The application of the diode laser on surgery has yielded excellent results.
Laser treatments in contact mode are comparable to traditional scalpel treatments.
With a good knowledge of laser characteristics one can profit from them in the best way and perform a bloodless surgical operation with very clear view of the operating field. Moreover, laser acts as effective haemostatic without causing any harm to adjacent tissues.
The most widespread laser for such surgical applications is the laser with 810 nm wavelength. The laser ray possessing 810 nm wavelength is easily absorbed by such dark-coloured substances like hemoglobin and melanine (water is not so well absorbed), which enables a considerably deep cut.
There are some indisputable advantages laser has in comparison with the cold blade of a scalpel:
- the scalpel cuts more precisely, but, unlike the laser, it does not have any bactericidal or coagulant properties
- in comparison with the electric scalpel, laser does not cause any fasciculation of the muscular tissue
- the outcome of laser interventions is more predictable, since during the healing phase there is no tissue regression
- the antiseptic and biostimulating action of the laser reduces the necessity to resort to post-operative medicaments
In implant uncoverings , in the treatment of periodontal pockets as well as in vascular therapy diode lasers are more advisable than are more aggressive lasers like CO2 and Nd Yag.
Distinctive features of diode lasers applied to surgery are:
- the notable cutting precision without alterations in the bones
- strong coagulating effect, which allows to have a bloodless operating field also on patients with coagulation disturbances
- drastic reduction of the required anaesthetics
- less pain for the treated as well as for the adjacent tissues
- less post-oparative disturbances
- less post-operative edemas
- no tissue retraction during the healing phase
- better appearance of the operated tissue after the operation
- healing improvement
- reduced need for post-operative medicines
On the grounds that the tissue does not retract during the healing phase, the laser becomes indispensable for "re-shaping" the oral soft tissue, if the surgical intervention is needed to re-locate the tissue correctly or to ablate it.
The word gingivectomy indicates the surgical ablation of the gingival tissue performed in the area of the epithelial attachment, in order for a new marginal gingival tissue to grow.
This method is used to remove gingival or periodontal pockets, to access and operate on periodontal tissue, which would otherwise be not accessible and to reach the interior part of the pocket and eliminate the tartar.
The hypertrophy and hyperplasia of the gengiva is to trace back to many causes:
inflammations, pharmaceutical causes or mechanical-traumatic causes.
The laser is an instrument which helps to heal this illness and limitate the pain for the patient.
For those patients who have coagulation problems the laser is particularly helpful because it contributes to the scar process, it vaporises the tissue and keeps the operating field bloodless.
Anaesthetics are not always necessary , although their use is recommended in case the patient reports to feel pain.
The word gingivoplastic refers to the re-shaping of the gingiva and to the restoration of the physiologic morphology of the gingiva. This surgical intervention is often associated with gingivectomy: the tissue in excess is ablated without bleeding and the gingival tissue is re-shaped , in order for the periodontal apparatus to gain back its correct morphology. With diode lasers, if the biologic opening is large enough, it is possible to re-shape the gingival profile, so that it looks perfectly normal again.
The frenulus is a thin thread of muscles and fibres coated with a mucosa thatruns from the alveolar mucosa to the muco-gingival joint line (vestibular frenulus) and from the ventral face of the tongue to the lower part of the mouth (lingual frenulus).
Performing a frenectomy means to partially remove the frenulus or to relocate it elsewhere.
This intervention ha s the aim of improving the stability of the teeth or of alleviating the traction downwards exerted by a short lingual frenulus.
Usually this intervention is performed on very young patients and for this reason laser turns out to be the most appropriate choice.
The patient that undergoes a laser treatment does not feel any pain; in case of need an anesthetic gel can be applied on the frenulus surface.
The irradiated tissue is instantly vaporised, whereas the operating field is bloodless (this facct also helps to make the patient more collaborative).
The post operative recovery takes place easily and fast without any stitches.
Haemostasis means literally "absence of blood". One of the features of diode and Nd:Yag laser is to bring about an instant scar processand to avoid the occurrence of small haemorrhages that would occur by using traditional methods.
The procedure prescribes first of all to thouroughly cleanse the wound and to remove the blood in excess before beginning with the actual treatment. Afterwards the fiber has to get several times in contact with the wound.
The duration of the treatment depends on the dimensions of the tissue that has to be treated.
This procedure suits evry intervention, in which it is necessary to get a clear operating field where the natural coagulation process occurs too slowly or is not satisfactory.
Surgical ablation of tumours
The laser as cutting instrument enables the removal and the ablation of parts of tissue as well as of both benign and malignant neo-formations.
Fibromi: fibromi show up chiefly in the area of the buccal (area?)and must be ablated if they grow bigger or if they disturb the patient. The ablation occurs by 810 nm laser irradiation at low power.
Haemangioma: are often unaesthetic and irritating and tend to grow to bigger and bigger. Traditional therapies are based on invasive interventions such as plastic surgery or electro-coagulation.
By using the laser within 1.5 W and 2W powerthe tissue ablation is perfect and the adjacent areas are clearly visible.
Epulis: epulis is a tumour that affects the periodontal area and is caused by inflammatory stimuli as a result of an inadequate oral hygiene. Therapy consists in the removal of the inflammation and in the subsequent ablation of the tumour. Depending on the kind of intervention, a subsequent gingivoplastic might be necessary.
Cysts can also be eliminated with the same tissue ablation technique.
Cysts are made of a membrane that contains liquid, soft substance and gas.
There are several kinds of cysts:
- dental cysts: they affect a single tooth and its supporting structure
- follicular cysts: they contain a tooth or a part of a tooth, originating from the enamel
- radicular cysts: they appear in the area of the root canal and are caused by granulomic processes due to root inflammationscaused by chronical parodontitis of the apex
- retention cysts: caused by the obstractionof a salivar gland
- sebaceous cysts: due to the obstruction of a sebaceous gland
- traumatic cysts: due to a wound or a trauma
The dental cyst can be determined either by a wrong development of the tissues reponsible for the odontogenesis or by inflammatory stimuli.
The most frequent groups of cysts are follicular and radicular cysts: they usually show a painless decourse and can be detected by a radiographic exam that clearly highlights the external membrane delimiting the area.
Cyst ablation can be very painful for the patient: by using the scalpel one had to stitch up the area completely, whereas with the laser no more stitches are required and no swelling, nor tissutal traumas show up. The tooth impression can be takenduring the same sitting.
The apicectomy is indicated for the cases in which the root canal (both artificial or natural)is obstructed. In presence of a granuloma or of a root canal difficult to access (not reachable by usual canal instruments), one usually resorts to apicectomy, which is anyway an invasive intervention, debilitating for the patient , because the tooth becomes shorter and duration.
The intervention consists in the surgical removal of the radicular apex of a tooth, as well as the ablation of the surrounding soft tissue affected by sevral pathologies.
Apicectomy is performed in order to cure the complications deriving from a tooth with necrotic pulp, or affected by abscesses or granulomi, but only when the endodontic treatment cannot be applied.
In presence of a dental granuloma it is necessary to operate because the affection cannot spontaneously heal, nor by means of pharmaceutical therapy.
Since at the basis of this pathology there is an infective process, it is advisable to operate with the laser on account of its bactericidal properties.
This operation consists in the ablation of a part of the gingiva which is generally located on an emerging wisdom tooth. The traditional operating method prescribes the use of the scalpel, but the laser, in comparison to that, does not only sensibly reduce the post-operative swelling but also causes much less pain to the patient.
Abscess incision and drainage
An abscess is a suppurative process that grows around the tooth, depending on where it is located. One usually distinguishes between periapical abscess (pus around the radicular apex) and periodontal abscess (pus inside the periopdontal tissues).
The most frequent cause are infections.
To incide an abscess means to open up an artificial fistula in order for the purulent material to stream out.
In comparison to traditional abscess drainage techniques, the use of the diode laser allows to operate in a much less painful way for the patient. By decreasing the employed energy, or by using a topic anaesthetic, it is possible to put pain under control
By means of the laser the bleeding is minimized, so that the drainage can be performed without compression. In this way the problem of the blood stagnation caused by gauzes is eliminated.
Thanks to its powerful antiseptic effect the laser ray eliminates the risk of post-operative infections.
The treatment is effected by vaporising the superficial mucosa layer with the rapid movement of the fiber perpendicular on the operating area.
During the operation it is recommended to regularly cleanse the fiber tip with a gauze soaked in hypochloride.
Crown lengthening is an operation which is sometimes necessary in order to uncover a further part of the tooth and to perform a restorative intervention on the crown, without damaging the connective attachment of the area.
The purpose of this surgical operation is to extend the crown surface of tooth by moving the gingival attachment to the apex, either with or without removing the bone supporting structure.
There could be different reasons for undergoing a crown-lengthening: aesthetic reasons, subgingival caries, wide fracture under the gingiva close to the alveolar crest, the necessity of lengthening the prosthetic props, in order to increase their adherence.
This can even be a pre-prosthetic operation. The traditional method prescribes, if the crown is not visible and the root emerges directly from the gingiva, to first open up a gingival flap and then to ablate the bone all around its perimeter with a sterile bur, in order for the tooth to come out of the gingiva.
With the laser it is possible to vaporise the flap and to ablate the whole tissue around the bone without damaging the bone itself.
In most of the cases it is not necessary to resort to anesthetics but, if need be, it is recommended to begin with a low power output and to increase it gradually according to requirements.
It is an abnormal opening in the gingival tissue, whereby a peri-apical abscess drains.
For this kind of operation it is important to use a sharp fiber, not so long as to reach too close to the bone.
The operation is performed by the tecnique called "intraluminal coagulation".
The fiber is introduced into the fistula up to the end of the duct. Thereafter the duct is irradiated, which brings about an internal and subsequently also external coagulation.
Papillectomy is an operation consisiting in the ablation or in the reduction of the papillae of the oral cavity.
The laser desensitizes the operating zone and brings about the reduction of the papillae by vaporising the tissue, which does not need any stitches.
Idiopathic crown lengthenings characteristically appear in patients who have undergone an odontoiatric treatment before. Before proceeding with the treatment one has to assess the biologic width. If the operating area displays an adequate biologic width, the laser can re-shape the gingival contour without having to open up the gingiva.
In case the operating area is too narrow, it is necessary, after having detach the gingival flap, to operate on the marginal bone in order to create a harmonic contour that ends at least 3mm before the adherent gingiva. If necessary, the gingiva can be reduced, so as to get the best aesthetic result.
It is often necessary to cure also gingival hyperplasiae due to the assumption of medicines, for instance medicines derived from idontoin or immunodepressors. For such patients, it is necessary to first of all proceed with a gingivectomy at regular intervals, since it is not possible to interrupt the assumption of the medicines.
With diode laser such hyperplastic alterations can be removed and perfectly re-shaped. Patients can resume their noprmal eating habits without any limitations, immediately after the anesthetic effect is over.