Electrosurgery for Definitive Conservative Modern Periodontal Therapy

Abstract

Reliable research investigations have confirmed the clinical evidence that fully rectified, surge-free, undamped electronic high frequency cutting current is so incredibly self-limiting in its destructiveness that when it is properly employed, cells immediately adjacent to the line of incision remain normal and totally unaffected by the heat energy that has been generated. This fully rectified radio-frequency cutting energy is therefore safe and remarkably effective in the conservative management of definitive periodontal surgery. Not only is this energy thoroughly safe, its inherent advantages make it extraordinarily effective for thorough debridement of intraosseous periodontal defects. Its inherent advantages include: (1) hemostasis of the electrosurgical currents, which reduces or eliminates the handicap of free bleeding obscuring vision in the operative field, so that the internal aspect of the defects can be examined visually; (2) the flexibility and adaptability of the loop electrodes, which can be manipulated effectively to debride areas into which rigid steel instruments cannot be introduced or manipulated effectively; (3) the electronic energy sterilizes as it cuts; (4) with electronic cutting neither the operator nor the electrode really does the cutting, which is accomplished by the electronic energy. Hence, there is no need to exert pressure to cut tissue, and neither sharpness of the cutting instrument nor the angle at which it is held are relevant factors. Rigid cold steel instruments lack these advantages. Therefore, it is impossible to debride comparable periodontal pockets with them unless access is provided by incising and reflecting a mucoperiosteal flap of tissue to expose the operative field. Gingival mucosa detached from the underlying periosteum and bone promptly contracts when it is elevated, and the loose tissue flap becomes highly mobile. It is difficult to make an accurate incision fo split the tissue and dissect away the internal half of the flap. The contractile nature of the fibrous scar tissue repair makes it almost impossible to keep it at its original level, even when the tissue flap is restored and sutured into position through the embrasures. Several millimeters of exposed roots almost invariably result from the alteration of the gingival level. By contrast, the natural tendency of the tissues to regenerate toward their original level following atraumatic electronic cutting, minimizes the likelihood of root exposure, especially since the gingival tissues have not been disturbed from their normal attachment to periosteum and bone.