ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title A Comparison of 3 Surgical Techniques [Laser Excision, Scalpel Gingivectomy and Periodontal Flap] to Treat Calcium Channel Blocker Induced Gingival Overgrowth Favoring Laser Excision
Clinical Question In an elderly hypertensive patient with calcium channel blocker induced gingival enlargement requiring surgical resection; does laser excision or surgery with a periodontal flap technique lead to a lower recurrence rate than does a classic gingivectomy?
Clinical Bottom Line Recurrence of gingival overgrowth over a 6 month period is significantly reduced when surgery employs laser excision rather than a periodontal flap technique.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 16856895Mavrogiannis/200650 organ transplant patients with gingival enlargement caused by cyclosporin or a calcium channel blockerRandomized Control Trial
Key resultsThis study compared each surgical technique with a conventional gingivectomy (2 cohorts) by separating the anterior maxilla into 2 surgical sites (canine to central incisor on either side). The periodontal flap technique, when compared to a scalpel gingivectomy, had a CI value of -2.6 ± 11.4(-7.2, 1.8) and p value 0.225. Laser excision compared to scalpel gingivectomy, on the other hand, had a statistically significant difference [p value of 0.05 and CI -7.1 ± 16.78 (-14.86, -0.02)].
Evidence Search Gingivectomy[Mesh]; Surgical Procedures, Operative[Mesh]; Calcium Channel Blockers[Mesh]; Gingival Overgrowth[Mesh]
Comments on
The Evidence
Patients in this study were carefully selected based on gingival presentation and medical history. Post-surgery, gingival healing and overgrowth were measured on plaster study models at specific time intervals by a collaborator blinded to which surgical technique had been employed. Systems of variable analysis were listed.
Applicability Although laser excision proves to be an effective form of treatment with reported postoperative pain comparable to that for a scalpel gingivectomy, the notable cost of the procedure may limit its use. The periodontal flap technique provided less assurance of long term stability and significantly increased postoperative pain compared to a conventional gingivectomy.
Specialty/Discipline (Oral Medicine/Pathology/Radiology) (General Dentistry) (Periodontics)
Keywords Gingivectomy, calcium channel blocker, gingival overgrowth, hypertension, surgical therapy
ID# 2201
Date of submission: 04/19/2012spacer
E-mail smithve@livemail.uthscsa.edu
Author Veronique Smith
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Geza T. Terezhalmy, DDS
Faculty mentor/Co-author e-mail terezhalmy@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
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Comments on the CAT
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