Lasers in Dentistry: Minimally Invasive Instruments for the Modern Practice
Course Number: 394
Course Contents
Gingivectomy
Gingivectomy is the most common procedure performed with dental lasers. All laser wavelengths can be used to precisely incise gingiva for restorative, cosmetic, and periodontal indications. Rapid healing and reduced pain are commonly seen post operatively and patients rarely need periodontal packing or sutures. The thermal effects of diodes, Nd:YAG and CO2 lasers must be understood to avoid collateral damage, but in properly trained hands these devices are quite effective. Erbium edlasers pulsed technology, shallow penetration, and water absorption produce a minimal thermal effect and minor procedures can sometimes be achieved with no anesthetic at all. The nearly "cold cutting" effect of erbium tissue interaction creates a remarkable post-operative course.
Figure 19. Crowns/Gingivectomy.
Pre-operative severe idiopathic gingival hyperplasia. The anterior teeth were highly restored with multiple restorations and resin veneers. Crowns were indicated and the patient’s chief complaint was that her teeth looked too short, even though the prior veneers established an incisal position many millimeters below the occlusal plane.
Figure 20. Crowns/Gingivectomy.
Immediate post Er,Cr:YSGG gingivectomy and gingivoplasty just prior to crown preparation at the same appointment. No osseous reduction was needed, as there was no biological width disruption.
Figure 21. Crowns/Gingivectomy - One week later.
Teeth were temporized with a chair-side fabricated six unit splint and the patient returned for impressions one week later. The patient complained of minor discomfort only. The gingiva already appears well healed with stippling apparent just one week later.
Figure 22. Crowns/Gingivectomy - Cementation.
Gingivectomy and ClasssV Restoration - An elderly patient lost a classV restoration while hospitalized The gingiva grew into the defect significantly. The patient was on Plavix and aspirin. Er:YAG gingivectmoy allowed for precise control of the gingival margin and placement of a restoration.
Fig 23. Implant/Gingivectomy.
Fibrous gingiva growing over implant healing cap excised with Er:YAG laser at abutment placement appointment. No anesthesia was required. Erbium lasers do not interact with titanium and can be safely used around titanium implants.
Video 2.
Gingivectomy with a diode laser (1064 nm XLASE). Procedure done by Dr. Larry Kotlow, video courtesy of Technology4Medicine, LLC.