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Ortho Tribune Middle East & Africa No.1, 2018

Dental Tribune Middle East & Africa Edition | 1/2018 ◊Page E3 ORTHO TRIBUNE gingival enlargement, on the basis of some studies, in cases of poor oral hygiene status.7 However, there is no clear definition on its aetiology, al- though it is probably associated with the inflammatory response induced by the corrosion of orthodontic ap- pliances, particularly those of nickel,8 linked to an inflammatory response considered a Type IV hypersensitiv- ity and manifested as nickel-induced allergic contact stomatitis, even if its aetiology has not yet clearly been de- fined.9 The treatment of these conditions is surgical. Histological and histochem- ical studies have demonstrated that the removal of the gingival papilla can promote the formation of nor- mal connective tissue.10 Because the classic intervention performed by scalpel has some disadvantages, mainly linked to the discomfort for the patient (e.g. anaesthesia by in- jection and sutures), there has been great interest in the utilisation of la- ser technology. Case report A 14-year-old female patient was referred to our department by the orthodontics unit because, at the end of fixed orthodontic treatment, she had developed gingival en- largement in the upper arch (Fig. 1), probably related to the fast closure of the spaces associated with very poor oral hygiene due to bleeding during toothbrushing. Just after the removal of the appliance, a topical anaesthetic (EMLA, AstraZeneca) was applied to the gingivae (Fig. 2) and a gingivectomy was performed using a diode laser (XD-2, Fotona) accord- ing to the technique of removal of the inter dental papillae (Fig. 3). The parameters used were as follows: a wavelength of 808 nm,3 W in contin- uous wave, a 320 µm fibre in contact mode. The intervention had a dura- tion of 375 seconds, and the patient did not feel any pain (Fig. 4). After the intervention, the patient did not take any kind of pain medication, and the healing process was completed in five days (Fig. 5). Discussion The first laser appliance was built by Maiman in 1960, and some years later, it was successfully employed in medicine and in oral surgery with several advantages. It may provide excellent incision performance with sealing of small blood and lymphatic vessels, resulting in haemostasis and reduced postoperative oedema. Furthermore, target tissues are dis- infected as a result of local heating and production 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 ad- vantages, such as reduced cost and size, and offer the operator the pos- sibility to work both in continuous and chopped mode. Based on our experience, we can confirm that this technology may represent a new ap- proach to the resolution of gingival enlargement during orthodontic treatment, with better comfort for the patient during and after surgery. Editorial note: The article was origi- nally published in International Mag- azine for Orthodontics 2/2017. The list of references is available from the publisher. Prof. Carlo Fornaini is a lecturer at the MI- CORALIS Laboratory of the Côte d’Azur Univer- sity in Nice, France, and a dentist at the “Special Needs and Maxillofacial Surgery Unit” of the “Guglielmo da Sali- ceto” hospital in Piacenza, Italy. He can be contacted at: E3 Dr Aldo Oppici is the Head of “Special Needs and Maxillofa- cial Surgery Unit” of the “Guglielmo da Saliceto” hospital in Piacenza, It- aly. Dr Elisabetta Merigo is a lecturer at the MI- CORALIS Laboratory of the Côte d’Azur Univer- sity in Nice, France, and a dentist at the “Special Needs and Maxillo fa- cial Surgery Unit” of the “Guglielmo da Saliceto” hospital in Piacenza, Italy. Dr Luigi Cella “Special Needs and Maxillofacial Surgery Unit” of the “Guglielmo da Saliceto” hospital in Piacenza, Italy. The role of 3-D imaging systems in present orthodontics By Dr Enrique González García, Mexico our patients and resulting in a more thorough diagnosis. tain the most essential information that these methods provide. Abstract Traditionally, the diagnosis in ortho- dontics gives a lot of importance to cephalometry and the analysis of the dental casts. The development of new technologies does not intend to discard traditional concepts, in fact, it intends to provide more informa- tion allowing a wider approach of Introduction Adapting to new three-dimensional concepts is not an easy task and is even harder considering that the in- formation is so vast that it can result overwhelming. That is why when evaluating a patient for orthodontic treatment, it is intended to use a sys- tematic method so that we can ob- The method consists of the follow- ing: · Coronal, sagittal and axial general visualisation · Teeth and surrounding structures · Airways and paranasal sinuses · Soft tissues · Temporomandibular joint (TMJ) General visualisations To perform a general exploration, it is necessary to know the three ana- tomical planes: coronal plane, sagit- tal plane and axial plane. Coronal plane (Figs. 1 & 2) The coronal plane is located in the anterior part of the face, approxi- mately parallel to the buccal surfaces of the anterior teeth. It divides the skull in two; anterior and posterior. Fig. 1: 3-D reconstruction inferior view. Fig. 2: Coronal plane Fig. 3: 3-D reconstruction anterior view. Structures can be seen from back to front or front to back. Sagittal plane (Figs. 3 & 4) The sagittal plane divides the skull in two symmetrical parts. Has a transversal orientation allowing examining two segments: right and left. Axial plane (Figs. 5 & 6) The axial plane is parallel to the floor and the occlusal plane. It divides the skull in two equal parts: superior and inferior, allowing the view of struc- tures from top to bottom and bot- tom to top. The overview of these three anatomical planes should give the specialist a complete exploration of the 3-D anatomy. The result is a deeper knowledge of the anatomy of the patient or, like in some cases, a number of findings that might result in the modification of our treatment plan. Teeth and surrounding bone structures For obvious reasons, one of the main areas to check is the dental zone. Im- ages that allow to check the teeth that are present and the ones in pro- cess of eruption, if that is the case, should be generated. As well as the characteristics of the adjacent bone and even take some numeric refer- ences. Airways and paranasal sinuses Breathing is the foundation of life. CBCT scans offer a precise visual of the airways and surrounding cranio- facial structures that influence them, such as the mandible, palate, parana- sal sinuses, facial relations, adenoid Fig. 4: Sagittal plane Fig. 5: 3-D reconstruction anterior view Fig. 6: Axial plane. ÿPage E4

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