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CASE REPORT
Year : 2016  |  Volume : 10  |  Issue : 1  |  Page : 19-22

810 nm diode laser: A reliable tool for periodontal surgeries


Department of Periodontology, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, India

Date of Web Publication23-Jun-2016

Correspondence Address:
Madhuri Alankar Sawai
C - 765, Ground Floor, Rear Portion, New Friends Colony, New Delhi - 110 065
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0976-2868.184603

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  Abstract 

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

How to cite this URL:
Sawai MA. 810 nm diode laser: A reliable tool for periodontal surgeries. J Dent Lasers [serial online] 2016 [cited 2020 Apr 4];10:19-22. Available from: http://www.jdentlasers.org/text.asp?2016/10/1/19/184603


  Introduction Top


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. [1] 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. [2] 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 Top


Case 1

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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Figure 2: Denlase® diode laser unit

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Figure 3: Postoperative view - 2 weeks after gingivectomy

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Case 2

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].
Figure 5: Intraoperative view using laser

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Figure 6: Immediately after surgery - no bleeding seen

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Figure 7: Postoperative view - 45 days after vestibuloplasty

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Case 3

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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Figure 9: Immediately after surgery

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Figure 10: Postoperative view - 2 weeks after frenectomy

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  Discussion Top


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. [3],[4]

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. [5]

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. [6] 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. [7],[8] 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

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Prabhuji ML, Madhupreetha SS, Archana V. Treatment of gingival hyperpigmentation for aesthetic purposes using the diode laser. Int Mag Laser Dent 2011;3:18-9.  Back to cited text no. 1
    
2.
Mani A, Mani S, Shah S, Thorat V. Management of gingival hyperpigmentation using surgical blade, diamond bur and diode laser therapy: A case report. J Oral Laser Appl 2009;9:227-32.  Back to cited text no. 2
    
3.
Niemz MH. Laser-Tissue Interaction. Fundamentals and Applications. 3 rd Enlarged Edition. Berlin, Germany: Springer; 2007. p. 45-6.  Back to cited text no. 3
    
4.
Goldman L. Chromophores in tissue for laser medicine and laser surgery. Lasers Med Sci 1990;5:289-92.  Back to cited text no. 4
    
5.
Govila V, Gulati M, Govila S. Diode laser applications in periodontics. Indian J Dent Sci 2011;3:64-7.  Back to cited text no. 5
    
6.
Azma E, Safavi N. Diode laser application in soft tissue oral surgery. J Lasers Med Sci 2013;4:206-11.  Back to cited text no. 6
    
7.
Chomette G, Auriol M, Labrousse F, Vaillant JM. The effect of CO2 laser radiation on the morphological changes of mucocutaneous wound healing in oral surgery. A histo-enzymologic and ultrastructural study. Rev Stomatol Chir Maxillofac 1991;92:1-7.  Back to cited text no. 7
    
8.
Zeinoun T, Nammour S, Dourov N, Aftimos G, Luomanen M. Myofibroblasts in healing laser excision wounds. Lasers Surg Med 2001;28:74-9.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10]



 

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