Is there anything worse in dentistry? Your last patient on Friday afternoon (and you don't work on Saturday) comes in with a significant dental emergency. This happened to me several weeks ago.
Alan frantically called to tell us his upper left second to the back tooth (#14) had just broken while eating at a business luncheon. We told him to come over immediately and we would try to "put him back together". Looking at his electronic chart, I knew the tooth was previously endodontically treated; I just did not know what to expect.
Fig 1 - Radiograph shows endodontic treatment in #14 still intact. |
My assistant immediately radiographed the tooth and thank goodness the root canal appeared to be intact (Fig. 1), but when we visually examined the tooth, there was a problem. Tooth #14 had an old porcelain inlay, but the lingual tooth was gone (Fig. 2). The fracture ended about 2 mm subgingival.
Fig. 2- Tooth #14 missing lingual half of the tooth. |
This would be hard enough to restore, but the patient was leaving the country on business the next day, so even a well-fitting temporary would not do.
Fig. 3- Laser troughing creates visible margins for exceptionally accurate impressions. |
These are situations when I am glad that I have a lot of technology! I utilized the Discus Dental NV Microlaser to simply trim the lingual gingival tissue (without encroaching on biologic width). I was also able to use the laser to "trough" the preparation (Fig. 3) so that I could immediately and easily take a digital impression and construct a CEREC all-ceramic crown.
Fig. 4- The digital impression provides easy-to-read margins. |
Fig. 5- The CEREC crown bonded into place. |
I constructed the crown in about 15 minutes, had it cemented (Figs. 4 and 5), and sent the happy patient on his way. He was initially worried about going on his business trip because he thought he the tooth would need to be extracted. He could not imagine how he would be able to see clients with a large hole where his tooth should be. Instead, he left my office thrilled that his severely broken down tooth was repaired with a final crown in slightly over an hour.
When I look back at this case, I am amazed with the tooth-saving benefits of the diode soft-tissue laser. Without it, this patient would most likely have decided on an extraction due to his business schedule. There is no way I could have trimmed the gingival tissues with a blade or electrosurge and then comfortably send the patient on his international trip. I was able to easily circumferentially "trough" the preparation with the NV and clearly see all of the margins. This is a huge benefit with a CAD/CAM device like CEREC, allowing the camera to capture the complete margin onscreen.
Fig. 6- Note the excellent lingual margin. |
Even for dentists without CAD/CAM technology, a diode laser allows you to immediately take an accurate, bloodless impression for an excellent, well-fitting laboratory constructed restoration. Eliminate the retraction cord and all those remakes with a laser!