Comparative evaluation of healing after gingivectomy with electrocautery and laser

Histological artifacts associated with laser and electroscalpel gingivectomy: Case series

Introduction. Over time, efforts have been invested in the design of new instruments that overcome the disadvantages of the gold standard instrument in surgery, the scalpel. As a result, electronic equipment has emerged such as the electric scalpel and laser devices. The available evidence on these instruments suggests that the tissue response is related to each instrument’s physical and biological cutting principles. Objective. To compare the histological changes in gingiva samples associated with surgical cutting performed with a 940 nm diode laser, a 2780 nm erbium, chromium: yttriumscandium-gallium-garnet (Er,Cr:YSGG) laser, and an electric scalpel, by presenting a series of cases. Case presentation. We present three cases of healthy patients undergoing cosmetic surgery. The clinical examination revealed exposure of a keratinized gingiva band greater than 4 mm, normal color and texture in gingival tissue, with a firm consistency and no bleeding on periodontal probing. Gingivectomy was indicated with the following protocols: Diode laser of 940 nm at 1 W, in continuous mode; Er,Cr:YSGG laser of 2780 nm at 2.5 W, 75 Hz, H mode, air 20, water 40, gold tip MT4); and electric scalpel in cutting mode at power level four. Gingival tissue samples were taken and stored in 10% formaldehyde for histological analysis. Conclusion. All the evaluated cutting instruments generated histological changes produced by the thermal effect, the main ones being collagen coagulation and carbonization. The depth of thermal damage caused by the 2780 nm Er,Cr:YSGG laser was much lesser than that induced by the electric scalpel and the 940 nm diode laser.

Similarities and differences between kaiy in Persian medicine and moxibustion in Chinese medicine

Kaiy (medieval cautery) is an ancient method of heat therapy in traditional Persian medicine (TPM). Some of its important applications have been neglected during the medical revolution. Meanwhile, different treatment modalities that incorporate heat, including moxibustion, have progressed in traditional Chinese medicine. In this study, we reviewed the main TPM textbooks that were written specifically in the field of kaiy. We considered the traditional teachings in the context of contemporary information, gathered from the scientific literature about moxibustion and modern cauterization. Some surgical therapeutic indications of kaiy (e.g., debridement and coagulative procedures) have been advanced by the innovation of electro-cauterization. However, those therapeutic applications that were based on the TPM humoral theory for relieving body coldness or myofascial pains-which are similar to moxibustion usages-have not received the same attention. Apart from the broad similarities of kaiy and moxibustion as thermal therapies with similar indications, there is a striking correspondence between kaiy point mapping and acupoints. Therefore, further research on different kaiy aspects is recommended. Please cite this article as: Jaladat AM, Alizadeh Vaghasloo M, Atarzadeh F, Ayati MH, Kazemi AH, Akin E, Hashempur MH. Similarities and differences between kaiy in Persian medicine and moxibustion in Chinese medicine. J Integr Med. 2023; Epub ahead of print.

Long-Term Esthetically Depigmented Gingiva in a Short Operative Duration, Using Two Modes of 940 nm Diode Lasers-A Randomized Clinical Trial

AIM

This study aims to compare the effectiveness of the two modes of 940 nm diode lasers on gingival depigmentation.

METHODS

Twenty patients (11 females and 9 males) participated in this study; they were free of any systemic or local condition and randomly assembled into two groups: continuous wave (CW) and pulsed groups, in contact modes. The diode laser was of 940 nm wavelength and 1-2 W irradiation power for the two modes in all cases. A single session of irradiation was applied to the facial gingivae of the upper and lower anterior segments. Photographs were taken preoperatively and postoperatively for all patients, and a questionnaire and follow-up were carried out for the next four weeks and after three years.

RESULTS

The intraoperative duration of both modes was considerably short, with a short chair time subsequently. A statistically significant decrease in the intensity of pain, discomfort, and bleeding (p ≤ 0.05) was noticed during the first week of follow-up within each group. Nonetheless, the two groups showed a close pattern of decline with no statistically significant differences between them. It was also clear that pain and discomfort were strongly correlated with each other within each group, and the correlation was statistically significant. On the other hand, carbonization was minimal in a few cases treated with CW mode but still not statistically significant. Finally, although the gingival pigmentation index (GPI) differences were not statistically significant between the two groups, they were significant within each group.

CONCLUSIONS

The diode laser (940 nm) offered an effective and safe modality, providing an optimal aesthetic result that can meet patient satisfaction with minimal pain, bleeding, discomfort, intraoperative time, and the possibility of recurrence in the treatment of gingival hyperpigmentation.

Efficacy of three surgical methods for gingivectomy of permanent anterior teeth with delayed tooth eruption in children

OBJECTIVE

To compare the efficacy of three surgically assisted permanent anterior tooth eruption methods (laser surgery, electrosurgery and routine surgery) in children.

METHOD

Sixty-three orthodontic children with retarded permanent anterior tooth were selected and according to the random number table divided into three groups: laser surgery group (group A), electrosurgery group (group B) and routine surgery group (group C). The total operative time (min), the duration of pain after gingival excision (d), Visual Analogue Scale (VAS) pain intensity scores (0-10 cm), and gingival healing time (d) were all recorded. Six months after treatment, periodontal indexes of the three groups, including gingival indexes (GI), plaque indexes (PLI), probing depth (PD) were checked by the same periodontist and recorded.

RESULTS

Surgical records showed that compared with group C, there were statistically significant differences in operative time, pain duration, pain intensity and healing time in group A and B (P < 0.05). There was no significant difference in these four results between group A and group B. Periodontal examination indicators 6 months after surgery showed no statistical differences in GI, PLI and PD among group A, B and C. Oral clinical examination found that the three groups of patients with different treatment, dental eruption was normal.

CONCLUSION

All the three treatments can effectively solve the problem of delayed eruption of permanent anterior teeth in children. Particularly, laser surgery and high-frequency electrosurgery have good efficacy, little pain and high operability, which can be considered as a better method to aid teeth eruption.

Gingivectomy with high-power laser for correction of the gummy smile resulting from altered passive eruption-a case series

To compare the efficacy between the surgical techniques of gingivectomy with high-power laser (HPL) and conventional gingivectomy for correction of a gummy smile (GS) due to altered passive eruption (APE). This was a case series of six female patients diagnosed with GS associated with APE. For the conventional gingivectomy procedure and for the one using the diode laser (808 nm, 2 W, in continuous mode), the six upper anterior teeth were divided into two groups (control (CG)-# 11, # 12, # 13, and test (TG)-# 21, # 22, # 23). Analyses of intraoperative bleeding and levels of pain and postoperative tissue repair were performed. The thermal pattern analysis was performed using infrared thermography. The level of significance was set at p < 0.05. There was no intraoperative bleeding in the TGs (p = 0.002). The CG showed tissue repair significantly better than the TG on the 14th postoperative day (p = 0.004). There were no statistically significant differences regarding the level of postoperative pain between the groups (p > 0.05). Regarding the thermographic analysis, there were also no statistically significant differences (p > 0.05). HPL gingivectomy was more effective, regarding the absence of intraoperative bleeding, while the conventional technique promoted better tissue repair. No significant differences were observed in the other parameters, possibly due to the minimal damage caused by gingivectomy, with either HPL or the conventional procedure, as there was no removal of bone tissue.

A Novel Concept of Combined High-Level-Laser Treatment and Transcutaneous Photobiomodulation Therapy Utilisation in Orthodontic Periodontal Interface Management

This case report is aimed to demonstrate the synergetic effects of λ940 nm laser photobiomodulation (PBM) therapy in augmenting the advantages of high-level-laser treatment (HLLT)-mediated reaction orthodontic periodontal interface management. Materials and Methods: A 32-year-old female who presented with a persistent gummy smile of upper incisors and low upper midline frenum attachment post-orthodontic treatment, was seeking a better smile appearance. She had a history of delayed wound healing without underlying medical conditions; otherwise, she was fit and healthy. She underwent laser ablation of the upper midline frenum and gingivoplasty of the upper incisors region with λ940 nm and λ2780, respectively, as well as transcutaneous PBM therapy (λ940 nm) to accelerate wound healing. The laser protocols were as follows: λ2780 nm: power output—2 W, pulse width—60 μs, free running pulse (FRP), spot area—0.0016 cm², pulse repetition rate—25 pulses per second (s), 80 mJ/pulse, 90 s, λ940 nm: 1.2 W, continuous wave (CW) emission mode, 300 μm, 60 s; whereas the adjunctive λ940 nm induced-PBM parameters were as follows: power output—1.4 W, CW—120 s, single application, spot area—2.8 cm². An acceleration of the wound healing was observed on the 4th day of treatment with no immediate or post-operative complications. The results showed no functional or aesthetic relapses at a long-term follow-up of 6 months. The authors concluded that λ940 nm laser-PBM can provide a synergetic effect to HLLT in accelerating wound healing and offering a precision smile with minimal to none post-operative complications. It is safe and justifiable to utilise dual therapy over the conventional methods, which serves our patients’ needs in our daily practice and in various clinical indications. The concept and laser protocols of this clinical case report can pave the roadmap for future extensive studies.

The use of diode laser in esthetic crown lengthening: a randomized controlled clinical trial

This clinical trial assessed patient comfort, satisfaction, and the achievement and maintenance of ideal gingival margin levels using laser compared to conventional surgery in sculpting the soft tissues during esthetic crown lengthening. Eighteen patients with altered passive eruption were treated in a randomized split-mouth design by laser or scalpel crown-lengthening surgery. Patients were evaluated for intra- and postoperative pain and bleeding at 3 and 7 days. Clinical parameters including clinical crown length, probing depth, plaque index, bleeding on probing, and clinical attachment level were recorded at baseline, 3 and 6 months postoperatively. A gradual reduction in postoperative pain was recorded for both sides with no statistically significant difference at 3 (scalpel: 4.4 ± 1.33, laser: 4.8 ± 1.34; p = 0.088) and 7 days (scalpel: 1.8 ± 0.94, laser: 1.8 ± 1.10; p = 0.655). A statistically significant gain of coronal tooth structure was observed at 1, 3, and 6 months. Stability in the post-crown-lengthening level of the gingival margin was achieved one month following the procedure with no significant changes in the following months. All patients reflected acceptable results based on clinical evaluation and patient-reported outcomes. The diode laser can be used effectively as an alternative to the scalpel for the management of altered gingival contour. CLINICAL SIGNIFICANCE : This study demonstrated that a diode laser is an effective tool for the management of cases with altered passive eruption. In addition, it gives insight to practitioners regarding the timing of esthetic restorative procedures and emphasizes the preservation of the gingival complex dimensions.

Pre-endodontic restoration of structurally compromised teeth: current concepts

Teeth that require endodontic treatment are often structurally compromised and this considerably complicates endodontic procedures. Therefore, pre-endodontic restoration is a key approach that dentists should consider for such teeth. This article discusses current concepts of pre-endodontic restoration, with a focus on adhesive restorative methods and surgical/orthodontic techniques, and provides a relevant decision-making flowchart.

Highlights the importance of pre-endodontic restoration for the predictability of endodontic treatment.

Discusses restorability aspects for structurally compromised teeth.

Reviews current restorative and surgical/orthodontic techniques for pre-endodontic restoration and provides a decision-making flowchart.

Knowledge about the effects of electrosurgery smoke among operating room nurses during COVID-19 Pandemic: A Cross-Sectional Study

Background

Electrosurgery smoke is the smoke emitted from tissue cauterization when using the electrosurgery device. Accordingly, in this smoke, more than 80 harmful toxins have been discovered. In the current study, we aimed to investigate the level of knowledge reported by the operating room nurses on the effects of electrosurgery smoke during the current COVID-19 pandemic.

Methods

This descriptive, survey-based cross-sectional study was performed on 533 OR nurses in all the referring hospitals of COVID-19 infection. The required information were collected using a questionnaire regarding the knowledge on the side effects of electrosurgery smoke. The obtained data were then analyzed using t-test and ANOVA by SPSS software.

Results

Most of the included participants (93.6%) had a low level of awareness and only a small number of them (0.4%) had a good level of knowledge on the effects of electrosurgery smoke. As well, a significant relationship (P˂0.05) was found between the level of knowledge reported by the OR nurses and the type of hospital (educational or private). Most of the studied hospitals used no electrosurgery smoke reduction equipment during electrosurgery.

Conclusion

The level of knowledge reported by the OR nurses was generally poor. It is recommended that managers and health officials try to increase the level of awareness of OR nurses during the COVID-19 pandemic by providing standard and protective equipment as well as holding some well-organized and related training courses.

Hereditary Gingival Fibromatosis: A Report of a Rare Case in Siblings and Its Management Using Diode Laser

Hereditary gingival fibromatosis (HGF) is a proliferative fibrous lesion causing severe gingival enlargement, affecting the esthetics, as well as posing various periodontal problems. This case report addresses the diagnosis and treatment of one such rare case of HGF where the patient presented with generalized diffuse gingival enlargement involving the maxillary and mandibular arches extending on the buccal and lingual/palatal surfaces and covering the incisal/occlusal third of the tooth, resulting in altered esthetics, difficulty in speech, and mastication. Gingivectomy was carried out in all the four quadrants using diode laser. The healing was uneventful; the patient was satisfied with her esthetics and was able to resume her oral hygiene practices. Even though recurrence cannot be predicted, the risk of recurrence can be outweighed with the psychological and functional benefits. Long-term follow-up will be required to evaluate the predictability of the different surgical techniques.

The Integration of a Dual-Wavelength Super Pulsed Diode Laser for Consistent Tissue Ablation in the Esthetic Zone: A Case Series

Introduction

A diode laser is one of the universally compact accepted laser systems used fundamentally for soft tissue applications. Most diode laser devices have a single wavelength of either 810 nm for superior coagulation or 980 nm for tissue ablation. In these case series, the use of dual wavelengths (810 nm and 980 nm) in combination with super pulsing has provided a cleaner cut (no charring) with faster healing that eases the placement of the final restoration in the esthetic zone. Case Description. The present case series describe four cases in the esthetic zone that achieved hemostasis ablation without collateral damage to enhance gingival balance of definitive restoration. The gingivoplasty and gingivectomy modes are used to achieve efficient tissue ablation. Although there is no specific mode indicated in the FDA laser requirement for gingival depigmentation, the procedure could be safely performed with the dual-wavelength diode laser.

Result

All four patients revealed a good esthetic outcome and reported no pain postoperatively. Healing was uneventful, and definitive restoration was delivered within two to four weeks postoperatively.

Conclusion

Within the limitation of these case series, the dual-wavelength super pulsed diode laser has the capacity to deliver peak powers resulting in efficient cutting and less tissue charring and also as an alternative tool for removal of gingival pigmentation. Prospective clinical research with larger sample size is needed for conclusive results.

Nonsurgical Periodontal Treatment by Erbium:YAG Laser Promotes Regression of Gingival Overgrowth in Patient Taking Cyclosporine A: A Case Report

Objective and background: To report on a case of cyclosporine A-related gingival overgrowth (GO) treated by conventional scaling and Erbium:YAG laser that unexpectedly showed complete healing with normalization of the gingiva, making unnecessary further surgical treatment for gingival volume reduction. Since Erbium:YAG laser was approved in 1997 by the U.S. Food and Drug Administration for hard and soft tissue treatments in dentistry, several studies have been published to demonstrate its efficacy for bone cutting, plaque and subgingival calculus removal, and antiseptic effects both on soft and hard periodontal tissues. Methods: We report herewith the case of a patient undergoing cyclosporine A therapy, affected by GO who underwent scaling and full mouth disinfection with chlorhexidine 2% rinses, followed by Erbium:YAG laser treatment of gingival pseudopockets, without surgical removal of the overgrown gingiva. Results: Unexpectedly, complete healing of the periodontal tissues was observable after one single laser application and no adjunctive surgical procedure was necessary. Conclusions: Erbium:YAG laser could be considered a really effective option for the nonsurgical treatment of drug-induced GO, avoiding the surgical procedures and also promoting a fast healing and a patient compliance surely higher than conventional techniques.

Nonsurgical Periodontal Treatment by Erbium:Yag Laser Promotes Regression of Gingival Overgrowth in Patient Taking Cyclosporine A: A Case Report

OBJECTIVE AND BACKGROUND

To report on a case of cyclosporine A-related gingival overgrowth (GO) treated by conventional scaling and Erbium:YAG laser that unexpectedly showed complete healing with normalization of the gingiva, making unnecessary further surgical treatment for gingival volume reduction. Since Erbium:YAG laser was approved in 1997 by the U.S. Food and Drug Administration for hard and soft tissue treatments in dentistry, several studies have been published to demonstrate its efficacy for bone cutting, plaque and subgingival calculus removal, and antiseptic effects both on soft and hard periodontal tissues.

METHODS

We report herewith the case of a patient undergoing cyclosporine A therapy, affected by GO who underwent scaling and full mouth disinfection with chlorhexidine 2% rinses, followed by Erbium:YAG laser treatment of gingival pseudopockets, without surgical removal of the overgrown gingiva.

RESULTS

Unexpectedly, complete healing of the periodontal tissues was observable after one single laser application and no adjunctive surgical procedure was necessary.

CONCLUSIONS

Erbium:YAG laser could be considered a really effective option for the nonsurgical treatment of drug-induced GO, avoiding the surgical procedures and also promoting a fast healing and a patient compliance surely higher than conventional techniques.

A randomized controlled clinical trial on the effectiveness of three different mouthrinses (chlorhexidine with or without alcohol and C31G), adjunct to periodontal surgery, in early wound healing

OBJECTIVES

The use of chlorhexidine (CHX) with or without alcohol has been recommended for a number of clinical applications. On the other hand, there is a plethora of widely subscribed antiseptics, such as agent C31G (alkyl dimethyl glycine/alkyl dimethyl amine oxide), which has not yet been evaluated postsurgically. The effectiveness of three different mouthrinses (CHX with and without alcohol, C31G) in plaque control and early wound healing was compared postoperatively.

MATERIALS AND METHODS

In this, randomized, double-blind, controlled clinical trial 42 patients were allocated to three groups assigned to 2 weeks rinsing after non-regenerative periodontal flap surgery with or without osseous surgery with C31G (group A), alcohol-free CHX 0.12% (group B) or alcohol-based CHX 0.12% (group C). At days 7 and 14, plaque and early wound healing indices were recorded. At day 14, total bacterial counts were estimated utilizing real-time quantitative polymerase chain reaction (qPCR). Statistics included linear and generalized linear mixed models.

RESULTS

At day 7, healing response was not significantly different among groups. At day 14, group A revealed the highest while group C demonstrated the lowest plaque index values (B vs A, odds ratio-OR = 0.18, p = 0.012; C vs A, OR = 0.01, p < 0.001; C vs B, OR = 0.06, p < 0.001). Group C demonstrated the lowest bacterial counts levels at day 14 (38.470 × 10⁶, 48.190 × 10⁶, and 3.020 × 10⁶ for groups A, B, and C, respectively). At day 14, healing was significantly better in group C compared to B (p = 0.007). Group A showed no significant differences compared to other groups.

CONCLUSIONS

(1) The presence of alcohol may increase the effectiveness of CHX in early wound healing, (2) C31G might be an alternative solution prescribed during early postoperative period after non-regenerative periodontal flap surgery.

CLINICAL RELEVANCE

The present study found that active agent C31G displayed no significant differences to CHX formulations regarding periodontal wound healing improvement and might be used alternatively after non-regenerative periodontal flap surgery. In addition, an alcohol based 0.12% CHX mouthwash was more effective than an alcohol-free 0.12% CHX and C31G mouthrinse on plaque control in the absence of mechanical oral hygiene.