• Electrosurgery (ES) has been used in dentistry for over 50 years. ES units are able to cut or coagulate soft tissues by passing high-frequency waveforms or currents through them. ES is used in a wide range of applications in dentistry including gingivectomies, gingivoplasties, frenectomies, operculectomies, crown lengthening, and sulcular troughing for impression making. ES is also used to produce hemostasis. In general, ES is valued because it can produce pressure-less incisions, control hemorrhage, increase operative efficiency, and help maintain a clear view of the operative site.
• Most ES units consist of four components: a current generator, active electrode, passive electrode, and an on-off switch. The current generator produces the high-frequency waveform, which usually ranges from 1 to 4 MHz depending on the power (e.g., 70 to 100 W). Higher frequency units produce less lateral heat at the operative site. The active electrode allows the current to enter the soft tissues. Electrode tips for the active electrode are available in various shapes and sizes for a variety of clinical procedures. There are three basic types of electrodes: wire, loop, and ball. Each is suited for a particular type of procedure. Wire electrodes are usually used for incising or excising, while loop electrodes are used for tissue planning. Ball electrodes are used for coagulation. The passive electrode, also known as the dispersive electrode or ground plate, is a flat, broad plate that contacts the patient's body. It allows the current that has entered the surgical site from the active electrode to return to the unit, thereby completing the circuit. The on-off switch activates and deactivates the unit and can be operated via a foot control or handpiece switch.
• There are two basic types of ES units available today based on how the current flows from the active to the passive electrode. They are monopolar and bipolar. Both monopolar and bipolar ES units can be used to cut and coagulate tissues. Monopolar ES units are distinguished by the fact that they use a handpiece with a single electrode tip, and the current produced by the tip is drawn to a ground plate beneath the patient. When the tip is brought into contact with the soft tissues at the surgical site, a spark jumps between the electrode tip and the patient's soft tissue. The heat produced diffuses into 1 to 2-centimeter region peripheral to the surgical site. Because the heat is not confined to the immediate surgical area, a larger area of tissue can be affected. Bipolar ES units, on the other hand, use an asynchronous waveform, which causes cutting to occur without creating general tissue resonance. As a result, the heat that is produced does not extend outward from the surgical site. Bipolar ES units use a handpiece with two electrodes, one that acts as the active electrode and the other as the passive electrode. No grounding plate, therefore, is necessary. Current flow occurs only between the two electrodes and does not spread outwards into adjacent tissues. As a result, manufacturers of bipolar units claim they can be safely used near vital structures such as bone and tooth structure.
• ES units have varying power, frequency, and waveform options. The type of waveform(s) the unit produces is an important characteristic because it determines the clinical application for which the unit can best be used. Four different waveforms are commonly encountered: fully rectified filtered (which cuts), fully rectified unfiltered (which cuts and coagulates), partially rectified (which coagulates), and fulguration (which causes surface destruction of soft tissues). The fully rectified filtered waveform can be used for all soft tissue surgery procedures. The fully rectified unfiltered waveform produces less effective cutting but causes superficial coagulation. It can be used for most minor surgical procedures (e.g., gingivectomy, gingivoplasty, excising hyperplastic tissue, gingival troughing). The partially rectified waveform is inefficient at cutting but produces good coagulation. Finally, fulguration causes superficial destruction by carbonizing soft tissues and is ideal for removing the remnants of cysts following enucleation.

• Radiosurgery is the introduction of a high frequency radio wave of 3.0-4.0 Megahertz (MHz) above AM and below FM frequencies. The high frequency radio signal produces a pressureless, micro smooth incision with hemostasis and minimum tissue alteration. The radiosurgical instrument produces the radio wave which is transmitted to two metallic plates, one being active and the other passive. A small metallic wire electrode acts as the active plate and a large metallic antenna plate acts as the passive one.
• The soft tissue is placed between the two electrodes and the radio signal is allowed to flow from the active to the passive electrode. The passage of these high frequency radio waves through the tissue causes the tissue to heat as a result of the tissue's natural resistance to the radio signal. Cell destruction or volatilization is created at the tip of the electrode as a result of this resistance and the heat generated. The radio signal is guided through the tissue by the active electrode leaving a path of cell destruction and, in turn, an incision is produced.

The ability to vary the waveform of the radio signal, together with the combination of the different active and passive electrodes, offer the doctor numerous advantages:

• It permits any degree of hemorrhage control that is desired.
• It prevents seeding of bacteria into the incision site.
• The active electrodes are flexible fine wires which can be bent or shaped easily to fit any requirement.
• The electrodes never need resharpening and are self-sterilizing.
• It permits planing of soft tissue, a procedure unique to the RF Technology.
• It provides a clear and improved view of the operative site.
• It eliminates scar tissue formation.
• It increases operative efficiency.
• It reduces chair time for each operation.
• It improves the quality of restorations.
• It reduces the fatigue and frustrations of the operator.
• It minimizes postoperative discomfort and treatments.
• It has a pressureless cut with a 'paintbrush'-like stroke.

• 
  Incisions produced by the Dento-Surg are similar histologically to those produced by a scalpel. These incisions lack thermal and mechanical artifact due to the low level of lateral heat produced. The scalpel requires pressure on incision with immediate bleeding and compromised surgical visibility. Electrosurgery produces more tissue alteration and histologic thermal artifact as a result of the increased lateral heat produced by the low frequency radio wave of 0.5-2.9 MHz. The laser has been shown to histologically produce char and thermal artifacts due to the increased lateral heat and thereby increases tissue alteration.

  Characteristic	LASER	Scalpel	Dento-Surg 90 F.F.P.™
  Variety of incisions	Yes	Yes	Yes
  Excisions	Yes	Yes	Yes
  Cutting tip	Yes*	No	Yes**
  Ability to obtain biopsies	Yes	Yes	Yes
  Self-sterilizing	Yes	No	Yes
  Production of a sterilized incision	Yes	No	Yes
  Elimination of bleeding	Yes	No	Yes
  Healing time	Same	Same	Same
  Production of scar tissue	Little	Yes	No
  Ability to plane soft tissue	Yes	No	Yes
  *Fiberoptic wand is flexible. **Electrode tips are bendable to desired shape.

   

• Surgery that is performed with modern radiosurgical equipment should not be confused with the results obtained with electrocautery, medical diathermy, spark gap generators, or partially rectified devices that do not provide surgical cutting waveforms. Thus, before reviewing the instructions and clinical use, a brief definition of radiosurgery and of the radiofrequency waves that produce this phenomenon may prove helpful.
• Radiowave surgery is an atraumatic method of cutting and coagulating soft tissue, without the post-op pain and tissue destruction of electrocautery.The cutting effect, known as electrosection, is performed without manual pressure or crushing tissue cells. It results from heat generated by the resistance the tissues offer to the passage of a radiofrequency wave, which is applied with a fine wire called a surgical electrode. The heat disintegrates and volatizes the cells in the path of the waves. This causes the tissue to split apart as though it had been cut with a razor-sharp knife. Electrocoagulation is a non-volatilizing destruction of tissue cells by a radiofrequency wave.
• The atraumatic nature of electrosection provides a noteworthy advantage. The lack of trauma results in tissue healing without fibrous contractile scar tissue, which characterizes healing of wounds created by manual cutting.
• Radiowave surgery, as a result of these advantages, facilitates, accelerates, and improves surgical procedures tremendously. It also helps to eliminate the unfavorable post-operative sequelae such as swelling, infection, and postsurgical shock from excessive blood loss, that are so often experienced after "traditional" instrumentation for comparable surgery.

Technology Overview

• Electrical current, in one form or another, has been applied to human tissues as a surgical modality for over 100 years. Electrosurgical units generally operate from 200 to 1000 kHz. Devices operating in this range cause the electrode that comes in contact with the tissue to become hot therefore acting like true heat cautery. High frequency radiosurgery, above 1,500kHz (1.5 MHz), transmits pure radiowaves to the tissue without heating the electrode
• The radiation spectrum is reviewed to identify Ellman's technology at the frequency of 1.7MHz and 4.0 MHz.
• The Electromagnetic Spectrum represents forms of energy propagated in waves.
• Standard ESU's and low frequency RF products occupy a band ranging between 100kHz to 500kHz. These frequencies emit energy in the form of heat. Resulting tissue effects are inconsistent and without absorption control.
• Ellman's patented technology includes the frequencies of 1.7MHz-4.0MHz which is a pure radiosignal range. Absorption of this frequency is by the water component of cells. Surface cell absorption produces controlled depth of penetration and minimal cellular alteration. (see absorption chart)

• The Surgitron emits high frequency radiowaves which are self-limiting in the destructiveness. Tissue effects result from volatilization of surface cells thereby minimizing the amount of tissue alteration. Histologic evaluation has determined that the frequency range of 1.7 MHz to 4.0MHz produces optimal surgical results.

• Fresh brain tissue measuring 2.0 x 1.0 x 1.0 cm in largest dimension was submitted post surgical harvest. Histologic evaluation of surgical incision created by 4.0MHz radiofrequency technology was requested by the surgeon. Microscopic evaluation of the area of radiofrequency electrosurgical incision shows minimal superficial changes measuring from 10 - 20 microns thickness.

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