Cosmetic Dentistry Assisted by Laser

Keywords

Laser; Freerectomy; Gingival Depigmentation; Aesthetics; Surgery.

Introduction

Nowadays, the laser has become more and more popular in the field of dentistry. It is a technology that aims to facilitate the work of the practitioner and make it much more precise and relevant. It thus gives the image of a modern dentistry more reliable than traditional practices and thus allows a clearer prognosis and comfort for the patient. However, our patients have become more and more demanding and sensitive to the smallest details because they know the possibilities that can be offered today by the new cosmetic dentistry.

Indeed, by virtue of its interactions with the soft and hard tissues of the oral cavity, the laser is of growing interest in the field of dental aesthetics. Laser-assisted therapy therefore seems to begradually establishing itself as one of the new standards of this modern dentistry.

In this article, we will focus more particularly on the aesthetic applications of lasers in dental surgery.

Lasers Used in Dental Surgery

According to their applications, lasers can be classified into two groups:

- Hot lasers for surgical use: CO2 laser, Erbium laser, Nd: YAG laser, Argon laser

- Cold lasers or soft lasers for gentlet herapeutic applications: The Helium-Neon laser, The diode laser (semiconductor lasers). In this article, we deal with two clinical cases which illustrate the aesthetic applications of the diode laser in dental surgery.

The diode laser (semiconductor lasers)

It is very effective for soft tissue providing excellent incision, hemostasis and coagulation. The diode laser has similar characteristics to the Nd: Yag laser. Both offer high penetrability in biological tissues (fig. 1).

Aestetic Applications Of Lasers In Dental Surgery

Clinical case n°1: Freinectomy Frenectomy consists of the ablation of an iatrogenic brake in order to reduce the traction itexerts on the gingival mucosa, free the inter-incisorspace and improve aesthetics, especially in the presence of a high smile line. In our case, we will focus on maxillary labial free rectomy. There are two main procedures for its realization: the simple horizontal incision and the V or rhomboid incision with or without papillary recall. For this case, we will use the diode laser (fig. 2). The intervention begins with a traction on the upper lip showing the brake (fig. 3) which is put in tension, the tip of the laser fiber is then directed according to the outline of the incision which will be in our case an incision in V (fig. 4). We then start by making an incision in the axis of the brake (fig. 5), which will be followed by a transverse incision until a rhomboid shape is obtained. The laser energy is delivered by pulse (20 pulses per second), the practitioner works in contact mode while keeping the laser fiberalways moving along the line of the incision, which is essential to avoid carbonization of the tissues and deep damage. In fact, the duration of tissue exposure is associated with the increase in temperature in situ. The lip must bekept in tension throughout the procedure in order to maintain optimal cutting precision. Keep in mind that the ablation time depends on the composition of the target tissue, therefore the frenumcord section maybe longer than the rest of the incision. We must not shred the fabricswith the fiber, we must let the laser energy make the cut. Hemostasis is controlled throughout the operation thanks to the coagulation effect of the diode laser (fig. 6). Sutures are not necessary and the wound will heal by second intention (fig 7.a and 7.b). Laser frenectomy has many advantages over conventional scalpel surgery: - Topical anesthesia which allows increased acceptance in patients, especially children - Immediate hemostasis and increased intraoperative visibility - No sutures - Absence of pain per or post-operative without prescription analgesic - Reduced edema - Sterilization of the site: bactericidal effect of the laser used - Fasthealing Clinical case n° 2: Depigmentation/Freinectomy Gingival hyperpigmentation due to melaninis a major aesthetic damage, especially in patients with a gum smile (fig. 8). This staining due to melanin varies from light brown to black and depends on the amount and distribution of melanin in the tissues. In our case, the patient consulted with the “blackishgum” as the main complaint (fig.9). Intraoral examination revealed general blackish pigmentation of the gum tissue, but the gum was healthy and completely free from inflammation. A low insertion of the maxillary labial frenulum was noted. A laser depigmentation procedure was planned, followed by a maxillary labial frenectomy using the same diode laser. The patient had not previously received anytopical or local anesthesia. The melanin-pigmented gingiva was resected by vaporization with the diode laser. The procedure was performed on all pigmented areas. The remnants of the resected tissue were removed using sterileg auzemoistened with saline solution. This procedure was repeated until the desired depth of tissue removal was reached. The labial frenectomy was performed identically to the first case (fig. 10). No periodontal dressing or stitches are necessary, and the wound will heal from the 2nd intension (fig.11.a and 11.b). Analgesic and 0.2% Chlorhexidine mouth washes have been prescribed. Here again, the laser has certain advantages: It is considered the least painful technique thanks to the formation of a protein clot on the surface of the wound, which serves as a biological dressing and seals the endings of the sensory nerves. The effects of laser photo-modulation help in stimulation of fibroblasts, angiogenesis and acceleration of lymphatic flow, whichimproves tissue repair and regeneration. It is an excellent hemostatic agent, which significantly improves visibility during the operation. Finally, he presents very little recurrence; in fact, no gingival repigmentation at 6 months of depigmentation by the laser has been observed, and this following the destruction of the epithelialcells of the basal layer by the laser beam. However, you have to becareful with the risks of gingival ulceration and recession, especially in the event of a lateperiodontium.

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Conclusion

Lasers providea real benefit for the success of our treatments in cosmetic dentistry but also in all other areas of dentistry (simplification of protocols, operative comfort, biostimulation, reduction of postoperative effects, etc.). The application of the laser appears to be an effective and safe method, if the choice of laser radiation is suitable for the case, and if the precautions indicated by the manufacturer are observed during its use.