electrosurgery in periodontics

ELECTROSURGERY IN

PERIODONTICS

IT INCLUDES:

• HISTORY• PRINCIPLE• DEFINITION• USE• ADVANTAGES• DISADVANTAGES• TECHNIQUE• HEALING• COMPLICATIONS

HISTORY

• Cusel, a Russian was the first to apply electricity to surgical excision in 1847 . He attempted to destroy a neoplasm with electric current.

• Cushing and Bovie were responsible for the refinement in equipment and increasing the popularity of this technique(1972)

PRINCIPLE• Using two electrodes ,an alternating

current may be passed through the body with no effects other than the production of heat.

• The current must be of sufficiently high frequency to avoid nervous or muscular response.

• Surgical application of electricity often make use of this principle:-

• The heat produced is solely the result of the resistance offered by the tissue to the passage of the current .

•

• When the electrode is large (dispersive )and the other small (active), the current is no longer evenly dispersed.

• This results in a concentration of current at the smaller electrode and the effects are dehydration ,warming of the area ,coagulation or tissue destruction by heat depending on the type ,the size and the frequency of the active electrode and the duration of application.

DEFINITION

What is electrosurgery?Electrosurgery is the use of a high

frequency electrical energy in the radio transmission frequency band applied directly to tissue to induce histological effects.

(current is in the range of 1.5 -7.5million per second or megahertz)

LIKE LASER TREATMENT , electrosurgery is thermodynamic and develops heat directly within tissue cells. electrosurgery however works over the entire surface of the electrode tip in contact with tissue, which makes it ideal for sculpting living tissue.ELECTROCAUTERY:-Cautery is the application of external heat to tissue to induce a controlled third degree burn. This technique does not use the principle of diathermy.The term “electrocautery”when applied to electrosurgery is erroneous.

Four basic types of electrosurgical techniques

are-• Electrosection• Electrocoagulation• Electrofulguration• Electrodessication• Electrosection-used for

incision ,excision and tissue planing.• Done with single wire active

electrodes that can be bent or adapted to accomplish any type of cutting procedure.

ELECTROCOAGULATION-HAEMORRHAGE CONTROL OBTAINED BY USING THE ELECTROCOAGULATION CURRENT.

ELECTROSECTION AND ELECTROCOAGULATION ARE THE PROCEDURES MOST COMMONLY BUSED IN ALL AREAS OF DENTISTRY.

ELECTRIFULGURATION AND ELECTRODESSICATION ARE NOT IN GENERAL USE IN DENTISTRY.

USESWhere is electrosurgery used?

In two words : soft tissue. In general surgery, electrosurgery is used on nearly every soft tissue in the human body. The energy introduced by electrosurgery reacts with water molecules within the cells of the tissue being treated, therefore, in dentistry it is not effective on hard tissues like enamel or bone.

ADVANTAGES

Why use electrosurgery in dental practice?

• Electrosurgery may be thought of as the sculpture of living tissue because it works without pressure, unlike scalpel, which makes it ideal for aesthetically significant interventions.

• Bleeding is controlled by electrosurgery, and adjustable concurrent hemostasis is inherent during electrosurgical intervention, which makes it very valuable when treating hemolytically compromised patients.

• Electrosurgery is also effective as an adjunct to other therapies due to its ability to induce heat in fluid. For example : in root canal sterilization, accelerating whitening agents in spot whitening, accelerating desensitizing agents, and in gingival curettage.

DISADVANTAGESDISADVANTAGES• The treatment causes an unpleasant

odor.• If the electrosurgery point touches the

bone,irreperable damage can be done.• The heat generated by injudicious use

can cause tissue damage and loss of periodontal support when the electrode is used to close to bone.

• Electrode when touches the root, areas of cementum burns are produced.

Contraindications

•CANNOT BE USED IN PATIENTS WHO HAVE NON COMPATIBLE OR POORLY SHIELDED CARDIAC PACEMAKERS.

USE OF ELECTROSURGERY IN PERIODONTICS

• Should be limited to superficial procedures such as removal of gingival enlargements.

• Gingivoplasty• Reduction of frenum and muscle

attachments.• Incisions of periodontal abscess and

pericoronal flaps• (extreme care should be exercised to avoid

contacting the tooth surface)• Note:-it should not be used for procedures

that involve proximity to the bone ,such as flap operations or mucogingival surgery.

How is electrosurgery applied?

• First of all, local anesthesia is required for electrosurgery.

It is applied By means of two electrical connections called "electrodes".

• In "monopolar" electrosurgery, one is an "active" electrode and is used to introduce therapeutic current into tissue.

• These are also called "tips" or "electrode tips" and come in a wide variety of sizes and shapes suited to specific clinical indications for incision, excision, curettage, and coagulation.

• There are three classes of active electrodes ;

• single wire electrodes for incising or excising .

• Loop electrodes for planing tissue; and Heavy bulkier electrodes for coagulation

procedures.

• The other electrode is the "dispersive" electrode and is in the form of a large flexible pad.

• "Dispersive" connection to the patient is by means of capacitive coupling which works through normal street clothing without direct skin contact so that the patient reclines against the dispersive pad (or plate) completing the electrical circuit.

• .

• The "active" electrode is many orders of magnitude smaller in surface area that the "dispersive" electrode so that therapeutic current is highly concentrated in the area being treated.

• In contrast, therapeutic current is distributed over the very large area of the "dispersive" pad such that current density at any point is too low to induce any measurable histological effect hence the term “dispersive”.

• In "bipolar" electrosurgery, both electrodes are the same or similar size and are mounted on a common hand piece.

• No separate dispersive plate or pad is used and the cable from the bipolar hand piece to the electrosurgery unit has two conductors.

Technique and usage

• The removal of gingival enlargement and gingivoplasty is performed with the needle electrode ,supplemented by the small ovoid loop or diamond shaped electrodes for festooning.

• A blended cutting and coagulating (fully) rectified )current is used

• In all reshaping procedures the electrode is activated and moved in a concise “shaving” motion.

• The active electrode should be passed through the tissue as quickly as possible in a brush stroke movement with no pressure.

• A continous rapid movement is important because delay in one cause tissue burning.

• Allow time between each stroke for dissipation of heat so that there is less tissue damage(5 to 10 seconds)

• Precaution: tissue should not be stretched.

• The active electrode must not come in contact with periosteum or bone.

• Incision is given to establish drainage with the needle electrode without exerting painful pressure.

• Incision remains open because the edges are sealed by the current.

• After the acute symptoms subside the regular procedure for the treatment of the periodontal abscess is followed.

• For the hemostasis , the ball electrode is used .hemorrhage must be controlled by direct pressure (via air,compress,or hemostat)

• Then the surface is lightly touched with a coagulating current.

• Electrosurgery is useful for controlling isolated bleeding points.

• Bleeding areas as located interproximally are reached with a thin bar shaped electrode.

Relocation of muscle and frenal attachments.

• They can be relocated to facilitate pocket eliminating using a loop electrode.

• The frenum or muscle is stretched and sectioned with the loop electrode and a coagulating current.

Acute pericoronitis

• Drainage may be obtained by incising the flap with a bent needle electrode.

• A loop electrode is used to remove the flap after the acute symptoms subside.

Healing after electrosurgery.

• Clot formation • Underlying tissue becomes acutely

inflamed with some necrosis.• The clot is replaced by granulation

tissue.• After 24hrs :increase in new

connective tissue cells mainly angioblasts.

• By third day numerous young fibroblasts are seen in the area.

• Highly vascular granulation tissue grows coronally creating new free gingival margin and sulcus.

• Simultaneously after 12-24 hrs epithelial cells at the the margins start to migrate over the granulation tissues separating it from clot.

• Surface epithelialization is generally complete after 5-14 days.