Dr.

Pattanshetty ET AL: Gingivectomy with Diode Laser World J Adv Sci Res

Gingivectomy With Diode Laser-

A Case Series.

Dr. Rashmi S Pattanshetty*, Dr. Amit Walwekar**, Dr. Basavaraj SS***, Dr. Jayaprakash

GS****, Dr. Nithya R Krishnan*

*PG Student, Department Of Periodontics, **Professor And HOD, Department of

Periodontics, ***Professor And HOD, Department Of Prosthodontics, ****Reader,

Department Of Periodontics

Coorg Institute Of Dental Sciences,Virajpet, Coorg-District, Karnataka State.

ABSTRACT

Gingivectomy is the most common procedure performed with dental lasers. All laser

wavelengths can be used to precisely incise gingiva for restorative, cosmetic, and periodontal

indications. Rapid healing and reduced pain are commonly seen post operatively and patients

rarely need periodontal packing or sutures.Here we present 15 cases of gingivectomy

successfully treated with laser.

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Keywords: Laser, Gingivectomy, Gingival hyperplasia

INTRODUCTION

The ultimate goal of periodontal therapy is to re-establish anatomical and physiological

conditions conducive to long-term health and function of the periodontium. Gingival

hyperplasia is a common clinical finding and is related to a variety of etiologic factors and

pathogenic processes (e.g., dental plaque, mouth breathing, hormonal imbalance, medications

etc.).1These enlargements may lead to functional disturbances like difficulty in mastication,

altered speech, aesthetic andpsychological problems.2

Gingivectomy is a procedure employed to eliminate the pseudopockets seen in the enlarged

gingiva. The procedure is employed to remove the diseased tissue, to improve the esthetics,

for prosthetic and orthodontic purposes and to reduce the probing pocket depth of periodontal

pockets.3

However, this is considered by many as very invasive and may not be effective if self-care

oral hygiene practices remain poor.

In recent decades, considerable attention has focused on the use of lasers (diode,

erbium:yttriumaluminum-garnet, neodymium:yttrium-aluminum-garnet, carbon dioxide

lasers of varying wavelengths) for management approaches as they offer a less invasive

surgical approach.4

Laser therapy is a fast growing, simple and atraumatic technique, which has been used in

dentistry since the 1990s. The application of laser in animal models and in clinical trials has

been reported to stimulate wound repair especially during the first few days of the healing

process. Improved infection control, reduced postoperative pain and sensitivity, reduced

patient anxiety and minimizing the need for anesthesia are the other advantages of laser.5

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Dr. Pattanshetty ET AL: Gingivectomy with Diode Laser World J Adv Sci Res

Gingivectomy using diode laser may prove to be beneficial to the patient as it decreases

patient morbidity and results in faster healing as compared to the conventional scalpel

technique.

AIM- The aim of this randomized controlled clinical trial was to evaluate the effectiveness of

diode laser gingivectomy in the management of gingival enlargement cases.

A total of 15 patients complaining of enlarged gums visited the Department of Periodontics,

Coorg institute of Dental Sciences. Phase I therapy was carried out consisting of ultrasonic

scaling, oral hygiene instruction, and 0.2% chlorhexidine mouthwash twice a day.The diode

laser gingivectomy was performed under topical anestheticgel.Laser safety precautions were

followed.Thelaser fiber tip (300 µm in diameter) was held at 1 mm from the gingival tissue,

and the gingivectomy was performed with gentle, sweeping brush strokes with a power

output of 1 W in pulsed mode (pulse length of 0.05 ms, pulse interval of 0.2 ms). High-

volume suction was used to evacuate the laser plume and charred odour.

Patients were checked for hemostasis and were given postoperative instructions.VAS score

was evaluated for each individual.

The visual analog scale (VAS) was used to evaluate the subjective pain level experienced by

the patient. The VAS consisted of a horizontal line of 10 cm (100 mm) long, anchored at the

left end by the descriptor “no pain” and at the right end by “unbearable pain”. The patient

was asked to mark the severity of the pain. The distance of this point, in centimeters, from the

left end of the scale was recorded and used as the VAS score: 0 = no pain; –3 = slight pain;

3.1–6 = moderate pain; 6.1–10 = severe pain.

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Dr. Pattanshetty ET AL: Gingivectomy with Diode Laser World J Adv Sci Res

Evaluation of VAS score.

2 patients presented a score of 0=no pain.

8 patients presented a score of 1=mild,annoying pain.

1 patient presented a score of 3=slight pain

4 patient presented a score of 4=nagging ,uncomfortable, troublesome pain.

DISCUSSION

The most widely employed surgical approaches for the treatment of gingival enlargements is

gingivectomy by surgical blade, laser or electrocautery.6Among these modalities laser have

advantages like relatively bloodless surgery, minimal swelling, scarring and coagulation, no

need for suturing, reduction in surgical time and minimal or no post surgical pain.7 Also, the

laser instantly disinfects the surgical wound and allows a noncontact type of operative

procedure so that there is no mechanical trauma to the tissue. The diode lasers’ affinity for

ablating pigmented tissue, especially hemoglobin, make it superior for the soft tissue

gingivectomy procedures compared with the traditionally used scalpel in regards to

hemostasis.8

In this case series, the use of 810 nm diode laser for gingivectomy resulted in complete

healing with minimum post-operative discomfort. It was also shown to be a safe and effective

method for acceptable esthetic result and maximum patient comfort.

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CONCLUSION

For many intraoral soft tissue surgical procedures, the laser is a viable alternative to the

scalpel. In the modern dental practice using laser technology, procedures can be

accomplished with less invasive methods, a more relaxed appointment and less postoperative

discomfort.

REFERENCES

1. Trackman P, Kantarci A. Connective tissue metabolism and gingival overgrowth. Crit

Rev Oral Bio Med 2004;15:165-175.

2. Jhadhav T, Bhat KM, Bhat GS, Varghese JM. Chronic Inflammatory Gingival

Enlargement Associated with Orthodontic Therapy – A Case Report. J Dent

Hyg.2013;87(1):19-23.

3. Carranza FA, Hogan EL. Gingival enlargement. In: Newman MG, Takei HH,

Klokkevold PR, Carranza FA. Carranza’s Clinical Periodontology. 11th ed.

Philadelphia, Penn: W.B. Saunders Company; 2006:373–390.

4. Deppe H, Horch HH. Laser applications in oral surgery and implant dentistry. Lasers

Med Sci2007;22:217-21.

5. Coluzzi D. Fundamental of lasers in dentistry: Basic science, tissue interaction, and

instrumentation. J Laser Dent 2008;16:4-10.

6. Nartey NO, Mosadomr HA, Al-Cailani M, Al-Mobeerik A. Localized inflammatory

hyperplasia of the oral cavity: Clinico-pathological study of 164 cases. Saudi Dent J

1994;6(3):145-50.

7. Harris DM, Pick RM. Laser physics. In: Lasers in Dentistry. Miserendino LJ, Pick

RM (editors); 1995. Quintessence, Chicago: pp 27–38.

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8. Coleton S. Lasers in surgical periodontics and oral medicine. Dent Clin North Am

2004; 48: 937– 62.

PRE-OPERATIVE CASE I

POST-OPERATIVE CASE I

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Dr. Pattanshetty ET AL: Gingivectomy with Diode Laser World J Adv Sci Res

PRE-OPERATIVE CASE II

POST OPERATIVE CASE II

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Dr. Pattanshetty ET AL: Gingivectomy with Diode Laser World J Adv Sci Res

PRE-OPERATIVE CASE III

POST-OPERATIVE CASE III

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