Dental Tribune Pakistan Edition No.1, 2017

6(cid:9) DENTAL TRIBUNE(cid:9) Pakistan Edition(cid:9)January 2017 CLINICAL PRACTICE Anesthesia-free and drill-free deep decay removal By Dr. Robert Feudo A pplications and research on lasers in dentistry continue to expand, yet the Solea dental laser (Convergent Dental) is the first and currently the only laser system that can cut any tissue with a single setting. The one-setting- fits-all approach works for tooth structure, bone and soft tissue, enabling any dentist to reliably deliver anesthesia-free, blood-free, suture-free and pain-free results.(cid:9) The following case shows just how safely and easily caries disease, specifically a deep-decay situation, can be removed by dentists using Solea, and the esthetically pleasing results that follow. Solea's revolutionary software is so easy to use that any dentist can become a laser dentist while providing the patient a more pleasant experience. Case presentation(cid:9) The patient presented with recurrent subgingival buccal decay on tooth #18 and #19 (B) (Fig. 1). The clinical objective was to completely remove the caries and then restore the teeth. The total procedure was completed in approximately 10 minutes and did not require any injectable anesthetic. Technique using Solea(cid:9) For the first step of the procedure, the enamel needed to be cut to access the decay (Fig. 2). This procedure was performed using the "Hard and Soft Tissue" setting and was adjusted to 100 percent mist to effectively penetrate the enamel. For soft tissue, a reduced mist setting would be applied for appropriate coagulation.(cid:9) To prepare the enamel as well as the patient, it's recommended to outline the prep at approximately 10-20 percent power and observe the patient and the analgesic effect. Simply apply pressure to the foot pedal (Fig. 3) to increase or lessen the laser power.(cid:9) Once the enamel was outlined, a 1.25 mm spot size was chosen and a cutting speed of between 40-60 percent was used to smoothly and gently break through the enamel. With Solea, the learning curve is minimal; maneuvering the handpiece back Fig-1 Fig-2 Fig-3 Fig-4 Fig-5 Fig-6 and forth is all it takes for a clean and efficient cut. Once the proper amount of enamel was removed, I then removed some soft tissue as well to better access the subgingival decay. I used a 1.00 mm spot size setting and 40-50 percent cutting speed along with 100 percent water mist. I did not need to adjust the water and usually don't unless the area is extremely inflamed.(cid:9) The dentin was now exposed, and I was ready to eliminate the deep decay (Fig. 4). For the decay removal in the dentin, the same 1.00 mm spot size was chosen with a cutting speed between 30-40 percent. The decay was then thoroughly and easily removed using the laser by applying a gentle gliding back-and-forth motion of the handpiece. Both teeth were then ready for restorative work using only the Solea and a spoon excavator.(cid:9) The teeth were then restored using Ultra-Etch (Ultradent), Adhese Universal (Ivoclar Vivadent), and Filtek Supreme Ultra Universal Restorative A3B (3M). The total procedure, from start to finish, was a mere 10 minutes (Fig. 5). Benefits of Solea(cid:9) Solea has drastically changed the way I practice dentistry. This is just one of many cases that I've completed using this truly revolutionary laser. Using Solea has provided my practice substantial surges in production and workflow efficiency, and, moreover, patient compliance has dramatically increased.(cid:9) Procedure time was reduced from typically 40 minutes compared with a mere 10 minutes with Solea to complete the case. Productivity was increased in several ways. Because the patient did not require any anesthetic, a significant amount of time was saved. If I were to use traditional instrumentation, there would have been at least one injection given and then time spent waiting for anesthetic to set in. In addition, the occlusion was accurately checked with the patient at the completion time of the procedure - potentially avoiding a follow-up appointment for a bite adjustment. Eliminating the anesthetic process also allows the ability to perform multiquadrant dentistry in the same appointment. About the author(cid:9) Dr. Robert Feudo maintains a state-of-the-art dental facility on the North Shore of Boston in Danvers, Mass. He holds a BS in biology from Suffolk University and received his DMD from the Tufts School of Dental Medicine. Feudo is a member of the American Dental Association and the Massachusetts Dental Association. - DT , General Dentistry USA Non-surgical laser has sleep applications By Harvey S. Shiffman, DDS O f the commercially available hard- and soft-tissue lasers, o n l y t h e L i g h t Wa l k e r (Fotona, San Clemente, Calif.) combines two proven wavelengths, Nd:YAG and Er:YAG, with unrivaled power and precise pulse control resulting in high levels of efficacy for a wide range of procedures. With this advanced level of performance comes significant patient comfort.(cid:9) The procedure described here has been developed to take advantage of these attributes. Snoring and sleep disordered breathing affect millions of Americans, both adults and children.[1,2] The signs and symptoms are the result of partial or complete collapse of the upper airway during sleep.[3 ]The structures involved in our protocol include the soft palate, NIGHTLASE Snoring and Sleep Apnea Reduction Therapy NIGHTLASE Snoring and Sleep Apnea Reduction Therapy elevates the soft palate and uvula and tightens elevates the soft palate and uvula and tightens oropharyngeal oropharyngeal tissues to improve upper airway volume. tissues to improve upper airway volume. Research also documents a 30-90 percent reduction in snoring tone and volume. uvula and the base of the tongue.[4] The goal of the treatment is to decrease the amount of blockage of the upper airway.[5](cid:9) Dentists are in a great position to help screen and in many cases treat t h e s e p r o b l e m s w i t h a i r w a y management. Helping patients improve their sleep can profoundly improve their health, quality of life and well-being of their loved ones. The "Gold Standard" for the treatment of sleep disordered breathing is the CPAP type device. Following that in 1981 was the introduction of Mandibular Advancement Devices (MAD). Compliance with both of these treatment modalities shows a reduction in compliance over time and significant side effects. However, the "NIGHTLASE Snoring and Sleep Apnea Reduction Therapy" protocol is a unique approach to treatment using the Fotona LightWalker dental laser with a proprietary protocol and handpiece. Another positive benefit is Continued on Page 07

Dental Tribune Pakistan Edition No.1, 2017

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