Clinical application of diode laser radiation for surgical treatment of patients with dental diseases

Full Text

A problem of high incidence rate of dental diseases among Russian population remains one of most important ones [1, 2]. At the modern stage of development of medical science and practice, the quality and effectiveness of dental care depend on the quality of therapeutic process especially in the conditions of dental outpatient clinics. Medical technologies do not stay at the same level, in particular, there is a wide application of minimally invasive surgical methods aimed at minimization of injurious effects and at reduction of the risk of postoperative complications.

In surgical dentistry high intensity laser radiation is used as an alternative to cutting instruments. Being a multifunctional instrument, laser radiation possesses a wide spectrum of biological effects, a high hemostatic effect, bactericidal effect, sterility, minimal traumatic effect on tissues, an insignificant postoperative edema, mild pain syndrome which may even be absent [3, 4, 5]. Of all variety of dental lasers, the most financially available and widely spread are diode lasers that have a wide spectrum of indications and are easy to handle [6]. Reliability of diode lasers is ensured by use of electronic and optical components with few mobile elements [7]. It is worth noting that laser radiation can be easily delivered through thin quartz light guides to any point of exposure practically without losses, which is especially important in surgical procedures in the mouth cavity [8].

Aim of study – to improve effectiveness of surgical treatment of dental patients by use of a diode laser.

Materials and Methods

In the period from 2016 to 2018 in the Dental Center of I.M. Sechenov First Moscow State Medical University (Sechenov University) and Dental Polyclinic of RyazSMU 134 patients from 18 to 82 years of age were examined and given surgical treatment for neoplasms of the oral mucosa, pericoronitis, gingival hypertrophy, shortened frenulum of the lower lip, small buccal cavity of mouth.

Surgical treatment was conducted by a traditional method and with use of a «PICASSO Lite» diode laser with 810 nm wavelength manufactured by AMD Lasers

(USA) (Fig. 1).

 

Fig.1. Diode laser «PICASSO Lite»

 

 Depending on the used method of treatment patients were divided into 2 groups by random sampling technique. In I group traditional method of treatment was used in 58 patients, in II group 76 patients received surgical treatment with a diode laser.

In I group surgical treatment was conducted under infiltration anesthesia with anesthetics of articaine line. Tissues were excised with scalpel № 15C with subsequent application of stitches on the postoperative wound or with covering the wound surface with iodoform tampon, fixed with stitches. To prevent collateral edema, local application of cold was recommended for 15-20 minutes every 2-3 hours on the first day after the operation. In the postoperative period antibacterial, anti-inflammatory, analgesic and desensitizing therapy were administered, and locally – oral baths of 0.05% chlorhexidine solution. On the 5^th-6^th day when the wound surface covered with granulations, iodoform tampon sutured to the wound surface was removed and application of solkoseryl (dental adhesive paste) was recommended on the surgical wound area 2 times a day. In case of suturing, stitches were removed on the 7^th day.

Treatment with surgical laser was conducted under anesthesia with anesthetics of articaine line given in lower quantity than in traditional treatment. Diode laser with 810 nm wavelength and 0.6 to 1.0 W radiation power was used in continuous or pulsed mode in a contact way with 30 msec pulse duration and 30 msec interval. The procedure was bloodless, with formation of coagulation layer covering the wound surface. To prevent collateral edema, application of cold was used for 15-20 minutes every 2-3 hours on the first day after the operation. In the postoperative period the patients were not administered antibacterial and antihistamine drugs.

Intensity of pain syndrome was determined by 4-point pain assessment scale (Ohnhaus E.E., Adler R., 1975). Scale parameters: severe pain – 3 points, pain of moderate intensity – 2 points, mild pain – 1 point, absence of pain – 0 points. In the presence of pain sensations a single intake of non-steroid anti-inflammatory drugs (NSAID), rinsing of the mouth cavity with 0.05% chlorhexidine solution three times a day were recommended.

Results and Discussion

In surgical treatment of I group of patients with the traditional method (using scalpel №15С) there was intraoperative bleeding from the wound surface which impaired visualization of the operative field. In II group of patients with surgical treatment with the diode laser, the operation ran without bleeding and with simultaneous formation of coagulation film on the wound surface. Circular movements of the optic fiber permitted formation of the coagulation film over the whole wound surface. Good visualization of the operative field was noted due to reduced intraoperative bleeding which enabled excision of tissues in a precisely determined amount.

According to the data of our clinical studies, in patients of II group operated with the diode laser, no evident collateral edema and pain syndrome were noted, which eliminated the need for non-steroid anti-inflammatory drugs (Table 1). Patients of I group given traditional treatment noted pain and edema within the first 3 days after surgical intervention with the underlying intake of analgesics. Thus, the data obtained by us confirm reduction in edema and pain syndrome in surgical treatment with the diode laser [3-5].

 

Table 1. Characteristics of the Postoperative Period

Groups	Period of wound healing	Pain syndrome			Collateral edema
		1st day after operation	3d day after operation	7th day after operation	1st day after operation	3d day after operation	7th day after operation
I group Traditional treatment (n=58)	7th day	2	1	0	1	2	0
II group Diode laser (n=76)	10th day	0	0	0	0	0	0

Note: Scale used: 3 – severe pain; 2 – moderate intensity pain; 1 – mild pain; 0 – no pain

 

 In clinical examination of the wound in early postoperative period it was found that after operation with use of laser radiation in II group of patients epithelization occurred on the 7^th day. On the 30^th day soft elastic scars formed.

In I group of patients with traditional treatment epithelization occurred by the 10^th day, with persistence of infiltration of soft tissues until the 14^th day. After 1.5 month, formation of dense scar tissue was observed.

The obtained results corresponded to changes in the area of wound surface depending on the kind of surgical intervention. Thus, on the 3^d day the wound surface area in patients of II group twice decreased, and on the 5^th day reduction in the wound surface area continued. Epithelization of postoperative wound was observed on the 7.0^th ±0.5 day due to complex antibacterial, antiinflam-matory and stimulating effects of laser radiation on regenerative processes [3, 4, 8].

In patients of I group granulations appeared on the 3^d day and completely covered the wound surface by the 5^th day. After the 6^th day the wound was managed by the open technique, and by the 14.0^th±0.5 day the wound surface covered with a young connective tissue (Fig. 2). Examination after 30 days revealed beginning of formation of coarse scars on the mucous membrane which softened and became elastic only by the 6^th month, with maturation of the tissue.

In both groups of patients there were no purulent-inflammatory complications in the postoperative period, which is attributed to bactericidal effect of laser radiation [6].

 

Fig. 2. Dynamics of parameters of the wound surface depending on the method of treatment (cm2)

 

 Clinical case 1. A female patient S., 21 years old, applied to the outpatient clinic with complaints of periodical pain, restriction in the opening the mouth, discomfort in the region of the third lower molar on the right, permanent biting of the mucous membrane with the upper molar within half a year. On examination the mucous membrane was locally hanging over the distal lingual cusp of 4.8 tooth, which erupted to 3/4 of its crown out of the alveolar socket. The antagonist tooth completely erupted. At the moment of examination, no signs of inflammation were seen on mucosa of the retromolar region (Fig. 3). On X-ray examination, 4.8 tooth was in the dental arch. The mouth opened to 3.5 cm. The diagnosis: pericoronitis in the region of 4.8 tooth, half-impaction of 4.8 tooth. The patient was made operation of operculectomy with a diode laser under infiltration anesthesia. The hanging mucous membrane was excised in the pulsed-periodic mode with 0.7 W radiation power (Fig. 4). Postoperative period ran without complications, epithelization occurred on the 10^th day.

 

Fig. 3. The hanging edge of mucous membrane before operation

 

Fig. 4. Surgical wound after excision of the mucous membrane by a diode laser

 

 Clinical case 2. A female patient D., 82 years old, was directed from the orthopedic department for elongation of the clinical crown of 4.2 tooth (Fig. 5). On examination: fracture of the crown part of 4.2 tooth. Under infiltration anesthesia the crown part of 4.2 tooth was extracted (Fig. 6) and gingivectomy was conducted with the diode laser in pulsed-periodic mode with 0.7 W radiation power (Fig. 7). The contour of the gingival edge recovered. After that an orthopedic structure was fixed in the mouth cavity. In the postoperative period no complications were observed. In the postoperative period formation of the optimal esthetic contour of the gingiva in the region of surgical intervention was noted (Fig. 8).

Clinical case 3. A female patient M., 20 years old, was directed from orthodontic department for plasty of the frenulum of the lower lip. On examination: high attachment of the frenulum of the lower lip, recession of the gingiva in the region of 4.1, 3.1 teeth (Fig. 9).

Under infiltration anesthesia resection of the frenulum was implemented from the alveolar process to the mucogingival junction with the diode laser in the continuous mode of operation with 0.7 W radiation power (Fig. 10). Epithelization was observed on the 10^th day (Figs. 11, 12).

Clinical case 4. A female patient D., 19 years old, referred to the outpatient clinic with complaints of the neoplasm on the tongue. Anamnesis: the patient noticed formation about 1 month before and noted its slow growth. On examination of the mouth cavity a neoplasm of round shape 0.3 cm by 0.3 cm in size on a narrow base was seen on the left part of the anterior third of the tongue (Fig. 13); it was soft, painless and mobile to palpation. Clinical diagnosis: papilloma of the tongue.

 

  

Fig. 5. A view in the mouth cavity before the operation

                       

Fig. 6. A view in the mouth cavity after removal of the crown part of 4.2 tooth with the diode laser

 

Fig. 7. A view of the formed gingival edge after excision with the diode laser

 

Fig. 8. A view in 10 days after gingivectomy with the diode laser and orthopedic treatment

 

 

Fig. 9. Shortened frenulum of the lower lip before the operation

 

Fig. 10. A view of the mouth cavity after correction of the frenulum with the diode laser

 

Fig. 11. A view of the postoperative region in 5 days after the operation

 

Fig. 12. A view of the postoperative region in 14 days after the operation

 

Fig. 13. Papilloma of the tongue before the operation

 

Fig. 14. Surgical wound after treatment with the diode laser

 

 The neoplasm was excised under infiltration anesthesia using a diode laser of 0.7 W radiation power in the continuous mode (Fig. 14). The obtained material was sent to pathohistological examination. Postoperative period was without complications. Epitheli-zation of the wound was observed on the 7^th day (Fig. 15). The diagnosis was verified pathomorphologically.

Clinical case 5. A female patient V., 47 years old, referred to the clinic with complaints of a neoplasm in the region of the crown of 1.6 tooth. Anamnesis: the patient detected the neoplasm about 3 months before, noted its slow growth. On examination of the oral cavity a neoplasm was found on the maxilla between the crowns of 1.6 and 1.7 teeth on the vestibular and palatal side on a wide base, of dense-elastic consistence, painless and mobile to palpation (Fig. 16). Clinical diagnosis: fibromatous epulis of the maxilla in the region of 1.6 and 1.7 teeth.

 

Fig. 15. A view of postoperative wound in 7 days after surgical treatment with the diode laser

 

Fig. 16. A view of fibromatous epulis before the operation

 

Fig. 17. Operative wound after excision of epulis with the diode laser

 

 Under infiltration anesthesia excision of the neoplasm was conducted using diode laser in the continuous mode with 0.8 W radiation power (Fig. 17). The obtained material was sent to pathohistological examination (Fig. 18). Postoperative period was without complications. Epithelization was observed on the 7^th day (Fig. 19). The diagnosis was verified pathomorphologically.

 

Fig. 18. Pathohistological preparation

 

Fig. 19. A view of postoperative wound in 7 days after surgical treatment with the diode laser

 

Clinical case 6. A female patient, 74 years old, referred to the outpatient clinic with complaints of formations of cyanotic color on the upper and lower lip. Anamnesis: the patient noticed the formations 10 years before as painless spots of blue color. They grew slowly without making any discomfort. Recently they began to increase. On examination spots of cyanotic color and round shape were detected on the right side of the red border of the lower lip and on the left side of the upper lip, 0.3 cm and 0.5 cm in diameter, respectively (Fig. 20). Formations were immobile, painless to palpation, with positive filling syndrome. The diagnosis: cavernous hemangio-mas on the right side of the lower lip and on the left side of the upper lip. Ablation was conducted with the diode laser under infiltration anesthesia (Figs. 21, 22). Immediately after laser treatment the formations significantly diminished and grew paler. Postoperative period was without complications. In 10 days regression of vascular structures was observed (Fig. 23).

 

Fig. 20. A view of hemangiomas before operation

 

Fig. 21. Action of the diode laser radiation on hemangioma on the lower lip

 

Fig. 22. Action of the diode laser radiation on hemangioma on the upper lip

 

Fig. 23. A view of postoperative region on the 10th day after laser treatment

 

 Conclusion

Thus, according to the data of the study, a diode laser with 810 nm wavelength reduces injury to tissues in surgical procedures in patients with dental diseases of the oral cavity. Besides, laser radiation provides a more favorable course of postoperative period, reduces edema and pain syndrome, accelerates healing of the postoperative wound, reduces risk of inflammatory purulent complications. Introduction of the laser into a wide clinical practice will permit to improve effective- ness of treatment and prevent recurrences of diseases.

About the authors

Elena A. Morozova

I.M. Sechenov First Moscow State Medical University (Sechenovsky University)

Email: SanekZhu@yandex.ru
ORCID iD: 0000-0002-5312-9516
SPIN-code: 5490-3554

MD, PhD, Associate Professor of the Department of Dental Surgery

Russian Federation, 8-2, Trubetskaya street, Moscow, 119992

Svetlana V. Tarasenko

I.M. Sechenov First Moscow State Medical University (Sechenovsky University)

Email: SanekZhu@yandex.ru
ORCID iD: 0000-0001-8595-8864
SPIN-code: 3320-0052

MD, Grand PhD, Professor, Head of the Department of Dental Surgery

Russian Federation, 8-2, Trubetskaya street, Moscow, 119992

Aleksandr N. Zhuravlev

Ryazan State Medical University

Author for correspondence.
Email: SanekZhu@yandex.ru
ORCID iD: 0000-0002-8334-062X
SPIN-code: 8776-9170

Assistant of the Department of Dental Surgery

Russian Federation, 9, Vysokovoltnaja str., Ryazan, 390026

Lyubov B. Filimonova

Ryazan State Medical University

Email: SanekZhu@yandex.ru
ORCID iD: 0000-0002-0679-541X
SPIN-code: 6759-6330

MD, PhD, Associate Professor, Head of the Department of Dental Surgery

Russian Federation, 8-2, Trubetskaya street, Moscow, 119992

Yevgenia V. Stekolschikova

I.M. Sechenov First Moscow State Medical University (Sechenovsky University)

Email: SanekZhu@yandex.ru
ORCID iD: 0000-0002-8981-0602
SPIN-code: 8521-3105

IV year student of Educational Department of Institute of Dentistry

Russian Federation, 8-2, Trubetskaya street, Moscow, 119992

References

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