Electrosurgery in Periodontics

Contents HISTORY PRINCIPLE of electricity DEFINITION Electrosurgical units Principles of electrosurgical units Uses Applications in Periodontics ADVANTAGES DISADVANTAGES 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).

Principles of Electricity All electronic effects are caused by the movement of electrons. (Electron Theory) Electricity: This term actually describes movement of free electrons from orbit of one atom to another. (Bohr’s Theory) Free electrons are present on the outer most orbits and their movement creates electric current.

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. Application of electrical current through tissue to cut tissue or coagulate bleeding.

Electrosurgical Units Parts of E.S.U Control Unit Foot Control Handpiece connector

Electrosurgical Units Types of Tips Used Conization Electrode - Cervical aperture enlarging Blade Electrode - Cutting/coagulation Bipolar Forceps - Coagulation

Electrosurgical Units Types of Tips Used Loop Electrode - Tissue Sectioning/Sampling J-Hook - Incision - Resection Spatula - Fulguration - Desiccation Dissector - Dissecting

Electrosurgical Units Based on Mode of Usage: Electrosurgery – Electrical currents applied directly to tissue. Utilizes AC. Electrocautery – Uses heated wire to burn tissue. No electricity enters body. Utilizes DC. Based on Working Mechanism: Monopolar / Unipolar Electrosurgery Bipolar Electrosurgery

Electrosurgical Units Based on Clinical Applications Electrosection – Used for incision, excision and tissue planing (single wire active electrodes). Electrocoagulation – Haemorrhage control obtained by using the electrocoagulation current. Electrofulguration – Not in general use in Dentistry. Electrodessication – Not in general use in Dentistry.

Principles of Electrosurgery Using two electrodes, an alternating current may be passed through the body with no effects other than the production of heat. The heat produced is solely a result of the resistance offered by the tissue to the passage of the current . The current must be of sufficiently high frequency to avoid nervous or muscular response. (current is in the range of 1.5 -7.5million per second or megahertz)

Electrosurgical Units Monopolar Electrosurgery Active electrode Dispersive electrode (Grounding pad) Placement of grounding pad is critical to avoid electrical burns to patient. Pad must be in complete contact with patient’s skin Portion of pad not in contact may result in 2nd/3rd degree burns to patient.

Electrosurgical Units Mechanism of Unipolar Electrosurgery

Electrosurgical Units Grounding Pad

Electrosurgical Units Bipolar Electrosurgery 2 prongs of electrodes – active and inactive electrodes. Current passes through 1 tip, passes through the tissue and disperses to the other tip. Used for delicate procedures under presence of moisture and prevents nerve damage.

Electrosurgical Units Handpiece with Bipolar Electrodes

Uses Where 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.

Applications 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. Crown lengthening. Note: It should not be used for procedures that involve proximity to the bone, such as flap operations or mucogingival surgery. (Extreme care should be exercised to avoid contacting the tooth surface)

Gingival Enlargement & Gingivoplasty Techniques Gingival Enlargement & 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.

Techniques 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 continuous rapid movement is important because delay causes tissue burning. Allow time (5 to 10 seconds) between each stroke for dissipation of heat so that there is less tissue damage Precaution: Tissue should not be stretched. The active electrode must not come in contact with periosteum or bone.

Gingival & Periodontal Abscess Techniques Gingival & Periodontal Abscess 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.

Relocation of muscle and frenal attachments Techniques Relocation of muscle and frenal attachments The frenum or muscle is stretched and sectioned with the loop electrode and a coagulating current. They can be relocated to facilitate pocket eliminating using a loop electrode.

Techniques 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.

Maintenance of Haemostasis Techniques Maintenance of Haemostasis For haemostasis, ball electrode is used. Haemorrhage must be controlled by direct pressure (via air, compression, 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.

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.

Healing after electrosurgery Highly vascular granulation tissue grows coronally creating new free gingival margin and sulcus. Simultaneously after 12-24 hrs, epithelial cells at the margins start to migrate over the granulation tissues separating it from clot. Surface epithelialization is generally complete after 5-14 days.

Advantages Works without pressure, unlike scalpel; which makes it ideal for aesthetically significant interventions. Bleeding is controlled by electrosurgery, which makes it very valuable when treating haemolytically compromised patients. Effective as an adjunct to other therapies due to its ability to induce heat in fluid. Ex: In root canal sterilization, accelerating whitening agents in spot whitening, accelerating desensitizing agents.

Disadvantages The treatment causes an unpleasant odour. If the electrosurgery point touches the bone, irreparable damage can be done. The heat generated by injudicious use can cause tissue damage and loss of periodontal support when the electrode is used too close to bone. Electrode when touches the root, areas of cementum burns are produced. C/I: CANNOT BE USED IN PATIENTS WHO HAVE NON-COMPATIBLE OR POORLY SHIELDED CARDIAC PACEMAKERS.

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References Clinical Periodontology, Carranza., 10th Edition. Clinical Periodontology & Implantology, Jan Lindhe,. 4th Edition www.howstuffworks.com www.xenomed.com www.pubmed.com