SO SÁNH HIỆU QUẢ CỦA PHƯƠNG PHÁP CẮT NƯỚU BẰNG DAO PHẪU THUẬT VÀ LASER TRONG ĐIỀU TRỊ NƯỚU TRIỂN DƯỠNG Ở BỆNH NHÂN CHỈNH NHA BẰNG KHÍ CỤ CỐ ĐỊNH

Abstract

Background: Gingival enlargement (GE) is a frequent complication associated with fixed orthodontic treatment. It can negatively impact oral hygiene, esthetics, periodontal health, and even compromise the progress of orthodontic therapy. Among the treatment options, scalpel gingivectomy and diode laser surgery are commonly employed. However, direct comparative studies assessing the efficacy of these techniques in orthodontic patients remain limited. Object: To compare the clinical, microbiological, pain-related, and postoperative bleeding outcomes of scalpel versus diode laser gingivectomy in the management of gingival enlargement during fixed orthodontic treatment. Materials and method: This randomized controlled clinical trial employed a split-mouth design and included 13 orthodontic patients diagnosed with gingival enlargement, corresponding to 44 pairs of teeth. Each side of the mouth was randomly assigned to undergo gingivectomy using either conventional scalpel surgery or diode laser surgery. Clinical parameters—including the Plaque Index (PlI), Gingival Index (GI), Probing Pocket Depth (PPD), Gingival Margin Position (GMP), and Bleeding on Probing (BoP)—were recorded at baseline (T0), one month (T1), and three months (T3) after treatment. Subgingival plaque samples were also collected at the same time points to quantify the presence of Porphyromonas gingivalis (Pg), Fusobacterium nucleatum (Fn), Treponema denticola (Td), and Tannerella forsythia (Tf). Postoperative outcomes, including pain perception and bleeding, were evaluated on days 1, 3, and 7 following surgery. Results: Both treatment methods significantly improved clinical parameters and reduced subgingival bacterial counts. The diode laser group showed better results in GI and BoP, and demonstrated greater improvements in PPD and GMP at T1, with these parameters better maintained through T3. This group also reported less postoperative pain and bleeding, particularly on the first day following surgery. However, the differences in subgingival levels of P. gingivalis, F. nucleatum, T. forsythia, and T. denticola between the two groups were not statistically significant at any time point. Conclusion: Both methods were effective in the treatment of gingival overgrowth in patients undergoing fixed orthodontic treatment. Although the differences in the subgingival plaque levels of Pg, Fn, Td, and Fn between the two groups were not statistically significant, gingivectomy using a diode laser demonstrated several advantages, including better improvements in clinical indices (GI, BoP, PPD, GMP), as well as less postoperative pain and bleeding.