You asked, we answered

During each CE session, runners collected questions from the audience for our esteemed panelists to answer. Due to the outstanding influx of questions, we didn’t have time to answer them all on stage. Rather than toss those valuable questions, our experts will offer answers here on the e-show daily.

(Don’t see yours? Don’t worry! We’ll continue to post as we get answers back from the panelists.)

Technology panel: Part I

Q: Drs. Lowe or Flucke: I am a PPO dentist. All the ideas you present excite me. But what can I do to make all these expensive toys a part of my practice when I don’t get paid so much.

A: The initial investment for a hard tissue laser is about $80,000, a significant investment. Being in a PPO practice, I don’t see how you can continue to work without one…you can work so much faster, prepping for composites often without anesthesia. Multiple small occlusals in multiple quadrants are done much faster and efficiently with the laser…you will produce more, therefore make more. Once your investment is paid off, even more dollars will go to your bottom line. You need to go for it!

Q: Dr. Lowe: as a practicing periodontist utilizing lasers for almost four year now, I can honestly say that lasers are mandatory for the future of dentistry. Why are our colleagues so slow in incorporating this into their practices? Patients love this!

A: This question puzzles me as well. I am glad to see a practicing periodontist recognize this. I have been doing soft tissue and osseous procedures for over 26 years and there is no better instrument! I don’t need to see 20 years of research on how lasers cut bone. They cause less collateral damage than burs…healing and post op discomfort are less as a result…and yes, closed flap osseous crown lengthening for minimal osseous correction works and works well!

Q: Dr. Lowe: How can lasers be used to improve soft tissue management for immediate load cases?

A: I don’t know exactly, because I haven’t restored an immediate load case. But, for implants in general, again, I restore quite a few. Lasers are safe around titanium, therefore, very useful to contour soft tissue around implants and clear implant platforms of tissue when seating abutments, and for uncovering (second stage) as well.

Q: Dr. Lowe: how do you get reimbursed from insurance when you do crown lengthening when you do the prep for the crown on the same day?

A: I have heard that some insurance companies have issues, only because they are years behind the times when it comes to current dental procedures. They still don’t reimburse for laboratory resin crowns when at times they are indicated over porcelain. A photograph and explanation may help. However, you are saving your patient extra appointments and sometimes an invasive surgical procedure. In my office, I charge $350 per tooth for closed flap crown lengthening. Most periodontists in my area charge $1,000 to $1,200 for a single tooth surgical crown lengthening. Even with 80% reimbursement, the out of pocket is comparable to my charge without any coverage. So…bottom line…let the patient chose. Insurance has never been an obsticle for me in this area.

Q: Dr. Lowe: what is healing time on the closed flap crown lengthening? How soon can you seat the crown?

A: Healing time for a closed flap crown lengthening procedure can take from 4-6 weeks to several months, however, the beauty is that you take the impression the day of surgery, deliver the crown 3 to 4 weeks later, and let the tissue mature around the definitive restoration rather than an ill-fitted, over-contoured temporary restoration.

Q: Dr. Lowe: is there a risk of damaging the root surfaces when doing closed flap bone reduction with the laser?

A: Only if you fall asleep with the laser pointing at the tooth…seriously, the ErCr, YSGG laser is an end cutting instrument. As long as the tip of the laser is parallel with and in contact with the tooth/root surface, it can not possibly harm the root. The same cannot be said for rotary instruments (burs). It is also less invasive as far as potential damage to the root surface than a Cavitron or sonic scaler!

Q: Dr. Lowe: why all the controversy over closed flap osseous recontouring (crown lengthening)?

A: Why the controversy? Because people voice opinions without ever having done the procedure, or the procedure is done in less than minimal circumstances where an open flap procedure would be more appropriate. I have done hundreds of closed flap procedures for esthetic crown lengthening of gingival zenith areas and for minor proximal biologic width corrections…this procedure works! As far as how smooth is the bone after laser treatment…not as smooth as when treated with hand instrumentation, but the bone remodels. How smooth is the bony crest after a tooth is extracted without laying a flap? Does the bone remain jagged? Does the marginal tissue remain hemorrhagic and edematous? The answer is no. As far as I am concerned, if the tissue is pink, if there is a probable sulcus that does not bleed, the tissue is healthy. Again, I don’t need to flap it and look at it to verify this like some of the comments I see in the “dental forums”.

Find more questions and answers in Part II »

~ by cwaring on May 20, 2008.

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