gingival hyperplasia - Laser Dentistry Forum

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November 22, 2004 at 4:09 am #3394 Reply

jetsfan
Spectator

Here’s a case of drug induced gingival hyperplasia.
I treated with Waterlase instead of diode, as I thought it would be quicker..Lidocaine was used.
I started at .5W but that didn’t do a thing . I quickly upped it to .75W, then 1.25W. Tissue was so fibrous and patient was numb, so I upped it to 2W 15%W 20%A
That seemed to cut well, without charring. After the large mounds of tissue were removed , I was still left with much fibrous tissue on the ridge. I essentially had a buccal and lingual flap and removed fibrous tissue which lined the flaps. A few gut sutures were placed, pain meds given. I called patieint in evening and he said he was fine and was eating. The post op shown is 5 days post op.
I’m sure there is more than one way to treat this,Nd/Yag, diode even CO2. Would diode have been a better choice? Why or why not. Same question for other wavelengths.

Robert.

November 22, 2004 at 5:24 am #10833 Reply

Glenn van As
Spectator

WOW what a neat case. Thanks Robert for showing this. A couple of thoughts.

1. The erbium cuts large amounts of tissue fast, but hemorrhage is an issue. Was it a problem here.

2. The chisel tip can help alot with something like this and I think the Waterlase users have an option for planing tissue down with a bigger footprint tip. Am I correct that this exists. I would have “whacked off” the tissue with the erbium and a soft tissue tapered tip. Then smoothed off the ragged edges and givent he laser bandaid with the chisel tip.

A diode would have taken a long time but it coagulates so much better.

Neat case and thanks for showing a very very interesting case……

Looking forward to the answers.

Glenn

November 22, 2004 at 12:29 pm #10830 Reply

jetsfan
Spectator

Glen,
Bleeding was an issue but certainly not unmanageable.
I forgot to mention that after I did gingivectomy, I extracted #25.
I do remember thinking when I started that I wished I had one of those C6 tips for this case. As I didn’t have one I used G9 tip. I think it would have gone faster with the C tip.
Patient was thrilled with result.

Robert.

November 22, 2004 at 2:58 pm #10836 Reply

Robert Gregg DDS
Spectator

Robert,

I am wondering about the localized nature of the lesion. Upon reduction, did you remove calculus that appears to be on the teeth pre-op?

Why was the tooth extracted? Looks like plenty of tissue for regeneration techniques if the tissue isn’t amputated away.

My preference would be to trouch the tissue open with a pulsed Nd:YAG at a hemostatic setting, use power ultrasonics to debride the calculus, lase to control hemorrhage, then allow the tissue to contract on its own w/o deliberate tissue removal and see how it resolves with some Peridex. Splint the moble tooth to preserve it.

Bob

November 22, 2004 at 7:22 pm #10832 Reply

Glenn on the road
Spectator

Hey Bob ….arent these the kind of heroic regenerative cases that the Periolase is perfect for. It would have been a nice case to treat all around with the Periolase and see how it all heals up huh.

Still think that Robert did a great job with the ErYAG as it was but I too wonder now what the Periolase could have done.

I talked to two docs from Dallas Ft Worth area who own the Periolase together in their practice and were at the Hoya Con Bio course held at the Nash Institute , they were raving about the cases they were treating (they have had the Periolase for 7 months and are just getting cases back for probing after they finished Day 4 at your office).

Continued success and oh ya , I sent back the lecture form so I will be in Las Vegas in February for your annual extravaganza….if you are interested in Bobs technology….I AM!! then cya there

Glenn

November 22, 2004 at 9:28 pm #10835 Reply

N8RV
Spectator

Hey, Glenn — didya notice that when you’re on the road, you’re a NEWBIE + 1″ just like lil’ ol’ me?

Ha! I love it …

— Don

November 23, 2004 at 2:06 am #10831 Reply

jetsfan
Spectator

Bob,
I should post an xray. This tooth was too far gone, even for a Nd/Yagoholic. It was more mobile than a MASH unit. Absolutely no bone on mesial , which wrapped around the apex with a large
P.A.R. #24 is questionable as well , but I am attempting to save that one. And you are also correct. there were some other etiologic agents involved: tons of supra and subging calculus, occlusal factor, no oral hygiene.
There is plenty more to do for this chap, but I think we made a good start.

Robert.

November 23, 2004 at 3:40 am #10837 Reply

Robert Gregg DDS
Spectator

Thanks Robert,

I am a Nd:Yagoholic as charged!:biggrin:

I have learned to dehydrate and dessicate these sorts of tissues, clean up the etiology, irrigate with Chlorhexadine, adjust the occlusion and splint “hopeless” teeth and give some time for healing. Often the tissue that looks like it needs ressection, needs a chance to recover….and for bone to fill in.

Thanks for posting Robert and responding to my questions.

Glenn–glad you met some our guys! This ain’t no voodoo. This is the real deal.

I can’t tell you how excited and honored I am to know you will be presenting at our next Clinician’s meeting–on erbiums and microscopes.

This is not just for MDT customers. It is a weekend of fun and learning with great folks like Glenn, Ray Yukna, Lloyd Tilt, Ron Schalter, Dawn Bloore, Jeff Cranska to name a few.

The date is February 18-20 in Henderson NV (Las Vegas) at the Ritz Carleton Resort and Spa. Anyone interested call 888-49-LASER for more info.

Bob

November 23, 2004 at 5:31 am #10834 Reply

Glenn van As
Spectator

Bob I consider it a true honour to lecture with your group. I am staying the whole time this time not flying in and out because I do want to hear Ray speak and some of the testamonials from your great group. In addition it seemed like it was a TON of fun last time.

Besides I have to say hi to your lovely wife……….

You and Del deserve all the kudos, especially after all the daggers you got in the early years.

Cmon Hack2……you gotta come so I can shake your hand!!

All the best Bob and thanks so much for including me…….PS if Hack 2 does come you gotta tell me…..I am gonna have more open flap stuff this time!!

Cya

Glenn
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