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Table of Contents
SHORT COMMUNICATION
Year : 2015  |  Volume : 5  |  Issue : 1  |  Page : 54-56

Gingival contouring in full mouth rehabilitation case with the laser - A 3-year follow up case report


Department of Periodontics, S. D. M College of Dental Sciences and Hospital, Dharwad, Karnataka, India

Date of Web Publication12-Aug-2015

Correspondence Address:
Pragathi R Bhat
Department of Periodontics, S. D. M College of Dental Sciences and Hospital, Dharwad, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2229-5194.162746

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   Abstract 

Gingivoplasty, gingivectomy, and crown lengthening procedures are routinely carried out in dental practices to correct irregular gingival contours, remove excess gingival tissue, gingival overgrowths, and to expose the finish lines for restorative purposes, respectively. These soft tissue excision procedures are routinely performed either with gingivectomy knives, bard parker blades and electrosurgery. However, in the recent past, with the advances in the technology the use of lasers for the soft tissue treatment has emerged. Moreover, the increased postoperative discomfort and bleeding that have been associated with conventional methods has always weighed on the minds of the practitioners, as well as the patients. This paper describes a case where the gingival margins were stable even after 3 years of follow-up with the laser method.
Clinical Relevance to Interdisciplinary Dentistry

  • Full mouth rehabilitation requires a multidisciplinary approach. In this present case LASER has been used for gingival contouring, and has been compared with scalpel.

Keywords: Diode laser, gingivoplasty, scalpel, soft tissue excision


How to cite this article:
Bhat PR, Setty S, Thakur SL. Gingival contouring in full mouth rehabilitation case with the laser - A 3-year follow up case report. J Interdiscip Dentistry 2015;5:54-6

How to cite this URL:
Bhat PR, Setty S, Thakur SL. Gingival contouring in full mouth rehabilitation case with the laser - A 3-year follow up case report. J Interdiscip Dentistry [serial online] 2015 [cited 2019 Jun 20];5:54-6. Available from: http://www.jidonline.com/text.asp?2015/5/1/54/162746


   Introduction Top


Gingival soft tissue excision procedures incorporate the use of gingivectomy knives, bard parker blades, and electrosurgery. [1],[2] Although the merits of using these conventional methods include the ease of use, low cost and less time consumption, the demerits include increased postoperative discomfort, bleeding after excision and coronal migration of the soft tissue margins during healing, making it difficult for recording the finish lines, necessitating an additional step prior to making final impressions. [3] Thus, a need was always felt to have a technique that was more predictable with respect to the stability of soft tissue margins. [4],[5] Laser dentistry is used routinely for soft tissue procedures. [6]

Here is a case wherein soft tissue contouring was performed initially with a scalpel followed by laser method and further followed up for a period of 3 years.


   Case report Top


An 18-year-old male patient with amelogenesis imperfecta was referred from the Department of Prosthodontics with the chief complaint of stained teeth since childhood. The medical history was unremarkable. Comprehensive clinical examination of the oral cavity revealed a pale pink gingiva with melanin pigmentations in the premolar-molar regions of upper and lower arches on the right and left sides. The contours were irregular with the upper anteriors, and consistency was soft with the lower anteriors. The overall size of the gingiva was markedly increased [Figure 1]. After the initial therapy, the patient was scheduled for gingivoplasty with a conventional scalpel method [Figure 2]. After 1-month postgingivoplasty, crown cutting was done, finish lines were placed, the provisional restoration was given, and the patient was recalled for a permanent prosthesis.
Figure 1: Preoperative

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Figure 2: One-month postgingivoplasty

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After 3 weeks at the time insertion of the permanent prosthesis, it was noticed that there was a gingival tissue rebound that had taken place leading to the collapse of the finish lines [Figure 3]. Thus gingival contouring was done again with the laser method, wherein Gallium-aluminium-arsenide diode laser with a wavelength of 940 nm set at a power of 2.00 W, 1.00 ms/1.00 ms pulsed focused contact mode was used to expose the finish lines [Figure 4]. The provisional restoration was placed the next day and permanent restoration after 4 weeks. However, with the laser method, it was noticed that the soft tissue margins were stable at the point where they were excised. The patient was evaluated after 6 months posttreatment and after 3 years. We observed there was no gingival tissue rebound with the laser method in comparison with scalpel technique that was performed 3 weeks earlier to the laser technique [Figure 5], [Figure 6] and [Figure 7].
Figure 3: Collapsed finish lines

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Figure 4: Soft tissue contouring with laser

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Figure 5: Permanent prostheses

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Figure 6: Six months follow-up

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Figure 7: Three years follow-up (stable gingival margins)

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   Discussion Top


In the recent past, various studies on soft tissue recontouring procedures have shown promising results with the laser method as compared to the conventional methods both from the patients,' as well as the dentist's perspective. [6],[7],[8],[9] In the present case, soft tissue contouring was recommended and initially, it was performed with the scalpel method followed by crown preparation and placement of the provisional restoration. However, after 4 weeks, we observed the maximum tissue rebound taking place along with the collapse of the finish lines in spite of patient maintaining a good oral hygiene. This could be due to the complete epithelial and connective tissue repair taking place that led to the movement of the gingival margins in the coronal direction further collapsing the finish lines. [4]

Thus soft tissue recountouring was done with the laser method wherein, the finish lines were exposed and provisional restoration was placed the next day, followed by permanent restoration after 4 weeks. It was observed that with the laser method, the soft tissues were stable even after 3 years posttreatment. This could be attributed to the fact that the cells at the cut margins were dead and the blood vessel in the surrounding tissue up to the diameter of 0.5 mm were sealed by the laser leading to minimum scarring. Thus, the margins remain at the point where they were cut rather than recede or creep up. [10] In second, laser wounds are sterile and less likely to become inflamed. Due to this, the rebound of soft tissue that happens as it heals is minimized and thus, the soft tissue contours achieved with the laser excision are more predictable. [2],[11],[12]


   Conclusion Top


The level of the marginal gingiva was more accurate and predictable with the laser method allowing for more well-defined finish lines in the final restoration.

 
   References Top

1.
Takei HH, Carranza FA. Gingival surgical techniques. In: Newman MG, Takei HH, Klokkevold PR, Carranza FA Jr, editors. Carranza's Clinical Periodontology. 10 th ed. St. Louis, Missouri: Saunders, Elsevier Inc.; 2006. p. 914-5.  Back to cited text no. 1
    
2.
Melnick PR. Preparation of the periodontium for restorative dentistry. In: Newman MG, Takei HH, Klokkevold PR, Carranza FA Jr, editors. Carranza's Clinical Periodontology. 10 th ed. St. Louis, Missouri: Saunders, Elsevier Inc.; 2006. p. 1044-5.  Back to cited text no. 2
    
3.
Cobb CM. Lasers in periodontics: A review of the literature. J Periodontol 2006;77:545-64.  Back to cited text no. 3
    
4.
Ishikawa I, Aoki A. Recent advances in surgical technology - Part 2. In: Newman MG, Takei HH, Klokkevold PR, Carranza FA Jr, editors. Carranza's Clinical Periodontology. 10 th ed. St. Louis, Missouri: Saunders, Elsevier Inc.; 2006. p. 1031-7.  Back to cited text no. 4
    
5.
Schwarz F, Aoki A, Becker J, Sculean A. Laser application in non-surgical periodontal therapy: A systematic review. J Clin Periodontol 2008;35 8 Suppl: 29-44.  Back to cited text no. 5
    
6.
Christensen GJ. Soft-tissue cutting with laser versus electrosurgery. J Am Dent Assoc 2008;139:981-4.  Back to cited text no. 6
    
7.
Kois JC. Clinical techniques in prosthodontics: Relationship of the periodontium to impression procedures. Compend Contin Educ Dent 2000;21:684.  Back to cited text no. 7
    
8.
Neiburger EJ. Rapid healing of gingival incisions by the helium-neon diode laser. J Mass Dent Soc 1999;48:8-13, 40.  Back to cited text no. 8
    
9.
Damante CA, Greghi SL, Sant'ana AC, Passanezi E. Clinical evaluation of the effects of low-intensity laser (GaAlAs) on wound healing after gingivoplasty in humans. J Appl Oral Sci 2004;12:133-6.  Back to cited text no. 9
    
10.
Schwarz F, Aoki A, Sculean A, Becker J. The impact of laser application on periodontal and peri-implant wound healing. Periodontol 2000 2009;51:79-108.  Back to cited text no. 10
    
11.
Bader HI. Use of lasers in periodontics. Dent Clin North Am 2000;44:779-91.  Back to cited text no. 11
    
12.
Pick RM, Colvard MD. Current status of lasers in soft tissue dental surgery. J Periodontol 1993;64:589-602.  Back to cited text no. 12
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]



 

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