R. Yu. Kotok

State Institution “Dnipropetrovsk Medical Academy of Health Ministry of Ukraine”

Department of Dentistry of the Faculty of Postgraduate Education, State Institution “Dnipropetrovsk Medical Academy"

SURGICAL GINGIVAL RETRACTION WITH A DIODE LASER "PICASSO LITE"

Summary. In this article we study the relevance of saving a tooth under conditions of significant destruction of its coronal part. Orthopaedic intervention in the context of such defects should be aimed at the restoration of the crown, the root and the chewing function of the tooth. In the course of clinical observations the high efficiency of diode laser application has been shown, it created the optimal access to the tooth and was followed by rapid regeneration of the marginal gingiva.

Key words: gingival retraction, cast post-and-core inlay, ferula, marginal periodontium.

Complete destruction of the tooth coronal part occurs due to caries and its complications, injuries, abnormal abrasion, under the artificial crown at cementing failure, damage of teeth having large or multiple fillings, and due to other causes. Loss of the tooth coronal part may lead to significant changes in the morphological structure of the dental arches, such as the convergence of adjacent teeth, antagonists shift towards the defect (Popov-Godon phenomenon) [1]. Orthopaedic treatment of such destruction shall be directed to the restoration of the coronal part and chewing function of the tooth. It is necessary to conduct additional studies to detect possible complications in the root end and marginal periodontium [5]. In cases of such defects of teeth crowns, many authors recommend to restore them with cast post-and-core inlays and afterwards to coat them with one of the types of orthopedic structures [3, 4].

The destruction of hard tooth tissues up to and below the gingival margin, within the upper quarter of the length of the root (index of tooth occlusal surface destruction ≥ 0.8) leads to inflammation of the marginal periodontium. The presence of periodontal pocket, local gingivitis, and gingival hypertrophy is possible.

Despite the fact that this problem is studied in a large number of works, and methods of manufacturing the cast post-and-core inlays are widely used in practice, the question of marginal fitness and durability of this construction remains up to date. In order to restore the tooth coronal part destroyed at the gingiva or below the gingival margin it is necessary to expose the remaining dental stump (ferula). For this purpose, surgical techniques of retraction are mainly used, i. e. gingivectomy with the application of surgical tools such as scalpel, electrosurgical devices (coagulators), photodynamic therapy (laser), dental burs [2].

Research Objective. To study the quality of cast post-and-core inlay fit modeled at the significant deep destruction of the tooth coronal part with prior gingival retraction by the diode laser. As well as to determine the state of adjacent periodontal tissues in the rehabilitation period. Our goal was to create an optimally comfortable access to the preserved tissues of the tooth, for the most precise fitness of the modeled construction. A special diode laser equipment "Picasso Lite" was applied, it provides fine-focus radiation of 1.8 W with a wavelength of 810 Nm. Manipulations were held in a contactless manner – the end of the waveguide is directed to the operated area of the gingiva. The duration of each pulse is 30 msec, period of interpulse pauses is 30 msec. The total exposure time is chosen individually.

Research Materials and Methods. At the Department of Dentistry of the Faculty of Postgraduate Education, State Institution “Dnipropetrovsk Medical Academy", a series of clinical observations of application of surgical and mechanical methods of retraction at the restoration of tooth destroyed at the gingiva and below the gingival margin was held. The state of soft tissues was assessed based on the quality of the gingival margin, sulcus bleeding index (Muhlemann and Cowell), on the presence and depth of the periodontal pocket and on the enlargement X-ray film (the degree of bone resorption).

40 patients having cast post-and-core inlays were examined and 40 prosthetic appliances were made for their teeth. The main group (I) consisted of 18 people, for whom cast post-and-core inlays were manufactured with prior gingival retraction by the diode laser. For the group II of patients the cast post-and-core inlays were installed with prior excision of the gingiva with the help of the twelve point hard-metal turbine bur. Group III consisted of 11 patients gingival reposition for which was performed with the help of retraction cords. Inlays for all patients were manufactured for single crowns both on the anterior and grinding teeth. Supragingival part of the tooth was prepared with the help of cone-shaped diamond burs with rounded tip, with the creation of a shock-absorbing and stabilizing platform [1]. The preparatory tooth treatment was carried out by diamond burs with a blue marking (the average diamond grit of 105–125 microns), finishing was performed by burs with red marking (small diamond grit 27–53 microns). The expansion of root canals was performed by reamers Largo Peeso Reamer # 1, 2, 3, 4, 5. The inlays were modeled by the direct method using the fast-hardening ashless plastic Patern Resin (GC, Japan). Ashless cores Burn Out Post (Directa, Sweden) were used as an internal support (reinforcement) of the plastic bars.

Research results and their discussion. A year later, it was found that in group I 12 persons' marginal gingiva in the area of the tooth restored with help of cast post-and-core inlay had no signs of inflammation, in 6 persons a slight swelling and hyperemia were marked in the named area. The sulcus bleeding index in the examined area of teeth of 9 persons was equal to 0 score, of 7 persons – to 1 score, and of 2 patients to 2 scores. The periodontal pocket depth was 1–2 mm in average for the group. The bone resorption was not defined on the X-ray. In group II, the marginal gingiva in the area of the restored tooth in 3 persons had no signs of inflammation, and in 8 patients a slight swelling and hyperemia were marked in the named area. The sulcus bleeding index in 3 persons was equal to 0 score, in 5 persons – to 1 score, in 1 person – to 2 scores, and in another one to – 3 scores. The depth of the periodontal pocket was 2–3 mm for the group. On the X-ray the bone resorption in the area of the root was 1–2 mm. In group III, the marginal gingiva in the area of the restored tooth in 1 patient had no signs of inflammation, in 4 persons swelling and hyperemia were marked in the named area, and in 6 people hypertrophy and painfulness of the adjacent gingiva were marked. The sulcus bleeding index in 3 persons was equal to 1 score, in 3 persons – to 2 scores, in 5 person – to 3 scores. On the X-ray the bone resorption in the area of the examined root was 3–4 mm.

It is found that the restoration of the gingival structure and contour in the defect area occurs more quickly in patients who used laser retraction. A significant reduction in inflammation and bleeding is noted. The gingiva in the area of the eliminated defect is pale pink, has a flat and smooth contour, and fits tightly to the restored tooth crown. Patients noted rapid disappearance of pain and bad breath.

Conclusions. The datum received in the course of clinical observations have shown that surgical gingival retraction by "Picasso Lite" diode laser contributes to the creation of good access for modeling a dental stump, to the rapid recovery of the marginal gingiva and the absence of complications. The long-term results revealed a high functional and aesthetic effectiveness of the treatment.

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