Al, You flatter me! When you do more and more, they get faster and easier, and you ought to try, just to “do it” one without the diamond. I really like what you are doing. Great post. No, I wouldn’t laugh at you! I am sitting here smiling, knowing that you are outside the envelope, and should be proud of yourself. My initial crown preps were flukes, patient wanted them, BUT since then, I have developed the technique much further, and quicker. I am developing tips with Biolase, that should help us out too. Hopefully available soon. This is why I published the article, to stimulate, and get others to do neat things, thanks for taking it the through the steps you have with the “modified” technique. Have a GREAT and Happy Thanksgiving!
Mark

Al : Many times in various formats I am accused of slandering Biolase, but I want to personally say that I love what you did.

The photos are exceptional, the treatment and dentistry sublime.

I think that a diode, Nd:yag or other dedicated soft tissue laser is a little easier to cut the tissue with for hemostasis but your impression speaks volume for your technique .

The sharing that goes on here is exceptional and the comraderie without equal…………

Congrats to you and your patient has been better served even if you dont look at the microfracture issue and only concentrate on the pulpal temperature rise with diamonds versus the laser. Perhaps long term there will be less endos doing the gross work with the laser and the finishing at low revolutions with an electric handpiece………..

My feelings are………

CLAP CLAP CLAP……..thanks for sharing.

Glenn

A,
I strongly support the fine word forwarded to you! The wow moment for me was realizing since Mark and you can do it, it is probably possible. Which means I can’t wait for that next crown prep opportunity. Like you guy and gals I am having fun. I noticed this morning I began preping the tooth with a defocused 4W which was a step up for me and it seemed natural.

Anyone taking mobile primary teeth out using the laser to “anesthetize” the soft tissue? I thought about it this morning but got cold feet.

Pat

Great job Pat! Congrats on your boldness to move forward. I hope it was easier than you thought it would be.  To answer some of your questions, the best I can…

“What are you doing to smooth out the rough and irregular surface? “

If you angle the tip, so you “shave” the tooth on very low power, around 1.25-2.25W with 40%air, 20-30%water, you can smooth it that way, which is the way I did it. You can actually see the shaving taking place. We are developing new tips to try to acheive this, but I don’t have em yet!

“Are the white pocked margins on the shoulder a problem at the lab? “

No they are not, again, lower the wattage to 1.25 or less with 30%air and 20% water to acheive margination, it was surprising how well this worked for me. The lab has had zero problems finding and getting great margination for me.

“I had a hypersensitive patient today.  I “Anesthestized” the tooth at 6W for 45 seconds on a lower first molar and he kept jumping when the laser touched his tooth as the cervical facial (4w).  Does a second “anesthetic” prep of 45 seconds usually help?  It did not help in this case.  Is this a time for the local anesthetic?”

First of all, I recommed at least 90 sec anethesia time, not 45 seconds. Also, on a cervical area, you really need not have your settings any higher than 1.25-1.75W with low air and water. It usually is a very sensitive area anyhow, lower settings usually work much better in that area. 4W in my estimation would be way too high. One of the things I have learned from Bob Gregg, Glenn Van As and Stu Rosenberg is that the lower the power you can use, the better in most cases for all procedures. I only use higher wattage when I am anesthetizing and JUST getting into the enamel on a class I or II. As far as using a local, you could have, but I think if you decrease your power settings, you would have success.

“When I use the laser to trim back tissue around a crown prep I get white pocking on the prep margin.  Is this a concern?”

It can be. Make sure you are angulating your tip correctly, it is END cutting so you should not get any collateral effect if the angulation is correct. That is my experience so far.  In addition, I use a T-6 tip to trough, I like it better. I can use less energy, usually .25-.5W with 11%air and 7%water, it’s only 200 microns so it’s smaller, with less chance of collateral damage even it the tip isn’t angled quite the right way.

I sure hope I have helped you see a few things. I am no expert, but I DO try a ton of things everyday. I learn more from all of you everytime I read something here, so if I can pass a tidbit along once in a while, it makes me feel like I am contributing.

BTW, I removed an amalgam yesterday, without local, did what you guys have been teaching ME, and it worked like a charm. Used the high speed, after anesthetizing, and then back to the laser to finish, the patient thought it was way cool, and then his wife came in later that day and said he couldn’t stop talking about it! How’s that for internal marketing!!! Love that laser!!
Mark

Mark,

You are a great help. I know I was suprised at how fast I preped with the laser and I see from the pictures I was about right in my procedure. I will add your suggestions. I suspect you will talk about this at Dana point and thought it would be good to do one or two before I get there. The desensitizing method for the cervical makes good sense and I will try this.

Completed four restorations on a three and a half year old today. No problem. Her mother was impressed.

A fellow came in because of a lost filling which was actually enamel fracture around decay. I cleaned it out with the laser and placed a temorary as we planned for a crown( another new patient arrives). As he was leaving he said his son had been to the dentist two days before and had two cavities and he wanted to know if he could bring him to our office for laser care. I won’t be high on that dentist’s list.

I find myself roughing up the abutment prior to cementation for sterilization but also for retention on short crowns. What do you think? Where is Whitefish I couldn’t spot it on a travel map? But then I just discovered that you need to click on page two and three if you want to read those messages.

Pat

Pat, I think it’s great to rough up prior to cementation, remove any smear layer, and give yourself optimum retention. I do that quite often. Also, Whitefish, is in Northwest Montana, about 22 miles due west of Glacier National Park. You ought to come visit sometime!
Here is a picture of our view!

Thanks for sharing guys, this stuff is a blast! Glenn, I understand your lack of patience, BUT, I feel that it is such less trauma, for the LITTLE bit more of time it takes, and without anesthetic, which is safer, it’s worth it to me. And of course, no more  cracking, and crazing…etc…you know. Just my anal thinking I guess. BTW, Global emailed me, should be seeing a scope soon! I can’t wait. Christmas is right around the corner!
Mark