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Histological evaluation of effects produced in alveolar bone following gingival incision with an electrosurgical scalpel.

Gingival incisions were performed distal to each of the two lower incisors on 25 adult male guinea pigs. For every animal, electrosection with an electrosurgical scalpel was used on one side, and a conventional scalpel was used on the other. The surgical instruments in all cases were brought into direct contact with periosteum. Five animals were sacrificed at each postoperative period (12, 24, 48, 72, and 96 hours), and sections of the areas of surgery were prepared by standard laboratory procedures. At 12 hours postoperatively there were far more soft tissue necrosis, a more extensive inflammatory reaction, and greater destruction of periosteum after electrosurgery. No significant changes in osteocyte viability were seen after either technique. However, by 24 hours, many empty lacunae were observed in the bone associated with electrosurgery, such necrosis being even more extensive by 48 hours. In contrast, only very minor, localised areas devoid of some osteocytes were seen after use of the conventional scalpel. By 96 hours the electrosurgical connective tissue wounds were still lined by coagulum, but repair of the scalpel wounds had begun. The periosteum and bone had the same features that were seen at 48 hours. Throughout the study, no increase in osteoclasts was seen in any section, nor were significant changes in adjacent bone marrow observed.

Alveolar Process↗

Split thickness flap, apically replaced, with protected linear periosteal fenestration.

The split thickness flap, apically replaced, with internal linear periosteal fenestration, is a combination of two known techniques. This procedure is another choice to solve mucogingival problems. The advantages in addition to securing a firmer bond of periosteum to bone and mucosa to periosteum at the selected position are: there is no bone exposed, healing is apparently faster and postoperative pain is minimal. An experimental work, carried out on dogs to study the histological reactions after this procedure, is in progress. The results of these observations will be reported in a future publication.

Fenestration, Labyrinth↗

A clinical study of healing in humans following the excisional new attachment procedure.

The excisional new attachment procedure was used to treat 75 suprabony pockets on 32 teeth in 9 patients. One-year postoperative measurements demonstrated an overall mean pocket reduction from 4.7 mm to 2.0 mm, of which 2.1 mm (77%) was new attachment and 0.6 mm was recession. Average amount of new attachment and percentage of new attachment were greatest on the midlingual surfaces of the teeth treated in this study. The results of this study showed the excisional new attachment procedure to be a simple, effective, and predictable procedure for achieving pocket elimination by means of a clinical new attachment of the gingival tissues in suprabony pockets.

Epithelial Attachment↗

Effects of electrosurgery on the gingival attachment in rhesus monkeys.

A biometric and histometric study of electrosurgical gingival "troughing" with a fully rectified current was accomplished in four Rhesus monkeys. The operation resulted in a statistically significant recession of the free gingival margin and loss of connective tissue attachment associated with apical migration of the junctional epithelium. Burn marks from contacts with the electrodes were observed on the cemental surfaces and in the dentin under the enamel close to the cemento-enamel junction. The cemental burn marks usually were covered by epithelium, which may explain the apical migration of the junctional epithelium observed in the experiemtal teeth. A slight loss of crestal alveolar bone occurred in the experimental areas and a bone sequestrum formed in one instance. Secondary dentin was found in response to electrosurgical contact of the cemental surface.

Animals↗