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ePaper created 2017-10-26, 15:28:59 | version 1.38.0
| case report Maxillary frenectomy with a diode laser Author: Dr David L. Hoexter, USA There are many opinions, both in favour of and against, regarding utilisation of lasers in periodontal therapy. There are also many reports of the different surgical techniques utilising sharp metallic instru- ments for exacting predictable and desired results. The use of a laser to achieve these results does not mean that there are no other efficient, “classical” procedures that would accomplish the goal. Yet, a laser might be a more direct and efficacious path to achieve the same goal, with easier healing and less side effects. This case presentation allows me to demonstrate the utilisation of a diode laser to allow ease of tech- nique, avoid unnecessary bleeding, avoid the use of sutures (and their removal), and provide a comfort- able transition for the patient without swelling or need for a periodontal dressing after the surgery. Case report Fig. 1: Pretreatment labial view shows the large maxillary frenum and its large attachment. Fig. 2: X-ray of same area. Notice the large dark-appearing space between the centrals’ roots. Note the large restorations’ mesial overhanging margins. Fig. 3: Another labial pretreatment view. In this presentation, a young female patient pre- sented in my office complaining about her frenum in the maxillary anteriors. She related that it hurt when- ever she bit into a firm substance, such as corn on the cob. Her tongue constantly reached to this uncom- fortable area, affecting her speech, and she felt pain in her lip when she tried to smile. A few years prior, she had a lot of dentistry done in her maxillary anteriors for aesthetic purposes. She had been aware of and bothered by a natural, large diastema between her Fig. 1 Fig. 2 Fig. 3 12 laser 3 2017 maxillary centrals. The previous dentist had closed the diastemic space between the crowns by overbonding the area, leaving overhanging margins on the mesial of both centrals (Fig. 1). The area now appeared clini- cally closed, but the constant irritation and bleeding in the area, especially due to the frenum pull, made this teenage patient feel very uncomfortable. X-rays taken by my office revealed an obvious space, seen as a large radiolucent dark area between both central incisor roots, covered with tissue (Fig. 2). In this case, I made a decision to use a laser to do the frenectomy because of the possibility that a classical approach might result in leaving a large void between the centrals. Moreover, use of a laser allows complete control in this technique to avoid what might other- wise be a devastating disaster. If the natural, large void between the centrals submarginally was to have been exposed, it would have left a vast undesirable, unaesthetic, dark-appearing hole. Treatment with diode laser Because this was a surgery that involved only soft- tissue, our choice of lasers is the CO2, Nd:YAG and diode lasers. Other lasers may be used for both soft- and hard-tissue. I chose to utilise just a tissue laser, and chose a diode laser. This diode laser also offered the use of a disposable tip containing a thin fibre that would transmit the therapeutic treatment. The tip, being disposable, will aid in the consistency of main- tenance and hygienic cleansing in and during our treatment. A standard frenectomy, where we might remove the frenum with a sharp stainless steel instrument, might lead to further complications by exposing the large void pointed out in Figure 2 that is covered by tissue. If the frenum is just incised and removed, the area will have an obvious, huge, dark-appearing void. Yet, the frenum should be removed. The obvious restorative necessities and options were discussed first. This young patient wished to do a little at a time, starting with the frenum removal.