Exposure of canine for bracket - Laser Dentistry Forum

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February 23, 2006 at 10:45 am #3335 Reply

Glenn van As
Spectator

Did this one today before I left without anesthetic. Used TAC 20 topical with methylene Blue in it (just helps show it up a little bit better) and used the Er:YAG at 10 Hz and 40 mj with a 400 micron tip , no water but the assistant spraying a little air and water spray to keep patient comfortable. Quite a hunk of attached tissue we took off for the bracket (no photo of that as running behind).

I do this alot now when the patient is all lined up but the canines are taking their time. Watch for the attached tissue though as you must be careful to not cut all of it away……….it is a problem then that will require a graft.

Hope its interesting.

glenn

PS I used Astringident in an Ultradent syringe to get hemostasis quickly, could have used the diode too.

February 23, 2006 at 11:14 am #10320 Reply

Glenn van As
Spectator

PS – check out how even at 10 Hz and 40 mj you can still get some iatrogenic notching on the enamel surface in the last photo at super high mag!!

Cya

Glenn

February 24, 2006 at 7:52 am #10314 Reply

dkimmel
Spectator

Glenn that is a nice cut at 10Hz and 40mj. A lot smoother then I would have thought and no enamel ablation.
Cool blue color!!

February 25, 2006 at 2:41 pm #10321 Reply

Glenn van As
Spectator

David, my thoughts are that if you are doing work without anesthetic (chemical) that you should try to keep the Hz below 20 (most patients cant tolerate it) and if the soft tissue work is done with anesthetic then 40-50Hz is fine.

Magnification makes all the world of difference.

Glenn

October 4, 2006 at 12:17 pm #10317 Reply

kapalua
Spectator

Beautiful job on that precise clean cut. I assume this could also be done with an Odyssey 810 nm laser? What is the best topical to use and where can I obtain it?

Tom

October 5, 2006 at 12:38 pm #10318 Reply

Benchwmer
Spectator

Don’t try this with a Diode without local anesthetic.
Jeff

October 5, 2006 at 3:40 pm #10322 Reply

Glenn van As
Spectator

You can do this Jeff but you need to use low settings with a very strong topical like
EMLA, DRK liquid, TAC 20 etc.
I use 0.5 -0.6 w CW with this but leave the topical on for a while and use high mag because the tissue will not cut quickly. I have done these with the diode but its not as fast but it is safer to not cut the tooth.

Cya

Glenn

October 5, 2006 at 4:29 pm #10315 Reply

kapalua
Spectator

Thanks Glenn, Where can I obtain those topical anesthetics?

Tom

October 5, 2006 at 4:29 pm #10319 Reply

Benchwmer
Spectator

Glen,
I would use a pulsed, Nd:YAG for such a case.
I like being able to fire at the tissue w/o fear of damage to the tooth.
I’ve used Dr K liquid, now I have my local phamacist make me the potion all kinds of flavors, but for me it never is a replacement for LA during a NdYAG gingival surgery procedure. Works for some small Erbium procedures.
Glad it works so well for you.
Jeff

October 6, 2006 at 8:50 pm #10323 Reply

Glenn van As
Spectator

Hi there Jeff and gang.

EMLA is not available over the counter in the USA as it is in Canada.
I use Topical TAC 20 which is Lido 20%, Tetracaine 4% and Phenlyephrine 2%.

I get this from Professional Arts Pharmacy in Lafayette , LA.
Ph. 888 237 4737

I know Ron Kaminer has a DRK liquid that he helped make because he is fearful of sloughing and sytemic effects due to the lidocaine (hasnt happened to me) and he gets the liquid from

Whites compounding pharmacy 318 631 2005

I have cases I have done with the diode and it can be done, and I can post them but it takes longer and is more sensitive than the erbium. The erbium risks cutting the tooth. The NdYAG I dont have but it is a pulsed laser like the erbium and therefore can be less sensitive and because it is a soft tissue laser wont effect the enamel.

Hope that helps

Glenn

October 6, 2006 at 9:13 pm #10316 Reply

kapalua
Spectator

Hi Glenn,
I found EMLA in the Southern Anesthesia and Surgical catalogue.
Thanks for the info on the other topicals. I appreciate your help.

October 7, 2006 at 6:31 am #10324 Reply

Glenn van As
Spectator

My pleasure Kapalua……..hope it helps and be judicious with the stronger topicals as they can burn if left too long.

Gotta run……literally a marathon on Sunday so off to bed.

Glenn
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