Marko Blašković

Surgical Treatment of Excessive Gingival Display Using Lip Repositioning Technique and Laser Gingivectomy as an Alternative to Orthognathic Surgery

Excessive gingival display (EGD) is a condition in which an overexposure of the maxillary gingiva (>3 mm) is present during smiling. The proper diagnosis and determination of its etiology are essential for the selection of the right treatment modality. Different techniques have been used in cases of hyperactive upper lip: botulinum toxin injections, lip elongations with rhinoplasties, lip muscle detachments, myotomies, and lip repositions. This report presents a case of a young woman with an EGD larger than 10 mm during smiling caused by altered passive eruption, vertical maxillary excess, and a hyperactive upper lip that was treated with a modified lip repositioning technique and laser gingivectomy because she strongly refused orthognathic surgical treatment. A novel addition to the technique is proposed, a reversible trial accomplished just by applying sutures on the borders of the future split-thickness flap, marked using diode laser, before starting the flap incision.

Evaluation of Bone Healing After Osteotomies Prepared With Er:YAG Laser in Contact and Noncontact Modes and Piezosurgery--An Animal Study.

PURPOSE To analyze the healing of bone tissue treated with Er:YAG laser contact and noncontact modes of and piezosurgery in a rat model using triangular laser profilometry. MATERIALS AND METHODS Twenty-four 10-week-old adult male Wistar rats were used in the study. Three osteotomies on the medial part of tibia were performed in each animal, 1 in the right tibia and 2 in the left tibia. The osteotomies were performed with a piezoelectric device set at maximal power and the Er:YAG laser in contact mode (power, 7.5 W; pulse energy, 375 mJ; repetition rate, 20 Hz; MSP mode) and noncontact mode (power, 7.5 W; pulse energy, 750 mJ; repetition rate, 10 Hz; QSP mode) with a novel type of circular, digitally controlled handpiece (x-Runner). After surgery, 6 animals were immediately euthanized (group 1), and the others were euthanized after 1 week (group 2, n = 6), 2 weeks (group 3, n = 6), and 3 weeks (group 4, n = 6). Bone healing after osteotomy was analyzed using a 3-dimensional laser scanning technique (ie, laser triangulation profilometry). RESULTS The volume reduction rates are similar for all 3 techniques (0.2 to 0.25 mm(3) per week). Greater volume reduction of 0.25 mm3 per week was observed for the Er:YAG laser in noncontact mode (x-Runner). After 3 weeks, almost complete healing of the prepared osteotomy was observed. CONCLUSION Within the limitations of this study, the osteotomies performed by the Er:YAG laser in digitally controlled noncontact mode healed the fastest.

Bone healing following different types of osteotomy: Scanning electron microscopy (SEM) and three-dimensional SEM analyses

The aim of the present study was to compare dynamics of the bone healing process after different types of osteotomies. In total, 24 Wistar rats were subjected to different types of osteotomy performed with standard steel bur, piezosurgery, contact, and non-contact Erbium:yttrium-aluminum-garnet (Er:YAG) laser ablation. The animals were randomly divided into four groups, to be euthanized immediately after the procedure, or at 1, 2, or 3 weeks after surgery. The obtained bone samples were analyzed by scanning electron microscopy (SEM). Immediately after surgery, there were significant differences in the appearance of the bone defects, with presence of bone fragments and debris after standard steel bur preparation, compared with the clean smooth walls and relatively sharp edges in all other groups. The initial bone formation in defects prepared by piezosurgery was observed to be the most rapid. After 3 weeks, all bone defects were completely restored; although, differences in the healing pattern were noted, with a modest initial delay in healing after laser preparation. The first stage of the bone healing process was delayed when contact and non-contact Er:YAG laser modes were used and accelerated by piezosurgery; however, the results after 3 weeks demonstrated similar restitution of defects in all tested groups.

Advanced Applications of the Er:YAG Laser in Oral and Maxillofacial Surgery

Lasers are becoming widely used in medicine and dentistry due to their beneficial effects such as: coagulation properties (less postoperative bleeding), less pain and edema. Lasers also allow good and rapid healing, a very low level of discomfort both during and after intervention and a rapid disappearance of symptoms.Laser technology has certain advantages such as accuracy of the incision, absence of vibration and manual pressure during use ; this is also true for Er: YAG laser application. Due to laser positive coagulation effects during surgical procedure, better sight of the work field is obtained.Lasers have played an integral part in the evolution of oral and maxillofacial surgery (OMS) ; and rapidly became the standard of care for many procedures performed by oral surgeons.The reason for this transition is simple: many procedures can be executed more efficiently and with less morbidity using lasers when compared with scalpel, electrocautery or high frequency devices.Laser surgery has emerged as an established method in advanced medicine. Laser- induced remote tissue treatment provides a number of advantages: controllable coagulation and cutting of surgical tissues with wavelength tissue-specific cutting efficiency.