Microsurgery, Antimicrobial Therapy, and Laser Principles

Posted on Feb 7, 2025 in Biology

Microsurgery Defined

Microsurgery is defined as a refinement in operative technique by which visual acuity is enhanced with the surgical operating microscope.

Microsurgery vs. Macrosurgery

The difference between microsurgery and macrosurgery is: In macrosurgery, hand movements are guided proprioceptively, whereas in microsurgery, they are guided visually.

Microsurgery: Advantages and Disadvantages

Advantages

  • Less tissue trauma
  • Less morbidity
  • Less patient anxiety
  • Atraumatic tissue manipulation
  • Accurate primary wound closure
  • Increased diagnostic skills
  • Minimally invasive

Disadvantages

  • Education requirements
  • Long adjustment period for clinical proficiency
  • Initial increase in surgical time
  • Higher patient cost
  • Limited surgical access

Antimicrobial Photodynamic Therapy Mechanisms

Mechanisms involved in antimicrobial photodynamic therapy:

  • Bactericidal effect is by two potential mechanisms.
  • One is DNA damage.
  • The other is damage caused to the cytoplasmic membrane of the bacteria.

Treatment of Aggressive Periodontitis

Treatment Considerations

These cases are often difficult to control and suffer frequent relapses.

Several general principles apply to these cases:

  • These cases are often associated with alteration in host defense; the therapy should begin by exploring factors that may contribute to changes in the defense system.
  • The lack of a strong association between plaque accumulations and disease severity in aggressive periodontitis, and the host alterations noted above, often mean that these patients are less responsive to conventional periodontal therapy (SRP).
  • Surgery may not be advisable in aggressive periodontitis until the infection is under control.

General Treatment Plan

  • Samples of subgingival flora of affected sites should be taken for microbiological investigations, in particular to monitor A.a. and its antibiotic sensitivity.

Oral hygiene instruction and counseling of the patient.

Administration of antibiotics: Metronidazole 500 mg and amoxicillin 500mg three times daily (tid) for 7 days. Or Metronidazole 500 mg tid for 7 days. Or Tetracycline 250mg four times daily (qid) for 14 days.

Principles of Lasers

Light: A form of electromagnetic energy that behaves as both a particle and a wave. The basic unit of energy is called a photon.

  • Monochromatic – one color.
  • Collimation – a beam having specific spatial boundaries which ensures the size and shape of the beam.
  • Coherence – light waves produced in the instrument are all the same.

Efficiency

  • Amplification: That occurs inside the laser.
  • The optical cavity is the center of the device – it has active media.
  • Identifying the components of the device – understanding how light is produced.
  • Stimulated Emission: Using quantum theory of physics.
  • Quantum – the smallest unit of energy absorbed by electrons of an atom/molecule causing brief excitation – photon.
  • Radiation: Refers to the light wave produced by the laser as a specific form of electromagnetic energy.
  1. An electron is pumped to a higher energy level.
  2. The pumping level is unstable, so the electron quickly jumps to a lower energy level.
  3. The electron relaxes to a lower energy state and releases a photon.
  4. Light and electrons are in an excited energy level.
  5. The procedure produces 2 photons of the same wavelength and phase.
  6. A mirror reflects photons.