Postoperative discomfort after Nd:YAG laser and conventional frenectomy: comparison of both genders

Effects of topically administered 0.6% hyaluronic acid on the healing of labial frenectomy in conventional and 940-nm indium gallium arsenide phosphide (InGaAsP) diode laser techniques in pediatric patients: a randomized, placebo-controlled clinical study

This study aimed to investigate the effects of 0.6% hyaluronic acid (HA) gel on the healing process and postoperative pain levels after diode laser-assisted labial frenectomy in pediatric patients. Ninety-six pediatric patients (females, 50 and males, 46) aged 8-14 years were randomly divided into four groups as follows: (1) conventional frenectomy with 0.6% topically administered HA (CFH, n = 24); (2) conventional frenectomy with placebo gel (CFP, n = 24); (3) frenectomy performed by diode laser with 0.6% topically administered HA (DLH, n = 24); and (4) frenectomy performed by diode laser with placebo gel (DLP, n = 24). HA application was continued for 1 week thrice daily after the frenectomy. Visual analog scale forms were collected from patients 1 week after the operation. In addition, the plaque index, gingival index, periodontal probing depth, and keratinized tissue width and thickness were recorded. This process was repeated 1 and 3 months after the first visit. The DLH group revealed significant differences in the probing depth, bleeding on probing, keratinized gingiva width, and attached gingiva width according to dual comparisons of the initial, first, and third-month values (p = 0.010, p = 0.007, p<0.001, and p = 0.001, respectively). Significant differences were observed between the CFP and CFH groups according to the initial and initial third-month values with regard to the bleeding on probing (p=0.019 and p = 0.019, respectively). The attached gingival thickness revealed significant differences between the CFP and CFH groups for the initial and initial-third-month comparisons (p = 0.005 and p = 0.007, respectively). The mean values of the initial and initial-third-month differences were significantly higher in the CFH group than those in the CFP group. HA- and laser-assisted labial frenectomies revealed better outcomes in terms of the probing depth, attached gingiva width, keratinized gingiva width, healing process, and postoperative comfort.

Labial Frenectomy using Laser: A Scoping Review

Labial frenectomy is a surgical technique, that aims to remove the frenulum with its attachment to the underlying bone. Frenectomy, is indicated if the frenulum attachment causes midline diastema, gingival recession, hindrance in maintaining oral hygiene, or if it interferes with lip movements and for prosthetic needs. A labial frenectomy can be performed either by the routine scalpel technique, electrocautery, and most recently medical lasers. The aim of this study was to evaluate, whether the laser technique is more effective than the conventional surgical technique, and whether there are differences between the different types of lasers. The scoping review was conducted and prepared on the basis of the indications of the PRISMA guidelines (PRISMA Extension for Scoping Reviews, PRISMA-ScR) of PRISMA checklist, and nine papers were considered admissible to the qualitative analysis for the following outcomes: bleeding during intervention, use of sutures, duration of the intervention, and use of analgesic drugs in the days following the intervention. This review suggests that laser-performed labial frenectomy is faster and offers better intra- and postoperative management; however, due to the limited number of available papers, the final results of the present review are not absolute.

Diode laser chairside frenectomy in orthodontics: A case series (DIODE LASER FRENECTOMY: CASE SERIES)

Offering the whole orthodontic and surgical treatment to the patient as a single package in a one office can save them considerable time and the trouble. Diode laser enables orthodontists to do so while enjoying its benefits over the scalpel.

Perioperative outcomes of frenectomy using laser versus conventional surgery: a systematic review

Introduction: Frenectomy is an oral surgical procedure usually performed with a scalpel. Several authors recently reported the interest of laser, as a minimally invasive and efficient alternative tool to perform frenectomy. This study aimed to compare the perioperative management of patients requiring a frenectomy using scalpel versus laser. Materials and methods: A systematic review of the literature has been carried out from Pubmed and Scopus databases following PRISMA guidelines. PICO method was used to select the relevant articles. Clinical studies comparing the perioperative outcomes of patients requiring frenectomies using scalpel versus laser were included. Results: Ten articles involving 375 patients were included. Pre-operative parameter (anxiety before surgery) and per-operative data such as anesthesia, surgery duration, bleeding, suture and difficulty were assessed. The post-operative outcomes investigated were pain, analgesics use, functional discomfort, edema, healing and satisfaction of patients. Laser achieved satisfactory peri-operative outcomes such as shorter operative time, without suturing requirement, as well as less post-operative pain and functional discomfort. Discussion: The low number of eligible studies, the different type of lasers used and heterogeneity across the methodology of the selected studies were the limits of the study. Conclusion: Laser-assisted surgery became an attractive tool to perform oral soft tissue surgery.

Periodontal Wound Healing and Tissue Regeneration: A Narrative Review

Periodontal disease is a major public health issue, and various periodontal therapies have been performed to regenerate periodontal tissues. The periodontium is a complex structure composed of specialized tissues that support the teeth, and most periodontal surgeries are invasive procedures, including a resection of the gingiva or the alveolar bone. The periodontal wound healing process is slightly different from cutaneous wound healing and is similar to fetal healing, being almost scar-free. The aim of this review article is to provide an overview of periodontal wound healing and discuss various surgical and pharmaceutical approaches to achieve stable wound healing and improve the treatment outcomes. In addition, detrimental and limiting factors that induce a compromised prognosis are discussed, along with the perspective and future direction for successful periodontal tissue regeneration.

Evaluation of Patient's Perceptions, Healing, and Reattachment After Conventional and Diode Laser Frenectomy: A Three-Arm Randomized Clinical Trial

Objective: The aim of this study is to compare the conventional and diode laser techniques in terms of patient's perceptions, epithelization, reattachment, and periodontal clinical parameters in the treatment of abnormal papillary frenum. Materials and methods: Forty-eight patients with abnormal papillary frenum were enrolled in the study. Patients were randomly assigned into three groups; conventional frenectomy operation (C group), diode laser-assisted frenectomy (L group), and diode laser-assisted frenectomy with conventional horizontal incision on the periosteum (L + P group). Postoperative pain, discomfort in speaking, and chewing scores were assessed with visual analogue scale (VAS) at postoperative 3rd hour and on days 1, 7, 14, 21, and 45. Epithelialization process of the wound surface was evaluated by hydrogen peroxide solution applied to the wound on days 7, 14, 21, and 45 following operations. The distance between the frenum attachment point and mucogingival junction (FMGJ) was recorded at baseline, postoperative 45th day, and 6th month to assess the reattachment of the frenum. Plaque index, gingival index, bleeding on probing, and probing depth were recorded at baseline and postoperative 7th, 14th, 21^st, and 45th days. Results: On the 1st and 7th day after operation, VAS pain score in the C group was significantly higher than in the L and L + P groups (p < 0.017). Difficulty in speaking and chewing scores were significantly lower in the L and L + P groups compared to the C group at postoperative 3rd hour and 7th day (p < 0.017). The FMGJ and epithelization period demonstrated no difference among the groups at any time point (p > 0.05). Conclusions: Our results suggest that diode laser provides better postoperative patient's perceptions than the conventional technique in frenectomy operation. In addition, both conventional and laser-assisted frenectomy surgeries prevent the frenum reattachment regardless of periosteal horizontal incision.

Clinical comparison of the use of ER,CR:YSGG and diode lasers in second stage implants surgery

OBJECTIVES

To compare the effects of diode and erbium, chromium: yttrium-scandium-gallium-garnet (Er,Cr:YSGG) lasers in second-stage implant surgery applications.

METHODS

This is a cross-sectional study that was carried out on patients who received implant treatment at the Departments of Oral and Maxillofacial Surgery and Periodontology, Van Yuzuncu Yil University, Van, Turkey between January 2017 and January 2018. Implants of the patients in the first group (n=20) were exposed with 940 nm Ga-Al-As diode laser while the implants of the second group (n=20) were uncovered with 2780 nm Er,Cr:YSGG laser in the second-stage surgery. Visual analogue scale (VAS) values during day 0 and following the operation on days 1, 2, 3 intraoperative bleeding grades, number of analgesics used in the postoperative period, operation time per implant, and postoperative complications were recorded.

RESULTS

When gender, smoking, the presence of systemic disease, toothbrushing frequency, analgesic use, bleeding and complications observed at the control session were analyzed, no statistically significant relationship was found between the 2 groups. It was observed that males had statistically significant higher VAS values than females (p less than 0.05).

CONCLUSION

Since diode lasers are more economical, smaller, and can meet the clinical needs of clinicians, it is likely that these lasers may be the preferred choice of the clinicians in surgical procedures.

High Power Laser and Photobiomodulation in Oral Surgery: Case Report

Introduction: The labial frenum is a fold of mucous membrane that attaches the lip and the cheek to the alveolar mucosa, the gingiva, and the underlying periosteum. In some cases, its presence can cause a midline diastema, periodontal diseases related to food impaction, or retention of biofilm, among others. In such cases, lip frenectomy is indicated as treatment, which can be performed with a scalpel (conventional method), an electric scalpel, or a surgical laser. Objective: To show a clinical case performed at Laser Extension Project in Dentistry, Federal University of Maranhão grounded in a literature review. Case Presentation: A laser frenectomy was performed on a female patient, aged 20, who had a diastema between the upper central incisors and an indication for frenum removal. The high-power diode laser is excellent for procedures in soft tissue because its wavelength is well absorbed by hemoglobin and other pigments; its use also allows a reduction in the amount of anesthetic and medicines used. The parameters used were 2 W, in a continuous mode, 808 nm infrared emission; with delivery of the beam through optical fiber 300 μM; energy of 120 J; 20 pps. Conclusion: the high power diode laser allowed a satisfactory result, the procedure was safe, the technique was a simple one and of reduced clinical time, as mentioned in the literature. It is worth noting that the technique is dependent on the skill of the professional performing it.

Laser Techniques or Scalpel Incision for Labial Frenectomy: A Meta-analysis

Introduction

Labial frenectomy is a common procedure in the oral surgery specialty. Nowadays, laser surgery seems to provide better post-operative results than scalpel surgery. Thus, the aim of this study was to analyze whether trans-surgical and postoperative variables of labial frenectomy are better when performed with laser than with conventional scalpel.

Materials and Methods

A systematic review has been performed based on PRISMA criteria. The search included three databases, with no limitations of time or language. After screening, seven papers were included in qualitative analysis and six in meta-analysis. Bias analysis was performed according to Cochrane Handbook. Pain during the first (MD - 3.18, 95% CI - 4.03 to - 2.32) and seventh post-surgical days (MD - 1.04, 95% CI - 1.45 to - 0.64); discomfort during speech on the first (MD - 2.15, 95% CI - 3.94 to - 0.37) and the seventh post-surgical days (MD - 1.60, 95% CI - 1.96 to - 1.24); discomfort during chewing on the first (MD - 2.90, 95% CI - 3.35 to - 2.45) and the seventh days (MD - 1.56, 95% CI - 2.21 to - 0.91); and average surgery time (MD - 1.84, 95% CI - 3.22 to - 0.46) were lower in the laser group than in the scalpel group.

Conclusion

The results of this systematic review have shown better results to laser group in the following variables: pain, discomfort during speech and chewing. However, the evidence is limited due the high risk of bias.

Laser Surgery of Soft Tissue in Orthodontics: Review of the Clinical Trials

Introduction: Recently, a wide variety of procedures have been done by laser application in orthodontics. Apart from the mentioned range of various treatments, laser has become a tool for many soft tissue surgeries as an alternative to conventional scalpel-based technique during orthodontic treatments in the management of soft tissue. Due to scarce information in the latter subject, this study was designed in order to include clinical trials that included soft tissue ablation by laser in orthodontics. Methods: Literature was searched based on PubMed and Google Scholar databases in 5 years (2010-2015) with English language restriction and clinical trial design. Studies that performed soft tissue application of laser during orthodontic treatment were extracted by the authors. Results: Only eight studies met the inclusion criteria. No significant difference was found between laser ablation and conventional scalpel technique in the matter of treatment outcome. However, few issues remained to clarify the differences in the mentioned procedures. Conclusion: Laser performance can be recommended in case of preceding less bleeding and discomfort during surgical procedure. There are still quandaries among clinical application of scalpel-based surgery in aesthetic region with bracket-bonded teeth. Precaution and knowledge regarding the characteristics of laser beam such as wavelength, frequency, power and timing is extremely needed.

Soft tissue molding technique in cleft lip and palate patient using laser surgery in combination with orthodontic appliance: A case report

BACKGROUND

Although surgical treatment protocols for cleft lip and palate patients have been established, many patients still have some soft tissue defects after complete healing from surgical interventions. These are excess soft tissue, high attached fraena and firmed tethering scares. These soft tissue defects resulted shallowing of vestibule, restricted tooth movement, compromised periodontal health and trended to limit the maxillary growth. The aim of this case report was to present a method of correcting soft tissue defects after conventional surgery in cleft lip and palate patient by using combined laser surgery and orthodontic appliance.

CASE REPORT

A bilateral cleft lip and palate patient with a clinical problem of shallow upper anterior vestibule after alveolar bone graft received a vestibular extension by using CO₂ laser with ablation and vaporization techniques at 4 W and continuous wave. A customized orthodontic appliance, called a buccal shield, was placed immediately after surgery and retained for 1 month to 3 months until complete soft tissue healing. The procedures were performed 2 episodes. Both interventions used the same CO₂ laser procedure. The first treatment resulted in partial re-attachment of soft tissue at surgical area. The second laser operation with the proper design of buccal shield providing passive contact with more extended flange resulting in a favorable outcome from 1 year follow up. Then the corrective orthodontic treatment could be continued effectively.

CONCLUSION

The CO₂ laser surgery was a proper treatment for correcting soft tissue defects and the design of buccal shield was a key for success in molding surgical soft tissue.