A dental laser makes several procedures possible—from uncovering an unerupted tooth to creating more enamel surface area—that can make adolescent orthodontic treatment better for the patient and the practice.

By Steven Luccarelli, DDS

Adolescent treatment is the first thing that comes to mind when thinking about orthodontics. With over 4 million patients in braces, 75% of them adolescent patients, it is both the focus and foundation of most orthodontic practices. Providing our adolescent patients with great alignment, precise occlusion, excellent function, and a beautiful smile is our top priority. These are the results that we constantly strive for, and our patients are so grateful. However, it is worth noting if our patients could ask for one more thing, it would likely be for faster treatment. It has become increasingly important to our younger patients to reach these results, and complete treatment as quickly as possible. Today, more than ever, patients want to be finished as instantaneously as possible, and technology can help us with that. By treating our patients more efficiently, they are done with procedures faster, they are treated with fewer appointments, they have a better overall experience, and we are more profitable in the process.

We have been using dental laser technology in our office for over 15 years. Our recent addition, the Epic X from BIOLASE, is the most sophisticated, precise, and easy-to-use laser that we have ever tried. It is specifically designed for orthodontists with overall positive utilization. It only takes a few minutes to learn how to use it, and a few hours of training to become fully laser certified. The benefits of adding a laser to your practice can be revolutionary and game changing.

Figure 1: Here, enough enamel was uncovered to place a bracket. The procedure can reduce a patient’s treatment time by 6 months.

The most common laser procedure done by orthodontists is uncovering an unerupted tooth, frequently a cuspid or bicuspid (Figure 1 and 2). We see it all the time, a slow erupting cuspid slamming on the brakes of our treatment progress, increasing treatment time, decreasing efficiencies, and ultimately making you less productive. With the Epic X, you select your preferred settings and within minutes you can uncover enough enamel to place a bracket, and with nothing more than topical. It is minimal or no bleeding, no post-op concerns, and minimal if any discomfort. This very predictable procedure can be done immediately and can reduce a patient’s treatment time by 6 months or more.

Figure 2: Again, the dental laser is used to expose unerupted teeth.

We often see adolescent patients with preexisting gingival inflammation, or they develop it during their treatment. Once they have it, it is very difficult to reverse it. A simple gingival laser procedure can assist in getting the tissue back to its uninflamed state. It will remove the redundant tissue, create a healthier environment for hygiene, and allow us to place our brackets right where they belong (Figure 3). Everything not only looks better but is so much healthier, giving the patient a brand-new start and more confidence.

Figure 3: The dental laser can be used to address gingival inflammation and/or remove redundant tissue. The procedure creates a healthier environment in terms of hygiene and allows for proper placement of brackets.
Figure 4: When teeth do not track in adolescent aligner treatment due to lack of surface area, a gingivectomy with a dental laser can create more plastic to enamel surface area.

More and more of our adolescent patients are choosing clear aligner treatment over braces, and we are looking for ways to make the treatment option for our teens more consistent and calculable. Compliance and surface area are usually two of the most important factors for aligner treatment predictability. However, even when our teens wear them well, sometimes certain teeth just will not track. We see it often with upper incisors, and specifically with maxillary laterals. This can be due to a lack of surface area, especially for our younger patients. By performing a simple gingivectomy with the Epic X, we can remove excessive gingival tissue, and create more plastic to enamel surface area (Figure 4). This simple gingival recontouring at the beginning of treatment or any refinement allows for better tracking, better results, and a much more aesthetic after-treatment smile.

Figure 5: When gingival contours stand in the way of achieving the perfect smile, a dental laser can be used to manage the gingival architecture, increasing tooth length.

As we look ahead to the future of orthodontic treatment and procedures, probably the most rewarding dental laser procedure that we perform is the gingival recontouring of our finished cases. We are diligent to achieve perfect alignment and occlusion for each patient, but often gingival contours stand in the way of us achieving that perfect smile. It may be altered passive eruption, a gingival asymmetry, low frenum, or excessive tissue. By managing the gingival architecture, you can reduce the “gummy” smile, increase tooth length, and make a tremendous difference in the result (Figure 5). With this extra step, made possible by the innovation of dental lasers, we can take a very nicely treated case and instead make it exceptional. This is the type of treatment that will differentiate your practice from all the others.

Dental laser technology advances the aesthetic-focused approach to treatment, helping give patients the best smile possible. Thanks to dental laser technology, the future of adolescent orthodontic treatment can be a positive, pain-free experience for patients and providers alike.OP

Steven Luccarelli, DDS, received his dental degree from Columbia University School of Dentistry. He received a specialty certificate in orthodontics from Columbia University and became a diplomate of the American Board of Orthodontics. He has been a clinical professor of orthodontics at Columbia University for 35 years, and an orthodontic attending at the NYU Langone Dental Residency Program. Luccarelli has been practicing orthodontics for over 35 years, and he practices with his partner, Joseph Barrese, DDS, MS.