Dental Tribune Middle East & Africa Edition | 5/2018 ORTHO TRIBUNE 3 Use of diode laser in the treatment of gingival enlargement during orthodontic treatment Case report By Prof. Carlo Fornaini, Drs Aldo Op- pici, Luigi Cella & Elisabetta Merigo, Italy Introduction In recent decades, we have witnessed the substantial development and expansion of the use of fixed ortho- dontic appliances. While their appli- cation has many advantages, several problems 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 ery- thema multiforme,2 gingivitis3 and gingival enlargement.4 Gingival enlargement is a very com- mon complication during ortho- dontic treatment,5 but fortunately, it seems to be transitory and generally resolves after orthodontic therapy, even if sometimes incompletely. Gingival overgrowth induced by or- thodontic treatment shows a specific fibrous and thickened gingival ap- pearance, different from fragile gin- giva with marginal gingival redness common in allergic or inflammatory gingival lesions.6 Several clinical studies suggest that orthodontic treatment may be asso- ciated with a decrease in periodontal health, causing a hypertrophic form of gingivitis. However, the actual pathogenesis of gingival enlarge- ment is not yet completely under- stood, although probably involves increased production by fibroblasts of amorphous ground substance with a high level of glycosaminogly- cans. Increases in mRNA expression of Type I collagen and up-regulation of keratinocyte growth factor recep- tor could play an important role in excessive proliferation of epithelial cells and increased development of 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 histo- chemical studies have demonstrated that the removal of the gingival pa- pilla can promote the formation of normal 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 re- ferred to our department by the or- thodontics unit because, at the end of fixed orthodontic treatment, she had developed gingival enlargement in the upper arch (Fig. 1), probably re- lated to the fast closure of the spaces associated with very poor oral hy- giene due to bleeding during tooth- 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 gingivec- tomy. Fig. 4: Clinical view just after surgery. Fig. 5: Healing five days after surgery. Fig. 6: One month follow-up. brushing. Just after the removal of the appliance, a topical anaesthetic (EMLA, AstraZeneca) was applied to the gingivae (Fig. 2) and a gingivec- tomy was performed using a diode laser (XD-2, Fotona) according to the technique of removal of the inter dental papillae (Fig. 3). The param- eters used were as follows: a wave- length of 808 nm, 3 W in continu- ous 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. Prof. Carlo Fornaini He is a lecturer at the MICORALIS Labora- tory of the Côte d’Azur University in Nice, France. carlo@fornainident.it Dr Elisabetta Merigo She is a lecturer at the MICORALIS Labora- tory of the Côte d’Azur University in Nice, France. elisabetta.merigo@gmail.com Dr Aldo Oppici He is the Head of “Special Needs and Maxillofacial Surgery Unit” of the “Gug- lielmo da Saliceto” hospital in Piacenza, Italy. A.Oppici@ausl.pc.it Dr Luigi Cella He is a maxillofacial surgeon at the “Spe- cial Needs and Maxillofacial Surgery Unit” of the “Guglielmo da Saliceto” hospital in Piacenza, Italy. L.cella@ausl.pc.it 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: This article was originally published in the 2/2017 issue of ortho_interna- tional magazine of orthodontics. A list of references is available from the publisher. AD AVAILABLE SOON Just scan the QR code and to get further details. ormco.eu