Hallazgos histológicos asociados a gingivectomía con láser de Er, Cr: YSGG (2780 nm) / Histological Findings' Associated with Gingivectomy with Er, Cr: YSGG (2780 nm) Laser

RESUMEN Introducción: Al realizar una intervención quirúrgica, el instrumento de corte utilizado cobra especial importancia, pues el mismo está vinculado a los signos y síntomas intra- y posoperatorios y al tiempo de reparación de los tejidos. En respuesta a esto, con el tiempo se han propuesto nuevos instrumentos, particularmente la tecnología láser ha venido sufriendo un avance rápido y significativo y en la actualidad se utiliza para un sinnúmero de tratamientos odontológicos. Al láser se le han atribuido diferentes ventajas en la cirugía estética periodontal: desde facilitar el proceso de hemostasia, hasta la estimulación del proceso de reparación tisular. Sin embargo, es pertinente realizar estudios que demuestren a nivel histológico los cambios que generan en la mucosa oral y obtener información que permita conocer de qué manera influye en el proceso de reparación del tejido. Objetivo: Describir los hallazgos histológicos asociados al corte con láser de Er, Cr: YSGG de 2780 nm en muestras de encía obtenidas mediante gingivectomía. Presentación del caso: Paciente femenina, de 21 años, sistémicamente sana. Asistió a la consulta por presentar por inconformidad estética al sonreír. Se diagnosticó con exposición de banda de encía queratinizada mayor que 4 mm. Como parte del plan de tratamiento se indicó gingivectomía con láser de Er, Cr: YSGG (2780 nm) (Waterlase®, BIOLASE®), el procedimiento se realizó solo bajo anestesia tópica. Se tomaron muestras histológicas de tejido gingival para análisis histológico. Conclusiones: El láser Er, Cr: YSGG (2780 nm) preservó la morfología de los fibroblastos después del corte, no hubo evidencia de carbonización, ni profundización de la lesión térmica en el tejido. Este instrumento fue una herramienta de gran utilidad para la ejecución del tratamiento en este caso. Tuvo ventajas importantes como la ausencia de dolor posoperatorio, buena hemostasia y la reparación epitelial casi completa en tan solo 4 días(AU)

ABSTRACT Introduction: When performing a surgical intervention, the cutting instrument used is especially important, since it is associated with intraoperative and postoperative signs and symptoms and to the time of tissue repair. In response to this, new instruments have been proposed over time, particularly laser technology has been undergoing rapid and significant advancement and is currently used for countless dental treatments. Laser has been attributed different advantages in periodontal cosmetic surgery: from facilitating the hemostasis process, to stimulating the tissue repair process. However, it is pertinent to carry out studies that prove, at histological level, the changes in the oral mucosa and obtain information that allows us to know how it influences the tissue repair process. Objective: To describe the histological findings associated with the Er, Cr: YSGG (2780 nm) laser cut in gum samples obtained by gingivectomy. Case presentation: Female patient, 21 years old, systemically healthy. She attended the consultation for presenting aesthetic dissatisfaction when smiling. She was diagnosed with exposure of keratinized gum band greater than 4 mm. As part of the treatment plan, Er, Cr: YSGG (Waterlase®, BIOLASE®, 2780 nm) laser gingivectomy was indicated. The procedure was performed only under topical anesthesia. Histological samples of gingival tissue were taken for histological analysis. Conclusions: The Er, Cr: YSGG (2780 nm) laser preserved the morphology of the fibroblasts after the cut. There was no evidence of carbonization or deepening of the thermal injury in the tissue. In this case, this instrument was a very useful tool for the performance of the treatment. It had important advantages, such as the absence of postoperative pain, good hemostasis, and almost complete epithelial repair in just four days(AU)

Evaluation of the effects of photobiomodulation therapy and ozone applications after gingivectomy and gingivoplasty on postoperative pain and patients' oral health-related quality of life.

The aim of this study was to evaluate the effects of photobiomodulation therapy (PBM) and ozone applications on patients' quality of life after gingivectomy and gingivoplasty. In this study, 36 patients with chronic inflammatory gingival enlargement underwent gingivectomy and gingivoplasty. The groups were randomly divided into control (n = 12), PBM (n = 12) and ozone (n = 12) groups. GaAlAs diode laser 810 nm wavelength at a non-contact and continuous mode with a power of 0.3 W and a density of 4 J/cm2 used for PBM for 1 min. Ozone was applied for 1 min for every 5 mm2 in contact mode at power level 9 using probe number 3. PBM and ozone applications were performed immediately after the operation, on the 3rd and 7th days. Pain assessment was performed at 3rd, 7th, 14th and 28th days after gingivectomy and gingivoplasty by using visual analogue scale (VAS). Oral Health Impact Profile (OHIP-14) records were obtained from the patients before gingivectomy and gingivoplasty and postoperative 7th and 14th days. OHIP-14 questions were also evaluated individually. VAS pain levels of the control group measured on the 3rd day were higher than the PBM group and on the 7th day were found to be significantly higher than both groups (p < 0.05). The total OHIP-14 score of the control group on the 7th postoperative day was found to be higher than the PBM group (p < 0.05). The mean score obtained from the third question of OHIP-14 at 7th and 14th day of the PBM group was found to be lower than the control and ozone groups (p < 0.05). The PBM and ozone applications after gingivectomy and gingivoplasty reduce the pain levels of patients and have a positive effect on patients' quality of life.

Mucosal co-delivery of ketorolac and lidocaine using polymeric wafers for dental application.

The current study aimed to investigate the effectiveness of a developed sodium alginate and polyvinylpyrrolidone K-25 (PVP K-25) polymeric wafer for the co-delivery of ketorolac and lidocaine to soft tissues for healing and pain control following gingivectomy. Nine ketorolac/lidocaine lyophilized wafers were formulated and assessed for their hydration capacity, mucoadhesion ability and in vitro release profile to select the optimum system for further clinical investigation. Wafer F6 containing 2:1 sodium alginate to PVP K-25 and 10% glycerol showed optimum properties and was selected for the clinical study. Twenty patients were included in the study and the ketorolac/lidocaine wafer was assessed versus a market product. Visual pain analog was evaluated daily for the first week and wound healing index was evaluated for one week, two weeks and one month following the procedure. The developed ketorolac/lidocaine polymeric wafer proved to be an effective method of reducing pain and discomfort together with enhancing wound healing following gingivectomy.

Histological Gingival Assessment after Conventional and Laser Gingivectomy.

BACKGROUND: Gingivectomy is a procedure often performed in everyday clinical practice using numerous instruments. AIM: To evaluate and compare the gingival cut surface after gingivectomy with 6 different surgical instruments - a surgical scalpel, an Er:YAG laser, a CO2 laser, a ceramic bur, an electrocautery device, and a diode laser. MATERIALS AND METHODS: Gingivectomy using the above listed instruments was performed in 18 patients. The histological samples excised with a surgical scalpel were assigned as a control group and the other five types - as test groups. The following histological parameters were measured: coagulation layer thickness (in µm); presence or absence of a microscopic rupture and presence or absence of hemostasis in-depth. RESULTS: The best instrument of the above listed ones which demonstrated excellent results is the CO2 laser. The Er:YAG laser has a thin coagulation layer and lack of hemostasis in-depth. The diode laser has the widest coagulation layer which is an advantage from a clinical point of view. Electrocautery proved to be as effective as the diode laser, but it should not be used around metal restorations. The ceramic bur has less pronounced hemostasis in-depth. CONCLUSIONS: Modern dentistry uses a wide variety of methods that are designed to be applied in everyday practice. Good knowledge of the ways to use them, their advantages and disadvantages is essential to obtaining the optimal result depending on the clinical case.

Surgical removal of an oral pyogenic granuloma and subsequent root coverage with a pedicle graft.

Pyogenic granuloma (PG) is a lesion characterized by non-neoplastic proliferation of endothelial cells, occurring in gingival tissue and representing an excessive reaction of the connective tissue to stimuli or injuries. The purpose of this report was to describe the treatment of an oral pyogenic granuloma, with emphasis on clinical, histopathological, and radiographic aspects. The surgical therapy comprised lesion excision followed by pedicle graft to cover the exposed root surface. The patient's pyogenic granuloma has been under control for a year, and recurrence has not been observed. The permanent teeth erupted correctly and the gingival tissue of both the receptor and donor sites shows a satisfactory clinical appearance.

Pain experienced by patients undergoing different periodontal therapies.

BACKGROUND: The authors assessed the levels of postoperative pain, postoperative dentin hypersensitivity and discomfort patients experienced during various periodontal treatments by using a visual analog scale (VAS). They aimed to determine whether VAS scores could be predicted by patient's age and sex and to evaluate the factors associated with the pain. SUBJECTS AND METHODS: The study was carried out with 56 patients who had chronic periodontitis. Using a split-mouth design, the authors selected one quadrant in each patient and treated it with scaling and root planing (SRP). They treated other quadrants with the surgical therapies of modified Widman flap (MWF), flap with osseous resection (OF) and gingivectomy (GV), depending on the patient's diagnosis and treatment needs. They measured patients' discomfort during periodontal treatments, postoperative pain and postoperative dentin hypersensitivity by asking patients to mark a VAS. RESULTS: The authors' analysis showed no statistically significant differences between the patients' discomfort levels associated with the four therapy types during periodontal treatment. However, postoperative pain was significantly higher for OF (P < .01) and GV (P < .05) procedures than for SRP and MWF procedures. All surgical procedures produced significantly more dentin hypersensitivity than did nonsurgical therapy. The analysis showed no statistically significant differences between male and female patients' discomfort during periodontal treatments. For all periodontal treatments, VAS scores decreased with increasing age. CONCLUSIONS: Discomfort during periodontal treatments, postoperative pain and postoperative dentin hypersensitivity were associated significantly with age, type of therapy and higher scores on Corah's Dental Anxiety Scale. CLINICAL IMPLICATIONS: Periodontal treatment is experienced as painful by substantial numbers of patients. Therefore, the dentist should count the pain responses during and after treatment and estimate the degree of pain according to sex, age and therapy type.

P2X4 is up-regulated in gingival fibroblasts after periodontal surgery.

Several studies have shown that surgical detachment of marginal gingiva close to the cervical cementum of molar teeth in a rat mandible is a distinct stimulus for alveolar bone resorption. Recently, we found that P2X4, an ATP-receptor, is significantly up-regulated in marginal gingival cells soon after surgery. We hypothesized that local release of ATP signaling through P2X4 elicits activation of osteoclasts on the alveolar bone surface. In this study, we identified intense immunoreactivity of gingival fibroblasts to P2X4-specific antibodies and a 6.4-fold increase in expression by real-time RT-PCR. Moreover, a single local application, at the time of surgery, of Apyrase (which degrades ATP) or Coomassie Brilliant Blue (an antagonist of purinoreceptors) significantly reduced alveolar bone loss. We propose that ATP flowing from cells after surgery can directly activate P2X4 receptors in the sensor cells of marginal gingiva through Ca(2+) signaling, or by direct activation of osteoclasts on the bone surface.

Post-surgical infections: prevalence associated with various periodontal surgical procedures.

BACKGROUND: Of the various adverse outcomes that may be encountered following periodontal surgery, the risk of infection stands at the forefront of concern to the surgeon, since infection can lead to morbidity and poor healing outcomes. This paper describes a large-scale retrospective study of multiple surgical modalities in a diverse periodontal practice undertaken to explore the prevalence of clinical infections post-surgically and the relationship between diverse treatment variables and infection rates. METHODS: A retrospective review of all available periodontal surgical records of patients treated in the Department of Periodontics at Wilford Hall Medical Center, San Antonio, Texas, was conducted. The sample comprised 395 patients and included 1,053 fully documented surgical procedures. Surgical techniques reviewed included osseous resective surgery, flap curettage, distal wedge procedures, gingivectomy, root resection, guided tissue regeneration, dental implant surgery, epithelialized free soft tissue autografts, subepithelial connective tissue autografts, coronally positioned flaps, sinus augmentations, and ridge preservation or augmentation procedures. Infection was defined as increasing and progressive swelling with the presence of suppuration. The impact of various treatment variables was examined including the use of bone grafts, membranes, soft tissue grafts, post-surgical chlorhexidine rinses, systemic antibiotics, and dressings. Results were analyzed using Fisher's exact test and Pearson's chi-square test. RESULTS: Of the 1,053 surgical procedures evaluated in this study, there were a total of 22 infections for an overall prevalence of 2.09%. Patients who received antibiotics as part of the surgical protocol (pre- and/ or post-surgically) developed eight infections in 281 procedures (2.85%) compared to 14 infections in 772 procedures (1.81%) where antibiotics were not used. Procedures in which chlorhexidine was used during post-surgical care had a lower infection rate (17 infections in 900 procedures, 1.89%) compared to procedures after which chlorhexidine was not used as part of post-surgical care (five infections in 153 procedures, 3.27%). The use of a post-surgical dressing demonstrated a slightly higher rate of infection (eight infections in 300 procedures, 2.67%) than non-use of a dressing (14 infections in 753 procedures, 1.86%). Despite these trends, no statistically significant relationship was found between post-surgical infection and any of the treatment variables examined, including the use of perioperative antibiotics. CONCLUSIONS: The results of this study confirm previous research demonstrating a low rate of postoperative infection following periodontal surgical procedures. Although perioperative antibiotics are commonly used when performing certain regenerative and implant surgical procedures, data from this and other studies suggest that there may be no benefit in using antibiotics for the sole purpose of preventing post-surgical infections. Further large-scale, controlled clinical studies are warranted to determine the role of perioperative antibiotics in the prevention of periodontal post-surgical infections.

Extensive bleeding during surgical treatment for gingival overgrowth in a patient on haemodialysis--a case report and review of the literature.

Before performing renal transplantation, a most important concern is to control any infection, including oral infections before transplantation. The bleeding diathesis of patients with uraemia is a significant clinical concern, especially when surgery is required. A 44-year-old female patient on haemodialysis was referred for evaluation of gingival overgrowth. The patient was planning a renal transplantation two months later. As the lesions were not considered successfully treatable before transplantation, a gingivectomy and teeth extraction was performed. In pre-operative examinations, an abnormal bleeding time was not detected and other coagulation tests were normal. Under general anaesthesia, 19 teeth were extracted and overgrown gingiva was removed. During the operation, extensive blood loss of 1650ml occurred and four units of concentrated red blood cells were transfused. This study suggests that patients with renal failure undergoing dental surgery require careful pre-surgical evaluation including assessment of their coagulation ability.

Gingival prostheses--a review.

Gingival replacement is often a component of comprehensive prosthodontics. Gingival prostheses may be fixed or removable and may be made from acrylics, composite resins, silicones or porcelain-based materials. Undercuts or dental attachments are used to secure removable prostheses, which are esthetically pleasing and easy to maintain. This paper describes several clinical situations in which gingival prostheses were used effectively.

Dracula's teeth syndrome.

OBJECTIVE: To describe a patient with facial pain, ipsilateral facial dystonia, and phantom supernumerary teeth, beginning after resection of hypertrophic gums. She had familial sensorineural deafness. BACKGROUND: Atypical cranial dystonia subsequent to dental procedures is associated with facial pain, dysesthesias, or phantom phenomena, but not with phantom supernumerary teeth. Patients with migraine are susceptible to experience cephalic phantom phenomena after dental procedures. Wynne syndrome is a hereditary autosomal dominant disorder characterized by congenital sensorineural deafness and supernumerary teeth. METHODS: Clinical examination, computerized tomography of paranasal sinuses and facial bones, magnetic resonance imaging of the brain, cranial electrophysiological testing, and electroencephalogram. RESULTS: A 52-year-old woman with history of migraine without aura for 40 years exhibited focal right facial involuntary tonic contracture accompanying chronic severe pain over the same area after gum resection. She reported a daily sensation of having two extra upper canine teeth pressing on her tongue, simulating vampire's ("Dracula's") teeth. She had high-frequency bilateral sensorineural deafness. Her computerized tomography studies, brain magnetic resonance imaging, and cranial electrophysiological testing were normal. CONCLUSION: This patient with chronic migraine had atypical cranial dystonia beginning after a dental procedure. Her dystonia was complicated by the unusual phenomenon of phantom supernumerary teeth. This condition may be misdiagnosed as atypical or psychogenic facial pain when facial dystonia is localized or subtle and is, therefore, confused with an idiosyncratic gesture or habitual spasm. Her signs and symptoms are reminiscent of Wynne syndrome.

Increase in volume of lignocaine/adrenaline-containing local anaesthetic solution causes increase in acute postoperative pain after gingivectomy.

A randomized, single-blind, within-patient, crossover study was done in 44 patients (27 women and 17 men mean age 47 years, range 29-63) who had bilateral 'identical' gingivectomies. On one occasion a standard volume of local anaesthetic containing lignocaine 2% and adrenaline (1/80 000) was infiltrated into the mucosal tissue before operation. On the other occasion double the standard volume was infiltrated. The intensity of pain postoperatively was recorded by the patients on 100 mm visual analogue scale every hour for an 11-hour observation period. The intensity of pain when double volume had been given was significantly higher than that after the standard volume from 2 to 8 hours postoperatively (P < 0.04), the median (range) being 52.0 mm (0.0-434.0) compared with 30.5 mm (0.0-359.0) after the standard volume (P < 0.005). Doubling the volume of local anaesthetic containing adrenaline that was infiltrated increased the intensity of acute pain after gingivectomy.

Comparison of 1% and 2% lidocaine hydrochloride used as single local anesthetic: effect on postoperative pain course after oral soft tissue surgery.

It is known that some local anesthetics may cause pain when the initial local anesthetic effect disappears. The aim of this trial was to compare the postoperative pain intensities after infiltration of plain lidocaine 1% and 2% used in gingivectomies. The trial was done as a controlled, randomized, double-blind, parallel group study involving 117 patients with mean age 48 years (range 29-71 years) allocated to two treatment groups. There was no statistically significant difference between the mean postoperative pain courses of lidocaine 1% and 2% after gingivectomies during an 11-h observation period. A numerical difference was seen from 7 to 11 h in favor of lidocaine 1%. There were more patients experiencing no pain, but more patients reporting higher pain scores in the lidocaine 2% group than in the lidocaine 1% group. These differences were not statistically significant. It can be concluded that there is apparently no difference between lidocaine 1% and 2% with respect to postoperative pain experience when using gingivectomy as a pain model.

[Conditions of the successful outcome of mucogingival surgery during orthodontic treatment]. / Conditions de la réussite des interventions de chirurgie muco-gingivale au cours du traitement orthodontique.

For the last twenty years the mucogingival surgical technics, particularly displaced flaps, have brought gingival tissue when it is missing improving the periodontic outcome of orthodontic treatment. The displaced flaps are indicated where is a deficient attached gingiva or for uncovering retained cuspids. This state of the art is done both for the surgical and orthodontic care that are necessary as well as for the possible problems and complications after surgery.

Aspirin-induced post-gingivectomy haemorrhage: a timely reminder.

A case report is described of significant aspirin-induced haemorrhage following a gingivectory procedure in an organ transplant patient. Aspirin-induced platelet impairment secondary to low-dose aspirin was implicated as the cause of the haemorrhage. Haemostasis was eventually achieved after platelet transfusion. The case illustrates the problems that can arise when carrying out gingival surgery on patients medicated with low-dose aspirin.

Phenobarbital-induced gingival overgrowth? Report of two cases and complications in management.

Gingival overgrowth is a known side effect of several seizure, immunosuppressant and calcium channel-blocker medications. Gingival overgrowth is not a reported side-effect of phenobarbital. This case report describes two patients with marked gingival overgrowth who had been medicated with phenobarbital exclusively since the initiation of seizure disorders. The clinical findings, surgical management, bleeding complications, and recommendations in management are discussed.

Doxycycline prevents root resorption and alveolar bone loss in rats after periodontal surgery.

The effect of systemic doxycycline administration on frequency of root resorption cavities and extent of bone loss following periodontal surgery was studied in albino rats. Thirty Wistar rats with healthy gingiva were divided into four groups. Six untreated animals (Group 1) served as controls. Gingivectomy (Group 2, six rats), mucoperiosteal flap operation (Group 3, eight rats), and mucoperiosteal flap operation with doxycycline added to the drinking water (Group 4, 10 rats) were performed on the palatal aspect of maxillary left molars. After a healing period of 3 wk, the rats were killed by an overdose of sodium pentothal, and specimens of first molars were prepared for light microscopy. Root resorption was absent in normal and gingivectomized animals (Groups 1 and 2). Resorption cavities occurred in all flap-operated animals (Group 3) and in one of 10 doxycycline-treated animals (Group 4). The distance from cementoenamel junction to alveolar bone crest remained unchanged in gingivectomized (Group 2) and doxycycline-treated animals (Group 4), as compared with control specimens. In flap-operated animals (Group 3), the crestal bone level was located more apically than in doxycycline-treated rats (Group 4). This study has shown that root resorption and bone loss were associated with flap operations involving exposure of periodontal ligament and bone. Systemic doxycycline prevented both root resorption and bone loss.

Postoperative pain experience after gingivectomies using different combinations of local anaesthetic agents and periodontal dressings.

The present study examines postoperative pain experience following 243 gingivectomies in Norwegian patients using possible combinations of 3 local anaesthetics (lidocaine-adrenalin, prilocaine-felypressin or mepivacaine) and 3 periodontal dressings (Coe-pak, Wondrpak or Nobetec). When Coe-pak was used, the mean pain score was higher (P less than 0.05) in the group treated with lidocaine-adrenalin 4 to 6 h after gingivectomy than the groups treated with prilocaine-felypressin or mepivacaine. There was no significant difference between the groups treated with prilocaine-felypressin or mepivacaine. When Wondrpak or Nobetec were used, there was no significant difference between any of the local anaesthetics used. The present finding shows that the local anaesthetic combination of lidocaine-adrenalin (1:80,000) gives rise to a higher mean postoperative pain experience after gingivectomy than prilocaine-felypressin or mepivacaine. However, the relative difference in pain experience seen after gingivectomy when using the present local anaesthetic agents is masked when using an eugenol-containing periodontal dressing. Thus, the higher pain experience reported after lidocaine-adrenalin may only be clinically important when using periodontal dressings without local anaesthetic components such as eugenol.