Technology is great … until it isn’t. Dental lasers have long been in use and have made advanced invasive procedures easier to perform with minimal healing required. Knowledge on how to use these lasers from both biological and clinical aspects is necessary to avoid adverse outcomes. This case study demonstrates what can happen when lasers are used incorrectly.
Case presentation
A 49-year-old male presented with pain at tooth no. 9. A labial fistula was clinically present (figure 1).
A periapical radiograph was taken to ascertain the source of the infection (figure 2).
Clinical examination
Examination revealed an area of necrotic bone (burnt dead bone), which was removed and submitted for histological evaluation. The pathology report came back as a maxillary anterior bone sequestrum or area of bone that has undergone necrosis (figure 3).
A review of the patient’s dental history revealed a very recent visit to a dentist for a laser surgical procedure. More than likely, improper use of the dental laser caused overheating of the bone and trauma to this area, ultimately resulting in bone necrosis and sequestra. Both hard- and soft-tissue loss resulted, and an abscess denoting infection occurred.
Because this is a maxillary anterior area in the esthetic zone, it will require interdisciplinary management and a high financial cost to the patient to correct the problem. Tooth rotation, the presence of a diastema, interproximal papilla, gingival margins and contours, as well as tooth size will all be addressed.
Conclusion
Advanced technology such as lasers are readily available to the dental profession, and although they can make treatment more efficacious and expeditious, there are inherent risks. Without adequate training, adverse complications can occur, making challenging situations even worse. The importance of training and proper biological rationale for use cannot be overstated.
Editor’s note: This article originally appeared in Perio-Implant Advisory, a chairside resource for dentists and hygienists that focuses on periodontal- and implant-related issues. Read more articles and subscribe to the newsletter.
