Forums › Laser Treatment Tips and Techniques › Hard Tissue Procedures › Yet another Crown prep . . .
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arrowsmithSpectatorI wanted to share this crown prep I did recently . . .
Preop: fractured cusps we’ve all seen way too many times before
[img]https://www.laserdentistryforum.com/attachments/upload/DSCF01071_resize.JPG[/img]Removal of alloy with highspeed and Great White bur
[img]https://www.laserdentistryforum.com/attachments/upload/DSCF01081_resize.JPG[/img]Crown prep: YSGG, G-6 tip, initially with 5.0W 60/30 for enamel removal and then taper down to 2.25W 50/20 once in dentin.
[img]https://www.laserdentistryforum.com/attachments/upload/DSCF011011_resize.JPG[/img]
Refining the margins was way difficult . . . 1.5 W 15/11 works the best for me.
[img]https://www.laserdentistryforum.com/attachments/upload/DSCF0112_resize.JPG[/img]Impression . . . after coming back from the lab
[img]https://www.laserdentistryforum.com/attachments/upload/DSCF0128_resize.JPG[/img]Model work . . .
[img]https://www.laserdentistryforum.com/attachments/upload/DSCF0129_resize.JPG[/img][img]https://www.laserdentistryforum.com/attachments/upload/DSCF0130_resize.JPG[/img][img]https://www.laserdentistryforum.com/attachments/upload/DSCF0131_resize.JPG[/img]Gold Crown . . .
[img]https://www.laserdentistryforum.com/attachments/upload/DSCF0133_resize.JPG[/img][img]https://www.laserdentistryforum.com/attachments/upload/DSCF0135_resize.JPG[/img][img]https://www.laserdentistryforum.com/attachments/upload/DSCF0136_resize.JPG[/img]And, final cementation . . .
[img]https://www.laserdentistryforum.com/attachments/upload/DSCF0137_resize.JPG[/img][img]https://www.laserdentistryforum.com/attachments/upload/DSCF0140_resize.JPG[/img][img]https://www.laserdentistryforum.com/attachments/upload/DSCF0141_resize.JPG[/img]Make sure you don’t gab too long with the patient while Unicem is setting up, or you’ll end up putting scratches in that nice new gold like I did, getting the cement off!
This took me a REALLY long time to prep! I pretty much followed Mark’s technique as best as I could, however, I spent dang near 45 minutes just prepping the tooth! Mark is totally right though, doing a crown prep really tells you a lot about how the laser works.
Any comments? Suggestions? Questions?
aaroN
kellyjblodgettdmdSpectatorWas that without any anesthetic?
Nice crown.
Kelly
SwpmnSpectatorAaron:
Nice results, photos and great to see someone else still using GOLD on molars!!!!! In my own mouth I have five gold restorations on my molars.
Some time ago, I went through a period where we prepared teeth for crowns with erbium lasers. Prep time was similar to yours or in some cases less. Personally I could never attain the smooth prep you did without using a diamond bur in a handpiece.
Dr. Colonna and others have had excellent success with this technique. We did not find it to be practical within the time constraints present in our practice. There was no real advantage since the vast majority of the reason we placed crowns was on teeth just like your case where removal of old amalgam was necessary. Our erbium lasers are utilized as a replacement for round burs in the slow speed to excavate caries which we find under virtually 100% of these old amalgams.
Al
2thlaserSpectatorArrow,
Great job, nice technique! First, a couple of questions….
1. What magnification are you using?
2. IF you are using 4.5 or more, you need to consider finishing the margins at no more than .50W.I would love to show you more, you did a wonderful job on this.
Allen, I do gold on MANY molars. I still believe in its viability, especially concerning difficult cases where there is plenty of parafunctional activity occurring.
Neat to see some more practitioners doing crowns with the laser! I do so many, I don’t even take photo’s any more…guess I need to get a scope/with camera, to make that easier!!! Where’s Glenn when I need him!
Mark
(Edited by 2thlaser at 8:25 am on Sep. 2, 2004)
arrowsmithSpectatorKelly – If you can believe it, the patient requested no anesthetic, however, he made the comment that when we crown #2 next month, he’ll “go ahead and take the anesthetic.” I did use liquid topical around the gingiva.
Mark and Allen,
Thanks for the kind words. I LOVE gold, and fortunately, this guy did too. Mark, I’m only using 3.5X TTL loupes. I spent a lot of time with the margins and used the finest of “brush strokes” that I could in order to get it smooth, but still, it was very difficult for me. I’ve done a few other crown preps on premolars with the Waterlase and found it much easier, however, I still feel more comfortable with the highspeed. Time will make it easier no doubt . . .Mark, please show me more! Maybe I should just make a trip up to Whitefish . . . maybe Kelly can join me, we’ll bring our guitars and ROCK!!!
aaroN
2thlaserSpectatorAaron,
you guys cmon up…I have the axes, the Waterlase, the brew, hmm…..what else do we need! I would LOVE it!Mark
dkimmelSpectatorAaron,
It always seems the patients push us to do more with the laser.Sooner or later if you do restortive with a laser a patient will ask you to do a crown with the laser.
It is great having Mark being the gunner here and sharing with us all.
Thanks for posting the case.Nice job. I would move up to a higher mag loops. 6X being the least. Marks ideawith .5W for the margins is a great idea. I have played with it and am still not there. I still feel better refining the margin with a diamond. I just pulled out some old enamel hatches and hoes. Plan to play with them this weekend.
David
Glenn van AsSpectatorHey Mark…….I still havent done a crown prep……..I just dont have the patience for it, but I admire those that do.
Now darn it Kimmel if you would just buy a scope you could finish those margins at .5 watts or with a blunt butter knife , whatever you found first!!
Just kidding and arrow……..nice photos.
Love the treatment plan, kudos to you. I couldnt believe what stuff I did this week with the laser, opena nd closed flap osseous, lots of restorative, uncovering teeth for ortho brackets, sterilization for endo, frenetomies, soft tissue recontouring , it was an amazing week for lasers………
ITs amazin to be lazin……….
To quote Stewart Rosenberg now when did you think that would ever happen!!
Glenn
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