Before purchasing a dental diode laser, it’s important to understand how this tool can be for soft tissue procedures. This article will follow a case by Dr. John Graber in a gingivectomy for post orthodontic papillary hypoplasia with a Pioneer laser.
Before planning the surgical removal of the excess gingival tissue, explore the depth of the overgrowth with a periodontal probe. Be very cautious as aggressive probing while assessing the epithelial attachment can remove the attachment.
A gingivectomy uses the contact technique for this procedure. The tip must be initiated, the mode set to continuous, and the power setting should start at 1.0 Watts. The Pioneer Elite has presets while the Pioneer Pro requires manual setting.
If needed, apply a local anesthetic and ensure the proper safety protocols are in place.
Begin by using the explorer tool to check the gingiva for adequate local anesthesia. Once confirmed, continue with the explorer to create bleeding points which mark an incision line.
Use the excision method for the tissue removal process.
To avoid tissue charring and more efficient tissue removal, hold the laser fiber in the same plane as the final tissue contour. After the bulk of the excess tissue is removed, the incision line is beveled into the adjacent attached gingiva.
When beveling, the perpendicular lazing of pretreated tissue, be cautious as to not cause deep thermal damage. This can occur due to unnecessary amounts of power being used or if a spot is treated for a long period of time. Minimize the time during this part of the procedure.
When dealing with larger mounds of tissue, unremoved bulk from the initial incision can be removed and further refining of the excision can be done during this stage of the procedure.
The Clean Up
Blackened tissue tags can be removed by gently scrubbing the lazed areas with a liquid such as three-percent hydrogen peroxide or water. This is to help immediately improve the postoperative appearance of the lasing site.
Finish by rinsing the area with an air-water syringe to see the thickness and integrity of the coagulated connected tissue. This layer will protect the underlying tissue from postoperative bleeding and seal the sensory nerve endings.
Want to watch the full video? Check out the Gingivectomy procedure from Dr. John Graber on our videos page.