Using Lasers for Everyday Dentistry P3
2013
Pulp autonomies can now be done without having to use former, to be opened up and be treated with the laser, dropped inside of the pulp chamber with the laser. We use a little MTA on top of that and then go ahead and place our restoration. When we talk about indo terbium chromium YSTG laser uses the radial firing tips and they are much provisioned for removing bacteria form the root canal system and also removal of the smear layer. As you can see on this photograph look at the dental tubes they’re wide open. 15% of root canals that GPs do each year require retreatment and generally it’s because of reinfection. 99.7% reduction in bacteria count is when a canal is sterilised with a laser.
The radio fire tips as you see into his photograph here have a unique being because of the angle on the tip it disperses the energy laterally at an angle and if you notice it comes to a very exact point. When the tip comes to a point like that no energy is omitted thrush the end of the top. At this case we do want it to go laterally. If it goes out the end it ocean gout the end of the root ad stimulate some apical bleeding.
Here you see an indo tip , one that’s a brand new one and one that’s been used one too many times. As you can see in the photograph it’s blunted and if we use one too long and it becomes too blunted like this then the energy can travel out the end of the tip, out the end of the root of the tooth and cause an apical bleeding. There are two different sized tips at 200 and 300 micron they fit east [toy down inside the canals. Here you see a tip in use and we can set working length by the rubber stop that you see on the tip.
Down on the canal you admit their energy on the way out to remove the smear layer and to get rid of any bacteria that may be present. When we look down in the canal after that this is what we see. You will see that the canal are really frosted looking, very clean and a wonderful environment. It gives us a better seal between the [Inaudible] and the tooth. We can actually open the tooth up for indo using the laser if we need to. Other times if it’s a really hot tooth and you go in with your hand piece you know that the vibration that you get from hand piece, woven though you have good anaesthesia the patients still feels it. If you have a really hot tooth like that one of the best thing you can do is to open the tooth and get you access with you laser.
We use conventional instrumentation after that and then we turn to the laser for cleaning. It removes the smear layer, only takes about 2-3 minutes and also we get micro agitation tip to help clean out the cancel. From this photograph you can see with the laser it in water as laser energy has admitted it, it cause bubbles and squeezes down inside the canal. I see little particles falling out all the time as it cleans. It does a wonderful job of cleaning the root canal system. Then we can turn to the laser drive for disinfection. It reaches out into the dental canals and destroys the hidden bacteria that might there. Reamer we are using a radio fire tip.
Let’s talk just briefly and give another examine of another thing we can use the laser for and in endeavonance for an apectomy. Teeth 9 and 10 and on the radiograph we see a rather large lesion inn association with the apices of 9 and 0 and in kHz radio graph you can see that we’ve complete the indo on both of those two teeth . We just measure up from the incision edge to locate the approximate apex of that teeth and we will make out incision using the laser. Once we have the incision and woe open up the indoor of the bone using the same laser tip and then once the window is complete us clean out the legion area and wee amputate the apex with a little slight beble for access.
After we do that we can use the laser to go to the end of the root of the teeth and take out the gutter putura or the material it might be using at the very end and then we can do a retriivabatye field using MTA. Following that we can use a brine graph, seek though the area and then we are finished. With the laser we’ve made our access with an incision, we’ve amputate the root, we’ve opened up the root at the end of the tooth. It’s just a great tool and here you eel postoperatively our legion as it started and post operatively here is the lesion after we did the apical.
This is one week later, six week later and 12 months later. One thing that I mention about this particcualr case is that this patient was an extreme diabetic so healing was even compromised by that fact and I think you can tell that we got wonderful healing in this case.
Now let’s talk a little bit abs tout soft tissue. The treatment of a respective legation, we could also use the same treatment for an after ulcer. you want to get to the legion why it is still in the vesicular state before it gets into the vesicular stage , when the patient can first feel it coming on this time to treat it .We treat the herpetic legion with the laser. We just fire around the outside and work our way to the centre covering all of it. We want to be sure when you do a good high volume suctions system and one of the better quality mass.
You can also treat an after sulphur inside the mouth with the sane techniques. We do quite a few biopsies in our offices. This a biopsies for the removal of a fibroid, it’s a very large none. We use soft tissue pick up forceps and soft tissue tip on the laser and an incision to remove the entire fireman and after tan we use chisel tip to go back and do the laser band aid. It says here to put a little oxy fresh gel on top of the legion and here it is 6 days post operatively.
One of the things that you see with the laser is that healing is just wonderful after using a laser, much better than if you use a blade or an electro surge. By the way the patient that you saw in the photograph here was 86 years old at the time this was done so I think that was pretty good healing for someone off that age. A Paloma on the tongue , again using soft tissue pick up forces and soft issue tips on the laser , we just go around and remove that and if you notice the absence of one thing here., the absence of bleeding . Even though we are working on the tongue which is just full of blood vessels we have little to no bleeding and these are not touched up photographs one we didn’t blot the tongue just before we made the photographs to impress you. This is the we way it really looked immediately after we removed the papilloma.
The laser candid, we put socket gel, oral pain gel on top of that and here it is 6 days later and you can see that it has healed up so well .It really a little difficult to even tell where the pap lama was before we took it off. I don’t know if you have this in your practise, I just want to mention it to you. You can purchase this through Henry Schein dental, it uses The Dental Pie 300, it’s a multi oral cancer screening device. We use it in urn I office it has a wide wave length that just helps to eliminate the mouth. The violet with speckle glasses will show up any kind of legions as a dark spot in the tissue and then you can help to differentiate it by the green amber light and it shows you the vasculature to the area that you are concerned about. A very concise vasculature probably means it so and a very diffuse vasculature is something that concerns.
This is a wonderful tool and I know that it goes hand in hand with laser se and we use it in our office routinely .We did do a training video for them and you can see that at abystintrimera.net.
Prenectomies
Again remember every day , very way dentistry we see people come in all the time with a Lowe attach phrenic or a diasoma between 8 and 9 and were phrenectomy is necessary and remember we see the problem if we have a solution to that problem . Here’s an ortadontist case, a very; low attached perineum removed with the laser. Again look at we do not see, bleeding. We do a pretty aggressive phenectomy and we have very little bit of bleeding when we do this. Post operatively several weeks after the fact look at what our attachment reoccurred I’m going to show you in the next series of slides how you determine where you can place your reattachment of the phrenic and we can put it exactly where you want it to reattach.
Here’s that phrenctomy step by step, also with the distraction of kea legion. Low attach premium again, soft tissue pick up forces in the laser. We do an aggressive phrenectomy. We’re going to take the entire little muscle out. Very little bleeding here. Turn it over and do the other side. Now we’ve removed the perineum and then we go back between the central insiders and actually cleanout. There is always that little area between the teeth where there is a lot of tissue attachment and the bone just sort of invigilate there. We’re cleaning that out there really good to make sure that we have all the fibres.
Then a very important step is to score the periostum. The way that we determine how we do that so we look at the junction of the removable and the attached tissue and where we scored the perisotuium there we will have a scar band and that scar band will determine where the phrenum reattaches. If you’ll just lock that in your in as we got through these remaining slides you wills eye that the phrenum actually goes back and reattach exactly to that spot. With these you could probably leave them open. I think we get better healing and also by placing sutures it prevents any kind of reattachment in there of the tissue.
Now it’s healed up from that but you still see that we have a little legion of here to the right and we will go in and remove this legion using the ablation process. Thad is a chisel tip and instead of sizing it and cutting it out we’re just going to ablate it away. The tissue is just taken down cell layer by cell layer until it’s gone and here it is a few weeks after that when it is healed up completely. Remember in your mind where we score court pereostum and this is where our attachment will go back to.