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Electrosurgery for the General Practitioner
by Dr. Robert D. Thomas, DDS
Savannah, TN
I recently conducted a presentation on electrosurgery for our dental
society, and was shocked to discover that only 30% of the attendees
had even tried a surge. That’s a shame considering what a useful
addition it is to a GP’s armamentarium. I rely on mine daily
for a wide range of largely blood-free soft-tissue applications.
Nothing except possibly a laser ($10,000) can compare with my e-surge
($595) for frenectomies, exposing cervical caries, or giving tissue-impacted
teeth some help erupting. And because the electrosurge provides
hemostasis as it cuts, it allows gingivectomies of inflamed tissue.
Learning e-surgery basics is easy. There are several helpful introductory
videos on the technique. (Gordon Christensen offers an excellent
overview in one of his PCC Videos.*) Surgery courses tend to be
sponsored by manufacturers or their spokespersons, but if you ignore
the subtle selling that goes on there - courses are a good place
to pick up pointers.
Or you can do what I did. You can train
yourself.
Go to the supermarket and buy a cheap steak. Use it as your “patient”
to become comfortable cutting with electricity instead of a scalpel.
Learn what kind of cuts are created by the various electrodes and
the effects of the different power and currrent-form settings.
Once you have an electrosurge in your bag of tricks, you’ll
find ever-increasing applications.
For example, a lady in her seventies recently presented at the office.
She had developed several small pedunculated fibrous lesions that
were constantly irritated by her complete denture (figs 1&2).
She was in pain. And as a retiree on a limited income, she was almost
as concerned about the costs involved as what kind of painful procedure
would be required to remove the growths.
She was relieved to discover that, using our e-surge, we could excise
both growths in a total of 10 minutes at a single appointment. No
need for sutures, and at a cost far below her expectations!
This short article isn’t intended for the beginner. Parkell
asked me to offer a few technique hints for those of you who own
a surge but don’t feel you’re getting everything out of
it you should.
Help for the tongue-tie
Here are several tricks I’ve discovered for fast, predictable
frenectomies.
To minimize discomfort, I always use an extra-short 30-gauge needle
for the anesthetic.
When you pull the lip or tongue (depending which frenum you’re
cutting), you stretch the frenum like a rubber dam. Then the instant
you cut the tissue it springs back. So it’s easy to lose your
orientation. That’s why I’ve found the next two hints
so helpful.
After the patient is numb, I pre-place a suture (figs 6&7).
I put the 3-0 gut in a deep location. That way when I’m finished,
it’ll be easy to tack the tissue up into place. Incidentally,
this suture isn’t intended to stop bleeding, it’s to control
the position of the healing tissue.
Then I clamp the frenum with a small mosquito hemostat (fig 5).
This holds the tissue firmly in position throughout the procedure
and provides a template for the incision.
I take a straight wire electrode with my Sensimatic e-surge set
to “cut/coag” and the power set to 6 and trace the curved
outline of the hemostat with my electrode. By following the hemostat,
I’m certain that I’m removing both the most superior and
inferior portions. Obviously, I take care to avoid touching the
metal with the electrode.
Then after the tissue is removed I simply tighten my preplaced suture
to pull the loose tissue into place. I use gut, so the suture won’t
have to be removed.
Except for post-op instructions to the patient and parents, I’m
done. Not counting the time for the anesthesia to take effect, the
entire frenectomy takes just a few minutes.
My technique for a labial frenum is essentially the same (figs 3
and 4.)
* “Electrosurgery -
An indispensable adjunct to practice” Video #V4349 - 1-800-223-6569
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