Wired for Success Alan A. Curtis, DDS, MS, Editorial Director, Orthotown Magazine

 

Incorporating Laser Treatments
into Routine Orthodontic Practice


by Alan A. Curtis, DDS, MS, Editorial Director, Orthotown Magazine

Like many of you, soft-tissue laser treatments were not a part of my orthodontic curriculum. Incorporation of soft-tissue management in my practice has been something that has developed over time. The purpose of this article is to share with you a few cases that illustrate typical uses of a diode laser in routine orthodontic care.

Maxillary Frenectomies

Maxillary diastemas are a frequent occurrence in the orthodontic office. While their etiology may vary, often the cause is a low maxillary frenum. A handyman would be foolish to restore the wet drywall before repairing the leaky pipe behind the wall. Unfortunately, far too often the diastema is closed but the cause of the gap (low frenum position) remains untreated. During my initial exam, low fremun attachments are discussed and the associated laser frenum treatment is planned for after the orthodontic treatment. I have chosen to include the cost of the procedure as part of the comprehensive treatment plan. Parents are typically grateful and understand the necessity of the procedure.



Gingival Architecture

Upon finishing a case, gingival architecture is evaluated for aesthetics. Zenith position of the central incisor and its relationship to the lateral incisors and cuspids are compared together with probing depths to determine proper relationships. Pseudo-pocketing (depths greater than 3mm) indicates areas where contouring can be performed. Cuspids and central incisors should have equal relative gingival margins. The zenith of the central incisor should be placed distal to the long axis of the central incisor.



Uncovering Teeth

Here's the scenario, you've bonded the case prior to the eruption of the maxillary cuspids or the mandibular second molars (a topic for another column), you are 12-18 months into a 24-month treatment plan. A panoramic film shows good root development and teeth that are on the verge or errupting. The adolescent looks up at you and asks, "When am I getting my braces off?" Time to get out your trusty diode laser and get some brackets on those teeth.



Lumps and Bumps

Although benign, enlarged/clogged salivary ducts can be worrisome to patients and can be aggravated next to fixed orthodontic appliances. Having a soft-tissue laser to excise them off with relative ease and comfort is a service that is much appreciated. I personally do not typically charge for such a service.



Mid-treatment Hyperplasia

During treatment, whether induced by poor brushing, mouth breathing or other etiologic factors, gingival hyperplasia can be a worrisome occurrence for parents, patient and doctor. Having a diode laser to control gingival overgrowth can be very useful.



My experience with diode lasers started with a trip to my local supermarket where I obtained a hot dog. After I could properly and comfortably burn my name into an Oscar Meyer, I graduated to a pig head (I had to go to my local Asian market and fork out $15). On the pig head I practiced contouring around teeth until I felt comfortable with the cutting action of the diode. I have attended laser courses held at the dental school near my practice to understand the physics of laser dentistry. I now use my diode laser a few times a week and cannot imaging practicing without it. What's your experience with lasers? Post your most interesting laser cases online at Orthotown.com!

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