ELECTROSURGERY

IN PERIODONTICS
 IT INCLUDES:
• HISTORY
• PRINCIPLE
• DEFINITION
• USE
• ADVANTAGES
• DISADVANTAGES
• TECHNIQUE
• HEALING
• COMPLICATIONS
HISTORY
• Cusel, a Russian was the first to
apply electricity to surgical excision
in 1847 . He attempted to destroy a
neoplasm with electric current.
• Cushing and Bovie were responsible
for the refinement in equipment and
increasing the popularity of this
technique(1972)
PRINCIPLE
• Using two electrodes ,an alternating
current may be passed through the body
with no effects other than the production
of heat.
• The current must be of sufficiently high
frequency to avoid nervous or muscular
response.
• Surgical application of electricity often
make use of this principle:-
• The heat produced is solely the result of
the resistance offered by the tissue to the
passage of the current .

•
• When the electrode is large
(dispersive )and the other small
(active), the current is no longer
evenly dispersed.
• This results in a concentration of
current at the smaller electrode and
the effects are dehydration ,warming
of the area ,coagulation or tissue
destruction by heat depending on the
type ,the size and the frequency of
the active electrode and the duration
of application.
DEFINITION

What is electrosurgery?
Electrosurgery is the use of a high
frequency electrical energy in the
radio transmission frequency
band applied directly to tissue to
induce histological effects.
(current is in the range of 1.5
-7.5million per second or
megahertz)
LIKE LASER TREATMENT , electrosurgery
is thermodynamic and develops heat
directly within tissue cells.
electrosurgery however works over
the entire surface of the electrode tip in
contact with tissue, which makes it ideal
for sculpting living tissue.
ELECTROCAUTERY:-Cautery is the
application of external heat to tissue to
induce a controlled third degree burn.
This technique does not use the principle
of diathermy.
The term “electrocautery”when applied
to electrosurgery is erroneous.
 Four basic types of
electrosurgical techniques are-
• Electrosection
• Electrocoagulation
• Electrofulguration
• Electrodessication
• Electrosection-used for incision
,excision and tissue planing.
• Done with single wire active
electrodes that can be bent or
adapted to accomplish any type of
cutting procedure.
ELECTROCOAGULATION-
HAEMORRHAGE CONTROL
OBTAINED BY USING THE
ELECTROCOAGULATION CURRENT.
ELECTROSECTION AND
ELECTROCOAGULATION ARE
THE PROCEDURES MOST
COMMONLY BUSED IN ALL AREAS
OF DENTISTRY.
ELECTRIFULGURATION AND
ELECTRODESSICATION ARE NOT IN
GENERAL USE IN DENTISTRY.
 USES
Where is electrosurgery
used?
In two words : soft tissue. In general surgery,
electrosurgery is used on nearly every soft
tissue in the human body. The energy
introduced by electrosurgery reacts with water
molecules within the cells of the tissue being
treated, therefore, in dentistry it is not
effective on hard tissues like enamel or bone.
 ADVANTAGES
Why use electrosurgery in
dental practice?
• Electrosurgery may be thought of as the sculpture of
living tissue because it works without pressure, unlike
scalpel, which makes it ideal for aesthetically
significant interventions.
• Bleeding is controlled by electrosurgery, and
adjustable concurrent hemostasis is inherent during
electrosurgical intervention, which makes it very
valuable when treating hemolytically compromised
patients.
• Electrosurgery is also effective as an adjunct to other
therapies due to its ability to induce heat in fluid. For
example : in root canal sterilization, accelerating
whitening agents in spot whitening, accelerating
desensitizing agents, and in gingival curettage.
 DISADVANTAGES
• The treatment causes an unpleasant odor.
• If the electrosurgery point touches the
bone,irreperable damage can be done.
• The heat generated by injudicious use can
cause tissue damage and loss of periodontal
support when the electrode is used to close
to bone.
• Electrode when touches the root, areas of
cementum burns are produced.
 Contraindications
• CANNOT BE USED IN
PATIENTS WHO HAVE NON
COMPATIBLE OR POORLY
SHIELDED CARDIAC
PACEMAKERS.
USE OF ELECTROSURGERY IN
PERIODONTICS
• Should be limited to superficial procedures
such as removal of gingival enlargements.
• Gingivoplasty
• Reduction of frenum and muscle
attachments.
• Incisions of periodontal abscess and
pericoronal flaps
• (extreme care should be exercised to avoid
contacting the tooth surface)
• Note:-it should not be used for procedures
that involve proximity to the bone ,such as
flap operations or mucogingival surgery.
 How is electrosurgery applied?
• First of all, local anesthesia is
required for electrosurgery.
It is applied By means of two electrical
connections called "electrodes".
• In "monopolar" electrosurgery, one is an "active"
electrode and is used to introduce therapeutic
current into tissue.
• These are also called "tips" or "electrode tips"
and come in a wide variety of sizes and shapes
suited to specific clinical indications for incision,
excision, curettage, and coagulation.
• There are three classes of active electrodes ;
• single wire electrodes for incising or excising .
• Loop electrodes for planing tissue; and
Heavy bulkier electrodes for coagulation
procedures.
• The other electrode is the
"dispersive" electrode and is in the
form of a large flexible pad.
• "Dispersive" connection to the
patient is by means of capacitive
coupling which works through normal
street clothing without direct skin
contact so that the patient reclines
against the dispersive pad (or plate)
completing the electrical circuit.
•.
• The "active" electrode is many
orders of magnitude smaller in
surface area that the "dispersive"
electrode so that therapeutic
current is highly concentrated in the
area being treated.
• In contrast, therapeutic current is
distributed over the very large area
of the "dispersive" pad such that
current density at any point is too
low to induce any measurable
histological effect hence the term
“dispersive”.
• In "bipolar" electrosurgery, both
electrodes are the same or
similar size and are mounted on
a common hand piece.
• No separate dispersive plate or
pad is used and the cable from
the bipolar hand piece to the
electrosurgery unit has two
conductors.
 Technique and usage
• The removal of gingival enlargement
and gingivoplasty is performed with
the needle electrode ,supplemented
by the small ovoid loop or diamond
shaped electrodes for festooning.
• A blended cutting and coagulating
(fully) rectified )current is used
• In all reshaping procedures the
electrode is activated and moved in a
concise “shaving” motion.
• The active electrode should be passed
through the tissue as quickly as possible in a
brush stroke movement with no pressure.
• A continous rapid movement is important
because delay in one cause tissue burning.
• Allow time between each stroke for
dissipation of heat so that there is less tissue
damage(5 to 10 seconds)
• Precaution: tissue should not be stretched.
• The active electrode must not come in
contact with periosteum or bone.
• Incision is given to establish
drainage with the needle electrode
without exerting painful pressure.
• Incision remains open because the
edges are sealed by the current.
• After the acute symptoms subside
the regular procedure for the
treatment of the periodontal abscess
is followed.
• For the hemostasis , the ball electrode is
used .hemorrhage must be controlled by
direct pressure (via air,compress,or
hemostat)
• Then the surface is lightly touched with a
coagulating current.
• Electrosurgery is useful for controlling
isolated bleeding points.
• Bleeding areas as located interproximally
are reached with a thin bar shaped
electrode.
Relocation of muscle and frenal
attachments.
• They can be relocated to
facilitate pocket eliminating
using a loop electrode.
• The frenum or muscle is
stretched and sectioned with the
loop electrode and a coagulating
current.
 Acute pericoronitis
• Drainage may be obtained by
incising the flap with a bent
needle electrode.
• A loop electrode is used to
remove the flap after the acute
symptoms subside.
Healing after electrosurgery.
• Clot formation
• Underlying tissue becomes acutely inflamed
with some necrosis.
• The clot is replaced by granulation tissue.
• After 24hrs :increase in new connective
tissue cells mainly angioblasts.
• By third day numerous young fibroblasts
are seen in the area.
• Highly vascular granulation tissue
grows coronally creating new free
gingival margin and sulcus.
• Simultaneously after 12-24 hrs
epithelial cells at the the margins
start to migrate over the granulation
tissues separating it from clot.
• Surface epithelialization is generally
complete after 5-14 days.