Surgical Extraction - Laser Dentistry Forum

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January 29, 2003 at 11:56 pm #3493 Reply

Anonymous
Guest

Hi all,

After a morning of discouragement with the Er,Cr:YSGG (2nd molars on females 14-25 are something else aren’t they?), I decided to get a little laser assistance with a surgical extraction of a fractured endo tooth (Pt didn’t have &#36 for crown lengthening)

Preop images

.

Used Er,Cr:YSGG 4.0 W 50 h20/40 air with 6mm tip. Place tip interproximally to remove bone mesial and distal.
Post ‘troughing’ image

Elevated 2 pushes on distal and 1 push on mesial and out it popped.

Extraction site Image

Extracted Tooth Image

Patient was thrilled. I had told her ahead of time that conventionally we’d flap, remove bone with burr, suture, and that the tooth would break up and she’d be very sore afterward.
I think she’ll do a little better than that

January 30, 2003 at 1:23 am #11794 Reply

Patricio
Spectator

Ron,
Great presentation. Great idea also. This use is one more reason to support the fact that we are working with the next generation technology.
Pat

January 30, 2003 at 1:46 am #11795 Reply

Robert Gregg
Participant

Awesome Ron!

I was asked this past weekend if they could use a pulsed Nd:YAG to break the ligaments around the tooth and use the laser to extract.

I said, “NOPE!” You need an FR Er:YAG or YSGG for that. And that ought to work out very nicely.

And Ron, what a nice case you demonstrated that for all of us.

I’d like to encourage you to do that in more clinical situations, like ankylosed teeth.

Bob

Bob

January 30, 2003 at 2:43 am #11783 Reply

jetsfan
Spectator

Ron,
I had a very similar case last week. Just finished endo thru
patients old crown. She returns two weeks later with the crown loose due to fracture subgingival, subcrestal. First I t told her that she was going to lose the tooth. I then turned to my handy dandy Waterlase and told her that I would like to try to save the tooth(root). She agreed and I then preformed a crown lengthening. I must admit there was more bleeding than I would have liked , so I used some cuttrol to control bleeding. A post was then placed with a luxacore buildup. The patient returened to my office today. I was concerned as to what I would find. She reported absolutely no swelling, and took not a single pain med. I prepared the tooth for a crown and was so excited to see how well the procedure worked out. She was naturally quite pleased. My only regret was that I took no photos.
JETSFAN

February 3, 2003 at 10:57 pm #11780 Reply

Anonymous
Guest

Follow-up on surgical extraction. Patient only needed ibuprofin 1 day post extraction.

4 days post extraction image

February 4, 2003 at 6:17 am #11789 Reply

Glenn van As
Spectator

RON: CLAP CLAP CLAP……..what camera are you using, its not your IO cam anymore and those are excellent photos.

Nicely done……..gotta go through 1000 emails as I was lecturing on board a cruise ship for a couple of days.

Glenn

February 4, 2003 at 12:04 pm #11781 Reply

Anonymous
Guest

Welcome back, Glenn
1 year ago I took a computer class and a guy in there did digital imaging for a living. He said he was putting together a dental package and I decided to give it a try. The camera is a Fuji finepix s602 zoom with a ring flash. 6.0M recorded pixels,3.1 M effective.4.4 digital zoom, 6.o optical.The ring flash is difused with whiteout (like you use for typing mistakes). It also has a UV filter , external 4 hour battery pack. I’m still learning, but so far I’m happy with it especially since the whole package was under &#361200. The camera guy said he had a couple docs trade in there S2’s for it because the images were close to the same.

February 4, 2003 at 11:15 pm #11796 Reply

Swpmn
Spectator

Nice case Ron and great photos!!!!!

Al

February 5, 2003 at 4:30 am #11787 Reply

Glenn van As
Spectator

Here is something I havent seen Mark or anyone else do and I feel like there arent many things that havent been done by these gurus.

I had a patient who vertically fractured the lower right first molar and then on the extraction I had a heck of a time getting the roots out.

Finally got it all but the sequestrum came up on the lingual and in addition there was a sharp bony fragment that was poking through the gingiva so I decided to try and smooth both out without anestethetic.

Placed topical that was it and then used the laser to remove the sequestrum (it actually flew out of there and was maybe the only sore thing) and I smoothed off the bone as well as sterilizing it.

Settings were 30 Hz and 30 mj with lots of water and air in the beginning and afterwards ( a minute or so to get him used to it) I bumped it up to 30 Hz and 70 mj and the patient didnt feel anything at all.

I really was surprised at how nice the loose part flew out, and how easy it was to smooth down the bony fragment………

Mark did I beat you to the punch?

GRIN (probably not) .

I was so tempted to put anesthetic in but now feel impressed that I did it without. Gosh sometimes its hard to let go of the feeling that you have to have anesthetic.

Glenn

February 6, 2003 at 12:44 am #11797 Reply

Swpmn
Spectator

That’s one cool case Glenn!

Those bony spicules that are still embedded and you can’t quickly pick out with cotton pliers can be a real pain ’cause the patient always pops in at the worst time! Then you have to anesthetize and try to smooth down with a handpiece.

Would be great to just use the laser without anesthesia to smooth out or dislodge the irritant.

Al

February 6, 2003 at 3:27 am #11790 Reply

Glenn van As
Spectator

Hi Allen: I was so tempted to use the syringe but thought I would try it knowing that bone has no pain fibers and sure enough it worked WITHOUT anesthetic and the patient said he felt nothing.

The weird part was how the loose fragment FLEW out of there. That was eery.

Thanks for the compliment.

CYa Allen

Glenn

February 13, 2003 at 2:32 am #11792 Reply

Happy2th
Spectator

QUOTE

Quote: from Ron Schalter DDS on 7:04 am on Feb. 4, 2003
The ring flash is difused with whiteout (like you use for typing mistakes).

What a GREAT idea!! My ringflash is almost too powerful for my digital camera and I think that this idea is going to be a godsend!!! Can’t wait to try it!

February 13, 2003 at 2:44 am #11778 Reply

Anonymous
Guest

Welcome to the forum, Rich.
The whiteout works pretty well, you just have to be careful as the whiteout will scratch off. I’ve had to do a little touchup once in awhile.

February 13, 2003 at 3:08 am #11786 Reply

2thlaser
Spectator

Glad to see you have got a nice camera set up Ron. Rich, Great to see you here, it was real nice to meet you in Vegas. Any questions when you get your laser, call!
Glenn, Hate to say it, you only beat me to the punch with the photos! I did a VERY similar case about a week before you posted yours. I have been lecturing in Dana Point and in Vegas, so I haven’t been on much lately. I had great results like you, and the healing is so darn fast. Patients LOVE that laser. How “quick” did the bone ablate for you in the smoothing process? When I use the Waterlase, it’s like a hot knife in butter, so I use very low energy settings, lots of water and air to keep the area clean of debris. Man, I can’t wait to get up and see you. I hope next month. Great stuff guys!
Mark

February 13, 2003 at 7:14 am #11791 Reply

Glenn van As
Spectator

Hi Mark………any time , just call in advance. I will be happy to have you come up and see the scopes and to see the waterlaser………I mean Delight Laser (grin)

I dont use mine all day like you but use it enough to make it very valuable.

Take care and let me know when so I can make sure I am not off lecturing.

Glenn
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