Forums › Laser Treatment Tips and Techniques › Soft Tissue Procedures › Removal of fibrous lesion
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dkimmelSpectatorRon, Thanks for making a spot . Should turn into a great place to quickly find relevant article. Maybe we can get hack2 to post a few of his!!
I have used the wand with the laser for some TMD patients. Thought about it with the tongue. Pretty tough getting back in the posterior regions .
David
dkimmelSpectatorRon, So smart you are! Used the wand with the Lasersmile. 5W 15 sec. continous. Results maybe be better then with the Waterlase. Bit tough in the posterior but much faster and no water.
We are on day 10 and it has almosted cleared up. In the past she would have been full blown and looking at a month to get to this point!
David(Edited by dkimmel at 11:41 am on June 27, 2003)
AnonymousGuestOk David, now I’m going to do what Bob Gregg 😉 used to do to me when the board first started.
Why did you use the settings and times you used , and how did you arrive at them? Why that time? Why continous as opposed to pulsed?
Don’t in any way take this as me trying to be difficult, but one of the great things Bob Gregg taught me was that, as a laser user, you better have good reasons to do what you did and be able to defend them (witness the hack2, rfw, azoperio posts on DT). The other reason for the question is I’m still learning and like to see how people arrive at the treatments they do.
Glad the suggestion appears to be useful,
dkimmelSpectatorRon, You got me! I just pushed the buttons and fired her up. Lased away.
As I said before I am real bad with articles. Somewhere I picked up using the Diode at half the Watts(5W) in the bleaching mode for 15 sec. It sounded pretty good but I did the math. Came up with a dose of .15 J/cm2. This is seemed a rather low value . If you use a 1 J/cm2 as max. Since less is better, I fiqured I could retreat.
The patients feedback after treatment determined if retreating was indicated. None was. She could feel the decrease in swelling rather quickly. At first I though I was numbing the area, but 6 hours later to still have no pain is not form numbing.
Continous vs pulsed? I really can not justify why I did not us pulsed. Most of what I had read was with continious! Any thoughts on using pulsed over continous.
Bob is right and so is hach2. Looks like I need to have my ducks in a row.Speaking of ducks.
How are you writing up your charts. Are you giving specfic settings that you are using? Indicating the estimated dose given?
David(Edited by dkimmel at 5:19 pm on June 27, 2003)
AnonymousGuestQUOTEQuote: from dkimmel on 5:15 pm on June 27, 2003The patients feedback after treatment determined if retreating was indicated. None was. She could feel the decrease in swelling rather quickly. At first I though I was numbing the area, but 6 hours later to still have no pain is not form numbing.
Continous vs pulsed? I really can not justify why I did not us pulsed. Most of what I had read was with continious! Any thoughts on using pulsed over continous.How are you writing up your charts. Are you giving specfic settings that you are using? Indicating the estimated dose given?
David(Edited by dkimmel at 5:19 pm on June 27, 2003)
David,
As I understand it (any experts feel free to jump in and correct me ), the dose is more important than pulsed vs. continous. Low pulse rates seem to give better results than high rates (T. Karu book).
Did your patient feel any thermal effect? I know that, one of the things Del told me about using the nd:YAg to treat a sprain, was to get a thermal effect w/o causing pain. Was your patient’s relief, before or after feeling a thermal effect (if she did)? Just curious.
As far as notes go-
I’d enter the following e.g for troughing
Diode 1.0CW PEW (CW = continous wave, PEW= protective eye wear)
If it was biostim I’d include time and whether it was the fiber or the whitening attachment .One of the great things about the Periolase MVP 7 (nd:YAG) is that the machine records Joules and can print it out w/ the operator and patient name on it- really cuts down on chart entry. Just one of those things that Bob and Del knew to include because they actually use the laser they designed (wish the Waterlase and Lasersmile did the same).
dkimmelSpectatorRon,
She felt better after the thermal affect.
Bob and Del are really starting to tick me off!! Why did they not go to DentalTown in Vegas. I hope they make it next year.
I am finding that keeping great records are a must with the use of the laser. You tend to get a few more of the dental delights then usual. I had one the other day. We worked on tooth#2. Four days later she has a numbness feeling on her lower lip. She wants to see me right away as she has had a bad reaction to the laser. The bad reaction was that she has been chewing on her lower lip. She is wound rather tight! Just reinforced the need to document!
David
AnonymousInactiveSorry we didn’t get to you first David. Wish we could be more places at once to share. Yesterday we had three places to be at once and so Bob’s family suffered because he was doing training. Don’t get me wrong – we truly love what we’re doing – but it does come with a price. We do feel it is worth it though.
N8RVSpectatorI just did my first soft-tissue lesion removal with my Er:YAG laser and could use some advice.
1 cm fibrous lesion on the lower lip of a 60-year-old woman. Been there for decades, no discoloration or alteration, asymptomatic — except when she accidentally bites it.
After discussion about whether and how best to remove it, she opted for using the laser.
I used topical only (2.5% lido/prilo creme) and the soft-tissue tip on the laser at 10Hz/35mJ. Going was pretty slow. Then I realized that the settings on this laser were different from the ones I was used to. My normal setting would have been 25/150, so I adjusted. It was still pretty slow going and there was no charring of tissue. The patient reported no sensation and there was very little bleeding. I did, however, note some discoloration of the laser tip.
Post-op instructions included offering to recontour the area after healing if needed.
I was surprised how slowly the laser cut through the tissue with the soft-tissue tip. I’m used to doing some slight gingival recontouring with the 30- or 80-degree tips and watching it melt away.
Anyone have a recommendation for more effective settings when doing this kind of surgery?
Thanks,
Don
kellyjblodgettdmdSpectatorDon – Do you think something was wrong with the tip? If you were using 25Hz and 150mJ/pulse (3.75W), this should be blazing through the soft tissue, especially w/ an Erbium laser. Something’s not adding up.
If the tip wasn’t transmitting the energy properly, this might explain what was going on. Also, it would put your handpiece at great risk. What model Er:YAG is this?
Kelly
N8RVSpectatorHey, Kelly —
I’ll be sure to mention it to the repair guy. It’s a Hoya DELight. Yeah, I was surprised how slowly it cut through the tissue.
FWIW, a followup call to the patient yesterday afternoon yielded the news that she continued to be pain free and doing well.
— Don
kellyjblodgettdmdSpectatorGreat – the patient’s health and perceptions are the most important part. Glad to hear she’s doing well.
Kelly
AnonymousGuestDon,
I agree w/ Kelly. Way more energy than should be needed. I’ll do fibromas w/ topical at .75-1.25 W.I’d put that tip aside and not use it anymore. Look at both ends of the tip for brown or darkspots. It would also be good to check the output of your machine w/ a power meter to make sure it was only a tip problem. If you do a search there are some posts about power meters or just get the rep out to check it. My concern is that from the energy not going thru the tip as it should you may have damaged the fiber/handpiece also.
ASISpectatorHi Don,
How is your Delight performing otherwise? If it is fine, than it may well be just that soft tissue tip. Was the tip threaded onto the sleeve all the way? I am certain you have already checked that.
Andrew
N8RVSpectatorThanks for the input, guys. I’ll have the rep look at the tip tomorrow when he installs the new DELight.
Yeah, the final resolution of my ordeal with the laser seems to be finally approaching. Since they can’t seem to figure out what’s going wrong with my laser, they’re replacing it. The fiber checks out OK, and aside from some bad sleeves and tips, it just doesn’t seem to work at times.
If the new one works like the loaner, I’ll be happy.
Since this was the first time I’d used the soft-tissue tip, I was wondering what would have been wrong with using a 30-degree hard-tissue tip? I’ve never had any problems ablating tissue with the tips (when recountouring gingival tissue during a restoration, for example) — it goes through like a hot knife in butter.
Thanks again for the tips,
Don
N8RVSpectatorJust an update on this treatment of a fibrous lesion …
The patient was in today for her regular recall appointment and I took a look at how the site had healed. She exclaimed that it was “nearly gone” after only a couple of days, and that she never had any real discomfort with the procedure. (Since her daughter is a lawyer, I was somewhat relieved to hear that!)
Sure wish I’d had my nifty digital camera when I did the procedure to completely present the case. However, since I just got it, you’ll have to take my word for it that there really WAS a 1cm fibrous lesion where the red circle is.
I’m anxious to document a similar case in the near future. It’s not big stuff, but it’s nice when it works for both us and the patient.
–Don
Edit: Well, I THOUGHT I had added a photo, but it’s evidently not here. Sorry.
(Edited by N8RV at 5:16 pm on Sep. 15, 2004)
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