Print this page Email this page Users Online: 105
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 

 Table of Contents  
CASE REPORT
Year : 2014  |  Volume : 2  |  Issue : 1  |  Page : 20-24

Electro surgery in dentistry: Report of cases


1 Professor, Department of Pedodontics, Vyas Dental College, Jodhpur, Rajasthan, India
2 Senior Lecturer, Department of Pedodontics, Vyas Dental College, Jodhpur, Rajasthan, India
3 Department of Conservative Dentistry and Endodontics, KLE Dental College, Belgum, Karnataka, India
4 Department of Prosthodntics, MGV Dental College and Hospital, Nasik, Maharastra, India

Date of Web Publication10-Apr-2014

Correspondence Address:
Prashant Babaji
Department of Pedodontics, Vyas Dental College, Jodhpur - 342 001, Rajasthan
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2321-6646.130379

Rights and Permissions
  Abstract 

Electrosurgery is an application of electrically generated heat energy to tissue to alter it for therapeutic purposes. Electrosurgery has been used in dentistry for many purposes such as for, gingivectomy, pulpotomy, frenectomy, operculectomy and hemostasis. This paper highlights its application and usage in dentistry. This paper covers various procedures performed under electrosurgery and scalpel for e.g., Case 1: Describes lingual frenectomy using electrosurgical method, Case 2: Operculectomy with electrosurgical method, Case 3: Soft-tissue uncovering of upper incisors with electrosurgery, Case 4: Soft-tissue uncovering using only scalpel and Case 5: Soft-tissue uncovering of unerupted molars using electrocautery method.

Keywords: Electrosurgery, Frenectomy, Pulpotomy, Surgical Procedure


How to cite this article:
Babaji P, Singh V, Chaurasia VR, Jawale MR. Electro surgery in dentistry: Report of cases. J Pediatr Dent 2014;2:20-4

How to cite this URL:
Babaji P, Singh V, Chaurasia VR, Jawale MR. Electro surgery in dentistry: Report of cases. J Pediatr Dent [serial online] 2014 [cited 2020 Feb 21];2:20-4. Available from: http://www.jpediatrdent.org/text.asp?2014/2/1/20/130379


  Introduction Top


Electrosurgery has been defined as high-frequency electrical current passed through tissue to create a desired clinical effect. It requires the presence of a circuit for current to flow. [1] It has been used routinely in various aspects of dentistry and medicine since 1914. [1],[2] William T Bovie was named as the father of electrosurgery. [1]

Electrosurgery is different from electrocautery. In electrocautery, electricity is used to heat an object and to burn a specific site. Although in electrosurgery, electrical current heats the tissue. [3] Soft-tissue cutting generally did with scalpel, which can result into excessive bleeding at operatory site, inadequate visibility when compared to electrosurgery. Electrosurgical procedure can be useful in achieving bloodless surgery. Electrosurgery operation is advantageous as it has little post-operative pain, minimal bleeding, less chair time, patient satisfaction and yield good result. [2] It can be used for cosmetic correction of gingival appearance and for various other purposes.

Four basic types of electrosurgical techniques used are coagulation, desiccation, fulguration and cutting. Desiccation is direct energy application that slowly drives water out of the cells creating a drying out of the cells. Desiccation can be achieved with either the cutting or the coagulation current by contact of the electrosurgical device with the tissue. Fulguration, a form of coagulation, is the arcing or sparking of energy above the tissue to create a surface charring. Cutting waveforms vaporize the cellular fluid causing cellular explosions, which result in a scalpel like dissection. [3] Most of the clinical operations are performed by electrosection (cutting) current type. [4]


  Case Reports Top


Case 1: Lingual frenectomy

A 7-year-old female patient presented with an inability to protrude tongue and speech problem. Upon clinical examination prominent lingual frenum was observed [Figure 1]. Lingual frenectomy was planned and performed under local anesthesia and using electrosurgical method [Figure 2]. Post-operative wound healing was uneventful [Figure 3].
Figure 1: Prominent lingual frenum

Click here to view
Figure 2: Lingual frenectomy with electrocautery

Click here to view
Figure 3: Post-operative photograph

Click here to view


Case 2: Operculectomy

A 13-year-old male patient was reported with pain in the lower left and right back region of teeth. On examination inflamed pericoronal flap was observed in relation to left and right mandibular second molars [Figure 4]. Removal of pericoronal flap was done with electrosurgical technique [Figure 5] with uneventful post-operative healing.
Figure 4: Infl amed pericoronal fl ap

Click here to view


Case 3: Soft-tissue uncovering

A 9-year-old female patient was reported with unerupted upper front tooth. On clinical examination partially erupted upper left central incisor and unerupted right central incisor was observed [Figure 6]. Radiographic examination confirms the presence of central incisors. Unerupted tooth was due to thick soft-tissue covering. Treatment was planned to uncover the soft-tissue electrosurgically [Figure 7].
Figure 5: Post-operative view after electrocautery procedure

Click here to view
Figure 6: Soft-tissue covering on unerupted central incisor

Click here to view
Figure 7: Electrocautery exposure of central incisor

Click here to view


Case 4: Soft-tissue uncovering

An 8-year-female patient reported with unerupted upper front teeth [Figure 8]. On examination completely erupted lower centrals and unerupted upper incisors was noted. Parents were very much concern about unerupted teeth. Hence, surgical exposure of unerupted teeth was done with scalpel [Figure 9]. Bleeding and post-operative pain was more as compared to electrosurgical technique.
Figure 8: Soft-tissue covering on upper centrals

Click here to view
Figure 9: surgical exposure of incisors with scalpel

Click here to view


Case 5: Soft-tissue uncovering

An 8-year-old male patient reported with unerupted lower and upper molars. Radiographic examination revealed the presence of teeth germs with thick soft-tissue covering. Surgical uncovering of soft-tissue was carried out using electrosurgical method [Figure 10].
Figure 10: exposure of soft-tissue covering with electrocautery

Click here to view



  Discussion Top


Operation guidelines

Electrosurgery unit consists of foot control, adjustable setting of electric power, passive electrode, active electrode handle and attachment. Different types of electrode tips used for different purposes are ball tip (for coagulation, to stop bleeding spot), blade tip, needle type (for incision or excision) and loop type (for planning tissue, for lowering the interdental papilla. [4],[5]

Before starting the procedure check for proper attachment of parts and use suitable power intensity. An electrosurgical unit operates at one fixed frequency determined by the operator. [2] While replacing the electrode tip, foot should be removed from the pedal. Avoid the operation of equipment in a room with flammable or explosive materials. [4] Electrosurgery unit should be used with rapid, well-planned movements, without pressure and it should be like brushing strokes, keep electrode moving all the time, use high enough current. [5] Smooth cutting technique allows maximize advantages. Touch the tissue intermittently with cooling period to dissipate heat. [4]

Electrosurgery procedure facilitates the passage of high frequency, oscillating electric currents through tissue between two electrodes to fulgurate, desiccate or cut tissue. [3] It works on the principle that, during surgery, the generator converts the electricity to high frequency waveforms and creates the voltage for flow of current. When current is concentrated, heat is produced and the amount of heat produced determines the tissue response. [3]

The smaller the application area, greater will be current density at the application site. Electrosurgical generators can produce a variety of waveforms and each waveform creates different tissue results such as cutting, blending or coagulation. The cutting current will cut the tissue but provides little hemostasis. The coagulation current provides coagulation but does not allow for smooth cutting. The blend current is an intermediate current between the cutting and coagulation currents, but it is not a combination of the two as the name might imply. [2],[3] For surgical purpose, controlled, high frequency electrical (radio) currents in the range of 1.5-7.5 million cycles/s or megahertz can be used. [4]

There are two basic types of electrical circuits, that is monopolar and bipolar. Monopolar (monoterminal) is an electrosurgical technique in which the tissue effect takes place at a single active electrode and is dispersed (circuit completed) by a patient return electrode. Controlled cutting is achieved with heat production on contact of patient tissue with a single electrode. Bipolar (biterminal) is an electrosurgical technique in which the electrosurgical effect takes place between paired electrodes placed across the tissue to be treated. No patient return electrode is needed. The distance between the active and return electrodes in a bipolar circuit is very small since both electrodes are adjacent to each other. The current flows from one electrode to another, makes a broader cut than monopolar unit. [2],[3] Monopolar electrosurgery is used more often than bipolar. [2]

Precautions/guidelines

Fallowing factors should be considered while using electrosurgery for better result; select smallest possible electrode, incision should be made at the rate of 7 mm/s, allow cooling period of 8 s between successive incision, avoid contact of metallic restorations, use appropriate electric power. [4] Always use lowest possible generator setting, frequently clean the electrode tip using sponge, surgeon should not touch the patient with his free hand, avoid open circuit, while using multiple cords, cords should not be bundled together. When electrode is not being used, it should be placed in an insulated holster. [1]

Indications

  • Gingivoplasty
  • Gingivectomy [6]
  • Pulpotomy
  • Apericulectomy
  • Frenectomy
  • Incision of periodontal abscess [4]
  • To achieve hemostasis
  • Crown lengthening
  • Gingival melanin depigmentation [7]
  • Tooth uncovering [8]
  • Removal of pulp or gingival polyp


Contraindication [4]

  • Patient with pace maker
  • Procedures involving proximity to bone such as flap operations, mucogingival surgeries


Advantages [4]

  • Controls hemorrhage
  • Permits adequate contouring of tissues
  • Less discomfort to patient
  • Less scar formation
  • Lesser chair time


Disadvantages [4]

  • Causes unpleasant odor
  • Possibility of tissue damage or necroses
  • Gingival recession


Electrosurgery is effective in performing soft-tissue surgery with a positive result. [9] Tongue is an important structure in the oral cavity, which is necessary for proper speech and mastication. Presence of tongue tie (ankyloglossia) can restricts tongue movement and results in disturbed speech. Incidence of tongue tie is 2-4.8%. Problems associated with tongue can be corrected if treatment done at an earlier age. This necessitates early frenectomy procedure. [10]

An unerupted tooth beyond the normal age results into increased parental apprehension due to unaesthetic look. Its prevalence estimated to be 2.6%. Uneruption of teeth occurs due to thick soft-tissue covering, bony coverage or due pathology. Etiological factors should be identified before treatment planning. This requires earlier tissue uncovering by creating small window to allow normal tooth eruption. [11]

Periocoranitis is a condition occurs due to inflammation of pericoronal flap covering the erupting tooth. It occurs due to frequent food lodgment. Treatment involves removal pericoronal flap surgically.

The gingiva is most commonly affected intra-oral tissue responsible for an unpleasant appearance. Melanin pigmentation often occurs in the gingiva as a result of an abnormal deposition of melanin. This problem is aggravated in fair skinned patients and those with a gummy smile. Several studies showed that effective depigmentation with electrosurgical method can be achieved with uneventful healing at fallow-up visits. [7],[12],[13] Several studies showed that electrosurgical pulpotomy can be done with greater success. [14]

Various changes on tissue at different tissue temperature

The temperature rise in tissue is directly proportional to: the resistance of the tissue, the current density, the power output, time of the current application, duration of contact between electrode tip and tissue, size of tip and electrosection wave current. [3],[4] High intensity electrode will spark and may cause tissue damage. Insufficient intensity of current can result in tissue pulling or tearing. [4] Tip size is directly proportional to the operating area. [4]

Reversible changes occur in tissue when tissue temperature reaches 37-45°C while doing electrosurgery. Beyond 45°C coagulation of the protein contents of cell occurs, which is irreversible state. When tissue temperature rises above 60°C, water content of the cell is driven out. This process continues until all water dissipate or until temperatures reaches 100°C. Beyond this desiccation temperature, heat causes disintegration of cellular components into oxygen, nitrogen, hydrogen and other elements including carbon. Vapors generated when temperature rises beyond 100°C. [1],[2]

Glickman and Imber [15] found no difference in wound healing between electrosurgery and periodontal knives. [2] Stevens et al. [16] observed extremely increase in heat adjacent to electrosurgery electrode when used on dog gingiva. [4] Kalkwarf et al. [17] concluded that cooling period for 8 s between subsequent incisions is necessary for dissipation of heat. [4] Engelberger and Rateitschak [18] observed good epithelization fallowing gingivectomy with electrosurgery compared with a surgical blade. [4] Some studies proved that 70-100% of the lost tissue or regaining of gingival recession observed over a period of time. [2],[4]

Even though electrosurgery has advantages, but its use in dentistry is declining due to lack of knowledge during earlier days, production of heat by unit, chances of gingival recession and introduction of lasers. [2],[4] However, response to electrosurgery from various studies shows that it is promising and can be used in clinical dentistry.


  Conclusion Top


Electrosurgery can be used as an alternative to conventional surgery. Successful result can be obtained with careful usage and having proper knowledge.

 
  References Top

1.Massarweh NN, Cosgriff N, Slakey DP. Electrosurgery: History, principles, and current and future uses. J Am Coll Surg 2006;202:520-30.  Back to cited text no. 1
    
2.Bashetty K, Nadig G, Kapoor S. Electrosurgery in aesthetic and restorative dentistry: A literature review and case reports. J Conserv Dent 2009;12:139-44.  Back to cited text no. 2
[PUBMED]  Medknow Journal  
3.Megadyne. Principles of Electrosurgery. Electrosurgery Book 4.indd. p. 1-35. Available from: http://www.megadyne.com/pdf/Electrosurgery1.pdf. [Last updated on 2005 Jul 13 1:21:36 PM].  Back to cited text no. 3
    
4.Ravishankar PL, Mannem S. Electro surgery: A review on its application and biocompatibility on perodontium. Indian J Dent Adv 2011;3:492-8.  Back to cited text no. 4
    
5.Fisher DW. Electrosurgery in restorative dentistry. Available from: https://www.regtransfers-sth-se.diino.com/.../_dentalgates_/dentistry%20varitie. [Last accessed on October 10 2013]  Back to cited text no. 5
    
6.Lozano FJ, Pérez AS, Villaescusa MJ. Use of an electrosurgical scalpel in gingival overgrowth associated with Rendu-Osler-Weber syndrome. J Craniofac Surg 2008;19:1648-9.  Back to cited text no. 6
    
7.Kasagani SK, Nutalapati R, Mutthineni RB. Esthetic depigmentation of anterior gingiva. A case series. N Y State Dent J 2012;78:26-31.  Back to cited text no. 7
    
8.Kurtzman GM, Silverstein LH. Bipolar electrosurgery: Gingival modification in passive eruption cases. Dent Today 2008;27:112, 114-5.  Back to cited text no. 8
    
9.Flocken JE. Electrosurgical management of soft tissues and restorative dentistry. Dent Clin North Am 1980;24:247-69.  Back to cited text no. 9
    
10.Tuli A, Singh A. Monopolar diathermy used for correction of ankyloglossia. J Indian Soc Pedod Prev Dent 2010;28:130-3.  Back to cited text no. 10
[PUBMED]  Medknow Journal  
11.Yaqoob O, O'Neill J, Gregg T, Noar J, Cobourne M, Morris D. Management of unerupted maxillary incisors, 2010. p. 1-13. Available from: http://www.rcseng.ac.uk/fds/publications-clinical.../ManMaxIncisors2010.pdf. [Last accessed on 2013 October 10]  Back to cited text no. 11
    
12.Parwani S, Parwani R. Achieving better esthetics by gingival de-pigmentation: Report of three cases with a review of the literature. J Mich Dent Assoc 2013;95:52-8, 78.  Back to cited text no. 12
    
13.Deepak P, Sunil S, Mishra R, Sheshadri. Treatment of gingival pigmentation: A case series. Indian J Dent Res 2005;16:171-6.  Back to cited text no. 13
    
14.Nematollahi H, Sahebnasagh M, Parisay I. Comparison of electrosurgical pulpotomy with zinc oxide eugenol or zinc polycarboxylate cements sub-base. J Clin Pediatr Dent 2011;36:133-7.  Back to cited text no. 14
    
15.Glickman I, Imber I. Comparison of gingival resection with electrosurgery and periodontal knives: A biometric and histological evaluation. J Periodontal 1970;41:142-8.  Back to cited text no. 15
    
16.Stevens Y, Weil J, Simon B, Schuback R, Deasey M. Quantitative analysis of heat generated during electrosurgery. J Dent Res. 1981;60:432-8.  Back to cited text no. 16
    
17.Kalkwarf KL, Krejci RR, Edison AR, Reinhardt RA. Lateral heat production during tissue excision with electrosurgery. J Oral Maxillofac Surg 1983;41: 653-7.  Back to cited text no. 17
    
18.Engelberger PR, Rateitschak KH. Die Wundhealing nach Gingivoplastik mit Eietrotom und Gingivektomiemesser. Act Parodontologica 1974; 84:93-109.  Back to cited text no. 18
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10]


This article has been cited by
1 Evaluation of electrocautery and stainless steel scalpel in oral mucoperiosteal incision for mandibular anterior fracture
GopalLahudas Nagargoje,Sheeraz Badal,SyedAhmed Mohiuddin,ArunachaleshwarSomnath Balkunde,SwatiSuresh Jadhav,DnyandeepRamkrushna Bholane
Annals of Maxillofacial Surgery. 2019; 9(2): 230
[Pubmed] | [DOI]
2 Orthodontic upright treatment for mesioangular impacted lower second molar
Baekgue Choi,Dongkee Jeong,Sunghoon Lim,Sungnam Gang
Journal of Dental Rehabilitation and Applied Science. 2017; 33(1): 25
[Pubmed] | [DOI]
3 Gingival pigmentation (cause, treatment and histological preview)
Rehab A. Abdel Moneim,Mona El Deeb,Amany A. Rabea
Future Dental Journal. 2017; 3(1): 1
[Pubmed] | [DOI]
4 Comparative Analysis of Radiosurgery and Scalpel Blade Surgery in Impacted Mandibular Third Molar Incisions: a Clinical Trial
Vimal Kalia,Nayla Siddiqui,Geeta Kalra
Journal of Maxillofacial and Oral Surgery. 2017;
[Pubmed] | [DOI]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Case Reports
Discussion
Conclusion
References
Article Figures

 Article Access Statistics
    Viewed9176    
    Printed211    
    Emailed2    
    PDF Downloaded1189    
    Comments [Add]    
    Cited by others 4    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]