Hi folks: this is a kinda cool case which shows the value of high mag with the scope. I have a 980 nm loaner which I am using for a while just to compare to other diodes. You can flood alot of water on the tissue and still have it cut (not easy with the Argon, and not as easy with the 810nm).

Mike Swick uses the high fluency technique with this laser which involves high wattage being pulsed at 20Hz per second (.05 on and off). NOw this isnt a Nd Yag pulsed laser but it does do some cool things.

It does cut with less charring with the water on. I dont often use the 10watts -15 watts that Mike does because you will get charring if the water flow doesnt hit the tissue as you are cutting. I typically will use 4-5 watts pulsed at .05 on and off.

Regardless in this case, the lady had deep interproximal decay on the 2nd molar on the distal. The patient has all her third molars and wouldnt part with them.

I eventually did a DO on the 2nd molar which was ok but had a bit of a resin overhang on it. When it finally went irreversible , I did the endo and suggested a crown when new decay popped up on the mesial of the 2nd molar.

I did the prep (note how the overhang on the distal was so readily visible at 10+ power). I removed interproximal tissue so that I could stop the bleeding (she has a little perio but many do (she is in her 60s)).

The distal was very deep and tough to see if the margin was on solid tooth but eventually I got it done on solid tooth on the distal. Then noticed the decay on the third molar which is so far back I couldnt get a clamp on it. The rubber dam was pulled back and it stayed long enough to get the restoration done on the mesial.

The troughing complete and the impression was taken and worked out very well on the very very deep distal.

THere is still decay on the occlusal but I was running out of time so will treat that at the insert appointment.

Hope it is interesting but this would have been a darn tough case to see the overhang, get crown margin on distal on solid tooth, and restore the third molar in that conservative fashion without the scope.

Cya

Glenn

Hi folks: this was an interesting case for me because I was wrong in how it was going to work out, and because the laser was actually easier to use than the handpiece for visibility and access.

This patient had a crown on his tooth and broke it off, due to a number of reasons including financial and guarded prognosis he decided to have it extracted after the crown broke off.

I decided to use the erbium to trough around the tooth and also to split the tooth into two sections. I used the following ….

140 mj and 30 Hz for the tissue without water to reflect it back around the tooth, and then

160 mj and 30 Hz for the bone with water to create a trough circumferntially and finally

240 mj and 25 Hz with water for sectioning the tooth (you need higher energies in my opinion for dentin than bone).

I try to limit the air on the unit for bone relief, and what was weird is the mesial came out almost immediately.

The distal which I assumed would be easier because of the straightness of the root was more difficult. I had to go piece by piece till I got the last 5mm piece out.

I took some PA and photos along the way to show you the progress, but what was interesting is that the pen type grasp of the Delight Delivery system was acutally easier to get to the small tip at the end than my regular handpiece with a surgical length bur, which kept bumping into the adjacent teeth. I found this very interesting because I would have had to cut a flap and resect ALOT more bone if I had used the handpiece only.

Worked out well in the end but I thought it was interesting how I could get the laser into an area better than my traditional handpiece. In addition I didnt have a 400 micron tip, which is longer and thinner and would have been very useful for this exo where the roots were very very long.

Hope you like it.

Glenn