Laser apicectomy

[ericbornstein]

Dr Milicich:

Nice case. I have done many of these with my Opus Erbium lasers.

In my opinion, the sparking that you are seeing is probably more from the Zinc Oxide and/or Barium Sulfate impregnated in the GP cone (for radiopacity) than from the cement. Just make sure you have good evacuation and heavy water spray on the area being irradiated.

Eric Bornstein DMD

[Robert Gregg DDS]

Very nice case.

Local anesthetic?   What type?  Topical used?

Excellent photo quality, color balance and image clarity.

What camera set-up are you using.

I’ve been using a Global scope and a Nikon CoolPix 4500.

Thanks,

Bob

(Edited by Robert Gregg DDS at 9:39 am on Sep. 18, 2003)

[marc andre gagnon]

hi
I have done some cases like that and like you say it’s probably the type of cement that have been used whhich is the cause of that sparking
I have done like eric cases like that with erbium and with diode 980 and in all the cases we have very good results
excellent photos
thanks for sharing with us

[Swpmn]

Excellent. Did you close with sutures? Could laser “tissue welding” have been used, perhaps with a different wavelength?

Al

[Graeme Milicich]

QUOTE

Quote: from ericbornstein on 8:07 pm on Sep. 18, 2003
Dr Milicich:

Nice case. I have done many of these with my Opus Erbium lasers.

In my opinion, the sparking that you are seeing is probably more from the Zinc Oxide and/or Barium Sulfate impregnated in the GP cone (for radiopacity) than from the cement. Just make sure you have good evacuation and heavy water spray on the area being irradiated.

Eric Bornstein DMD

The sparking was only coming from the walls of the canal. The GP cut out without problem. On all the other cases, there has not been any problem with the GP, just on a couple of occasions with the cement
Cheers

[Graeme Milicich]

QUOTE

Quote: from Robert Gregg DDS on 9:37 pm on Sep. 18, 2003
Very nice case.

Local anesthetic?   What type?  Topical used?

Excellent photo quality, color balance and image clarity.

What camera set-up are you using.

I’ve been using a Global scope and a Nikon CoolPix 4500.

Thanks,

Bob

(Edited by Robert Gregg DDS at 9:39 am on Sep. 18, 2003)

LA was used. (Xylocaine) Patient was not one of those you would push the boudaries with!!

The photos were taken with a Reveal intraoral camera. I find I can get better views with it compared to the Microscope where I am often using a mirror. These tight areas are sometimes difficult to get a straight line view of with the scope and I find using mirrors slows you down too much. (The whole case including photography took 30 mins)
Cheers

[Graeme Milicich]

QUOTE

Quote: from Swpmn on 4:17 am on Sep. 19, 2003
Excellent.  Did you close with sutures?  Could laser “tissue welding” have been used, perhaps with a different wavelength?

Al

I closed with sutures. There was too much tension on the incision site to close with welding. I would only attempt to close with welding if the incision line is passive.
Cheers

[Glenn van As]

Nice case Graeme and nicely documented…..clap clap clap.

I will say that Dr. Gary Carr makes small mirrors that are super reflective, will get into these hard to reach areas, have necks that are bendable on them.

THey are marvelous……..

Great pics and thanks for sharing.

Glenn

PS I am gonna do one too one of these days but I wont try to break your 30 min mark.

Grin

glenn

[Graeme Milicich]

I have now got two month follow-up Xrays.
Here is the post op Xray and then the follow-up at 2 months.
I have to say I am impressed at the healing that has occured already.

Cheers

(Edited by Graeme Milicich at 3:29 pm on Oct. 21, 2003)

[Swpmn]

Me too. Looks very nice Graeme.

Al

[ASI]

Very nice case, Graeme.

What was the material for the retrograde fill? Not back bone fill in just 2 months.

Andrew

[Graeme Milicich]

Retrofill was MTA

The infill of bone amazes me. Tee Xray was taken 9.5 weeks after the initial one. I didn’t place anything in the site following the debridement.

Cheers

[jetsfan]

Here is my first max molar apico.
Patient had endo done and  redone but pain persisted. Endodontist believed MB root probably sticking through buccal plate and needs apico. I told her I would do it with Waterlase. I used .5Carpule 2% lido 1:100,000epi.
outlined semilunar incision at .25W, then incised at .5W 11A 0W.
Flap elevated and sure enough there was the MB root. At 1.5W 15A 15W I enlarged the opening in bone, curetted granulation tissue, bevelled root and sterilized area. As patient has trouble taking oral meds I filled bone cavity with atridox, then sutured.
Patient did great, procedure was quick and post op was uneventful and her pain is gone.(I an not very good at posting photos. I hope the sequence is correct.)

Robert.

[Lee Allen]

Robert,

Nice case and nicely done. I too have a Waterlase and have done only a couple but our technique is similar. I do use some water during incision only since I have done some non anesthetic skin tag removal on myself and find that it is HOT without some water. The heat must have some latent tissue effect. It does however have less bleeding without as your photos reveal. Nice posting of the photos, by the way.

I noticed that you did not use a retofill. Was it because your case was clean at the apex in comparison to Graeme’s case where the apex had a discoloration around the apical foramen perhaps indicating a leakage or intracanal chromatogenic bacterial saturation prior to the fill ?

Did your endodontist have some idea where the MB canal was so you could make the cut accordingly? I have done molar endo for 30 years and find those 4th canals end up in the strangest places sometimes. It would seem important to retorfill if found by apical cut. I wonder if you go success from cutting back to a place below the accessory canals? Who knows?

I have never tried the Atridox in the apical surgical site before but like the results you got. Is this your standard modus? Are there times when you would not place it?

Post Op pain is very difficult to manage since it comes from so many possible origins. You did well to erradicate it for your patient. Well done.

I just reread this message and realize that while I wanted to comment on the success but found that I have left you with many questions unintentionally. Sorry, but this helps me figure out how best I can use this for my patients with endo PO pain.

[ASI]

Hi Robert,

Nice handling of the case. Thanks for sharing.

Can you post the pre-op PA if possible?

Do you think if the MB root wasn’t exposed through the buccal plate, it would have made any difference as far as persistent periapical infection is concerned?

Thanks.

Andrew

[Author]

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