Case Study: Anesthesia-Free Laser Gingivectomy

Monday, May 1, 2017

Case Study: Anesthesia-Free Laser Gingivectomy

Case Summary

The patient presented with central incisor fracture. Tooth #9 was fractured subgingivally. The patient was very phobic and only came in because his wife wasn’t going to allow him to go without a front tooth. Tooth #9 had a history of endodontic treatment and a crown. Patient had the crown with tooth structure and core material inside. Patient was made aware of the fact that future extraction and implant is likely.

The clinical objective was to expose tooth structure coronal to gingiva and bone. On day one, a gingivectomy was performed as well as a closed crown lengthening on the MF aspect of tooth #9. Minimal osseous removal was required to expose sufficient structure for restoration. A glass ionomer temporary was placed and the patient was scheduled for restoration for the following day.

On day two, a post/core was formed using the old crown as mold and re-cement. The patient was so happy that he has since returned to complete all of his other needed extensive restorative dentistry.

Technique Using Solea

No topical anesthetic or injectable anesthetic was used for this procedure. To begin, the area was probed to ensure that a gingivectomy alone would expose enough tooth structure while maintaining biologic width.  It was determined that the mesial of #8 would require some minimal osseous reduction. The entire procedure was performed with the Solea CO2 Dental Laser using the “Hard and Soft Tissue” setting, the 0.25 mm spot size, 1% mist with cutting speed between 10% – 40%. The total procedure time for the gingivectomy was less than 10 minutes.

Benefits of Solea

With other instruments, the patient would require an injection in the maxilliary anterior region around #8– one of the most uncomfortable places to receive an injection, regardless of the dentist’s skill level. As such, this procedure would have likely taken over 30 minutes to complete with traditional instruments, compared to less than 10 minutes with Solea. Time savings were achieved by not injecting the patient and not waiting for the patient to become numb. With Solea, there was no painful injection and minimal bleeding. This greatly enhanced the patient experience by minimizing post-operative pain and lessening the time it takes to heal.

Pre-Op Radiograph

Pre-Op

Pre-Op

Immediate Post-Op

Immediate Post-Op

One Day Post-Op 

One Day Post-Op

One Day Restored

Five Days Post-Op

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