDS
    Spectator

    Hi Etienne,

    Exactly what is PRP that you are referring to?

    I’m familiar with “Platelet Rich Proteins” as extracted from a patient’s blood…..

    Thanks,

    Bob

    April 16, 2006 at 4:32 pm in reply to: Versawave and Upgrading the Delight #7775

    N8RV
    Spectator

    Another thing to consider along with magnification is the condition of the tips. I suppose this should probably be posted on a separate thread, but while we’re talking about cutting efficiency …

    I was aware that sometimes my laser doesn’t seem to cut very well, and I had attributed that to my current use of 3.5x loupes instead of 6x (my assistant broke them). However, swapping tips didn’t always help, unless I switched to a brand-new one.

    WELL …

    Because I still have access to a Global G6 demo unit, I decided to take a really close look at the condition of my tips. WOW. Almost every one was butchered up — chipped, cracked, pitted.

    Under high mag, was able to polish the tips again to something that more closely resembled flat and polished and the difference was remarkable.

    So, if you haven’t looked at your tips recently, do so…

    April 16, 2006 at 6:36 pm in reply to: Frenectomy-Gingivoplasty #5728

    mkatz
    Spectator

    I agree that it is a nice result… and it can be done easily with a scalpel. Don’t underestimate the power of “old” standby tools.

    April 16, 2006 at 9:04 pm in reply to: Surgical2 #5514

    etienne
    Spectator

    Hi Bob
    “PRP” is platelet rich plasma. I assume that is what you meant. It is extracted from blood, but not necessarily the patients own blood. The product that I used now is prepared from donor blood and frozen and therefore has the 3 year shelf life that I mentioned. Some people add BMP (bone morphogenetic proteien) to it to enhance the bone regeneration properties. The idea is to concentrate the growth factors in the wound area and also in this case, to create a scaffold for regeneration of bone.
    Take care
    Etienne

    April 16, 2006 at 9:25 pm in reply to: General Nd:YAG Forum #2736

    etienne
    Spectator

    Hi Guys
    This is another endo case that was completed recently after sterilization and stimulation with the Nd:YAG laser.

    compilation4.jpg

    I use the Nd:YAG as part of my standard protocol for endo these days and am very pleased with it.
    Take care
    Etienne

    April 17, 2006 at 12:38 am in reply to: Versawave and Upgrading the Delight #7751

    d2thdr
    Spectator

    Don

    My assistant has standing orders to beat me to a pulp if I do not polish the tips prior to the patient departing the room!!

    April 17, 2006 at 12:15 pm in reply to: Frenectomy-Gingivoplasty #5729

    Benchwmer
    Spectator

    I haven’t picked up a scalpel for a gingival surgery since 1999.
    Why would I?
    Increased patient comfort, increased rate of healing, less anesthetic, no sutures, less chairtime, bloodless.
    Patients go to soccer practice right after surgery. No pain killers needed. Parents sit in the operatory and watch if they want. Quick, clean, fast. Wonderful technology and service for my patients.
    Jeff

    April 17, 2006 at 4:38 pm in reply to: WCLI Lecture By Professor Moritz #11426

    etienne
    Spectator

    Hi Ron
    I also saw Prof Moritz’s SEM pics on bleaching damage to enamel. I have mentioned it to quite a few dentists and even showed them some of the pictures but it seems as if nobody is concerned about it.

    What are your feelings about this?
    Take care
    Etienne
    PS: I saw his bonding pics as well, awesome!!

    April 17, 2006 at 4:58 pm in reply to: General Erbium Discussion #2926

    etienne
    Spectator

    Hi Guys
    I have been using the Deka Smart 2940D+ Er:YAG laser for a few months now. Most patients complain about sensitivity and have to be numbed. Even when I turn the pulse energy down as far as 50-100mJ with 5-10Hz the patients still experience pain. I am using the shortest pulse duration available, starting out in defocussed mode with maximum waterflow and they still complain. I have been in dentistry long enough to be able to tell when patients are just being difficult but am convinced that these people are more than uncomfortable during treatment.

    Even for something as small as these lesions I need to use local anesthetic.

    prep2.jpg

    Any suggestions?
    Thanks!
    Etienne

    April 17, 2006 at 5:08 pm in reply to: Sensitivity!!! #7272

    2thlaser
    Spectator

    Etienne,
    What type of tips are you using? What type of magnification are you using? Just to start with….

    Mark

    April 17, 2006 at 6:05 pm in reply to: Sensitivity!!! #7268

    etienne
    Spectator

    Hi Mark
    I am using their “window” handpiece with either 4,3X loupes or microscope.
    Take care
    Etienne

    April 18, 2006 at 5:46 am in reply to: Sensitivity!!! #7276

    brucesown
    Spectator

    Just for what it’s worth. I find occlusal erosions like the ones in your image to be some of the most sensetive teeth to work on. Even in people you’ve just finished a no LA tunnel prep on will often be sensetive. Not sure why.

    Bruce

    April 18, 2006 at 7:03 am in reply to: Versawave and Upgrading the Delight #7772

    Glenn van As
    Spectator

    Best thing I learned from the ALD from Wayne Seltings EXCELLENT lecture on a study looking at the debris from one pulse on enamel vs dentin. In enamel there was over 2000 particles on the surface of the tip from one pulse on a new tip.

    Dentin debris was 7-8X as bad as when the laser was used on enamel.

    Bottom line was efficiency could drop by up to 40% from Debris alone on the tip and his solution………

    Polish for 5 secs after each use with a Soflex super fine polishing disc.

    He uses the Delight so I cant speak for the MD or Waterlase.

    Hope that helps…..it was an awesome home research project that he did with material he bought of Ebay. Awesome job Wayne.

    Glenn

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