|Year : 2012 | Volume
| Issue : 1 | Page : 26-29
Multidisciplinary applications of diode Laser in rehabilitation of complex clinical situation
Deepak Rai1, Amanish Singh2, Sheetal Rai3
1 Department of Orthodontics, Manav Rachna Dental College, Faridabad, Haryana, India
2 Department of Orthodontics, Adesh Institute of Dental Sciences and Research, Bathinda, Punjab, Private Practice, India
3 Department of Orthodontics, Dr. Rai's Dental Care & Orthodontic Centre, Noida, India
|Date of Web Publication||15-Sep-2012|
G163, Sector 41 Noida, U.P 201303
Source of Support: None, Conflict of Interest: None
The incorporation of Dental Lasers as a practice builder has been proven beyond doubt .Clever selection of cases which will benefit from this modality determines rewards in long term for clinician and the practice. Current perceptions of soft tissue laser use in Orthodontic patients requiring adjunctive soft tissue surgeries is gaining popularity. This article presents a case report of a young unmarried women requiring Multidisciplinary treatment for correction of her dental problems, where diode laser has been used as an useful adjunct for various applications like frenectomy, orthodontic micro-implant salvage, crown lengthening and even bleaching in the same patient, enabling comprehensive rehabilitation of the patients dental problem.
Keywords: Multidisciplinary treatment, midline diastema, diode lasers
|How to cite this article:|
Rai D, Singh A, Rai S. Multidisciplinary applications of diode Laser in rehabilitation of complex clinical situation. J Dent Lasers 2012;6:26-9
| Introduction|| |
The incorporation of Dental Lasers as a practice builder has been proven beyond doubt.  Clever selection of cases which will benefit from this modality determines rewards in long term. Current perceptions of soft tissue laser use in Orthodontic patients requiring adjunctive soft tissue surgeries is highly positive.  This article presents a case report of a young women requiring Multidisciplinary treatment for correction of her dental problems, where diode laser has been used for different applications like frenectomy, orthodontic micro-implant salvage, crown lengthening and even bleaching in the same patient ,enabling comprehensive rehabilitation of the patients dental problem.
| Case Report|| |
An unmarried lady in her late twenties reported to the clinic with chief complaint of large midline space between central incisors causing immense psychological drain and affecting her professional growth  [Figure 1]. She wasn't confident about smiling and had been through many consultations regarding optimal line of cure for her problem.
As she was given a comprehensive plan involving orthodontic redistribution of spaces assisted with microimplants along with dental soft tissue laser to correct the causative and contributing factors the patient was keen to undergo a long term rehabilitation process. Explanation of using dental lasers sends the wave of excitement in her eyes and was very interested how this modality can contribute to her final result. It has been observed that patients perceptions like apprehension before laser procedure and discomfort after the procedure is negligible as compared to other surgical modalities. 
- Orthodontic redistribution of spaces: Objective was to close anterior spaces [Figure 2] and [Figure 3] and distribute them distally in the arch. The mechanics used were to ensure retraction and closure of anterior spaces by sliding method over ceramic braces, using orthodontic microimplants for anchorage purpose [Figure 5].
- Frenectomy of thick labial frenum-The upper labial frenum was thick and flabby and after the orthodontic space closure was achieved the frenum was excised using diode laser (AMD LASERS TM , LLC, 7405 WESTFIELD BLVD. INDIANAPOLIS,IN46240 www.amdlasers.com ) [Figure 4] and [Figure 6]. Post frenectomy healing was uneventful and patient expressed satisfaction with the least discomfort postoperatively.[Figure 6].
- Retraction of anteriors using microimplants-The orthodontic microimplants were used as anchorage to retract anteriors after spaces had closed and frenectomy site had healed [Figure 6]. The microimplants often develop mucositis at site of entry and diode laser was used to salvage these microimplants using laser at biostimulatory mode (0.8watts noncontact mode).[Figure 7] and [Figure 8]. After retraction orthodontic appliance was debonded and a permanent retainer was bonded from palatal aspect.[Figure 9]
- Crown lengthening- The smile of patient revealed small clinical crown height with excessive gingival display. Clinical evaluation revealed possibility of gingivoplasty with diode laser and the results were encouraging as has been reported in literature.  [Figure 10]
By this time patient had developed immense faith in the success of soft tissue lasers as part of treatment plan and wished to have her teeth bleached. Pola office bleach (POLA OFFICE, SDI LIMITED, 3-13 BRUNDSON STREET, BAYSWATER,VICTORIA 3153, [email protected]) was used and upper and lower arches were bleached at custom setting of 7 watts 10 sec each tooth with two applications per tooth [Figure 11]. Postbleaching the results was encouraging. [Figure 12] are comparison of before treatment and after treatment smile. An elated patient after Multidisciplinary treatment using diode laser for varied applications. All essential protocols for laser safety were strictly adhered to in clinical use of diode laser. 
| Discussion|| |
The management of complex cases requiring multidisciplinary treatment is bound to have benefits by soft tissue diode lasers which are now becoming the routine technological acquisition by every major dental practice. Laser dentists are often questioned by those who haven't yet braced this modality as to what are the situations you use this treatment modality, and often the ones who are ahead in the learning curve feel difficulty in enumerating the benefits as the benefits of using diode lasers are more than one can count on fingers. They are truly a practice builder as quoted by Parkins. 
Orthodontists have embraced this modality and there perceptions of lasers are highly positive as stated by Burke  in there survey. Handling clinical situations like midline diastema as reported in this clinical case report requires a multidisciplinary effort. 
Proper case presentation and formulating a plan that enables patients participation in understanding benefits is a must and offering the new technology like diode lasers often elicits favorable response by patients as observed by authors in a study done on comparison between lasers and radiosurgery. 
Diode lasers have been used successfully in varied treatment options and the real success comes by proper understanding of clinical and laser parameters and judicious and safe use of this modality. 
| References|| |
|1.||Parkins F. Lasers in pediatric and adolescent dentistry. Dent Clin North Am 2000;44:821-30. |
|2.||Burke B, Hamdan AM, Tufekci E, Shroff B, Best AM, Lindauer SJ. Perceptions of soft tissue laser use in orthodontics. Angle Orthod 2012;82:75-83. |
|3.||Mohammad AK. The multidisciplinary management of median diastema. Bangladesh J Med Sci 2010;9:234-7. |
|4.||Rai D. Comparison of labial frenectomy done with radiosurgery and diode (810nm) laser using visual analogue scale for patents perceptions of preoperative distress and postoperative pain. APOS Trends in Orthodontics Journal Of Asia Pacific Orthodontic Society, Vol II No 3 Available at www.apospublications.com/APOS_trends_oct2011.html. |
|5.||Lagdive SB, Lagdive SB, Marawar PP, Bhandari AJ, Darekar A, Saraf V. Surgical lengthening of the clinical crown using semiconductor diode laser: A case series. J Oral Laser Appl 2010;10:53-7. |
|6.||Sweeney C. Laser safety in Dentistry. Gen Dent 2008;56:653-9. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12]