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C2 CLINICAL Cosmetic Tribune U.S. Edition | April 2017 ◊ LASERS, page C1 leaving the affected hard tissue dried out and brittle. Early laser technology that was promoted as appropriate for hard- tissue procedures made lots of noise, cost lots of money and at best achieved minimal and limited results. Recently, however, new laser technology for use on hard-tissue dental structures has proved to be more capable of meeting goals of both practicality and effectiveness. This article, though, will limit its fo- cus to the soft-tissue side: specifically, achieving desired esthetic results by us- ing soft-tissue laser technology to treat gingival hyperplasia. My personal experience with lasers dates back more than 25 years to when I bought a CO2 laser for my private prac- tice. It was an adventurous and costly (about $60,000 in early ’90s dollars) commitment. There were no laser den- tal societies back then — just a few of us dentists trying to find newer techniques to more effectively and comfortably achieve the results our patients desired. Hyperplasia of epithelial tissue of the gingival area breaks the smooth appear- ance of the periodontal tissue, compro- mising esthetic goals. It also makes it difficult for patients to maintain good oral hygiene, leading to inflammation of tissue and increasing risk of progression to periodontitis. Case 1 As illustrated in Fig. 1, a patient present- ed in my office with a singular local- ized dense hyperplastic area, confirmed through oral examination. The 31-year- old female had neat clothes and clean, well-maintained hands and nails. She related how difficult the local area was to clean, describing that cleaning efforts hurt and caused bleeding, especially when she flossed. The local area also didn’t look clean visually, creating an un- esthetic appearance. There was a break in the continuity of the smooth appearance of the gingiva, causing the tooth to ap- pear uneven. As mentioned, there are and have been several laser devices available for years for use in a variety of soft-tissue dental procedures. All have the ability to achieve desired results when the practitioner is experienced with the technology and procedure. Some laser devices have the adaptability for different strengths, but, when used correctly, all can treat soft- tissue disease with desired results. To correct this particular defect, we had the choice of using a sharp, cold-steel in- strument or a laser. We opted to use a di- ode laser, which is easy to use and causes no bleeding in the wound, thus avoiding the need for a periodontal dressing that would be necessary to cover the resulting wound if cold steel was used. The results documented in Figs. 1–4 were achieved using the AMD Picasso (Indianapolis) diode laser exclusively. Instead of being heavy or bulky, it is por- table and lightweight. It can be moved easily into each operatory as needed, removing the need to purchase separate units for each operatory. Also, the fiber tips are disposable, ensuring sterility. A key factor for me in choosing the AMD Picasso laser was cost. Tradition- ally, costs for soft-tissue lasers seemed relatively high, ranging from $12,000 to $120,000. This light, portable system ranges from $2,000 to $2,500. In my ex- Fig. 2 Fig. 3 Fig. 4 Fig. 2: In case No. 1, diode laser removes dense, undesired hyperplastic tissue in minutes with no bleeding. Fig. 3: Periodontal probe in the treated area. There is no tissue depth at all, and the patient is able to maintain her oral health. Fig. 4: Area healed, esthetically blended. Fig. 5 Fig. 5: In case No. 2, initial labial view of teenage patient with inflamed hyperplastic gingiva of maxillary anteriors. Fig. 6 Fig. 7 Fig. 6: Removal of undesired hyperplastic tissue using AMD diode laser with disposable laser tip. Fig. 7: Tissue removed from maxillary anterior area, progressing toward desired results. Fig. 8 Fig. 8: Healed, healthy gingival tissue, homogeneous in color. Patient ready for orthodontics. perience, the system not only achieves results comparable to the more expen- sive systems, but it does so with ease. In this particular case, a diode laser was used. The result was an esthetic, smooth, homogeneous color background that blends unnoticed with its environment and enables oral hygiene techniques that keep the area healthy, esthetically pleas- ing and easily maintainable. thus would not treat him), until the acute periodontitis had been eliminated and overall oral health restored. With the par- ents’ permission secured and the patient showing newly minted enthusiasm, we proceeded with the case, as illustrated in Figs. 5–8. The figures and captions docu- ment the treatment of a simple local hy- perplastic tissue area, as well as a com- plex acutely inflamed hyperplastic area. Case 2 This second case demonstrates use of the diode laser in an acutely inflamed hyper- plastic situation in the maxillary anteri- or of a male teenager who desired a more pleasing smile (Fig. 5). Initially, the patient visited an ortho- dontist to seek treatment of his rotated, overlapping dentition and red, acutely edematous, easily bleeding tissue. The orthodontist advised the patient that he could not treat him predictably (and Conclusion In both of these cases, the patients were treated by using a soft-tissue laser to achieve correct, desired results. While any soft-tissue laser system might have achieved similar results, in these cases, a diode AMD Picasso laser was used. I chose this particular laser primarily because of what I consider to be its rea- sonable cost when compared with oth- ers, its ease of use and the disposable tips that make it easy to maintain sterility. DAVID L. HOEXTER, DMD, FICD, FACD, is director of the International Acad- emy for Dental Facial Esthetics and a clinical professor in periodontics and implantology at Temple University, Philadelphia. He is a diplomate in the International Congress of Oral Implantologists, the American Society of Os- seointegration and the American Board of Aesthetic Dentistry. He lectures throughout the world and has published nationally and internationally. He has been awarded 12 fellowships, including FACD, FICD and Pierre Fauchard. He has a practice in New York City limited to periodontics, implantology and esthetic surgery. Contact him at (212) 355-0004 or drdavidlh@gmail.com. COSMETIC TRIBUNE PUBLISHER & CHAIRMAN Torsten Oemus t.oemus@dental-tribune.com PRESIDENT & CHIEF EXECUTIVE OFFICER Eric Seid e.seid@dental-tribune.com GROUP EDITOR Kristine Colker g.colger@dental-tribune.com EDITOR IN CHIEF DENTAL TRIBUNE Dr. David L. 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