Master of Science (M.S.) in Dentistry
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College of Dental Medicine
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Nova Southeastern University
Mehdi Garashi. 2018. Comparing the Efficacy of Scalpel, Electrosurgical, and Laser Gingivectomies for the Management of Gingival Enlargement Following Orthodontic Therapy. Master's thesis. Nova Southeastern University. Retrieved from NSUWorks, College of Dental Medicine. (83)
Introduction: Gingival enlargement can occur during orthodontic therapy and often may not subside following removal of the orthodontic appliances. It may lead to esthetic concerns, as well as potential reservoirs for bacteria and hinder oral hygiene efforts. Treatment has included nonsurgical debridement alone or in combination with gingival resection using laser, electrosurgery, or conventional scalpel. Objectives: To compare the clinical effectiveness of three resective techniques in the management of gingival enlargement following orthodontic therapy with regards to: Gingival margin position (GMP), probing depths (PDs), bleeding scores, plaque index (PI), gingival index (GI) and patient postoperative discomfort. Materials and Methods: 17 healthy adult patients, who recently completed orthodontic treatment and presented with at least two posterior teeth in each quadrant with 4 mm or greater gingival pocketing were screened. Six qualified for the study. A periodontal evaluation and the GMP were recorded using a customized stent. The patients received initial nonsurgical debridement and were re-evaluated after 4-6 weeks. Two patients dropped during the course of the study (one relocated, and the other no longer had gingival enlargement). The four remaining patients underwent surgical treatment by a Secondary Investigator (experienced periodontist) in a split mouth design. Three quadrants were randomly assigned a surgical treatment (laser, electrosurgery, or scalpel) while the fourth quadrant served as a control, with all quadrants receiving additional nonsurgical debridement during that visit. The Primary Investigator was blind to the surgical treatment and returned after the procedure to measure the GMP. The first follow-up visit was at 1-2 weeks post-surgery during which patients were also asked about postoperative discomfort. Further evaluations were performed at 4-6 and 12-14 weeks post-surgery. Results: Four patients with a total of 61 posterior teeth (29 premolars and 32 molars) completed the study. Three of the four patients reported more postoperative discomfort in the electrosurgery treated regions, while one patient reported the laser treated region causing the most discomfort. All three surgical groups (laser, electrosurgery, and scalpel) showed significantly more reduction in the GMP compared to the control. All subjects had statistically significant reduction in the overall PDs, bleeding scores and PI by the end of the study, while not in the GI. Furthermore, when comparing the three surgical techniques to each other, no statistically significant differences were found for any of the clinical parameters (PD, bleeding, GMP, PI, and GI), however, the laser group had the most reduction in all the evaluated clinical parameters. Lastly, analysis by tooth type revealed that premolar teeth had significantly more reduction than molar teeth in bleeding score, PI, and GI, but not with respect to GMP and PDs. Conclusion: Within the limitations of this study, it was shown that all three resective techniques (laser, electrosurgery, and scalpel) were more effective at reducing gingival enlargement than nonsurgical therapy alone. Most patients reported the electrosurgery treated group as having the most postoperative discomfort, followed by the laser treated group. Although there was no statistically significant difference when comparing the three techniques to each other, the laser had the most reduction in all clinical parameters (GMP, PDs, bleeding score, PI, and GI). Further studies with longer follow-up are recommended to strengthen the evidence in support of their effectiveness.
Electrosurgery, Gingival Enlargement, Gingivectomy, Laser, Orthodontics, Periodontology
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