Electrosurgery--a biological approach

Application of platelet rich fibrin for management of an electrosurge induced osteonecrosis involving maxillary alveolus

BACKGROUND

Application of principles of electrocautery for hemostasis dates back to prehistoric times. Its modern implementation in various fields of general and head and neck surgeries have been well documented. However its usage in minor oral surgical procedures has gained popularity only recently. Complications associated with electro-surgery in the dental field are relatively rare and there is insufficient literature on its management.

CASE REPORT

We present a case report on management of an electrosurgery induced osteonecrosis involving maxillary alveolus of left premolars.

DISCUSSION

Inadvertent contact of the electrosurgery tip on bone can result in necrosis making it necessary to remove the sequestrum and graft the defect. Platelet rich fibrin in combination with bone grafts have been well documented to provide successful periodontal regeneration.

CLINICAL IMPLICATIONS

Our aim of presenting this report is to create awareness among the health care providers regarding electrosurgical injuries. To our knowledge, this is the first time platelet rich fibrin has been used in the management of intraoral electrosurgical injury. Combining bone grafts with platelet rich fibrin is a good alternative as it can be done with relative ease and predictable outcome.

Clipping the (tongue) tie

Ankyloglossia is an uncommon congenital oral anomaly that can cause difficulty with breast-feeding and speech articulation. For many years, the subject of ankyloglossia has been controversial with practitioners of many specialties having widely different views regarding its significance and management. This study is about a series of five cases of ankyloglossia subjected to surgical correction by frenectomy procedure. Three cases were treated with electrocautery, one case with diode laser and one case with conventional scalpel technique. 1 week and 1 month post-operative follow-ups were done and healing was compared with the available literature. Manipulation of tissues was better in laser and electrocautery techniques when compared with scalpel. Post-operative complication of swelling and pain was seen in scalpel technique whereas it was largely uneventful in other techniques. Though, there was no difference in healing at the end of first month clinically, scalpel technique has shown better results in organization of muscle fibers. This clinical study indicates that laser and electrocautery treatment used for frenectomy operations provides better patient perception in terms of postoperative pain and function than that obtained by the scalpel technique. Considering the above advantages, when used correctly, the laser and electrocautery offers a safe, effective, acceptable and impressive alternative for frenectomy operations.

Comparison between electrosurgery and cold blade in tongues of rats: a preliminary experimental study

PURPOSE

To compare tissue cicatrization in the tongue of rats using electrosurgery and the cold blade.

METHODS

Ten adult male Wistar rats were divided into two groups of 5 animals each, according to the time of sacrifice (3 and 7 days). Each animal had two incisions, one made with a cold blade and the other with an electric blade, both of which were approximately 0.5 mm in length. Following sacrifice of the animals, the tongues were submitted to a histological study in order to classify the presence of angiogenesis, fibroblastic proliferation, epithelial proliferation and inflammatory cells as good, moderate and weak.

RESULTS

The wound made with electric blade presented a delay in the healing process and a greater inflammatory response as compared with the cold blade, despite the fact that there was no statistically significant difference (p<0.05).

CONCLUSION

There were no significant statistical differences between electrosurgery and the cold blade in relation to angiogenesis, fibroblastic proliferation, epithelial proliferation or the presence of inflammatory cells at any time of evaluation.

The management of drug-induced gingival overgrowth

OBJECTIVES

This review critically evaluates the different therapies that are available to manage drug-induced overgrowth (DIGO).

MATERIAL AND METHODS

This review is based on literature identified using the online databases MEDLINE and PUB MED. It is not a systematic review, but a conventional review of the relevant literature.

RESULTS

Patients benefit from a non-surgical approach if this can be delivered before commencement of medication although in many instances this may not be practicable. Systemic antibiotic usage has been evaluated in the management of ciclosporin-induced gingival overgrowth. Efficacy appears to be equivocal and long-term use is undesirable. Surgical excision remains the main treatment option especially for patients with severe overgrowth. Few studies have compared different techniques with respect to recurrence rate or post-operative sequelae.

CONCLUSION

DIGO is a common clinical problem that often requires intervention. Non-surgical techniques can limit the occurrence of this unwanted affect, reduce the extent of plaque-induced gingival inflammation and reduce the rate of recurrence. Wherever possible this management strategy should be adopted first. Surgical treatment is often the most reliable option and scalpel gingivectomy remains the treatment of choice. Further investigations are required to develop appropriate management strategies to prevent recurrence of DIGO.

Bacteremia following laser and conventional surgery in hamsters

The CO2 laser prevents bleeding by sealing blood and lymph vessels as it vaporizes tissue. Bacteremia following oral surgery might not occur under these conditions. To test this hypothesis, a 0.2-mm-deep incision 1 cm long was made in the right buccal cheek pouch of hamsters using either laser, electrosurgery, or a scalpel. Twenty minutes later, 1 mL of blood was taken from each animal by cardiac puncture, inoculated on a blood agar medium, and incubated anaerobically for 4 days; then the colonies were counted. Using an operational definition of bacteremia as five colonies or more per plate, there were no positive results out of 18 trials (0/18) for laser surgery, 7/8 for electrosurgery, and 8/12 for scalpel surgery. Based on the Student t test using the binomial distribution, the laser produced statistically less bacteremia than the other two methods (P less than .01). Because the five-colony cutoff was arbitrary, the nonparametric Wilcoxon Rank test was also used. Colony formation from blood from the laser group was significantly less than from the electrosurgery group (P less than .01) and the scalpel group (P less than .05). The laser surgery group was not statistically different from the control (nonsurgerized) group. These results suggest that there is a considerable bacteremia following scalpel and electrosurgery, but that laser surgery produces no bacteremia.