1 What soft-tissue procedures using a laser should an orthodontist consider?

Orthodontists continually strive to find methods to enhance treatment results and reduce treatment time. The advent of soft tissue lasers allows the orthodontist to have more control over factors that previously could impede treatment time and compromise treatment results. Several clinical instances exist where the use of a soft-tissue laser would be beneficial to both the orthodontist and the patient: gingival recontouring, aphthous ulcer management, expedition of tooth eruption, removal of operculae, and frenectomies.< ?xml:namespace prefix = "mbp" />^1–4

Removal of soft tissue with the laser is useful for gingival recontouring in orthodontics for esthetic, health, and time reasons. Gingival reshaping for uneven gingival margins, improving tooth proportionality, and improving a gummy smile can greatly enhance the esthetic treatment outcome. Gingival recontouring is also indicated in patients with poor hygiene where inflamed gingiva, pseudopockets, and difficulty brushing and flossing are present.^3,4 Excessive gingival tissue can often prevent the orthodontist from placing brackets in an ideal position. The removal of this gingival tissue permits the orthodontist to bond a bracket to the tooth in the desired position in a timely manner.^3,4

Aphthous ulcers can be very uncomfortable and painful for the patient (Fig. 24-1). Traditionally, salt water rinses, topical anesthetic, and tetracycline would be prescribed to alleviate the symptoms.³ The orthodontist now has the ability to lase the aphthous ulcer, thus relieving the patient of pain almost immediately. The laser is activated for 30 seconds at a very low wattage and kept at a distance of 1 to 2 mm away from the lesion.^3,4 Aphthous ulcers generally take up to 14 days to heal, but with laser surgery, the ulcers can heal within 1 day after treatment. The laser wound that replaces the ulcer is nonpainful and allows the patient to have a faster and more comfortable recovery.^3,4

FIG 24-1 Aphthous ulcer (before and after). A, Aphthous ulcer before laser surgery. B, Aphthous ulcer immediately after laser surgery. C, Aphthous ulcer 1 week after laser surgery.

Soft tissues can sometimes cover a tooth and impede its eruption into the arch. The soft tissue laser can be used to remove overlying tissue so that the orthodontist can bond a bracket and begin moving the tooth immediately.^3,4

Orthodontists sometimes find themselves waiting to band second molars when an operculum is present. The soft tissue laser can remove opercula so that the orthodontist can band the second molars and keep treatment on track.⁴

Patients who present with a large diastema often have a low frenum that contributes to the excessive spacing. After orthodontically closing the space, it is often recommended to perform a frenectomy to help stabilize the space closure. The soft-tissue laser makes frenectomy procedures easier to manage, minimal in discomfort, and hemostatic.

2 What type of laser should be used in orthodontics?

A laser is made up of a monochromatic light that travels through a tube that collimates the light energy. A protective shield encircles the light, allowing the laser to be released only at the tip and not through the sides.² This exposed energy can be controlled by the operator through the power adjustment. The laser cuts the tissue through