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Endo tips    Better Endo    Endo abstracts    Endo discussions

Other cases of Glenn Van As (rxroots):
Laser -2  Laser -3   Non vital bleaching   Gold Inlay  Gold Inlay -2   Removal of Screw Post   Simple Case
Soft tissue lasers

The opinions and photographs within this web page are not ours. Authors have been credited
for the individual posts where they are. - Photos courtesy of Glenn van As - www.rxroots.com

From: Kachman
Sent: Wednesday, April 11, 2001 8:52 PM

Glenn...you are spot on about the healing...definitely more predictable than a scalpel
or burr...do you do much cosmetic reshaping of gingival levels...esp. on those people
with high smile lines?....I attended a Hornbrook lecture a few years back and the results
he had prior to veneering or what ever was amazing...now I cannot look at photo or a
patient without seeing discrepancies...its almost a curse

From: Glenn van As
Sent: Thursday, April 12, 2001 10 53

Phil:  I dont use cord anymore at all.  The only time the tissue recedes with the laser
is when you use it to trough around unhealthy tissue and then it heals by shrinking back.
This is used in laser curettage which we do for moderate adult periodontitis cases
before they go off to the periodontist.

Dr. Larry Finkbeiner a periodontist in Colorado springs looked at 1300 pockets and found
that the average pocket reduction when using the laser was 40%.

As for Soft tissue preoperative laser contouring with a soft tissue laser ( I have an
Argon soft tissue laser and an Erbium hard tissue laser) it is easy to use to even up
the gingival zenith of the teeth prior to doing the veneers as long as you sound and
find enough of a pocket ( bone is far enough away).  If there is inadequate tissue prior
to bone then obviously osseous recontouring is a necessity to even the gingival
architecture out.

Soft tissue lasers (ND Yag, Argon and more recently Diodes are wonderful to use around
implants , amalgams, gold crowns) to reduce tissue without fear of metal interaction.

As an aside to GPs in this group, diode lasers will soon be seen in most offices as the
prices are coming closer and closer to the magic 10,000 figure.

One company I deal with will be releasing a diode laser which is 12-15 pounds ( portable) ,
110 volts so pluggable in any outlet, and will sell for 12-13 thousand.  You can pay it
off in 4-6 months if you do nothing else but use it for gingival curettage ( a billable
procedure) and gingival troughing for veneers and crown.

Enough about lasers cuz this is the endo forum.  I apologize for ranting and here to
satisfy even the pickiest of the endodontists is a case I did today with radiographs
yet of my mistakes.  I did this endo and found 4 canals but it failed because I was
short on the palatal ( my cone pulled out after my trial cone and I didnt realize it
and only got the Obtura to backfill.  A post was placed and I had to go back in today
to get that post out.  Feeling pretty smug until the end when the composite crown came
off.  All I had time today was to remove the post and irrigate and reinstrument the
palatal canal.  I am thinking of redoing the others next time as I feel they had
salivary contamination because the whole composite crown was leaking.  I am going
to get periodontal consult for the tooth but thought you would like pics at high mag
of the long post removed.

What do you think?   Glenn
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From: Kachman Sent: Thursday, April 12, 2001 1:33 PM Glenn...I will admit it...your postings are most impressive....the laser by far has provided you a better working field with superior control of your materials and easy access for a great finishing job...don't stop putting these cases on for us to see Phil Kachanoski Peachland BC From: Glenn van As Sent: Friday, April 13, 2001 10 12 Phil : I would be honoured and thank you so much for the kind words........ I make my fair share of mistakes but the microscope gives me a fighting chance in a lot of situations. Today I had to do a preparation on the Disto buccal of the lower second molar where the decay was subgingival due to the former presence of a mesioangularly involved third molar which was recently extracted. I was able to actually see the decay preop, and access it from the facial of the distobuccal line angle. Prepped the tooth ( with a bur), and reduced the tissue with an Argon soft tissue laser and then was able to put an automatrix band on the tooth. WIth the help of the scope I cut a window in the band where the DB approach on the tooth was and actually filled the preparation through the window. No way I could have done such a conservative prep on such a difficult tooth without the laser and the scope. My assistant and the patient both asked what I would have done in the past, I said........ "well we would have watched that one!" Take care and thanks for the very kind words. I take the compliments with alot of pride as I truly am an average GP who tried to become better through todays new technology and if I show an odd case or two that people think is interesting, its not because I have a great set of hands , just a better set of eyes and some great staff. Cya - Glenn
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