Bob,

I would go with a retreatment wondering if some laser bone stimulation would help.  I would include a protocol of topical biocidal irritant to eliminate any reinfection from the top down.  Since at a 6 mm plus depth there is likely residual biofilm I would consider a periodontal appliance to maintain 24 hour tissue contact with the biocidal.  Food trap?  Poor oral hygiene on the mesial?

Pat

Hi Glen,

I like to place 2 releasing incisions, one mesial and one distal to the cuspid, and connected at occlusal side with semi-lunar type design.
Make sure you have enough attached gingiva and apically reposition it and suture it down @ cuspid’s CEJ or as close as possible to it. It will come down with the crown and vary rarely requires a graft.

Nice case, thanks for sharing.

Vince

Hi David,
Nice stuff, and questions. I just got back from the WCM in Vancouver, and wow, what a meeting! As for the settings, I use the 5.5W for the anesthesia, and make my INITIAL cuts in enamel using 5.5 80%air, and 50% water, not the 90/60 thing anymore. THis is an ever evolving process, and as we learn what works in our differing hands, we pass it on. Real cool. Don’t forget that the focused mode, 1.5-2mm from the tips end, IS the most concentrated energy, therefore, it SHOULD cut a bit faster. For me, I am not looking for ultimate speed, but for control of ablation, not too fast, not too slow, but just right. Everyone’s eyes, hand/wrist motions are a bit different, and so not every setting is a “cookie cutter” approach, which you have proved with your photos. Excellent conversation here, and keep sharing. I will try what you and Kim have shown, and see how it works in my hands. Should be interesting.

Mark

Will that 980 ablate “optically”, in other words, out of contact as the company claims? Are you contacting the tissue in these photos?

Great composite!!!!! You might just watch it, that thing will probably last for years.

Al

Great thread here guys.

How much of the slower cutting do you think is due to the fact that with the increased water and air it is more difficult to see exactly how far away you are from the tooth. I still think that the magnification is as important.

The water spray should not be flooding the prep and having not seen what the 90/60 gives you it may be that the lower air and water combo gives you both less pooling, and allows for better vision.

I like your pics David, very very well done.

Now in all honesty if HK was a big deal wouldnt the higher water and air levels make it easier to cut??

Again David, awesome pics and I know that was alot of work to do that and the pics are really nice.

You know the defocussed one sure gives you a nice bevel though doesnt it. That is why I like to use caries settings or 2watts or so for enamel bevels in class 4s to decrease the depth of each ablative cut into the tooth. It makes it easier to get bond into each and also in my hands makes it easier to hide the white etched enamel if you use lower settings to bevel.

Cool stuff David……thanks again.

It was too bad that Mark and I didnt get a chance to touch base but perhaps next time. Our schedules just didnt match but we did have a nice conversation on the phone.

Cheers to all and cya in 1-2 weeks.

Glenn