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Medical Forum / General / Dentistry / December 2005

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Question re: gum surgery   laser vs scalpel

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QW - 06 Dec 2005 05:53 GMT
Can somebody help me please?

My dentist wants to perform this type of surgery in order to fill a cavity
below  the gumline.   He would not use a laser for this (he says he prefers
the scalpel, but I am not sure, maybe he does not have the instrument -he
has a fairly small practice, so cost may be an issue).    But I read about
the many advantages of using a laser for gum surgery.  Should I look for
somebody else to have this treatment done?

Many thanks in advance.
Amatus Cremona - 06 Dec 2005 12:34 GMT
> My dentist wants to perform this type of surgery in order to fill a cavity
> below  the gumline.   He would not use a laser for this (he says he
[quoted text clipped - 3 lines]
> the many advantages of using a laser for gum surgery.  Should I look for
> somebody else to have this treatment done?

If you know so much about how to do the procedure, perhaps you should be
teaching it at the dental school  :-)

Teasing sarcasm there.

If you are having excess gingival trimmed to improve dental esthetics, are
having hyperplasic tissue removed after dilantin or pregnancy, then the
laser does a super job.  If you are having flap surgery for pocket
elimination, osseous recontouring, infra-bony grafting, etc. then the
scalpel is the instrument of choice.

I think the chief advantage, of a laser, in the situation you describe, is
being able to do the procedure (often, but not always) without anesthetic.
However, the tooth has to be numb anyway, so who cares ?  Personally, I
would use the laser if there was at least 3-4 mm of connective tissue
attachment supra-osseous.  Otherwise, a scalpel, lay a flap and recontour
the osseous tissue to allow sufficient space for soft tissue attachment.

Signature

/

Amatus

/

> Can somebody help me please?
>
[quoted text clipped - 7 lines]
>
> Many thanks in advance.
Mark & Steven Bornfeld - 06 Dec 2005 15:20 GMT
> Can somebody help me please?
>
[quoted text clipped - 6 lines]
>
> Many thanks in advance.

    I didn't know that AC had a laser.  I don't, but I don't see one as
superior to the other.  Laser or electrocautery work fine, but the wound
takes a bit longer to heal.  The best thing about laser or
electrocautery is that there is no bleeding.  I've heard that the laser
is less painful, but it is not clear to me why.  I have also heard that
the claim may be overblown.  They claim that it kills the nerve endings.
    Caution:  In these matters I am a bit of a retro-grouch.

Steve

Signature

Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001

QW - 06 Dec 2005 18:48 GMT
Thanks again to all who took time to respond.

I had some laser surgery done many years ago to trim a bit of  gum
overgrowth under a crown and it was done with anestetic, but there was no
bleeding and it seemed very quick to heal.  I just didn't understand why
this time I have to go though the extra bleeding and wear a gum pack for a
week, but I think Amatus has answered the question (i.e. different tool for
different problem)

> Can somebody help me please?
>
[quoted text clipped - 6 lines]
>
> Many thanks in advance.
Dartos - 06 Dec 2005 19:30 GMT
I do own a laser, and I would not use a scalpel unless I
just didn't have a laser around for this purpose.  I can usually
remove the gum tissue and fill the same day with the laser.

It's so easy that I don't even charge separately for a gingivectomy.

Soft tissue lasers aren't too expensive, but they are fairly
limited in their applications.

More versatile machines go up in price rapidly, but I can trim the
gingiva and remove the decay with the same laser (though the claim
of no anesthesia is quite exaggerated).

JMO,
Dartos

> Thanks again to all who took time to respond.
>
[quoted text clipped - 18 lines]
>>
>>Many thanks in advance.
Bill - 06 Dec 2005 19:44 GMT
The scalpel gives very exacting and predictable results for crown
lengthening surgery where bone is involved. Laying a flap with a
scalpel allows visualization of the surgical site and access for
removing bone. Once sutured, it usually heals very well.

Where no bone is involved, a simple electrosurgery unit (using
radio-frequency) is a very quick and easy way to eliminate gum tissue
that blocks access to the carious lesion. The extent and location of
the lesion, and the objectives of the surgery, will help determine the
instrument of choice.

(Unless, of course, you are looking for a special ultrasound gizmo to
blast your impacted wisdom teeth to a powder, to be sucked out with a
little tube which is threaded down into the impacted alveolus . . .
wait, that was another post, never mind!)

- dentaldoc

> Thanks again to all who took time to respond.
>
[quoted text clipped - 4 lines]
> week, but I think Amatus has answered the question (i.e. different tool for
> different problem)

> > Can somebody help me please?
> >
[quoted text clipped - 7 lines]
> >
> > Many thanks in advance.
 
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