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Partial Dentures P2

Jan
2014
30

posted by on Gum Disease Prevention

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So the whole framework will go down levelled and everything engages at the same time. If there’s a curve on your path of insertion, or the rotational path, the back end seats first and then the front end rocks in. If people see if you are going to do your brock after this, one of the things you need to think through out with your brock out is on the distal side of this front tooth you can see that this is going to go off and on so if you have a pair of dividers then you put one on to the [inaudible] here and you put the other on to the [inaudible] so it just barely touched the [inaudible] the distal marginal ridge of that tooth that the arch that divided out this [inaudible] you have to brock that out. Because if your framework doesn’t fit any tighter to the distal corner of this tooth down to the cervical can you [inaudible] you try to rock it into place it wouldn’t seat at the time. That part of the proximal plate goes right here. If it wasn’t blocked out curves that line, if it fit tighter to the distal length too it wouldn’t rock into place when you seat it. So those are the things you want to look at when you want to brock it out for rotation [inaudible]. Okay, in the linear placement again all rest seats seat simultaneously. So if it’s not a curvilinear here, if it’s not a rotational path it’s just a straight up and down path of insertion for the most part, all the occlusional [inaudible] simultaneously. And you can see in this area we have brock [inaudible] where that undercut exists on the mesial of that tooth or when the undercut exists on the distal of that tooth, they [inaudible] blocked out parallel with the path of insertion. So when everything [inaudible] it just all slides down and what’s holding this partial denture framework on that tooth is an occlusal rest [inaudible]. So if you said okay in the same situation if there is a little bit of an undercut on the mesial proximal of that tooth but if I go and do a curvilinear path of insertion so that my brock out on the mesial of that tooth is entirely [inaudible] and I planned completely on having my proximal plate fit that more intimately. There’s still brock out here to allow that arching type motion to come down and clear the distal of that tooth. So if there’s not as much brock out here,  there is no buccal clasp on ,there is no lingual reciprocal one. But when the partial denture is fully seated, this distal part can’t come up in the air because this proximal plate is wedged or captured in that undercut on mesial. So it’s an intentional use of that undercut without blocking it out. That’s the whole idea of rotational kind of partial. What types do you got? You got front to back, you got back to front, and in some situations you can do them sideways. So if I do basically front to back, that is very similar to the one that is right on the cover on your Krol manual. Again, if you look at that upper set of pictures it shows the case where you got a patient that’s got [inaudible] teeth being replaced when that partial denture goes into place front is going to seat first and then the back is going to rock in. So that’s going to be front to back. Okay?

We’ve got back to front and that’s the same one shown on the cover that you seat the back first and then you rock it to the front. So you got back to front or front to back and sometimes you can have a lateral. So that’s in teeth missing right here, so you’re missing basically your lateral incisor and cuspid. Instead of doing fixed partial denture they just thought could we fit a partial denture framework in there and then basically let this part seat down first and then arch or rock the partial denture down to get the clasp to the [inaudible] over here. So for as long as this part of the partial denture stays seated there is a couple of undercuts that have been gaged over our [inaudible] by rocking into them. So as long as this side stays fully seated, these things can’t lift up in the air because these are rocked in into a undercut. Categories. We got categories. Category one is more like the picture that we showed you at the very top of the lecture of the lower class 3 partial where the posterior rests would seat completely. The posterior rest seats would seat completely and then you rock the partial in place with those rest seats acting as a [inaudible] basically. Category 2 or dual path instead of [inaudible] rotation path… it is more similar to the picture on front cover of your book that’s the upper case. So the way that one works, if you got one of these clasps [inaudible] and you’re trying to make use of the undercuts on the mesials of the cuspids, or the mesials of the first bicuspids, you seta the partial denture in anterior angulation so that the end of the plane sits down first and then you rock it in. So the rest seats themselves don’t hit right away .You don’t sink the rest seats and then wrap it around the rest seats. In the back to front the rest seats are fully seated and then you rock it into place with the rest seats [inaudible]. That was that molar class 3. The upper class 4 the rest seats are not fully seated when you angle them from that front direction. You get the edge of the [inaudible] all seated and then as you brock it to place during the rocking to place the front rest seat sits and then just a little later the posterior rest seat sits.

But in the type 2 or the category 2, these rest seats are totally seated on the rotational part. You see [inaudible] dual path of insertion. So it would be seated at an angle and the rocked in. Here’s a category like one we talked about. It’s basically these rest seats sit completely. This would be the class 3 arch [inaudible] on the other side of the arch. SO this rest seat sits completely, you rock it down in place so when this is seated this wedges into the undercut. Okay, we look at basically category 2. Sometimes in these situations if you were to imagine this to have anterior teeth set out in the front, and that gain is the picture on the front to your manual. What would happen in these situations is as it was being seated in the front part seat first the end of the plane would sort of [inaudible] here but the rest seats themselves would not fully be seated. So we angle that on this forward angulation this way. Seat the flange in, start rocking it down and as it’s rocking down in place later on then the front rest seats come to rest and then last of all the back rest seats come to rest. So it’s first the flanges going in, then we start arching it, and then the rest seats of the front are seated a little bit later and the back rest seats seat last of all. But in the category 2 which is front to back or back to front, we don’t completely sink the rest seats and they are not [inaudible]. What we want to look  at when we’re doing cast analysis. It’s basically sort of like any partial that we would be doing. You got to look at your plane of occlusion. And when you’re looking at the plane of occlusion, we sort of talked about that stuff, but as you got to set a cast…what does that really mean? If you are assessing the plane of occlusion can you see that if really goes up and down a lot that’s not a good thing? Or some teeth have gone missing. Let’s say posterior molar teeth are extremely up in the air and some [inaudible] upper teeth are going down. So your plane of occlusion [inaudible].

That’s’ not such a good thing. But if your plane of occlusion has posterior molars extremely tilted along way. So it seems like when you sort of look at your lower plane of occlusion it seems fairly reasonable at the front but as you get toward the back of the mouth it like really curves up in the air a lot so your overall plane of occlusion [inaudible] ski jump going up there. Not such a good thing. Maxillary plane of occlusion. Some posterior teeth on the [inaudible] have extremely [inaudible]. So your maxillary plane of occlusion goes level across here and then dives way downhill. Not such a good thing. So look at your plane of occlusion. How long is the edentulous span? Again many times what people look at is if the edentulous span is fairly short. One of the things you think about is [inaudible] fixed partial. There are some situations in which edentulous span gets longer. Think of the stress you’re potentially going to put on your buccal teeth. If you do a fixed partial denture there’s a lot. So those may fail over time. You might not just trash the teeth. Can people think of other possible problems with the really long span bridges that has nothing to do with losing the teeth or putting too much stress on them? How many people have delivered a crown and not that much later the porcelain fractured off? Anybody got one of them? [inaudible] The patient’s back and one of their complaints is a bunch of the ceramics fractured off my bridge that you’ve just done last year. Well, that kind of stuff happens as you build longer span bridges. How come? Cause the substructure may flex a little bit. And if the substructure flexes a little bit over a long span and the overriding ceramic doesn’t then it’s going to develop stress fractures and fall off. So the length of span is sort of an issue. As spans get fairly long they are almost easier to deal with an rotational path. Why? Cause spans get pretty long. If I were to imagine a molar and let’s say I had a short span not that I would do this with a rotational path. But I got a short span to bicuspid and I’m planning on making a rotational path and [inaudible] this first and then arching the partial denture down place. Let’s say I got a similar case. Molar’s the same way. Let’s say I miss first molar, I’m missing a bicuspid. [inaudible] The longer the span gets this way, at this thing arcs forward, I’ll need less block out on the distal of this tooth with a longer span that I’d need with a shorter span. [inaudible] As the radius gets longer any section of arch down here becomes more nearly a straight line.  [inaudible] a very short radius your curvature here is pretty tight. So it takes a lot of block out right here. But when arch is a lot longer, arch is not nearly so tight you don’t need to block out so much. So can people see how longer edentulous span requires less block out when you’re doing a rotational path? And very short spans [inaudible] if you’re thinking about rotational path concept. The shape of the dental arch and how much undercut are we working with. So again what we’re looking. The plane of occlusion affects the depth of the undercut. So if we look here. Again, these are all in your books. Where do we locate the undercut on these?

Partial Dentures

Jan
2014
23

posted by on Gum Disease Prevention

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Watch the video: http://www.learnerstv.com/video/Free-video-Lecture-4814-Dental.htm

Now the thing about rotational pass concepts is basically it’s the cover of your book .So those of you who have got Krol manual I mean the picture that’s right on the cover of your Krol manual shows both an upper rotational path and a lower rotational path. So that’s the cover straight off your book so we’re going to go over it. If this were a standard class 3 partial dentures, the lower picture. If you had a molar on each side and then you went up to a first bicuspid with this longer span. If it were a conventional class 3 partial it is a non-rotational path partial, the path of insertion for the partial would be straight up and down. Now sometimes some of you that had worked with [inaudible] partial dentures where you got these teeth at the back end for the lower partial, you may or may not be aware many times you got these situations in the mandibular arch this molar posterior tooth is very off and tilted mesially and lingually. How many people had one of those? [inaudible] You got this lone standing molar in the back and it’s sort of leaning mesially a bit and it’s leaning lingually a bit. So if you’re thinking of trying to [inaudible] to give you a nice straight path of insertion it’s reasonably difficult because many times where the tooth is leaning lingually if you’re trying to find a path of insertion that will let your partial denture come down past that lingual cusp of the tooth, when it gets down to interior edge of the framework it nowhere near the tissue and you say “Gee, I might have a hard time [inaudible] lingual of that tooth.” And similarly for a mesial tilt. In the upper case as it’s shown right on the cover of your book you can see many times if you have got clasp [inaudible] partial denture upper clasp [inaudible] replacing the anterior teeth, one of the downsides of in the upper partial or upper partial replacing the anterior teeth,  are these guys right here, that is the clasp.

Now I would argue that the way they designed the clasp on this particular partial looks reasonably good. [inaudible] The clasp is an [inaudible] clasp so it stays up fine and it contacts the tooth very near pregingival margin so that’s not an extremely ugly clasp as clasps go. But many times you may be able to find a situation in which you can do a rotational path partial and eliminate the clasp on the anterior aspect of the partial completely. In this case it would be front to back rotation. Then the lower example that you see for the class 3 it’s the posterior seats first and then once these rest seats are in place you just [inaudible] the anterior down in and [inaudible] posterior rest seats first, [inaudible] the anterior down in and when it’s totally seated, the proximal plate back down the molar literally takes advantage of the fact that there’s a undercut on these molars. It uses it. So you start to seat the partial in the back first, rock it down so now that it’s fully seated they back can’t come up because you have engaged the proximal undercut. Then the situation here is a similar situation only from front to back and we’ll talk more about that later. So what are general considerations? If you got a rotational path all of your seats do not necessarily seat simultaneously. It’s not a straight path of placement. It’s a curved path of placement. Many times you can eliminate unesthetic clasps.  The clasps are replaced by rigid retainers is what we need. In the case that we’ve talked about before in the posterior aspect no need for a clasp here because the rigid retainer being the proximal plate of this partial denture framework, once the partial denture rocks down in place there is a good occlusal rest on this and then the proximal plate rocks in to the undercut. So as long as the partial denture can’t move mesially, this can’t come up. It’s rocked in. As long as this stays down this is rocked in. So clasp in this case would be replaced by a rigid retainer [inaudible] proximal plate and the occlusal rest. So we don’t plan on the retainers flexing. If it’s a clasp you plan on the clasp flexing over the height of contour and coming to rest at the desired [inaudible] undercut. If it’s a rotational path that part of the rotational path framework it seats first and then you rock it to place. That’s what really [inaudible] rigid retainer just by going in and rocking to place [inaudible]. So the rigid retainers do engage undercuts and with many of these there is little tolerance for error because if these are off just a bit there can be problems. How many people so far have delivered as definitive partial, I mean the partial that’s got a metal framework and the [inaudible] teeth on half of it? Little less than half. So for those that have or for the people that are about to deliver some partials what [inaudible] is you try the partial denture framework in to make sure it fits okay if you take a bite registry.

So you say “Gee doctor this framework fit pretty good, we got the occlusion adjusted and we took a bite.” Now you come back and you go to deliver the partial with the teeth processed on. And very many times when you go to deliver the partial now that the teeth are processed on you come and get me “Gee, my partial denture won’t seat. I can’t get it into place.” What’s the only thing that’s changed? It’s that we got teeth and plastic on it. So in many of those situations what happens is where the plastic has being processed meaning where there is a tooth set out here and there is pink plastics processed in here, many times as you are trying to seat partial the pink plastic plate interferes with the undercut you are trying to engage. As with many of these there’s not a lot of tolerance for error. Why do we always have you people [inaudible] or your partially [inaudible] on the surveyor table?  So that it’s leveled front to back and leveled side to side. We talked about this over and over. Sometimes in the preclinic even, and in the books they were talking about at the time I was in school, I was always sort of left with the impression when I took partial denture undergrad that if you put a cast, just took a model out of the patients mouth, took an alginate [inaudible]. If I fiddled with this thing enough on the surveyor [inaudible] I can find some orientation of this cast that will satisfy all the requirements necessary to make a nice partial denture framework. I was just always too dumb to find it. But supposedly if I [inaudible] enough…well what really what should have been happening is just orient the cast  so that the occlusal plane is leveled front to back and leveled side to side, draw a design that would be my most ideal framework design that I would like to draw, forget the contours and the teeth. Just draw a nice design.

Now go back and look at the teeth. Now if you got your design drawn you say “Which areas in the teeth are going to work with the design I’ve drawn? And which contours on the teeth, typically axial contours, are fighting me, are not working with the design I’ve drawn?” Now the reason we want to orient the cast leveled front to back and leveled side to side is if I want an undercut where I’m looking for the desirable undercut for the clasp, again, where do we want those clasps to engage? We want the clasps to help hold the partial denture in place, to resist the tendency for the partial to be pulled out of the mouth when people eat sticky foods. So any time you’re eating sticky foods once your teeth come together when you start to open your mandible, open your lower jaw, during the first millimeter to two millimeters of opening of your lower jaw can everybody see that the direction that your lower jaw is going to be in is pretty much perpendicular to the occlusal plane. I know the jaw opens on the arch. I know that. But can you see just the first 2 millimeters of movement? That first bit is pretty perpendicular to the plane of occlusion. And once you’ve opened 5 or 6 millimeters, the partial is already off the teeth be it a jujube or a gummy bear for the time your front teeth are 5 millimeters apart, the partial is already completely unseated. So it’s just during the first couple of millimeters of opening is when you want that resistance to displacement. So since during just the first millimeter or two of opening if there’s [inaudible] the direction of the vector is pretty nearly perpendicular so I got to find out what the desirable and undesirable undercuts are for my proposed partial perpendicular to the plane of occlusion. See if I can do a lot of gymnastics, if I can really orient the surveyor table all over the place to try to find some orientation where I can [inaudible] the point is that‘s not the direction that people are going to chew.  Okay?

When they open their jaw the vector is not going to go over this way somehow, it’s going to come straight up here.  So if I orient my cast in some odd orientation to find an undercut but when I bring my cast back level level front to back and side to the side, if that undercut now goes away that’s a false undercut. Because a false undercut is one that you can orient the cast somehow to find it, the question is does this still exist when the occlusal plane is leveled front to back and side to side? Cause that’s the direction that the removal [inaudible] is going to fall on the partial. People call that [inaudible]. as easy as can be. Put it on the darn framework, level front to back and level side to side and then start analyzing the contours of your proposed [inaudible] teeth. [inaudible] do they tilt lingually? Do they tilt lingually so far that it would be difficult to seat the framework? Cause there is difficulty if you’ve passed the tooth and still haven’t touched the gum. Many times if they lean lingually so that the lingual of the tooth is in the way, what do you suppose is the situation out at the buccal of the same tooth in terms of undercut for your [inaudible]? It ain’t there. There are things leaning lingually so  just looking at the orientation of the teeth when we got things oriented when we…when basically our cast is leveled front to back and leveled side to side. Then again these pictures. I’m not going to go over these things [inaudible] because these are all straight out of your book. I just stand them. So the thing here we’ve talked about if you got linear path of insertion everything goes up and down at the same time. If there is a mesial undercut here we brock it out parallel. If there’s an undercut here we brock it out parallel.

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Matt: Lorne just one other thing the same tips that Rd.  Wilson was speaking about that do not have to be cleave d are also use on the I -Lays. There are disposable, different lengths, different diameters that easily interchange on and off.

 

Lorne: That’s good to know. Don another question about using the laser tips for indo. Is there are risk of those laser tips breaking off in the root canals?

 

Don: They are very flexible Lorne. I’ve never had one that break. We use both the 200 and 400 micron tips.  You never want to force those in the canal. We usually go about too about 2mm  short of the  apex and we’re careful about our  settings but that has not been an issue but you never want to wedge them into the canal  either but they are very flexible and they are designed to be one use.

 

Lorne: Another question you showed a specific case about teeth whitening. Was there any sensitivity on the patient after the whitening and if so how was it treated?

 

Don: We didn’t. If we had we would be treating it with some fluoride butt we didn’t have any post-operative sensitivity at all. I have had the exact same procedures done on myself and I can tell you it was very comfortable. We go through two cycles, the laser will expose abbot a quadrant at a time and we do about j 30 seconds on each quadrant and then we move. It  just take a few outs to activate  the bleaching solution  and then once its activated we  leave it alone for about 5-7  minutes , rinse and the we do it again.

 

Two cycles accomplished  what you saw there and I don’t think I really mentioned it but with the bleaching wand that you saw their on the photograph it can also  be used as  a low  level laser tool and you can set the Boar laser and use  it for  treating TMJ . That’s another nice function of the Easy Lays that you would not be able e to use the bleaching wand on the new I-Lays. It only would allow you to use disposable tips.

 

Lorne: Great we’re down to three questions here. We’re going to finish on time. Have you done any guided tissue regeneration using the laser?

 

Don: I have not personally done that. I have seen Brett Dear present some really nice case on that but in I have not personally done this.

 

Lorne: Another question about the removal of epithelium layer for the peril reattachment.  You might give a quick recap of that and the other question they had was if they could get the slide show. I want to remind everyone that we did record the entire webinar. I’m going to have it on my site, I imagine Schein will have it as well. there’s certifiably will be ways for people l to … When we see you the CE  forms as well as the follow  up  I certainly will let you know when whew available to download and watch the who presentation .  Can you do a quick recap as far as what you recommend there as far as that epithelia layer?

 

Don : I can  run  and I would like to say  to those of you when you purchase the lase and you get a radio fire perio tip Boa Lays u has some really good and concise material   that comes with he tip . It gives you the settings and some diagram sand sort  of the step by step in he procedures so if you need to have that little cheat sheet there as you go along and  do this  for the first few times,

 

The first step is to trap around the tooth, going down in between the tooth and the tissue and because it is a radio filing tip it will shoot energy at an angle towards the tissue which will deapethliaze the lining of the pocket. If you remember form the diagram there is a little blunted in that will allow some energy to go down towards the bottom of pocket.

 

The first thing we’re gapping  to deapethelize the lining of the pocket then after that we will tilt the tip very slightly toward the  tooth  to get a little more favourable  direction on  our radio fire tips , still down inside  the pock and we will use that to go around   using an ear water spray , we will use that to go around an remove calculus that  I down inside  the pocket from the tooth . You will actually see those little bits of calculus coming off.

 

That also property this trot surface for goo reattachment. Then e move outside the pocket and we deapethliase   the outer portion of the pocket, we’re enough inside of the pocket now. So we’re deapethilasing outside the pocket  and we are taking those cells  back away from the top so they have to grow  further before they can turn and go  down in the pocket so we don’t  have the [Inaudible] in the pocket again to   prevent  reattachment . What we are allowing to happen is that the functional epithelium we are giving it a little more time to reattach at the bottom and grow up then once we had done that we use moist tiles and   awe compress very firmly for five minutes to get a blood clot to form underneath there.   That’s a very important step in this I procedure.

 

Then after five  minutes we’ve got  a nice  dry environment and we seal up around the necks of the teeth , the top of the tissue wit  derma bond  and seal that up and then send the patient home .

 

Lorne: When do you bring them back to remove that surface epithelia again or do you?

 

Don: We do , we bring   them back in one week and  if there is any residual derma bond  left on there we would  go ahead an d clean that up . We will deapethlize just the outside of that pocket. That portion doesn’t use anaesthesia   by the way to do that. It’s very comfortable for anybody .We don’t have to sue topical on there. We do not put derma bon on that next time unless it’s in the case of   a smoker that we might but derma bond on it. One more week of we get somebody that smokes.

 

Lorne: When you are deign that RST procedure in your option is that amusing any kind of etching into the trot surface.

 

Don: No, not at the settings that you are using. Another thing with ought getting too technical, the angle of the laser. If we were using a regular 400, 5000, 600 micron tip  , regular tip and wife we were  directly perpendicular  to the roots surface then i would be very  much concerned  about that but because we are going g won into the pocket  parallel  and values we are using radio fire  tips  and we are using the appropriate e  setting s , meaning the wattage  and the pulses per second and air and water because  we are using all of the correct setting as recommended then know that’s not a concern

 

Lorne: Final question. I guesses this is partly for Don, partly for Matt as well. For someone that really just neat to get  more information about laser  is there a good website that they should go to or any video out there, what would either of you recommend for eosin  who is just  thinking about  it and really wants to get a little bit more information  online .

 

Matt: Certainly there are a number of different ways that we would love to help you with him education process. Again I know Don has it on the screen. We would love to come out certainly to youth office and present some different applications and list all the benefits to you and your staff, come in and do a presentation for you ring your lunch.  We have seminars throughout the United States, North America koi that matter.

 

Lorne: re these hands on course matt?

 

Matt: Some  of them are hands on and then some  of them are certainly  just  luncheon presentations  but you  can  go to again the Henry Schein website  and find one  or the  Boa Lays website near  you , a location that’s convenient  and words for tour schedule  and again we would  be more than happy too come into the office ad do an in office demo is that is something that  you also need to get information .

 

Dan: Ladies and gentlemen what is old really recommend to you is to let one of the reps come in and bring a unit in and work with it right there in your office. I think that’s a great way for you to learn. You will get a lot of experience just by having it in your own office and they are happy to do that. There are some wonderful courses, they are designed dos that once you purchase the laser you can come there and take those ads you basic learning but you can also go to those and sit in on them as a learning experience   before you purchase the laser. If you like that so that  you can sort of kick the tires and cleome more  familiar with the  overall technique I  would invite you to go to one of those courses and participate in it .

 

 

Lorne: On more question for you Don, clinical question. If a patient is taking any type of Vida dilators do you see the advantage of using the other lasers such as it relates to equalisation time.

 

Don: There rely isn’t any concrete indication to use in the laser.  That the wonderful things about it, even during pregnancy. Bleeding is not a big problem or us so it is a huge advantage for us being able to do that I recently was in a situation where we did seem crown lengthening on a patient that was 6   month pregnant and owned some blood thinners and did a little own lengthening and even at that time it was just not a problem.  Good question.

 

Lorne: I want to thank bout of you. Don that was an excellent orientation, very informative, we   had a lot goof great k questions here. Matt tanks for being on the call as well. Soon you call all see the phone number bad the website. If you want to get more information, get any office demo, I would highly recommend it. Thanks very much Dr Schein and Boa Lays for helping us with it. Any of you who have ever done a lecture or a webinar know that these things are not easy to put together and it made my life much easier, especially Don it makes my life so much easier when I can just sit here and listen to an expert rather than me having to ring through all these kind of stuff here. Thank again Don. Many of you keno I do these webinars on a regular basis .Thesis is certainly not the last webinar that we are going to do on lasers. When you find out you should have a chance to let us know if you need a little bit more information, some comments. Some of you  would like some more advanced courses, just in soft tissue lasers we can customize anyway you want  but certainly every 3-4  months  I think  I would like to do another laser  webinar.

 

As I said it will be available   on my website. We will let you know about any locations for them. Thank you everyone for being on the call and we will see you’re shortly for the next webinars

 

 

 

 

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The impossible is nothing .It so the reality of lasers for every day dentistry. For those of you that had been with sus the whole time I want to thank you for your time again tonight. It has been a pleasure woo join you this way tonight. I hope that I provided you with  some information that you’ll find very helpful in making lasers   part of your very day , every way  practise  and I will be on the line now with Lorne to fill as many questions as much as we possibly can and feel free to contact  me in the future. Lorne?

 

 

Lorne: Thank you doc that was great and you are not   done yet.  We have a lot of questions here. I’m going to get to it because we do have a number of questions and they are still pouring in. Thanks again   that was just fantastic information. Matt are you still on the line as well?

 

Matt: Yes.

 

Loren: There may be a couple of questions that I’m going to ask you as well. One of the first question we got Don was how was the learning curve for you? How difficult was it for you to start incorporating this into your practise?

 

Don: Please bear in mind that when we started lasers it was back in 1998 and we had to learn by asking all the mistakes.  There really  weren’t good course for me to  go to back   then and so those of use two were using lasers around  the country  sort of had to learn  by trial and error . I’m going to tell  you  I think we’ve made this  big mistake around laser and  I wane  say that  I think  I’ve  been a part of that as a laser educator. Folks this is just not hard and we’ve  have some wonderful courses around the country , we have this great course in  charlotte that Patrick  Brim does , Bill Chin has one in St Louis  and there are others around the  country .  Those are just two that I personally attended. Brett Dior is a wonderful periodontist. There is plenty of help out there but you already know how to do this procedures it just a matter of adapting the techniques. I want to tell you the learning curve in my opinion is not steep at all.

 

Lorne: I guess this question is more for mat? Matt is there a formal trading program that sis typically recommended for people that are getting to lasers?

 

Matt: Yes there is .When you purchase  the Water Lays  and the Odessa 100  it comes with a day and a half to 2  day training course and they’re  going to go over all the ins and outs  of how to add the water , woo to change  the tips  but  importantly going over the basic procedures, how  you’re  going to class one  through six cavity preps , how you’re going do periodontal procedures,  things of that nature to get you very comfortable with the basic procures  day in and day out that you are going to encounter .

 

Lorne: Great thank you, Don did you change your fees when you started using lasers?

 

Don: No we really right at first. I felt like I needed time to establish them in my practise and really we have not increase because we own a laser per say. I think out quality of dentistry have improved  and we have increased our fees across  the board annually as I’m sure that each of  you do  but the laser becomes  a tool in the toll box and it  really pays for itself . I will tell you that think, I know that my patients perceive this as a wonderful thing. There is not a day that goes by that I don’t have a patient tell me that you know why I come here doc? It’s because   you use a laser, I really appreciate it. So I think they are willing to pay y more. We don’t charge a laser fees we just incorporate that into our regular fee schedule.

 

Lorne: I guess this question is for both of you, there is a question about the new Boa Lays laser which I assume is the I-Lays. I thought in Chicago when you manage it now I know it just got FDA approval when I first saw it.

 

 

Matt: Yes. The I-Lays is currently shipping. We have had a  very strong response form he market and we arte  juts about caught up with all the back  orders which is  good thing .Now if you order a boa lays  that  will be shipped   very quickly after the order  comes in . The answer to that question is yes, and we will be happy you talk to you mire about that.

 

Lorne: Don have you had a chance to see the new I-Lays?

 

Don: I do not have one in my practise yet, I want to put it on there.  I saw it just before it was released and I think it is a remarkable tool I think it’s amazing to have that much technology in something that can fit inside your pocket.

 

Lorne: Another question for you Don, how do you keno when you are going to need anaesthesia and how common is it for you to stop and give an injection after you start?

 

 

Don: I don’t always know in advance that we won’t need the anaesthesia. I make the assumption that we will not. You a kind of tell by Workington some patients that they are a little but more nervous, or a little bit more fraud perhaps than others.  So  we explained to  all of our first time patients who are  suing the laser for the first time what to expect and if the patients have  some sensitivity the first thing that I don’t do is to grab  for my syringe. Once you got through some laser training you can learn how to adjust your settings and you can keep adjusting those settings   until you can get almost anyone comfortable and as you go into the procedures, then a lot of time you an up your pulses per second or you can up your energy per pulse and you can go on at a good speed.

 

There are things that you csan do to help  regulate that but if I have a patient that requires anaesthesia  I want to tell you guys that it takes very , very little . They do not have to be just profoundly number. Even the ones that are really skittish about that.

 

 

Lorne: What about the up keep on the laser. Are your staff the ones that are doing that and do they need any special straining?

 

 

Don: When Boar Lays install a laser they will come in and give training  to you and your staff  on site plus when you  go to the training courses  you get even more but I have an wonderful staff, my girls are highly  trained in laser use  because we’ve used it so long but they do  all the  maintenance and the day to day cleaning and do it very appropriately an take care of our  hand pieces and tops a den that sort of thing and off course we have  boa lays to come in and check tour laser at least on an annual  basis .

 

Matt: Ok this is an orphan question now. Can you do a transection friberaotmy for post orthodontist tabulation easily with this units?

 

Don: Yes you really can. On one of the trice things that Boar Lays offer are some really small tips.  You can go down to 200 microns and yes you can do a transperol frioberontomy using these smaller tips. It’s actually a very great way to do that.

 

 

Matt: This other question I guess it came right around the time of you were showing   your first peril case and the question is do you need tot the patient number for those procedure that you are showing.

 

Don: Yes you do. We talk about anaesthesia fee dentistry. I do that operative and there are some fast tissue procedures where you can use anaesthesia free or application of maybe just a typical but in a peril procedure like that no I do have amnesties and we dint have to have as much as we were dignity conventional l with the blade and seatrain and that sort of thing but yea I have amnesties for that.

 

 

Matt:  There is another question related to that procured what do you believe ease the eulogy for the pocket and access on number 9 with [Inaudible] removes during the use of the RFT.

 

Don: I think mainly the eulogy of that was traumatic exclusion for an extending period of them when this patient when it perfusion she was really riding heavily on that tooth and the reason I said that is because the surrounding teeth as you remember in the photograph they look and her over all dental health was good so this was an isolated   teeth so for that reason I think it was due to the traumatic allusion that she had and I don’t know that I remember specifically. I would say that we had some cactus come out of there   bit I don’t think much. It wasn’t like there was a lot of calculus under the tissue there.

 

Lorne: Another question here, what about using a Boa Laser to treat perusal pockets?

 

Don: You definitely can use a BAO laser in treating personal pockets. That’s a very common practise in my state in Alabama as well as a few of the other states. I don’t remember how many they are now. I would say probably 10-12 where hygienist cannot use a Boa laser. In my state    if I want to use a Boa laser in routine perio therapy I ‘m going to have to do that not my hygienist.

 

Yes it does work very well. If it’s a 4-6 mm pocket we would still follow up with the new erbium technique using the radio fire tips on the YSGG. Those are the perfect cases.  You will get reattachment on those but yes a Boa laser can be used.

 

Lorne: Are there a variety of tips that are available for Boa Laser?

 

Don: Yes there are quite a few different tips that were available now. For those of you that are in the audience now that  have an existing Boa Laser you probably are accustomed  to using your Boa Laser of having to cleave the fibre. The fibre is your tip and sometimes it’s difficult to get a really good cleave. With the Easy Lays   it has removable, supposable tips. No more cleaving , just screw it on and thy come in different  diameters bad  different lens and I  don’t think  I showed one in  my PowerPoint tonight but you can bend that tip to get a true right angle so that you can reach distal  to number 3 or number 15 very easily .

 

Lorne: This question is more for Matt. We have a number  of questions here about the cost to  purchase  from  entry level all the way  up to the MD turbo would  be best for the  local Schein  reps to  contact those individuals ?

 

Matt: That would be great and again I know Dr Wilson has left the slide on the screen. You can either call us or go to the website and we can address all of j the different financing options that we have e, different terms, different lengths and any promotion that we currently have going on the product. If you have specific questions Lorne I can address those as well.

 

Lorne: We do have a few questions on the pricing, we know who ask them so we will be able to give that information to you in case the Schein reps want to follow up with that.

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Now then a gingivatomy per quadrant, again maybe a procedure that you are not currently doing but a very simple procedures that you can do with the lease. I you add one per week   $33 350 added to this practise. Gingiva flat surgery. This is the perio procedure that I was just showing you just a few moments go. Maybe you currently send toss out to the periodontist. You can do them in house. No cut, no sew m peril surgery. if you can do just one power week and I know   how many of  your patients have  periodontal tissue j but if you just did one per week  you could add $4 150 to this  practise.

 

Clinical  crown lengthening .If you do very  much cosmetic dentistry  I know that you are going to run in to  the  need for crown lengthen  or if you work with crowns in the posture part of the mouth  with  large deep amalgams that go down  near the born level it know you’re  going to need the crown lengthen to not violate biological width in  your restoration . So we do far more  that one of these  power week but  if you just dis one per week you could add $38 750  to this practise .

 

Osco surgery with the graph. These things just come up from time to time. This is every day, every way dentistry. We see patients with these problems, we have a solutions if we just did one per month we   could add $19 896 to this practise. An apical rectum y you think might be beyond your scope. I will tell you the first  time in my life my career  that it ever did in apicalectomy  I called a good  friend of mine in California  on Sunday night t  he gave me directions how to do it with a laser . I did  it  on money and since then  we’ve been doing apical atomies all the time even m on molars .So if you just do one per month  you could  add  $23 352   to this practise . In new procedures that will total up to $170 8978 that you can add.

 

Let look last of all at time savings .We definitely can save time with lasers, no waiting door anaesthetic in at least 80% of the cases in restorative work, faster restorative procedures. . I’m not trying to say the laser is going to cut faster than a hand piece I’m just saying that because we don’t have to wait for anaesthesia the overall process is short, we can treat multiple quadrant in one visit j instead of having to have multiple visits that it such a savings and over hit for our office and gingival trifling your crowning bridge instead of having to pack cord. . Faster   soft tissue surgical procedures. No sauterne following a lot of them the way the laser works, a lot of times we would have to serene things it the past we don’t have to do that now. surgical and restorative  procedures in one appointment for example if we are going to do a flapless or a modified close flap crown lengthening if we need to we can  go ahead an d make out r impression for our crown at  that same appointment . Surgical and  restorative procedures  during hygiene , if we have a hygiene patient that  needs a little  procedure done and we have a equity chair in a fee w minutes we can move that person over  and just  do it there instead of  bringing them back for a separate   appointment  and more efficient treatment  of emergencies and non-schedule patients  if you remember the photograph earlier of the kid who fractured  the central incisor . We did not have an appointment for them, we work them in and we did definitive treatment instead of just temporary.

 

One appointment root canal  most of our  root canals we are able to do in one appoint and confident that we have sterilise  the inside of the canal because of the laser  in faster and improver cosmetic procedures and  I think we have shown several examples  of those this evening already .

 

So  one hour per day  at  950 an hour  times 200 days per year we can add about  $190 000 to this practise so all total we will be able to add $580 048 to this $750 000 practise. That is a 77% increase. Now you say you’re crazy those are not realistic numbers actually they are realistic numbers h because those are numbers these have actually taken from our own practise but if you  think it’s too much , if you think it really, of the all that lasers can do that  lets cut it in half. Even if you can only y do half that much that’s still a 39% increase $290 000 increase on this practise. That’s enough to pay for a laser and all the canned ham or smoked ham that you can possibly eat during the year and still have $175 000 in your pocket.

 

Briefly it want you to think outside the box, think outside the box for the gentlemen in our office to night. Won’t you look at the bigger precise by expanding ding your practise by adding partners or associates. If it ask you the question what’s the back bone of a good practise?  There are a lot of correct answers but it think the most correct answer r is a strong and consistent flow of your patience. These are actual numbers from our practise, we put a laser in our practise in 1998 and the only thing that we did differently from here to here is that we put laser dentistry into our practise and we properly marketed it and during that time we were averaging 189 new patients over month and all we did jaws to market the fact that we had a laser to our community.

 

Our production also increased.  We went from one million to 2.4 million in production during that same time period.  Again the only difference between here and here is the laser in the practise and proper marketing. New patients do equal near partners or associates so we j grew a regroup practise from 97 to 2003 we were able to add two partners into the practise from 2004-2007 we wren bale to have 5 different associates in the practise. 2008 I sold out two partners and started a new practise and nice that time we now have go grown that practise over a million per year and we were talking about a buying associate. In fact it got a phone call from two people ahoy are interested in coming and looking at the practise to join us as associates.

 

In the end are the results worth the effort and the answer is you bet they are. As some of you may know or may have gathered from an earlier slide I do like to fly and if I’m going to trust my life to an air plane I don’t want to settle for second k best l I chose a serious aircraft to be my own [personal aircraft for a reason and one of the reason is a parachute. If all goes wrong while we are flying and there are no other solutions we can pull   a handle it rocket launches, a parachute that gooses out behind the lane, it opens up and safely floats the plane to that’s the only aircraft that has that .Even though it cost a little but more money I don’t ant to fly second best when my life depends on it. If I’m going to trust  my practise through a laser    well you know the rest of the story , I want the very best and after  having used all the lasers that are on the market  today my feeling is that  the Water Lays  MD  is by far the best laser out there  and I have used all of them .

 

I want to conclude tonight with laser marketing. We must learn to think like our patients think, not like dentist we must think like patients. Stewart Sink why  is  frim our are  here in fact his  parents  olive right down the street from  us  he drives  for show  but you put for dough and in talking about that and comparing that too laser marketing we can do all of our  marketing relative to operated dentistry . As you can see we do many, many procured besides operative dentistry   but thinking like the patient thinks. When a family member goes to see their dentist for a recall visits and they get home the first question that is asked is how many blank you had. The answer for the blank is how many cavities you had because patients equate the dental office to fillings. That’s what they think about. I now we do all toads other wonderful procedures but the    patients think about how many filling s I need.

 

 

With that in mind we did all off our marketing really based upon filings. No shots at the dentist suite, we talked about no shot, no drill, and no numb lift. [Mumbles] I should have used the lasers, translated I should have used the laser. Again talking about anaesthesia free restorations, not shot no drill, no numb lip. Seven R campaign was how refreshing talking about laser dentistry and aso2008 a reason to smile and then No shot No drill No numb lip. So you can see all of our marketing that’s focused around that patients think about and that is restoration. In our 2009 we have switched to a little bit different twist, lasers and cosmetic destroy because   we switch to our nee practise signature smile and then 2010 falling in love with your smile.

 

We do a lot of marketing. These are   some of out marketing campaigns that we sues. If you don’t  like this , talking  about if you don’t like  an injection or if you don’t like a drill or if you don’t like  a numb lip then we have those to offer you. no problem  campaign , real life situations a dental  filling , a free clean  up no problem because a lot of  our patients do leave here  and  go to a school function our a luncheon  meeting or a church function or an outing  and they are  able to  go without a numb limp an they really like that .

 

The  no , no, no  campaign ,  no shot , no drill , no numb  lip and this can’t  be dentistry  campaign and then we did get with the times. We did ads that related to the months in which they ran. This was our January  add , anaesthesia is so last year, talking about the fact that can  do Anaesthesia , free dentistry  ,  sweet campaign , no shots at  the dentist, eating right after a filling, you can still feel your face sweet  and these were one of my favourites .  These ads were not ours, issued a company of DR. Olsen was away dental but self-confessed ads .Talking about people that have phobias about coming to see h the dentist and how the laser releases their phobia.

 

I don’t know if you can hear this one our not… I front believe it’s going to. I had one of   the radio spots I ants sure that you would be able to hear that or not. We also have post cards, brochures, direct mailers, talk about laser destroy. Feel free to copy anything that we do in our practise. Our marketing is done by a dental promotional group that is here in the Florence areas. You can contact them at the number you see or Angela Bailey, ang@dentalpromotions.com. She does a wonderful job for us and she has laser campaigns that are available for purchase if you would be interested in one of those once your purchase your laser. No fluff with proper marketing, the results can absolutely blow you away. I encourage you to take you practise to the next level. Let that rocket and enter the world of laser dentist. You mission if you decide to accept it is very possible. This is every day, every way dentistry and I’m here to tell you that if a guy in Alabama can do it then you can certainly do it too.



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