ESTHETIC AND THERAPEUTIC CROWN LENGTHENING USING LASER

A healthy periodontium and incisal wear with adequate tooth structure for restorations may require only restorative treatment. A sound, intact dentition with gingival hyperplasia may require only periodontal treatment. A tooth that has been damaged by caries or trauma to the extent that there is less than 3 mm of sound tooth structure coronal to the alveolar crest will require periodontal and perhaps orthodontic treatment prior to fabrication of a definitive restoration. When significant discrepancies exist in face height, lip length or lip thickness, periodontal and restorative treatment may need to be coordinated with orthognathic and/or plastic surgery procedures If the patient is unwilling or unable to obtain this additional care, then he or she must be informed that limited improvement may result from periodontal and restorative treatment. It is absolutely essential that a complete, comprehensive diagnosis be developed in order to plan treatment that will predictably produce optimal results with long-term stability. It is important to keep in mind that excessive gingival display, often referred to as the ‘‘gummy smile’’ may be the result of several factors, including gingival enlargement, altered or delayed passive eruption, insufficient clinical crown length, vertical maxillary excess and a short upper lip.

Following the formulation of a complete and accurate diagnosis, a comprehensive plan for treatment is developed. When full-coverage restorations are indicated, it is preferable to avoid placing margins subgingivally; however, in anterior areas margins frequently must be placed within the sulcus for aesthetic reasons. In order to minimize colonization of the sulcus by microorganisms associated with periodontitis, it is important to avoid overhangs and to reproduce the original contours of the tooth as closely as possible

Therapeutic crown lengthening for better crown adaptation 

              In anterior areas where aesthetic considerations are highly significant, surgical crown lengthening alone may have an unacceptable result and the use of Lasers gives the patient a comfortable, painless and bloodless experience to achieve what they want both esthetically and with therapeutic indications.

Esthetic crown lengthening

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GINGIVAL DEPIGMENTATION

GINGIVAL DEPIGMENTATION

Gingival hyperpigmentation is more of a esthetic procedure rather than a medical problem. Black gums are of esthetic concern for not only fair skinned individuals but almost all people of all age groups. Various treatment modalities have been practiced for gingival depigmentation, such as scalpel, cryosurgery, electrosurgery, abrasion of the gums using diamond burs, free gingival grafting procedures lasers.

Melanin pigmentation, is a brown pigmentation of the skin and gums that occurs in all races. Gingival depigmentation is a perioplastic surgical procedure, whereby the gingival hyperpigmentation is removed or reduced by various techniques. The use of Lasers compared to other surgical procedures have been proven to be more palliative despite fulfilling the requirements of the patient.

Advantages of  Laser  over other surgical procedures:

1.      Dry and bloodless procedure.

2.      Instant sterilization of the surgical site.

3.      Reduced bacteremia.

4.      Reduced mechanical trauma.

5.      Minimal postoperative swelling.

6.      Faster healing time.

7.      Minimal postoperative pain.

8.      No need for periodontal dressing (usually used for protection of the wound created by scalpel)

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TREATMENT FOR GINGIVAL OVERGROWTH

GINGIVAL OVERGROWTH

Gingival enlargement or overgrowth is an increase in the size of the gums .it is a common feature of gingival disease. Gingival enlargement can be caused by a number of various stimuli, for example, people under orthodontic treatment with poor oral hygiene maintenance can develop gingival overgrowth due to plaque as a stimuli. People taking antihypertensive drugs, drugs for epilepsy etc can cause gingival overgrowth, "treatment is based on an understanding of the cause and underlying pathologic changes.

 

Inflammatory enlargement 

Inflammatory enlargement is the most common cause of gingival enlargement. The gums appear  red, swollen, soft and discoloured. This is due to stasis of blood and fluid in the tissue spaces which is caused by prolonged exposure to bacterial plaque.

 

Drug-induced enlargement 

Drugs which cause enlargement of gums includes

• Anticonvulsants (such as phenytoin, phenobarbital, lamotrigine, valproate, ethosuximide, topiramate and primidone)
• calcium channel blockers, such as nifedipine, amlodipine and verapamil. The dihydropyridine derivative isradipidine can replace nifedipine and does not induce gingival overgrowth.
• Immunosuppresant like cyclosporins. 

Systemic factors that induce enlargement includes

Pregnancy

Puberty

Vitamin C deficiency

Systemic diseases like: Leukemia, neoplasms can also cause enlargement.

False enlargement 

when there is an underlying bony or dental tissue lesion it can be shown as gingival enlargement.

TREATMENT FOR GINGIVAL OVERGROWTH- LASER

LASER is chosen as the latest treatment method because it has photothermal, chemical and plasma mediated effects. LASERs have an advantage over all the conventional techniques by accomplishing removal of the soft tissue and producing a favourable environment for healing. LASERs have potential advantage of bactericidal, detoxifying effect. Diode lasers have been used in a variety of soft tissue surgical procedures and have many advantages such as less pain, bleeding, scar formation and infection. Less postoperative swelling and pain is another advantage of lasers which most likely correlates with decreased tissue trauma and an alteration of neural transmission.

Laser application for excising oral hyperplastic lesions shows some advantages such as less bleeding that is suitable for surgical treatment that are suitable for oral mucosal lesions which are rich in blood vessels.

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Quick Tips To get rid of oral ulcers - LASER is the answer......

The  role of the diode laser in helping with palliative care in the treatment of  ulcerative oral lesions  (Recurrent Aphthous Ulcers (RAU or RAS)) and Oral Herpetic lesions (HSV-1)).

The reason for the recurrence of these ulcers is unknown most of the time, might be a viral infection as with the case of Herpes infection which is associated with mild fever and vesicles in the corner of the mouth. but the exact reason for aphthous ulcers is idiopathic, the possible etiologic factors include: citrus fruits, trauma, stress, lack of sleep, immune system reactions, and deficiency of B12, Iron or Folic Acid. These lesions are found on the “loose” tissues of the mouth including the inner aspects of the lips, buccal mucosa, tongue, soft palate and the floor of the mouth.

These ulcers begin with a mild burning sensation as first sensed by the patient and appears as a yellow or white oval lesion surrounded by an inflammed red border. At this stage it is usually painful and gets aggravated on taking any hot and spicy food. Even the use of toothpaste can trigger the pain in some.

LOW LEVEL LASER THERAPY has been proven to accelerate wound healing and reduce the pain symptom. The dental diode laser technology has an anti- bacterial effect and offers patients dramatic, almost instant relief. The diode laser emits light that is coverted into heat which vapourizes the ulcer without damaging the surrounding tissue.

Benefits of Laser Treatment

• Promotes faster healing
• Pain relief is immediate and profound
• Affordable 
• Stops progression of the ulcer
• Only takes a few minutes
• No anesthesia
• Little if any discomfort
• Sores reoccur with less intensity and frequency at the same site

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What is Peri-implantitis

Peri-implantitis is defined as an inflammatory reaction, with the loss of supporting bone in the tissues surrounding a functioning implant. The features to be observed are 

1. bleeding gums

2. swollen gums

3. shaking implant

4. exposure of implant screw threads

5. Loss of bone in the X- ray

                               

Treatment of peri-implantitis

According to the best available evidence, traditional periodontal infection control including plaque control regimens and mechanical cleaning of the affected areas possessing professional cleaning should be performed. 

It is essential to inform the patient about the need for effective oral hygiene procedures (particularly around implants), and the patient should be carefully instructed in the proper use of necessary additional oral hygiene aids. Oral hygiene procedures should be trained under professional supervision.

Surgical exposure of the lesions was performed, and the affected implants were cleaned using hydrogen peroxide.

Systemic antibiotics were administered according to a susceptibility of bacteria. The applied surgical and antimicrobial treatment strategy was successful in less than 60% of the treated implants. Despite treatment and re-treatment of peri-implantitis–affected areas, additional loss of supporting bone was found in up to 40% of the advanced peri-implant lesions.

LASERS to treat Peri-implantitis

A promising method for decontaminating implant surfaces involves the use of laser energy. Unlike mechanical decontamination methods, which cannot fully adapt to the irregularities on the surface of an implant, lasers can irradiate the whole surface, reaching areas that are too small to receive mechanical instrumentation. Power settings are variable, and the clinician can choose a setting that will effectively disinfect the implant while not damaging the surface. 

Conventional approaches include:

• Systemic administration of

   antibiotics

• Removal of supragingival bacterial plaque

• Removal of granulation tissue

   with plastic curettes

• Debridement of the exposed surface by using mechanical brushing, air powder abrasives, citric acid, disinfectants like chlorhexidine or topical tetracycline, plaque inhibitor like delmopinol, or low-intensity ultraviolet radiation

• Removal ofthe peri-implant pocket

• Regeneration of peri-implant hard tissue by means of guided tissue regeneration

• Plaque control and oral hygiene.

Advantages of Laser in the treatment of Peri-implantitis

• The laser easily vaporizes any existing granulation tissue.
• The implant surface can be debrided by lasing directly on the implant’s exposed screws with a low-energy setting. Both the target tissue and implant surface are disinfected without damage.
• The laser is bactericidal.

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Website: www.chinthamanilaserdentalclinic.com