Forums Laser Treatment Tips and Techniques Hard Tissue Procedures I’d like to see the basic stuff

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  • #3500 Reply

    pfgetty
    Spectator

    A lot of you guys have long ago posted and talked about the basic stuff………..pedo preps, class two preps on molars and premolars, etc, etc,
    But I don’t have a laser, and if you are doing this stuff I’d love to see cases that aren’t 4 years old…………I know you guys are doing these still and to you they seem routine, of course. But you know more than you did a few years ago when you started doing them. So how about some updates and show how the preps should be prepared, how you remove the decay, how you finish the margins, the use of acid etch and bonding, whether you could use Fugi IX if you wanted, etc. etc.?

    #11869 Reply

    dkimmel
    Spectator

    A challange??
    A call to action??
    You are correct in things are not the same as 4 years ago…

    This is a tough time of year though to ask. One very busy last day of the year for me tomorrow…

    I’ll have to get back to you in Jan….

    David

    #11873 Reply

    pfgetty
    Spectator

    Thanks for the reply, and I am in no hurry at all.

    #11874 Reply

    Glenn van As
    Spectator

    Paul……..you are on.  I will begin to post the small stuff.  The stuff everyone buys a laser for and then moves on.  I will start by saying that for the most part I use the laser for restorative dentistry in the following situation.

    1. Pedo (kids are great with the laser) especially the interproximal back to back lesions on the primary molars.
    Great to do without anesthetic but you have to develop soft touch on the tissue with matrices and topicals work great for that.

    2. Adults

    Class 1 and 2s that are small (ie less than 40 on the diagnodent) and only Class 2s where the patient is adamant that they want it done with the laser.  ITs slower and I charge more for it.

    Anterior Class 3, 4 and all Class Vs are great with it.  Its not a panacea for all but I tell you , patients love it when it works.

    You need to use resins or GI for these preps as they are rougher, so amalgam is not possible.

    I will post some “beginner ” stuff or bread and butter stuff over the Xmas season as time permits.

    Hope this helps you but many buy the laser in the hope of being faster, being able to do tons without anesthetic but as my good friends Kimmel, Williams and McNamara say, the key is to success without anesthetic is patient selection and trial and error gives you some idea as to what will work without anesthetic and what wont.

    One change in settings that has occurred over the years has been a gradual reduction for enamel ablation from Higher Hz rates (pulses per second ) to lower Hz.  In the old days most of us would use 30Hz on the Delight and on the old Waterlase it was always 20Hz as that was the only setting.  Alot of Opus users were able to penetrate enamel at 10Hz and very high energy per pulse (the Opus Principle or the Jackhammer (high hertz) vs the Sledge Hammer (low hz) effect).

    Effectively this did a couple of things.  It gave more time between pulses for tissue relaxation and each pulse was at a huge energy compared to the old days.  More chance of success in decreasing sensitivity during the preps.  

    In addition another change I have seen is in the bevels on Class Vs, 2s etc at the cavosurface margins.

    More and more people are using lower energy settings and higher Hz for a smoother cut that doesnt give such a big ablation crater per pulse.  What these big ablation craters did was decrease bond strength leading to staining at the enamel margins so people now use say 40-50 Hz and 30-40mj which gives a smoother margin and better bonding.  I will scrape the margins with a spoon, some use a diamond , others AA.

    One last suggestion for someone looking into lasers.  Make sure that you are using good magnification for laser dentistry.  Loupes above 4.5X make it far easier for the hard tissue lasers and to a lesser degree soft tissue lasers to see what you are doing.  Hard tissue lasers depend far less on tactile ability than do other aspects of dentistry.  You dont feel what you are doing , but you must see what you are doing.

    Hope that starts you off on the right path.

    Glenn

    Here is one case where I did some Class Vs

    Diode used at 0.8w pulsed with TAC topical.
    Erbium for preps on Abfractive lesions (patient wouldnt go for grafts and it was sensitive).  50 Hz and 30-40 mj on enamel for bevel.
    Point 4 opaque flowable for material.

    Simple, no anesthetic laser preps.

    Glenn

    Class V standard_resize.jpg
    Class V restoration.jpg

    (Edited by Glenn van As at 2:36 pm on Dec. 22, 2005)

    (Edited by Glenn van As at 2:38 pm on Dec. 22, 2005)

    #11876 Reply

    Glenn van As
    Spectator

    One more before I go back to work. Here is one recently on a canine without anesthetic on the lower. A class 3. I nicked the adjacent tooth with the laser for 3 pulses as you can see. THe initial entry on this was at 10Hz and 220 mj into the enamel. Decay removal at 20Hz and 100 mj and finally bevel at 40Hz and 50mj ( a little heavy for me).

    I placed the restoration in with a hybrid , Gradia.

    Gotta run, hope this helps. Off to do 2 occlusals with the laser. Will post them.

    Glenn

    Class 3 edited.jpg

    #11872 Reply

    pfgetty
    Spectator

    Thanks, Glenn.
    That is just the kind of thing I need to see.

    They looked very nice. I’m surprised the whitish ring around the restorations disappear with the final bonding and filling.

    #11877 Reply

    Glenn van As
    Spectator

    Paul , it is absolutely CRITICAL that you use the right settings to get rid of the white line.

    You must cut way back on the energy setting because if you use enamel settings , the ablation craters are so large that you will see all the white spots afterwards.

    I bevel at

    40Hz and 40-50 mj
    or sometimes 50 hz and 35-40 mj

    Some scrape the bevel with a spoon afterwards, or Air abrasion or a diamond to remove the white spots.

    I repeat dont use Enamel settings where the mj is 300-400 as you will see the white spots.

    Glenn

    #11870 Reply

    owlish
    Spectator

    Glenn
    thanks for all of your informative posts. I have recently purchased a laser (an Opus duo) and would like your thoughts on the learning process. Is there an authoratative text for laser procedures? It seems like there is not, yet? I feel pretty confident about the physics, and I’ve had Opus’ basic wavelength certification class, but I’m wondering where best to put my money and time next? How do you feel about the ALD? Is the Tuscon meeting a ‘must’?

    #11878 Reply

    Glenn van As
    Spectator

    Hey there Owlish……welcome to the wonderful world of laser dentistry. If you send me your email I will send you a PDF of the chapter I did on Erbium Yag Laser dentistry for Dental Clinics of North America , its a little scientific but at least with the PDF the photos are in color.

    I like the ALD but its scientific. There are alot of good meetings depending on what you are looking for. I dont know if Opus still does the Symphony of Lights symposiums, or if anyone is doing any hands on specifically for that laser.

    If not, then you are looking at a general meeting like the ALD or Bob Greggs great laser lecture in February in Vegas (18-20th I think)……….

    Tucson is a bit more scientific

    Bobs has a bent towards NdYAG and his Periolase but alot of great minds for laser dentistry are out there.

    You can get Jeff Mannis textbook on laser dentistry, also get started reading posts from here on the Erbium Yag forums and Dental town as well.

    I really think that there are a ton of bright minds. I know that Jeff Cranska (aka Benchwarmer ) knows the Opus laser pretty well.

    Please tell me what you are looking to do……..learn your laser better, learn about lasers in general, learn about Erbium lasers as I can direct you into different directions depending on what you want to accomplish.

    Take care and thanks for the kind words…..

    Glenn

    #11879 Reply

    Hubert
    Spectator

    Hi Glenn,
    Hi owlish,

    Glenn, if you don’t mind I would definitely like a copy of your chapter on Er/Yag as well. My e-mail is
    [email=”docHu@t-online.de.”]docHu@t-online.de.[/email]
    Owlish, congrats on your purchase! You made the right decision as the Opus is really a wonderful piece of equipment.
    What exactly would you like to know about the use of the Opus? I visit this forum not on a regular basis due to lack of time but if you dig in here you will find a wealth of information unlike any other place I know of on the internet. If you have any specific questions let me know. I will try to answer them from my personal Opus perspective and experience. Post the Q’s here and mail me privately so I will know you asked a question, if that is okay with you.
    Re the ALD, preparing for the standard proficiency and taking the courses they offer really gives you a sound knowledge, unbiased, that you can always relate to.
    BTW, I plan to attend the Tuscon Meeting and this time I hope to socialize more than in New Orleans, as I was really preparing for my Standard Proficiency Exam.
    Glenn, keep up the wonderful work and inspire us!
    You all take care
    Hubert

    #11871 Reply

    owlish
    Spectator

    Hubert,
    thanks for the offer. I am getting a good feel for the machine, and have scheduled simple, predictable procedures to get my feet wet. I will post questions as I think of them.

    #11868 Reply

    Anonymous
    Guest

    Pretty basic laser assist w/ extraction-

    Preop-

    30ext1.jpg

    Section, Er:YAG 300mj/20hz 80 degree tip

    30ext2.jpg

    Trough bone- 200/10hz

    30ext4.jpg

    Immediate post op-

    30ext5.jpg

    2 twists of straight elevator and we’re done. Didn’t use nd:YAG for coagulation because site just didn’t bleed much in mesial area of socket.

    Again, can be done w/o laser but just a little easier with.

    #11875 Reply

    Glenn van As
    Spectator

    Awesome Ron……….WOW.

    I love it. The sockets always look so clean. Now tell me did you do this with the scope.

    Isnt it a joy to be able to watch so clearly how you are doing with the laser tip at 80 degrees .

    The water spray makes things visible compared to a bur.

    The healing is always awesome and I dont think I have had an infection after one of these.

    Great photos by the way……..you nailed everything about this case, the clinicals, the laser usage and the documentation.

    CLAP CLAP CLAP

    Great stuff

    Glenn

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