Lasers for use on gum tissue were first approved in the 1990s and have been increasingly used. The use of lasers in dentistry is exciting because it offers a minimally invasive way to assist in the resolution of periodontal (gum) disease. There are many different dental lasers, such as Diode, Nd:YAG, Erbium, and CO2. One of the more common lasers is a diode laser with brands Biolase, Picasso, and Gemini. The Biolase can be used for a variety of procedures such as tooth whitening with LaserSmile and periodontal (gum) procedures such as reducing bacteria, removing excess gum tissue, and removing infected gum tissue within deep periodontal pockets.
Gingivectomy:
What is a “gummy” smile? There are two major reasons a person could have a “gummy” smile. Either their smile muscles are so strong that their upper lip gets pulled up much higher than their gum line or they have excessive gum tissue. Usually, excessive gum tissue results in the patient’s teeth looking short and small in size. If this is the case, the removal of excessive gum tissue could reveal more tooth structure and nicely fill in the patient’s smile. This procedure is called a gingivectomy.
Gingivectomies are usually performed by either removal using a blade or laser. Using a laser results in cauterization as it removes the gum tissue, which reduces bleeding compared to using a blade. The procedure involves measuring the distance of the start of your gum tissue to your bone level (bone sounding) to ensure safe removal without causing harm to the surrounding bone. Once determined safe, removal of excess tissue is completed with the laser. This results in increased length of the tooth, revealing a less “gummy” smile.
Laser bacterial reduction (LBR):
When bacterial plaque builds up around our teeth, it starts to affect the surrounding gums and bone. The presence of bacteria in gum pockets causes inflammation to occur. This inflammation results in bleeding. To bring our gums back to a state of health, it is important to combine home care with professional cleanings. During professional cleanings, the plaque is removed from our teeth and gums, which over time can result in reduced inflammation and bleeding due to the removal of harmful bacteria. To speed up the healing process, “laser bacterial reduction” (LBR) can be used in conjunction with a regular cleaning. Laser bacterial reduction (LBR) uses a diode laser to decontaminate the gum tissue by removing the bacteria causing inflammation and bleeding.
The procedure is quick and easy to add to any cleaning appointment. After evaluation, if excess bleeding or inflammation is seen in any gum pockets, laser bacterial reduction can be completed. The procedure is painless, therefore numbing is not required.
Curettage:
In patients where inflammation and bacteria have built up and progressed, we start to see the development of periodontal disease. Periodontal disease usually involves calculus, or calcified plaque, developing within the gum pockets. This bacterial calculus build-up results in severe inflammation, which causes deepening of the gum pockets and bone loss. These deep gum pockets are extremely difficult for patients to clean at home, resulting in the progression of periodontal disease. To get the periodontal disease under control, a deep cleaning or “scaling and root planing” is needed. This procedure involves removing calculus from the root surface below the gums.
Although scaling and root planing is an excellent way to get periodontal disease under control, combining it with laser curettage can improve results. Similar to laser bacterial reduction, bacteria is removed to help stop the disease at the source. Furthermore, curettage also involves removing the infected gum tissue within the pocket, which results in faster healing than a deep cleaning alone.
Hard Tissue Lasers:
In addition to treating gum tissue, lasers can treat hard tissue, such as teeth and surrounding bone. A few common lasers designed for hard tissue treatment are Biolase Waterlase, Fontona LightWalker, and Solea. These lasers can reach higher wavelength settings that make this possible. There are many benefits to using a laser for cavity removal, such as reduced post-operative sensitivity, less tooth structure removal, and even no need for local anesthesia (no shot to get numb).