Using Lasers for Everyday Dentistry P4
2013
Tongue tie release, remember every day, every way you will see some one occasionally that is tongue tied if you are looking for them if you have a solution to this problem. When the patient raises their tongue we get the classic valentine shape there and they can’t stick their tongue out very far past their lip. This is a very simple procedure. Its lingual phrenectomy. You place haemostats at the base of the tongue and then we cut on the side ops at the haemostat then we go back about 3/4 of an inch to an inch to release.
Then you let the patient move their tongue around and see if they can touch the roof of their mouth and of they can extend it out past their lip now and when you have gone back as far back as far as you thin you need to go then you can place your sutures. It is very important in this case to make sure… I ideally place 3 sutures so that you do not get any reattachment.
Here’s a very large mucus seal. I’m sure there are days that people come in your office and you see a mucus seal. If you’ve taken one out you know that they can be a little not hard to determine the borders so this one was incised using the laser. Again very little bleeding. Look at the size of this, very large mucus seal. Seven days later wonderful healing and I want you to notice something in the pathology report. Yes it was a mucus seal but look lateral and deep margins are free of legions indicating complete excision. That means we’ve gotten on there and we’ve got out there with the laser and we remove the mucus seal in total.
Ovate ponits
This lady now have a really beautiful smile. It didn’t look that way just prior to the bridge she has. It looked like this. For quite some time we encouraged her to take out the f tooth in the frond and consider doing a bridge so we took the teeth h out and to give us a better look we use the chisel tip of the laser to ovate our ponic size all the way cross to the front, we use the double embossment t on each side. This gave use little bit better, a little bit natural look for this patient and age her a prettier smile. Now she is interested in doing the remaining teeth in her mouth.
Every day dentist y certainly includes crowning bridge j and it includes eight packing chord or using a laser to trop around crown grips. We use the Easy Lays 9400, it’s wonderful. It has disposable tips instead of having to clean the fibre of the tops you can just use once and then throw them away. Here is a lower full mouth case where we would have to pack a lot of cord yet we didn’t pack a single cord. In fact we don’t have any cord in my oppotuires, we never use any cord.
It allowed us to make a nice impression and get good results with our rotation. For asius procedures, surgical extraction assert notes that for time to time your face with a case like this and sometimes we have to consider laying a flap and removing some bone to get a broken root like this out. With laser we can use this 400, 5000 or 600 micron tip, Boa Lays have a nice selection of tips. The longer ones work really well or this. We can go down around the root and break the attachment between the period ligament in the bone and the tooth and then we can either with forceps or with thin elevators , peritonea, elevate the tooth out of the socket without having to lay a flap .
Just another example of this I really think you will be quick to admit if this walked in your office you’re going to be thing in about laying a flap and you’re going to be thinking about removing some bones. Look at the bone levels on this .The tooth is us all the way down to the bone yet we still have a full sized root. Yet we were able to go in with a laser an uncover it and elevate it out without flap. That also works out very nicely if you’re going to do an immediate implant placement. Here’s a surgical extraction with the root amputation, a rather unusual case is a bridge on the upper right.
We notice on the radiographic examination that distal buckle root had been severed from the tooth, [Inaudible] decay and so we went in with the laser and just took the root out into having to lay a flap and this is the way it looked immodestly postoperative. A few weeks later we actually went back and actually used this second molar as a bridge abutment with just a medium buckle and the powerful roots. You can see it radigraphically and excuse the blood in the field but this is right after we cemented it in and cleared around it.
Now we got a nice bridge abutment without having to have out r patient have to have an implant or other processes there. An apical granuloma, between x-rays we found this root tip left behind, granuloma tissue around it. Incision with the laser, open up the window with the laser, clean out the area, palace some bone graph material and here it is BS shortly after that. I think this was one week later, on week or ten days later. Olio surgery with the graph, this particular tooth had to have indo. It had really low decay here to the media and we had to open it up and do a little bone crack in he are , re contour the bone just a little bit . All one with the laser. You can see after indo was done a build-up will material will be forward on the tooth because that’s where the decay when originally.
Here it is about 6 months lather and here you can see the restoration that we were able to place so we were able to keep the tooth by moving the bone level back , doing a little bone graphing in this area and it gave us great results.
Crown lengthening
In this particcualr case we will take it all the way though, you can see that we are in a cross bite here, interior open by a low tissue line on the literal insider and this later insider is wearied out. Just make a mark with the sharpie to see where we want to move the tissue line, move it back with the Boa Lays laser and then use the chisel tips for recon touring the tissue. Once we establish our tissue lien when we want to move the bone up so that we have 3, boiologiocicl width. When I say we do this flapless we use a gold pirate and we actually will go, well it doesn’t actually show in the picture but we will retract the tissue back a little bit so that we can actually see the bone underneath there so we are not on tally working blind but it does allow is not to disturb the filling on either side of the tooth and maintain a nice sharp point there. Just clean it up with the pirate and we apply a title l pressure, use ox fires gel, eye it applied here and I think this was one week later. We did not disturb the lingual side and a few weeks later we did our preps for 360 porcelain, we chopped with the dial wood laser, our temporaries are in place ad ten the finish product. We’ve got a nice height on our later incisor, we corrected the cross bite, we closed up the bite in the front so here’s your before and after. Lasers were very much an important part of this and we wound up with some beautiful results on this overly patient.
Crown Lengthen Open flap this is a case where we had a three unit bridge , the patient had a decay underneath the [Inaudible] , it was just completely decayed out from under the abutment so we had to make an decision here and we decided to do indo and a build-up pan it and then we reflected a flap and removed some bones so we could crowd lengthen and continue to use this as abutment.
Here is immediately post-operative. One week post opt and six weeks post up > we have great healing, we now have a biological width sufficient that we can put a crown. Now we will go back and remove the other abutment bad sod a new bridge for this patient. we had done some interior corn work and we won’t doo the back cupids but as you can see the tissue line dips way down so in other to keep a good look we wanted to move the tissue up a little bit and so we dotted it with a Boa laser move the tissue back to the new line we waited to open flap and then by using weather 400 to 600 micron tip and then with chisel tip we were able to move the bone back and then after 6 weeks healing we can go back in and do our restorations and get a more pleasing tissue line .
Cosmetics, this is a new brochure we have in our office that we hand out to our patients. I just want to introduce you to some of our patients that have fallen in love with their smile. I will explain that later. I don’t have any prompts I on this lady on my PowerPoint but you can see and all of cosmetics we have done some tissue reocontouring , tissue touch up before we place their porcelain work . This is a case and a very beautiful last. Preoptivlely she had some dark stain, discoloured teeth. She just wanted that to have a better look. There’s minimal prep veneers to help cover pup the dark staining and you can see out r end result. She was very please. Pictures of those case e will actually be in the LBI magazine this fall.
This is a great patient, a wonderful person that we just did a full mouth reconstruction and the laser played a big part of that. This is his bite. He actually does have lower teeth here, he just have an extreme over bit it’s what the lower look like and the upper. Actually tooth number 29 was fractured and we just decided too cut it done with a laser and do some mat and like a retro field except from the inclusion and put the tooth to sleep and let it stay in there rather than try to take it out. You can see that that the root remains underneath there. Also in the interior you just really dint have anything to support crown so we had to g o in and crown lengthen his teeth across the front t with the laser and here you can see immediately after we upper with his temporary [Inaudible] and on the upper there was someone teeth we just couldn’t save , we had to take them out , we had to do some crown lengthen then we were able to open up his bite. For once in his life in a long, long time he was able to see that he had teeth in his mount and when he smiled folks knew that he had teeth.
Up until then you really couldn’t tell that he had any teeth at all. So good patient, great case thanks to the lasers. One final case along that line is just there’s some great results from an interior aesthetic stand point with six porcelain crowns to restore smile for this excellent patient of ours, this wonderful guy. Now he is ready to do the lower and currently we have had to crown lengthen this tooth after we did indo on it so we are working on this case as we speak now.