Comparing the 810nm diode laser with conventional surgery in orthodontic soft tissue procedures.

AIM: To compare the use of the 810nm diode laser with conventional surgery in the management of soft tissue mucogingival problems associated with orthodontic treatment. METHODS: Orthodontic patients requiring different soft tissue surgical procedures were randomly assigned to receive conventional surgery or soft tissue diode laser, (wavelength 810 nm). MAIN OUTCOME MEASURES: Parameters documented include the type of anaesthesia used, intra and post operative pain, bleeding, the use of scalpel and sutures. The chi-squared test was used to test for significance at 95% confidence level. Probability values (p-values) less than 0.05 were regarded as significant. RESULTS: Only 2(16.7%) of the procedures carried out with the soft tissue laser required infiltration anaesthesia compared to 10 (90.9%) with conventional surgery and this was significant (P<0.001). Post operative pain was significantly reduced in all cases treated with the diode laser (P<0.001). There was also a significant difference (P<0.05) in post operative bleeding in all cases treated with the diode laser. No sutures were used in all soft tissue cases managed with the diode laser and this was significant (P<0.001). There was no statistically significant difference in treatment time in the use of the laser compared with conventional surgery. CONCLUSION: Orthodontic patients treated with the diode laser required less infiltration anaesthesia, had reduced bleeding during and after surgery, rapid postoperative haemostasis, elimination of the need for sutures and an improved postoperative comfort and healing.

Laser-assisted gingivectomy in pediatric patients: a novel alternative treatment.

Gingival enlargement is quite a common pathology in pediatric patients and may be inflammatory, noninflammatory, or a combination of both. Idiopathic gingival fibromatosis, although rare, is a slowly progressive benign enlargement that affects the marginal gingiva, attached gingival, and interdental papilla. The fibromatosis may potentially cover the exposed tooth surfaces, causing esthetic and functional problems. The treatment of gingival fibromatosis is essential because it causes difficulties with mastication, speech problems, mispositioning of teeth, esthetic effects, and psychological difficulties for the patient. Traditional gingivectomy procedures have been a challenge for dentists who confront issues of patient cooperation and discomfort. In the last decade, laser procedures in oral cavity had shown many optimum effects in both hard and soft tissue procedures. Laser soft-tissue surgery has been shown to be well accepted by children. The following case report describes a laser-assisted gingivectomy procedure performed on a 13-year-old female.

Investigation of mast cells in human gingiva following low-intensity laser irradiation.

OBJECTIVE: The aims of the present study were to investigate the effect of low-intensity laser irradiation on the total number of mast cells as well as the percentage of degranulation in human gingiva. Blood vessel dilation was also evaluated. BACKGROUND DATA: It has been proposed that low-intensity laser irradiation can ameliorate pain, swelling, and inflammation. In periodontal tissue, mast cells may influence either the destructive events or the defense mechanism against periodontal disease via secretion of cytokines and through cellular migration to improve the healing process. Mast cells play an important role in the inflammatory process. METHODS: Twenty patients with gingival enlargement indicated for gingivectomy were selected. Gingival fragments were obtained from each patient and divided into three different groups before surgery. One fragment was removed without any irradiation. The two others were submitted to punctual irradiation with an energy density of 8 J/cm(2) at an output power of 50 mW at 36 Hz for 36 sec before gingivectomy. Nondegranulated and degranulated mast cells were counted in five areas of the gingival fragment connective tissue. Major and minor diameters of the blood vessels were also measured. RESULTS: Both red and infrared radiation promoted a significant increase in mast cell degranulation compared to controls; however, no statistically significant differences (p > 0.05) were observed between the irradiated groups. No significant differences among the groups were observed regarding blood vessel size. CONCLUSION: The results suggests that red and infrared wavelengths promote mast cell degranulation in human gingival tissue, although no dilation of blood vessels was observed. The effects of premature degranulation of mast cells in human tissue and the laser radiation protocol applied in this study encourage further investigations to extend these results into clinical practice.

Hospital periodontal surgery.

Phenytoin-induced gingival overgrowth is a recognized side effect in many cerebral palsy patients using diphenyl hydantoin for the control of seizures. Severe gingival overgrowth in these patients can affect normal masticatory function, lead to poor occlusal development, and compromise esthetics. This report addresses the complex nature of treating phenytoin-induced gingival overgrowth in a mentally retarded 20-year-old female patient. For this patient, full-mouth gingivectomy procedure was performed under general anesthesia in a single session. Post operative follow-up was uneventful. This article discusses major indications, contraindications, and protocols to be followed for periodontal surgical procedures done under general anesthesia.

Effectiveness of periodontal therapy in patients with drug-induced gingival overgrowth. Long-term results.

BACKGROUND: Drug-induced gingival overgrowth (DGO) is one of the well-recognized side effects of cyclosporin A (CsA) or nifedipine (Ni). After surgical periodontal therapy, the incidence of DGO recurrence is not known. The aim of this study was to evaluate the results of surgical periodontal therapy in patients receiving CsA or Ni and who exhibit severe long-term DGO. In addition, the relationship between various variables and the recurrence of severe DGO after periodontal surgery was investigated. METHODS: A total of 38 patients, 22 with CsA-induced DGO and 16 with Ni-induced DGO, were included in this study. At baseline, patients received initial periodontal therapy, after which either the upper or lower anterior segment in each patient was surgically treated. Surgical periodontal therapy consisted of the flap technique with a 90 degrees gingivectomy incision. Following surgery, patients were placed on a maintenance therapy recall program and were monitored for 18 months. Patients were seen once a month for the first 3 months and once every 3 months for the following 15 months. Plaque index (PI), papilla bleeding index (PBI) and DGO scores in the treated segments were recorded at each recall appointment. Attendance at recall appointments was also noted for each patient. RESULTS: Recurrence of severe DGO was observed in 13 of the 38 patients (34%) 18 months following periodontal surgery. Multiple regression analysis indicated that age, gingival inflammation, and attendance at recall appointments were significant determinants of the recurrence of severe DGO. CONCLUSIONS: This study suggests that regular re-motivation and professional care at frequent recall appointments after periodontal surgery are of great importance in patients receiving CsA or Ni. By maintaining periodontal health, the life quality of these patients may be raised.

Prevention and treatment considerations in patients with drug-induced gingival enlargement.

Drug-induced gingival overgrowth is an iatrogenic disease caused by the use of phenytoin, cyclosporine, nifedipine, and other medications in the susceptible patient. The gingival overgrowth can be due to three causes: noninflammatory, hyperplastic reaction to the medication; chronic inflammatory hyperplasia; or a combined enlargement due to chronic inflammation and drug-induced hyperplasia. Drug-induced gingival enlargement can be minimized, but not prevented, by elimination of local irritants, meticulous oral hygiene, and regular periodontal recall. If gingival enlargement interferes with function, speech, esthetics, or oral hygiene, tissue reduction can be accomplished by gingivectomy or a flap procedure. Gingival enlargement may recur, especially in the patient with poor oral hygiene.

Combined treatment approach to gingival overgrowth due to drug therapy.

A case of severe gingival overgrowth associated with combined drug therapy of cyclosporin A and nifedipine is reported. The frequently increased vascularity of the gingival tissues in such cases often causes problems with bleeding both during and after surgery. Acrylic suckdown splints have been used postoperatively to assist haemostasis; however, these can interfere with function and cause discomfort. This report describes a combined treatment approach using conventional gingivectomy and carbon dioxide laser for the removal of the hypertrophic soft tissue. The benefits of such combined treatment include reduced bleeding during surgery with consequent reduced operating time and rapid post-operative haemostasis, thus eliminating the need for a splint.