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ePaper created 2015-12-29, 14:54:09 | version 1.38.0
40 3_2015 laser 40 laser_opis przypadku I research 12 I laser2_2015 programmed to 50–75mJ with a frequency of 10 to 30Hz.Toreinforcethehemostasis,theErbiumlaserwith energy of 65mJ is used, frequency of 20Hz and pulse duration of 600 µs.3 Figures 4a–c demonstrates a case withexposureofinterruptingpremolar. Er:YAG laser is very effective when the impacted toothislocatedintra-bony,becauseitcanworkonmu- cosa,gingivalandboneatdifferentparameters.TheEr- biumlaserwithenergymorethan100mJandfrequency of20Hzisusedforsofttissuecuttingandboneremoval. Gingivalremodellingandgingivectomy In children with gingival hypertrophy, we can use variouslasersforgingivalremodelling.Gingivalhyper- trophy can be caused by some hydantoin anticonvul- sants or other medications.58 It can be induced during different stages of orthodontic treatment and espe- cially when there is poor oral hygiene. Also, in cases of toothdecaythatgoesunderthegingiva,it’spossibleto use a laser to remove gingival tissue and proceed throughrepairstageswithoutgingivalhaemorrhage.In gingivectomy,Erbiumlasercanbeusedatlowenergyof 55–80mJ and frequency of 10–20Hz (Figs. 5a–c). The use of water spray reduces pain and helps tissue cool- ing. The procedure is usually accompanied by control- lable bleeding. A gingivectomy during an orthodontic treatment brings the natural contour of the gingival margin.Itmakestreatmenteasierandcomfortableboth forthepatientandtheclinician.Iftheovergrowngingi- valtissuecoversthebrackets,itwillprolongandtrouble thetreatment.Gingivalremodellingimprovesthesmile line.Itisimportanttopreservethebiologicwidthofthe periodontal tissue. The procedure is performed under anaesthesia and the parameters for Er:YAG laser must bereducedto50mJ,10–20Hz. Laser therapy offers minimally painful treatment that will not leave negative emotions. The technique is safe,fastandeasytoreproduce.Thedecreasedoperat- ing time leads to patient’s acceptance and early treat- mentwithoutwaitingforfurthercomplications. Treatmentofaphthousulcersandherpeticlesions Aphthous ulcers are very common in children. One oftheeasiestandmostappropriatewaystotreatthese lesionsistheapplicationofalowpowerlaserliketheEr- biumlaserwithoutusinglocalanaesthesia.Itispossible touseErbiumlaserwithfrequencyof15Hzandenergy of 35mJ in a non-contact way. First, the laser is main- tainedfor15sonthelesionandthenitismovedinaro- tation pattern above the lesion. The treatment is pro- longedtoa1mmmarginoutsidethelesion.59, 60 Theidea is to detoxify and dehydrate the ulcer as well as to in- ducebio-stimulatingeffect.59 Herpetic gingivostomatitis is the most frequent oralpathologyinsmallchildren.Alasertreatmentwith mid-infrared lasers like Erbium laser, allow the evolu- tionofthelesionsandconsequentlyinstantdehydra- tion.Er:YAGlasereffectivelystopsthepainandmakes the treatment procedures shorter in time and less in number. Minimal energy at a low frequency must be usedatthebeginningofatreatmentaroundthelesion and then towards the centre of the lesion. The white appearance is an indication for a complete dehydra- tion. The procedure it asymptomatic and has a lasting relief. Medicallycompromisedconditions To provide thorough and safe treatment for med- ically compromised patients, who cannot tolerate care, dentists must carry out more complex dental treatmentsforthesafetyandcomfortofthepatients. Physically and emotionally exhausting treatments cannot be tolerated by such patients. Naturally, sys- temically compromised patients quickly discover that theycannotwithstandthestressofroutinetreatment used in conventional dentistry. Therefore, after some unpleasant experiences, patients will only seek dental support when there is an emergency or when they have aesthetic concerns, and they abandon elective complete treatment.61 The treatment of oral diseases that individuals with systemic conditions receive has a direct impact on their overall health and/or medical therapy,andincludescaretocontrolandmitigatepain and infection and the restoration of function. Oral health care is an integral part of systemic treatment. _Patient emotional impact-based situations The terms dental fear, dental anxiety and dental phobia are currently being used interchangeably in dental literature when referring to negative feelings related to dental treatment. Dental fear represents a normal emotional reaction to a specific external threateningstimulusinadentalsituation.Dentalanx- Figs. 5a–c_Laser gingivectomy of lower left quadrant with LiteTouch, Er:YAG laser. Fig. 5a Fig. 5b Fig. 5c