Is it possible to perform a full upper and lower reconstruction in only 2 appointments?
Well, prior to owning a diode laser, I would have said no. But having this great piece of technology and an engineering marvel, I was able to do just that.
Let's go back a while. A gentleman I'll call Martin, has been a patient of mine for over 30 years. I have restored almost every tooth in his mouth. And if you look at Figure 1 below, those beautiful (?) composite restorations were all placed by me. I take full responsibility. If you look closely, Teeth #12 and #21 both have 2 dark dots on their buccal surface. He had fractured off the buccal, I placed 2 titanium pins into the remaining tooth surface, horizontally, and placed composite over them. Initially, it looked fine. Initially, ALL of his composite fillings looked fine, but with wear and tear, they all wore down. His own, remaining natural tooth surface wore down too!
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Figure 1 |
Martin is a great patient. He loves to come in for his routine hygiene appointments (periodontal maintenance), by my hygienist, Kyle, who has been with me for over 33 years and is the only one who has cleaned his teeth. Every 3 months, like clockwork, he would come in. I would examine his teeth and EVERY time, I would tell him, "it is time that I crowned all of your teeth, before you have nothing left". But he would say, "maybe sometime".
At one appointment he came in with another broken tooth, and I again repaired it and mentioned that I should crown all of his teeth. Finally that "sometime" occurred and he said yes! I was shocked! But then he said, "I am giving you 2 appointments to do it all". I immediately said YES. I took upper and lower alginate impressions and a wax bite registration to construct his temporary restorations. Because of his appointment specifications, I would need to rebuild his mouth into his existing plane of occlusion. Therefore I had the temporaries constructed to his occlusal plane, which was stable and comfortable.
After he left the office with an all day appointment scheduled, I began to wonder, how I could do a full reconstruction in 2 appointments. Many questions came to mind, What if the full arch impressions were not right, and I needed to take quadrants? When performing a full mouth reconstruction, the patient would typically remain in temporaries for a period of time to adjust to a modified new plane of occlusion. Typical reconstructions could take many appointments over many months to attain the ideal results. I would usually try in the metal frameworks and pull with a master impression, and construct the final restoration into the plane of occlusion dictated by the adjusted temporaries, but with only 2 appointments, I did not have that luxury.
I immediately decided that I needed a soft tissue laser so that I could obtain as close to perfect an impression as possible. Luckily, it was February and I practice in Chicago--the Mid-Winter Dental Meeting was about to start so I made it my mission to evaluate all of the soft tissue lasers and I was determined to buy one.
I went to the meeting and stopped at every dental laser booth. I saw the SoftLase, and was impressed with a knowledgeable and helpful staff. After 10 minutes of "playing" with this laser, I bought it, and it arrived in less than 1 week, the diode laser arrived at my office. Please note I had no prior training, but there was very little learning curve. Martin represented my training—as well as the complete ROI for the laser.
On the day of the appointment, I anesthetized the upper and lower arches in the usual manner and took an initial wax bite registration and VPS putty impressions. I prepared the upper teeth, and EASILY troughed around each preparation with the laser. It took me very little time to do; actually much less than the time it would take to pack cord around each tooth. I immediately took a beautiful upper full arch impression, and there was absolutely no wait time as is the routine with cord placement. I added to my bite registration, then prepared the lower teeth, and again EASILY troughed around each preparation and took a beautiful lower full arch impression. There was no bleeding and no seepage. Figure 2 shows the troughing around Preparation #14. The impressions were PERFECT and all margins were easily seen. I then completed the sequential bite registration so as to keep his occlusal plane consistent to his prior level and I constructed and seated the full arch temporaries. The patient was done and out the door in less than 4 hours. I was amazed and relieved all at the same time.
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Figure 2 |
I immediately sent the impressions to the laboratory, Premium Dental Laboratory in Chicago and was surprised when Mark, the lab owner called and asked me what I did with this case, as he said the impressions were perfect. I simply told him that I entered the "Age of Laser Dentistry". He constructed beautiful crowns, which went in with NO ADJUSTMENT, you see them in Figure 3. Martin loves his new smile and his wife said he looks 20 years younger!
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Figure 3 |