Excision and incision biopsies
Hemostatic/Hemostasis assistance
Treatment of apthous ulcers
Gingival incision and excision
Gingivectomy
Gingivoplasty (reshaping)
Gingival troughing
Gingival recontouring
Tissue retractions for impressions
Oral papillectomy
Sulcular debridement
Sulcular tissue removal
Removal of granulation tissue
Frenectomy
Frenotomy
Abscess incision and draining excision
Operculectomy
Removal of fibromas
Soft tissue crown lengthening
VestibuloplastyThe
The 810 Diode Soft Tissue Laser
|
The Informed Consent for Soft Tissue
Laser Procedures* |
|
|
|
| In the CW (continuous wave) mode
the power to vaporize gum (soft) tissue varies .1 watts to 3.0
watts. 1.5 watts is typical. |
In the P (Pulsed wave) mode the power to vaporize gum (soft)
tissue varies .1 watts to 5.0 watts. |
|
|
|
| Here you see me holding the
barrel of the laser which is covered by a protective plastic
sac. |
Here you see me shining the "aiming" beam
(632nm) on my hand. The 810nm laser beam is contained in the
center of the red aiming beam. The laser itself is not
activated. If it were it would be vaporizing my skin. |
|
|
|
| Here you see the mock start of
the maxillary "frenectomy" procedure. In real life very strong
topical anesthesia has been applied or a local injection
anesthesia would be given. The frenectomy takes 5-10 minutes.
There is no bleeding. No stitches are required. |
Here you can see the laser beam within the
aiming beam. The beam is being delivered from a 4mm long
quartz/glass tip 400 microns wide. |
|
|
|
| The assistant, the operator and
the patient are required to wear the laser 810nm wave length
light-specific glasses. |
|
| |
|
|
*Informed Consent for Procedures
in Which the Soft Tissue Laser is Used
The Laser
procedure that will be undertaken is called:
_____________________________
Dr. Rothstein
has strongly advised me to visit his web page at:
http://drted.com/LaserGumTrimmingGingivectomy.htm to obtain
a thorough understanding of the use of the Laser in the
management of soft-tissue problems where laser is an
appropriate/approved form of treatment. He has encouraged me to
look at the videos present on that page in order to acquaint me
with the procedure which is planned for me/my child.
The patient
undergoing the laser soft tissue procedure is allergic to--List allergies
here:
The
fee for the particular Laser service being provided are in
addition to the fee for the Orthodontic treatment and are rarely
covered by insurance. I understand this office does not operate
on the assumption that insurance will reimburse me for the
treatment rendered.
Laser
procedures as a general rule offer positive results that can be
achieved by informed and cooperative patients. Thus, the
following information is routinely supplied to all who are
considering a laser procedure. While recognizing the benefits of
healthy teeth and tissues, you should also be aware that laser
treatment has limitations and potential risks. These are seldom
serious enough to indicate that treatment should be avoided, but
they should be considered in making the decision whether or not
to undergo laser surgery. Laser treatment usually proceeds as
planned; however, as in all areas of medicine, results cannot be
guaranteed, nor can all consequences be anticipated. Some
unexpected consequences/side effects include: post-procedure
swelling, infection and tooth sensitivity.
Laser surgery
strives to improve either the overall appearance of the smile by
reducing and recontouring the gingival tissues, or by removing
the excess gum tissue that is preventing the timely eruption of
permanent teeth, which slows the progression of orthodontic
treatment.
Laser surgery
is performed in our office utilizing a strong topical anesthetic
which is painted onto the gums that are being treated. The
surgery cauterizes the tissue, therefore bleeding is minimal.
The recovery period is brief, lasting for as little as three
days, but for some patients may last up to two weeks. The area
being treated will be a “caramel” color after the procedure is
completed and the patient will experience bleeding during
brushing for the first few days, but brushing should not be
discontinued. Oral antiseptic rinses are recommended to promote
healing in the days following the procedure.
In addition, I have been advised to gently
cleanse the areas that have been treated with a 3% peroxide
solution three times each day for three day and to avoid
traumatizing those areas while tooth brushing as well to avoid
hard crunchy food. Normal oral hygiene can be resumed in 3-7
days.
All forms of
medical and dental treatment have risks and limitations.
Fortunately, complications are infrequent with laser procedures.
Nevertheless, they should be taken into account in deciding
whether to undergo laser surgery. Some of the primary concerns
may include:
1. Prolonged
healing at the surgical site.
2. Possible
gingival recession that may require intervention by a
periodontist
3. The topical
anesthetic may leave the area numb for a minimum of ten-twenty
minutes. Some younger patients may find this feeling awkward and
may make swallowing difficult. Younger patients are cautioned to
avoid chewing or biting their lip or cheek while numb.
4. Although the
strong topical anesthesia is usually effective in
controlling/eliminating pain and discomfort resulting from
reshaping the gum tissue, sometimes a local injection of
anesthetic will be required to entirely eliminate all sensations
of discomfort during the procedure.
5. Gum tissue that has been removed can/will
sometimes regrow especially when good oral hygiene/home care is
not carefully observed.
As with any
elective procedure, there are alternatives that patients/parents
may consider. You may choose to accept your present oral
condition, or chose one of the following alternatives:
1. Have the
procedure performed by an oral surgeon under a local anesthetic
2. Have the
procedure performed by a periodontist, also under a local
anesthetic
3. Decline the
surgery, understanding that orthodontic treatment may be
delayed.
ACKNOWLEDGMENT
OF INFORMED CONSENT
I hereby
acknowledge that the major treatment considerations and
potential risks of laser surgery have been presented to me, I
have read and understand this form and also understand that
there may be other problems that occur less frequently or are
less severe, and that the actual results may be different from
the anticipated results.
Dr. Rothstein
has discussed the planned treatment with me to my satisfaction
and has answered all the questions I presented to him. I have
consented to have him proceed doing the procedure.
I understand that photographs and or video
clips may be produced for
educational/demonstrational/comparative purposes and may be
appropriately placed on the web site showing before and after
images of the areas treated.
Signature/Patient, Parent or
Guardian_____________________________ Date ___________
Witness_________________________ Date ________
|
Literature References
(*Articles Available to Read)
1. Am J Orthod
Dentofacial Orthop. 2005 Feb;127(2):262-4.
HERE AT AAO
*
Principles of cosmetic dentistry in orthodontics: Part 3. Laser
treatments for
tooth eruption and soft tissue problems.
Sarver DM, Yanosky M.
sarverd@aol.com
PMID:
15750548 [PubMed - indexed for MEDLINE]
2. Dent Clin North Am. 2007 Apr;51(2):525-45, xi.
HERE AT AAO
*
Laser use for esthetic soft tissue modification.
Magid KS, Strauss RA.
Department of Cariology and Comprehensive Care, New York University
College of
Dentistry, 345 East 24th Street, New York, NY 10010, USA. drmagid@adfow.com
In esthetic dentistry, expanding the evaluation beyond the teeth is
necessary to
achieve a truly desirable result. The lips, attached and unattached
mucosa, free
gingival margin, and osseous position and contours must be considered
and changed
if
necessary. Although many treatment modalities are available to
accomplish
these modifications, the use of lasers of varying wavelengths provides
advantages
not possible by other means. Lasers are often thought of as generic
instruments,
but different laser wavelengths function differently, and each has its
place in
the esthetic continuum. Diode, neodymium:YAG, CO(2) and erbium lasers
each have
advantages that can be exploited to maximum effect and disadvantages
that must be
taken into consideration. A thorough understanding of their mechanism of
action,
their tissue effects, and laser safety is vital to obtaining excellent
results.
PMID:
17532926 [PubMed - indexed for MEDLINE]
3. Dent Clin North Am. 2004 Oct;48(4):833-60, vi.
HERE AT AAO
* Lasers in aesthetic dentistry.
Adams TC, Pang PK.
Las Vegas Institute, 9501 Hillwood Drive, Las Vegas, NV 89134, USA.
This article focuses on lasers and aesthetic dentistry and their unique
parallel
in
history from their early development to their present day usage and
application. The demand for aesthetic dentistry has had a major impact
not only
on
treatment planning but also on the choice of materials, techniques, and
equipment. It is this demand that has married the use of lasers with
aesthetic
dentistry. A short literature review on the five basic laser types
precedes the
basic premise of smile design and its critical importance in attaining
the
desirable aesthetic end result. A short review on biologic width and
biologic
zone reinforces their importance when manipulating gingival tissue. Four
case
reports highlight the use of diode, erbium, and carbon dioxide lasers.
The end
results show the power of proper treatment planning and the use of a
smile design
guide when using these instruments and confirm a conservative, aesthetic
treatment without compromising the health and function of the patients.
PMID:
15464555 [PubMed - indexed for MEDLINE]
4. Dent Today. 2008 Feb;27(2):156-9.
HERE AT AAO
Soft-tissue surgery: use of the Er,Cr:YSGG laser.
Tracey R.
rtracey@yahoo.com
PMID: 18330202 [PubMed - indexed for MEDLINE]
5.
Gen Dent. 2008 Nov-Dec;56(7):663-70; quiz 671-2, 767.
HERE AT AAO
*
Lasers in cosmetic dentistry.
Pang P.
Academy of Laser
Dentistry.
Lasers have become a necessary instrument in the esthetic restorative
armamentarium. This article presents smile design guidelines for soft
tissue
lasers, as well as an overview of hard tissue procedures that may be
performed
using all-tissue lasers. The goal is to help dentists determine the
appropriate
laser for a given clinical situations.
PMID:
19014026 [PubMed - indexed for MEDLINE]
6. Gen Dent. 1996 Jan-Feb;44(1):47-51.
HERE AT AAO
*
Laser treatment of orthodontically induced gingival hyperplasia.
Convissar
RA, Diamond LB, Fazekas CD.
New York Hospital Medical Center of Queens, USA.
Several studies have shown that gingivitis is common in children and
adolescents.
Introduction of orthodontic devices may exacerbate the gingival
inflammation.
Orthodontically induced gingival hyperplasia in adolescents, its
etiology, and
treatment alternatives are discussed. Three instances in which laser
therapy was
used are described.
PMID: 8940569 [PubMed - indexed for MEDLINE]
7. J Am Dent Assoc. 1998 Jan;129(1):78-83.
HERE AT AAO
*
Case report. Use of an argon laser to treat drug-induced gingival
overgrowth.
Mattson JS, Blankenau R, Keene JJ.
Department of Periodontics, Creighton University School of Dentistry,
Omaha, Neb.
68178, USA.
This article explores the use of an argon laser to treat severe
drug-induced
gingival overgrowth. The patient was being treated with phenytoin (Dilantin,
Parke-Davis), cyclosporine and a calcium channel blocker. He had
undergone a
kidney transplantation and had insulin-dependent diabetes mellitus. He
had severe
gingival overgrowth, which prevented him from wearing his removable
prostheses,
and a superimposed Candida albicans infection. An argon laser was used
to excise
the gingival overgrowth so new maxillary and mandibular prostheses could
be
fabricated.
PMID:
9448349 [PubMed - indexed for MEDLINE]
8.
J Clin Pediatr Dent. 2003 Winter;27(2):123-6.
HERE AT AAO
Cyclosporin-induced gingival overgrowth in a child treated with CO2
laser
surgery: a case report.
Guelmann
M, Britto LR, Katz J.
Department of Pediatric Dentistry, University of Florida, Gainesville,
FL
32610-0426, USA. mguelmann@dental.ufl.edu
A
case of a 10 year-old boy with gingival overgrowth due to cyclosporin
therapy
after heart transplantation is described. Different treatment approaches
are
discussed and the surgical effect of CO2 laser is illustrated. The
critical role
of
routine professional cleaning and good oral health maintenance for the
healthy
status of the gingival tissue is also emphasized in this paper.
Replacement of
cyclosporin by tacrolimus, another immunosuppressive agent associated
with
minimal to none gingival overgrowth, might be considered in cases with
reported
recurrences.
PMID:
12597682 [PubMed - indexed for MEDLINE]
9. N Y State Dent J. 2009 Jun-Jul;75(4):26-9.
HERE AT AAO
*
Laser gingivectomy for pediatrics. A case report.
Kelman
MM, Poiman DJ, Jacobson BL.
Cedars-Sinai Medical Center, Los Angeles, CA, USA. michelle.kelman@gmail.com
Republished in
Todays FDA. 2010 Jan-Feb;22(1):41-5.
Traditional gingivectomy procedures have been a challenge for pediatric
dentists
who confront issues of patient cooperation and discomfort. Treatment of
pediatric
patients must involve minimal operative and postoperative discomfort.
Laser
soft-tissue surgery has been shown to be well accepted by children. For
the
pediatric patient, the greatest advantage of the laser is the lack of
local
anesthesia injection and the associated pre- and postoperative
discomfort. The
following case report describes a gingivectomy procedure performed on a
14-year-old female.
PMID:
19722478 [PubMed - indexed for MEDLINE]
10. Pediatr Dent. 2009 Jan-Feb;31(1):8-13.
HERE AT AAO
Gingival overgrowth in a child with arthrogryposis treated with a
Er,Cr:YSGG
laser: a case report.
Soares
FM, Tarver EJ, Bimstein E, Shaddox LM, Bhattacharyya I.
Department of Pediatric Dentistry, University of Florida College of
Dentistry,
Gainesville, Fla, USA.
The present manuscript reports a case of a 21/2 year old girl, diagnosed
with
arthrogryposis, presenting increasing gingival hyperplasia which was
treated with
Er,Cr:YSGG Laser. The patient was treated under general anesthesia by
the
Pediatric Dentistry and Periodontics departments. Er,Cr:YSGG laser G6
tip was
used at 1.50 watts, 20 pps, 8% water and 11% air, which is recommended
by the
manufacturer. Scalpel and periodontal curettes were used to complement
the laser.
Tissue samples from the anterior maxilla, anterior mandible and palatal
sites
were formalin-fixed and submitted for evaluation. The samples biopsied
revealed
prominent hyperplasia of the fibrous connective tissue with areas of the
epithelium exhibiting pseudoepitheliomatous hyperplasia. At 1 week and 3
months
follow up, oral examination showed appropriate healing of gingival
tissue. The
use of Er,Cr:YSGG laser in the present case proved to be effective in
the removal
of
large amounts of hyperplasic gingival tissue and resulted in fast
heeling and
mild discomfort.
PMID: 19320254 [PubMed - indexed for MEDLINE]
11. Quintessence Int. 2007 Jan;38(1):e54-9.
HERE AT AAO
Combined treatment approach of gingivectomy and CO2 laser for
cyclosporine-induced gingival overgrowth.
Haytac CM, Ustun Y, Essen E, Ozcelik O.
Department of Periodontology, Cukurova University, Faculty of Dentistry,
Balcali/Adana, Turkey. cenkhaytac@cu.edu.tr
The aim of this report is to present a combined treatment approach with
gingivectomy and CO2 laser for the management of cyclosporine-induced
gingival
overgrowth in 4 cases. Four renal transplant patients were surgically
treated for
marked gingival overgrowth by means of gingivectomy and CO2 laser.
Postoperatively, all patients were followed for bleeding, pain,
infection during
the early healing period, and recurrence of gingival overgrowth for 12
months.
The healing was uneventful, and no signs of bleeding,
postoperative
pain, or
infection were observed in any patient during the early healing period.
In the
12th postoperative month, there was evidence of mild recurrence in 1
patient,
while no sign of recurrence was observed in the other patients during
the
follow-up period. The advantages of this combined technique include
satisfactory
bleeding control and clear visibility during the procedure, as well as
reduced
postoperative pain and swelling.
PMID:
17508077 [PubMed - indexed for MEDLINE]
Diode Soft Tissue Suggested
Settings for a Variety of Common Procedures:
Advanced Laser Training.com;
877-Laser66
1.
Setting Number
One:
1.5-2.0
Watts continuous initiated
Soft Tissue with anasthesia,
Gingivectomy, frenectomy, gingival troughing around crown preps
instead of using retraction cord, uncovering implants, fibroma
removal, operculectomy
2.
Setting Number
Two:
3.0 Watts pulsed
initiated
Soft Tissue without anasthesia,
Gingivectomy, frenectomy, gingival troughing around crown preps
instead of using retraction cord, uncovering implants, fibroma
removal, operculectomy
3.
Setting Number
Three:
1.0 Watt
continuous initiated
Sulcular Debridement-eliminates
granulation tissue in periodontal pockets
4.
Setting Number
Four 1.5 Watts pulsed 30/30 uninitiated
Sulcular decontamination, and tip
initiation
With
uninitiated
tip at 1.5 Watts
pulsed 30/30 you can do the following,
·
Tooth desensitization, (Start 5 mm away
and paint the area BUT DO NOT TOUCH THE AREA) with the tip, keep
about 1-2 mm away from tooth contact at all times, if patient
reports warmth or discomfort move fiber further away from tooth
until comfort returns, paint 60 seconds then repeat for more
profound effect
·
Hemostasis- paint the area until
bleeding stops, 1-2 mm from touching tissue, tissue will turn bluish
grey color
·
Ulcer treatment,
herpetic lesions- 90 seconds of painting the area from 1-5 mm away
from the lesion
The above settings are a good place to set your 4 preset buttons on
your diode laser system. As operators learn more about the system
and it’s capabilities, they can adjust the wattage up or down to fit
individual preferences. Please note that these settings are
suggestions only and are not a replacement for clinical judgment or
training.
*
Ted Rothstein DDS PhD
Specialist in Cosmetic Orthodontics
and Dentofacial Orthopedics
Adults and Children
Specialist in Orthodontic Jaw Wiring
American Association of Orthodontists
35 Remsen St., Bklyn, NY 11201
718 852 1551 www.drted.com
drted35@aol.com
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