Novel treatment approach of localized juvenile spongiotic gingival hyperplasia with use of Nd:YAG laser

INTRODUCTION

This article describes the management of two patients who presented with localized juvenile spongiotic gingival hyperplasia. This disease entity is poorly understood, and literature regarding successful treatment is scant. However, there are common themes to management including proper diagnosis and treatment via removal of the affected tissue. The biopsy demonstrates intercellular edema and neutrophil infiltrate with epithelial and connective tissue disease components, so surgical deepithelialization may not be adequate to definitively treat the disease.

METHODS AND RESULTS

This article presents two cases of the disease and suggests the use of the Nd:YAG laser as an alternative management modality.

CONCLUSION

To our knowledge, we present the first cases of localized juvenile spongiotic gingival hyperplasia treated with the Nd:YAG laser.

KEY POINTS

Why are these cases new information? To our knowledge, this case series illustrates the first use of an Nd:YAG laser to treat the rare pathology localized juvenile spongiotic gingival hyperplasia. What are the keys to successful management of these cases? To properly manage this rare presentation, proper diagnosis is paramount. Following diagnosis with microscopic evaluation, deepithelialization and treatment of underlying connective tissue infiltrate via the Nd:YAG laser offers an elegant option to treat the pathology and maintain esthetic outcomes. What are the primary limitations to success in these cases? The primary limitations of these cases include the small sample size, which is attributable to the rarity of the disease.

A comparison of Er,Cr:YSGG laser to minimally invasive surgical technique in the treatment of intrabony defects: Twelve-month results of a multicenter, randomized, controlled study

BACKGROUND

The purpose of this publication is to report on the 12-month clinical and radiographic results comparing the surgical use of the Er,Cr:YSGG laser (ERL) and minimally invasive surgical technique (MIST) for the treatment of intrabony defects in subjects with generalized periodontitis stage III, grade B.

METHODS

Fifty-three adult subjects (29 females and 24 males; 19-73 years) with 79 intrabony defects were randomized following scaling and root planing (SRP) to receive ERL monotherapy (n = 27) or MIST (n = 26). Fifty subjects completed the study. Recession (REC), probing depth (PD), clinical attachment level (CAL), treatment time, and standardized radiographs were assessed and compared for each treatment group. Clinical measurements were recorded at baseline, 4-6 weeks following SRP, and 6 and 12 months following surgical therapy. Radiographic results were compared to baseline at 6 and 12 months following surgical therapy.

RESULTS

The following primary and secondary outcome variables were non-inferior with the following margins: CAL with a non-inferiority margin of 0.7 mm (p = 0.05), PD with a non-inferiority margin of 0.7 mm (p = 0.05), and REC with a non-inferiority margin of 0.4 mm (p = 0.05). Standardized radiographs suggest similar bone fill of 1.14 ± 1.73 mm for MIST and 1.12 ± 1.52 mm for ERL.

CONCLUSIONS

This is the first multicenter, randomized, masked, and controlled study demonstrating the ERL is not inferior to MIST at 12 months in terms of clinical outcomes and similar to MIST in terms of radiographic bone fill for the surgical treatment of intrabony defects.

Comparing the efficacy and safety of laser treatments in tattoo removal: A systematic review

BACKGROUND

Although lasers have been the criterion standard for tattoo removal, selecting the best modality can be challenging because of the varying efficacies and adverse effects.

OBJECTIVE

To evaluate all lasers used to remove tattoos and assess their efficacies and adverse effects.

METHODS

Our systematic review searched PubMed, MEDLINE, Embase, Scopus, CINAHL, Cochrane Central Register of Trials, and ClinicalTrials.gov for all laser treatments. The outcomes measured included laser parameters, treatment methods, patient and tattoo characteristics, clearance rate, and adverse effect rate. The quality of the included articles was appraised by using specific assessment tools and given a high, moderate, or low risk of bias.

RESULTS

Our search led to 3037 studies, with 36 being included in the systematic review (7 randomized controlled trials, 2 nonrandomized controlled trials, and 27 case series). Although quality-switched neodymium-doped yttrium-aluminum-garnet lasers are safe and effective, picosecond lasers have shown superiority with blue, green, and yellow tattoo pigments. Both are safe and effective for black tattoos.

LIMITATIONS

Variability among studies.

CONCLUSIONS

Picosecond lasers show superiority when treating blue, green, and yellow tattoos. The R20 and R0 novel techniques can effectively reduce treatment time. Further randomized controlled trials are required to make a more definitive recommendation.

Immediate Effects of Laser-Assisted New Attachment Procedure (LANAP) on Human Periodontitis Microbiota

OBJECTIVE

The Laser-Assisted New Attachment Procedure (LANAP) surgical protocol was compared to ultrasonic root debridement alone for immediate post-treatment effects on putative bacterial pathogens in deep human periodontal pockets.

METHODS

In a case series of 26 systemically healthy adults with severe periodontitis, 20 patients were treated with the LANAP surgical protocol and 6 patients received ultrasonic root debridement alone. LANAP surgery was performed using a free-running, pulsed Nd:YAG laser, with laser energy (4.0 W, 150-μs pulse duration, 20-Hz) first directed circumferentially around teeth parallel to root surfaces in a coronal-apical pass to probing depth for selective pocket epithelium ablation and to initiate reflection of a gingival fl ap. After ultrasonic root debridement and gingival flap advancement to the alveolar bone crest, a second laser pass (4.0 W, 650-μs pulse duration, 20-Hz) was similarly performed in an apical-coronal direction to thermally induce a fibrin clot at the tooth-gingival flap interface. Subgingival biofilm specimens were collected before and immediately after completion of the treatments from 2 inflamed periodontal sites with greater than or equal to 6 mm probing depths on a single tooth per patient, and selected periodontal pathogens identified using established anaerobic culture techniques.

RESULTS

Red and orange complex bacterial species were culture-negative immediately post-treatment in 17 (85%) of 20 LANAP-treated patients, but only 1 (16.7%) of 6 patients subjected to ultrasonic root debridement alone.

CONCLUSIONS

The LANAP surgical treatment protocol, but not conventional ultrasonic root debridement alone, immediately suppressed red and orange complex periodontal pathogens below culture detection limits in most deep human periodontal pockets.