52 The Dentist October 2009

lasers

Surgical applications
Mark Cronshaw explores the benefits of the Waterlase MD in crown lengthening surgery.

I
t is a common misconception that
all lasers are hot cutting tools.
In fact the Waterlase MD uses
water energy to cut. The 2780nm
wavelength of the Waterlase MD has
an affinity for water; when the laser is
activated any water in the target zone lFig 1: Osseous crown lengthening is required
of operation expands 1,600 times in in this case to correct the poor width to length
a 50th of a second. It is the explosive ratio: pre-treatment.
lFig 2: Cerec crowns placed same day as a
expansive power of the water that
closed flap procedure: healing at one week.
breaks the tissues apart, a process
described technically as ablation. As lymphatic drainage and is associated
the laser energy is contained in a very with increased manufacture of beta
narrow beam without any significant endorphins. In sum this is a surgical
scatter, the area outside the operating tool that is precise, sterilizes as it cuts
field is untouched. The depth of the and promotes healing. As such the
cut away from the active field is only Waterlase MD offers benefits over
two cells deep. As a result peripheral conventional tools.
collateral damage is minute and the There are many other surgical
absence of trauma to the retained advantages to the laser as it can
lFig 3: Excessive display of buccal gingivae:
tissues permits coagulate blood
Peripheral collateral damage is gingival and osseous reduction required.
very rapid healing minute and the absence of trauma vessels as it cuts
of the surgical to the retained tissues permits thus markedly
area. The laser very rapid healing of the surgical reducing bleeding
also has the area. in the surgical
power to promote field. Incisions
healing as at low levels the laser light made with the laser have little if any
has a beneficial effect on the tissues associated inflammation and there is
immediately around the surgical a marked reduction in post-operative
zone. The laser energy at low levels oedema and pain. Tissues heal very
activates the mitochondria such that rapidly as an entire section of the
there is increased ATP production healing process is avoided due to the lFig 4: Finished veneers in place: three weeks
resulting in increased cellular activity. reduction in collateral damage and post laser surgery (closed flap).
There is much increased fibroblast the stimulatory benefit of the low level
activity along with angiogenesis, laser energy.
osteogenesis and a marked reduction In dentistry the applications of alveolar ridge in situ in a so called
in the usual post surgery inflammatory this surgical tool are universal and closed flap procedure. This does not
process. In addition it promotes the clinical benefits to patient and involve raising a flap at all and in thin
operator are immense. Take for tissue types for selected cases it is
example osseous crown lengthening: often possible to take the definitive
conventional techniques necessarily impressions for crown and veneer
involve considerable trauma to the work or in the case of the Cerec,
tissues. It can take several months place the definitive crown on the
for the tissues to fully recover and the same day as the crown lengthening
surgery is associated with marked procedure. Post-operative tissue
Mark Cronshaw patient post-operative discomfort. shrinkage is not an issue and it is
is a private practitioner in Using the laser it is possible to reset possible to use either the acrylic
Cowes, Isle of Wight. the gingival level and resect the temporaries or the Cerec crown
54 The Dentist October 2009
lasers
lFig 5: High lip line and excessive display of
labial gingivae.
lFig 6: Following gingivoplasty: final veneers in
place two weeks post surgery.
to act as a matrix to permit the
reformation of the gingival margin in a
highly predictable way. Providing one
follows the requirements of respecting
the biological zone and ensure the
newly set free gingival margin is 3mm
away from the underlying alveolar
ridge then there is no problem with
the surgery. Healing is rapid and
involves minimum discomfort. The
entire procedure to the finished
restorations can be completed very
quickly. By measuring 5mm from the
interdental ridge to the cervical point
of the major connector it is possible
to predictably fill embrasures. The
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Waterlase MD allows unparalleled using the laser tips such that a loose
possibilities to sculpt and recontour flap of tissue can be detached from
hard and soft tissues. This is an the underlying bone permitting easy
obvious boon to anyone interested direct visualization of the crestal bone.
in aesthetic and cosmetic dentistry Often this can be achieved whilst
as all procedures associated with the the depth of the flap is still in the
need to accurately manipulate hard attached gingivae. The bone can then
and soft tissues are relatively easily be removed by the laser (ablation).
accomplished. Procedures such as If needs be the bone and the soft
this are not the sole province of the tissue can be recontoured before the
specialist practitioner and subject to miniflap is sutured in place. Healing is
some hands-on instruction are easily rapid and uneventful and again there
accomplished by a GDP. is little in the way of tissue shrinkage.
There are, of course, limitations and In the aesthetic zone it is, however,
it is essential to use high power loupes normal to allow the tissues a week
so as to ensure or two to reform
the crestal bone is The closed flap procedure is before proceeding
removed and not limited to crown lengthening in to the definitive
merely gutted. thin tissue types. impressions. In the
The closed case of a posterior
flap (no flap) procedure is limited crown this may not be significant
to crown lengthening in thin tissue such that a final Cerec crown can still
types where under magnification with be placed at the time of the osseous
high power loupes you can see the procedure.
bone in the sulcus. When there is Over the past three years I have
any doubt about visualizing the bone completed many such procedures with
or where the tissues are thicker or great success. By comparison to the
perhaps a more extensive procedure conventional approach the benefits of
is required then it is recommended the laser are overwhelming. Lasers
to raise a flap. However this can be as surgical tools offer unique and
achieved with a mini flap that does strong advantages to the conventional
not require relieving incisions. The armentarium and it is only a matter of
initial incisions are made horizontal time before they are adopted generally
to the gingival margin and a cut is as the surgeons tool of choice.
made through the papilla in order that
it may be preserved. The gingival
level is then remodelled to the desired For more information visit www.
new level. The flap is then raised biolase.com
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