2013 northern california seminar …€¦ · contemporary cosmetic dentistry hugh flax, ... john...
TRANSCRIPT
CONTEMPORARY COSMETIC DENTISTRY
Hugh Flax, DDS FICOI
Accredited Member AACD
Atlanta ,GA
2013 NORTHERN CALIFORNIA SEMINAR
JOIN THE REVOLUTION OF NEW TECHNOLOGY
Smarter
Quicker
More precise
More comfortable for the patient
Greater satisfaction
Bottom line: You are “raising the standard of care”
Copyright Flax Dental Atlanta GA
LASER is an acronym for :
L = Light
A = Amplification by the
S = Stimulated
E = Emission of
R = Radiation
Doctor’s advantages when using a laser
1. Less Hemorrhage to control
2. Less Pain - Reduced need for prescription drugs for pain
3. Less need for post operative bandages…lymphatic help seal
4. Less need for local anesthesia….saves time for many procedures
5. Patients appreciate the technology and will pay more
6. Fewer post-op complications …..reduced microbial colonization.
Zone of Necrosis -tissue is irreversibly damaged and will die
Zone of coagulation - most of the tissue will recover and return to normal
Vaporized
Area
Tissue effects caused by thermal exposure
Spectrum of Medical Lasers
110000 nnmm 440000 nnmm 775500 nnmm
UUllttrraavviioolleett VViissiibbllee IInnffrraarreedd
HHeeNNee ((663322nnmm))
KKTTPP ((553322nnmm))
AArrggoonn ((551144 nnmm))
DDiiooddee 881122nnmm
DDiiooddee ((998800nnmm))
NNdd:: YYAAGG
((11,,0066 µµmm))
EErrCCrr::YYSSGGGG 22..7788 µµmm
EErr::YYAAGG (( 22..9944µµmm))
1100,,000000 nnmm
XXeeFF((335511 nnmm)) EExxcciimmeerr
XXeeCCll ((330088 nnmm))
KKrrFF ((224488nnmm))
AArrFF ((119933nnmm)) RRuubbyy ((669944nnmm)) HHoo:: YYAAGG
((22,,0088 µµmm))
--rraayyss xx--rraayyss UUVV vviissiibbllee IIRR mmiiccrroowwaavveess rraaddiioo wwaavveess aaccoouussttiicc wwaavveess
AArrggoonn ((448888 nnmm))
1100--1122
1100--99
1100--66
1100--33
11 110033 wwaavveelleennggtthh,, mmeetteerrss
CCOO22 ((99..66 oorr 1100..66mm))
Copyright Flax Dental Atlanta GA
Excited region vaporizes
and expands rapidly.
After excitation
2.78-µm light
(ErCr:YSGG)
During excitation
Expansion and Micropropulsion of a Macrosphere of Water Molecules
Droplet (macrosphere)
propelled by rapidly
expanded molecules.Copyright Flax Dental Atlanta GA
Laser - Tissue Interaction
•
•Thermal Relaxation is the time that the laser energy is off. This is the time during which the target tissue is allowed to cool.
• If we want to cool tissue we can change thermal relaxation time by switching from Continuous Wave to Gated. Free-running Pulsed laser has a longer thermal relaxation time than does gated.
• Always use the lowest power setting that will achieve the desired results.
Copyright Flax Dental Atlanta GA
What does HydroKinetic® mean ?
The Energy of Water in Motion
Examples:
1. Erosion to the rocks caused by the oceans moving
2. Hosing down the sidewalk to remove debris
3. Damage to property caused by rivers during flooding
4. Mining for precious metals using high pressure hoses and water
Cosmetic Restorative Clinical Applications
Soft Tissue Procedures
•Gingival Recontouring
•Gingivectomy
•Frenectomy
•Troughing
•Fibroma Removal
•Hemostasis
Copyright Flax Dental Atlanta GA
Cosmetic Restorative Clinical
Applications
Hard Tissue Procedures
(for adult & pediatric patients)
•Desensitization for bleaching
•Cavity Prep - Classes I-VI
•Caries and Restorative Material Removal
•Roughening & Etching
•Enameloplasty
•Bony recontouring
Copyright Flax Dental Atlanta GA
Clinical Paradigm Shift
Micro dentistry (conservative care)
Minimally invasive soft/hard tissue treatment
Little to no need for anesthesia
Copyright Flax Dental Atlanta GA
BE GENEROUS TO YOUR PATIENTS !!
(as if the clinical benefits weren’t enough)
Give them comfort
Give their teeth strength
Give people courage and hope
Give them beauty...mimic nature
Give people a message
Copyright Flax Dental Atlanta GA
Erbium Laser Anesthesia
Proposed mechanism of action
Reducing the action of the sodium potassium pump at the cellular level thereby slowing or even stopping nerve conduction in the pulpal tissues long enough to “painlessly” ablate enamel and dentin without the use of anesthesia in most cases
Copyright Flax Dental Atlanta GA
DENTAL CARE COMFORTABLE !!!
Reduction of intra- pulpal temperature 0° to 2°C (Rizoiu, et al 1998) compared to : High speed (wet) 3° to 4°C increaseHigh speed (dry) 14° C increase
Vibration free- fewer microfractures and less functional disturbance
TheoreticalPhoto-acoustic effect (Scott,2003)Blocking the C-fiber afferent nerves (Japan) Chemically- Increased endorphins
Decreased serotonin Decreased pain
Copyright Flax Dental Atlanta GA
WHAT IS ESTHETICS ?
The science of beauty in nature as an art
“Beauty is the association of many complex associations”
Charles DarwinCopyright Flax Dental Atlanta GA
GINGIVAL SYMMETRY/CONTOUR
No excessive display
Centrals match each other
and canines
Laterals?
Edentulous
spaces ?
Copyright Flax Dental Atlanta GA
Evaluating Gingival Contour*
Ophraic Line (eyebrows)
Interpupillary Line (mid-eye)
Interalar Line (nose)
Commissural Line (lips)
FACIAL LANDMARKS
*From Ken CanzoneriCopyright Flax Dental Atlanta GA
Most Common Undesirable Outcome
Using the incisal plane as
the sole reference
point for gingival
evaluation.
Copyright Flax Dental Atlanta GA
Reality Check
“The Biologic Zone determines the cervical limitations of
tooth preparations and will ensure the preservation of a
healthy periodontal attachment.”
John Kois
Contemporary Esthetic Dentistry Vol.2 No.1 1996
Copyright Flax Dental Atlanta GA
John Kois Contemporary Esthetic Dentistry Vol.2 No.1 1996
“Biologic width is not a contrived illusion of mathematical precision. Because of human variability, the precise clinical delineation of the individual components of the DGC is illusive”
Degree of inflammation
Amount of probing force
Location of the tooth
Copyright Flax Dental Atlanta GA
“The total dentogingival complex is more clinically significant to ensure predictable results”
John Kois“Altering gingival levels: the restorative connection part I: biologic variables”J Esthet Dent Vol 6 No1 1994
Based on a study of 100 healthy patients with unrestored teeth
Copyright Flax Dental Atlanta GA
In this study it was found that 85% -90% of the time
John Kois
Contemporary Esthetic Dentistry Vol.2 No.1 1996
Copyright Flax Dental Atlanta GA
The Gingival-Esthetic Restorative ChallengeHow to:
Create an esthetically pleasing gingival architecture ?
Maintain biologic width by mimicking the osseous scallop?
THE ANSWER:
Using a
Erbium Hard/Soft Tissue LaserCopyright Flax Dental Atlanta GA
WHAT’S NEXT?
Evidence based research (co-op?)
Specialty acceptance
New standard of care
Public awareness to increase demand
Penetration into the dental market
Copyright Flax Dental Atlanta GA
DO IT OFTEN!IF YOU DON’T USE IT YOU LOSE IT!
Practice
Always try new things as you climb up the “learning curve” Unconscious
Competence
Conscious
Competence
Conscious
Incompetence
Unconscious
Incompetence
THE LEARNING CURVECopyright Flax Dental Atlanta GA
CONCLUSIONS
Avoid lengthy recovery times from gum surgery (less invasive.....no stitches !)
Give the dentist more control of their cosmetic cases (no referrals and better
artistry !)
The best part: Patients are happier by completing the "smile makeover“ cases 2-3
months faster (much better customer service!)Copyright Flax Dental Atlanta GA
A FINAL THOUGHT…….
“We are not creatures of circumstance;we are creators of circumstance”
Benjamin DisraeliCopyright Flax Dental Atlanta GA
CONTACT INFORMATION
HUGH FLAX,DDS(404) 255-9080
Email: [email protected] lecture info
on cosmetic dentistry and lasers
http://www.catapultelite.com/flax.php