Ortho Tribune United Kingdom Edition No. 2, 2017

22 ORTHO TRENDS Ortho Tribune United Kingdom Edition | 7/2017 Use of diode laser in the treatment of gingival enlargement during orthodontic treatment: Case report Prof. Carlo Fornaini, Drs Aldo Oppici, Luigi Cella & Elisabetta Merigo, Italy orthodontic In recent decades, we have wit- nessed the substantial develop- ment and expansion of the use of ﬁ xed appliances. While their application has many advantages, several problems re- lated to the health of the soft tis- sue may sometimes appear during treatment. In fact, the use of ﬁ xed orthodontic appliances may pro- voke labial desquamation,1 ery- thema multiforme,2 gingivitis3 and gingival enlargement.4 therapy, even Gingival enlargement is a very common complication dur- ing orthodontic treatment,5 but fortunately, it seems to be transi- tory and generally resolves after orthodontic if sometimes incompletely. Gingi- val overgrowth induced by ortho- dontic treatment shows a speciﬁ c ﬁ brous and thickened gingival appearance, different from frag- ile gingiva with marginal gingival redness common in allergic or in- ﬂ ammatory gingival lesions.6 Increases Several clinical studies sug- gest that orthodontic treatment may be associated with a de- crease in periodontal health, causing a hypertrophic form of gingivitis. However, the actual pathogenesis of gingival enlarge- ment is not yet completely un- derstood, although probably in- volves increased production by ﬁ - broblasts of amorphous ground substance with a high level of gly- cosaminoglycans. in mRNA expression of Type I colla- gen and upregulation of kerati- nocyte growth factor receptor could play an important role in excessive proliferation of epithe- lial cells and increased develop- ment of gingival enlargement, on the basis of some studies, in cases of poor oral hygiene status.7 How- ever, there is no clear deﬁ nition on its aetiology, although it is probably associated with the in- ﬂ ammatory response induced by the corrosion of orthodontic ap- pliances, particularly those of nickel,8 linked to an inﬂ amma- tory response considered a Type IV hypersensitivity and mani- fested as nickel-induced allergic contact stomatitis, even if its aetiology has not yet clearly been deﬁ ned.9 The treatment of these con- ditions is surgical. Histological and histochemical studies have demonstrated that the removal of the gingival papilla can pro- mote the formation of normal connective tissue.10 Because the classic intervention performed 1 3 5 2 4 6 Fig. 1: Clinical view, showing gingival enlargement, just before the debonding procedure. – Fig. 2: Application of a topical anaesthetic. – Fig. 3: Surgical laser-assisted treatment via laser gingivectomy. – Fig. 4: Clinical view just after surgery. – Fig. 5: Healing ﬁ ve days after surgery. – Fig. 6: One month follow-up. Prof. Carlo Fornaini is a lecturer at the MICORALIS Laboratory of the Côte d’Azur University in Nice, France, and a dentist at the “Special Needs and Max- illofacial Surgery Unit” of the “Gugliel- mo da Saliceto” hospital in Piacenza, Italy. He can be contacted at: carlo@fornainident.it Dr Aldo Oppici is the Head of “Special Needs and Maxillofacial Surgery Unit” of the “Guglielmo da Saliceto” hospital in Piacenza, Italy. A.Oppici@ausl.pc.it Dr Elisabetta Merigo is a lecturer at the MICORALIS Laboratory of the Côte d’Azur University in Nice, France, and a dentist at the “Special Needs and Maxil- lofacial Surgery Unit” of the “Guglielmo da Saliceto” hospital in Piacenza, Italy. elisabetta.merigo@gmail.com by scalpel has some disadvan- tages, mainly linked to the dis- comfort for the patient (e.g. an- aesthesia by injection and su- tures), there has been great inter- est in the utilisation of laser technology. Case report A 14-year-old female patient was referred to our department by the orthodontics unit because, at the end of ﬁ xed orthodontic treatment, she had developed gingival enlargement in the up- per arch (Fig. 1), probably related to the fast closure of the spaces associated with very poor oral hy- giene due to bleeding during toothbrushing. Just after the re- moval of the appliance, a topical anaesthetic (EMLA, AstraZeneca) was applied to the gingivae (Fig. 2) and a gingivectomy was per- formed using a diode laser (XD-2, Fotona) according to the tech- nique of removal of the interden- tal papillae (Fig. 3). The parame- ters used were as follows: a wave- length of 808 nm, 3 W in continu- ous wave, a 320 µm ﬁ bre in contact mode. The intervention had a duration of 375 seconds, and the patient did not feel any pain (Fig. 4). After the interven- tion, the patient did not take any kind of pain medication, and the healing process was completed in ﬁ ve days (Fig. 5). Discussion The ﬁ rst laser appliance was built by Maiman in 1960, and some years later, it was success- fully employed in medicine and in oral surgery with several ad- vantages. It may provide excel- lent incision performance with sealing of small blood and lym- phatic vessels, resulting in hae- mostasis and reduced postopera- tive oedema. Furthermore, target tissues are disinfected as a result of local heating and pro- duction of an eschar layer, which results in a decreased amount of scarring owing to decreased post-operative tissue shrinkage, allowing one to avoid the use of sutures. Diodes, the last generation of laser used in dentistry, have several advantages, such as re- duced cost and size, and offer the operator the possibility to work both incontinuous and chopped mode. Based on our experience, we can conﬁ rm that this technol- ogy may represent a new ap- proach to the resolution of gingi- val enlargement during ortho- dontic treatment, with better comfort for the patient during and after surgery. Editorial note: A list of references is available from the publisher. This article was originally pub- lished in the Ortho magazine No.2/2017 Dr Luigi Cella is a maxillofacial surgeon at the “Special Needs and Maxillofacial Surgery Unit” of the “Guglielmo da Sali- ceto” hospital in Piacenza, Italy. L.CELLA@ausl.pc.it

Ortho Tribune United Kingdom Edition No. 2, 2017

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