|Year : 2016 | Volume
| Issue : 1 | Page : 19-22
810 nm diode laser: A reliable tool for periodontal surgeries
Madhuri Alankar Sawai
Department of Periodontology, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, India
|Date of Web Publication||23-Jun-2016|
Madhuri Alankar Sawai
C - 765, Ground Floor, Rear Portion, New Friends Colony, New Delhi - 110 065
Source of Support: None, Conflict of Interest: None
Periodontics deals with surgeries of the gingiva and soft tissues in the vicinity of teeth. In Periodontics, the amount of gingiva is a critical factor in maintaining the health of periodontium. A very minimal loss of gingiva can at times produce esthetic problems or can be difficult to maintain for the patient. So any periodontal surgical procedure should be directed towards minimal loss of soft tissues. Periodontal procedures conducted with scalpel cause pain, post operative edema, scaring and would lead to soft tissue loss postoperatively. Hence, a tool which can efficiently conduct periodontal surgeries with minimal loss of soft tissue is required. In this facet, a soft tissue diode laser is the most appropriate tool. It can be very conveniently used for frenectomy, gingivectomy, vestibuloplasty, epulis excision, gingival depigmentation and second stage implant surgery. This article emphasizes that a diode laser is a suitable instrument for oral soft tissue surgeries.
Keywords: Diode laser, frenectomy, gingivectomy, vestibuloplasty
|How to cite this article:|
Sawai MA. 810 nm diode laser: A reliable tool for periodontal surgeries. J Dent Lasers 2016;10:19-22
| Introduction|| |
Periodontics extensively deals with soft-tissue surgeries involving gingiva and adjacent oral tissues. Surgeries using a scalpel can be problematic to both patient and clinician. Pain, trauma, bleeding, scaring, and postoperative edema are associated with conventional methods of surgery. Hence, to overcome these drawbacks, a diode laser can be used to perform various surgical procedures.
A diode laser is a solid-state semiconductor laser that typically uses a combination of gallium, arsenide, and other elements, such as aluminum and indium, to change electrical energy into light energy.  It does not interact with dental hard tissues, making it an excellent soft-tissue surgical laser. It is used for cutting and coagulating gingiva and oral mucosa and for soft-tissue curettage or sulcular debridement.  It causes minimal damage to the periosteum and underlying bone as soft-tissue penetration is less. Hence, it can be used for a multitude of periodontal surgeries without impacting the adjacent tissues.
The case reports presented here describe a few periodontal surgical procedures using 810 nm diode laser to highlight its benefits.
| Case Reports|| |
A 21-year-old female patient was referred from the Department of Orthodontics to Department of Periodontology, Faculty of Dentistry, Jamia Millia Islamia (JMI), for exposing the clinical crowns of the maxillary anterior teeth as the clinical crown height was insufficient for placement of brackets [Figure 1]. The patient reported no significant medical history. She was explained about the treatment and informed consent was obtained. After oral prophylaxis, gingivectomy with laser was planned. 810 nm diode laser (Denlase® ) [Figure 2] was used with an initiated fiberoptic core diameter of 400 μm in a pulsed contact mode at 5.0 W and 1 ms pulse interval after administration of infiltration anesthesia (2% lignocaine with 1:100,000 adrenaline). There was minimal bleeding during the procedure, and postoperatively, the patient complained of no discomfort. Healing was uneventful and desired gingival contour could be obtained with the central incisors, canines, and first premolars within 20 min [Figure 3].
|Figure 1: Preoperative view of the maxillary central incisors, canine, and first premolars showing asymmetric gingival contours|
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A 30-year-old female patient reported to the Department of Periodontology, Faculty of Dentistry, JMI, with a complaint of receding gums in the lower anterior teeth region. The condition had persisted for the past 1-1½ years; however, the condition was deteriorating for the last 1-2 months [Figure 4].
|Figure 4: Preoperative view showing decreased width of attached gingiva and gingival recession in tooth 31, 41|
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A staged procedure was planned, wherein vestibular deepening was planned with frenectomy to increase the width of attached gingiva apical to the recession area and relieve the tension. Root coverage was planned in the second stage. An informed consent was taken. Under infiltration anesthesia, diode laser was used at 5.0 W in the pulsed mode. Precise incisions could be given with minimal bleeding and the procedure took approximately 10-15 min [Figure 5]. Healing was satisfactory with a gain in the width of attached gingiva [Figure 6]. At 6 months postoperatively, gingival recession seemed to decrease may be due to creeping attachment and hence, the patient did not give consent for further root coverage procedure [Figure 7].
A 20-year-old female patient reported to the Department of Periodontology, Faculty of Dentistry, JMI, with the chief complaint of spacing in the upper front teeth region. The patient reported no significant medical history. There was the presence of midline diastema and high maxillary labial frenum (extending till the interdental papilla) [Figure 8]. The patient was to undergo orthodontic treatment for the diastema after frenectomy. The patient was explained about the procedure and informed consent was obtained. The frenum was excised with diode laser in a pulsed mode at a setting of 5.0 W, 1 ms pulse interval. The procedure was completed in approximately 10 min with minimal bleeding and discomfort to the patient. No suturing was required and the area was covered with periodontal dressing [Figure 9]. Healing was uneventful and no scarring was seen at 10 days postoperatively [Figure 10].
|Figure 8: Preoperative view showing high frenum attachment - till the interdental papilla|
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| Discussion|| |
Lasers and their applications in dentistry are rapidly evolving. They are being used for procedures involving soft and hard tissues of the oral cavity. The diode laser is one such tool which is versatile for conducting various periodontal surgeries. The diode lasers emit light in the near infra-red spectrum of the electromagnetic radiation and fall in the range between 810-980 nm. During use, they change electrical energy into light energy. The diode lasers are highly absorbed in hemoglobin and other pigments such as melanin. The primary chromophores for intraoral soft-tissue ablation are hemoglobin, water, and melanin. ,
Diode laser provides various benefits such as coagulates small blood vessels and lymphatics, helps in better visualization, able to negotiate curvatures and folds, reduces the amount of bacteria and other pathogens at the surgical site, reduces bacteremia, decreases swelling, edema, pain, and scarring, improves postoperative healing, faster recovery time, no deleterious effect on root surface, and can be used around orthodontic brackets and dental implants. As there is minimal tissue shrinkage, the tissue margins remain at the same level after healing as they are immediately after surgery. 
The cases presented prove that 810 nm diode laser is a very useful tool as it precisely cuts the soft tissues. The laser-induced wounds, because of definite and clean wound, generally heal with secondary intention and no scar formation compared to scalpel incisions.  This may be due to the minimal degree of wound contraction following laser irradiation which occurs through induction and formation of smaller number of myofibroblasts and collagen. , As they are gentle, the overall patients' acceptance is high. Thus, using soft-tissue diode laser is not only beneficial to the patient but also to the operator as the results are more predictable and less stressful to patients and clinicians.
The present case reports thus highlight the valuable benefits of using diode lasers in periodontal surgeries to make them more predictable.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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