RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE – KARNATAKA
ANNEXURE – II
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1. NAME OF THE CANDIDATE DR JYOTSNA
AND ADDRESS POST GRADUATE STUDENT,
DEPT. OF ORAL AND MAXILLOFACIAL
K.V.G. DENTAL COLLEGE AND
2. NAME OF THE INSTITUTION K.V.G DENTAL COLLEGE AND
3. COURSE OF STUDY AND MASTER OF DENTAL SURGERY
SUBJECT (ORAL AND MAXILLOFACIAL
4. DATE OF ADMISSION TO 24 – 06 – 2008
5. TITLE OF THE TOPIC A COMPARATIVE STUDY OF
ELECTROSURGERY AND SCALPEL
SURGERY IN MINOR ORAL SURGERY.
6.) BRIEF RESUME OF THE INTENDED WORK
6.1) NEED FOR THE STUDY:
Minor oral surgical procedures are ,traditionally ,carried out with the help of scalpel/ B.P.
blades ,used for incising the tissues.The use of scalpel is the most commonly used
technique for oral surgeries due to its proven success since centuries and inexpensive
nature without the need of additional equipments.However,considerable intra-operative
bleeding due to severing of blood vessels and post surgical scarring are the major
drawbacks with the use of scalpel / B.P. blade.
Electrosurgery is the application of a high-frequency electric current to human tissue as
a means to remove lesions, staunch bleeding, or cut tissue. Electosurgery offers oral
surgery many unique , invaluable advantages .Hemostasis obtained with fully rectified
cutting current , scar free healing of electrosurgical wounds by granulation secondary
repair as well as by primary intention , the ability to perform precise tissue cutting
without use of manual pressure , and sterilization of the surgical fields are especially
Atruamatic tissue cleavage and sterilization of the wound eliminate unfavourable
postoperative sequeale common to scalpel surgery and contribute materially to rapid ,
uneventful postoperative healing. The ability to incise tissue precisely without use of
pressure and effective hemostasis make possible sophisticated oral surgery procedures
that cannot be duplicated safely by scalpel surgery .
So,although electrosurgery has been used in dentistry for more than 50 years , both
opponents and advocates of electrosurgery have presented a variety of clinical studies in
favour of their respective opinions. Henceforth ,this study aims to compare electrosurgey
and scalpel surgery in minor oral surgical procedures.
6.2) REVIEW OF LITERATURE:
A comparative study was done in which comparision of healing and pain following
excision of inflammatory papillary hyperplasia with electrosurgery and blade-loop knives
in human patients was done. Questionnaires were used to assess pain and patient
preference during a 7-week postoperative period, and photographs were made to chronicle
the healing process. Healing occurred at approximately the same rate following each
procedure. The majority of subjects did not perceive a difference in discomfort with either
technique on the day of surgery or at any time during follow up.Of those who did have a
preference, a significant majority favored electrosurgery on the day of treatment.1
An experimental study was done to compare the histologic effects of scalpel, CO2 laser,
electrosurgery, and constant-voltage electrosurgery incisions on the mucosal tissue of
swine.Tissue samples of tongue and buccal mucosal incisions and excisions were
histologically examined at 0, 3, 7, 14, 28, and 42 days after surgery to evaluate tissue
damage and wound healing properties induced by the four instruments. On subjective
evaluation of ease of use, constant-voltage electrosurgery scored highest followed by the
CO2 laser. Speed of incisions and excisions was fastest with the scalpel and electrosurgery
unit. The amount of bleeding was least for electrosurgery and CO2 laser. Histologic
damage, as expected, was least with a scalpel. 6
Another experimental study on the effects of steel scapel,electrocautery and various lasers
was done on rat tongue.The tip of tongue (3 mm ) was cut off and fixed for histology..Pre-
operative bleeding was measured and attention was paid to wound contraction and
inflammatory cell infiltration.Post-operative bleeding occurred with scalpel and
electrocautery ,but not with lasers.The steel scalpel causes less tissue damage than the
thermal knives, whereas the advantages of a bloodless operation can be achieved with both
lasers used in this study.3
Electrosurgery has been used in dentistry for several decades, but the technique is not
widely practiced. This article briefly explains the principles of electrosurgery and attempts
to clear up some misunderstandings about the healing of electrosurgical wounds. Clinical
application of electrosurgery for the management of some common oral conditions is also
Compared to scalpel surgery, electrosurgery requires more expertise, but the advantages
counter the technical complexities. For the operator to obtain predictable results,
electrosurgery should be restricted to proven indications for soft-tissue surgery. Contact
with alveolar bone, and restorations in vital teeth should be avoided. Lateral-heat
accumulation should be minimized by following the principles discussed. Profound
anesthesia, and high-speed suction for odor control, should be used to facilitate patients'
Electrosurgery has been used in dentistry for more than 50 years. Both opponents and
advocates of electrosurgery have presented a variety of clinical studies in favour of their
respective opinions, which are discussed in the following review. In some studies, wounds
created by electrosurgical techniques were observed through the healing stages, in
comparison to those following incision by a surgical blade, with no significant difference
being discovered. Waveform, frequency, size of the electrode, time of contact and cooling
periods are some of those considered to be of importance in the studies. Providing that
these safeguards are adhered to, scientific evidence supports the biological compatibility
of electrosurgery for intraoral surgical procedures.2
6.3) AIMS AND OBJECTIVES OF THE STUDY:
To compare the efficacy of electrosurgery and scalpel surgery in minor oral
To compare the following in procedures done by electrosurgery and scalpel
surgery using clinical parameters :-
i. Bleeding intraoperatively.
ii. Pain – both intraoperatively and post operatively.
iii. Healing of the surgical site post operatively.
7) MATERIALS AND METHODS:
7.1) SOURCE OF DATA:
Thirty individuals with age group 15-65years who will report to the Department of Oral
and Maxillofacial Surgery, K.V.G. Dental College, Sullia, for pre-prosthetic surgeries and
lower third molar surgery .
7.2) METHODS OF DATA COLLECTION:
i) DEFINITION OF STUDY SUBJECT:
Thirty patients between age group ranging 15-65years, who will undergo electrosurgery or
scalpel surgery for pre-prosthetic surgeries and lower third molar surgery under local
anesthesia, will be the study subjects.
Written consent will be taken from the subjects prior to treatment.
ii) INCLUSION AND EXCLUSION CRITERIA.
a) Subjects with unremarkable health history
b) Age group 15-65 years
c) Subject willingness.
(a) Subject having electric pacemaker.
(b) Patients with hematological parameters not within normal limits.
( c ) Subject with concomitant cardiac or neurological disease or hypertension or
relevant systemic disease .
(d)Subject on immunosuppressive drugs.
(b) STUDY DESIGN
a) Method of Surgery
Thirty patients requiring following minor oral surgical procedures will be examined and
clinical diagnosis will be done.
The following minor oral surgical procedures will be studied in the same patient at two
different sites (one site operated by electrosurgery whereas another site operated by
scalpel surgery ) –
1. Bilateral lower molar impactions.
2. Pre-prosthetic surgeries
Following pre- prosthetic surgeries having similar clinical presentation at two different
sites will be studied :
- soft tissue excisions
- mandibular tori removal
All treatments were performed on an outpatient basis.
Following standard parameters will be used in both the types of surgery :-
1. Cleaning the site with topical antiseptic – Cipladine ( Povidone iodine solution
5 % ) with help of sterile gauze.
2. Local anaesthesia will be achieved by injecting Lignox ( 2% lidocaine
hydrochloride with 1:80,000 epinephrine).
3. Sutures given with round body 3-0 black silk (lifeline) after surgery.
4. Post-operative analgesics and antibiotics will be prescribed as follows-
Cap Amox (Amoxicillin) 500 mg thrice daily for 5 days .
Tab Coreflex (Acelofenac) 100 mg twice daily for 3 days.
For surgical site undergoing electrosurgery,monopolar diathermy is used.The indifferent
electrode is a flat steel plate which is put in contact with the patients back, thigh or
buttocks or arm .The active electrode is used to give incisions so that small bleeders get
coagulated as cutting occurs.
For surgical site undergoing steel scalpel surgery, surgical procedure is done with steel
scalpel / B.P. blade no. 15 .
Clinical Parameters :
Various preoperative , intraoperative and postoperative parameters will be used to evaluate
the study subjects . They are –
Preoperative assessment :
All thirty patients will be evaluated for the following :
- blood group
- hemoglobin %
- platelet count
- bleeding count
- clotting count
Intraoperative assessment :
All thirty patients will be evaluated for the following :
Time taken to complete the surgery (in minutes) from the time of incision till the
elevation of mucoperiosteal flap.
Bleeding measured by weighing blood soaked gauzes from the time of incision till
the elevation of the mucoperiosteal flap.
Pain assessments: patients will be asked to record on 100 mm Visual Analog Scale
(VAS), with 0 = no pain and 10 = worst pain possible
Post operative assessment :
The subjects will be clinically examined at 2nd day, 1st week and 4th week post operatively
for the following :
1. Pain assessments: patients will be asked to record on 100 mm Visual Analog Scale
(VAS), with 0 = no pain and 10 = worst pain possible
2. Scar (present or absent measured by comparing to the surrounding mucosa)
What is evaluated and how ?
To compare the efficacy of electrosurgery and scalpel surgery in various minor
oral surgery procedures , using clinical parameters.
(c) STATISTICAL ANALYSIS
Wilcoxon Signed Rank Sum Test, Mann-Whitney U test and Mcnemar Test will be
used for statistical analysis of the data.
7.3. DOES THE STUDY REQUIRE ANY INVESTIGATION OR
INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER
HUMANS OR ANIMALS? IF SO PLEASE DESCRIBE BRIEFLY.
Yes, clearance has been obtained from ethical committee and the guide of the
department for the study. This study will be done under supervision of our guide.
7.4) HAS ETHICAL CLEARENCE BEEN OBTAINED FROM YOUR
INSTITUTION IN CASE OF (7.3) ?
Yes, the ethical clearance certificate from our institution has been enclosed.
(8) LIST OF REFERENCES:
1.Rathofer S.A. ,Gardner F.M. ,Vermilyea S.G. “ A comparision of healing and
pain following excision of inflammatory papillary hyperplasia with
electrosurgery and blade-loop knives in human patients “ Oral surg Oral med
Oral pathol Oral radiol Endod 1985; 59: 130-135
2 Krejci R.F., Kalwarf K.L., Krause- Hohenstein U.“Electrosurgery--a biological
approach” J Clinical Periodontol 1987 ; 10 : 557-563
3. Hukki J. ,Castren M. ,Nordling S. ,Schroder T. “ An experimental study on the
effects of the steel scalpel, electrocautery and various lasers on oral tissue
“Lasers in medical science 1989 ;volume 4 :103
4. Moore D.A. “Electrosurgery in dentistry: past and present” General dentistry
1995; 43 :460-465
5. Gnanasekhar J.D. ,Al-Duwairi Y.S. “Electrosurgery in dentistry “ Quintessence
Int 1998 ; 29 (10): 649-654
6.Liboon J., Funkhouser W.,Terris D.J.A “comparison of mucosal incisions made
by scalpel, CO2 laser, electrocautery, and constant-voltage electrocautery