Effect of laser surgery in pericoronal flap excision Daniel Silas Samuel, Dhanraj Ganapathy, Ashish R. Jain* ‘ABSTRACT ‘Aim: This study aims to evaluate and compare the efficacy of conventional surgical knife to that of laser-asssted excision of, ‘operculum in terms of patient comfort assessment, post-operative pain, and healing. Background: Periodontal therapy and ‘management have come a long way since their inttoduetion into dentsty, The earlier surgeries performed were effective, and it involved removing apart ofthe erestal bone a thee techniques were not achieved esthetcally newer techniques came {nto practice involving bath esthetic management and removal slayer af gingival tissue overlying the affected ates Inthe following article, we should discuss about the newer techniques can be wsed ane by managing withthe heal off surgical knife ‘management and other by diode laser. Materials and Methods: This study was conducted in Savectha Deatal College and Hospitals, Chennai. The study consisted of 30 patents with clinically diagnosed pericoronitis who required excision of the ‘operculum. They were divided into two groups: A and B. Group A comprised eases were operculum excised with surgical knife and Group B comprised cases were operculum excised using diode laser. Clinical parameters such as patient comfort, post-operative pain, and healing were assessed and compared between two groups. Results: The results were based on patient ‘comfort, with Group-A who underwent surgical knife for opereulectomy with a value of $9.12 + 2.64 end Group-B had ‘operculectomy done by means of laser with a value of 93.12 + 1,69 (P <0,05) and patient post-operative pain, with Group- who underwent operculectomy with a value of 13.52 + 4.67 and those who underwent management by diode laser had a mean value of 8.42 £ 3.17 (P< 0.05). There was no statistically sigificent difference between both the techniques with respect to ‘wound healing, Conelusion: The use of diode laser in excision of operculum has several advantages over surgical knife such as enhanced hemostasis, less post-operative pain, and a better post-operative healing. Therefore, lasers ean be considered as better and acceptable alternative for excision of pericoronal laps, KEY WoRD! ode laser, Flap excision, Pericoronitis, Surgical knife INTRODUCTION teeth, Pericoronits classically presents with a history ‘ofan acute pain slong with swelling ofthe pericoronal Pericorontis may be defined as an infection involving flap and tissues, quite ofien tenderness on closing the soft tissues surrounding the erown of « partially Gye to the occlision of the swollen tissue with the rupted tooth involving the lower third molars Spposing tooth!” Acute peticoroits is treated by mainly.) The resulting inflammation surrounding jocal antiseptic lavage and gentle curettage under the the impacted teeth may be acute, subacute, oF flap, with systemic antibiotics. Ifthe patent uses hot chronic in nature, Although theoretically any tooth saline mouth baths, they are most effetive therapeutic may be involved in such an inflammatory process, measure." The elimination of the impinging cusps of in practice, the mandibular third molar is affected in maxillary molar, by either the extraction or grinding most cases. It may affect patients of any age but is of the cuspal interference, specds resolution, and ‘most frequently seen in patient groups between: 16 cases pain, The applicution of « periodontal pack and 30 years of age, with the peak incidence in the Comprising of zine oxide eugenol below the gum flap 20-25-yearold age group. Pericoronitis has an also eases the pain and the prescription of suitable average of 8% incidence associated with wisdom qaigesc tablets is also of value in this respect Once the acute phase is managed, the opposing this molar is extracted or a wedge of hyperplastic pad wo ooteyere Of tissue is removed!" Some established methods of conventional surgery, eleetrosurgery, and use of Department of Prosthodontics, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Ch ‘Tamil Nadu, India “Corresponding author: Ashish R. Jain, Research Scholar, Department of Prosthodontics, Saveetha Dental College and Hospital, Savectha University, Poonemaliee High Road, Chennai - 600 127, Tamil Nadu, India, Phone: ~91-9884233423, E-mail: deashishjain_r@yahoo.com Received on: 15-08-2018; Revised on: 26-09-2018; Accepted ox: 29-10-2018,Danie Sits Samuel, ea lasers. The use of lasers in oral surgery is becoming standard for several procedures which are performed ‘more efficiently and with less morbidity than with a surgical knife. Literature study reveals that diode laser has several distinet advantages over the surgical knife such as the ability to coagulate, cut, ablate, or vaporize target tissue elements, enabling dry field surgery through the sealing of small blood vessels and achieving hemostasis, decreased pain, disinfection of the tissue, reduced post-operative edema through the sealing of small Iymphatic vessels and decreased scarring, contributing to faster and more efficient treatment resulting in improved treatment outcome, and inereased patient comfort and satisfaction." It has bboen observed that tissue overheating isa disadvantage while leading to tissue damage which can be prevented by continuous movement and gentle cooling of the tip ‘a pause between each tooth can ease the process. In this study, we employed diode laser withthe objective ‘of comparing healing tendency and its efficacy with conventional surgical knife and diode laser in ‘opereiilectomy eases MATERIALS AND METHODS ‘This was an in vivo study. The study protocol was reviewed and approved by the Saveetha University Ethics Committee. The nature and purpose of the study to be performed and the surgical protocol was explained to the patients and a written consent was obtained before proceeding with the study. All the treatment procedures were performed and managed, by the same operator to prevent interoperator variations and following up of different techniques. ‘The study was conducted in Saveetha Dental College, Chennai. The study sample consisted of 30 patients with clinically diagnosed pericoronitis who required excision of the operculum and relieved them of the acute problem, They were randomly assigned to Group A and Group B of 15 each. Group A comprised ‘operculectomy cases treated with surgical knife and Group B comprised operculectomy cases tweated using Picasso diode laser. The inclusion criteria were patients reporting with moderate to chronic recurrent pericoronitis in mandibular thied molar region, who ave consent for procedure and who were fit for procedure under local anesthesia and proceeded with the further treatment, The exclusion criteria were acute infection and medically compromised patients who ‘were not fil for the procedure under local anesthesia ‘The unit used in our study was a soft tissue diode laser which has one fiber-optic cable that is threaded thru handle and used with an operating tip. It requires no water and air connections with a wavelength of 810 nm, output energy 0.1-7 W, a thorough clinical ‘examination and diagnosis were done before starting ‘with the research protocols. Patient was informed about the procedure and a written informed consent obtained. Pre-operative photographs were taken, The site was prepared with betadine using antiseptic techniques to avoid post-operative sepsis. In Group A, following local anesthesia, the pericoronal flap was held with the help of Adson’s tissue holding forceps and excision was performed with a B.P. Blade No, 12 and 15, Any remaining tissue tags were removed, hemostasis was achieved by means of sterile gauze by applying direct pressure on the removed space. In Group B, following local anesthesia on the prepared surgical site, pericoronal flap was held with Adson’s tissue holding forceps and resection was performed employing diode laser handpiece. The tip of the diode laser was used in light strokes with a wavelength 810 iim, power of 4.0 W. Burnt tissue was removed with means of a moist gauze. Hemostasis was achieved, and wound debridement was done with betadine. Patients were advised to take paracetamol $00 mg ‘twice daily for 3 post-operative days. They were instructed to have a soft diet and avoid hot and spicy food and smoking for the next 24h, All patients were advised to maintain oral hygiene and rinse twice a day with a 0.2% chlorhexidine gluconate solution for 2 weeks. Patient was recalled after the 2", 75, 14%, and 30® days following the procedure and during every follow-up patient was evaluated for pain and healing using pictorial scale to assess the healing post- ‘operative. Photographs of intraoral surgical site were taken and documented of patients each visit. Pain was recorded on the 2", 7, 14%, and 30 post-operative ay using visual analog scale (VAS) (Seale of 0-10, ‘where 0 denotes no pain, 10 denotes severe pain) ‘Wound healing - was assessed on the 2", 7*, 14°, and 30" post-operative day utilizing Landry, Turnbull, and Howley index (Seale of 0-5 where 1 is very poor, 2is poor, 3is good, 4 is very good, and S is excellent). The, results were compared and analyzed, RESULTS Thestudy sample consistedof30patientswithelinically diagnosed pericoronitis who required excision of the operculum. They were randomly assigned into Group A and Group B of 15 each. Group A comprised patients who underwent operculectomy by means of surgical knife and Group B comprised operculectomy cases excised using Picasso diode laser. The pain and healing seores were recorded on the 2%, 78, 144, and 30" days postoperatively with means of VAS for pain (0-100, 0 denoting no pain and 100 extreme pain and healing by means of Landry, Turnbull, and Howley index and patient comfort using VAS from 0 to 100, 0 denoting extreme discomfort and 100 maximum comfort, Collected data were analyzed by percentage, ‘mean, and standard deviation and comparison was done using test. The results showed were based on patient comfort, with Group-A who underwent surgical knife for operculectomy with a value of 89.12 = 2.64 andanil Silas Samuel Group-B who had operculectomy done by means of laser with a value of 93.12 = 1,69 (P < 0.05) and patient post-operative pain, with Group-A who ‘underwent operculectomy with a value of 13.52 4.67 and those who underwent management by diode laser hhad a mean value of 8.42 +3.17 (P < 0.05). There was no statistically significant difference between both the techniques with respect to wound healing, DISCUSSION Treatment of perivoronitis is broadly classified into conservative and effective management. Conservative management includes irigation beneath the operculum to remove debris and inflammatory ‘exudate, warm saline mouthwash, and smoothening margins of opposing cusps. Symptomatic relief is with the use of antibiotics and analgesics. Definitive ‘management includes extraction or operculectomy of the associated tooth. Operculectomy can be performed with various methods with certain advanteges and disadvantages. There are various methods of cutting coral soft tissues"! These are conventional surgery, clecirosurgery, and use of lasers. Each is different in terms of hemostasis, healing time, width of the cut, anesthesia required, and disagreeable characteristics such as smoke production, odor of burning tissue, and undesirable taste. Excision of soft tissue with scalpel results in excessive bleeding which obscures the operative ficld and increases the fear of surgery." It is the conventional, cheap, and effective method (Malhotra and Kaur, 2012; Douglass, 2003). Lasers offer certain advantages. Fist, the hemostatic property of laser is of great value and allows the surgeon to work with better visibility! Second, pain reduction is considerable when compared to conventional surgery and, even if the exact physiological process is still unknown, an alteration ofthe neural transmission, and the decreased tissue insult has been found out, comparison of healing process of operculectomy with laser and surgical knife! The better post-operative tissue healing and a reduction of scar tissue formation are due to decreased tissue collateral damage, less trauma, control of the depth of tissue damage, and fewer myofibroblast cells in laser wounds." Other advantages of the laser versus surgical knife surgery include bloodless field and highly decontaminated surgical bed which allow for less swelling and pain during the postoperative period, Evaluating, diode laser with conventional surgical ‘knife surgery, it has certain distinct advantages such, ‘as dry operating field, decreased pain, and better postoperative healing with overall better patient ‘acceptance. The limitation of the present study was that the sample size was small consisting of 30 patients. Hence, a more elaborative study with a larger number ‘of clinical cases is essential to be more conclusive that diode laser can be used to the conventional surgical knife. CONCLUSION The use of diode laser in excision of operculum, hhas several advantages over surgical knife such as enhanced hemostasis, less post-operative pain, and a better post-operative healing, Therefore, lasers ean be considered as a better and acceptable alternative for excision of pericoronal flaps. REFERENCES 1. Dougles AB, Douglass JM. Common dental emergencies. Am am Physician 2008;67 11-6 2. Howe GL. Pesicronts, In; Textbook of Minor Oral Surgery ‘3 od. Piladelpia, PA: VPS, Saunders, 1996, 238-47. 43. Haytae MC. Fvaluaon of pains perceptions afer enectony operatians: A comparison of eatbon dioxide laser and scalpel techniques. J Periodontal 2006,7: 1815-3 4, leelyamu IN, Sshesb BD, Edetnlen BE. 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