Dr Naisi Nasim
Dr Anju Mathew
Dept of Periodontics
INTRODUCTION
SOFT TISSUE APPLICATIONS
GINGIVAL SOFT TISSUE
PROCEDURES
FRENECTOMY
• Frenectomy procedures with a laser are predictably successful so long as the
following steps are incorporated:
1. Creation of a periosteal fenestration at the base of the frenectomy to prevent
reattachment of fibers
2. Removal of all impeding muscle fibers
Depth of penetration for diode and Nd:YAG lasers is much higher (500 μm) than for
erbium or CO2 lasers (5 to 40 μm), so settings must be monitored closely to prevent
thermal damage to the underlying periosteum and bone. (Themes U 2018)
Procedure
Diode laser (810 nm).
An initiated tip of 200 μm was used with an average power of 2 W in a continuous mode.
Applied in a contact mode with focused beam for excision of the tissue .
The tip of the laser was moved from the apex of the frenum to the base in a brushing
stroke cutting the frenum.
The ablated tissue was continuously mopped using wet gauze piece.
No suturing ……..Antibiotics, analgesics and warm saline rinses to facilitate faster
healing.
FRENECTOMY
DEPIGMENTATION
• Recognized as one of the most effective, comfortable, and reliable techniques.
• Based on the principle of selective photothermolysis
• Laser light must be at a wavelength that is specific and well absorbed by the
particular chromophore being treated.
• Diode laser is 810 nm, allows high levels of energy to be absorbed by soft tissues,
water, and chromophores, such as melanin and oxyhemoglobin.
Anderson RR et al,1983
DE PIGMENTATION
GINGIVECTOMY
 The gingivectomy can be used when suprabony pockets
are present and access to osseous structures is not
necessarily important.
 The procedure assists in decreasing gingival tissue in
cases of enlargement and in altering fibrotic gingiva.
 Gingivectomy is contraindicated when
(1) access to osseous structure is critical or
(2) gingival attachment is inadequate (minimal) or absent.
Local anesthesia 2% lidocaine was administrated in the
buccal vestibule of the maxillary incisors.
Measurements were made with a periodontal probe
following the maximum reduction measurements and
bleeding points made with an explorer.
A 980-nm diode soft tissue laser was set to continuous
mode with 0.5-watt amplitude.
The laser was initiated by touching the tip to occlusal
paper at 45 degrees and running it along the paper
until smoke was released.
Following initiation, the laser was changed to
pulsating mode and 0.6-watt amplitude.
GINGIVECTOMY
GINGIVOPLASTY
SOFT TISSUE CROWN LENGTHENING
CROWN LENGTHENING
Operculectomy
LA
Angled handpiece …held perpendicular to the target lesion
Avoid contact between the laser beam and the tooth enamel.
If operculum covers part of the tooth, an adaptive tool (for example, a
wax spatula) needs to be inserted between the tissue and the tooth to
prevent possible damage/ shield the tooth during the procedure)
Vestibuloplasty
LA
808 nm wave length diode laser (SUNNYTM, MSI,
Bangalore) with 400 μm surgical tip was used (1 to 1.5W in
a continuous mode using an initiated tip.)
Initiated at the MGJ …horizontal stoke …parallel to the bone
slowly relieving the muscle fibers till the desired depth .
Tension …retracting the patient’s lip to enable the laser
assisted excision of the muscle fibers.
After a sufficient vestibular depth ….lip was once again
pulled …residual muscle fibers if any excised with laser tip.
FLAP
PROCEDURES
 Practitioners perform periodontal flap procedures either exclusively or
adjunctively with a laser.
 Once the flap is reflected, lasers again can be used for sulcular debridement
and deepithelialization on the inside of the flap.
 If root debridement will be done with a laser, it is strongly suggested that only
an erbium laser be used, because of possible thermal damage with diode and
Nd:YAG lasers.
 CO2 lasers may be used according to the protocol of Crespi et al. to increase
fibroblast attachment to the root surface.
 When osseous surgery is necessary after flap reflection, it can be performed
with erbium lasers or conventional instrumentation such as a high/slow-speed
handpiece, diamond/carbide burs, and manual devices (e.g., chisel).
PHOTOBIOMODULATION
(PBM)
Therapeutic low intensity laser and
light emitting diode (LED)
irradiation is termed
photobiomodulation (PBM) and
this type of treatment has been
suggested as an adjunctive measure
in the management of periodontitis.
PBM has been found to have the
capacity to modify the cytokine
cascade away from a reactive pro
inflammatory locally destructive
process to an anti-inflammatory
cycle.
LASER ASSISTED NEW ATTACHMENT PROCEDURE
The innovators, Gregg and McCarthy formulated a set of
criterion for LANAP which received Food and Drug
Administration (FDA) clearance in 2004.
Patients needing standard periodontal treatment with pocket
depth (PD) ≥4 mm are indicated for LANAP.
LANAP, when compared to conventional periodontal surgery, provided
some elusive advantages like,
 Minimally invasive with better patient compliance
 Decreased postoperative pain and morbidity
 Less likely to develop hypersensitivity
 Less prone to recession
 Faster healing
 Natural teeth as well as implant both show regeneration of the
surrounding tissues
PROCEDURE
1. The patient is profoundly anesthetized
initially with a local anesthetic to properly
access the extent of intrabony flaw with a
probe.
2. An optic fiber tip measuring 0.3-0.4 µ is placed
parallel to the root surface, to carry away the
epithelium lining of the pocket in coronal to
apical motion to reflect the gingival flap.
3. Calcified plaque adherent to the root surface
is removed.
4. Selective photothermolysis removes unhealthy,
infected and inflamed epithelium of the pocket
sparing the intact connective tissue separation of
the layers of tissues at rete pegs and ridges level.
REMOVAL OF POCKET EPITHELIUM
Bleaching