Author: Dr. Jerry Clark
Have you ever completed treatment and ended up with a “gummy” smile? Have you ever waited and waited and waited for a canine to erupt so you can bracket the tooth and move forward with treatment? Have you ever completed treatment, had the teeth aligned perfectly, only to find that the gingival heights of some of the maxillary anterior teeth are at levels thus adversely affecting the esthetics of your patient’s smile? Have you ever tried to band a second molar and had an operculum obstructing your ability to band the tooth? Have you ever had a patient with poor oral hygiene that presents with inflamed hypertrophic gingival tissues that are growing over the patient’s brackets? These are just a few of the problems that can be easily and painlessly eliminated by using a soft tissue diode laser. Today, for the orthodontist who desires to provide the finest treatment for their patients, a soft tissue laser is an affordable must for your practice. They are easy to use and the positive effect you can have on your patient’s orthodontic treatment results are too significant to ignore.
Are lasers really that affordable?
Today there are many cost effective soft tissue diode lasers available to the practicing orthodontist. Since the procedures that are required for orthodontic care are relatively simple it is not necessary to purchase a high-powered laser. The laser manufacturers, in fact, have developed lasers that are relatively modest in price yet sophisticated enough for any of the needs of an orthodontic practice. Not so long ago lasers cost between $10,000 and $15,000, but now you can purchase a quality laser from any number of companies for approximately $4,000. Our practice uses the Picasso Lite+ laser manufactured by AMD but there are many other options available from other manufacturers. If you don’t have a laser, now is the time to buy because any additional price reductions in the future are going to be minimal.
What are lasers and how do they work?
Laser stands for Light Amplification by Stimulated Emission of Radiation. The laser provides a single wavelength light that is focused and extremely powerful. There are a wide variety of wavelengths and watts of power available for all types of surgical procedures. However, for orthodontics we only need an 810 nm wavelength and 2.5 watts of power which is minimal as far as laser technology goes. This is important because 810 nm is highly absorbed in hemoglobin and melanin thereby making it absolutely perfect for soft tissue procedures. This gives the diode laser the ability to easily cut, coagulate, ablate or vaporize soft tissue.
What are the benefits for our patients?
No needles, for one! The wonderful thing about using a diode laser is that we can provide some incredible benefits for our patients by removing or re-contouring soft tissue while requiring only a topical anesthetic (TAC Alternative – Lidocaine- HCL 20%, Tetracaine 4%, Phenylephrine 2%) to accomplish these procedures. The combined local anesthetics are powerful in blocking pain while the Phenylephrine promotes local hemostasis. The laser’s ability to coagulate the blood also contributes to the lack of bleeding. Post-operatively most patient’s report that they felt no pain or discomfort while the surgery was being performed and afterwards reported little if any pain or discomfort in the period following the procedure. Our patients have been enthusiastic about the ease of the procedure and have been delighted with the treatment results.
What else will the orthodontist need to get started?
After the orthodontist has purchased their laser they will need to purchase a few additional things in order to get started. A topical anesthetic will need to be purchased from a pharmacy (we obtain our anesthetic from Stanley Apothecary 1-866- 698-0247). Articulating paper will be needed to carbonize the tip of the laser fiber which enhances the effectiveness of the laser in cutting tissue. Hydrogen peroxide will be needed to help clean the surgical area. Purchase some Vitamin E capsules to give to the patient once the surgery has been completed. Vitamin E helps to sooth the cauterized tissue, promote healing and reduce postsurgical discomfort. For the next 24 hours encourage the patient to take whatever medication they would normally take to relieve headache symptoms. Take the time to read the instruction manual that comes with the laser. Learn the proper settings to be used for performing the various procedures with the laser. Generally a setting of 1.2 watts would be used for soft tissue removal, a setting of 1.4 watts for denser tissue, and 1.6 watts would be used for a frenectomy. Also, there are some videos on the Internet that would be beneficial to watch to allow you to become more familiar with the laser procedure. Laser surgery will also require a chairside assistant to help with the procedure and the use of high-speed evacuation to remove charred tissue and evacuate the odors created by the cutting of the gingival tissue.
What procedures can be performed to benefit our patients?
Gingivectomy – Occasionally a case is completed, the teeth are properly aligned, the occlusion is one that Dr. Ron Roth would be proud of and yet the final result still falls short of the final esthetic result desired. The patient still exhibits a “Gummy smile”. At that time it is important to determine if the problem is the result of a true maxillary skeletal excess requiring maxillary impaction surgery to improve the esthetics, or is the problem due to excessive gingival tissue requiring only a simple gingivectomy to correct.
Canine Exposure – The laser is ideal for removing tissue that is covering canines in order to facilitate their eruption and in many cases significantly reduce the patient’s treatment time. This procedure can make the overall treatment much easier for both the patient and the orthodontist.
Hypertrophic Tissue – The accumulation of hypertrophic tissue can happen in cases where patient brushing is inadequate as tissue swells up around their brackets, but tissue can also build up when spaces are being closed even when brushing is adequate. The diode laser provides a significant patient benefit by eliminating this excess tissue and allowing for greater ease in the brushing of these areas.
Frenectomy – Simple frenectomies can be easily accomplished by using the diode laser. Both maxillary and mandibular lingual frenectomies can be cost effectively done by the orthodontist. However, when a maxillary frenectomy is being considered an x-ray should be taken of the maxillary incisors to verify that there is no tissue entrapment in the mid-palatal suture. If it is found that there is tissue entrapment in the mid-palate area, then the case should be referred to a periodontist for surgery.
Tissue Impacted Second Molar – Sometimes treatment can be delayed significantly when a mandibular second molar is mesially impacted and the tooth is still covered by gingival tissue. The diode laser offers a tremendous solution to this vexing problem.
Operculum Removal – Sometimes it is not possible to bond or band a second molar due to a persistent operculum. Using the laser for this procedure can make bonding or banding these teeth much easier and much more comfortable for the patient.
So, what are the overall benefits of the Diode Laser?
As orthodontic professionals it is incumbent on us to continually strive to provide the very finest treatment for our patients. The simple diode laser procedures mentioned in this article highlight some of the significant improvements in patient care that now can be so easily accomplished. These benefits specifically include:
- Tremendous improvement in treatment esthetics
- These are procedures that can be accomplished without injections, with little if any pain, discomfort or bleeding
- Cost-effective procedures for both the patient and the practice
- Significant reduction in many of our patient’s treatment time
- Also, the laser can allow you to increase your practice’s high-tech image
I strongly recommend that all orthodontist professionals strongly consider a diode laser for their practices in order to dramatically improve the quality of their patient care.
- Feuerstein, P: Cuts Like a Knife, Dent. Economics, Vol. 99 (9): 110, 2009.
- Freedman, G and Goldstep, F: Diode Laser Provide Endless Possibilities at Lower Costs, Dent. Today, Vol. 28 (10): 102-104, 2009.
- Hilgers, J.J.: Clinical Uses of Diode Lasers in Orthodontics, J. Clin Orthod. ;38 (5): 266-73, 2004.
- Radz, G: High-tech Practice Builder: Your Diode Laser, Dent. Economics, Vol 101 (2): 52, 2011.
- Fig. 15, 12, 23 Courtesy of Lou Chmura
Dr. Jerry Clark maintains a successful orthodontic practice in Greensboro, NC. He received his BS and DDS Degrees from The University of North Carolina and his Masters Degree in orthodontics from St. Louis University. He is Board Certified and has practiced orthodontics for over 35 years and been lecturing on various orthodontic topics for over 30 years. He is also a Partner in Bentson Clark and Copple – a company dedicated to assisting orthodontists with successful succession planning practice valuation, and sale of their orthodontic practices (1-800- 621-4664).