By Dr Sana Farista, Dr Shanin Farista
Every discipline of dentistry has been positively affected by laser technology. From pediatric and operative to periodontics, from prosthetics to cosmetics and Implantology; lasers have made a tremendous impact on the delivery of dental care in the 21st century and will continue to do so as technology continues to improve and evolve. At the same time, it justifies the phrase that gleamy beam (lasers) definitely dominates over cutlass (scalpel) because of numerous known advantages.
Diode laser is versatile and has been used in wavelengths 800-980nm.This article enlightens some of the clinical applications of the 810nm diode laser (Picasso, AMD LASER®), 940 nm diode (Biolase,Ezlase®), 980 nm diode laser (DC lase, DC International) for the management of procedures like gingival polyp, removal of mucocele, papilloma excision, aesthetic gingival sculpting/contouring and lip depigmentation.
Case 1: GINGIVAL POLYP
Gingival Polyps are localized reactive soft tissue lesions also known as localized gingival enlargement. The primary reason for the occurrence of gingival polyp or epulis is attributed to local factors such as caries, calculus and tooth malposition. The gold standard for its treatment is surgical excision performed with a scalpel, electrocautery or lasers. The primary purpose of utilizing a laser in pediatric patients is to create an atmosphere devoid of fear and anxiety while enhancing the treatment acceptability, and to serve this purpose a diode laser is ideal choice with its excellent hemostatic abilities, minimal pain and immediate restorability. (Figure 1-3)
Case 2: REMOVAL OF MUCOCELE
Mucocele or retention cysts are mucus-filled cavities in the oral cavity, which are painless most of the times and reoccur if total elimination is not achieved. Tentative diagnosis of a mucocele is made from the clinical history, clinical presentation and palpation of the lesion and the definitive diagnosis is made by histopathology. Various treatment options have been reported in the literature such as surgical removal, the creation of a pouch (marsupialisation), freezing (cryosurgery), micromarsupialisation and laser vaporization. In this case, as the lesion was huge and deep seated, the procedure required the use of local anesthetic agent and sutures but the excellent hemostatic properties and minimal post operative discomfort added to credit of lasers, keeping the procedure effective and easy. (Figure 4-6).
Case 3: PAPILLOMA EXCISION
Oral squamous papilloma is one of the most common benign epithelial neoplasm frequently seen on the tongue, palate, uvula and gingiva and found to be associated with Human Papilloma Virus (HPV) 6 and 11. Laser assisted surgery as a treatment protocol is advantageous because of salient features like successful hemostasis, devoid of suture, wound sterilization, free from post operative pain and edema along with less chair side time consumption.(Figure 7-10) Surgery performed with the laser showed significant reduction in virus load per cell as compared with scalpel and electrocautery.
Case 4: ESTHETIC GINGIVAL SCULPTING/CONTOURING
Gingival sculpting is to remove and resculpt uneven or enlarged gingival tissue at the same time taking into consideration biologic width of gingiva. In our case, sculpting was done to upper left central incisor to match the zenith of the right upper central incisor followed by immediate diastema closure for complete esthetic enhancement. This resulted in creation of right balance between the pink and white component ultimately leading to healthy and natural looking smile. (Figure 11-13).
Case 5: LIP DEPIGMENTATION
Lip hyperpigmentation is a prime issue with the young adults where the dark patchylip makes an unsightly appearance. This enhances the personality of the patients. Different from facial skin, the lip skin is more delicate and very sensitive to the outside environment and thus, requires a more meticulous approach. The lip depigmentation procedure using laser is bloodless, relatively painless, reduced anesthesia and medications and has initiated and encouraged the patient’s to undergo such corrections willingly. (Figure 14-17)
Looking to the future, it is expected that minimally invasive laser technologies will become essential components of contemporary dental practice as long as the clinician receives the proper training to use this technology safely and effectively.
Fig 1: 11-year-old patient with gingival polyp.
Fig 2: Diode laser assisted excision.
Fig 3: Immediately after the procedure, good homeostasis achieved.
Fig: 4 Pre-operative view of mucocele in lower labial mucosa.
Fig 5: Immediate postoperative view under local anaesthesia.
Fig 6: Lesion after removal.
Fig 7: Pre-operative view of papilloma on the tongue.
Fig 8: Excision of the lesion using Diode Laser.
Fig 9: Immediate post-operative view.
Fig 10: Post-operative view after ten days.
Fig 11: Gingival Zenith before the procedure.
Fig 12: Sculpting the gingiva with Diode Laser.
Fig 13: Gingival Zenith immediate post-operatively.
Fig 14: Pre-operative View of 19 year old boy with lip hyperpigmentation.
Fig 15: Using diode laser for depigmentation procedure.
Fig 16: Immediate post-operative view.
Fig 17: One month post-operative view.