Bob,
Your comments on the sales tax can not be generalized. In Michigan, businesses are required to voluntarily pay sales tax on all non taxed out of State purchases which would be taxed if purchased in Michigan as if they were purchased in Michigan.

Pat

I noticed something else yesterday, which I have seen before but never thought twice about: A patient has a OL amalgam on a max first molar and there is a crack which runs fron the filling gingivally. It is stained dark.
I always believed that it was the large filling causing the crack in the tooth. Now I’m not so sure. Perhaps it was the metal bur in the drill that caused the microcrack and it was stained over time by the amalgam.

Quote: from dkimmel on 10:54 pm on July 3, 2003
How important is this relaxation.?The more you have the less damaging affects. Does it affect pentration? What occurs with a rapid cycle of relaxation? Does this cause futher changes to the tissue? Does the relaxation/stimualtion have anything to do with Biostimulation?

Wow!
David, couldn’t you have started this post and directed it at Bob or Del , instead of Ron?  😉
I hope one of the experts will help me out here and do some correction where needed, but I’ll give it a try.

With less relaxation time I think you will have more of a thermal effect to a greater depth.  
As far as biostim, with CW there is generally 1 maxima where you get the desired effect and then when going past that you can get inhibition. Pulsed has several maxima. Most of what I have read seems to indicate dose is more important than pulsed vs CW in biostim. Not sure what you mean by rapid cycle of relaxation.

Quote: from dkimmel on 10:54 pm on July 3, 2003
I could see inceasing the pulse duration until you see the desired results. What of the interval. What will you see by incerasing/decreasing this?
What is the difference in tissue reaction to an activated tip vs an inactivated? Is it just that the tip gets hotter?

If you decrease the time between pulses (in a set time frame) then you will be delivering more eneregy (dose) in that given time frame.
If you increase the pulse duration, you also will deliver more energy in a given time frame.

As far as hot or activated tip goes- I understand activation to be a process whereby you are trying to keep the energy localized at the tip to use as ‘hot glass’  

Quote: from dkimmel on 10:54 pm on July 3, 2003 Better yet, here I am trying to remove granulation tissue in an active periodontal pocket and is this entirely a good idea? The presence of granulation tissue is involved in the healing process. Does removing all the granulation tissue slow the healing process?
How selective is the use of the laser in this process of removing the granulation tissue? Am I able to just remove this tissue or is there profound deeper tissue consequnces?
I think the answers here depend on how you’re going about removing the granulation tissue (hot glass diode vs. FR nd:YAG). Even with the perioscope, can you be sure you removed all the granulation tissue anyway?
Using an activated tip, if you stay too long in one place there can be profound deeper tissue consequences (I guess the same is true for unactivated, but I think the zones of abalation, necrosis, hemostatsis and hyperemia would be different )  .
I think the selectivity is greater when you have the ability to vary the pulse duration, allow use of the proper amount of energy to accomplish the effect while still allowing for relaxation.

Quote: from dkimmel on 10:54 pm on July 3, 2003
It sounds that you are  finding Periolase MVP 7 less  more useful then the Lasersmile?
DAvid
I originally bought the lasersmile with the idea of doing perio. I didn’t buy it for whitening. I got pretty good results in that we consistantly got 5-7 mm pockets down to 3’s or less. The amount of chair time in Tx was a big pain. Number of visits was calculated by taking pocket depth and subtracting three. 7 mm pockets would be treated 4 times (each visit 1mm shorter). Scheduling all these appts  1 week apart and getting patients to be consistent was difficult.
I am very happy with the Periolase MVP7 in the short time I’ve had it.  The perio patients I’ve treated have been very happy. I did one last week with generalized 6-8mm pockets and where # 4 was vertically compressible w/11mm  still tested vital. Did Bob and Del’s protocol and splinted #4 as well. Patient took 2 motrin the next day. Pt had to miss one week followup, because of family emergency out of state, but called to say that side of her mouth hadn’t felt that good in years. On another patient last week did extractions 22-27 (27 surgical root tip ) on a patient taking Plavix. Pt’s physician saw no reason to take off Plavix (PDR says 7 days- I’ll withhold my comment on the physician). Did extractions and used the laser to ‘clot’. No bleeding problem afterward at all. I know I haven’t even scratched the surface in what you can do with this FR nd:YAG. The laser is well thought out- meter for testing output (which I also use to check my Waterlase tips now), you can record and print out on paper the energies you used along with the patient name and procedure -talk about making chart entry easier.   Finally, as you can probably tell from Bob and Del’s posts-they know what they are doing and the training you get from them is awesome.    

Yeah, Pat, true.

I didn’t mean to over-generalize.

Every state has it’s own rules…..so that needs to be figured in to each buyer’s individual situation.

MDT just refunded tax collected in Alabama because MDT did not have a nexus in Alabama and the State tax collector said MDT should refund the money to the doctor, and not pay it to the State.

It can even get more complicated, as one Southern State (I can’t remember which one) required MDT to calculate and pay local/county sales tax in addition to State tax. They had a calculation table MDT had to follow.

Bob

Bob