Scholars Journal of Applied Medical Sciences (SJAMS) ISSN 2320-6691

Sch. J. App. Med. Sci., 2013; 1(5):530-534

©Scholars Academic and Scientific Publisher
(An International Publisher for Academic and Scientific Resources)
www.saspublisher.com

Review Article

Electrosurgical applications in Dentistry

Dr. Pallavi Samatha Yalamanchili1*, Dr. Pavithra Davanapelly2, Dr. Hemchand Surapaneni3
1
Reader, Department of Periodontics and Implantology, Drs. Sudha & Nageswara rao Siddhartha institute of Dental
Sciences, Chinnaoutpally, Gannavaram mandal, Krishna dist; Andhra pradesh-521286.
2
Post graduate, Department of Periodontics and Implantology, Drs. Sudha & Nageswara rao Siddhartha institute of
Dental Sciences, Chinnaoutpally, Gannavaram mandal, Krishna dist; Andhra pradesh-521286.
3
Reader, Department of Prosthodontics, Drs. Sudha & Nageswara rao Siddhartha institute of Dental Sciences,
Chinnaoutpally, Gannavaram mandal, Krishna dist; Andhra pradesh-521286.

Corresponding author
Dr. Pallavi Samatha Yalamanchili
Email:

Abstract: Electrosurgery which can also be called as radiosurgery has been used in dentistry for more than 50years.
Electrosurgery is a controlled precise application of radiofrequency electrical current to the soft tissue site to be cut
which is achieved by means of carefully designed electrodes. Electrosurgery is used in almost all branches of dentistry.
Electrosurgery is a continuously evolving field with active research into various new applications.
Keywords: Electrosurgery, waveform, lateral heat, wound healing, coagulation, bipolar

INTRODUCTION Electrosurgery or radiosurgery techniques and

Electrosurgery (ES) has been defined as the instrumentation
intentional passage of high-frequency waveforms, or There are three classes of electrodes: single-wire
currents, through the tissues of the body to achieve a electrodes for incising or excising; loop electrodes for
controllable surgical effect [1]. By varying the mode of planing tissues and heavy, bulkier electrodes for
application of this type of current, the clinician can use coagulation procedures (figure 1). The four basic types
ES for cutting or coagulating soft tissues. of electrosurgical techniques are electrosection,
electrocoagulation, electrofulguration,
Many credit “Bovie” as the father of electrical electrodessication.
devices. He developed the modern-day instrument and
helped bring it to the forefront of the profession. The
use of cautery dates back as far as prehistoric times,
when heated stones were used to obtain hemostasis.
Goldwyn described three eras encompassing the
development of the modern electrosurgical technology
[2]. The first era began with the discovery and use of
static electricity. The second era, best called
“galvanization,” evolved from Luigi Galvani’s
accidental discovery in 1786. He noted that muscle
spasms were induced in frogs’ legs hanging from
copper hooks. The third era, dating to 1831, was
ushered in with discoveries by Faraday and Henry in
England and America, respectively, who almost Fig. 1: Electrosurgical unit with different types of
simultaneously showed that a moving magnet could electrodes.
induce an electrical current in wire. In 1881, Morton
Electrosection, also referred to as electrotomy or
found that an oscillating current at a frequency of 100
acusection, is used for incisions, exisions, and tissue
kHz could pass through the human body without
planing. Incisions and excisions are performed with
inducing pain, spasm, or burn. Franz Nagelschmidt, in
single-wire active electrodes that can be bent or adapted
1897, discovered that patients with articular and
circulatory ailments benefited from the application of to accomplish any type of cutting procedure.
Electrocoagulation provides a wide range of
electrical currents. During the early 1900s, Simon Pozzi
coagulation or hemorrhage control by using the
used high frequency, high-voltage, low-amperage
electrocoagulation current. The active electrodes used
currents to treat skin cancers. In 1928 William Cameron
for coagulation are much bulkier than the fine tungsten
developed the first dental electrosurgical unit.
wire used for electrosection. The other two techniques,
electrofulguration and electrodesiccation are not used in
general dentistry. Electrosurgical technology offers two

530
Yalamanchili et al., Sch. J. App. Med. Sci., 2013; 1(5):530-534

types of devices for energy delivery: monopolar and reported that the needle-type electrode, which is used
bipolar. Both types of these units achieve their intended for incisions, creates a 0,12-mm-wide necrosis, and the
purposes well, but monopolar is used more than bipolar. loop electrode, used for tissue planing, makes a 0.31-
mm-wide necrosis [7]. The same report also concluded
Variables affecting electrosurgery performance that large electrodes cause more tissue damage than
Lateral heat small ones.
When the active electrode tip contacts the tissue, the
electrode itself does not produce any significant heat; Wave form
rather the intense heat that is required for the The choice of waveform depends on (1) the required
electrosurgical effect is generated within the tissues that Surgical effect, i.e., whether tissue separation or
are contacted by the electrode tip. While this hemostasis is required, and (2) the proximity of bone to
intracellular heat causes disruption of cells at the line of the surgical site. The fully rectified waveform produces
incision and/or coagulation, some of it also spreads to excellent tissue separation with the least amount of
the adjacent cell layers. This heat is called the lateral lateral heat, but it also produces very little hemostasis.
heat. Lateral heat causes coagulation necrosis on the The fully rectified, unfiltered waveform produces good
cell layers adjacent to all incision sites. However, this tissue separation with effective hemostasis. The
necrosis is minimal, and any unwanted tissue partially rectified waveform produces much more
destruction is caused by excess lateral heat. Therefore, lateral heat than the fully rectified, unfiltered waveform:
when ES is performed, the main objective is to produce therefore it can be used only for the control of
a clean incision or/and coagulation with minimal lateral hemorrhage in soft tissue.
heat.
Cutting time
Kelly & Harrison [3] measured lateral temperatures The quicker the active electrode is passed over the
in soft tissue following exposure to different types of tissue, the lesser the lateral heat. It has been estimated
electrosurgical currents. They found temperature rises that to generate an effective incision, while keeping the
of 5 to 86oF dependent upon the type of current, time of lateral heat at a minimum level, the electrode must be
current application and the distance from the electrode. guided over the tissue at a speed of 7 mm/s[8]. The
active electrode must not remain in contact with tissue
Stevens et al.[4] demonstrated extremely large for more than 1 to 2 seconds at a time and successive
increases in lateral heat adjacent to electrosurgery applications of the electrode on the same spot must
electrodes activated within dog gingiva. The group have a 10 to15 seconds interval. This interval allows the
however did not control many technique variables and heat produced on the wound to dissipate and prevents
the active electrode was left in contact with tissue for overheating of the tissue surface before the next
time periods much longer than would be used clinically. application of the electrode.

Kalkwarf et al. [5] showed that lateral heat Surface tissue condition
production adjacent to a fine wire needle electrode The surface of the tissue must be moist to allow heat
emitting fully rectified-filtered current was dependent dispersal. A dehydrated tissue surface causes .sparking,
upon the time of incision. They also demonstrated that tissue drag, and delayed healing [9]. Therefore, it is
three successive incisions into the same site desirable for the tissue surface to be wetted with the
dramatically increased the amount of lateral heat patient's own saliva or water or saline. Irrigation of the
production (8.0 - 48.0oC) at a distance of 1 mm from surgical site immediately after ES will also help to
the electrode. The authors demonstrated that a cooling minimize lateral heat.
period of at least 8 seconds between subsequent
incisions in the same area is necessary to assure that Indications
lateral heat production capable of initiating adverse  Elongation of clinical crowns
tissue responses does not occur. The same group, in a  Gingivectomies and gingivoplasties
separate study, found that an activated loop electrode  Frenectomies
generated more energy during surgery than a needle  Operculectomies
electrode [6]. Temperature increases in the adjacent  Incision and drainage of abscesses
tissue following use of the loop remained for longer  Hemostasis
periods of time than after use of a needle electrode.  Troughing of crown and bridge impressions
They calculated that a cooling interval of 15 seconds
 Tuberosity reduction
was necessary to properly dissipate heat between
successive entries into the same area of tissue with a  Biopsies (incisional and excisional)
loop electrode.  Periodontal pocket reduction

Size and type of active electrodes Contraindications

The thicker the electrode, the greater the amount of  A patient with pace maker cannot be treated
lateral heat. In a study of electrosurgical wounds, it was with monopolar electrosurgery.

531
Yalamanchili et al., Sch. J. App. Med. Sci., 2013; 1(5):530-534

 Should not be used for procedures that involve  A cooling period of 8 seconds should be
proximity to the bone. allowed between successive incisions with a
needle electrode at the same surgical site. The
Advantages period must be increased to fifteen seconds
 A clear view of the surgical site is provided. when a loop electrode is utilized for excisional
 Tissue separation is clean with little or no procedures.
bleeding.  The clinician should anticipate a slight amount
 The technique is pressureless and precise. of gingival recession when an electrosurgical
 Planing of soft tissue is possible. incision is used for troughing or excision of
 Healing discomfort and scar formation are the gingival crevice.
minimal.  Contact of the activated electrosurgery
 Access to difficult-to-reach areas is increased. electrode to the cemental surface of a tooth
 Chair time and operator fatigue are reduced. must be avoided in regions where connective
tissue reattachment is desired
Disadvantages  Intermittent contact of an active electrode
 Cannot be used on patients with poorly delivering a well-controlled current to alveolar
shielded pacemakers. bone will initiate only slight osseous
 Electrosurgery units cannot be used near remodeling which will not result in clinical
inflammable gases. changes. Incorrect current control or extended
 The odor of burning tissue is present if high- contact with alveolar bone may produce
volume suction is not used. irreversible changes capable of resulting in
diminished periodontal support.
 The initial cost of the ES equipment is far
greater than the cost of a scalpel.  Contact of an active electrosurgery electrode
with metallic restorations should be limited to
periods less than 0.4 seconds. Longer periods
Safety precautions
of contact may result in pulpal necrosis.
 Do not use near flammable gases.
 Electrosurgery may be used effectively for
 Use lowest current setting.
pulpotomy procedures.
 Do not use cautery blade as retractor.
 Use of electrosurgery to provide fulgurating
 Use suction to remove smoke.
sparks for use in obtaining hemorrhage control
should be used only after all other clinical
Post-operative instructions methods have been tried. A delayed healing
 The patient should avoid smoking, eating of response following the use of fulguration
hard or spicy foods, citrus juices and alcohol should be expected.
following surgery.  Electrosurgery may be used safely and
 A toothbrush may be carefully used in areas conveniently to excise inflammatory papillary
not involved with the surgical procedure. hyperplasia.
 Following electrosurgery, it is normal to
experience some discomfort; therefore Applications of electrosurgery for various
analgesics can be prescribed. procedures in dentistry
 To control swelling areas of extensive surgery, Devishree, et al [11] had presented a series of clinical
the patient should be instructed to apply ice cases of frenectomy which were approached by various
packs to the area. techniques, like Miller’s technique, V-Y plasty, Z-
 Patients should be instructed to call if any plasty and frenectomy by using electrocautery. Among
problem arises. all the procedures, electrocautery offered the advantage
of minimal time consumption and bloodless field during
Guidelines for use of Electrosurgery the surgical procedure, with no requirement of sutures.
Krejci et al [10] have provided the following clinical Verco P.J.W [12] had presented a case report on
guidelines. management of tongue tie using argon beam
 Incision of intraoral tissues with electrocautery in children. An 8 year old girl with
electrosurgery should be accomplished with a lingual tongue tie showing restricted movement was
higher frequency unit tuned to optimal power treated using ExplorAr plasma cutting electrode.
output and set to generate a fully rectified- Postoperative results showed uneventful healing with
filtered waveform. little or no post-operative pain and lack of eschar at 4
 The smallest possible electrode should be months follow up.
selected to accomplish the incision.
 Electrosurgical incisions should be made at a Gregori M, Kurtzman, and Lee H. Silverstein [13]
minimum rate of 7 mm/s. had presented a case report on usage of bipolar
electrocautery for gingival modification in passive
532
Yalamanchili et al., Sch. J. App. Med. Sci., 2013; 1(5):530-534

eruption cases. A female patient with excessive gingival number of osteoclast and osteoblasts in the areas where
display was treated using Bident Bipolar 3303 electrosurgery was done.
gingivectomy handpiece to remove excess gingival and
to taper the gingival margin to ideal contour. A 4 week Ian E. Shuman [19] had presented a case series on
postoperative examination demonstrated a more clinical applications of electrosurgery. Here bipolar
aesthetic smile with improved width-crown proportions electrosurgery was used in circum coronal
and elimination of excessive gingival display. gingivoplasty, caries access and exposure, implant
exposure and frenectomy. Results showed uneventful
Kusum Bashetty et al [14] presented a series of healing with no post-operative complications.
casereports where monopolar electrosurgery unit was
used for gingival recontoring, excision of gingival Jeffrey A, Sherman [20] had treated a 52 year old
tissue extending into carious lesion, excision of gingival female patient with slight soft tissue over growth
tissue extending into fractured area of the tooth around implants with a straight, bipolar electrode to
suggesting electrosurgery to be of immense use in incise tissue and expose the implant fully.
clinical dentistry.
Electrosurgery can be used to perform gingivectomy
G J Livaditis [15] had presented a clinical report on and gingivoplasty. However, extra caution must be
vital pulp therapy with bipolar electrocoagulation after carried out to avoid contact with the bone since
intentional pulp exposure of fixed prosthodontic irreparable damages will occur. The only advantage of
abutments. The protocol included a definitive cavity electrosurgery today is the coagulation to reduce
preparation to create space in the exposed dentin for an bleeding and resulting in a clean field with better
adhesive pulp barrier and the use of precise bipolar visibility for the surgery.
electrocoagulation to provide durable hemostasis for
restoration of the pulp wall and a relatively clot-free CONCLUSION
surgical wound to facilitate healing followed by Electrosurgery can never completely replace the
application of gentle surgical and restorative procedures scalpel but it requires more knowledge, skill and
to support the inherent healing process to restore the complete understanding of the biophysical aspects of
health of the pulp. the interaction of electrosurgical energy and tissue.
Continued research into the area of tissue interaction
Glickman and Imbert [16] compared the effect of shows promise in the potential development of novel
gingival resection with electrosurgery and periodontal applications of electrosurgery.
knives. Electrosurgery was used on the right side,
whereas the scalpel surgery was carried out on the left REFERENCES
side. Two types of laceration were evaluated, the deep 1. Osman FS; Dental electrosurgery: Genera!
and the shallow resection. Results showed precautions. Can Dent Assoc J, 1982; 48:642.
electrosurgery when performed with deep resection can 2. Goldwyn RM. Bovie:The man and the
result in extensive gingival recession, bone necrosis and machine. Ann Plast Surg 1979;2:135–153.
furcation involvement when used close to the bone 3. Kelly WJ, Harrison JD; Heat generation and
where as such did not occur followed the use of penetration in gingival tissues using
periodontal knives. electrosurgical currents. In: Electrosurgery in
dentistry, Oringer, M. J. (ed.) 2nd edition,
Aremband and Bryan Wade [17] studied wound 1975; 154-176.
healing in gingivectomy with electrosurgery and knives 4. Stevens V, Weil J, Simon B, Schuback P,
in 27 patients. Results revealed that there was no Deasey M; Quantitative analysis of heat
observable difference between the two modalities generated during electrosurgery. Journal of
following three week post operative period. Pain was Dentat Research, 1981; 60(126): 432.
insignificant and experienced equally in both modalities 5. Kalkwarf KL, Krejci RF, Edison AR,
and cytological evaluation revealed no difference in Reinhardt RA; Lateral heal production
both connective tissue and epithelial maturity in both secondary to e!ectrosurgery incisions. Oral
modalities suggesting electrosurgery can be effectively Surgery, Oral Medicine and Oral Pathology,
used for gingivectomy procedures. 1983b; 55:344-348.
6. Kalkwarf KL, Krejci RR, Edison AR.,
Pope [18] found that repair following electrosurgery Reinhardt RA; Subjacent heat production
persists for much longer time when compared to the during tissue excision with electrosurgery.
scalpel surgery. He conducted a split mouth design, on Journal of Oral and Maxillofacial Surgery,
four mongrel dogs with electrosurgery procedure on the 1983a; 41:653-657.
left side and the scalpel surgery on the right side of the 7. Noble WH, McClatchey DD, Douglas GD. A
mouth. The results indicated that there is more severe histological comparision of effects of
and greater degree of bone injury, indicated by a larger electrosurgical resection using different
electrodes, J Prosthet Dent ,1976;35:575-579.
533
Yalamanchili et al., Sch. J. App. Med. Sci., 2013; 1(5):530-534

8. Kalkwarf KL. Krejci RF. Shaw DH. Edison

AR, Histologic evaluation of gingival response
to an electrosurgical blade, J Oral Maxillofac
Surg l987;45:67l-674.
9. Flocken JE; Electrosurgical management of
soft tissues and restorative denlistry. Oral
Health, 1980;70:35-40.
10. Krejci RF, Kalkwarf and Krause-Hohenstein
U; Electrosurgery – a biological approach. J
Clin Periodontol, 1987;14;557-563.
11. Devishree, Sheela Kumar Gujjari, Shubhashini
P.V Frenectomy: A Review with the Reports
of Surgical Techniques. Journal of Clinical and
Diagnostic Research, 2012;6(9):1587-1592.
12. Verco PJW; Case report and clinical
technique: argon beam electrosurgery for
tongue ties and maxillary frenectomies in
infants and children. European archives of
Paediatric dentistry, 2007; 8 (suppl. 1)
13. Gregori M, Kurtzman, Lee H; Silverstein
Bipolar Electrosurgery: Gingival Modification
in Passive Eruption Cases. Dent Today, 2008;
27(8):112-114
14. Kusum Bashetty, Gururaj Nadig, Sandhya
Kapoor; Electrosurgery in aesthetic and
restorative dentistry: A literature review and
case reports. J Conserv Dent, 2009;12:139-44.
15. Livaditis GJ; Vital pulp therapy with bipolar
electrocoagulation after intentional pulp
exposure of fixed prosthodontic abutments: a
clinical report. J Prosthet Dent, 2006; 86
(4):400-406.
16. Glickman I, Imber L; Comparision of gingival
resection with electrocautery and periodontal
knives- a biometric and histologic study,
journal of Periodontology, 1970;142,
17. Aremband D, Wade AB; A comparative
wound healing study following gingivectomy
by electrosurgery and kives, Journal of
Periodontal Research, 1973;8:42,
18. Pope JW, Garginlo AW, Staffileno H, Levy S;
Effects of electrosurgery on wound healing in
dogs. Periodontics, 1968; 6:30-37.
19. Shuman IE; Bipolar Versus Monopolar
Electrosurgery: Clinical Applications, Dent
Today, 2001;20:74-81.
20. Jeffrey A, Sherman; Implant exposure using
radiosurgery, Dentistry today. 2007; 26(4):92-
96.

534