principles of using electrosurgery

1. By :
Dr Saeid Nemati (DDS,Msc in esthetic Dentistry,
Laser fellowship)
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 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. ◼ Often “electrocautery” is used to describe electrosurgery.
This is incorrect.
◼ Electrocautery refers to direct current (electrons flowing in
one direction) whereas electrosurgery uses alternating
current.
◼ During electrocautery, current does not enter the patient’s
body. Only the heated wire comes in contact with tissue.
◼ In electrosurgery, the patient is included in the circuit and
current enters the patient’s body.

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

8. ◼1907 Doyan used Extreemly High Fr (3
mill cyc./S)with an active and passive
Electrode
◼Poor Quality incision

9. ◼1908 Deforrest Radio-tube high Fr
◼1920 Refined Apparatus
◼1960 Transistor Replaced
◼Recent E.S.Units

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

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

12. ◼E.s: convert current to Electromagnetic
Radio frequency (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

14. 1. Generator (electrosurgical unit)
2. Inactive dispersive electrode (grounding pad)
3. Active electrode (“Bovie” pencil)

15. Copyright© Valleylab, a division of Tyco Healthcare Group LP: All rights reserved

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

17. ◼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)

18. 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.

19. 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

20. ◼ 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.

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

25. 2-Partially Rectified Current
It pulses but does not change direction
1st half it flow
2nd half no flow

27. 3 – Fully Rectified current
1st half like above
2nd half repeat the same flow
Incise and coagulate at
the same time

29. 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)

31. ◼ 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)

32. ◼Most ESU units on the market today have
REM technology.
◼REM system continually monitors the heat
build-up under the grounding pad
◼If the system detects excess heat build-up it
will shut off the current flow to prevent
patient injury

33. ◼ A return electrode burn
occurs when the heat
produced, over time, is not
safely dissipated by the
size or conductivity of the
patient return electrode.

34. ◼ In the case of reduced contact area, the current flow is
concentrated in a smaller area.
◼ As the current concentration increases, the temperature at
the return electrode increases.
◼ If the temperature at the return electrode site increases
enough, a patient burn may result.
◼ Surface area impedance can be compromised by: excessive
hair, adipose tissue, bony prominences, fluid invasion,
adhesive failure, scar tissue, and many other variables.

35. 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

36. ◼ Proper Probing
◼ Biologic Width Detection

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

39. ◼ 5-drug hyper plastic tissue
◼ 6-poor oral hygiene
hyper trophies

44. ◼Eruptive force mislead /dissipate before
H of C emerge incomplete crown
length

45. ◼Incomplete passive eruption
◼Insufficient lip length
◼Over growth of maxilla
◼Combination of above

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

47. ◼Malpositioned papilla or
Hyper trophy
Diastema closure

48. ◼ Although possible to complete E.S and restorative
treatment at the same time
Best result gain within1-2 week healing period

49. 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)

50. 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 volatilized)
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

51. 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

53. 7 -consider zenith point
8 -penetrate the gingiva with an explorer to determine the
amount of tissue removal

54. ◼Desirable H / W = 10/8 = 80%

55. 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.

56. 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

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

64. ◼Gingival Margins must not invade
Biological Width
Requirements for Periodontal Health.

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

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

67. ◼ the units cost much less than do lasers;
◼ the electrode cuts on its sides as well as on its tip;
◼ the electrode may be bent to meet the clinical need;
◼ cuts are made with ease when the device is set correctly;
◼ hemostasis is immediate;
◼ cutting is consistent; the wound is nearly painless after the procedure;
◼ the soft tissue has minimal trauma;
◼ the tip is self-disinfecting.

68. ◼ : anesthetic is required for cutting;
◼ both the name and the use of electrosurgery cause fear in some patients;
◼ there is an unavoidable burning-flesh odor;
◼ the operator has only a low tactile sense of exactly what is being cut;
◼ the heat developed by monopolar electrosurgery units does not allow for
their use around implants (careful use of bipolar electrosurgery is acceptable
around implants because it
produces less heat);
◼ bone can be damaged;
◼ electrosurgery is dangerous in an explosive environment;
◼ although this issue is controversial, electrosurgery may disrupt the action of
pacemakers16;
◼ patients who have undergone irradiation, have diabetes or have blood
dyscrasias can experience poor postoperative healing.

69. ◼ : gingivectomy;
◼ gingivoplasty;
◼ biopsy;
◼ gingival troughing;
◼ crown lengthening;
◼ subgingival curettage;
◼ operculectomy;
◼ frenectomy;
◼ apthous ulcers;
◼ leukoplakia;
◼ elimination of open pockets;
◼ reduction of tuberosity;
◼ vestibuloplasty;
◼ uncovering implants.

70. ◼ : their use requires minimal or no anesthetic;
◼ they do not harm dental hard tissues;
◼ their judicious use does not injure the dental pulp;
◼ because of low or no heat production, they can be used around dental
implants;
◼ they are antimicrobial;
◼ they remove endotoxins from root surfaces;
◼ there is growing evidence that laser use may be positive therapy for
periodontal disease;
◼ laser technology is considered state of the art by the lay public, so patients
are more accepting of its use in their treatment than of electrosurgery.

71. ◼ : the cost of laser is significantly higher than that of electrosurgery units;
◼ most of the techniques suggested for laser overlap with those for the much
less expensive electrosurgery;
◼ because of the potential hazard of laser light, laser use requires a learning
period and strict precautions;
◼ laser can cause eye damage, so protective glasses are required during its
use;
◼ cutting with lasers usually is slower than that with electrosurgery;
◼ there is a burning flesh odor;
◼ some techniques are time consuming;
◼ laser plume requires use of a high-filtration face mask, because of the
possible presence of pathogens in the plume

73. 1. Mucosal – when the frenal fibres are attached up to the
mucogingival junction
2. Gingival – when the fibres are inserted within the attached
gingiva.
3. Papillary – when the fibres are extending into the interdental
papilla.
4. Papilla penetrating – when the frenal fibres cross the alveolar
process and extend up to the palatine papilla.

78. CTT: Ceramic Tissue Trimmer