34 The Dentist December 2009
lasers
Surgical applications
Mark Cronshaw looks at the ability of lasers to manipulate soft tissues.
O
ne of the biggest advantages
of using a laser in dentistry
is the unparalleled ability to
manipulate soft tissues. Due to the
precise and highly targeted zone of
operation it is possible to cut tissues
with minimal collateral trauma. The
laser can coagulate blood vessels as
it cuts so there is very little bleeding,
and it sterilizes as it cuts and promotes
healing. The low level laser energy
outside of the zone of destruction has
profound physiological effects and the
rate at which tissues repair post laser
surgery is remarkable and there is little
in the way of post treatment pain and
swelling.
I routinely use the laser to make
The rate at which tissues repair
post laser surgery is remarkable
and there is little in the way of
post treatment pain and swelling.
incisions for flaps as it gives me a
nice clean operating area due to the
reduced haemorrhage as well as
cutting cleanly through the periosteum
so I no longer shred flaps. If I wish
to split the tissues this is easy to
accomplish and raising connective
tissue grafts and free gingival grafts
are relatively easy procedures. Of
course soft tissue procedures such as
gingivectomy are easy to accomplish
and it is very convenient post surgery
to carry on immediately with the
definitive restorative work, due to the
absence of bleeding and the absence
Mark Cronshaw
is a private practitioner in
Cowes, Isle of Wight.
lGingivectomy with the EZ-lase: note the
absence of bleeding or inflammation.
lOne week post laser frenectomy.
of post treatment recession. As a
matter of routine I now use the laser
to trough the tissues prior to taking
impressions so I end up with nice clean
margins either for the optical images of
the Cerec or the conventional silicone
impressions I use for more extensive
crown and bridge work.
There are a wide variety of soft
tissue procedures I have integrated
as a matter of routine into my practice
as a consequence of owning a laser.
Take for example frenectomy. This is a
much under-prescribed procedure with
a number of important applications.
These include removing a mid line
frenum prior to orthodontic closure
of a mid line diastema and the relief
of tongue tie caused by a prominent
lingual frenum.
In addition I have found frenectomy
invaluable in the management of
gingival recession associated with a
frenal pull. The obvious example of
this is the frequently seen recession
seen around lower central incisors.
Due to a prominent frenum which
impairs oral hygiene and also the
lProminent midline frenum- removal required
prior to orthodontics.
lPolyp at right commissure.
lImmediate post laser surgery.
lOne week post surgery.
mechanical pull of the frenum on the
gingival tissues I often see cases of
associated recession. Treatment is
very straightforward as frenectomy is
an easy process with the laser.
Having cut the frenum I place a laser
generated scar on the bone to prevent
reattachment of the frenal fibres. In the
case of recession I also perform an
additional procedure, a vestibuloplasty.
This involves nothing more than
opening up the post frenectomy
wound at the base of the cut to
create a tear shaped wound. This
heals by secondary intention and in
 35 The Dentist December 2009

lasers

be achieved without a local anaesthetic tip. The Waterlase MD ablates the

lThe EZ-lase diode laser with the healing
attachment in place. This attachment can also
be used for laser whitening treatments.
consequence to the combined benefits
of the relief of the frenal pull and the
gentle action of the laser, new attached
gingiva forms and you get a degree of
creeping reattachment of the attached
gingiva to the exposed root dentine.
Another easy application of the laser
is the removal of polyps. This can even
and the wounds invariably heal without
scarring. As a matter of routine I send
the excised tissue for biopsy to the
histopathology lab at the local hospital
for a report.
Post surgery I apply the diode
laser with its attached healing head
to promote rapid repair. I have also
recently taken to using the diode to
treat TMD with great success. A single
30 second application of the diode
can relieve acute myogenic pain more
or less immediately and with lasting
benefit. The US FDA has recently
approved the EZ-lase for this clinical
application and although to date I have
only treated a few cases so far my
impressions are very positive indeed
(as are my patients’).
All the soft tissue procedures can be
achieved either with the diode or the
Waterlase MD. My strong preference
for most of these procedures is to use
the Waterlase MD, as with the EZ-lase
the cut tissues tend to stick to the diode
tissues as it cuts so you can achieve
a much more easily defined cut with a
cleaner margin. For the low level laser
therapy to promote healing, and in
the treatment of TMD, the EZ-lase is
the instrument of choice. As the diode
cannot cut hard tissues the advantage
of owning the Waterlase MD is strong.
The EZ-lase offers many advantages
over conventional instruments and it
is highly adaptable, portable and has
many useful applications including
the management of periodontal
pockets. This laser deserves a place
in any well equipped practice as it is
beautifully designed and easy to use
with great ergonomics and a whole
host user friendly features, plus it is
relatively inexpensive.
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