There are times when simply having access to top of the line technology makes all the difference in the world… and today was one of those days.
We had a patient in this afternoon who has been with us a long time. A really nice person, very few dental problems, in fact I could not remember the last time this patient was seen for any treatment other than a routine recare (and perhaps that might have been all the treatment our office had ever rendered). Well, at the last recare visit, bitewing radiographs clearly indicated interproximal caries on 2 teeth.
There was a DO lesion on tooth #13 (FDI 25) and an MO lesion on #14 (FDI 26). Both areas were definitely in need of treatment.
Today the patient returned to have the caries removed and restorations placed. However, after the patient was seated and the dental assistant was just beginning to discuss today's treatment, the patient wanted the assistant to know that they suffered from a true pathologic fear of needles. Was there *anything*, the patient asked, that could be done to avoid needles?
It is moments like this, where having access to our technology can make such a difference to everyone involved. Both the patient and the team can benefit. The patient, obviously, benefits directly from whatever technology comes into play clinically, while the team gets the benefit of knowing they have helped the patient by providing state of the art care.
In this case, the choice was simple. For a patient who is very frightened of needles, our treatment option immediately went to our erbium YAG (Er:YAG) laser. The laser is sold and supported by Technology 4 Medicine . An Er:YAG laser is a wonderful treatment device and allows the doctor to perform a wide variety of procedures, many only possible with the laser. However, today our focus was on no needle, no drill, no pain restorative dentistry.
Once the patient had indicated the degree of needle fear they were experiencing, assistant Rachel came and explained the situation to me . The patient and I then had a discussion of how we would use the Er:YAG laser in this particular situation. Once things were explained and informed consent was received, we set about completing the procedures.
Since the teeth and surfaces needing treatment approximated each other and because no pre-existing occlusal restorations were present on either tooth, I decided to do "slot" preps on both #13 and #14. A slot prep is created by going straight through the marginal ridge and expanding until all caries is removed. This creates the "interproximal box" of a traditional Class II category preparation, but leaves the occlusal surface intact. Since no mechanical retention is required when restoring with composite, more natural tooth structure is left.
The preparations were completed from start to finish with the Er:YAG laser. A Kavo ComfortDrive electric handpiece was used, but only to bevel the cavosurface margins. The missing walls were re-created using a Triodent V3 system available through Ultradent in the US.
Due to the size of the restorations and the fact that we were attempting to get the procedure done quickly so that the patient did not miss another appointment, the preparations were etched with Ultraetch (Ultradent), bonded with Optibond Solo (Sybron Kerr), and filled in one bulk fill increment per tooth utilizing SonicFill (Sybron Kerr).
The bonding agent & the composite were photo polymerized utilizing a wide spectrum high output light, the VALO cordless LED curing light (Ultradent).
The restorations were polished using a combination of the Diamond Composite Polisher - Kit (Komet) and a Jiffy Polishing Kit (Ultradent).
The patient left on time with no feeling of numbness. The restorations were delivered using state of the art techniques from the first step to the last.
The best part? The patient was amazed at not only the clinical results, but also with all the technology involved to deliver those results.
My passions are "Clinical Technologies that Improve Patient Outcomes" and I truly feel that goal was met today.