basic operative

[kellyjblodgettdmd]

Amen, Mark! I don’t know about you guys, but when I’m talking to other dental professionals about lasers, it’s hard not to get into all the other aspects that make laser dentistry great. For instance, I always mention that the reason I have great success with lasers is (1) I took the time to “learn before I ‘burned'”; (2) For predictable positive results, you have to see what you’re doing! (i.e. – buy a scope!) and (3) without a good understanding of minimally invasive concepts and prep designs, you’re wasting your time.

A number of times, I’ve had dentists ask me how do I quickly prep a GV Black style class II with a laser?! I guess the importance of this is to recognize that in the process of becoming a minimally-invasive dentist, it not only requires a complete overhaul of all your instrumentation, but also a complete overhaul of your clinical paradigm.

I give my sincerest thanks to guys like Kim Kutsch, Graeme Milicich, Mark Colonna, Glenn van As, Bob Gregg, and others who have made the learning curve so much easier for a “regular Joe Lunch-bucket” like me. What a great fraternity!

Kelly

[2thlaser]

Kelly,
I have news for you, you are NOT a regular “joe lunchbucket” guy. You are a wonderfully gifted clinician, with a great mind to boot. What you share with us has taught us a great deal as well. Don’t sell yourself short. You are “one of the gang” as far as I am concerned, and I thank YOU for all you share on these boards on a regular basis. In addition, lecturing with you is one of the most gratifying times I have ever had in teaching those about lasers. Thanks for being who you are….

Oh, and your bro too! ( I can only tell by the watches you wear!)….

Mark

[kellyjblodgettdmd]

WOW! – Thanks, Mark. Man, you warm my heart!

You know, one of the best things about this forum is its positive nature. Thanks everybody for that, especially Ron Schalter for giving us the forum to do so. I can be having the worst day ever, and when I come to this site and see dentists helping eachother be better dentists – what an uplifting place!

Kelly

[Glenn van As]

Thanks Kelly, I am glad that I have been able to help. I cant tell you how much I have learned here that directly helps me in my teaching. I do find now that even in lasers I am starting to shake my head sometimes at what the gifted are doing (I dont mean only the gifted crown preppers like Mark……) but sinus lifts, implants, treatment of failing implants etc.

Its a marvelous world out there and I am glad that LDF has opened my eyes to a wealth of possibilities from a number of different laser companies.

Its a great board Ron has created here, exceptional in its mature response and admirable in its breadth and scope (pun intended!!)

Glenn

[Nick Luizzi]

I know the public has a problem with the word “shot” but I can deliver mild to profound anastetic in about 2 minutes that works about 99% of the time. This is about the amount of time that is beging used in a defocused mode with the er:yag. but is effective about 60-70% of the time. The technique is not anything that I can lay any propritary claim on, it is very widely discussed in the literature by now, but maybe we should re-visit it. I don’t really think of it as an injection in the classsical way because it is intrasulcular and really only engages the free gingival sulcus. But it is tremendously effective when performed correctly. First, use only septocaine. Use only a 30 ga short. wash the sulcus with a gentle motion. Then ingaged the distobuccal at a slight blanch. the patient will not feel it. Slight and gentle pressure for 20 seconds, then go to the mesial buccal and do the same, for 20 seconds. Then do the linguals. The tooth is totally ready for laser prep. There is no numb tongue or cheek and no pain during the administration of the septocaine or the laser beam. This technique as described in the townie mag has allowed me to even do endos on lower molars without trauma to the patent’s psyche. It is fast and predicatable. I would not get on an airplane that had a 70% chance of landing safely, would you?

[Anonymous]

Hi Nick,

I assume you’re talking about the “Perkin’s’ technique?
Do you find the patient has discomfort the day of the injection, after the anesthesia has worn off?

I also think that, with a couple exceptions , most of the laser users here don’t consider it a sin to numb people up.

Welcome to the forum!

[dkimmel]

Nick,
I would like you to try something for 30 days. On each patient you numb up keep a log the list if you felt the patient recieved a painless injection and felt nothing. Then also list if the patient felt the injection ,was painless and felt nothing. You will need to have the assistant ask the patient these questions after you are out of the room or have the front desk ask the patient.

I would agree that if you are having a 70% success rate keeping your patient comfortable with the laser, that is not acceptable. I would advise you to take a closer look at your technique as well as patient selection. You can get a better success rate.

Predictablity is key. You need to perfect your technique with the laser to predictable make the procedure comfortable for the patient, without the shot. You also need to predictable select those cases that can be treated with the laser without the shot!

Using the laser is full of great rewards and fustrations. I have found that I can learn more from my failures in making patients comfortable then my successes. Trying to determine what was different. Was it the patient? Was it the tooth? Was it the laser? Was it me?

What makes laser dentistry different is you cannot just pick up the laser like the drill and go to it. You have to think about what you are doing. Not just feel it . But see it and think about it.

The best part about laser dentistry is you have Ron’s forum with some great people to help you out.

David
Off to the boat and then to do some dentistry on my mother inlaw. Got to learn on someone!

[emc85]

that is just a periodontal injection…i thought it went out of favor as it causes periodontal damage from the increased pressure into the ligament space. there seemed to be a lot of pt discomfort afterwards.

please enlighten

[Vince C Fava]

My experience with the PDL (my primary LA technique for posterior mandible) is that the slower you go, you get little to no post op issues.

Regards

[kellyjblodgettdmd]

Nick – I think you make a good point about the reliability of “laser anesthesia”. It is certainly far more predictable to use Septocaine to numb than to take the time to learn how to use a laser to predictably “numb” a patient.

However, if a patient’s primary reason for coming to see me is that they heard I have a laser and that they can avoid getting the dreaded “shot”, then I’m not really meeting their expectations by trying to talk them into having one. As we all know, pain exists as much in the mind as it does in what we actually do to tissue. If a patient gets sweaty palms at the thought of a needle, then I wouldn’t suggest using one. I have a number of patients that would much rather contend with some mild laser sensation than to have a needle jammed into their PDL space. (I can’t blame them for that).

The key issue in my mind is: Have we asked what the patient wants. I think that we are in such a habit of telling patients that “This is how we do things…” when in fact we have a number of options. If a patient prefers to feel nothing, I reach for the Septocaine. Ir they want to avoid having shots, then I’ll spend extra time using good laser technique, low power and a microscope so that I meet their expectation. I think that although it may not be possible to achieve 100% “anesthesia” with Er lasers, it is possible to achieve 100% patient satisfaction if our treatment modalities meet the patients goals.

Kelly

[emc85]

well said, kelly…you must lecture or something. haha

as much as we ‘sell’ the idea of using the erbiums without needles…there is that population in the practice that want the laser with anesthesia…they don’t like the sound or vibration of the drill, but don’t mind the needles.

my experiences have been that once they have had the erbium used on them….patients are very open to the idea of conventional dentistry, too. in addition, it allows me to guide them to a better long term treatment plan as well.

[Glenn van As]

Kelly ……..magic post there buddy. Really like your thinking there and I do believe that in the beginning with the laser the anaesthesia free laser dentistry is a big goal . After a while I dont get to hung up on this but listening to the patient is a big deal.

Having a whole practice filled with laser patients who are looking for everything to be done without the shot is no piece of cake. Thats one reason I raised my fees for the laser. Ask David Kimmel on one of the drawbacks of being one of the “laser guys” in town.

Well this was an excellent thread. I was bragging this weekend about Rons site to more than one person at the Nash Institute including Bob Lowe because this site really is a wealth of mature professional advice from those who are passionate about seeing lasers make a difference in our profession……….

Wonderful stuff……….

Glenn

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