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   Table of Contents - Current issue
Coverpage
July-December 2016
Volume 10 | Issue 2
Page Nos. 33-84

Online since Thursday, December 29, 2016

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EDITORIAL  

Editor's Message p. 33
Naresh Thukral
DOI:10.4103/2321-1385.196950  
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REVIEW ARTICLE Top

Untangle the lingual aberrant frenum by diode laser: A case report with review of literature p. 34
Mohammad Arif Khan, Mohd. Kamran Farooqui, Charanjeet Singh Saimbi, Sunil Kumar Yadav, Anurag Saxena
DOI:10.4103/2321-1385.196953  
A frenum is an anatomic structure formed by a fold of mucous membrane, connective tissue, and sometimes muscle fibers connecting the lips, cheek, or tongue to the jawbone. Tongue-tie or ankyloglossia is a rare congenital anomaly. In this condition, the tongue is attached to the floor of the mouth and the patient is unable to protrude his tongue properly, difficulty in speech, suction, feeding, and also difficulty in maintaining the oral hygiene has been reported. We report a case of partial ankyloglossia in a 7-year-old male child which was treated with diode laser and followed up by without having any complication.
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ORIGINAL ARTICLES Top

A clinical and histological comparison of mucosal incisions produced by scalpel, electrocautery, and diode laser: A pilot study p. 37
Anuradha Bhatsange, Ekta P Meshram, Alka Waghamare, Lalitha Shiggaon, Vijay Mehetre, Alkesh Shende
DOI:10.4103/2321-1385.196962  
Aim: The aim of this study was to clinically and histologically compare mucosal incisions of oral tissues after surgical procedures with scalpel, electrocautery, and diode laser. Materials and Methods: Nine standardized incisions were performed in oral mucosa by scalpel, electrocautery, and diode laser. Specimens were classified into three groups according to tool used for surgical excision. Group A: Three specimens excised through a Bard-Parker (BP) scalpel blade no. 15c; Groups B and C included three specimens each excised through electrocautery and diode laser, respectively. Cut margins of biopsy specimens, adjacent peripheral mucosa were evaluated using light microscopy and histologic zones were identified, assessed: For epithelial changes, incision morphology, lateral tissue damage. Intra- and post-operative parameters assessed were the duration of surgery, bleeding, postoperative pain and healing. Results: Immediate hemostasis was seen with electrocautery and laser compared to scalpel (P < 0.011), mean time taken by electrocautery and laser was less compared to scalpel (P < 0.001). The analysis of regularity of incision and postoperative pain experienced by patients revealed a statistically significant difference (P < 0.01). Histologic damage was least with scalpel. The extent of degeneration was lowest with scalpel followed by laser or electrocautery (P < 0.05). Conclusion: Laser and electrocautery have upper hand over scalpel in relation to hemostasis, but have demerits such as lateral heat damage, tissue necrosis, delayed wound healing, and high cost. Even with advanced treatment modality, conventional scalpel treatment is better option in terms of precise incision, lower cost and faster reepithelization than laser and electrosurgery. Heat generating devices may not allow reliable histologic interpretations, particularly assessing margins of small biopsy specimens or malignant conditions.
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Evaluation of root-end cavity preparation using erbium, chromium:yttrium, scandium, gallium, and garnet laser, ultrasonic retrotips, and conventional burs p. 43
Sarika Chaudhry, Sudha Yadav, Gunpreet Oberoi, Sangeeta Talwar, Mahesh Verma
DOI:10.4103/2321-1385.196989  
Aim: To compare root-end cavities prepared with ultrasonics (Group A), with those created by burs in a conventional handpiece (Group B) and erbium, chromium:yttrium, scandium, gallium, and garnet (Er, Cr:YSGG) laser (Group C). Materials and Methods: After root canal instrumentation and filling, apices of 60 single-rooted teeth were resected. Retrograde Class I cavities 3 mm deep were prepared using ultrasonic retro-prep tips (Group A), round burs (Group B), and Er:YSGG laser (Group C). An ultrasonic unit was used with computed tomography-5 retrotip at the frequency of 32 KHz. Laser beam parameters were a pulse of very short duration (100 s), energy of 280 mJ, and repetition rate of 10 Hz. The apical root portion and root-end cavities were replicated and prepared for stereomicroscopic analysis. Results: The degree of chipping associated with the margin of the root-end cavities and the incidence of root face cracks were noted. Marginal chipping of root-end cavities prepared using ultrasonic instrumentation was significantly higher than that produced by bur (P < 0.001) or laser, with laser group showing the least amount of chipping. Conclusion: There was a significant difference between the number of cracks produced by the three methods, with the laser group having the least number of cracks and marginal chipping.
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A randomized, clinical split-mouth study comparing conventional techniques to lasers for second-stage implant uncovering p. 47
Andrew Rossi, Robin Weltman, Gena Tribble, Sudarat M Kiat-Amnuay
DOI:10.4103/2321-1385.196990  
Purpose: This randomized, clinical split-mouth study compared participants' pain perception, quantified the inflammatory cytokines interleukin (IL)-1 β and IL-6, and assessed changes in the quantity of five periodontal pathogens, after implant uncovering. Materials and Methods: Twelve persons who received bilateral implants participated. After healing, implants were randomly uncovered using either a scalpel (control) or a 940 nm diode laser (experimental). The participants' pain perception was assessed by questionnaires and visual analog scale. Crevicular fluid was collected around the implants at day 1 and 7, and IL-1 β and IL-6 levels were measured by ELISA. Bacterial samples were collected around the healing abutments at day 1 and 7. Results: A statistically significant difference in change of pain score over time was found. The laser sites showed an increase in pain that continued until day 3, while the scalpel sites showed an increase in pain that declined by day 2. A global health questionnaire showed that patients overwhelmingly preferred the laser to the scalpel. IL-1 β levels were significantly lower in the laser group as compared to the control group at day 1 (387.2 pg/mL vs. 456.2 pg/mL, P = 0.02). No statistically significant differences in IL-6 or bacterial quantities were found between test and control sites. Conclusions: Even though a slightly greater amount of pain was perceived over the first 2 postoperative days, patients significantly preferred the laser to the scalpel. Less inflammatory cytokine production of IL-1 β was found after the 1 st day of healing after laser surgery. Bacterial sampling was similar between test and control groups.
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Scanning electron microscope evaluation of morphological changes in dental hard tissue after root resection in apicoectomy by Er,Cr:YSGG laser and #702 TC Bur: Part I p. 58
Prashant Dadasaheb Babar, Haridas Das Adhikari
DOI:10.4103/2321-1385.196993  
Aim: The aim of this study was to compare surface characteristics and morphological changes in Er,Cr:YSGG laser and bur resected root ends in apicoectomy. Settings and Design: 5 W, 20 Hz, 50% air, 100% water, 300 mJ. Materials and Methods: Forty freshly extracted human central incisors treated endodontically. gutta-percha-obturated teeth were resected apically 3 mm with 0° bevel. Twenty samples were resected with #702 TC Bur while rest half were resected with Er,Cr:YSGG laser with 600 μm sapphire tip. Samples were examined for cemental damage, surface roughness, and cracks under surgical operating microscope (SOM) at ×16. Then, samples were fixed, dehydrated, and gold sputtered for observation under scanning electron microscope (SEM). Statistical Analysis Used: Data obtained were subjected to statistical analysis using Chi-square/Fisher's exact test, Kruskal-Wallis test, whenever required. Results: Under SOM, no cemental damage was detected; while under SEM, 14 bur and 1 laser resected samples exhibited damage (P < 0.001). Under SOM and SEM, bur resected surface showed roughness in 17 and 20 samples, respectively, while laser resected surface appeared to be smoother in 18 and 19 samples, respectively (P < 0.001). Under SOM, cracks seen in only 1 bur resected sample, while in laser resected samples, no cracks revealed. Under SEM, bur root resection revealed cracks in 16 samples; laser root resection revealed cracks in 3 samples (P < 0.001). Conclusions: Er,Cr:YSGG laser resection as compared to #702 TC Bur resection exhibits less damage to cementum, smoother dentinal surface with least or no surface cracks/microcracks.
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Scanning electron microscope evaluation of morphological changes in dental hard tissue after root resection in apicoectomy by erbium, chromium:yttrium-scandium-gallium-garnet laser and #702 TC Bur: Part II p. 67
Prashant Dadasaheb Babar, Haridas Das Adhikari
DOI:10.4103/2321-1385.197019  
Context: In Part I of this in vitro SEM study, we have discussed the effect of root resection tools on root end in terms of Cemental damage, Dentin Surface texture and Dentinal Cracks. This part (Part II) will focus on effect of root resection tools on root end in terms of Debris, smear layer, Dentinal tubules, Intertubular Dentin and Root Dentin - Gutta percha interface. Aims: To compare surface characteristics and morphological changes in erbium, chromium:yttrium-scandium-gallium-garnet (Er;Cr:YSGG) laser and bur-resected root ends in apicoectomy. Settings and Design: 5 W, 20 Hz, 50% air, 100% water, 300 mJ. Subjects and Methods: Forty freshly extracted human central incisors treated endodontically. Gutta-percha (GP) obturated teeth were resected apically 3 mm with 0° bevel. Twenty samples were resected with #702 TC Bur while the rest half were resected with Er,Cr:YSGG laser with 600 µm sapphire tip. All the samples were examined for debris, smear layer dentinal tubules, intertubular dentin and interface of GP, and root dentin on resected root surface under surgical operating microscope at ×16. Then, samples were fixed, dehydrated, and gold sputtered for observation under scanning electron microscope (SEM). Statistical Analysis Used: Data obtained were subjected to statistical analysis using Chi-square/Fischer exact test whenever required. Results: SEM observation revealed the absence of debris and smear layer with clean cut surface and patent dentinal tubules with exposed intertubular collagen, less gap (mean 9.95 µm), and least damage to apical adaptation of GP to root dentin walls in Er,Cr:YSGG-laser-resected root surface; while bur-resected samples revealed irregular, rugged root surface covered with debris, smear layer clogged dentinal tubules more gap (mean 20.98 µm) and damage to interface at GP, and root dentin walls. Conclusions: Er,Cr:YSGG-lased root surface provides better surface morphology, more conducive surface for regeneration of periodontium as compared to bur root resection.
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CASE REPORTS Top

Fibroepithelial hyperplasia excision by diode laser: A novel treatment approach in periodontal therapy p. 77
Veena Kalburgi, Shefali Jain, Niyatee Varma
DOI:10.4103/2321-1385.196995  
Laser first came into light in 1960 and has been used extensively in various fields of dentistry. Lasers are widely used for a numerous procedures such as de-epithelization, pocket disinfection, frenectomy, scaling and root planing, and surgical procedures such as excision of soft-tissue growths. Improved healing, hemostasis, and sutureless excisions are some of the many advantages of laser over conventional treatment modalities. It is because of these advantages that laser is becoming more and more popular as a treatment option in various aspects of dentistry. We hereby present a case report, where we have used soft-tissue diode laser for surgical management of a fibroepithelial hyperplasia with reactive bone formation, because of its many advantages over conventional methods. Fibroepithelial hyperplasia is most commonly seen at the site of trauma in mouth or in other areas of the body. This polyp is usually not harmful and does not grow in size. However, at times, these tags may need to be surgically excised for esthetic and functional purposes or for the fear of malignancy.
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Lymphangioma of lip treated with carbon dioxide laser p. 81
Reenesh Mechery, Manoj Kumar, Piyush Arora, Nithya Dinakar
DOI:10.4103/2321-1385.196996  
Lymphangiomas are benign hamartomas of lymphatic channels mostly present as developmental malformations arising due to sequestration of lymphatic tissues not communicating with patented lymph channel. They are generally congenital and more frequently diagnosed in childhood but rarely do they occur in adults. In head and neck region, they have a high predilection for occurrence in tongue followed by lips . This article describes a case report of lymphangioma of lip in the light of current information with clinical and histological aspect in a young patient, which was successfully treated with carbon dioxide laser.
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