Scalpel Technique Research Articles

A Clinical Comparison of ErCr:YSGG Laser and Scalpel Techniques in Gingival Depigmentation.

Gingival depigmentation impacts patient self-confidence and quality of life. This study compares the Er,Cr:YSGG laser to the traditional scalpel technique for reducing gingival hyperpigmentation, assessing their effectiveness and other relevant factors. We conducted a double-blind, randomized trial with a split-mouth design. Forty participants were selected from the university's dental clinic and randomly assigned to receive either the Er,Cr:YSGG laser (2780 nm) or surgical scalpel. Pain intensity and smile satisfaction were assessed post-surgery, and treatment duration was evaluated. The Dummett Oral Pigmentation Index (DOPI) was used to determine the initial severity of pigmentation and to track both reduction and potential repigmentation over time. The Gingival Melanosis Record (GMR) was used to evaluate the presence and extent of pigmentation and to monitor recurrence after 1 and 12 months. Both the Er,Cr:YSGG laser and surgical scalpel similarly reduced GMR and DOPI scores over time, without significant differences at 12 months (p > 0.05). A significant examiner variability was noted in GMR scoring (β &#61; -1.2 for Examiner 2; p < 0.001). Power analysis indicated a higher confidence for detecting treatment effects in DOPI (75%) compared to GMR (55%). Patient satisfaction with smile significantly improved (p < 0.001). Treatment type did not influence postoperative pain levels. The Er,Cr:YSGG laser required longer surgery times (p < 0.001). Under the conditions of the present study, both Er,Cr:YSGG laser and surgical scalpel were equally effective in reducing gingival hyperpigmentation. Although lasers offer better bleeding control and require less anesthesia than the scalpel technique, clinicians should also consider surgery duration, cost, and expertise when selecting a treatment method. Future research should focus on long-term outcomes and economic evaluations, utilizing standardized clinical measures.

Determining confidence and anxiety of Australian community podiatrists in managing foot ulceration: A cross-sectional study.

Diabetes related foot ulcer (DFU) is a leading cause of impaired quality of life, disability, hospitalisation, amputation and mortality in people with diabetes. It is therefore critical that podiatrists across all settings, including community settings, are confident and capable of providing care for diabetes-related foot complications. This study aims to describe current practice, confidence and anxiety levels of community podiatrists in the management of patients with foot ulceration. Furthermore, current barriers to service provision and interest in future educational opportunities will also be explored. An online cross-sectional survey was distributed to Australian community podiatrists. Descriptive variables including gender, age, professional experience, practice location and practise setting were elicited. A modified competitive State Anxiety Inventory-2 (CSAI-2) was utilised to measure anxiety related to managing a foot ulcer. Other questions included a combination of multiple choice and open-ended free-text responses relating to assessment, confidence and referral pathways. One hundred and twenty-two Australian community-based podiatrists responded to the survey. A variety of ulcer sizes and complexity were reported to be managed in community settings. Confidence in DFU management was high in most manual skill domains including: stabilisation of the foot (85.7%, standard deviation [SD] 17.42), scalpel control (83.0%, SD 20.02), debridement with a scalpel (82.7%, SD 18.19) and aseptic technique (81.0%, SD 18.62, maintaining integrity of healthy tissue (77.3%, SD 21.11), removal of appropriate tissue (75.6%, SD 22.53), depth of ulceration (73.7%, SD 23.99) and ability to manage messy wounds (69.1%, SD 26.04). Curette debridement had substantially lower levels of reported confidence (41.0%, SD 34.24). Performance anxiety was low with somatic and cognitive anxiety of 6/24 and 3/8 on the CSAI-2, respectively. Community podiatrists are managing foot ulcers of varying size and complexity. Confidence and anxiety do not pose a barrier to care. Adherence to wound assessment clinical guidelines is low and confidence with the use of curette was sub-optimal. Further educational programs may overcome these barriers and support shared models of care between community and acute podiatry services.

Evaluation of patient perception and intraoperative bleeding in labial frenectomy: A comparision of diode laser and conventional scalpel techniques

: High frenal attachments are abnormalities corrected by surgical procedure called frenectomies. The scalpel technique is associated with pain, bleeding and postoperative discomfort. To overcome these shortcomings, in the recent times, diode lasers are gaining popularity due to less bleeding, pain during the procedure, healing outcome, and need for analgesics: To compare the bleeding during the procedure and postoperative pain in patients requiring labial frenectomy using conventional scalpel and diode laser techniques. Twenty patients with high labial frenum attachment requiring frenectomy were included in this study. Patients were randomly divided into Group A: scalpel group and Group B: diode laser group. Pain assessment using VAS, severity of intraoperative bleeding and number of analgesics used were recorded: The analysis showed that VAS score for pain was significantly lower in the laser group as compared to the scalpel group Bleeding was mild in laser group, where as in scalpel group showed moderate or severe bleeding scores Post operative use of analgesics was more in scalpel group than laser group Laser was found to be an effective alternate to scalpel in performing frenectomy procedures, more importantly it showed less bleeding, less pain perception and more patient acceptance during the procedure.

Microneedling - A Novel Cosmetic Therapeutic Approach for Management of Gingival Hyperpigmentation and Review of Literature

Abstract A beautiful smile boosts an individual’s self-confidence. The harmony of a smile depends on the shape, colour, and position of teeth, as well as the gingival tissue. Excessive gingival pigmentation is a major aesthetic concern for many people. Gingival hyperpigmentation is usually caused by an abnormal accumulation of melanin in the gingival tissue, which gives the gingiva a dark appearance. A variety of different modalities have been proposed for removing hyperpigmentation like Scalpel technique, LASER, Radiotherapy, Electrocautery, Bur abrasion, Chemical methods etc. Though the initial results of depigmentation procedures are promising, repigmentation is a common problem associated with them which poses a financial burden to the patient. To overcome this hurdle, a promising novel technique which is in vogue in cosmetic dermatology is Microneedling. Microneedling is a minimally invasive, cost effective, simple procedure that creates microholes to facilitate the penetration of topical medications across the connective tissues. The procedure activates the natural healing process, promoting the regeneration of epithelial cells and the breakdown of clusters of melanin pigment. This article gives an insight regarding microneedling technique and also discusses in depth regarding melanin synthesis, classification, indices, etiology, gingival depigmentation procedures, and repigmentation.

Topographical and histological analysis of keratinized mucosal grafts removal techniques an ex-vivo study in porcine mandibles

The aim of this study was to assess the surface and tissue quality of keratinized mucosa grafts (KMG) obtained using the conventional scalpel and mucotome techniques. This was an experimental in vitro/ex vivo study involving six porcine hemi-mandibles. Specimens were harvested using both the mucotome and conventional scalpel techniques, with randomization determining the choice of technique for tissue removal. The specimens were prepared following predefined laboratory protocols and subsequently subjected to optical microscopy for evaluating epithelial and connective tissue and scanning electron microscopy for topographical and 3D profilometry analysis. Tissues harvested using the mucotome exhibited a linear base and uniform thickness, along with the presence of submucosa and fibrous connective tissue, all of which are ideal for graft success. Differences in the surface characteristics of specimens obtained through the two techniques were observed during a comparative analysis of images obtained through both microscopy types. KMG obtained using the mucotome technique displayed greater uniformity and reduced undesirable cell presence compared to the scalpel technique, thereby enhancing the likelihood of success in soft tissue graft surgical procedures. This study provides valuable insights to oral healthcare professionals and may contribute to future research aimed at achieving more successful surgeries, shorter postoperative recovery times, reduced discomfort, and an overall more positive patient experience.

Comparative Assessment of Gingival Depigmentation Using Scalpel Versus Microneedling With Ascorbic Acid: A Randomized Controlled Trial.

Background Gingival pigmentation (GP), characterized by the presence of melanin in the gingival tissues, is a common aesthetic concern in dental practice. While it poses no inherent health risks, the visible discoloration may cause psychological distress for individuals seeking optimal dental aesthetics. Understanding the efficacy of various methods is essential for refining treatment strategies and enhancing patient satisfaction in the realm of gingival depigmentation (GD). Aim The objective of the study was to compare the effectiveness of scalpel and microneedling (MN) with ascorbic acid in the treatment of GD. Materials and methods Sixteen patients who had a complaint of GP were included in the study, of whom eight were allocated for depigmentation with a scalpel, and the other eight patients were treated with the MN technique with ascorbic acid. Postoperative wound healing scores were evaluated on the first and seventh days, respectively. The intensity of depigmentation was assessed at baseline, in the first month, and at the end of the third month, respectively. Results The mean Dummett-Gupta Oral Pigmentation Index (DOPI) score at baseline was 2.65±0.16 and 2.61±0.17 in the surgical and microneedling groups with ascorbic acid, respectively. The mean DOPI score at the end of the third month was 1.67±0.39 and 0.87±0.17 in the scalpel and MN with ascorbic acid groups, respectively. There was a statistically significant difference between the scalpel and MN with ascorbic acid groups at the end of the first and third months, respectively, where MN with ascorbic acid showed aesthetically pleasing outcomes. Patients treated with the scalpel technique showed incomplete healing and ulceration on the first and seventh days after the procedure when compared to the MN technique with ascorbic acid. The healing index scores were statistically significant in the MN with ascorbic acid group. Conclusion The MN technique with ascorbic acid is a successful technique for treating GD. It showed aesthetically gratifying outcomes when compared to the conventional surgical technique.

Management of Ankyloglossia Using Conventional Surgical Technique: A Case Series

Periodontal plastic surgery is a more conservative and precise technique practised to create more functional and aesthetic results for the treatment of mucogingival problems. The presence of an aberrant frenum is one of the aetiological factors associated with the persistence of a midline diastema. Inadequate dental plaque removal, poor oral hygiene, bifid tongue, impaired speech, and mucogingival problems like recession and black triangles need more attention. Ankyloglossia, or tongue-tie, is a congenital anomaly with an abnormally short lingual frenulum. The aberrant frenum can be treated with surgical removal of the frenum using either frenectomy or frenotomy procedures. In the present case series, frenectomy was performed using a conventional scalpel technique for the treatment of tongue tie.

A case series of the Royal Perth Hospital cannula-first approach in the 'can't intubate, can't oxygenate' scenario.

At the Royal Perth Hospital, we have been developing and teaching a can't intubate, can't oxygenate (CICO) rescue algorithm for over 19 years, based on live animal simulation. The algorithm involves a 'cannula-first' approach, with jet oxygenation and progression to scalpel techniques if required in a stepwise fashion. There is little reported experience of this approach to the CICO scenario in humans. We present eight cases in which a cannula-first Royal Perth Hospital approach was successfully implemented during an airway crisis. We recommend that institutions teach and practice this approach; we believe it is effective, safe and minimally invasive when undertaken by clinicians who have been trained in it and have immediate access to the requisite equipment. The equipment is low cost, comprising a 14G Insyte cannula, saline, 5 ml syringe and a Rapid-O2. Training can be provided using low-fidelity manikins or part-task trainers.

Management of Ankyloglossia in a Non-Syndromic Patient Using a Super Pulsed Laser: A Life-Changing Treatment- A Case Report

Objective: Ankyloglossia affects a person’s overall well-being and life, from malnutrition due to poor feeding and mechanical problems to psychological stress and low self-esteem, thus affecting social life. This case reports the use of non-scalpel techniques, such as a super pulsed laser, to manage ankyloglossia in a non-syndromic patient suffering from speech incompetence and restricted tongue mobility and highlights its advantages over other conventional techniques. Case Report: A 17-year-old male patient presented with a complaint of restricted tongue mobility, due to which he could not pronounce certain words clearly. As the patient was apprehensive about the use of a scalpel, it was decided to manage ankyloglossia using a diode laser against the conventional scalpel technique. Thus, the laser-assisted lingual frenectomy using GaAs super pulsed laser was used to excise the lingual frenulum. Conclusion: This case report suggests that ankyloglossia can be successfully treated by using laser-assisted surgery and gives superior results specifically in terms of lesser pain and bleeding

Ultrasonic Bone Scalpel versus Conventional Technique for Thoracolumbar Spinal Decompression: A Prospective Randomized Controlled Trial.

Objective The purpose of the present study is to compare intraoperative blood loss, operating time, laminectomy time, hospital length of stay, and complications in thoracolumbar spinal decompression using ultrasonic bone scalpels (UBSs) with conventional procedures. Methods Forty-two patients who underwent decompressive laminectomy and pedicular screw fusion with a surgical level of 1-5 levels between February 1, 2020, and June 30, 2022, in a single institution were evaluated for eligibility, and 11 were excluded due to a history of spinal surgery ( n = 3), spinal tumor ( n = 3), and spinal infection ( n = 5). A total of 31 patients were randomly divided into the UBS group ( n =15) and the conventional group ( n =16). Intraoperative blood loss, operating time, laminectomy time, hospital length of stay, and complications were recorded. Results Intraoperative blood loss and laminectomy time were significantly lower in the UBS group (656.0 ± 167.6 ml, 54.5 ± 27.4 minutes, respectively) than in the conventional group (936.9 ± 413.2 ml, 73.4 ± 28.1 minutes, respectively). Overall operation time, hospital length of stay, and complications were all similar between the groups. Conclusion The UBS is a useful instrument for procedures performed near the dura mater or other neural tissue without excessive heat or mechanical injury. This device is recommended for various spinal surgeries in addition to high-speed burrs and Kerrison rongeurs.

Comparing the intraoperative and postoperative complications of the scalpel and electrocautery techniques for severing the inner layers of the lumbar disc during discectomy surgery.

Due to the sensitivity of the surgical site and a higher probability of injury, the use of a scalpel and electrocautery to create an incision in the spine is discussed. In this study, we will compare the intraoperative and postoperative complications of the scalpel and electrocautery techniques for severing the inner layers of the lumbar disc during discectomy surgery. This study was conducted in Iran as a randomized controlled trial with double-blinding (1,401). Sixty candidates for spine surgery were randomly divided into two groups of 30 using electrocautery (A) and a scalpel (B) based on available sampling. The VAS scale was used to assess postoperative pain. The duration of the incision and intraoperative blood loss were recorded. The infection and fluid secretions were determined using the Southampton scoring scale. Utilizing the Manchester scar scale, the wound healing status was evaluated. The SPSS version 16 software was used for data analysis (t-test, Mann-Whitney U, ANOVA). The electrocautery group had substantially lower bleeding, pain, and wound healing rates than the scalpel group (P > 0.05). However, the electrocautery group had significantly longer surgical times, more secretions, and a higher infection rate than the scalpel group (P > 0.05). In terms of demographic and clinical characteristics, there was no significant difference between the two groups (P < 0.05). Electrocautery reduces postoperative hemorrhage and, potentially, postoperative pain in patients. However, as the duration of surgery increases, so does the duration of anesthesia, and patient safety decreases. Additionally, the risk of infection increases in the electrocautery group compared to the scalpel group, and the rate of wound healing decreases. https://www.irct.ir/, identifier (IRCT20230222057496N1).

Management of inappropriate frenal attachment with conventional scalpel approach: A case report

The term "frenum" refers to a small fold or band of tissue that connects two structures within the body. These frenum can vary in size, shape and attachment points among individuals. In some cases, an oral frenum may cause issues such as restricted movement, speech difficulties, diastema (gap between teeth) or interference with orthodontic treatment. The frenum may jeopardize the gingival health when they are attached too closely to the gingival margin, either due to an interference in the plaque control or due to a muscle pull. The aim of this case report is to manage the inappropriate frenal attachment in single visit by conventional scalpel technique.

Comparison of Diode Laser and Scalpel technique in the treatment of Gingival Melanin hyperpigmentation

Background: A smile can bring happiness into one’s life and also create positivity in the surrounding environment. Black or brown gums is a very common problem among all races of men and women that one complains to a periodontist. Depigmentation of melanin hyperpigmented gingiva can be carried out using scalpel and diode laser. Material &amp; Methods: 10 patients having uniformly dense band of bilateral physiologic gingival hyperpigmentation on the facial aspect of maxillary and mandibular gingiva were included in this study. Each patient underwent initial phase 1 therapy (oral hygiene instructions, scaling and root planning) 1 week before the depigmentation procedure. A split mouth study was followed. In test group depigmentation was done by Laser and in control group depigmentation was done by scalpel. Followup was done at 1 week,1 month , 3 months and 6 months. Results: There was no statistical significance in plaque and gingival index in both the groups. At 6 months in group A, repigmentation was seen in 7 patients and in group B, repigmentation was seen in 6 patients. Conclusion: The methods used here produced desired results and above all, the patients were satisfied with the outcome, which is the ultimate goal of any therapy. The scalpel remains the gold standard because of its convenience and cost effectiveness, but with proper adhesion to safety measures, the diode laser can also be used to remove gingival pigmentation efficiently.

Evaluating the Clinical Efficacy of Maxillary Labial Frenectomy Procedure Using Diode Laser (980 nm) and Conventional Scalpel: An Observational Study.

This is an era of minimally invasive and least traumatic surgical interventions being focused on. The traditional scalpel frenectomy technique offers an increase in post-operative sequelae. To unravel this scenario a comparative evaluation is carried out to find out the clinical outcomes and quality of life after maxillary labial frenectomy using a conventional scalpel and diode laser frenectomy of 980 nm. Thirty-six subjects age ranging between 18 and 45 years reported to the Department of Oral and Maxillofacial Surgery, MES Dental College, Perinthalmanna with an aberrant frenal attachment of maxillary labial frenum were randomly assigned into two groups. Group A underwent the conventional scalpel technique and group B for the diode laser-assisted (980 nm) frenectomy technique. The post-operative parameters of ooze from the surgical site, pain, wound healing, and discomfort or acceptance of the procedure were assessed on day 1, day 7, and day 14, respectively. The diode laser group exhibited statistically significant clinical and healing outcomes. Less pain, minimal or absent ooze, increased healing, and better acceptance of the procedure with diode laser at 1, 7, and 14 days recall visit. Surgical interventions involving needle puncture and the associated post-operative sequelae are the most dreaded experiences that make patients indifferent toward surgical treatments. Thus in terms of better clinical outcomes and improved quality of life diode laser frenectomy is an excellent alternative wherein a needleless anesthetic success followed by minimal surgical intervention and less post-operative sequelae with fast recovery is possible.

A Comparison of Harmonic Scalpel and Conventional Techniques for Thyroidectomy.

Thyroidectomy is one of the most frequently performed surgeries. Conventional techniques using electrocautery carry the risk of tissue injury. Recently, there has been increased use of harmonic scalpels in thyroid surgery. The harmonic scalpel utilizes ultrasonic shears for cutting and coagulation, thus minimizing thermal injury. The objective of our study was to determine differences in operative duration, hypocalcemia, and RLN palsy. This single-center retrospective comparative study included consecutive patients undergoing hemithyroidectomies using the harmonic scalpel and conventional technique in the past one year (n = 64, harmonic group = 28 and conventional group = 36). The mean operative duration for the harmonic scalpel group was 70.4min, vs. 81.31min for the conventional technique group, and the difference in mean duration was found to be 10.84min (p = 0.027). There was no statistically significant difference in the rates of hypocalcemia (p = 0.751) or RLN palsy (p = 0.121). None of the patients in either group developed permanent hypocalcemia or RLN palsy. The use of a harmonic scalpel during thyroidectomy is safe. The overall surgical duration was reduced when the harmonic scalpel was used, and the complication rates were comparable to those of the conventional technique, making it a non-inferior technique for surgical intervention in thyroidectomy and warranting harmonic scalpel consideration as a valuable addition to the armamentarium of thyroid surgeons.

Extracranial Metastasis of Glioblastoma: A Case Report

Glioblastoma is the most frequent malignant neoplastic pathology among glial neoplasms, extra neural metastases are atypical, presenting in 0.2 to 2% of cases, risk factors include recurrence of the neoplasm, early age of the patient, and prolonged survival. The most frequent localization sites of metastases are lungs, cervical lymph nodes, bone tissue. This article details the case of a 36-year-old patient with no history of previous disease who presented tonic-clonic seizures. In extension tests, a right frontal intracranial tumor was observed. It was decided to perform resection of the tumor with pathology results that indicated a grade IV right frontal glioblastoma, presents a recurrence of the disease, for which reason a surgical reintervention is warranted and subsequent treatment with radiotherapy and chemotherapy one year after the second surgery, a right temporal extracranial lesion is evidenced, which was biopsied and reported as glioblastoma with a component primitively, resection of the tumor mass was chosen with the double scalpel technique and reconstruction with a cervicofacial flap and skin graft. Late post-surgical patient with adequate pain control, without signs of inflammatory response, without evidence of neurological deficit, is discharged.

Evaluation of Children’s Perceptions after Frenectomy: Diode Laser vs. Conventional Scalpel Technique

Objective: The presence of abnormal frenum may cause aesthetic or functional problems, which can be prevented by frenectomy operation. Therefore, the aim of this study is to compare children's perceptions of pain, speech and chewing difficulties after conventional scalpel technique and diode laser-assisted frenectomy operations. Material and Methods: Twenty-one patients, aged 10 to 16 years, who were indicated for Frenectomy were assigned to be treated with conventional scalpel technique or diode laser. In the comparison between both techniques, the Wong-Baker FACES Pain Rating Scale was used to evaluate pain immediately after surgery and pain, speech and chewing difficulties at days 1, 3, 7, and 10 following the procedure. Factors such as duration of surgery, use of anaesthetic, and need for analgesics were also recorded. Moreover, Corah's Dental Anxiety Scale was used to evaluate the dental anxiety levels of parents about their children. Results: When compared to the conventional scalpel technique, it was found that the surgery took shorter, and no postoperative analgesic was needed in the group that underwent Diode laser surgery. In addition, as the age of the children increased, the anxiety levels of the parents decreased. When the postoperative perceptions of pain and functional discomforts were evaluated, there was no significant difference between the groups. Conclusion: According to the results of this study, Diode laser provided benefits such as significantly shortening the operation time and not requiring surgical sutures and analgesics in children. It may also allow the use of less infiltrative anaesthetic during the operation.

RECONSTRUCTION OF PINK ESTHETICS USING SCALPEL TECHNIQUE : A CASE REPORT

Gingival pigmentation in anterior region alongwith high smile line often causes esthetic concern. Twenty-one years old sytemically healthy, nonsmoker female patient was reported in the department with chief complaint of brown gums in front teeth region. Gingival depigmentaion using scalpel technique was planned and patient-based evaluation of statisfaction in terms of esthetics was recorded using visual analogue scale. After one month of surgery patient reported visual analogue score of 10. This study suggests that scalpel technique is simple and effective in terms of achieving acceptable esthetics.

P203 Comparing the combine flap fixation and Harmonic scalpel technique with the Harmonic scalpel alone in reducing seroma formation after mastectomy in breast cancer patient: A pilot study for a RCT

P203 Comparing the combine flap fixation and Harmonic scalpel technique with the Harmonic scalpel alone in reducing seroma formation after mastectomy in breast cancer patient: A pilot study for a RCT

Physiological Gingival Melanin Hyperpigmentation Treatment with Injectable Vitamin C and Scalpel Technique: A Randomised Controlled Clinical Trial.

Harmony between facial complexion and gingival health goes hand in hand. Gingival depigmentation is an aesthetic correction of hyperactive melanocytes in gingival tissues that lead to hyperpigmentation. Current study compares depigmentation, pain scores, and itching with scalpel technique and nonsurgical intramucosal Vitamin C injection. 30 individuals in the age range of 18-40 years conscious of dark gums were randomly allocated to test and control group by lottery method. Thorough Phase I therapy was performed one week before the procedure. Area and intensity of depigmentation were evaluated preoperatively and postoperatively; pain score, itching, and repigmentation percentage were the postoperative parameters. After 24 hrs, test group showed significantly lesser VAS score for pain as compared to control group. There was no statistically significant difference in preoperative area of pigmentation between the test and control group (p=0.936). Postoperatively also, there was no statistically significant difference in area of pigmentation between the test and control group (p=0.932). For comparing area of pigmentation, an independent t-test was applied and Mann-Whitney test was used for differentiating the intensity of pigmentation, repigmentation, and VAS score between the groups. The study concluded that Vitamin C mesotherapy and scalpel technique showed comparable results in reduction of areas and intensity of gingival hyperpigmentation.