Joseph Sarkissian DDS

One of the most significant benefits of a #waterlase procedure is to remove very deep decay on a young teen, whose tooth was deemed as needing a root canal. The #tooth was vital. Old filling and gross decay was removed with an electric drill. The laser removed the rest of the deep decay plus gum tissue to allow proper access. After #ozone application, indirect cap was placed under the filling. Prognosis: excellent. Homeopathic hypericum for a week is given for the nerve. #biologicaldentistry @waterlase_laserdentistry

#jaworthopedics and #braces on a young boy. He got an upper removable expander and a lower Arnold expander 2 years ago. A month ago we placed braces, which will take less than a year due to proper jawbone size and foundation. It’s like building a larger house on a larger plot of land, all with straight bricks and plenty of room. #orthodontics #children #kieferorthopädie

Nice one. Hit it on the nail. From @dr.edholistic amazing holistic #pediatrician

Another #zsystems one piece #zirconia #implant restored, as usual after some #laser gum trimming with the #waterlase and margin exposure after the healing phase. #cerec was used to restore with a porcelain Emax crown. #biologicaldentistry #metalfreedentistry #keramikimplantate @waterlase_laserdentistry @zsystemsglobal

I hadn’t placed a #Zsystems #zirconia one piece tapered for a while and today the opportunity came up as I switched from a cylindrical one originally planned to this. Main reason being close proximity of adjacent roots. I used the #waterlase #laser to create a tiny flap and punch, semi guided initial access with a surgical guide, then all I needed was 2 drill burs to be able to screw in the implant which has aggressive threads but much narrower in the apical region. #biologicaldentistry @zsystemsglobal #metalfreeimplants #keramikimplantate @waterlase_laserdentistry

#laser #frenectomy with the #waterlase followed by cleaning with #ozone water and post-op home instructions. @waterlase_laserdentistry

The post I promised covering most of the steps of the bold restoration of #tooth 22 (10) of course omitting the #cerec steps. This patient is a #dentist himself and knows that otherwise his tooth would be doomed but we want to attempt to save it even if it is doe a few years only. I would gladly extract it and place an implant however due to the severe bone loss around the failing (but still stable) implant on 23 (11), it would jeopardize another implant in the vicinity. #waterlase to the rescue. This isn’t your standard troughing, it’s big time gingivectomy and tissue sculpting. A bonded post is placed after all the root decay is removed. The adjacent teeth are provisionals therefore we used a shade and shape which would fit the ideal future projection. #biologicaldentistry #metalfreedentistry @waterlase_laserdentistry

Another #operculectomy like yesterday’s post but this time on the older sister. Her operculum is almost double the size. STILL no anesthetic. She tensed up occasionally but braved it through. So proud of her. These teens always have to be given the choice of a shot and the ability to gesture to stop the procedure and receive an anesthetic. Once a patient trusts that this is an option, they have control psychological control over the procedure and most will do better. Never say it’s not going to hurt or diminish the experience, disregard or belittle the patient. I frequently stop and ask the if she is tolerating it, and acknowledge that it is stinging, and repeat the option fr an anesthetic. That gives them reassurance and boosts their bravery. #waterlase #children #lovemylaser @waterlase_laserdentistry

A #laser mini operculectomy on a #tooth which is about to receive a #laser minimally invasive filling. This young teen girl did not get a single shot for this whole procedure. @waterlase at its best. @waterlase_laserdentistry #biologicaldentistry great video recording and assisting by #futuredentist @nelliemanoukian

This post showcases #mercury safe removal of #amalgam filling, recurrent decay, and a #cerec onlay restoration. The point is that if there is cervical (gum line) decay, what do you do? OPTION 1: full crown extended subgingivally to cover the cervical decay (pro: faster, easier and insurance driven. Con: invasive. excessive destruction of perfectly healthy tooth structure). OPTION 2: as is the case here, and since I do not deal with insurances, this option involves a minimally invasive bonded #cerec onlay and a cervical bonded composite with the #waterlase. The healthy and thick tooth structure in the middle of the onlay and the filling is completely spared. #biomimetic #dentistry #biologicaldentistry #minimallyinvasivedentistry #laserdentistry

Safe #amalgam removal demonstrating the chunk removal technique. Drilling amalgam releases large amounts of #mercury vapor which is very toxic and when inhaled will immediately absorb into the body due to its fat-soluble nature and cross the blood brain barrier in an instant. Rubber dam, air filter and other measures are in place but the chunk removal with an electric drill allows us to avoid drilling and pulverizing the whole filling. instead we cut a few strategically positioned groooves into the amalgam and pop the chunks out manually. Before the removal, activated charcoal suspension is drunk by the patient. Right after the removal of the amalgam and the rubber dam, same suspension is used to rinse, gargle and spit out. #biologicaldentistry #iaomt #toxicmetals #quecksilber

Restoring a #zsystems tissue level #zirconia #implant with the cemented abutment. We used the #waterlase to trim and contour the gums into a light funnel shape for proper emergence. As you notice the actual implant is also beveled for a more stable crown fit and to transfer the margins slightly subgingically for the emergence anatomy. #cerec Emax is used and cemented with relyx unicem. #biologicaldentistry #metalfreeimplants #keramikimplantat @waterlase_laserdentistry @zsystemsglobal

A bonded fiberglass Maryland style bridge with a cantilever pontic. This is a long term provisional solution which will last years. All incisors had class I-II mobility with bone loss, as well as proximal and facial root decay, all of which were addressed at the same time. Couldn’t have been done without the #waterlase gingival contouring and deep decay removal. All #teeth are vital. The fiberglass reinforcement for the pontic also extended behind all incisors to splint and reinforce. The pontic was made to extend and rest over the adjacent PFM on the canine. All embrasures were contoured and polished to allow proxabrush access for oral hygiene. I applied brown stain along the contacts between the splinted teeth to impart the illusion of separate teeth. #biologicaldentistry #laserdentistry @waterlase_laserdentistry

Our sedation case from yesterday. 3 year old with enamel hypoplasia plus ECC aggravated from nighttime nursing. Objective is, as most of these cases, to avoid pulp exposure with atraumatic drilling, and build up these teeth freehanded with layered flowable composites. All surfaces have to be covered therefore the laser at high frequency is used after total caries excavation over the whole coronal surface to clean, prime and etch. Bonding agent is applied and the teeth are bu...ilt up. Steps are : 1. gross decay removal with electric drill and slow diamond bur. 2. Waterlase is used to remove deep decay. 3. Bonding 4. #ozone water 5. Bonding agent 6. Composite is added on all surfaces. I like the Kerr Revolution brand B1, XL. The same child also had a laser frenectomy at the end. #laserdentistry #waterlase #biolase #biologicaldentistry @waterlase_laserdentistry See more

A labial #laser #frenectomy on a child undergoing #dental treatment under sedation. The #waterlase is excellent in this respect. Excellent healing and less postoperative soreness. @waterlase_laserdentistry #biologicaldentistry #laserdentistry #liptie

A fast forward of a long and arduous #laser restorative procedure to avoid a #rootcanal on a #tooth with deep cervical decay. This scenario is ideally done with a #waterlase because the two factors which lead to failure are addressed. 1. Same day caries exposure and restoration through laser gingivectomy 2. Laser removal of deep decay leading to a direct or indirect cap with no touch, trauma or heat, perfect access and field of operations. This case had a pinpoint exposure which was capped with MTA. All steps are briefly shown but the longer version with proper captions and illustrations will be on my YouTube channel soon. #biologicaldentistry #laserdentistry @waterlase_laserdentistry

#laser pocket therapy around a 8 year old #zirconia #implant with the #waterlase. 4-6mm pockets acting up with some exudate therefore the side firing RFPT tip was used to treat and de-epihelialize the pockets, followed by gingivectomy to reduce the pocket height #biolase #laserdentistry @waterlase_laserdentistry

My questionnaire on my story revealed that around 30% of respondents believe it is a metal. (Some checked vegetable, I see their point. They look so white and appetizing that you want to eat it ) Zirconia is a non-metallic ceramic. All metal oxides are ceramics and constitute a large part of the earth’s crust. Zirconia is short for zirconium dioxide. Just like Alumina is short for Aluminium oxide. Zirconia is an excellent insulator and completely inert. In crystalline latti...ce form it is more brittle and looks just like a diamond. It has no electromagnetic, thermoconductive and electroconductive properties and does not corrode (unlike titanium). When modified with certain other ceramics (such as Yttria and alimina) under high pressure and heat, its physical characteristics transform into a very strong and unbreakable form which are used to make metal free #dental #implants and crowns and bridges. In Xrays they look very opaque, therefore many dentists believe they are another form of metal Over the past 20 years #zirconia implants have found widespread use and have become very resilient in their surgical applications, matching those of titanium implants. I myself have used them for the past 10 years and boast a success rate even better than the track record of titanium implants. In their tissue response they are far superior than titanium. Most people will choose a white and metal free option when faced with a choice for implants. (Unless they are misled into believing that they break by other dentists). Actually breakage is hardly even a factor in their statistical failure cases. Here are excellent Swiss-made brands I have used which have transformed my #biologicaldentistry practice. @zeramexusa @zsystemsglobal See more

Progression Zrays and photographs of a #zirconia fully metal free @dental #implant showing excellent bone generation and gum health. This is a #Swiss #Zsystems two-piece implant with the platform at gum level. Abutment is cemented and the crown was made same day with #CEREC. The final bitewing X-ray we got yesterday shows excellent hard bone formation surrounding the implant neck. #biocompatible ceramics such as zirconia actually stimulate bone growth. #biologicaldentistry @zsystemsglobal

Placing a #zsystems #zirconia #implant in an older lady who has had a partial denture for decades. Three more implants and she will throw that partial away. This is a #metalfree ceramic #Swiss #dental two-piece implant, with the platform placed at gum level or slightly below. My favorite system. But hey, Zsystems also has one piece implants, as well as their latest bone-level ones, for all scenarios, all fully metal free. #oralsurgery #keramikimplantat #teeth #kieferchirurgie @zsystemsglobal

A scene from the BBC TV Show call the midwife in which the setting is the 60’s and the #mercury #amalgam issue is discussed by this smart nurse as she meets this #dentist. So funny but inspiring that it was injected into the series. I wonder if there were really many health care workers and physicians back then who were concerned about the toxic effects of mercury in amalgam fillings. It seems back then and even now, people from every health profession, EXCEPT DENTISTS, voice more concern about the #toxicology involved and see the logic behind it.

Replacing an old crown on a root canalled and discolored #tooth. A bonded fiberglass post, #laser gum contouring and #cerec same day porcelain crown milled and glazed. The patient is done and does not have to come back. #digitaldentistry #biologicaldentistry #cosmeticdentistry

Restoring a two-piece #Zsystems #dental #implant in a one-minute nutshell. After healing for 6 months, I remove the healing cap, expose the margins with the #waterlase (this is a gum-level implant), prepare a buccal margin bevel with a new football shaped fine diamond, cement the abutment with relyx, shape it, scan with our #Cerec, design, mill and glaze the crown, cement and adjust. All in 2 hours including processing time. Basically an ideal marriage between #metalfree #Zirconia implants, #laserdentistry and same day #digitaldentistry. Many of the digital #cadcam steps can be carried out by staff under supervision. #biologicaldentistry @zsystemsglobal #biocompatible #toothimplants

A dialogue with my patient .... #zirconia #dental #implants #oralsurgery #metalfreeimplants #Zsystems #teeth #biologicaldentistry @zsystemsglobal

Tackling a difficult line-angle cavity growing along the cementoenamel junction of an incisor adjacent to the papilla, partly shielded by it. Difficult? Not if you own a #waterlase. As I am zapping the cavity I am also defocusing and trimming away the papilla to gain access. To be able to place a wedge I also trim away the proximal gingiva Just enough to create space for it without crushing gum tissue. The only part I used a drill was to remove overhanging enamel at the anterior margin and create a wide bevel. #laserdentistry @waterlase_laserdentistry

Using the #waterlase to expose a canine #tooth which was long overdue to erupt due to insufficient space. Last year we started #archdevelopment and then partial #braces. 3 months ago we placed open coil springs to open up the space for the canine. Today this young brave boy has the procedure done without a single shot. He felt the stinging, however with proper back and forth feedback I kept the speed and intensity of the procedure within tolerable limits. After exposing the c...oronal 1/4 of the tooth I cleaned the surface by defocusinf the same laser, etched 10 seconds, and placed a ceramic button. We tied the button to the nitanium arch wire. I concluded the visit with expressions of amazement and compliments for him being that brave. #nonextractionorthodontics #biologicaldentistry #children #straightteeth #laserdentistry @waterlase_laserdentistry See more

Moving the midline in a young girl whose crowding caused the central incisors to move sideways into the side of the crossbite. With the upper molars anchored with a fixed expander, this configuration with an active spring (open coil) on one side and a tissue guard on the other (with some room to allow the teeth space to move into) had its desired effect in two months. The midline discrepancy is almost gone in the lower photo. #jaworthopedics #nonextractionorthodontics #biologicaldentistry #toothcrowding #beautifulsmile #zahnspangen #kieferorthopädie

Having staff take over different steps in processing the in-house same-day manufacture of a porcelain crown. Ever since we got the #CEREC it has been an absolute pleasure. Especially when the patient utters an exclamation of delight when they hear the crown will be ready same day. The idea of coming back in two weeks to get a crown delivered is an absolute put-off for almost every patient. #digitaldentistry #cadcam #biologicaldentistry #sirona

A #laser gumline composite filling using only the #waterlase. In order to avoid failure or a visible seam line between filling and tooth, the enamel over the occlusal margin has to be slightly beveled and efficiently etched. Waterlase etch over the bevel at low power and high frequency, along with a 5 second acid etch creates the best surface for that. The composite has to cover that section and taper off. I used a freehand technique without contoured cervical formers. (The...se are also totally fine used with packable composite.) I use only flowable composite for this technique and with an explorer I carry and shape it as I want. I used two increments of Revolution flow and the last increment was an incisal flow shade to mimic enamel. We still have to make sure there is no spillover over the gingival margin, which happens but must be kept at a minimum. A white stone is used to carefully contour that excess back. #laserdentistry #biologicaldentistry @waterlase_laserdentistry See more

Three tiny perforations in a #tooth with serious decay. The tooth was soaked with ozonated water and the blood is seen streaming into the water into space as if there is no gravity. The slow blood flow is indicative of a lack of hyperaemia in the pulp. This fact, combined with the small size of the perforations, the lack of pre-op symptoms, the #waterlase used to clean out deep decay (no touch and no mechanical irritation), ozone, and the efficient use of the Isolite to av...oid contamination, gives this case a very favorable prognosis. After gross decay removal with the electric drill, the waterlase is used at high frequency and lower power to gently ablate or peel off deep decay. the Direct cap with MTA was performed, then self etching bonding agent is used (Brush and Bond: I apply it on the peripheral dentine and let it absorb into the MTA without actually touching it.) Obviously acid etch is impossible unless you etch only enamel before the cap. Then the MTA area is covered with ultrablend, then flowable composite, and the tooth is built up in layers with composite. It helps when there is no adjacent tooth. A successful direct cap procedure is almost impossible to achieve without a laser, and all the factors outlined above. #biologicaldentistry #avoidrootcanal @waterlase_laserdentistry See more

When a year after #braces spaces appear, check the occlusion. If there is centric contact between incisors, the lower jaw has grown and is putting pressure on the upper arch every time the patient bites, thus flaring the upper teeth and creating spacing. Closing these spaces with aligners or braces will invariably constrict the upper arch size and put more pressure on the lower jaw, which will wither cause lower incisor attrition, TMJ compression or a relapse appearance of ...upper spaces. For every action there is an equal and opposite reaction. Therefore in my office I always opt to widen the #teeth and use a meticulous bonding technique involving #laser gum trimming with the #waterlase and laser etching of the bondable surfaces. Here I used Z100 A2 as the Composite paste and incisal flowable to taper over the enamel. There are more steps to this, especially the adjustment phase, which I will put up on my YouTube channel. #biologicaldentistry #nonextractionorthodontics #zahnspangen #straightteeth @waterlase_laserdentistry #biolase See more