Lasers, which have been used in dentistry for nearly 30 years, are being continuously researched and are now gaining wide recognition across a variety of indications. The most common advantages and clinical benefits of using a soft tissue laser include precise excision of gingival tissue, heamostasis, reduction of bacterial presence, decrease of postoperative discomfort for the patient and periodontal treatment.
Our practice bought the Biolase Ezlase from Henry Schein Dental, a diode soft tissue laser of 940nm wavelength. Most often we use the device as an aid for the treatment of periodontitis, endodontic treatment, soft tissue contouring, excision of gingival tissue and implant related procedures.
Ezlase plays a fundamental role in all of our root canal therapies. We find it extremely effective specifically when dealing with heavily infected root canals and endo-perio lesions. Research shows that laser assisted disinfection of root canals can be superior to traditional rinsing methods due to deeper penetration of the laser into the dental tubules. Therefore a very advanced bactericidal effect can be obtained.
Case study
A 67 year old female presented for her initial examination. It was noticed that she needed a full scope of dental care, involving restorative and periodontal treatment. The patient was very distressed about the overgrown gingival tissue present in the mandible (fig 1). The patient had poor oral hygiene and the teeth were heavily affected with caries. The patient had clear medical history despite being a heavy smoker.
A well-defined exophytic lesion occupied the anterior area of the lower alveolus. The lesion was residing on the buccal aspect in the region of the lower left lateral incisor – lower left canine. The mentioned teeth were vital but had grade II mobility. The tissue was smooth with well-defined margins and with and no tenderness. The overgrowth had a fibrotic consistency and had the normal colour.
A provisional diagnosis of fibroepithelial polyp was made and a treatment plan designed as excisional biopsy of the lesion and histologic evaluation of this abnormality.
It was explained to the patient that removal of the lesion would facilitate treatment of the adjacent teeth and periodontal tissue which were in need of immediate attention. The patient was also made aware that oral hygiene routine at home would be easier to achieve in the area following the removal of the overgrown tissue. She gave consent to the procedure and surgery was carried out.
Local anaesthesia of the field was obtained using four per cent Espestesin with adrenaline 1:100,000. During this procedure we used a diode laser, output power 4.5W pulse mode, 300um fibre tip. The lesion was excised at the base and hemorrhage of the tissue was instantly arrested. This allowed for excellent vision of the site and therefore for a very controlled procedure with minimal damage to the surrounding gingival tissue. There was no need for suturing and the area was left to heal via secondary intention (fig 2).
After finishing this process, the biopsy sample was put in a fixative agent (formalin 10 per cent solution) and sent for microscopic evaluation. The pathology report confirmed the provisional diagnosis as benign fibroepithelial polyp with no evidence of dysplasia or malignancy.
The patient returned two weeks later for a review. The soft tissue healing was unremarkable allowing for the commencement of restorative and periodontal treatment (fig 3).
The advantages of using a laser for excision of tissue include minimal swelling and reduced post-operative discomfort, bloodless surgery, minimal or no scarring, and instant disinfection of the surgical field. Lasers play an important role in our daily practice and cases treated with Ezlase resolve quickly, resulting in high satisfaction for our patients.
References available on request.