Forums Nd:YAG lasers General Nd:YAG Forum Diode/Periolase

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  • #2710 Reply

    Anonymous
    Guest
    QUOTE
    Quote: from dkimmel on 10:41 pm on Mar. 18, 2004
    Got me!! smile.gif
    How about posting a few perio cases.
    DAvid

    Good timing ,David. Was headed into the office to demo some ADEC W&H electrics this morning. Think I might have mentioned this case to you at ALD (seen by hygiene while I was gone). Not a perfect outcome by any means but a definite step in the right direction. Sorry about the variety of charts (had to Photoshop some numbers in to make half way readable). Also have some cases of 4-8 mm’s that have resolved to all 2&3’s but too lazy to fix up all the perio charts to have web viewable (besides this case  should be more fun to discuss).

    Case that I originally treated by diode in ’02. Retreat w/ Periolase ’03

    Hx- 60 female ,smoker, perio surgery 15 yrs ago, limited &#36 , refused periodontist, has soft bite guard (refused hard biteguard&#36), pt has flipper ~ 5 yrs old

    Charting prior to diode tx. Tx using pocket depth minus 3 for number of  diode tx per site. Occlusal Adjustment.

    Pre-diode Tx chart

    prediode1.jpg

    Patient seen for polish at 3 month recall, no scaling or probing.

    6 month post- diode chart

    6mthpostdiode.jpg

    At 9 months post diode definite relapse. U/ molars now 2+ mobility

    9 month post- diode chart

    9mthpoistdiode.jpg

    Periolase Tx 2 weeks after above charting. Check at 1 week. Minor occlusal adjustment as U/molars were now sore. No mobility.

    6 month post- Periolase chart

    6mthpostperiolase.jpg

    PA’s were not conclusive yet regarding any bone fill (looks a little denser but angulation wasn’t great) but teeth are still non mobile.

    Will post xrays at 1 year.

    #5474 Reply

    Janet Century
    Spectator

    That is certainly a step in the right direction Ron. Are you using the Periolase on less advanced disease, and what kind of results are you getting? I don’t get too many of the 7-9mm folks in so I am wondering about using it for less advanced cases.

    Thanks.

    Janet

    #5479 Reply

    Robert Gregg DDS
    Spectator

    Nice comparisons Ron.

    Several things I noted:

    1. It was interesting to see some pockets in the diode tx appeared to get worse over time. I have never seen that with the Periolase.

    2. Pockets that do not resolve require more O.A.

    3. Teeth that are sore are re-attaching and require more O.A. as you did.

    4. It would be beneficial if you could get the patient into a hard splint. The soft splint may work to break things down.

    Nice job of showing resolution using three different technologies–conventional, diode, FRP Nd:YAG.

    Janet–the perio literature says that the defects you can probe w/o anesthesia are at least 2-3mm deeper once a patient is anesthetized and you explore the true depth of the defects. That takes a 4-6mm case to a 7-9mm (at least). You would be startled (as we have been) at just how “short” we used to treat our perio patients.

    Thanks for posting Ron.

    Bob

    #5469 Reply

    Anonymous
    Guest
    QUOTE
    Quote: from Robert Gregg DDS on 9:45 am on Mar. 22, 2004

    4.  It would be beneficial if you could get the patient into a hard splint.  The soft splint may work to break things down.

    Bob

    QUOTE
    Quote: from Janet Century on 9:19 pm on Mar. 21, 2004
    Are you using the Periolase on less advanced disease, and what kind of results are you getting?  I don’t get too many of the 7-9mm folks in so I am wondering about using it for less advanced cases.

    Thanks.

    Janet

    Bob, I’d have loved to do this w/ the hard BG but we did all the perio gratis as it was ( nice lady, all her money is spent on the 5 troubled teens she and her husband have adopted)

    Janet,
    Generalized 4mm’s who haven’t had any dental care in along while we still do SRP. Otherwise LPT w/ the Periolase and when you can follow all the protocol (unlike the patient above) you get very predictible results.

    #5471 Reply

    mmaccaro
    Spectator

    Hi Bob and Ron:
    Being new to PerioLase, excuse my ignorance:
    Would an NTI appliance be helpful for this patient? (fairly inexpensive, short term deprogrammer).

    Mike Maccaro, DMD

    #5476 Reply

    Robert Gregg DDS
    Spectator

    Hi Mike–

    It was great to have you out for training.

    We are very judicious in our use of anterior deprogramers like NTI or Panke Jigs.

    I would limit their use to one week.

    If there is class 3 mobility, then I would not want to use one for fear of super eruption.

    Since the need to stablize (like a cast on a broken leg) is longer than one week, we prefer a longer term fixation device.

    There are several ways to accomplish that result:

    1. Ortho wire
    2. Ribbond
    3. Tanner/Panke splint (Hard)
    4. Internal fixation–intracoronal wire.

    With an NTI or PJ you could lose control over that type of tooth–even those with lessor mobility.

    For other types of situations, you may not even need a splint at all. But you could then make a case for using NTI/PJ for short term (one week) resting of the recently treated site.

    Glad to see you posting. This is a great forum for discussin of these topics.

    Hope you got procedure #19 reset to dentin etch OK!

    Bob

    #5472 Reply

    BNelson
    Spectator

    Hi All,
    Wendy(my hygienist) and I have been putting together the perio charts we have been doing LPT and Laser Curretage on over the last year we’ve had the Periolase. We find that consistently the 4-5mm pockets resolve with the Nd- no problems. Some of these cases we’ve been treating for years conventionally with stable, non-bleeding pockets, but no resolution. 6 months post laser, nothing over 3mm. Most of our LPT cases are showing great results. A few molars that went from 6-8mm to 5-6mm. Still need more OA and a little retreat, would be my guess. A couple cases I wanted to extract Cl III mobile teeth with 10-13mm pockets, the patients decided to try LPT. they couldn’t stand the thought of losing more teeth. Ribbond spints, OA and LPT and nothing probing over 4mm at 9 months. Bob- I can’t say enough about how great the results of LPT are. Janet- lesser pockets respond very reliably. The more people hear what you can do non-surgically, the more really bizzare cases you’ll start to get. I never had cases like this before I had the Periolase. Best of luck to all!

    #5477 Reply

    Robert Gregg DDS
    Spectator

    Bruce,

    Thanks for posting your experiences. I have had similar experiences as well. And your comments could have been written by a number of our Periolase practitioners.

    I think the profession as a whole doesn’t “see” the extent of the disease state of our own patients the way they need to be appreciated, and I think we literally do not see the severeity of case types of patients who quit the dental profession because they were given treatment options they refused to “buy”.

    Thanks so much for sharing your perspectives Bruce.

    Millennium doesn’t just sell a laser, we sell an understanding and appreciation of perio disease AND the methodology and technology to successfully reverse it and maintain stability.

    As Lloyd Tilt, DDS, MS–a periodontist and PerioLase owner of over 4 years–has said (paraphrasing), If you are not getting the resolution, regeneration of bone and attachment gain, it’s not a failure of the technology or the technique. There’s something that hasn’t been addressed.

    But here is a quote for use with permission:

    “Promoting bone regrowth is the best thing I’ve seen in 35 years of practice. I’m just glad I’m still practicing to witness this new standard of care”
    — Dr. Barbara McDaniel, Dallas, Tx. PerioLase owner 18 mo

    Barbara was ready to retire. Then she saw a presentation I gave in Dallas–and the x-rays. She told me that this is what she has been waiting for all her career.

    Bob

    #5475 Reply

    John Eaton
    Spectator

    Bob et al, this is my first post on the forum.  I purchased the Periolase at the Dentaltown meeting in March.  I am really looking forward to having such a powerful tool at my fingertips and I am thrilled to be able to offer a new and greatly improved avenue of treatment for Periodontal disease.  I look forward to many discussions both here and on Dentaltown.

    One question.  How many periolase users are there out there?

    (Edited by John Eaton at 2:30 pm on April 15, 2004)

    #5480 Reply

    Robert Gregg DDS
    Spectator

    Not enough!!;)

    #5470 Reply

    kstringham
    Spectator

    I am new to the forum and have had a diode laser for 9 years. I am looking into a new laser and am intriqued by the claims of the Periolase. Can anyone tell me if this is a doctor only procedure or do your hygenists use the laser?

    #5473 Reply

    Glenn van As
    Spectator

    Bob Gregg posts LOTS here and as the co owner and co developer with Del McCarthy (who also posts here) he knows the most about the system BUT as someone who has spent quite a bit of time with Bob over the years (Purely plutonic!!) I can tell you that LANAP is not something delegatable to the hygienist.

    Doctors only, and the combo of the wavelength and the protocol is what works for Bob and so many others.

    Glenn van As

    #5478 Reply

    Robert Gregg DDS
    Spectator

    Glenn has got it right.

    And we do “hang out” together from time to time……;)

    Bob

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