Forums › Erbium Lasers › General Erbium Discussion › Decreasing root sensitivity
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Robert GreggParticipantHi All,
Good comments here.
Mark, you are right on with the calibration aspect of erbium lasers. My guess would be the optics/mirror alignment going out due to thermal lensing.
A far as jetsfan’s patient:
OCCLUSION.
When they are that isolated in location and symptoms and that specific in pain–OCCLUSION. It’s probably a cusp tip that won’t even mark paper very well. Use green occlusal indicating wax and see…….
My 2 watts (very funny Mark C)
Bob
Glenn van AsSpectatorHi Mark………guess why I like the Continuum unit.
It has a CALIBRATION PORT for self calibration of the fiber which I do around once per week.
Its great to know how your fiber is. Mine started at around 81% and now is around 73% and will be around 65 % when it needs replacement. The power drops and the unit recalibrates itself. Is this cool or what?
glenn
2thlaserSpectatorGreat answer Glenn. I would like that too. I am going to suggest it to Biolase. My fiber is a year old, and is still running unbelievable. The unit was a bit “hot” as I said in my earlier posts. After calibration, its humming along. I just love laser dentistry, it is the best thing that has happened to me professionally period. Secondly, is the friendship of you guys here. Thanks for all the input and education we share. I have a few other interesting things to post sometime soon. Just working on them. Have a great weekend everyone.
Mark
PatricioSpectatorOK Class,
Two Questions.
1. Can very sensitive teeth be desensitized after using a local anesthetic?2. If you feel you need to use local anesthetic for a particlular patient how long does it take before you begin with the laser? In the past as a general guide we have used 4 minutes for restorations, 6 for crown preps and 10 for extraction. I find it takes only a minute or two before you can begin with the laser.
Mark is excused from this one. We would have to wait to long for his results. Thoughts anyone???
My experience so far is you can begin within a minute or so maybe a little longer on molars.
Pat
jetsfanSpectatorjsut to let you know the outcome of my patient that I treated for hypersensitivity(the one that I couldn’t get close to with the laser and no anesthesia). I did give anesthesia, used laser on .25 W 0/0 for ~20-30 sec, then applied duraphat.On a follow up phone call to patient, the patient was ecstatic. She said I was the first DDS able to help her.She was absolutely amazed. Was it the laser, the duraphat or a combination ? I’m not sure, but I will try it on the other side without the duraphat and we shall see.
Glenn van AsSpectatorGreat stuff Jets fan. In general if I use anesthetic I will at least use the bur for alot of the procedure.
Its just my way .
Those patients who need anesthtetic often are not fun patients at the best of times ( at least in my office) and we want to get them in and out of the office as quickly as possible.
Glenn
jetsfanSpectatorI had a couple of people with cervical sensitivity, that was improved after using laser at .25W. However after a day or two they said the sensitivity came back. Suggestions?
PatricioSpectatorJetsfan,
I know there has been some discussion by Bob about elominating the neuroblastic tissues and biofilm on the tooth surface first from a distance and then closing the tubules at a closer range. Two steps. He also pointed out that occlusal interferences and bruixng can dampen success. He also pointed out that you must record on a scale of 1 to 10 the pain at the begining and the pain in your case the next day because the patient will interpret any pain as failure and not see pain reduction as success. How did I do Bob?
Pat
jetsfanSpectatorPatricio,
thanks for getting back to me so soon.
I did it in two steps as was suggested at .25W. I did not get a 1-10 fix by the patient before and after, however I was able to infer from his comments. The next day he was at zero. A day later it was worse than the start. Perhaps the occlusion needed adjusting but I succumbed and placed a composite. Patient now out of pain, which is all that matters.
JETSFANI hope I don’t sound like I am knocking this machine. Quite the contrary I love it. I have done crown lengthenings, apico, endo, biopsies , aphthous ulcers, surgical residual root removals, sequestrectomies, operculectomies …..
But for routine , fairly deep class I , II anesthesia is unpredictable in my hands. Also desenstizing also unpredictable. So I try to pick the brains of all who have success. Thanks again
PatricioSpectatorJetsfan,
Thanks for your comments. What a great group of contributors. I am sure this board will make significant contributions to the clinical effectiveness of lasers. I am thinking in my hands that certainty is uncertain. The predicability comes in the bag of tricks which experience brings to the table. For example in those deep sensitive spaces simply moving to a slow rotating high torque round bur in the electric handpiece does it. If this is not the case then intra osseous anesthesia will almost always cure the discomfort in a few seconds and it is back to the laser. The cure all that ends all marketing of the laser is probably not true. At least not for me. Thanks for sharing your experiences the info moves up all forward.
I did my first significant case of reverse bevel gingivectomy yesterday with the biolase. It was easy and I can see it will improve our results in those deeper pockets. I seem to get good results at 1.5w pre set with a G6 tip somewhat defocused. Just close enough to cut. Little to no bleeding and no charing. The tissue seemed to look good when I was done. I wish I had one those slick camera systems to share my beginnings.
Pat
AnonymousGuestPat,
How about more details-
Pocket depth
scaling/root planing 1st?
Goal of the procedure- removing inflamed tissue inside the pocket?/decreasing amount of attached gingiva to reduce pocket depth?/zapping the bugs?- some ,all or none of these?Next steps- when recall? when probe again?
Thanks for sharing your plan of attack and why.
(Bob Gregg’s training me well, wouldn’t you say? ) 😉
Glenn van AsSpectatorHi Pat…….there are some very good cameras that are digital which could really help you in taking photos.
Canon makes the G3 and you can get a macro lens and diffuser (type of flash system) from Photomed or Norman Camera and make and EXCELLENT camera for a reasonable price.
I think that photography has made me a better dentist, in that it has allowed me to look back at my cases ( especially with the ones taken through the scope) and critique it after the fact . I can and often do look at the pics at home and then decide what I could have done differently.
It really is amazing, and getting constructive criticism from others makes you even better.
My suggestion is go out , get a camera and start taking before, during and after pics.
Glenn
Robert Gregg DDSSpectatorPat–
You said it better then I did!
Ron–Training?? I’ll show you training soldier–at 3 days of Laser BootCamp!:biggrin:
But I like the questions for more detail, to be sure! Good going!
I surmise from the technique and description that Pat was dealing with little inflamation? I futher suspect an occlusal component to the defect–hence the lack of bleeding in and around the pocket.
Jetsfan–desensitization takes time and patience. Occlusion is more of a contributing factor to all sorts of problems than I ever thought in my first 10 years of dentistry–and I had Peter Neff as my instructor at Georgetown. He’s now at Pankey.
Resist the urge for instant gratification…..
Bob
(Edited by Robert Gregg DDS at 11:43 am on Feb. 14, 2003)
2thlaserSpectatorBob,
Your words of wisdom are always so great, thanks for all you do for us “newbie” laser users!
Mark
Robert Gregg DDSSpectatorThanks Luke,
Remember to use the Force.
OB
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