dental electrosurgery

1. By :
Dr Saeid Nemati (DDS,Msc in esthetic Dentistry)
Tehran Azad University
School of Dentistry

2. Color
Spacing
Arrangement
Soft tissue

3.  But be aware that
when he need
the most conservative
way to reconstruct
the patients Esthetic
without surgery
is Electro surg.

4.  Easy quick safe alteration in soft tissuesoft tissue with no
bleeding
 Remarkable Esthetic Results
 Gingivoplasty
 Hyper plastic removal
 Mucoperiosteal surg
 Frenuli removal
 Hemorrhage
 Bleaching
 Excision Biopsy
 root canal sterilization
 pulpotomy?!

5.  E.S. = surgical application of
fully controlled
self limiting
high frequency
electrically generated
heat

6.  Before 1891 :flame heated instrument
 1891:D’Arsonval
F>10,000 cycle/S
no potential damage / lethal
neuromuscular pain or shock

7.  1907 Doyan used Extreemly High Fr
(3 mill cyc./S)with an active and passive
Electrode
 Poor Quality incision

8.  1908 Deforrest Radio-tube high Fr
 1920 Refined Apparatus
 1960 Transistor Replaced
 Recent E.S.Units

9.  Misconception:
not a simple house hold unit
Every day electricity: alternating current which
cycle from + to - 60 times/ S = 60 Hz

10.  If applied to living tissue
Cell polarization 60 times/sec
contraction of muscles
painful and lethal
Occurs up to 10,000 Hz (10KHz)

11.  E.s: convert current to Electromagnetic
Radiofrequency (RF)wave which oscillate 2-4
million cyc./Sec (2-4 MHz)
 Impossible for cells to depolarize at this rate
Electrical resistance of tissue
localized intra cellular heat without
muscle contraction

12.  RF wave leave the unit (hand piece)
pass the tissue enter passive
electrode to the unit
Both electrodes remain at room temp.

13.  RF wave passing the tissue slight raise
in temp. Volatilization of one cell layer
( the other remain intact)
 Current set too low drag tissue
 Current set too high sparking burn
tissue (excessive heat)

14. Active electrode: Electrode used for achieving desired surgical
effect.
Coagulation: Solidification of proteins accompanied by tissue
whitening.
Desiccation: Drying of tissue due to the evaporation of
intracellular fluids.
Fulguration: Random discharge of sparks between active
electrode and tissue surface in order to achieve coagulation
and/or desiccation.
Spray: Another term for fulguration.

15. t-tº= 1/σρċ (j2ţ)
 whereTandTo are the final and initial temperatures (K)
 ,σ is the electrical conductivity (S/m)
 ,ρ is the tissue density (kg/m3),
 C is the specific heat of the tissue (Jkg–1K–1),
 J is the current density (A/m2), and t is the duration of heat
applications

16.  Monopolar electrosurgery
monopolar cutting instrument (usually the monopolar pencil) consists of a
single active electrode
 Bipolar electrosurgery
In bipolar scissors, the blades are the active and return electrodes.
Current travels from one electrode back to the other electrode through only
the small section of tissue that lies between the scissors blades.

17. 1. Sparking current
Alternating
Disorganized high F
cause localized heat
Superficial cell destruction
(fulguration)

18. 2-Partially Rectified Current
It pulses but does not change direction
1st
half it flow
2nd
half no flow

19. 3 – Fully Rectified current
1st
half like above
2nd
half repeat the same flow
Incise and coagulate at
the same time

20. 4- Fully Rectified Filtered Current
The same properties with reduced changes ( the pick of hills
eliminated)
Fine cut
The current of choice
For esthetic gingival
Recontouring
(the cleanest incision)

21.  It result from resistance of tissue
 To minimize:
1. Controlling electrode size
2. The time of contact with tissue(max.1-2 sec.)
3. The type and intensity of current
(lowest level that work)
4 . Keeping the tissue moist (water or saline)

22. report side effect but at least one item uncontrolled
No change in heart wave
No change in pulp (animal study)
Healing comparable with sculple surgery
Choosing a suitable unit
In approximation to bone E.S is CONTRAINDICATED

23.  Proper Probing
 Biologic Width Detection

25. 1. Excessive tissue by ectopic
erruption / incomplete passive erruption
2. Hyper trophies or malpositioned
3. Inflamed / hypertrophied gingoiva
(ortho treatments)

26.  5- drug hyperplasic tissue
 6- poor oral hygiene
hyper trophies

31.  Eruptive force mislead /dissipate before
H of C emerge incomplete crown
length

32.  Incomplete passive eruption
 Insufficient lip length
 Over growth of maxilla
 Combination of above

33.  If 1.5 mm or less ging. Sulcus
Or X ray revealed high bone level
E.S is CONTRAINDICATED

34.  Malpositioned papilla or
Hyper trophy
Diastema closure

35.  Although possible to complete E.S and restorative
treatment at the same time
Best result gain withn1-2 week healing period

36. 1. Pace maker (some types) 16 ft =4.8 m away
2. Patient with history of radiotherapy(delay healing)
3. Near chemicals like ethanol / chloroform
(explosion)

37. 1. No pressure for tissue separation
2. Smooth incision
3. Easy access in posterior
4. Better visibility due to coagulation
5. Little or no scar
6. Sterility (all bacteria in line of incision are volatalized)
7. Tissue Electro planning (electrode tangent to tissue and
remove or plane off a minimal layer)
8. Completion of treatment in one session if necessary

38. 1. Local anesthesia
2. No metal object in patient’s pocket(cause burn if touch the
plate)
3. Place the passive plate( thigh is preferred , scapula or
vertebral eminence have thin soft tissue)
4. Stabilize the jaw with bite block
5. Place moist cotton roll on either side
6. Hold an straight object parallel to inter papillary line

40. 7 -consider zenith point
8 -penetrate the gingiva with an explorer to determine the
amount of tissue removal

41.  Desirable H / W = 10/8 = 80%

42. 9- set the current
10-make a few practice with inactive electrode
11-the odor : place a 2*2 gauze with pleasant perfume
12- the depth of cut should be reaced in each
individual incision the length can be increased (3-4
short incision)
13- tissue contact not more than 1-2 sec.

43. 14-remove any tissue accumulation with alcohol moistened
gauze
15- clean the site (tissue tag) with scaler,…..)
16-healing 7-14 days
17-over heating can cause pain , swelling, inflammation,…
18-post operative instruction:
a- 3% H2O2mix with tooth paste
b-rinsing with saline
19-Antibiotic is not necessary

50. 1) Development of Adequate Crown
Preparation
2) Esthetics
Indications for Crown Lengthening

51.  Gingival Margins must not invade
Biological Width Requirements for
Periodontal Health.

52.  There must be a minimum of 1mm between
the apical level of the Junctional Epithelium
and the bone crest.

53. Gingival sulcus
Junctional epithelium
Connection tissue
attachment coronal to bone
0.69mm
0.97mm
1.07mm
Sulcus depth
Biologic Width