Versed, and Class 2 laser restorations in children

[whitertth]

Ok Buddy I’ll Bite..
what is a Tband and where do u get them?
Also what did u restore with? I often restore With GI or Hybrid…I hate doing composites for these large restorations …A fun material is Magic Fill by Zenith…It is a GI Hybrid that comes in cool colors…Nice Job as usual….

[Glenn van As]

Hi Ron……you always ask great questions!!

I learned about Tbands in school. A funny story , someone broke into the dental school and thought these thin brass strips which you fold the tabs over to make a ring were in fact gold and stole a whole bunch. Kinda humorous actually!!

I dont now where you get them but they are strips which we fold the tabs over to make a ring. I like them for pedo as I can get a good shape to them.

I restored with Dyract flow (compomer) for these . I was thinking about a Stainless steel crown but was afraid of losing the child with the high speed for a long period of time. She was awfully upset on her first visit with me and I didnt want to risk it.

She was sure dopey……….

I have heard of Magic Fill, seen the photos but in this case mom wouldnt have found the colors too humorous but I think the GI is a great idea.

Hope that helps, the flow is not very durable to occlusion (better than the GI ) but it only has to last a couple of years.

Glenn

[Benchwmer]

Hey Glen,
Nice photos and presentation as always.
Questions on materials, what do you use for pulp capping, what did you use in this case?
How do the lasers fit in?
Thanks.
Jeff

[djjafish]

glen, i am curious to know what settings you used for the prep on this girl. i have really learned a lot from your posts. and i look forward to meeting you at the nash course in charlotte in november–i just got a flyer in the mail today.

dave

[Glenn van As]

Hi Dave: First off thanks for the very kind remarks. Next off alot of what I have figured out is due to me being able to see pretty well with the scope. For me that has been the key.

Next off with kids teeth I rarely have to put in anesthetic, or to use low settings unless the child is very young or quite nervous.

I often use 30 Hz and 160 mj with a 600 micron tip in the beginning and then 30 Hz around 120 mj with a 400 micron tip for the middle part and much lower as I reach the contact point (it cuts too fast and then I hit the gingiva……..starts to bleed) so I will drop it to 30 Hz and 70 to 80 mj or something like that , sometimes even lower.

The highest energy is for the enamel and then I drop down once into dentin and decay. I make my enamel prep at the beginning resisting the temptation to drop into the decay until the enamel outline is done. Then I drop the settings.

Now another option is to not touch the settings and just defocus more to get the same effect.

In this case I could go fast for the enamel outlline with the VERSED. If that is the case or the child is very receptive to the laser then I can go Mach 2….25Hz and 240 mj or at maximum for the enamel outline.

If they need laser analgesia to get used to the water , and sound, I will often use high energies at high watts defocussed (ie 30 Hz and 200 mj) and then work down from that when I start to cut.

I like the ISOLITE for these preps.

Kids teeth are one of the joys with the laser, I can almost always cut them fast , without the dreaded needle and kids rarely feel much. Now those 14 year old female redheads or blondes that flinch with the cotton rolls, well I had one like that today.

Last time with the laser, today a high speed without anesthetic, it was very difficult to work on her.

All the best, hope that helps, and I LOVE THE NASH INSTITUTE , because it is just Don Wilson and I , its 3 days (Including the standard proficiency) , its small (40 people) and its going to be alot of fun in that great facility. IT was last time and I am sure this one will sell out!!

Looking forward to it.

Glenn

[Glenn van As]

Darn it all Jeff , I didnt notice your post sneaking in there.

My apologies.

I am not real sure on what to do in kids pulp caps. I didnt have an exposure in this case and was pretty confident I got all the decay out visually. I just placed in Dyract Flow after using the laser to remove the smear layer (30 Hz and 60-70 mj for instance) and if there is an exposure in an adult then I will often use the diode (need anesthetic) and coagulate the prep and then place the restorative part in afterwards.

I will look to see if I have a case that I did not all that long ago of an adult pulp cap but its a coin flip as to whether it works in my hands. Its sometimes ok, and sometimes it causes cold sensitivity that the patient cant handle leading to endo.

If its not all that big, right near the end on an adult then I try it. In kids most times its a pulpotomy if I hit the pulp. Often with a drop or two of anesthetic in the pulp (if I can get away with it) the diode to coagulate (or astringident) and then GI followed by Composite.

Glen

[Benchwmer]

Glenn,
What dentin bonding agent do you use?
I use the PerioLase in deep preps to remove the last of the caries, if exposure coagulate, then DBA, Flowable composite, then restore.
For the last year I’ve been using 3M Adper-Bond. Self-etching, mix two components and place.
My direct pulp caps are usually asymptomatic after placement, the 9-10 month timeline tells if a success or pulp necrosis occurs.
Thanks.
Jeff

[Glenn van As]

Hi Jeff: Usually I use Prime and Bond NT. I just did one the other day (lab fabricated resin onlay) for my staff using a self etch, but typically I feel more confident with the acid etch.

In some cases I have put MTA over vital pulp exposures that are very small under the scope (pin prick) then put over flowable then restore.

I agree with your timeline, and looking for necrosis , irreversible pulpitis or calcification. I belong to an endodontic forum and they HATE pulp caps because in 5 years when the non vital tooth acts up the canals are obliterated so I keep that thought in mind as well.

Hope that helps

Glenn

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