2013 northern california seminar …€¦ · contemporary cosmetic dentistry hugh flax, ... john...

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))


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.


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


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


Clinical Paradigm Shift

Micro dentistry (conservative care)

Minimally invasive soft/hard tissue treatment

Little to no need for anesthesia


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


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


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


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

ESTHETIC PROPORTION

From PPAD


GINGIVAL SYMMETRY/CONTOUR

No excessive display

Centrals match each other

and canines

Laterals?

Edentulous

spaces ?


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.


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


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


“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


In this study it was found that 85% -90% of the time

John Kois

Contemporary Esthetic Dentistry Vol.2 No.1 1996


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


DO IT RIGHT!Use the Right Tools

KaVo DIAGNOdent®

SLAM DUNK SUCCESSCopyright 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

mailto:[email protected]

http://www.catapultelite.com/flax.php

2013 northern california seminar …€¦ · contemporary cosmetic dentistry hugh flax, ... john...

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