Tissue Resistance to Soft Tissue Emphysema during Minimally Invasive Periodontal Surgery

Abstract

Aim The aim of this study was to determine the pressure where oral soft tissue resistance will be overcome resulting in soft tissue emphysema and to measure the safety of an antifouling device for a videoscope used during minimally invasive periodontal surgery. Materials and methods Resistance was measured in vitro in porcine tissue. One study arm measured palatal tissue resistance to air applied through a needle. Another arm measured resistance in a surgical access for minimally invasive periodontal surgery (MIS). India ink was placed on the tissue, pressure at 0,3,10,15,20, and 25 pounds/square inch (psi) applied, and penetration of India ink into the tissue was measured. Three trials in three sites were performed at each pressure in both arms of the study. Results Pressure applied to palatal tissue through a needle showed no significant penetration of India ink until 15 psi (0.90 ¡Ó 0.24 mm, p = 0.008). Penetration considered clinically significant was noted at 20 and 25 psi (4 to 6 mm, p „T 0.0001). No significant penetration was noted in minimally invasive incisions. Conclusion Within the test system, pressures of 15 psi or less seem unlikely to cause soft tissue emphysema. No evidence of tissue emphysema was noted with the videoscope antifouling device. Clinical significance The use of pressures greater than 15 pounds per square inch should be avoided during surgical procedures. The antifouling device for a videoscope appears safe for use during minimally invasive periodontal surgery. How to cite this article Harrel SK, Abraham CM, Rivera- Hidalgo F. Tissue Resistance to Soft Tissue Emphysema during Minimally Invasive Periodontal Surgery. J Contemp Dent Pract 2012;13(6):886-891.

Videoscope‐assisted minimally invasive periodontal surgery (V‐MIS)

“…This device allows a direct visualization and a greater magnification than either telescopes or a surgical microscope (Harrel et al. , ). A videoscope has a very small digital camera that is placed in the surgical site.…”

An Unusual Complication of Periodontal Debridement: Subcutaneous Emphysema and Pneumomediastinum

“…While the average pressure in air-flow devices is 40-100 psi, the minimum pressure required for the formation of soft tissue empyema has been reported 15 psi. 9,19 Direct and inappropriate use of such devices in the subgingival region, and especially in deep periodontal pockets can lead to CSE by causing reversible damage of the pocket epithelium. 9,15 Periodontal treatment alone may also cause minimal laceration of the periodontal pockets.…”

The MIS and V‐MIS Surgical Procedure

“…Recently, a videoscope has been designed for use with MIS [8,9]. This videoscope was described in Chapter 2.…”

“…He responded well to nonsurgical periodontal therapy consisting of root planing with local anesthetic. 9 An isolated area of calculus is visualized on the mid-lingual surface of the root. Several sites continued to have deeper pocket probing depth, gingival inflammation, and bleeding on probing.…”