Hey David, did I read correctly that you had trouble cutting the gingival tissues with the Waterlase? Was the tip damaged, is this a common occurence to have different cutting of the same tissues. Sorry about all the questions but I am a new Waterlase user first cases tomorrow – awesome. Could you also elaborate on your hemostasis control in this technique and you build up and temp crown technique. The temp crown in particular loooked awesome and considering you did it with no assistance even better. Great case thanx for posting.

Cam

Andrew, This took about an hour from the time the patient came and went. Seemed like forever. I really do depend on my assistants.
Cam, The waterlase can cut the gingival tissue well. My tip was fine. It was just odd that the tissue cut differently . That is the healthy tissue on the outer edges cut smoothly were as the granulated tissue seemed to absorb the laser energy and not cut. Be careful at what settings you are using. I am using a higher wattage but defocused then some. Try starting at the lower settings first. I used the diode in this case because I had it and wanted to see how it did with the granualted tissue.
Hemostasis is a problem with this patient in general. She has parathyroid and some renal problems. Everything was alright ttill I removed bone. Talk about bleed. That is why I packed an epi cord with Al chloride sponge on top. Let it set for 2 min and preped. Not ideal but I was not taking an impression .
The core was Build-IT with Simplicty as bond. I put the old crown back on and tacked it with composite then took a check bite impression with a bite material ( clear stuff from Miles). Then it was just a matter of sticking the temp. material in the impression and putting it back in the mouth. Trim it up and cement in place. This was the easy part. I was off on the temp color but I was getting lazy by the end of the appt.
Hope your case went well!
DAvid

Ron, This may sound odd but I have had better luck with the 2.75W /55w/65a defocused with the tissue removal. Far less bleeding to none.
I agree with the superoxol, nice , clean and works.
The diode is another great idea. I hear you about not wanting to use anesthic. Just got my TAC gel in today. This stuff is great. Could be a non injection option to allow cord placement or use of the diode.
DAvid

Hello: Just a few comments about tip activation with the diode, and especially concerning soft tissue periodontal pocket debridement.
You always start from the gingival crest and work down to the pocket bottom. Bob Gregg, Del McCarthy and a few of the rest of us old farts were taught by ADL in 1990 to do the reverse, and it made no sense then, and makes much less now. You should first calibrate you fiber extrusion out of the handpiece to the measured pocket depth MINUS 1 mm. Then, remembering to stay on soft tissue (and more precisely on the diseased soft tissue,) move the fiber from the gingival crest down toward the apical portion of the pocket. If you think about it, you can’t easily stay on soft tissue if you start down at the apical extension of the pocket, and you must remember that there’s some depth of penetration of this wavelength beyond the contact area.
Be very careful with two things: 1) don’t over initiate (not carbonize!) your tip, paying particular attention to avoiding putting carbon on the sides. 2) please clean off as much goop as possible, especially on the sides of the fiber. Otherwise, you can just heat up your endo explorer and accomplish the same thing, which could be some unwanted collateral thermal damage. You already know that diodes only operate either continuously or with very long “pulse” durations, so the thermal relaxation can be minimal.
Use minimal power settings (I like about 0.3-0.4W. CW) and work quickly.
Then you can return to the pocket, which is now more of a pool of fresh blood, and perform bacterial reduction with a slightly higher setting (like 0.6-0-0.8W CW) moving faster, like you’re performing hemostasis, again working crown down.
You can find some articles on this by Nora Raffetto, RDH, who, although she’s one of us veteran laser users, should not be called either old or fart or both. Keep Smiling………..DON

jetsfan
Dr. Mitchell Pohl
Dr. Greg Weinstein are both over in Boca Raton. Let me know if you want phone #’s and I will e-mail those to you.
DAvid

The surveys offer interesting snapshots of fluid market conditions so I think they are useful for monitoring the state of the market. However, I think a thought experiment on the positive utilities (fun, standard of care and economics) and the negative utilities (I am doing fine as is, too expensive, too close to retirement etc…) would be more useful at this stage of penetration. There are many factors to consider and many of them are variables that will change with increasing market penetration. I tend to think in simplistic terms and look only at the X-factor. X-factor being the ROI on the lasers. For example, if the gross revenue for an average successful user increases by 15%, what does his/her pre-laser revenue have to be in order for a laser purchase to have positive return? If the TOTAL cost of the laser is &#361600/month, then 12 * &#361600/0.15 = &#36128,000/year. You can add more complexity and real life distributions but the basic idea remains the same.