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ePaper created 2018-03-14, 11:21:34 | version 1.38.0
| industry Periodontal aesthetics with soft-tissue lasers Dr David L. Hoexter, USA The use of lasers in dentistry—and in medical proce- dures in general—has made great strides in recent years, not only in effectiveness but also in acceptance by pa- tients. Our colleagues in medicine, such as dermatolo- gists and ophthalmologists, have used lasers for years for myriad reasons. Visiting a dermatologist’s office recently, I observed a variety of large, bulky and costly lasers. The different types have been needed because the doctor’s choice of laser power source will vary based on the de- sired outcome goals for the procedure. Dermatological procedures are chiefly concerned with soft tissue—its re- sponses and reactions defensively as well as offensively. Fig. 1 Fig. 2 16 1 2018 As has been true with general medical uses of lasers, the laser systems recommended for dentistry have been relegated primarily to soft-tissue procedures. The reason for this is that with the exception of relatively recently in- troduced technology, using lasers on hard tissue in den- tistry would typically cause desiccation of the tooth or bone being treated, 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 technol- ogy 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 focus to the soft-tis- sue side: specifically, achieving desired aesthetic results by using 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 la- ser for my private practice. It was an adventurous and costly (about $60,000 in early ’90s dollars) commit- ment. There were no laser dental 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 appearance of the periodontal tissue, compromising aesthetic goals. It also makes it difficult for patients to maintain good oral hygiene, leading to in- flammation of tissue and increasing risk of progression to periodontitis. Case 1 As illustrated in Figure 1, a patient presented in my of- fice with a singular localised dense hyperplastic area, Fig. 1: Dense hyperplastic tissue interproximally between the tooth #11 and tooth #12. Because the hyperplastic overgrowth inhibits accessibility, the patient is unable to reach the desired area to maintain good oral hygiene. Fig. 2: In case 1, diode laser removes dense, undesired hyperplastic tissue in minutes with no bleeding.