Abstract
It is quite common to note chronic inflammatory Gingival overgrowths during and/or post orthodontic treatment. Sometimes the overgrowths may even potentially complicate and/or interrupt orthodontic treatment. With the introduction of soft tissue lasers these problems can now be addressed more easily. Amongst many LASERS now available in Dentistry DIODE LASERS seem to be most ideal for orthodontic soft tissue applications. As newer treatments herald into minimally invasive techniques, DIODE LASERS are becoming more promising both in patient satisfaction and dentist satisfaction.
How to cite this article: Shankar BS, Ramadevi T, Neetha M S, Reddy P S K, Saritha G, Reddy J M. Chronic Inflammatory Gingival Overgrowths: Laser Gingivectomy & Gingivoplasty. J Int Oral Health 2013; 5(1):83-87.
Keywords: : Gingival overgrowth, LASERS, DIODE, Compliance
Introduction:
It is quite common to note chronic inflammatory Gingival overgrowths during and/or post orthodontic treatment. Sometimes the overgrowths may even potentially complicate and/or interrupt orthodontic treatment. In spite of frequent patient education and motivation of the patient regarding oral hygiene, it's quite common to see patients developing gingival over growths because of poor compliance and complicated orthodontic appliance designs. Conventionally surgical gingival overgrowths are treated by Gingivoplasty or Gingivectomy using Surgical knifes & Blades. After evolution of soft tissue LASERS( Light Amplification by Stimulated Emission of Radiation) patients conventional techniques are replaced by LASER Gingivoplasty & Gingivectomy. The potential advantages of LASERS include: Minimized intra operative bleeding, Less operating time, Faster healing, Less postoperative pain and swelling, Good patient acceptance and ease for orthodontist to resume back to treatment fast1-4.
This article presents case reports of successfully treated gingival overgrowths with Diode LASERS.
Degree of gingival overgrowths can be scored as5
Grade 0: No signs of gingival overgrowth.
Grade 1: Overgrowth confined to Interdental papilla.
Grade 2: Overgrowth involves papilla and marginal gingival.
Grade 3: Overgrowth covers three quarters or more of the crown.
Case 1:
A 19 year old female patient was referred from depigmentation of Maxillary anterior Gingiva was performed. Post operatively patient was quite
Department of Orthodontics to Department of Periodontology after her orthodontic treatment for correction of Gingival symmetry. Clinical examination revealed Grade II Gingival Overgrowths in relation to Maxillary & Mandibular anteriors. Patient also has significant physiological melanin pigmentation of attached Gingiva , Marginal Gingiva and Inderdental satisfied with both gingival symmetry and gingival colour.
Case 2:
A 16 year old Female was referred from Orthodontics department to Department of Periodontology during her active treatment phase for assessment of Gingival condition. Clinical papilla (Figure:1). After appropriate patient education she was enrolled for Phase I periodontal therapy. After four weeks of recall there were no significant changes in the Gingival symmetry. Then patient was treated with Diode LASERS and Gingivoplasty and melanin examination revealed generalized gingival enlargements along with generalized bleeding on probing. Orthodontist was advised to remove the arch wires and molar bands. After patient was explained about her gingival condition and the treatment, she was enrolled for Phase I therapy. After for weeks the Phase I therapy results were evaluated and further decision was made to correct the residual Grade II gingival overgrowths by Diode LASERS (Figure: 2). After Diode LASER treatment outcomes7. In longterm orthodontics treatments only a 50% compliance rate has been noted8. Factors which can influence compliance Gingivoplasty gingival architecture was reverted to normal. Orthodontic therapy was resumed after 2 weeks of adequate healing.
Fig. 1: Case 1 Pre and Post Operative Views.
Fig. 2: Case 2 Pre and Post Operative Views.
Case 3:
A 18 year old female patient was referred to Periodontology department amid her Orthodontic treatment. Intra oral examination revealed Grade II type Gingival Overgrowth in relation to Maxillary anteriors and second premolars. Orthodontist was advised to take off the arch wire and patient was enrolled for Phase I periodontal therapy. After evaluation of phase I results the decision was made to correct gingival overgrowths by Diode LASERS. Gingival overgrowth correction and melanin depigmentation of maxillary anterior gingival was done employing Diode LASERS. Orthodontic therapy was resumed after 2 weeks of adequate healing (Figure: 3).
Fig. 3: Case 3 Pre and Post Operative Views.
Discussion:
Improper oral hygiene leads to plaque accumulations and subsequent periodontal problems and caries6. With fixed orthodontic appliances and patients' improper oral hygiene practices can compromise the orthodontic include: patient characteristics,treatment duration and complexity, Dentist and patient relationship and educational and behavioral interventions used9-13.
Orthodontists are frequently challenged by soft tissue problems associated with treatment.
Most frequent challenges include gingival overgrowths and gingival asymmetry that can turn even good treated case into one that falls short aesthetically. Conventional surgical gingivolplasties and gingivectomies have inherent patient related problems like: Surgical trauma, post operatve pain and swelling, poor patient acceptance etc. With the introduction of soft tissue lasers these problems can now be addressed more easily. Amongst many LASERS now available in Dentistry DIODE LASERS seem to be most ideal for orthodontic soft tissue applications14(Table: 1).
Table I: Comparison of LASERS.
DIODE LASERS are most ideal because of inherent advantages like16:
Sole purpose is soft tissue removal
No risk of damage to adjacent tooth Structure
Excellent hemostasis
Dry-field operation
Light contact of the fiber tip with tissue
Proprioceptive feedback
Portability
Incorporation of DIODE LASERS in orthodontists' office also helps to tackle with other soft tissue problems like17-20:
Aesthetic gingival recontouring,
Soft tissue crown lengthening,
Exposure of soft-tissue impacted teeth
Removal of inflamed and hypertrophic tissue and
Frenectomies
Tissue removal at the site for miniscrew
Conclusion:
With the advent of low intensity Soft tissue specific LASERS like DIODE, handling the soft tissue related complaints has become more ease and rewarding. As newer treatments herald into minimally invasive techniques, DIODE LASERS are becoming more promising both in patient satisfaction and dentist satisfaction.
Footnotes
Source of Support: Nil
Conflict of Interest: None Declared
Contributor Information
B Shiva Shankar, Department of Periodontology & Implantology, G Pulla Reddy Dental College & Hospital, Kurnool, Andhra Pradesh.
Ramadevi T, Department of Periodontology & Implantology, G Pulla Reddy Dental College & Hospital, Kurnool,Andhra Pradesh.
Neetha M S, Department of Periodontology, NIMS Dental College, Jaipur, India.
P Sunil Kumar Reddy, Department of Prosthodontics, G Pulla Reddy Dental College & Hospital, Kurnool, Andhra Pradesh.
G Saritha, Department of Conservative Dentistry and Endodontics, G Pulla Reddy Dental College & Hospital, Kurnool, Andhra Pradesh.
J Muralinath Reddy, Vananchal Dental College and Hospital, Jharkhand, India.
References:
- 1.Strauss RA. Lasers in maxillofacial surgery. Dent Clin North Am. 2000;4:851–873. [PubMed] [Google Scholar]
- 2.Coluzzi DJ. An overview of laser wavelengths used in Dentistry. Dent Clin North Am. 2000;4:753–765. [PubMed] [Google Scholar]
- 3.Eduardo CP, Navarro RS, Gontijo I, Haypek P, Correa MS. Utilizacao Clinica do Laser em Odontopediatria. In: Gutknecht N, Gutknecht CP, editors. A Odontologia e o laser- Atuacao do Laser na Especialidade Odontologica. GmbH, Quintessenz Verlags; Berlin: 2004. pp. 241–262. [Google Scholar]
- 4.Gontijo I, Navarro RS, Haypek P, Ciamponi AL, Haddad AE. The applications of diode and Er:YAG lasers in labial frenectomy in infant patients. J Dent Child. 2005;72:10–15. [PubMed] [Google Scholar]
- 5.Bokenkamp A, Bohnhorst B, Beier C. Nifedipine aggravates cyclosporine A induced hyperplasia. Pediatr Nephrol. 1994;8:181. doi: 10.1007/BF00865474. [DOI] [PubMed] [Google Scholar]
- 6.Loe H, Theilade E, Jensen SB. Experimental gingivitis in man. J Periodontol. 1965;36(3):177–187. doi: 10.1902/jop.1965.36.3.177. [DOI] [PubMed] [Google Scholar]
- 7.Gwinnett AJ, Ceen RF. Plaque distribution on bonded brackets: a scanning microscope study. Am J Orthod. 1979;75(6):667–677. doi: 10.1016/0002-9416(79)90098-8. [DOI] [PubMed] [Google Scholar]
- 8.Morris LS, Schulz RM. Patient compliance—an overview. J Clin Pharm Ther. 1992;17(5):283–295. doi: 10.1111/j.1365-2710.1992.tb01306.x. [DOI] [PubMed] [Google Scholar]
- 9.McGlynn FD, LeCompte EJ, Thomas RG, Courts FJ, Melamed BG. Effects of behavioral self-management on oral hygiene adherence among orthodontic patients. Am J Orthod Dentofacial Orthop. 1987;91(1):15–21. doi: 10.1016/0889-5406(87)90204-6. [DOI] [PubMed] [Google Scholar]
- 10.Yeung SC, Howell S, Fahey P. Oral hygiene program for orthodontic patients. Am J Orthod Dentofacial Orthop. 1989;96(3):208–213. doi: 10.1016/0889-5406(89)90457-5. [DOI] [PubMed] [Google Scholar]
- 11.Rinchuse DJ, Rinchuse DJ, Zullo TG. Oral hygiene compliance; a clinical investigation. Clin Orthod. 1992;26(1):33–38. [PubMed] [Google Scholar]
- 12.Weinstein R, Tosolin F, Ghilardi L, Zanardelli E. Psychological intervention in patients with poor compliance. J Clin Periodontol. 1996;23(3 pt. 2):283–288. doi: 10.1111/j.1600-051x.1996.tb02090.x. [DOI] [PubMed] [Google Scholar]
- 13.Richter DD, Nanda RS, Sinha PK, Smith DW. Effect of behavior modification on patient compliance in orthodontics. Angle Orthod. 1998;68(2):123–132. doi: 10.1043/0003-3219(1998)068<0123:EOBMOP>2.3.CO;2. [DOI] [PubMed] [Google Scholar]
- 14.Coluzzi DJ. An overview of lasers in dentistry. Alpha Omegan. 2008;101(3):125–126. doi: 10.1016/j.aodf.2008.09.001. [DOI] [PubMed] [Google Scholar]
- 15.Coluzzi DJ. An overview of lasers in dentistry cont. Alpha Omegan. 2008;101(4):179–180. doi: 10.1016/j.aodf.2008.10.004. [DOI] [PubMed] [Google Scholar]
- 16.Fornaini C, Rocca JP, Bertrand MF. Nd:YAG and diode lasers in the surgical management of soft tissues related to orthodontic treatment. Photomed Laser Surg. 2007;25(5):381–392. doi: 10.1089/pho.2006.2068. [DOI] [PubMed] [Google Scholar]
- 17.Hilgers JJ, Tracey SG. Clinical uses of diode lasers in orthodontics. J Clin Orthod. 2004;38:266–273. [PubMed] [Google Scholar]
- 18.Sarver DM. Use of the 810 nm diode laser: soft tissue management and orthodonticapplications of innovative technology. Practice Proced Aesthet Dent. 2006;18:7–13. [PubMed] [Google Scholar]
- 19.Gontijo I, Navarro RS, Haypek P. The applications of diode and Er:YAG lasers in labial frenectomy in infant patients. J Dent Child. 2005;72(1):10–15. [PubMed] [Google Scholar]
- 20.Sarver DM, Yanosky M. Principles of cosmetic dentistry in orthodontics: part 3. Laser treatments for tooth eruption and soft tissue problems. Am J Orthod Dentofacial Orthop. 2005;127:262–264. doi: 10.1016/j.ajodo.2004.07.036. [DOI] [PubMed] [Google Scholar]