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SwpmnSpectatorLooks like a real nice job, David.
Did the tooth have root canal therapy?
Al
brucesownSpectatorI’ve had a few resorption cases over the years and they always present a bit of a challenge. I have a patient coming in a couple of days who has a small resorption on the lingual of a lower central incisor. (41 for the canucks in the audience) I was thinking of doing a gingivectomy on it to expose the area entirely, and relieve some bone to establish biological width. Hopefully once it was healed, the defect would be supragingival and therefore unable to further resorb. I was thinking of using something like Fuji IX (my new best friend) to restore it. Any thoughts on this treatment plan? Would you do endo?
Any ideas greatly appreciated, I respect the people on this board a great deal; it is very comforting to have a place like this to turn to.
dkimmelSpectatorBruce,
Sounds like a workable plan as long as you don’t have to remove too much bone. These are always tough and unpredictable. Good luck.
Allen, The tooth was vital and I felt this was external resorption. It was pretty deep and you can see the canal if you look hard enough. I do expect to have to do endo.
Glenn van AsSpectatorDavid: clap clap clap…..very nice case and well handled. You didnt have the scope did you, its tough to do these cases without very high mag and the right tools to remove the tissue (TriChloracetic Acid works well) and the right stuff to restore them……nice idea on the Geristore.
Way to go……..no anesthetic right!!GRIN…..just kidding.
glenn
PS is that the Waterlase handpiece, was it hard to look around with the scope?
Glenn
adelddsSpectatorTwo days with the DeLight and I am delighted!
I have noticed that the preps are obviously quite different then when using a traditional handpiece. On Tuesday I kept feeling the prep with my explorer and kept getting a “stick.” I used caries detecting soln and had no stain. I used a slow speed and found nothing. I was told not to use the Diagnodent after using the laser bcz it gives off false info (is this true?). The loopes that I was using were only 2x (I just got my new 3.5 ef today). So my question is, is laser dentistry so “micro” that perhaps I was really feeling the binding of the sides of the prep on the explorer and not really caries at all?
Thanks,
Marc
adelddsSpectatorTuesday I used the loaner DeLight for the 2nd day. Truly amazing!
I was able to do a p/ssc w/o any local. I did however use DrK Soln (topical, TAC gel) around the ginviga for the rubber dam clamp. The pt said the tooth felt great but the gingiva was quite sore after placing the ssc. Do you guys place a bit of local in the gingiva when placing a ssc?
Marc
kellyjblodgettdmdSpectatorMarc – Good questions. I’m assuming that you were in dentin when you were getting these “sticks”. The laser definitely alters the tooth surface usually creating a surface that (1) will frequently give false positives using caries detection dye and (2) will react differently to the diagnodent.
My solution, as I think is true for a lot of seasoned laser users is to finish with either a NEW round bur or a very sharp spoon. The micro-spoons sold by Mark Colonna’s company are the best. So small and SO SHARP!
Hope that helps. Congrats on the new laser AND the new loupes. I don’t know how some dentists practice without them?!
Kelly
drnewittSpectatorI always place a bit of topical but the thing I find what makes the the biggest difference these days to treatments like you have described is the Isolite. No Clamp, No gingival trauma.
P.S. I don’t get royalties from Isolite ( a shame realy
)
drnewittSpectatorI’m with you Kelly
I always go in with my NSK electric and a sharp new slow speed. Very slow rpm and scoop. Then I go back over the prep with the laser at about 1.4 W (20hz/ 70mj) to resurface.
The preps will be quite different. no smear layer for one with the laser Vs. the high speed. I imagine you might still get a stick if you push an explorer into that ablated surface. I haven’t tried stick an explorer back in. The slow speed or spoons and then the “laser Etch”, which is going to destroy bacteria also, and a resin ionomer on top, seems to do the trick.
Oh, and use a self etching bond to remove the ablation products prior to filing material.
drnewittSpectatorDavid
How arre you finding the Geristore for these subging cases? are you using any bond? Drying the area or keeping it a bit moist? Have you been finding the Geriostore to offer good marginal seal and to stay put?
Vince C FavaSpectatorNice work. I haven’t done that yet. What settings did yo use? What was the condition of the pulp? Hyperemic, inflamed, necrotic? Thanks.
Vince C FavaSpectatorIt is or can be truly micro. When using higher mags (scope), it always seems like I’m creating huge troughs and holes, only to have my regular spoon or ball burnisher be way too large to fit the access! IMO, 3.5x mags (have DFV) is the ‘weakest’ mag when using lasers. A light source is crucial too.
My protocol is usually;
1. Verify diagnodent readings
2. Rondoflex for stain and junk in fissures.
3. DELight for prepping.
4. I like to use a 1/16th round bur (heard Glen mention this in a lecture when I purchased my laser and thought…1/16th!?!?! yup, a 1/4 round is the size of a darn boulder in most preps) after laser prepping if necessary.
5. Restore as required.Cheers
dkimmelSpectatorI am bonding. The trick is keeping the field dry. This case was an easy one to keep dry and I feel pretty good about geting it cleaned out. Still mayneed to do endo. The Grestore holds up great and the bone level appear to be stable. The pocketing on the older case is 3mm and heathy. I believe we have LJE attchment which is not as stable as we would like but seems to work if the patient OH is good.
AnonymousSpectatorHeads -up!
Coming in April (Dentistry Today)- CW near infrared Diode, and its use in Closed Periodontal Pocket procedures.This paper has more than 25 references from across the dental/medical spectrum, to help illustrate the points about “hot tips” in the closed environment of the periodontal pocket.
Soon as its in print it will be here also!
Thanks E.B.
adelddsSpectatornothing that special. Pt was 8 and had large distal decay on tooth #s. The decay was into the pulp chamber with No sign of abcess. I believe the settings I used were 20/240 (I will have to check). 60 secs on occlusal and 30 sec on buccal. Just went to work from there. Pt complained of no pain. I thought he would have jumped with the exposure of the pulp (didn’t). So I kept going. Once inside the chamber I switched to caries setting (I think it’s 30/60) to clean the chamber and not risk perforating the floor of the chamber. After the pulpotomy was complete, I switched to the high speed and prepped for ssc. What a breeze. The mother, the child, my assistant, my associate, and MYSELF were truly amazed! My associate did one today as well. We are hooked!
MarcPS today I had an old pt of mine (9 yr old girl) who has had extensive work in the past. Upon last recall we noted distal decay on tooth #B. She refused to get in the chair. When I asked why, she said, “I do not want a shot or the drill.” I said, “no problem.” Needless to say we used the DeLight and she did cart wheels down the hall. It sound like a comercial but I can’t make this stuff up. In the last week I have done so many fillings that I would have needed local to complete. My first laser frenectomy was too simple. And today I treated a boy with two apthous ulcers. All this before Charlotte. I can’t wait to see what else I can do with the propper training.
Marc -
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