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Lasers in Dentistry: Minimally Invasive Instruments for the Modern Practice
Gingivectomy

Course Author(s): Steven R. Pohlhaus, DDS

Gingivectomy

Gingivectomy is the most common procedure performed with dental lasers.  All laser wavelengths can be used to precisely incise gingiva for restorative, cosmetic, and periodontal indications.  Rapid healing and reduced pain are commonly seen post operatively and patients rarely need periodontal packing or sutures.  The thermal effects of diodes, Nd:YAG and CO2 lasers must be understood to avoid collateral damage, but in properly trained hands these devices are quite effective.  Erbium edlasers pulsed technology, shallow penetration, and water absorption produce a minimal thermal effect and minor procedures can sometimes be achieved with no anesthetic at all.  The nearly “cold cutting” effect of erbium tissue interaction creates a remarkable post-operative course.

Figure 19. Crowns/Gingivectomy.
This image depicts pre-operative severe idiopathic gingival hyperplasia.
Pre-operative severe idiopathic gingival hyperplasia. The anterior teeth were highly restored with multiple restorations and resin veneers. Crowns were indicated and the patient’s chief complaint was that her teeth looked too short, even though the prior veneers established an incisal position many millimeters below the occlusal plane.

 

Figure 20. Crowns/Gingivectomy.
This image depicts immediate post Er,Cr:YSGG gingivectomy and gingivoplasty just prior to crown preparation at the same appointment.
Immediate post Er,Cr:YSGG gingivectomy and gingivoplasty just prior to crown preparation at the same appointment. No osseous reduction was needed, as there was no biological width disruption.

 

Figure 21. Crowns/Gingivectomy - One week later.
This image depicts teeth that were temporized with a chair-side fabricated six unit splint and the patient returned for impressions one week later.
Teeth were temporized with a chair-side fabricated six unit splint and the patient returned for impressions one week later. The patient complained of minor discomfort only. The gingiva already appears well healed with stippling apparent just one week later.

 

Figure 22. Crowns/Gingivectomy - Cementation.
This image depicts Captek crowns cemented three weeks after gingivoplasty and gingivectomy.
Captek crowns cemented three weeks after gingivoplasty and gingivectomy. Proper occlusal plane re-established while giving the patient the longer appearing teeth she desired.

 

Figure 23. Implant/Gingivectomy.
This image depicts fibrous gingiva growing over implant healing cap excised with Er:YAG laser at abutment placement appointment.
Fibrous gingiva growing over implant healing cap excised with Er:YAG laser at abutment placement appointment. No anesthesia was required. Erbium lasers do not interact with titanium and can be safely used around titanium implants.

 

Video 2.
No narrative to video.
Gingivectomy with a diode laser (1064 nm XLASE).
Procedure done by Dr. Larry Kotlow, video courtesy of Technology4Medicine, LLC.
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