Lasers in periodontics

Evaluation of Carbon Dioxide Laser-Assisted Treatment for Gingival Melanin Hyperpigmentation

BACKGROUND

Smile aesthetics has a vital role to play in an individual's life and one of the factors affecting the beauty of the smile is gingival color. A gingival color change or gingival hyperpigmentation causes an unesthetic smile line, especially in patients with a gummy smile, which is also known as a black gummy smile. Numerous gingival depigmentation methods have been performed successfully for ablating gingival melanin pigmented epithelium. Thus, the aim of this study is to evaluate the treatment efficacy of gingival hyperpigmentation by using a carbon dioxide (CO₂) laser.

METHODS

A cross-sectional descriptive study was carried out with 38 patients at a hospital in Vietnam. Ponnaiyan classification and the Hedin melanin index were used to assess the distribution and extent of gingival pigmentation in the study. Pain assessment was performed using the Visual Analog Scale (VAS) to evaluate the intensity of pain during the laser treatment. In addition, clinical evaluation (i.e., wound healing) of each treatment procedure was conducted using the three level Dummett-Gupta Oral Pigmentation Index (DOPI) assessment.

RESULTS

This study showed that less pain was experienced by patients treated by CO₂ laser; the rates of no pain, mild pain and moderate pain after treatment were, respectively, 21%, 76% and 2.6%; there was 100% complete epithelization after 1 week. The DOPI rates for turning from a DOPI score of 1, 2 or 3 to a DOPI score of 0 after a 12-week treatment were 87.5%, 76.9% and 24%, respectively.

CONCLUSIONS

Using a CO₂ laser for gingival melanin pigmentation treatment is a safe and effective procedure.

Photodynamic Therapy for Peri-Implant Diseases

Peri-implant diseases are frequently presented in patients with dental implants. This category of inflammatory infections includes peri-implant mucositis and peri-implantitis that are primarily caused by the oral bacteria that colonize the implant and the supporting soft and hard tissues. Other factors also contribute to the pathogenesis of peri-implant diseases. Based on established microbial etiology, mechanical debridement has been the standard management approach for peri-implant diseases. To enhance the improvement of therapeutic outcomes, adjunctive treatment in the form of antibiotics, probiotics, lasers, etc. have been reported in the literature. Recently, the use of photodynamic therapy (PDT)/antimicrobial photodynamic therapy (aPDT) centered on the premise that a photoactive substance offers benefits in the resolution of peri-implant diseases has gained attention. Herein, the reported role of PDT in peri-implant diseases, as well as existing observations and opinions regarding PDT, are discussed.

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.

Comparative frenectomy with conventional scalpel and dual-waved laser in labial frenulum

Aim

The purpose of the study is to compare the labial frenectomy between the laser surgery (erbium yttrium aluminum garnet and neodymium-doped yttrium aluminum garnet (Er:YAG and Nd:YAG)) and the scalpel method.

Methods

The trial was a randomized controlled test. Thirty four patients aged from 5 to 10 years requiring the frenectomy were included in this study. Patients were randomly divided into two groups: group A: Er:YAG and Nd:YAG laser group and group B: scalpel group. In addition, this comparison considered the following factors: surgical time and Visual Analog Scale (VAS) pain score, which includes intraoperative pain, postoperative pain and complications, such as speaking and chewing, for 1 day and 7 days following labial frenectomy. After 3 months, we recorded the healing outcome by photos.

Results

There was a statistically significant difference in mean surgical time between laser surgery (mean=224±59 s) and scalpel surgery (mean=740±168 s). According to VAS scores of the intraoperative period (3 hours after the operation and 1st postoperative day of pain), chewing and speaking were statistically higher in group B than those in group A; but in the 7th postoperative day of pain, there was no significant difference in speaking and chewing. After 1 month, all of the patient results were recorded, including the healing of wound and scar. Except for one patient in group B who had a scar, all patients achieved good results.

Conclusion

Based on the results of this study, it can be concluded that Nd:YAG laser is an efficient and more comfortable alternative to the scalpel for a frenectomy in upper lip frenulum.

Ex Vivo Evaluation of Gingival Ablation with Various Laser Systems and Electroscalpel

Objective: The aim of this study was to perform a systematic and multifaceted comparison of thermal effects during soft tissue ablation with various lasers and an electroscalpel (ES). Materials and methods: Er:YAG, Er,Cr:YSGG, CO₂, Diode, Nd:YAG lasers (1 W, pulsed or continuous wave), an ES, and a scalpel (Sc; control), were employed for porcine gingival tissue ablation. Temperature changes during ablation were measured by using an infrared thermal imaging camera and a thermocouple. After ablations, the wounds were observed using stereomicroscopy and scanning electron microscopy (SEM), and histological sections were analyzed. Compositional analysis was also performed on ablated sites by SEM wavelength dispersive X-ray spectroscopy. Results: The surface temperature during irradiation was highest with CO₂ (over 500°C), followed by Diode (267°C) and Nd:YAG (258°C), Er:YAG (164°C), ES (135°C), and Er,Cr:YSGG (85°C). Carbonization was negligible (Er:YAG), slight (Er,Cr:YSGG), moderate (Nd:YAG and ES), and severe (CO₂ and Diode). Under SEM observation, Er:YAG and Er,Cr:YSGG showed smooth surfaces but other devices resulted in rough appearances. Histologically, the coagulated and thermally affected layer was extremely minimal (38 μm in thickness) and free from epithelial collapse for Er:YAG. Compared with other devices, less compositional surface change was detected with Er:YAG and Er,Cr:YSGG; additionally, the use of water spray further minimized thermal influence. Conclusions: Among various power devices, Er:YAG laser showed the most efficient and refined gingival ablation with minimal thermal influence on the surrounding tissues. Er:YAG and Er,Cr:YSGG lasers with water spray could be considered as minimally invasive power devices for soft tissue surgery.

Diode Laser as an Adjunct to Kirkland Flap Surgery-A Randomized Split-Mouth Clinical and Microbiological Study

Background: Mechanical methods of periodontal therapy alone may fail to eliminate the tissue-invasive pathogenic flora; therefore, considerable attention has been given to adjunctive antimicrobial measures. Objective: The aim of this study was to investigate and compare the clinical and microbiological effects of diode laser (DL) as an adjunct to Kirkland flap surgery versus Kirkland flap surgery alone for the treatment of generalized chronic periodontitis. Materials and methods: A total of 20 patients with generalized chronic periodontitis with probing pocket depth ≥5 mm after phase I therapy were included in this split-mouth study. Two contralateral quadrants of each patient were randomly assigned to either test or control group. Control group was treated with Kirkland flap surgery alone, whereas test group was treated with DL as an adjunct to Kirkland flap surgery. Periodontal parameters were recorded, and subgingival plaque samples were collected from both the control and test groups at baseline and third and sixth month. The plaque samples were then analyzed for red complex organisms using quantitative real-time polymerase chain reaction. Results: Compared with baseline, both treatments showed an improvement in periodontal parameters at the third and sixth month. However, test group produced a significant improvement in plaque index (1.039 ± 0.069 vs. 1.392 ± 0.17, p < 0.001), bleeding on probing (16.512 ± 5.982 vs. 37.051 ± 7.459, p < 0.001), probing pocket depth (1.727 ± 0.39 vs. 3.016 ± 0.47, p < 0.001), and clinical attachment level (2.054 ± 0.524 vs. 3.354 ± 0.728, p < 0.001) at third and sixth month compared with the control group. Moreover, in the test group, levels of red complex bacteria were significantly reduced at third and sixth month compared with the control group. Conclusions: DL as an adjunct to Kirkland flap surgery has resulted in a greater reduction in clinical and microbiological parameters compared with Kirkland flap surgery alone, thereby offering additional benefit in treating generalized chronic periodontitis patients.

Frenectomy with conventional scalpel and Nd:YAG laser technique: A comparative evaluation

BACKGROUND

Frenectomy is complete excision of the frenum attachment to the underlying bone. Conventional frenectomy with blade has been widely used; however, laser-assisted frenectomy is the most recent alternative.

AIM

The present study aims to compare two methods of frenectomy for the pain experienced, intraoperative bleeding, healing outcome, and need for analgesics.

MATERIALS AND METHODS

Twenty patients with high labial frenum attachment requiring frenectomy were included in this study. Patients were randomly divided into Group A: scalpel group and Group B: neodymium-doped yttrium aluminum garnet (Nd:YAG) laser group. Visual Analog pain score, intraoperative bleeding, number of analgesics used, and healing outcome 3 months postoperatively were recorded.

RESULTS

Group B patients experienced less pain (P = 0.016), less bleeding (P = 0.016), and required fewer number of analgesics (P = 0.008). Healing outcome at 3 months showed no significant difference between the two groups (P = 0.095).

CONCLUSION

Based on the results of this study, it can be concluded that Nd:YAG laser is an efficient and a more comfortable alternative to scalpel for frenectomy.

WITHDRAWN: Ethical and legal ramifications of using diode lasers for nonsurgical periodontal therapy

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Hereditary gingival fibromatosis: Characteristics and treatment approach

Hereditary gingival fibromatosis (HGF) is a rare disorder characterized by a benign, non-hemorrhagic, fibrous gingival overgrowth that can appear in isolation or as part of a syndrome. Clinically, a pink gingiva with marked stippling can be seen to cover almost all the tooth, in many cases preventing eruption. HGF usually begins during the transition from primary to permanent teeth, giving rise to a condition that can have negative psychological effects at that age. As it does not resolve spontaneously, the treatment of choice is gingivectomy, which can be performed with an internal or external bevel incision, depending on each case and bearing in mind the changes that will take place at the dentogingival junction (DGJ). This paper describes clinical aspects and treatment in two eight-year-old boys with HGF, considering different facets of the surgical approach with conscious sedation in young children. Key words:Hereditary gingival fibromatosis, gingivectomy, internal bevel incision, external bevel incision, gingival overgrowth.

Treatment of oral hyperpigmentation and gummy smile using lasers and role of plasma as a novel treatment technique in dentistry: An introductory review

Gingival hyperpigmentation and the condition known as gummy smile are very common dental cosmetic problems. Gingival hyperpigmentation arises due to the excess presence of melanin in certain regions of the gums. In the case of gummy smile, more than the required amount of gingival tissue is exposed upon smiling. An aesthetically pleasing smile should expose only a negligible amount of gingival tissue. Gummy smile and gingival hyperpigmentation can have detrimental effects on the aesthetic quality of a smile, and thereby a wide variety of treatment options must be taken into consideration depending patient outcome objectives. The use of a laser as a treatment modality is considered to be a promising option for such cases. We aim to explain the effects of using a laser on the gingiva and discuss the advantages and disadvantages of this type of treatment and the resulting alteration of the genetic composition of the gingival tissue. This article reviews the histological aspects and biological effects of a laser treatment for oral hyperpigmentation and gummy smile and analyzes the use of the laser as a modality to improve the smiles of people with hyperpigmentation and excessive gingival display. We also attempt to provide insight into the use of plasma as a novel technology for medical and dental research and its future implications with regard to, dental soft tissue procedures.

Comparative evaluation of depigmentation techniques in split-mouth design with electrocautery and laser

Excessive gingival pigmentation is a major esthetic concern for many people. Melanin pigmentation is known to be caused by melanin granules within the gingival epithelium. Smile is determined not only by the shape, the position, and the color of the teeth, but also by the gingival tissues. Gingival health and appearance are essential components of an attractive smile. It is not a medical problem, but it feels unesthetic for the patient and particularly in patients having a very high lip/smile line. Depigmentation is not a clinical indication but a treatment of choice where esthetics is a concern and is desired by the patient. For depigmentation of gingival, different treatment modalities have been reported such as bur abrasion, scraping, partial thickness flap, cryotherapy, electrosurgery, and laser. The present case series describes two simple and effective surgical depigmentation techniques treated with diode laser and electrosurgery.

Amlodipine-induced Gingival Hyperplasia - A Case Report and Review

Anticonvulsants, antihypertensive calcium channel blockers and immunosuppressants are the three main classes of drugs known to cause drug-induced gingival hypertrophy or hyperplasia. Among the calcium channel blockers, nifedipine administration has most frequently been associated with medication-related gingival hyperplasia. The incidence with amlodipine, which has a mode of action pharmacodynamically comparable to nifedipine, has rarely been reported. Here, we present a rare case of amlodipine-induced gingival hyperplasia in a hypertensive patient.

Evaluation of the use of a 940 nm diode laser as an adjunct in flap surgery for treatment of chronic periodontitis

BACKGROUND

Lasers have several potential benefits such as antibacterial effect and stimulation of wound healing. In addition, hemostasis and delaying epithelial migration may facilitate the outcome of flap surgery. There is a minimal research and evidence currently available for the optimum method of use of a diode laser in flap surgery and its benefit and safety. Hence, this study aimed to investigate the adjunctive effect of diode laser irradiation in open flap debridement (OFD), while treating chronic periodontitis.

MATERIALS AND METHODS

A total of 30 patients with generalized chronic moderate to severe periodontitis with pocket probing depth (PD) ≥5 mm post - Phase I therapy were selected for a split-mouth study. Flap surgery with adjunctive diode laser irradiation was performed in the test quadrant while routine OFD was done in the control quadrant. Clinical parameters including PD, clinical attachment level, gingival recession, plaque index, gingival index and tooth mobility were recorded at baseline, 3 months and 6 months following treatment. In addition, patients' rating of procedural pain as well as the development of complications postoperatively was assessed.

RESULTS

All clinical parameters significantly improved after therapy without any statistically significant difference between the two groups for any of the parameters. The exception was a significantly greater reduction in gingival inflammation in the laser treated group. The laser treatment was acceptable to the patient and did not cause any complications.

CONCLUSION

The diode laser can be safely and effectively used as an adjunct to the treatment of chronic periodontitis with the advantage of decreased gingival inflammation.

Use of carbon dioxide laser in oral soft tissue procedures

Lasers have been introduced in dentistry as an alternative to conventional knife surgery. The advantage to the operator includes a clean dry field that enhances visibility and reduces the procedure time. The patient benefits by minimal postoperative pain and swelling. The paper discusses use of carbon dioxide laser in five conditions commonly encountered in oral cavity.

Use of a Carbon Dioxide Laser as an Adjunct to Scaling and Root Planing for Clinical New Attachment: A Case Series

INTRODUCTION

Severe, chronic periodontitis (CP) is typically treated either with scaling and root planing (SRP) or surgical therapy in an effort to gain clinical attachment. The advantage of non-surgical therapy is decreased morbidity to the patient; however, the site typically heals by formation of a long junctional epithelium. The advantage of surgical therapy is access for debridement and the use of bone or bone substitutes in combination with a barrier membrane for epithelial exclusion. Compared with a non-surgical approach, surgical therapy is more invasive, and patient acceptance of treatment is typically more challenging. The use of lasers in dentistry appears to be rapidly increasing, as evidenced by the influx of new lasers into the dental market as well as numerous anecdotal reports of beneficial results with their use.

CASE SERIES

This report presents a novel approach to the treatment of severe CP using a carbon dioxide (CO₂) laser in combination with SRP. This study presents the findings of 17 patients (nine males and eight females, aged 34 to 71 years; mean age: 54 years) that were compared in a split-mouth design and followed for 3 months. To the best of the authors' knowledge, this is the first reported case series using a CO₂ laser for de-epithelialization in combination with SRP for the treatment of CP.

CONCLUSION

Sites treated with the CO₂ laser tended to show a greater decrease in probing depths, greater amounts of recession, and greater gains in clinical attachment levels, but the results were not statistically significantly better than SRP alone.

Is there a place for lasers in periodontal therapy?

This article aims to provide an overview on the clinical applications of lasers in periodontics.

Tissue restoration after improper laser gingivectomy: A case report

We report the case of 27-year-old female patient applied to our clinic with several pain at her upper teeth and weakness complaints. Anamnesis revealed that she experienced laser gingivectomy to have remarkable teeth. Clinical examination showed that maxillar alveolar bone was partially uncovered with gingivae and periosteum. Interproximal necrosed area was observed. She had sensitivity at her maxillar anterior teeth. Furthermore, she was so anxious and depressed. In order to ensure more blood supply and clot formation, perforations on uncovered cortical bone was prepared. Avoiding from infection antibiotic, antiseptic gel and for epithelization vitamin E gel were prescribed. During one month she was recalled every third day. Recall times diminished periodically, as new tissue evolves. Although laser’s irreversible photothermal effects on soft and hard tissue, after a year all denuded areas were covered with healthy tissues without any surgical procedures. Histopathologic comparing showed severe lymphocyte infiltration and increased fibrosis and kollagenization in restored gingiva, additionally epithelial loss was observed. Since there is not a case report about the complications of laser gingivectomy in literature, we tried to represent a treatment plan that may be elucidative for clinicians.

Laser and radiosurgery in veterinary dentistry

Lasers and radiosurgery frequently used in human dentistry are rapidly entering veterinary dental use. The carbon dioxide, diode, and low-level therapy lasers have features including hemostasis control, access to difficult to reach areas, and decreased pain, that make them useful for oral surgery. Periodontal pocket surgery, gingivectomy, gingivoplasty, gingival hyperplasia, operculectomy, tongue surgery, oropharyngeal inflammation therapy, oral mass surgery, crown, and frenectomy laser surgeries are described, including images.

Lasers in periodontics

Laser is one of the most captivating technologies in dental practice since Theodore Maiman in 1960 invented the ruby laser. Lasers in dentistry have revolutionized several areas of treatment in the last three and a half decades of the 20^th century. Introduced as an alternative to mechanical cutting device, laser has now become an instrument of choice in many dental applications. Evidence suggests its use in initial periodontal therapy, surgery, and more recently, its utility in salvaging implant opens up a wide range of applications. More research with better designs are a necessity before lasers can become a part of dental armamentarium. This paper gives an insight to laser in periodontics.

Histological and SEM analysis of root cementum following irradiation with Er:YAG and CO2 lasers

Recently, the Er:YAG and CO(2) lasers have been applied in periodontal therapy. However, the characteristics of laser-irradiated root cementum have not been fully analyzed. The aim of this study was to precisely analyze the alterations of root cementum treated with the Er:YAG and the CO(2) lasers, using non-decalcified thin histological sections. Eleven cementum plates were prepared from extracted human teeth. Pulsed Er:YAG laser contact irradiation was performed in a line at 40 mJ/pulse (14.2 J/cm(2)/pulse) and 25 Hz (1.0 W) under water spray. Continuous CO(2) laser irradiation was performed in non-contact mode at 1.0 W, and ultrasonic instrumentation was performed as a control. The treated samples were subjected to stereomicroscopy, scanning electron microscopy (SEM), light microscopy and SEM energy dispersive X-ray spectroscopy (SEM-EDS). The Er:YAG laser-treated cementum showed minimal alteration with a whitish, slightly ablated surface, whereas CO(2) laser treatment resulted in distinct carbonization. SEM analysis revealed characteristic micro-irregularities of the Er:YAG-lased surface and the melted, resolidified appearance surrounded by major and microcracks of the CO(2)-lased surface. Histological analysis revealed minimal thermal alteration and structural degradation of the Er:YAG laser-irradiated cementum with an affected layer of approximately 20-μm thickness, which partially consisted of two distinct affected layers. The CO(2)-lased cementum revealed multiple affected layers showing different structures/staining with approximately 140 μm thickness. Er:YAG laser irradiation used with water cooling resulted in minimal cementum ablation and thermal changes with a characteristic microstructure of the superficial layer. In contrast, CO(2) laser irradiation produced severely affected distinct multiple layers accompanied by melting and carbonization.

Biostimulation effects of low-power laser in the repair process

The wound healing process has always been an excellent subject for researchers. The use of low-power laser on wounds during the postoperative phase has increased the speed of the healing process. It has been implied that low power radiation affects cellular metabolic processes and promotes beneficial biological effects (analgesic, anti-inflammatory, and healing). Laser biostimulation appears to influence the behavior of the repair process. This paper aims at reviewing the most interesting aspects of the use of low-power laser in the tissue-repair process.

Efficacy of Er:YAG laser in the treatment of chronic periodontitis: systematic review and meta-analysis

Scaling root planing (SRP) has been proven efficacious as the traditional treatment approach for chronic periodontitis. However, important limitations such as difficult access in deep pockets, grooves, and furcations have led to the development of new therapeutic strategies. The erbium-doped:yttrium-aluminium-garnet (Er:YAG) laser is one of the most promising laser types for periodontal therapy. Its efficacy in radicular debris removal and root smoothing has been proven in vitro. However, the clinical effectiveness of the Er:YAG laser remains controversial. The aim of the present systematic review was to systemically assess the scientific evidence for the effectiveness of Er:YAG laser compared to SRP in the treatment of chronic periodontitis. Electronic database searches of MEDLINE, Cochrane Controlled Clinical Trial Register, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, CINAHL, Science Direct, ISI Web of Science, and SCOPUS were performed, as well as hand-searching of relevant journals through December 23, 2010. Quality assessment was made according to the CONSORT guidelines. The systematic review was performed according to the QUOROM statement and Cochrane Collaboration recommendations. Meta-analyses of the clinical attachment level gain, probing depth reduction, and changes in gingival recession were performed using weighted mean differences for continuous data with 95% confidence intervals, nested in a random effect model. No statistically significant differences were found in any of the investigated clinical parameters among the five random controlled trials (RCTs) entered into the study, indicating that there was no evidence of effectiveness. However, significant heterogeneity, a high risk of bias in three of the five included studies, and methodological shortcomings indicate that the results should be considered with caution. Future long-term, well-designed RCTs are needed to assess the scientific evidence of Er:YAG laser efficacy as an alternative treatment strategy to SRP.

Contemporary crown-lengthening therapy: a review

BACKGROUND

The authors conducted a literature review regarding the rationale, basic surgical principles, contraindications and wound healing associated with periodontal crown-lengthening surgery. They present a report of a clinical case illustrating crown lengthening with osseous resection.

TYPES OF STUDIES REVIEWED

The authors evaluated clinical and radiographic studies, as well as literature reviews. They selected only publications that pertained to the surgical exposure of the natural dentition to facilitate restorative therapy, esthetic concerns or both.

RESULTS

Periodontal crown lengthening can be used for esthetic enhancement in the presence of delayed passive eruption. Moreover, for teeth with subgingival caries, fractures or both, this treatment can establish a biological width and, if needed, a ferrule length facilitating prosthetic management. Crown-lengthening surgery involves various techniques, including gingivectomy or gingivoplasty or apically positioned flaps, which may include osseous resection. Authors of wound-healing investigations have reported that an average of 3 millimeters of supragingival soft tissue will rebound coronal to the alveolar crest and can take a minimum of three months to complete vertical growth.

CLINICAL IMPLICATIONS

Initiation of final prosthetic treatment should wait at least three months and possibly up to six months for esthetically important areas, as the free gingival margin requires a minimum of three months to establish its final vertical position. Dentists must be aware that osseous resection could affect periodontal stability and may pose a contraindication to crown-lengthening therapy.

Surgical treatment of gingival overgrowth with 10 years of follow-up

Background

In some pathological conditions, gingivitis caused by plaque accumulation can be more severe, with the result of an overgrowth. Nevertheless, the overgrowth involves the gingival margin with extension to the inter-dental papilla. The lesion may involve the inter-proximal spaces, and become so extensive that the teeth are displaced and their crowns covered. Severe overgrowth may lead to impairment in aesthetic and masticatory functions, requiring surgical excision of the excessive tissue. Aim of this study is to describe an operative protocol for the surgical treatment of localized gingival overgrowth analyzing the surgical technique, times and follow-up.

Methods

A total of 20 patients were enrolled and underwent initial, non surgical, periodontal treatment and training sessions on home oral hygiene training. The treatment plan involved radical exeresis of the mass followed by positioning of an autograft of connective tissue and keratinized gingiva.

Results

During 10 years of follow-up, all the grafts appeared well vascularized, aesthetically satisfactory, and without relapse.

Conclusions

Periodontal examinations, surgical procedures, and dental hygiene with follow-up are an essential part of the treatment protocol. However, additional effort is needed from the patient. Hopefully, the final treatment result makes it all worthwhile.

Submucosal glycerol injection-assisted laser surgical treatment of oral lesions

Recently, we modified laser surgery for superficial lesions in the oral cavity by using submucosal glycerol injection. This procedure was based on a technique for endoscopic mucosal resection (EMR) in the gastrointestinal tract. The aim of this study was to evaluate the effectiveness of the modified laser surgery assisted by a submucosal glycerol injection. Eleven superficial oral lesions in ten patients were treated with diode laser (continuous wave mode, 3 W) after a submucosal injection of glycerol solution. Injection of glycerol solution created mucosal expansion, which enabled the procedures to be done without bleeding, over cutting, over coagulation and unintended irradiation. The surface of the wounds showed little carbonization, resulting in good healing. Submucosal glycerol injection for laser treatment in the oral cavity is a promising technique for treating superficial oral lesions by virtue of less invasion and good results.

Excision biopsy of tongue lesions by diode laser

OBJECTIVE

The aim of this study was to evaluate the diode laser in excision biopsy of superficial proliferative tongue lesions under local anesthesia.

BACKGROUND DATA

Most mobile tongue lesions present as surface projections and have similar clinical features. They are usually excised for diagnostic purposes using conventional surgery or electrosurgery. The diode laser has proven itself useful in different oral surgeries.

METHODS

We report the results of a prospective pilot study where contact diode laser was used in excision biopsy of six mobile tongue lesions. All excised tissues were pathologically examined. To assess post-operative pain, patients were asked to correlate it to an 11-point Visual Analogue Scale (VAS); patients were also asked to assess their impression of alteration in tongue size on a 4-point scale. Healing, functional results, and recurrence rate were assessed.

RESULTS

All interventions were uneventful and done at the same out-patient setting. All lesions were benign. Healing occurred by secondary intention in the six cases with no residual ulceration. Postoperative pain was mild in four cases, while two cases suffered from moderate pain. Post-operative impression of tongue swelling occurred in all cases. The mild impression disappeared by the end of the first week and the moderate one by the end of the second week. No recurrence was observed over a mean follow-up period of 15 months.

CONCLUSION

The diode 980-nm laser is optimal for excision biopsy of superficial and benign proliferative lesions of the mobile tongue.

Low-power laser therapy in the treatment of parodontopathy

<zakljucak> Zahvaljujuci opisanim terapijskim efektima, laseri male snage deluju na biolosko tkivo, prvenstveno antiinflamacijski, ali i stimulativno na reparacijske i regeneracijske procese u inflamiranoj gingivi. Zbog toga se laseri danas primenjuju kao dopunska, veoma uspesna, fizikalna metoda lecenja, koja, uz tradicionalnu periodontalnu terapiju, daje bolje rezultate lecenja i utice na duze odrzavanje postignutih terapijskih rezultata.

Evaluation of Patient Perceptions After Frenectomy Operations: A Comparison of Carbon Dioxide Laser and Scalpel Techniques

BACKGROUND

A frenum that encroaches on the margin of the gingiva may interfere with plaque removal and cause tension. Frenectomy is the complete removal of the frenum that can be made by scalpels or with soft tissue lasers. The aim of this article was to compare the degree of postoperative pain, such as discomfort and functional complications (eating and speech), experienced by patients after two frenectomy operation techniques.

METHODS

Forty patients requiring frenectomy were randomly assigned to have treatment either with a conventional technique or with a carbon dioxide (CO2) laser. The postoperative pain and functional complication ratings of each patient were recorded using a visual analog scale on days 1 and 7.

RESULTS

The results indicated patients treated with the CO2 laser had less postoperative pain and fewer functional complications (speaking and chewing) (P <0.0001 each) and required fewer analgesics (P <0.001) compared to patients treated with the conventional technique.

CONCLUSIONS

This clinical study indicates that CO2 laser 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 CO2 laser offers a safe, effective, acceptable, and impressive alternative for frenectomy operations.

Effect of Er:YAG and Diode lasers on the adhesion of blood components and on the morphology of irradiated root surfaces

OBJECTIVE

The aim of this study was to evaluate in vitro, by scanning electron microscopy (SEM), the adhesion of blood components on root surfaces irradiated with Er:YAG (2.94 microm) and GaAlAs Diode (808 nm) lasers and the effects on the morphology of irradiated root surfaces.

METHODS

One hundred samples of human teeth were obtained. They were previously planed and scaled with manual instruments and divided into five groups of 20 samples each: G1 (control group) - absence of treatment; G2--Er:YAG laser (7.6 J/cm2); G3--Er:YAG laser (12.9 J/cm2); G4--Diode laser (90 J/cm2) and G5--Diode laser (108 J/cm2). After these treatments, 10 samples of each group received a blood tissue but the remaining 10 did not. After laboratory treatments, the samples were obtained by SEM, the photomicrographs were analysed by the score of adhesion of blood components and the results were statistically analysed (Kruskall-Wallis and Mann-Whitney test).

RESULTS

In relation to the adhesion of blood components, the study showed no significant differences between the control group and the groups treated with Er:YAG laser (p = 0.9633 and 0.6229). Diode laser radiation was less effective than control group and Er:YAG laser radiation (p < 0.01).

CONCLUSIONS

None of the proposed treatments increased the adhesion of blood components in a significant way when compared to the control group. Although the Er:YAG laser did not interfere in the adhesion of blood components, it caused more changes on the root surface, whereas the Diode laser inhibited the adhesion.

Short-term clinical and microbiologic effects of pocket debridement with an Er:YAG laser during periodontal maintenance

BACKGROUND

The erbium-doped:yttrium, aluminum, and garnet (Er:YAG) laser is considered a useful tool for subgingival debridement because the laser treatment creates minimal damage to the root surface and has potential antimicrobial effects. The aim of this randomized controlled clinical trial was to evaluate clinical and microbiologic effects of pocket debridement using an Er:YAG laser in patients during periodontal maintenance.

METHODS

Twenty patients at a recall visit for maintenance were consecutively recruited if presenting at least four teeth with residual probing depth (PD) > or = 5 mm. Two pockets in each of two jaw quadrants were randomly assigned to subgingival debridement using 1) an Er:YAG laser (test) or 2) an ultrasonic scaler (control). The laser beam was set at 160 mJ with a pulse frequency of 10 Hz. Clinical variables were recorded at baseline, 1 month, and 4 months after treatment. Primary clinical outcome variables were changes in PD and clinical attachment level (CAL). Microbiologic analysis of subgingival samples was performed at baseline, 2 days, and 30 days after treatment using a checkerboard DNA-DNA hybridization technique against 12 periodontal disease-associated species.

RESULTS

The mean initial PD was 6.0 mm (SD: 1.2) in the test group and 5.8 mm (SD: 0.9) in the control group. At 1 month post-treatment, the PD reduction was significantly greater for test than control sites (0.9 versus 0.5 mm; P <0.05). The CAL gain also was significantly greater (0.5 versus 0.06 mm; P <0.01). At the 4-month examination, no significant differences were detected in PD reduction (1.1 versus 1.0 mm) or CAL gain (0.6 versus 0.4 mm). Both treatments resulted in reduction of the subgingival microflora. No significant differences in microbiologic composition were identified between the treatment groups at various time intervals. Degree of treatment discomfort scored significantly lower for the test than the control treatment modality.

CONCLUSION

The results of the trial failed to demonstrate any apparent advantage of using an Er:YAG laser for subgingival debridement, except less treatment discomfort perceived by the patients.

Periodontal tissue healing following flap surgery using an Er:YAG laser in dogs

BACKGROUND AND OBJECTIVES

The purpose of this study was to compare periodontal tissue healing following flap surgery using an Er:YAG laser with that of conventional surgery.

STUDY DESIGN/MATERIALS AND METHODS

Bilateral premolars with experimentally induced periodontitis in six dogs were treated by periodontal flap surgery. Degranulation and root debridement in the furcation were performed using an Er:YAG laser or curet. At 3 months postsurgery, animals were sacrificed and decalcified specimens were prepared for histological and histometric analysis.

RESULTS

Degranulation and root debridement were effectively performed with an Er:YAG laser without major thermal damage and significantly faster than with a curet. Histologically, the amount of newly formed bone was significantly greater in the laser group than in the curet group, although both groups showed similar amounts of cementum formation and connective tissue attachment.

CONCLUSIONS

The Er:YAG laser irradiation can be safely and effectively utilized in periodontal flap surgery, and has the potential to promote new bone formation.

In Vitro, Clinical, and Microbiological Evaluation of a Linear Oscillating Device for Scaling and Root Planing

BACKGROUND

The purpose of this study was to conduct an in vitro and short-term clinical and microbiological evaluation of a linear oscillating device for scaling and root planing (SRP). A comparison was made between conventional ultrasonic scaling (US) and hand scaling (HS) with and without chlorhexidine.

METHODS

In vitro, SRP was carried out on human teeth with calculus. Roots and cross-sections thereof were microscopically examined for the efficacy of calculus removal, hard tissue loss, and surface smoothness. In vivo, 11 patients with chronic periodontitis and single-rooted teeth in all quadrants with probing depths of > or =5 mm were selected. One quadrant was treated with linear oscillation and compared to US with chlorhexidine irrigation in the contralateral site. The other arch was treated with HS and compared to HS followed by laser disinfection. One hundred twenty teeth were assessed for clinical attachment level, probing depth, bleeding on probing, and suppuration at baseline and 7, 28, 90, and 180 days. Microbiologically, total numbers of bacteria and six specific periodontal pathogens were determined by quantitative polymerase chain reaction prior to and 1 and 28 days after SRP. Clinical and microbiological data were analyzed statistically with respect to the SRP method, patient specificity, and time effect.

RESULTS

In vitro, linear oscillation preserved more root tissues but left more calculus (P <0.05). Significant improvements of all clinical and microbiological parameters were observed for all groups. However, 21 out of 24 tests demonstrated that the clinical microbiological correlations between linear oscillation and control groups did not differ (P <0.05).

CONCLUSION

Linear oscillation scaling was clinically acceptable and microbiologically comparable to the control groups despite microscopic remnants of calculus observed in vitro.

Histologic Evaluation of Three Methods of Periodontal Root Surface Treatment in Humans

BACKGROUND

Removing subgingival plaque and calculus is a major goal of periodontal treatment. Few attempts have been made to evaluate the use of lasers for root surface debridement in periodontal therapy. The aim of the present study was to compare, histologically, the effects of hand instrumentation, ultrasonic instrumentation, and CO2 lasers on the root surfaces of teeth treated in situ.

METHODS

A total of 33 teeth scheduled for extraction due to severe periodontal disease were divided into three groups. In the first group, teeth were treated by ultrasonic bactericidal curettage (UBC) with an ultrasonic scaler; in the second group, teeth were treated by hand instrumentation; and in the third group, after hand instrumentation, roots were lased by a CO2 laser. The samples were then processed for histological examination.

RESULTS

In the first and second groups, plaque and calculus were present in interradicular septa, lacunae, and surface concavities. In the third group, surfaces of specimens treated by a low-power defocused CO2 laser showed areas devoid of cementum, with completely sealed dentinal tubules, and no bacterial cell remnants.

CONCLUSIONS

The CO2 laser treatment, used at low power and in the defocused mode, combined with traditional mechanical instrumentation, could improve root surface debridement of periodontally involved teeth. More extensive, long-term studies are needed to confirm this hypothesis.