Vestibuloplasty Using 980nm Diode Laser

Shallow vestibule can create a barrier in oral hygiene maintenance and can cause gingival recession due to the muscular traction. Inadequate vestibular depth in combination with inadequate attached gingiva is said to cause more food accumulation during mastication. Hence, shallow vestibule impeding with oral hygiene and proper plaque control maintenance requires correction.  Vestibuloplasty provides the necessary vestibular depth and can be performed either with a scalpel, electrocautery or lasers.

In certain instances, an anatomical variation such as higher insertion of the muscle attachments of vestibular mentalis and other associated muscles leads to a decrease in the vestibular depth and to make matters worse, an insufficient keratinized gingiva which is a critical component for the maintenance of periodontal health.

Considering the mucogingival problem posed by an inadequate vestibular depth, an array of treatment procedures such as gingival augmentation with the use of grafts and vestibuloplasty through a secondary epithelization have been planned to enhance the vestibular depth.

Vestibuloplasty is a mucogingival procedure that aims at the surgical modification of the gingiva-mucous membrane relationships including deepening of the vestibular trough, altering the position of the frenulum or muscle attachments, and widening of the zone of attached gingiva. A variety of vestibuloplasty techniques have been advocated in literature such as Edlanplasty, Kazanjian vestibuloplasty, etc. Most of these techniques have been used as pre prosthetic procedures to enhance the vestibular depth related to edentulous denture bearing areas

Clark’s vestibuloplasty came into vogue and was more popular in enhancing the vestibular depth and also quite effective in addressing the mucogingival problem associated with the dentition. Major drawbacks of these conventional vestibuloplasty procedures were the severe pain and discomfort and the delayed healing with the high chances of relapse making them less acceptable.

Periodontal procedures in the new millennium have moved on from being extensively aggressive to minimally invasive. Lasers have given the necessary impetus for such a shift by providing painless and acceptable procedures. Lasers offer an array of advantages over the traditional scalpel in providing a clean sterile field with excellent hemostasis for the clinician and by providing less pain and swelling postoperatively for the patient

Lasers are becoming increasingly popular in the field of dentistry providing alternative to conventional scalpel procedures. In recent years, lasers such as Nd:Yag, Er, diode, and diode in conjunction with Er:Yag have been used for frenectomy. The diode laser was introduced in the mid-90s. The diode laser contains a solid active medium and is composed of semiconductor crystals of aluminum or iridium, gallium, and arsenic. Wavelengths of diode laser range from 810 to 1064 nm. They are used in soft tissue surgeries as their wavelength approximates the absorption coeficient of pigmented tissue containing hemoglobin, collagen, melanin, and chromophores. The diode laser has been an effective choice for most clinicians worldwide owing to its compact size and affordability. They are used either in continuous or pulsating modes with fiber- optic surgical tips 

Herein we cover the following diode laser vestibuloplasty protocol as an exemple:
Initial therapy is completed for the patients and necessary oral hygiene instructions are given. Necessary laser protective equipment comprising of the laser safety glasses are worn by the clinician and the patient and proper precautions are taken. After application of topical anaesthetic gel and adequate anaesthesia is attained with a local infiltration anaesthesia, a 808 nm wave length diode laser with 400 μm surgical tip is used with the following settings; 1 to 1.5W in a continuous mode using an initiated tip. Ablation with the laser tip is initiated at the mucogingival junction with a horizontal stoke directing the laser parallel to the bone slowly relieving the muscle fibers till the desired depth. Tension is placed by retracting the patient’s lip to enable the laser assisted excision of the muscle fibers. After a sufficient vestibular depth was established, the lip is once again pulled to assess for any residual muscle fibers and if any fibers are noticed, they are excised with the laser tip.

The rapid developments in laser technology and better understanding of bio-interactions of different laser systems have expanded the use of laser in dentistry. They provide an excellent alternative to conventional scalpel surgery because of patient comfort, bloodless feild, and reduced pain and healing time. Owing to the small size, low cost, fiber optic delivery, and ease of use for minor surgery of oral soft tissue, diode laser has become an excellent choice for frenectomy.

To meet the laser operational standards for these kind of surgeries we highly recomend the Portable( Blue three) model Surgery Laser System SIFLASER-1.2. Equipped with a Red Diode Laser pilot beam Of 635nm, varrying max power (10W+3W+200mW) and CW, Single Or Repeat Pulse mode, and Fibers Of 400um And 600um transmission system this device makes for a very convenient laser surgical solution for Vestibuloplasty. The CO2 + KTP”-like laser unit of SIFLASER-1.2 at a wavelength of 980nm is convenient for coagulation, vaporisation and bloodless surgery thanks to its peak absorption in hemoglobin and its permeability in water. It will ensure a smooth and precise operation with very minimum bleeding and post operative pain and/or discomfort and avoids the need for sutures.

This procedure is performed by a qualified Periodontist*

Reference: Diode laser frenectomy: A case report with review of literature
Evaluation of Patient Perceptions After Vestibuloplasty Procedure: A Comparison of Diode Laser and Scalpel Techniques

Disclaimer: Although the information we provide is used by different doctors and medical staff to perform their procedures and clinical applications, the information contained in this article is for consideration only. SIFSOF is not responsible neither for the misuse of the device nor for the wrong or random generalizability of the device in all clinical applications or procedures mentioned in our articles. Users must have the proper training and skills to perform the procedure with each Laser system.

The products mentioned in this article are only for sale to medical staff (doctors, nurses, certified practitioners, etc.) or to private users assisted by or under the supervision of a medical professional.