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ePaper created 2017-09-06, 09:11:22 | version 1.38.0
case report diode laser during orthodontic treatment Use of diode laser in the treatment of gingival enlargement during orthodontic treatment: Case report Authors: Prof. Carlo Fornaini, Drs Aldo Oppici, Luigi Cella & Elisabetta Merigo, Italy Introduction In recent decades, we have witnessed the sub- stantial development and expansion of the use of fixed orthodontic appliances. While their application has many advantages, several prob- lems related to the health of the soft tissue may sometimes appear during treatment. In fact, the use of fixed orthodontic appliances may provoke labial desquamation,1 erythema mul- tiforme, 2 gingivitis 3 and gingival enlarge- ment.4 Gingival enlargement is a very common com- plication during orthodontic treatment,5 but for- tunately, it seems to be transitory and generally resolves after orthodontic therapy, even if some- times incompletely. Gingival overgrowth induced by orthodontic treatment shows a specific fibrous and thickened gingival appearance, diferent from fragile gingiva with marginal gingival redness common in allergic or inflammatory gingival lesions.6 Several clinical studies suggest that ortho- dontic treatment may be associated with a de- crease in periodontal health, causing a hypertro- phic form of gingivitis. However, the actual pathogenesis of gingival enlargement is not yet completely understood, although probably in- volves increased production by fibroblasts of amorphous ground substance with a high level of glycosaminoglycans. Increases in mRNA ex- pression of Type I collagen and up-regulation of keratinocyte growth factor receptor could play an important role in excessive proliferation of epithelial cells and increased development of gingival enlargement, on the basis of some stud- ies, in cases of poor oral hygiene status.7 How- ever, there is no clear definition on its aetiology, although it is probably associated with the in- flammatory response induced by the corrosion of orthodontic appliances, particularly those of nickel,8 linked to an inflammatory response con- sidered a Type IV hypersensitivity and manifested as nickel-induced allergic contact stomatitis, even if its aetiology has not yet clearly been defined.9 The treatment of these conditions is surgical. Histological and histochemical studies have demonstrated that the removal of the gingival papilla can promote the formation of normal con- nective tissue.10 Because the classic intervention performed by scalpel has some disadvantages, mainly linked to the discomfort for the patient (e.g. anaesthesia by injection and sutures), there has been great interest in the utilisation of laser technology. 16 ortho 2/2017