Lasers and soft tissue: 'fixed' soft tissue surgery

Application of the diode laser for soft-tissue surgery in orthodontics: Case series

Referral to an oral surgeon for soft-tissue surgery before, during or after orthodontic treatment is not uncommon. This process may delay treatment and could potentially increase the risk of complications. In addition, seeing multiple specialties in different environments may demotivate paediatric or anxious patients from pursuing orthodontic treatment and could also adversely affect patient compliance and satisfaction. The development of laser technology provides a safe and effective alternative, allowing the orthodontic clinician to perform soft-tissue surgery. To date, there are no laser exposure protocols or UK guidelines regarding the use of laser surgery in orthodontics. This case series reports four clinical cases that demonstrate potential advantages of using a diode laser for the management of soft tissue in the field of orthodontics.

Diode Laser Assisted Excision and Low Level Laser Therapy in the Management of Mucus Extravasation Cysts: A Case Series

Introduction: Mucus extravasation cyst is a commonly occurring lesion in oral cavity that may result from traumatic severance of a salivary gland duct with subsequent extravasation of mucus into fibrous connective tissue. After a conventional excision or marsupialization, recurrence is not uncommon. Diode laser offers an effective modality for management of such lesions. Case Reports: Four patients were referred with painless fluctuant swellings on labial and buccal mucosa. After recording history and clinical examination, provisional diagnosis of mucocele was made. All the lesions were excised with a diode laser and biopsy was performed. Surgical wounds were treated with low-level laser therapy (LLLT). Results: Uneventful healing was observed in all 4 cases. Significant reduction in postoperative discomfort was recorded after application of LLLT. Histopathological findings were suggestive of mucus extravasation cysts. Conclusion: Diode laser appears to be a good alternative to conventional modalities for the management of mucus extravasation cysts.

450 nm Blue Laser and Oral Surgery: Preliminary ex vivo Study

INTRODUCTION

Dental diode lasers were started to be used at the end of the 1990s and were shown to possess several important characteristics, such as small size and low cost, as well as the advantage of optic fibers delivering system. Although only two wavelengths (810 and 980 nm) had been the most used dental diode lasers, a wavelength emitting in the blue portion of the spectrum has recently been proposed.

AIM

The aim of this ex vivo study was to compare the effectiveness of five different fiber-delivered laser wavelengths (450, 532, 808, 1064, and 1340 nm) in the oral soft tissue ablation.

MATERIALS AND METHODS

Specimens were surgically collected from the dorsal surface of four bovine tongues and, while deep thermal increase was measured by two thermocouples at 0.5 and 2 mm depth, surface temperature was recorded by an infrared thermometer. Subsequently, specimens were fixed in 10% buffered formalin solution, cut into slices, and embedded in paraffin blocks, and a pathologist made a morphological analysis by optic microscope assigning a score based on the quality of the cut and tissue damage.

RESULTS

The analysis showed the best quality of the cut and the lowest temperature increase on the specimens obtained with the shortest laser wavelength (450 nm).

CONCLUSION

Even considering this as preliminary study, the use of 450 nm blue diode laser in oral surgery may be suggested to the clinician in their daily practice.

CLINICAL SIGNIFICANCE

This study opens a new perspective in oral surgery. Blue diode laser has demonstrated a good quality of the cut with a low energy causing a minimal thermal damage to the tissue, promising a better comfort to patients.

Evaluation of Patient Perceptions After Vestibuloplasty Procedure: A Comparison of Diode Laser and Scalpel Techniques

INTRODUCTION

Inadequate vestibular depth results in poor plaque control owing to an insufficient width of keratinized gingiva. Vestibuloplasty provides the necessary vestibular depth and can be performed either with a scalpel, electrocautery or lasers.

AIM

To evaluate the patient perceptions related to pain and discomfort on the 1(st), 3(rd) and the 7(th) day post vestibuloplasty and also assess the healing outcomes related to the treatment of inadequate vestibular depth either with the diode laser or the scalpel.

MATERIALS AND METHODS

Twenty patients who had inadequate vestibular depth and required vestibuloplasty were assigned randomly to undergo the procedure either with the scalpel or the laser. The data obtained was analysed for intergroup comparison with an independent paired t-test and intragroup comparison was determined by a paired t-test.

RESULTS

Intragroup comparison within the laser group for VAS scores of pain and discomfort within all the reported days exhibited a significant difference (p<0.05). Inter group comparison revealed that the patients in the laser group had lower VAS cores for pain and discomfort compared to the scalpel group (p<0.05). Analysis of the three pointer scale for healing revealed that the patients in the laser group exhibited better healing outcomes on the 1(st), 3(rd) and the 7(th) day compared to the scalpel group.

CONCLUSION

Observations from the study highlight the opinion that laser can be a safe and effective alternative to traditional vestibuloplasty performed with the scalpel.

Four different diode lasers comparison on soft tissues surgery: a preliminary ex vivo study

Objectives: The introduction of diode lasers in dentistry had several advantages, principally consisting on the reduced size, reduced cost and possibility to beam delivering by optical fibbers. Up today only the wavelengths around 810 and 980 nm were the most utilized in oral surgery but recently more different lasers had been proposed. The aim of this study was to compare the efficacy of four diode laser wavelengths (810, 980, 1470 and 1950 nm) for the ablation of soft tissues. Material and methods: Specimens were surgically collected from the dorsal surface of four bovine tongues and irradiated by four different diode wavelengths. Thermal increase was measured by two thermocouples, the first at a depth of 0.5 mm, and the second at a depth of 2 mm. Initial and final surface temperatures were recorded by IR thermometer. Epithelial changes, connective tissue modifications, presence of vascular modification and incision morphology were histologically evaluated by two blind pathologists. Results: The time necessary to perform the excision varied between 271 seconds (808 nm, 2W) and 112 seconds (1950 nm, 4W). Temperature increase superficial level varied from 16.3° (980 nm, 4W) and 9.2° (1950 nm, 2 W). The most significant deep temperature increase was recorded by 980 nm, 4 W (17.3°) and the lowest by 1950 nm, 2 W (9.7°). The width of epithelial tissue injuries varied between 74 pm from 1950 nm diode laser at 2 W to 540 pm for 1470 nm diode laser at 4 W. Conclusion: The quality of incision was better and the width of overall tissue injuries was minor in the specimens obtained with higher wavelength (1950 nm) at lower power (2W).

Applications of Light Amplification by Stimulated Emission of Radiation (Lasers) for Restorative Dentistry

Light amplification by stimulated emission of radiation (laser) has been used widely in a range of biomedical and dental applications in recent years. In the field of restorative dentistry, various kinds of lasers have been developed for diagnostic (e.g. caries detection) and operative applications (e.g. tooth ablation, cavity preparation, restorations, bleaching). The main benefits for laser applications are patient comfort, pain relief and better results for specific applications. Major concerns for using dental lasers frequently are high cost, need for specialized training and sensitivity of the technique, thereby compromising its usefulness particularly in developing countries. The main aim of this paper is to evaluate and summarize the applications of lasers in restorative dentistry, including a comparison of the applications of lasers for major restorative dental procedures and conventional clinical approaches. A remarkable increase in the use of lasers for dental application is expected in the near future.

The Comparative Evaluation of Patient's Satisfaction and Comfort Level by Diode Laser and Scalpel in the Management of Mucogingival Anomalies

BACKGROUND

Surgical correction of mucogingival anomalies is required to enhance patient's compatibility to maintain oral hygiene or to improve facial aesthetics or both. Laser has become a desirable and dependable alternative for traditional surgical techniques because it is simple and painless with more predictable outcomes.

AIM

The aim of this study was to compare the effects of the conventional scalpel technique and the laser technique on the degree of discomfort, satisfaction, healing and postoperative pain experienced by patients after correction of mucogingival anomalies.

MATERIALS AND METHODS

In the present study 70 patients were enrolled and randomly distributed in two groups i.e. surgical correction of mucogingival anomalies by scalpel and by laser. Patient's comfort level, pain and satisfaction level was assessed by using Visual analogue scale (VAS) and healing was evaluated by healing index.

RESULTS

The results indicated patients treated with the diode laser had less postoperative pain and discomfort with remarkable satisfactory results and healing compared to patients treated with the conventional technique.

CONCLUSION

Laser is a desirable therapeutic alternative to correct soft tissue anomalies. It allows good control of haemorrhage with comfortable healing phase and appreciable satisfactory outcomes.

Peripheral ossifying fibroma: A clinicopathologic study of 27 cases and review of the literature with emphasis on histomorphologic features

The peripheral ossifying fibroma (POF) is a relatively uncommon, reactive gingival overgrowth usually composed of cellular fibroblastic tissue containing one or more mineralized tissues, namely bone, cementum-like material, or dystrophic calcification. The aetiology and pathogenesis of POF are yet not clear, but some authors have hypothesized a reaction originating from the periodontal ligament, as a result of irritating agents such as dental calculus, plaque, orthodontic appliances, and ill-fitting restorations. The aim of our study was to report the clinicopathologic features of a case series of POF from a single Italian institution. A total of 27 cases were collected over an 18-year period. Detailed relevant medical history, clinical and histological information were recorded for each patient. The age range of patients (m = 6; f = 21) was 17.2-80.1 years with a mean of 42.9 ± 18.1 years. Occurrence of the lesion in the mandibular and maxillary arches was similar, and 67.0% occurred in the incisor-cuspid region. The lesions ranged in size from 0.3 to 5.0 cm (mean, 1.3 cm ± 1.1 cm). All the different types of mineralization were present, with higher prevalence of lamellar bone. The lesions were treated by surgical excision and four lesions in three patients recurred after surgery. Surgeons should consider the high recurrence rate of POF and remove the lesion down to the bone involving also the adjacent periosteum and the periodontal ligament. Professional prophylaxis should precede any surgical procedure, and periodical dental hygiene recalls are important in order to remove any possible irritating factor.

Some dogmas related to prosthodontics, temporomandibular disorders and occlusion

It is the aim of this paper to give a few examples of dogmas related to prosthodontics and oral implants and to discuss the controversial role of occlusion in the aetiology of temporomandibular disorders. New knowledge is developing at a rapidly increasing rate in dentistry, as in other areas of society. Our lecturers at university taught us many useful things. But, as time goes by, what is still relevant? Some methods are so well established that they deserve to be called dogmas. It is implied that a dogma is not supported by strong evidence, even though it has existed and been practised for a long time. In the era of evidence-based dentistry it is appropriate to scrutinize such issues. A review of the current literature indicates that conflicting opinions exist concerning a number of common procedures in clinical dentistry, mainly due to a scarcity of good studies with unambiguous results. There is therefore a need for more high-quality clinical research in attempting to reach the goal of evidence-based clinical practice. The dental community should take an active part in this process.

Lasers and the treatment of chronic periodontitis

For many intraoral soft-tissue surgical procedures the laser has become a desirable and dependable alternative to traditional scalpel surgery. However, the use of dental lasers in periodontal therapy is controversial. This article presents the current peer-reviewed evidence on the use of dental lasers for the treatment of chronic periodontitis.