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Brooklyn Orthodontist Ted Rothstein demonstrates laser gum reshaping Gingivectomy

This film is intended to be shown as a 28 minute film on BCAT, and  as a  15-minute (or a two-part: 10-minutes each part) YouTube Video

Preparatory notes for videographer regarding filming the gum reshaping ("Gingivectomy") procedure.

(Suggested subject of film Clip in red)

 INTRODUCTION:

(Head shot: DrTed introduces subject)

Overgrown gums can substantially detract from an otherwise beautiful orthodontic treatment correction of a patient’s smile, and at times even impede the progress of orthodontic treatment dramatically. Consequently, one of the most common problems at the completion of orthodontic treatment is the need to resculpture/reshape the gums of patients whose gums have become bulbous/ overgrown/ uneven or misshapen. The soft tissue diode Laser can accomplish this in most cases painlessly, without swelling and without surgery/bleeding and without the need for stitches. It has a variety of other useful applications.

http://www.youtube.com/watch?v=YuuWzpm7nLI
(Here is  how normal gums look)  Images of "normal gums"
Images of "overgrown gums"

(shot revealing Kal-El’s overgrown- -BUT NOT INFLAMED--gums)

(Shot back to normal gums)

 (Shots of the Diode Laser)

Soft Tissue Laser Gum Reshaping Using the Diode 810 Laser: Kal-El Johnson-- age 15y/o

The expected time to complete the reshaping is 45-60 minutes.

Family and patient have visited the drted.com laser gum reshaping page and previewed the pertinent videos. The INFORMED CONSENT is an especially useful document for it provides important and helpful information to both the Parent-Patient and the Doctor.  It should be included as part of the video.  http://drted.com/LaserGumTrimmingGingivectomy.htm

(Film Clip showing the informed Consent)

Parent must read and sign the Inform Consent which is located on the same page as the videos.

Kar-El is seated where Dr. Rothstein usually treats him.

Just in back of the patent's dental chair is placed the Diode Laser in the top of the portable suction machine (which may or may not be used- usually not).

We will briefly acquaint Kal-El with the procedure and what he will experience.

(Medium Shot of Dr. Ted and Kal-El in the chair listening to DrTed describe the procedure and asking question as may be the case. Dr. Ted will show Kal-El the finger-up method to indicate he want DrTed to stop)

All members of the team will be wearing Laser safety-glasses including the videographer, Kal-El, Brian and myself. (Shot of Sign)

The Laser Safety Officer staff member will have posted a sign outside the treatment room warning that a laser procedure is being performed and "Please do not enter" during Laser Reshaping Gum Reshaping procedure.

(Close up of gums being painted)

We will begin by paint his gums high up with a gum numbing ointment and then wait for 5 minutes.

This will numb the area where I am going to give him an injection of local anesthetic “Novacaine”.  He will be given one injection to the right of his midline and one to the left of his midline.

The gum-numbing ointment greatly reduces the discomfort typically felt when an injection is given.

(Dr. Ted is shown administering the anesthetic)

We will then wait 10-15 minutes for the anesthesia to take effect on the gums that we are aiming to reshape.

During this wait we will test his gums with a semi-blunt instrument to be certain that he has achieved TOTAL /PROFOUND anesthesia.

(DrTed is shown pressing blunt instrument in to Kal-El’s gums to test that patient is profoundly anesthetized)

When anesthesia is completed and the patient assures us it is profound we can begin.

First we will photograph the gums to be reshaped the "BEFORE"

(Close-up of patient’s gums needing to be reshaped.)

We will then measure the depth and shape of the gums using a probing instrument with a small ruler and those measurements will be noted on the pre-operative sheet.

(Film showing how depth of overgrown tissue is measured with ruler-instrument, and gums marked to remove the correct amount of tissue.)

Typically Brian sits on the other side of the patient chair and assists in use of the laser reshaping since he has a perspective of the gums that reinforces our notion of the tissue that has to be reshaped (we use the term  "vaporizing the  tissue"

Upon marking out the tissue to be removed we set the laser machine to the watts of power we want to begin vaporizing the tissue at. Typically we choose 1.7 watts to 2.0 watts of “continuous” power. Sometimes we switch to the "pulsed" power setting and raise the wattage for more effective vaporizing.

(Shot of laser instrument control panel monitor).

Brian will "INITIATE" the tip of the laser's electrode with carbon paper thereby effectuating a sufficient efficient energy level to effectuate the vaporizing action.

(DrTed introduce assistant Brian Millard)

(Shot of Brian “initiating” the laser vaporizing tip with carbon paper)

I will begin reshaping the gums on the patient's right side. The power is activated and stopped by stepping on a foot-pedal.

When the laser is actively vaporizing/removing the overgrown gum tissue the laser cutting tip glows brightly and an audible beep will be heard every 3 seconds and a slight wisp haze can be noticed rising from the patient’s gums.

Where the gum tissue has been vaporized it turns color which will be visualized as being “caramel” color

(Various clips showing reshaping in action; cleaning tip of instrument and bathing surgical wound with peroxide)

We stop momentarily to take measurements to see how close we are getting to the target amount of tissue we planned on removing /reshaping.

We also stop momentarily to clean/remove the vaporizing tip of the tissue that was removed and is sticking to the tip.

We also stop momentarily to clean away tissue that has been cut but still adheres to the gums.

We frequently bathe the surgical wound with peroxide to keep it clean from tissue debris; it also disinfects and removes any tissue that shows charring.

(Various clips showing reshaping in action; cleaning tip of instrument and bathing surgical wound with peroxide)

 

The goal of setting the proper power level is to avoid charring and rather leave a caramel colored surgical wound.

Rarely is bleeding encountered; when bleeding is encountered it is minor and soon stops: this non-bleeding is because as the laser tip vaporizes it also cauterizes/seals the blood vessels and nerve endings.

During the procedure we constantly monitor the patient's welfare. Indeed the patient has been previously advised to raise a finger if they want us to stop and they need to take some "timeout"

When we have completed the gums reshaping the diode laser is turned off and we can remove our glasses.

The surgical wound is thoroughly cleaned again with peroxide and covered over with a Vitamin E coating to soothe the tissue and promote healing.

(Final shot of gums reshaped to normal and back to shot of his gums at the start)

No "bandage"/covering of any kind is placed over the gums since there is no bleeding and the gums have been desensitized.

The anesthesia will wear off in 1-2 hours.

(DrTed addresses Kal-El re use of Listerine; wearing-off of anesthesia, avoidance of crunchy food and gentle use of soft toothbrush.)

Patient discomfort is generally mild when the anesthesia wears off.

Discomfort the following day, if any, is well tolerated by the patient.

We will provide 6 Advil in case discomfort exceeds patient's tolerance which is rare in our experience.

Healing is typically uneventful over the next few days and by the 7th day the gums are back to normal.

We suggest that the patients begin brushing with a soft brush as soon as possible and to avoid foods that are crispy, crunchy and crusty so as to avoid aggravating the healing tissue. 

We encourage Kal-El write about his experience with special attention to what he experienced in the days following the Laser Gum Trimming.

DrTed is shown speaking to Kal-El suggesting he write a narrative about his experience with special reference to the next seven days during which healing will take place.

Following 7-10 days of healing Kal-El returns to office.

(Shot of how gums looked BEFORE laser reshaping and how they look healed--AFTER)

(Some footage of DrTed offering a very short summary of what we have seen)

Cordially,

Dr. Ted Rothstein

September 28, 2012

 

Ted Rothstein DDS PhD
S
pecialist in Cosmetic Orthodontics
and Dentofacial Orthopedics: Adults & Children
Specialist in Orthodontic Jaw Wiring
New Service for Overgrown Gums
American Association of Orthodontists--Life-active
35 Remsen St., Brooklyn NY 11201
7188521551 www.drted.com drted35@aol.com
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