| Abstract|| |
Background: Soft tissue excision around natural teeth is carried out to increase the clinical crown lengths, expose the caries apical to the gingival margins and to correct irregular and un-esthetic soft-tissue contours.
Aims: The study was carried out with an aim to evaluate the stability of the soft tissue margins after excision either with a laser or scalpel.
Materials and Methods: A total of 20 patients indicated for soft tissue excision for correcting soft tissue discrepancies were selected. The patients with thick gingival biotype were included in the study. They were grouped randomly into excision by laser or scalpel methods. The change in the soft tissue positions from the time of excision to 1-month follow-up were evaluated immediate postoperatively, after 2 weeks and after 1-month postrestoration.
Results: The soft tissues remained stable in the laser group at 1-month follow-up, in contrast to the scalpel group and were found to be statistically significant, (Student's t-test) (P < 0.05).
Conclusion: The soft tissue margins are more stable and stay at the point they were excised with lasers when compared with scalpel.
Keywords: Crown lengthening, diode laser, gingivectomy, gingivoplasty, soft tissue excision
|How to cite this article:|
Bhat P, Thakur SL, Kulkarni SS. Evaluation of soft tissue marginal stability achieved after excision with a conventional technique in comparison with laser excision: A pilot study. Indian J Dent Res 2015;26:186-8
Gingival soft tissue excisions are routinely carried out in dental practices.  These are done to correct irregular gingival contours, remove excess gingival tissue and gingival overgrowths and also to expose the finish lines for restorative purposes respectively. These have been performed either with gingivectomy knives, bard parker blades and electrosurgery. , The bleeding that happens after excision and the coronal migration of the soft tissue margins as they heal makes it difficult for recording the finish lines and has necessitated on the additional step prior to making final impressions.  Furthermore, the increased postoperative discomfort with conventional methods has always weighed on the minds of the practitioners as well as the patients and thus an alternate to these techniques was desired,  thus a need was always felt to have a technique that was less painful, reduced discomfort, provided more hemostasis and be more predictable with respect to the stability of soft tissue margins.  The evolution of technologies has made it possible for the application of lasers in dentistry. This coupled with an improved understanding of tissue healing has made it possible for routine use of lasers in soft tissue procedures. 
|How to cite this URL:|
Bhat P, Thakur SL, Kulkarni SS. Evaluation of soft tissue marginal stability achieved after excision with a conventional technique in comparison with laser excision: A pilot study. Indian J Dent Res [serial online] 2015 [cited 2021 Oct 27];26:186-8. Available from: https://www.ijdr.in/text.asp?2015/26/2/186/159159
The aim of the present pilot study was to evaluate the stability of soft tissue margins after excision with conventional surgery and with lasers, and to quantify the percentage of soft tissue changes if any.
| Materials and Methods|| |
This study was conducted at the Department of Periodontics and Implantology of our institute after obtaining ethical clearance from the institutional review board. A total of 20 subjects indicated for gingival excision for increasing the clinical crown lengths were included. The inclusion criteria were age range of 18-35 years, noncontributory medical history, nonsmokers, thick gingival biotype, ,,, patients agreeing to the terms of the study and ready to give informed written consent. Pregnant women and lactating mothers, patients on drugs that may influence the gingival and patients with systemic conditions and diseases were excluded.
All the patients underwent phase periodontal I therapy and acrylic stents were fabricated on patients' diagnostic models, which were to be used to measure the tissue levels. Prior to excision, the plaque and gingival index scores were to be ≤ 1 (Silness and Loe plaque index 1964; and Loe and Silness gingival index 1965). All the measurements were made on three sides of each tooth (i.e) mesio buccal, mid buccal and disto-buccal with a UNC-15 probe. These measurements were repeated, immediate postoperatively, after 2 weeks and after 4 weeks.
All the 20 subjects underwent soft tissue excision either with laser or scalpel, and this selection was done randomly with a toss of a coin. The excision with a scalpel was performed with a number 11 or 15 Bard Parker blade and in the laser group, Gallium-Aluminium-Arsenide diode laser with a wavelength of 940 nm set at power of 2.00 W, 1.00 ms/1.00 ms pulsed focused contact mode was used. The teeth were then prepared to receive the final prosthesis fabricated in porcelain fused to metal with equi-gingival margins. Subjective assessment of pain and bleeding during a surgical procedure was recorded for both the groups. The data were statistically analyzed with Student's t-test as shown in [Table 1].
| Results|| |
In all the patients, the healing process was uneventful, and no untoward incidents were reported. Over 1 month period, the gingival soft tissue was completely healed. The subjective feeling of reduced bleeding was felt by operator in sites treated by laser when compared to scalpel.
In all the sites, the amount of tissue excised was in the range of 1.03 ± 0.12, 1.12 ± 0.19 mm in dimension terms and 31.16 and 34.66 in percentage terms when compared to the preoperative, there was no difference between a scalpel and the laser groups immediate postoperatively.
When compared to preoperative, in all the sites there was a statistically significant increase in measurement at 4 weeks in both the groups. However there was no significant difference between the groups.
There was a statistically significant increase of 0.92 ± 0.26 mm (−21.76%) in the measurement in the scalpel group at 2-weeks postoperative when compared to the preoperative, and subsequently a significant decrease in the measurements of 0.79 ± 0.08 mm (15.27%) between the 2 nd and the 4 th week postoperative.
In the laser group all through the study period no change in the measurements from immediate postoperative period were noted.
At 2 weeks and in the interval between the 2 nd and 4 th week there was a significant difference observed between the two groups.
| Discussion|| |
The soft tissue excision around the teeth are carried out for various reasons; crown lengthening, correction of irregular contours, exposure of the finish lines prior to restorative therapy are a few of them. ,, The present study was conducted to evaluate the stability of the level of the soft tissue in sites excised with a scalpel and with a laser. Thin biotype cases were not taken into consideration as the response of the thin biotype to the excision may vary. ,,, All the patients in the present study belong to the thick biotype category.
In the present study, we found that in the sites treated with scalpel, the soft tissue margins receded from the point of excision at the 2-week interval. This was later followed over the next 2 weeks, wherein the soft tissue margins crept back on to the crown.
The increase in the measurements at 2 weeks is attributable to the external Beveled incision More Details made to excise the soft tissue, which removes more amount of the tissue on the buccal aspect of the soft tissue as compared to the tooth attached portion.  Second the fact that after 2 weeks surface epithelialization takes place, thus there is shrinkage of the gingival margins. 
The creeping up of the margins observed at 4 weeks is due to complete epithelial, and connective tissue repair takes place leading to the movement of the gingival margins in the coronal direction. 
However in the sites treated with laser, the soft tissue margins remained stable all through that is, from the time of excision to the 4 th week follow-up the soft tissue levels remained at the point of excision. This is attributable to mechanism of the action of lasers wherein the cells at the cut margins are dead and the blood vessel in the surrounding tissue up to the diameter of 0.5 mm are sealed by the laser leading to minimum scarring and healing process starts from the deeper tissues so the healing is slow and thus the margins remain at the point where they were cut rather than recede or creep up.  Second laser wounds are sterile and less likely to become inflamed. Due to this, the rebound of soft tissue that happens as it heals is minimized and thus, the soft tissue contours achieved with the laser excision are more predictable. ,,,,,,
Though the soft tissue margins were at the same level between both the groups at 4 weeks, this is due to the creep up of the tissues observed in the scalpel group from the 2 nd to the 4 th week.
The continual stability of the margins achieved with from the time of excision with laser makes it more predictable and favorable for restorative purposes as compared to scalpel excision wherein there is an initial receding of the margins followed by creeping back. ,,,,,
| Conclusion|| |
Though the data from this small cohort cannot be extrapolated to give definitive conclusions, within the limitations of this pilot study it can be said that soft tissue excision with laser is better than the scalpel for soft tissue re-contouring and the levels achieved with laser are stable.
| References|| |
Takei HH, Carranza FA. Gingival surgical techniques. In: Newman MG, Takei HH, Klokkevold PR, Carranza FA Jr, editors. Carranza′s Clinical Periodontology. 10 th
ed. St Louis, Missouri: Saunders, Elsevier Inc.; 2006. p. 914-5.
Melnick PR. Preparation of the periodontium for restorative dentistry. In: Newman MG, Takei HH, Klokkevold PR, Carranza FA Jr, editors. Carranza′s Clinical Periodontology. 10 th
ed. St Louis, Missouri: Saunders, Elsevier Inc.; 2006. p. 1044-5.
Cobb CM. Lasers in periodontics: A review of the literature. J Periodontol 2006;77:545-64.
Ishikawa I, Aoki A. Recent advances in surgical technology - Part 2. In: Newman MG, Takei HH, Klokkevold PR, Carranza FA Jr, editor. Carranza′s Clinical Periodontology. 10 th
ed. St Louis, Missouri: Saunders, Elsevier Inc.; 2006. p. 1031-7.
Schwarz F, Aoki A, Becker J, Sculean A. Laser application in non-surgical periodontal therapy: A systematic review. J Clin Periodontol 2008;35:29-44.
Christensen GJ. Soft-tissue cutting with laser versus electrosurgery. J Am Dent Assoc 2008;139:981-4.
Berglundh T, Lindhe J. Dimension of the periimplant mucosa. Biological width revisited. J Clin Periodontol 1996;23:971-3.
Cohen ES. Periodontal biotypes. In: Decker BC, editor. Atlas of Cosmetic and Reconstructive Periodontal Surgery. 3 rd
ed. Massachusetts; 2007. p. 247.
Ericsson I, Lindhe J. Recession in sites with inadequate width of the keratinized gingiva. An experimental study in the dog. J Clin Periodontol 1984;11:95-103.
Sharma S, Thakur SL, Joshi SK, Kulkarni SS. Measurement of gingival thickness using digital vernier caliper and ultrasonographic method: A comparative study. J Investig Clin Dent 2014;5:138-43.
Pontoriero R, Carnevale G. Surgical crown lengthening: A 12-month clinical wound healing study. J Periodontol 2001;72:841-8.
Schwarz F, Aoki A, Sculean A, Becker J. The impact of laser application on periodontal and peri-implant wound healing. Periodontol 2000 2009;51:79-108.
Bader HI. Use of lasers in periodontics. Dent Clin North Am 2000;44:779-91.
Pick RM, Colvard MD. Current status of lasers in soft tissue dental surgery. J Periodontol 1993;64:589-602.
Dr. Sudhindra S Kulkarni
Department of Periodontics, S. D. M. College of Dental Sciences and Hospital, Sattur, Dharwad, Karnataka
Source of Support: None, Conflict of Interest: None