Written by Jeffrey P. Cranska, DDS Friday, 30 November 2007 19:00
I am a laser dentist. The use of dental lasers has changed how I approach my everyday patient treatment care. The following simple case demonstrates the use of a soft-tissue laser utilizing principles from laser periodontal therapy to regenerate lost papilla tissue and recreate gingival form.
A 57-year-old female presented with the loss of papilla and scar tissue between teeth Nos. 9 and 10. An excisional scalpel biopsy had removed a pigmented lesion 8 months prior to this current examination. Gingival healing was complete. A restorative evaluation showed an intact dentition with no caries. Medical history was noncontributory.
Figure 1. View of post-biopsy site prior to laser treatment.
Figure 2. The radiographic exam did not show any bone loss or pathology.
The patient was very unhappy with the surgical results from the biopsy, despite the pathology report of only “hyperplastic gingivitis.” The surgeon who performed the biopsy had seen her 4 times with no solution to repair her loss (Figures 1 and 2). The periodontal exam did not show any pockets, only postsurgical loss of papilla tissue and scarring in the area of teeth Nos. 9 and 10. Treatment would consist of laser ablation of the gingival epithelium and scar tissue in the area of teeth Nos. 9 and 10.
My laser periodontal therapy has centered on removal of diseased pocket epithelium and healing after laser treatment. In this case I would remove the gingival epithelium, set a stable thermal clot, and allow the gingival tissue to regenerate. Would it return as a black triangle, scar tissue, or a papilla?
The indication for this procedure is to correct the patient’s cosmetic concerns. There is no contraindication for the laser therapy and are no alternative, nonlaser options available. The treatment objective is to remove the scar tissue and promote re-epithelization of the interdental papilla to return proper form and contour. A pulsed, free-running Nd:YAG Laser (PerioLase [Millennium Dental Technologies]), wavelength 1,064 nm, was used for treatment.
The power settings for laser tissue ablation were 3.0-W, 20-Hz, 150-microsecond pulse width. A 320-µm contact fiber was used to deliver this energy to the tissue. The exposure duration for this laser tissue ablation was less than 60 seconds; less than 100 total joules were delivered to the tissue. The stable thermal clot was established during the initial exposure at this setting.
The treatment sequence consisted of administering infiltration local anesthesia (one carpule of 2% mepivacaine hydrochloride with levonordefrin 1:20,000 injection), then the interdental papilla between teeth Nos. 9 and 10 was treated with laser ablation. Oral hygiene instruction was reviewed.
|Figure 3. Immediate postoperative view of surgical laser procedure, showing tissue ablation and thermal clot formation.||
Figure 4. Three-month postoperative view.
Figure 5. Six-month postoperative view.
Figure 6. Two-year postoperative.
The patient was placed on a one-week postsurgical follow-up, then 3-month recalls (Figure 3).
At each postoperative visit it was determined that the patient experienced no adverse effects during therapy. There was no need for any further treatment. One-week follow-up showed good healing, evidenced by normal color and a lack of bleeding at the surgical site. Three-month healing showed some regeneration of the papilla and no inflammation. The patient was seen at 3-month recalls. Inspection at 3-month, 6-month, 9-month, and 1-year appointments showed gingival tissue healing with proper gingival contour and no scar tissue. Postoperative evaluation showed no mobility or pocketing. (Figures 4 to 6).
Figure 7. Current photo of patient at seven years after treatment.
The gingival tissue dem-onstrated that total healing had occurred with regeneration of the papilla. There was no evidence of inflammation in the surgical area. Knife-edge margins returned to the papilla. Normal contours have since remained intact. These were the results from a 1-minute laser surgery. The patient is happy with the cosmetic result and the return to the cosmetic form of the interdental papilla (Figure 7).
This 1-minute laser therapy once again demonstrated for me the human body’s wonderful ability to heal itself if given the chance. Lasers give me the chance to make this happen for my happy patients.
Dr. Cranska, who maintains a private practice in Severna Park, Md, is one of the pioneers in the use of lasers to accomplish minimally invasive dentistry. Nearly 10 years ago, he sought training in LANAP (Laser Assisted New Attachment Procedure), a breakthrough procedure to treat periodontal disease, and in 1999 he became one of the first 10 dentists in the world to use it. Since then, he has become a premiere author, lecturer, and certified trainer of the LANAP procedure. He is a clinical instructor at the Institute for Advanced Laser Dentistry in California, holds Advanced Proficiency Certification with the Academy of Laser Dentistry, and speaks to dentists about LANAP technology and procedures. He can be reached by visiting cranska.com or calling (410) 975-9331 or (410) 974-1164.
Disclosure: Dr. Cranska has no financial interest in any laser company, but is compensated as a consultant for presenting and lecturing by Millennium Dental Technologies and training from the Institute for Advanced Laser Dentistry.
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