Greetings Etienne,

Nice treatment!

The appearance of the gingival tissues after FRP Nd:YAG lasing shows smart application of energy used–i.e. no recession. I’m thinking you used very little energy, on the order of 30 seconds for that result.

While the tissue still has “issues”, you can always go back and treat again once they firm up and the inflamation has resolved some.

How long between 1st and 2nd appts?

What sort of antibiotics did you prescribe?

Thanks,

Bob

Thanks Etienne,

No, never boring……….

Sounds good. I’m guessing you used 150usec, 20 hz, 3.0 watts for 30 seconds? Less power? What were your settings?

You may not have to retreat that pocket again.

The next time you numb the patient up, I would gently probe. If you meet the slighest resistance, don’t push. Unless or until there is BOP, or inflamation, I would not retreat to the base of the defect. Keep the gingiva clean and “closed”.

I would just use the laser in the canal.

If there is a pocket and/or BOP, I would treat as you did the first time.

Good luck,

Bob

Hi Bob

Good guess!! Actually it was 150usec, 20Hz, 4watt for 20sec.

So about 40 Joules, which is well within the tissue tolerances for that tooth and defect size.  Very smart on your part.

How long would you wait until you decide to evaluate?

30 days for both the RCT and the perio pocket.

I am seeing the patient shortly (next week I think) to complete the endo, would you wait longer?

No, that’s OK.

If you have BOP or a pocket, would you retreat to the base again?

Yes, but not with force.

What would you say were the chances of saving a tooth like this? 50%? 40% Just wondering.

I’d tell the patient 50%, but I’m thinking more like 90%.

Take care
Etienne
Good luck!

Bob

Hi Bob

Thanks very much for your note. Do you truly think the chances of saving a tooth like that is as high as 90%? WOW!!

Yes.

On another note, do you think the same effect could be reliably achieved using another kind of laser? Say for instance a diode?

No, not reliably……occasionally, not reliably.

My gut feel is that the difference in wavelength is not that important but the difference in gated pulse vs free running pulse is crucial. What are your thoughts regarding this?

I agree completely

Thanks!

Take care

Etienne

Thanks, you too.

Bob

Hi Bob
Do you remain several inches from the tooth?

Do you treat in contact with tooth structure when you etch dentin? Can you suggest a clinical situation where you would want to do that? Any restoration? Care to share the dentin etch setting?
Thanks
Etienne

(Edited by etienne at 3:42 pm on June 6, 2006)

Hi Bob

Do you remain several inches from the tooth?

No, I attempt to move in.

Do you treat in contact with tooth structure when you etch dentin?

Yes.

Can you suggest a clinical situation where you would want to do that? Yes. Any restoration? Yes. Care to share the dentin etch setting?

On your laser? The shortest PD (150 I think) and 300 mj/pulse. Can you get that much mj per pulse?

Thanks
Etienne

Sure. Bob

Jeff – Did you do this treatment gratis, or did you charge a fee? If you did, what was your fee, and what insurance code did you file? Thanks Bob Huskey