somebody please help me.My question is
1. Do you have to use the biolase bleach with the lasersmile.2.If not , what are my choices, because it is very hard to get the biolase bleach.
Thanks Dilshad

if you do a search of this forum, you will see alot of threads with pictures of perio…Just look through and you will find plenty…

If this is where I am supposed to reply to Ron’s e-mail, I think that a 2006 meeting of LDF members would be a great idea.

Mossman

Hey guys – I’m glad this got some interest going. I’ll try to answer all the questions and share with you my experiences. I’m sure a guy like Bob Gregg would have more information than me.

Are you saying that you are routinely anesthetizing teeth with your Nd:YAG? – Only when patients REALLY don’t want a shot, but they have sensitive teeth. Often with the Er lasers, I find that the air and water make it challenging since it’s so cold on the teeth. As an example, I had a 10 y.o. boy come in who had had a traumatic injury to #9. The tooth was vital but half of the clinical crown was broken off. The dentist he was seeing would work on him after giving him a shot, but he said he could always feel the pain. No amount of chemical anesthetic was able to produce pulpal anesthesia. With 60 seconds of energy applied to his tooth w/ the Nd:YAG (200mJ/pulse, 20Hz, 100usec pulses – 240 Joules total) at a distance of about 1cm, the tooth was totally numb. I could tell because prior to starting, I scraped the dentin surface of his tooth which he responded to by squinting his eyes and saying “That hurts!” After the laser light was applied, we did the same scraping to which the patient didn’t even flinch. We were then able to work on the tooth (quickly) without him feeling anything for the duration of the procedure.

Why is the Nd:YAG fiber used in a defocused manner and what is the distance? – I don’t want too focused of a beam hitting the pulp. I want a larger surface area being covered so that I’m able to have an effect on all the pulpal tissue.

If you place the fiber in contact with or 1-2mm from enamel do you see ablation? – No, I wouldn’t see ablation on the enamel w/ the Nd:YAG, unless there were some stains or something dark. But still, I stay away due to the reasons previously mentioned.

What would you estimate to be your overall success rate where you do not have to resort to chemical anesthesia? – I know it sounds crazy, but it’s been 100%. But so much of that it case selection. I agree and have had similar results w/ the Er laser. I also have learned to tell patients when I’m using the Er laser that they will probably feel “something”, but it is generally more comfortable than a shot.

Have you used Nd:YAG anesthesia for routine composite placement or crown preparation? – More for composite placement. I haven’t used it for crown prepartation. I haven’t had a patient that needed a crown that was that worried about the shot. (Lucky, I suppose)

What is the typical duration of the anesthesia? If the patient experiences discomfort, have you been able to “reanesthetize” using the Nd:YAG? – I have found that I can get 5-10 minutes of solid anesthesia. I haven’t had a patient say they felt anything after the initial “anesthetic” dosing, so I don’t know if I could re-anesthetize. My gut tells me that I could.

If the patient presents with a sensitive tooth(reversible pulpitis), how does the Nd:YAG anesthesia technique go? – Awesome. Since there is no air or water to stimulate the tooth, the 1064nm wavelength travels through the enamel and dentin to affect the pulp and the patient feels nothing. I always start out farther away, however and slowly approach the tooth stopping at about 1cm away. If I’m aiming at dentin, I’m really careful to stay away, unless I’m planning to remove that dentin (as in a root canal).

Does the patient experience pain while the laser is applied for anesthesia? – I haven’t had a patient mention any discomfort while applying the laser during the “anesthesia” period. It’s really quite comfortable, from what they say.

I’d like to mention that if I’m doing restorative care with my YSGG laser, I usually don’t use the Nd:YAG first. I’ve only had 2 patients where this is necessary. But usually if I use the Nd:YAG for anesthesia I want to “haul ass” when I set it down, so I’ll use handpieces to get done fast. So far, it’s been 100% successful. Again – case selection I think has been the most important part.

To answer Nick’s question – I use anesthesia daily (injectable, that is). This just happens to be one of the tricks I keep in my bag for when I need it.

Kelly

Can someone email me Rod’s technique:

kellyjblodgett@comcast.net

Thanks!

Kelly

Dave – I tried to open this but couldn’t. Any changes to the address? Thanks

Kelly