Updated: Feb 23
I used to hate seeing a SINGLE class II on the schedule. We would schedule 30 minutes for those to make them profitable. However, depending on when my hygiene checks fell at any given hour, I would start and stop twice during the procedure and it occasionally took 40-50 minutes to complete.
Thankfully, those days are virtually gone now. There is no need to leave the op after administering anesthetic, I simply start and finish. The following simple small class II took 10 minutes of my time and I was out of there. That is $200+ in 10 minutes or $1,200/hour type of productivity. That is incredible for fillings, but really it's starting to become one of the more productive procedures in my office. I never thought I would say that, but the numbers don't lie.
I prepped #13 with the laser for about 60 seconds to establish an analgesic effect. I set the governor at 60% power with a 1.25 mm spot size and 100% mist. I always ramp up within 3 seconds to the full 60% power and slowly trace the outline of where I think the caries extends. It generally takes me about 15 seconds to complete my first “lap” around a small prep like this. It feels like you are moving your hand incredibly slow. You must remember that the laser cuts faster the slower you move. Everyone has a tendency to move their hand way too fast when they first start. I angle the laser around 20-30 degrees off the long axis of the tooth. The beam should be on the facial or lingual wall of the box spending very little time pointing it straight down at the floor of the box. This technique is fundamentally different than how we prep with a bur. I find that I spend much more time focusing on breaking my contact bucco-lingually (by angling the laser as mentioned above) and the gingival half of the box generally takes care of itself.
After about one minute of constant laser energy, I switch to a high speed, electric hand piece with a diamond 245. Most of the buccal and lingual contact has been broken by the laser, so I focus on breaking gingival contact with the bur and removing unsupported enamel. This usually takes less than a minute. On larger cavities I prep 3-4 minutes with the hand piece because the analgesic effect is so profound.
It took 7 minutes to restore.
This patient was very happy that the procedure was quick, did not require a shot, and drilling was kept to a minimum.
To learn how the efficiency I demonstrated in this case improves the workflow and efficiency of my entire practice, read this article I wrote on Dentalcompare: Solving Productivity Killing Start and Stop Dentistry.