Electrosurgical electrodes and systems and methods including same

A method for treating surface tissue of a patient includes: providing an electrode having a contact surface, wherein the contact surface has a curved profile; placing the contact surface in contact with surface tissue of the patient; and sliding the contact surface across and in contact with the surface tissue while applying electrosurgical currents to the surface tissue via the contact surface to thereby vaporize and ablate the surface tissue and form a treated band of the surface tissue.

FIELD OF THE INVENTION

The present invention relates to electrosurgical apparatus and methods and, more particularly, to electrosurgical electrodes and electrosurgical apparatus and methods including the same.

BACKGROUND

Electrosurgery is a common procedure for dentists, doctors, and veterinarians. Electrosurgical handpieces are commercially available that will accommodate a wide variety of electrode shapes and sizes, such as needles, blades, scalpels, balls and wire loops. Also, multi-function electrodes are available.

The electrodes can be used in many surgical procedures in which a conventional scalpel is employed, mainly for general cutting procedures. An electrosurgical scalpel electrode has the advantage of providing electrosurgical currents at the sharp edge of the scalpel, which assist in cutting tissue while at the same time providing a coagulation effect. Another known shape is the ball electrode, which is a spherical ball on the end of an electrode shank used for coagulation.

While these various shaped electrodes are suitable for their intended purposes of cutting and coagulation, occasions arise from time to time when these electrodes are pressed into service to ablate tissue. In this situation, the known electrodes typically fall short of a desired outcome.

SUMMARY

According to embodiments of the invention, a method for treating surface tissue of a patient includes: providing an electrode having a contact surface, wherein the contact surface has a curved profile; placing the contact surface in contact with surface tissue of the patient; and sliding the contact surface across and in contact with the surface tissue while applying electrosurgical currents to the surface tissue via the contact surface to thereby vaporize and ablate the surface tissue and form a treated band of the surface tissue.

In some embodiments, the curved profile of the contact surface extends along a first axis, the contact surface has a linear profile along a second axis perpendicular to the first axis, and the step of sliding the contact surface across and in contact with the surface tissue includes sliding the contact surface across and in contact with the surface tissue in a direction substantially parallel to the first axis while applying electrosurgical currents to the surface tissue via the contact surface to thereby vaporize and ablate the surface tissue.

In some embodiments, the curved profile has a minimum arc radius of at least 1.5 mm.

According to some embodiments, the step of sliding the contact surface across and in contact with the surface tissue includes sliding the contact surface across and in contact with the surface tissue in a brushing direction while applying electrosurgical currents to the surface tissue via the contact surface to thereby vaporize and ablate the surface tissue, an engagement interface between the contact surface and the surface tissue defines a contact band having a first dimension parallel to the brushing direction and a second dimension perpendicular to the first dimension, and the second dimension is greater than the first dimension.

In some embodiments, the first dimension is in the range of from about 1 mm to 3 mm, and the second dimension is in the range of from about 1 mm to 4 mm.

In some embodiments, the step of sliding the contact surface across and in contact with the surface tissue includes ablating the surface tissue without cutting the surface tissue.

According to some embodiments, the electrode further includes a lateral edge, and the method further includes scraping residual tissue from the treated band using the lateral edge.

In some embodiments, the method further includes: mounting a wiping insert on the electrode; and wiping residual tissue from the treated band using the wiping insert.

In some embodiments, the electrode includes first and second opposed lateral edges, and the method includes monitoring the first lateral edge to determine a location of the second lateral edge relative to the patient.

In some embodiments, the electrode includes a bottom wall and a top wall overlying the bottom wall, the contact surface is on the bottom wall, the top wall includes a planar surface overlying the contact surface, and the method includes monitoring the planar surface to determine a depthwise location of the contact surface relative to the surface tissue.

According to some embodiments, the method includes: providing an electrode set including a plurality of electrodes having contact surfaces of different widths from one another, each of the electrodes having a curved profile; and selecting the electrode from the set of electrodes.

In some embodiments, the surface tissue is skin tissue.

In some embodiments, the surface tissue is gum tissue.

According to some embodiments, the method includes using the electrode to ablate the gum tissue to a depth in the range of from about 0.01 mm to 0.15 mm in the treated band.

In some embodiments, the method includes using the electrode to ablate an epithelium layer of the gum tissue while leaving an underlying connective tissue layer substantially undamaged in the treated band.

In some embodiments, the method is used to remove gingiva hyperplasia from the patient's gums.

In some embodiments, the method is used to remove racial pigmentation from the patient's gums.

According to some embodiments, the curved profile of the contact surface extends along a first axis, the contact surface has a linear profile along a second axis perpendicular to the first axis, and the step of sliding the contact surface across and in contact with the gum tissue includes sliding the contact surface across and in contact with the gum tissue in a direction substantially parallel to the first axis while applying electrosurgical currents to the gum tissue via the contact surface to thereby vaporize and ablate the gum tissue.

In some embodiments, the curved profile has a minimum arc radius of at least 1.5 mm.

According to some embodiments, the step of sliding the contact surface across and in contact with the gum tissue includes sliding the contact surface across and in contact with the gum tissue in a brushing direction while applying electrosurgical currents to the gum tissue via the contact surface to thereby vaporize and ablate the gum tissue, and an engagement interface between the contact surface and the gum tissue defines a contact band having a first dimension parallel to the brushing direction and a second dimension perpendicular to the first dimension, and the second dimension is greater than the first dimension.

In some embodiments, the first dimension is in the range of from about 0.5 mm to 2 mm, and the second dimension is in the range of from about 1 mm to 4 mm.

In some embodiments, the step of sliding the contact surface across and in contact with the gum tissue includes ablating the gum tissue without cutting the gum tissue.

In some embodiments, the electrode further includes a lateral edge, and the method further includes scraping residual tissue from the treated band using the lateral edge.

According to some embodiments, the method further includes: mounting a wiping insert on the electrode; and wiping residual tissue from the treated band using the wiping insert.

In some embodiments, the electrode includes first and second opposed lateral edges, and the method includes monitoring the first lateral edge to determine a location of the second lateral edge relative to the patient's gums.

In some embodiments, the electrode includes a bottom wall and a top wall overlying the bottom wall, the contact surface is on the bottom wall, the top wall includes a planar surface overlying the contact surface, and the method includes monitoring the planar surface to determine a depthwise location of the contact surface relative to the gum tissue.

According to some embodiments, an electrosurgical electrode for performing electrosurgery on a patient includes a bottom wall and a top wall overlying the bottom wall. The bottom wall includes a contact surface having a curved profile, The top wall includes a planar surface overlying the contact surface. The electrode is configured to enable a user to monitor the planar surface to determine a depthwise location of the contact surface relative to the patient.

According to some embodiments, an electrosurgical apparatus for performing electrosurgery on a patient includes an electrode and a wiping insert. The electrode includes a contact surface and a socket defined in the electrode. The wiping insert is removably mounted in the socket.

According to some embodiments, a method for performing electrosurgery on tissue of a patient tissue includes providing an electrosurgical apparatus including: an electrode including a contact surface and a socket defined in the electrode; and a wiping insert removably mounted in the socket. The method further includes: contacting the contact surface with the tissue while applying electrosurgical currents to the tissue via the contact surface to thereby electrosurgically treat the tissue; and thereafter wiping the tissue using the wiping insert in the socket.

According to some embodiments, an electrosurgical electrode for performing electrosurgery on a patient includes a contact surface. The contact surface that has a curved profile along a first axis, and a flat profile along a second axis perpendicular to the first axis. The curved profile has a minimum arc radius of at least 1.5 mm. A width of the contact surface in a dimension parallel to the second axis is at least 1 mm.

It is noted that aspects of the invention described with respect to one embodiment, may be incorporated in a different embodiment although not specifically described relative thereto. That is, all embodiments and/or features of any embodiment can be combined in any way and/or combination. These and other objects and/or aspects of the present invention are explained in detail in the specification set forth below.

DETAILED DESCRIPTION OF EMBODIMENTS OF THE INVENTION

It will be understood that when an element is referred to as being “coupled” or “connected” to another element, it can be directly coupled or connected to the other element or intervening elements may also be present. In contrast, when an element is referred to as being “directly coupled” or “directly connected” to another element, there are no intervening elements present. Like numbers refer to like elements throughout.

As used herein the expression “and/or” includes any and all combinations of one or more of the associated listed items.

As used herein, “monolithic” means an object that is a single, unitary piece formed or composed of a material without joints or seams.

As used herein, “operator” may include a physician, veterinarian, dentist or other clinician, for example. As used herein, “operator” may include two or more people in collaboration.

With reference toFIGS. 1-11, an electrosurgical system10according to some embodiments of the invention is shown therein. With reference toFIG. 1, the system10includes a brush electrode100according to some embodiments of the invention. The system10further includes an electrosurgical apparatus20, a handpiece30, and an electrically insulated electrical cable22operatively connecting the handpiece20to the electrosurgical apparatus20.

In accordance with methods of the invention, the electrosurgical system10and the brush electrode100can be used to treat tissue of a patient. As discussed herein, the system10and the electrode100can be used to electrosurgically vaporize and thereby ablate tissue by contacting the electrode100with the tissue while applying RF current from the electrosurgical apparatus20to the tissue through the electrode100. In some embodiments, an energized contact surface of the electrode is brushed or slid over a surface of exposed tissue such that the electrode contact surface ablates a treated band of the tissue. In some embodiments, the treated band is relatively broad and a substantially uniform depth of the tissue is ablated across the width of the treated band. In some embodiments, the ablated tissue is exposed surface tissue. In some embodiments, the ablated tissue is skin tissue. In some embodiments, the ablated tissue is gum tissue.

The electrode100may also be used to cut or scrape tissue without the application of the RF current. For example, the electrode100can be used to scrape away tissue that has been desiccated or coagulated by the aforementioned ablating step.

In some embodiments, the electrosurgical system10and the brush electrode100can also be used to electrosurgically cut, scrape, cauterize, coagulate, and/or desiccate tissue by contacting the electrode100with the tissue while applying RF current from the electrosurgical apparatus20to the tissue through the electrode100.

The electrosurgical apparatus20may be any suitable electrosurgical apparatus. According to some embodiments, the electrosurgical apparatus20is a radiofrequency (RF) radiosurgical energy source operable to selectively generate and deliver alternating polarity electrical current (hereinafter, referred to as an RF generator). In some embodiments, the electrosurgical apparatus is an ultra-high frequency RF generator. Suitable electrosurgical RF generators may include the RADIOSURGE 3™ electrosurgical unit available from Ellman International, Inc. of Hewlett, N.Y. In some embodiments, the apparatus20provides current to the electrode100at a high operating frequency (in some embodiments, in the range of 2 to 4 MHz and, in some embodiments, about 3.8 MHz). The electrosurgical apparatus20may include one or more switches that enable an operator to selectively turn the supplied RF current on and off. For example, the apparatus20may include a switch33(e.g., a button switch) on the handpiece30and a redundant foot operable switch (not shown).

The system10may further include a dispersive electrode26operatively electrically connected to the electrosurgical unit20or to electrical ground by an electrical cable26A. In use of the system10, the dispersive electrode26is mounted on and in electrical contact with the patient's body and spaced apart from the surgical region. The dispersive electrode26operates to disperse the RF current and thereby prevent unintended injury to the tissue underlying the tissue intended to be treated using the electrode100. The electric current oscillates between the electrode100and the dispersive electrode26with the patient interposed between the electrodes100,26.

The handpiece30includes a handle32and a locking mechanism34such as a collet. A bore36is located in the handle32and contains an electrical contact38. The electrical contact38is electrically connected to the cable22. The electrical contact38may be a tubular member.

The brush electrode100includes an electrode member110and an insulation sleeve102. The electrode100may further include a supplemental wiping insert104(FIGS. 2-4). In some embodiments, the insert104is a pliable, absorbent member and, in some embodiments, is a sponge or gauze.

The electrode member110is formed of an electrically conductive material or materials. In some embodiments, the electrode member110is formed of metal. Suitable metals may include brass, or molybdenum. In some embodiments, the electrode member110is a unitary body. In some embodiments, the electrode member110is monolithic.

The insulation sleeve102is formed of an electrically insulating material or materials. The insulation sleeve102may be a preformed component or a coating. In some embodiments, the insulation sleeve102is formed of a polymeric insulating material. Suitable materials may include heat shrinkable thermoplastic. The insulation sleeve102surrounds a portion of the electrode member110to prevent the electrode100from inadvertently burning the patient.

The electrode member110includes a shank112, a working portion (or active end portion)120, and a tail portion114. The shank112is a straight rod disposed in the insulation sleeve102, except for a connector portion112A that extends proximally from the insulation sleeve102. The shank112may have an outer diameter of about 1/16 inch.

In use, the electrode100is inserted into the bore36of the handpiece to electrically connect the working portion120to the contact38. The contact38is in turn electrically connected to the apparatus20via the cable22. The insulation sleeve102electrically insulates the portion of the electrode member110extending between the handpiece30and the working end120.

With reference toFIGS. 5-7, the working portion120has a primary or longitudinal axis L-L, a widthwise or first lateral axis W-W that is perpendicular to the longitudinal axis L-L, and a depthwise or second lateral axis D-D that is perpendicular to the longitudinal axis L-L and perpendicular to the first lateral axis W-W. The working portion120extends from a distal end122A (FIG. 3) to an opposing proximal end122B. The working portion120has an outer or top side122C and an opposing patient facing or bottom side122D.

The working portion120includes a thin band or strip124having opposed lateral edges126. The strip124is configured to form or define a loop128. In some embodiments and as shown, the loop128is generally tear drop-shaped in a cross-sectional profile plane P-P (FIGS. 5 and 6), the plane P-P being parallel to the longitudinal axis L-L and parallel to the depthwise axis D-D. In some embodiments and as shown, the loop128is generally tear drop-shaped in all planes parallel to the profile plane from lateral edge126to lateral edge126.

The working portion120may be formed by any suitable technique. In some embodiments, the working portion120is formed by bending a metal part. In some embodiments, the strip124and the tail portion114are formed by flattening a portion of a metal rod (e.g., by drawing) to a prescribed width and then bending the strip124back into the shape of the loop128.

In some embodiments, the lateral edges126or portions thereof are sharp. In some embodiments, one or both of the edges126is sharpened (e.g., by cutting, machining, extrusion, or casting) to a sharp edge. In some embodiments, the lateral edges126have substantially the same thickness as the remainder of the strip124.

The working portion120includes a top wall130, a bottom wall150and a transition wall140connecting the top wall130to the bottom wall150. The working portion120is hollow so that the walls130,140,150collectively form a socket125. The socket125extends laterally (substantially parallel to the axis W-W) and terminates at opposed openings125A.

The top wall130includes a planar outer surface132. The planar outer surface132extends lengthwise from a distal end E3to a proximal end E4, and laterally from a first lateral edge134to an opposing, parallel lateral edge134. In some embodiments, the top wall lateral edges134are sections of the strip lateral edges126. According to some embodiments, the outer surface132is substantially continuous and substantially planar from end E3to end E4and edge134to edge134.

In some embodiments, the planar outer surface132has a length L1(FIG. 5) in the range of from about 6.5 mm to 11.5 mm.

In some embodiments, the planar outer surface132has a width W1(FIG. 7) in the range of from about 1 mm to 4 mm.

In some embodiments, the planar outer surface132has an area in the range of from about 6.5 mm2to 48 mm2.

In some embodiments, the top wall130has a thickness T1(FIG. 7) in the range of from about 0.5 mm to 1.0 mm.

The bottom wall150is partially lobe-shaped. The bottom wall150has an outer contact surface152. As discussed in more detail below, the bottom wall150and the contact surface152each have a rounded, curved or arcuate longitudinal profile, and a linear or flat widthwise profile.

The contact surface152extends lengthwise from a distal end E1to a proximal end E2, and laterally from a first lateral edge154to an opposing, parallel lateral edge154. In some embodiments, the contact surface lateral edges154are sections of the strip lateral edges126. According to some embodiments, the contact surface152is substantially continuous from end E1to end E2and edge154to edge154.

The contact surface152has a curved or arcuate shape and defines a curved contact surface profile in the profile plane P-P. In some embodiments and as shown, the contact surface152has the curved profile P in substantially all planes parallel to the profile plane P-P from lateral edge154to lateral edge154and from the end E1to the end E2.

The curved profile P has an arc length AL2(FIG. 6) extending from end E1to end E2. The profile P is convex relative to the space below the bottom wall150and, when used to ablate by brushing, is convex relative to the surface of the tissue being treated. According to some embodiments, there are no sharp corners, sharp edges, hard angles or sharp transitions in the curve of the profile P. According to some embodiments, the profile P follows a smooth, continuous curve. In some embodiments, the profile P is a non-uniform curve.

In some embodiments, the profile P is or includes a truncated elliptical shape. In some embodiments, the profile P is or includes a partial cylindrical shape. In some embodiments, the profile P has a half heart curve shape.

In some embodiments, the minimum arc radius of the profile P is at least 1.5 mm. In some embodiments, the minimum arc radius of the profile P is in the range of from about 1.5 mm to 2.0 mm.

In some embodiments and as shown, the contact surface152is curved in the longitudinal direction and flat in the lateral direction from end E1to E2. That is, the contact surface152is flat or planar in a cross-sectional transverse plane T-T (FIGS. 5 and 7) that is parallel to the widthwise axis W-W and the depthwise axis D-D. In some embodiments, the contact surface152is flat or planar in substantially all cross-sectional transverse planes parallel to cross-sectional transverse plane T-T from lateral edge154to lateral edge154and from the end E1to the end E2.

According to some embodiments and as shown, there are no openings in the contact surface152.

In some embodiments, the contact surface152has a linear length L2(FIG. 6) in the range of from about 2 mm to 4 mm.

In some embodiments, the contact surface152has an arc length AL2(FIG. 6) in the range of from about 3 mm to 5 mm.

In some embodiments, the contact surface152has a width W2(FIG. 7) that is at least 1 mm and, in some embodiments, is in the range of from about 1 mm to 4 mm.

In some embodiments, the contact surface152has an area in the range of from about 1 mm2to 8 mm2.

In some embodiments, the bottom wall150has a thickness T2(FIG. 7) in the range of from about 0.5 mm to 1 mm.

The transition wall140connects the top wall120to the bottom wall150and extends between the planar outer surface132and the curved contact surface152. In some embodiments, the outer surface142of the transition wall140has a curved or arcuate shape in the profile plane P-P. In some embodiments and as shown, the outer surface142has a curved profile in substantially all planes parallel to the profile plane P from lateral edge126to lateral edge126. In some embodiments and as shown, the curved profile P of the outer surface142is convex. According to some embodiments, the curved profile P of the outer surface142is without sharp edges or transitions and follows a smooth, continuous curve. In some embodiments, the profile is or includes a truncated elliptical shape. In some embodiments, the profile is or includes a partial cylindrical shape.

In some embodiments and as shown, the outer surface142is curved in the longitudinal direction and flat in the lateral direction as discussed above with regard to the contact surface152. That is, the outer surface142is flat or planar in the cross-sectional transverse plane T-T and, in some embodiments, is flat or planar in substantially all cross-sectional transverse planes parallel to cross-sectional transverse plane T-T from lateral edge126to lateral edge126.

In some embodiments, the height distance H1(FIG. 6) between the top wall surface132and the lowest point of the contact surface152is in the range of from about 2.5 mm to 3.5 mm.

In some embodiments, the socket125has a volume in the range of from about 7.1 mm3to 50.25 mm3.

In some embodiments, the supplemental wiping insert104is a sponge or gauze. The supplemental wiping insert104may be disposable. In some embodiments, the insert104is formed of an electrically nonconductive material. In some embodiments, the insert104(e.g., sponge or gauze) is sized such that it can be inserted into the socket125with extension portions104A of the insert104projecting outwardly through the openings125A and beyond one or both of the lateral edges126a distance L3(FIG. 4). In some embodiments, the distance L3is in the range of from about 0 mm to 1 mm.

The electrode100may be formed by bending or otherwise forming a metal component into the shape of the electrode member110as described above. The insulation sleeve102is mounted around the shank112and the terminal end of the tail portion114. For example, the insulation sleeve102may be heat-shrunk about the electrode member110. Covering the tail portion114in this manner prevents the free end of the tail portion114from being exposed, where it may interfere with use of the electrode100(e.g., by catching on the patient or objects in the surgical field or the surgical table like gauze).

The system10and the electrode100may be used as follows in accordance with embodiments of the invention. The system10and the electrode100may be used to ablate tissue by vaporization in accordance with some method embodiments and the electrode100is especially well-suited to vaporize and ablate tissue in a controlled manner. The system10and the electrode100may be used to ablate skin tissue. The electrode100may be used to conduct cosmetic ablative procedures on skin tissue. The system10and the electrode100may also be used to scrape, cut, cauterize, coagulate, and/or desiccate tissue of a patient.

The electrode100may be used in different operational modes including a brushing mode, a cutting mode, a scraping mode, and a wiping mode.

In the brushing mode the electrode100is used to execute a brushing step, wherein an operator drags or slides the contact surface152of the working portion120in contact with and across an outer surface of tissue of a patient. As the electrode brushes across the tissue, it ablates a layer of the tissue.

For example,FIGS. 8 and 9illustrate the working portion120being slid or brushed across a surface KS of a surface tissue K of a patient J. The working portion120is placed in contact with the tissue surface K such that a contact band CB is formed. The contact band CB is the region of tissue K that is in contact with the contact surface152at any given time.

The contact surface152is maintained in contact with the tissue surface K while the contact surface152is displaced or wiped across the tissue K in a direction B. Simultaneously with the brushing movement, the electrosurgical apparatus20is operated to deliver RF energy to the contact surface152as discussed above. Displacing the electrode100in this manner progressively advances the contact band CB to thereby create a broad swath or treated band TB of treated tissue. In some embodiments, the electrode vaporizes and ablates the tissue in the contact band CB, so that the brushing step vaporizes and ablates a broad band of a layer of tissue and the treated band TB is tissue from which overlying tissue has been vaporized and ablated.

The broad width of the contact band CB facilitates quicker surgical times. In some embodiments, substantially the entire area of the tissue within the treated band TB is ablated by the brush stroke.

In some embodiments, the depth DB4(FIG. 9) of ablation across the width of the treated band TB is substantially uniform.

In some embodiments, the procedure includes executing a plurality of light pressure brush strokes over the tissue to create a controlled and uniform depth of tissue removal by ablation. The electrode100can be brushed in both the direction B and the opposite direction.

The broad line of contact (i.e., the contact band CB) distributes the energy from the apparatus20over a greater area, which may decrease undesired damage to collateral tissues.

In some embodiments, the CB has a width W4(FIG. 8; transverse to the brush stroke direction B) that is greater that its length L4(FIG. 9; generally parallel to the direction B). In some embodiments, the ratio of the width W4to the length L4is in the range of from about 1 mm to 2 mm.

The length L4of the contact band CB may be a function of the pressure applied to the tissue by the electrode100and/or the location of the contact band CB on the profile of the contact surface152. Thus, the length L4of the contact band CB may vary between a thin line to a thick line or band extending across the width of the treated band TB. In some embodiments, the length L4is in the range of from about 1 mm to 3 mm, in some embodiments is in the range of from about 1 mm to 2 mm, and, in some embodiments, is in the range of from about 2 mm to 3 mm.

In some embodiments, the width W4of the contact band CB is in the range of from about 1 mm to 4 mm. In some embodiments, the width W4is substantially the same as the width W2of the contact surface152. In some embodiments, the width W4is substantially the same as the width W5(FIG. 8) of the treated band TB.

As discussed above, in some embodiments, throughout the brushing step or stroke the electrode contact surface152applies only a light load or pressure onto the tissue to be ablated.

According to some embodiments, the electrode100does not cut tissue during the brushing step.

The contact band CB is tangential to the curve of the profile P. The smooth, continuous shape of the contact surface152and the contact band CB facilitates minimal drag resistance between the electrode100and the tissue for quick, precise execution of procedures (especially ablative procedures).

The broad width W4of the contact band CB and the geometry of the contact surface152(i.e., the smooth, gradual curvature of the curved profile P) reduce the depth of entry or embedding of the electrode100into the tissue for a given pressure of working portion120onto the tissue K. This enables the operator to more easily and accurately modulate or control the depth of entry into the tissue. As a result, the operator can more effectively and reliably prevent the working portion120from cutting the tissue when cutting is not desired. The operator can better control the depth of treatment of the tissue by ohmic heating. The operator can better limit ablation of the tissue to a shallow depth, if desired.

During the brushing step, the operator can gauge the position of one of the lateral edges126of the contact surface152by visually observing and monitoring the opposite parallel lateral edge126. Each of the parallel lateral edges126can thereby serve as a lateral field spatial reference for the other to enable the operator to better ascertain and track the position of the contact surface lateral edges154, and thus the contact band CB, relative to the patient. This feature can be particularly advantageous when one of the lateral edges126of the working portion120is obscured (e.g., by the patient's anatomy or equipment). The parallel lateral edges126allow the operator to have spatial awareness and navigate demarcated regions to prevent collateral tissue damage.

During the brushing step, the operator can also gauge the depthwise position of the contact surface152by visually observing and monitoring the planar top wall surface132, which is disposed a fixed distance above and overlying the contact surface152when the top wall surface132is substantially parallel to the tissue being ablated. The surface132can thereby serve as a depth field spatial reference to enable the operator to better ascertain and track the depth position of the contact surface152, and thus the contact band CB, relative to the patient. This feature can be particularly advantageous when the operator wants to carefully limit the depth of entry of the contact surface152into the tissue.

In the cutting mode, the electrode100is used to execute a cutting step wherein it cuts (and, in some cases, coagulates) tissue of the patient. Either or both of the lateral edges126can be used to cut the tissue. The electrode100can be used to electrosurgically cut tissue with the electrosurgical apparatus20operated to deliver RF energy to the contact surface152as discussed above. The electrode100can be used to cut tissue while non-energized.

In the scraping mode, the electrode100is used to execute a tissue scraping step. Either or both of the lateral edges126can be used to scrape the tissue. In some embodiments, the electrode100is used to scrape tissue with the electrode non-energized (i.e., without the electrosurgical apparatus20operated to deliver RF energy to the contact surface152as discussed above). However, in other embodiments, the electrode100may be energized during scraping.

The scraping step may be employed to remove tissue residue that has been volatized, desiccated, coagulated or otherwise treated by a brushing step or cutting step as described above. The provision of scraping edges126on the brushing electrode100relieves the operator of the need to exchange the brush electrode100for another instrument, and can thereby increase the safety of the patient by reducing surgical time.

In the wiping mode, the electrode100is used to execute a wiping step to remove tissue from the surgical region. In the wiping mode, the insert104is mounted in the socket125as shown inFIGS. 3 and 4. The extensions104A are then used to wipe material from the tissue of the patient. Typically, the electrode100is used to wipe tissue with the electrode100non-energized.

In some embodiments, the wiping step is employed to remove tissue residue that has been volatized, desiccated, coagulated, cut or scraped by a brushing step, cutting step or scraping step as described above. The provision of the wiping insert104on the brushing electrode100relieves the operator of the need to exchange the brush electrode100for another instrument, and can thereby increase the safety of the patient by reducing surgical time.

In some embodiments, the system10includes a plurality of electrodes100of different shapes and/or sizes to permit the operator to customize the system to the treatment, patient, or surgical step at hand.

In some embodiments, the socket125may be omitted or filled with an electrically conductive or nonconductive material. For example, the working portion120may be solid (i.e., void free).

Portions of the electrode100may be bendable to customize the shape or angle of the electrode100to permit the operator to customize the system to the treatment, patient, or surgical step at hand. For example, the working portion120and/or the shank112may be malleable. The electrode100may be bent into or supplied in different configurations to provide access to challenging spaces. Methods of using the system and electrode may include bending the electrode prior to use or between steps.

The system10and the electrode100may be used as follows in accordance with embodiments of the invention to execute dental gum treatments. The system10and the electrode100may be used to ablate gum tissue by vaporization. In some embodiments, the electrode100is used to ablate a layer offending gum tissue to effect a cosmetic treatment.

With reference toFIGS. 10 and 11, the electrode100is used in the brushing mode to vaporize and ablate a surface layer GK1of a gum tissue GK of a patient J. In the brushing mode, the operator drags or slides the contact surface152of the working portion120in contact with and across an outer surface of the gum tissue GK of the patient in the manner described above with reference toFIGS. 8 and 9.

For example,FIGS. 10 and 11illustrate the working portion120being slid or brushed across a surface GKS of the gum tissue GK. The patient's teeth M are also illustrated. The working portion120is placed in contact with the tissue surface GKS such that a contact band CB is formed. The contact surface152is maintained in contact with the tissue surface GKS while the contact surface152is displaced or wiped across the gum tissue GK in a direction B. Simultaneously with the brushing movement, the electrosurgical apparatus20is operated to deliver RF energy to the contact surface152as discussed above. In this manner, the contact band GCB is progressively advanced to thereby create a broad swath or treated band GTB of treated gum tissue. The electrode100vaporizes and ablates the gum tissue in the contact band GCB, so that the brushing step vaporizes and ablates a broad band of gum tissue and the treated band GTB is gum tissue from which overlying tissue has been vaporized and ablated. Tissue in the treated band GTB may be killed but not ablated, as well.

According to some embodiments, with reference toFIG. 11, the brushing step ablates and/or kills an epithelium layer GK1of the patient's gum tissue while leaving an underlying connective tissue layer GK2substantially unaffected, undamaged or minimally damaged by ablation or heat. In some embodiments, the depth of ablation DB6(FIG. 11) created by the brushing step is less than 0.01 mm and, in some embodiments, is in the range of from about 0.01 mm to 0.15 mm. According to some embodiments, the depth of ablation DB6is substantially uniform across the width of the treated band GTB. In some embodiments, the width W6(FIG. 10) of the contact band GCB is greater than the length L6(FIG. 11) of the contact band GCB. In some embodiments, the ratio of the width W6to the length L6is in the range of from about 1 mm to 2 mm.

As discussed above, the length L4of the contact band GCB may be a function of the pressure applied to the tissue. In some embodiments, the length L4is in the range of from about 0.5 mm to 2 mm, in some embodiments is in the range of from about 0.5 mm to 1 mm, and, in some embodiments, is in the range of from about 1 mm to 2 mm.

In some embodiments, the width W6(FIG. 10) of the contact band GCB is in the range of from about 1 mm to 4 mm. In some embodiments, the width W6is substantially the same as the width W2of the contact surface152. In some embodiments, the width W6is substantially the same as the width W7(FIG. 10) of the treated band GTB.

In some embodiments, the electrode100is used to treat gingival hyperplasia.

In some embodiments, the electrode100is used to treat racial pigmentation. The electrode may be used to treat both gingival hyperplasia and racial pigmentation in the same procedure.

As discussed above, in some embodiments, throughout the brushing step or stroke the electrode contact surface152applied only a light load or pressure onto the gum tissue to be ablated.

The smooth curved profile of the contact surface152enables the electrode100to slide smoothly across the tissue as it ablates. According to some embodiments, the electrode100does not cut gum tissue during the brushing step.

The broad width W4of the contact band CB and the geometry of the contact surface152(i.e., the smooth, gradual curvature of the curved profile P) reduce the depth of entry or embedding of the electrode100into the tissue for a given pressure of working portion120onto the gum tissue GK. This enables the operator to more easily and accurately modulate or control the depth of entry into the gum tissue. As a result, the operator can more effectively and reliably prevent the working portion120from cutting the gum tissue when cutting is not desired. The operator can better control the depth of treatment of the gum tissue by ohmic heating. The operator can better limit ablation of the gum tissue to a shallow depth, if desired.

During the brush step, the operator can gauge the position of one of the lateral edges126of the contact surface152by visually observing and monitoring the opposing parallel lateral edge126as described above. In particular, an exposed parallel lateral edge126can be used as a lateral field spatial reference for the other to enable the operator to better ascertain and track the position of an obscured lateral edge relative to a restricted region RR (demarcated inFIG. 10by dashed lines). The restricted region RR may be gum tissue that should not be ablated (“non-offending tissue”) such as tissue proximate the lip line. The lateral edge126of the electrode proximate the restricted region may be obscured by the patient's lip.

During the brushing step, the operator can also gauge the depthwise position of the contact surface152by visually observing and monitoring the planar top wall surface132, which is disposed a fixed distance above and overlying the contact surface152when the top wall surface132is substantially parallel to the tissue being ablated, as discussed above. The surface132can thereby serve as a depth field spatial reference to enable the operator to better ascertain and track the depth position of the contact surface152into the patient's gum tissue GK. This feature can be particularly advantageous when the operator wants to carefully limit the depth of entry of the contact surface152into the gum tissue.

Following the brushing step, the operator may cut and/or scrape gum tissue from the treated band using the cutting mode and/or the scraping mode as discussed above. Gum tissue may be cut or scraped from the treated region using either or both of the lateral edges126. The electrode100can be used to cut and/or scrape tissue either with or without the electrosurgical apparatus20operated to deliver RF energy to the contact surface152as discussed above. In some embodiments, the electrode100is used to scrape gum tissue without the electrosurgical apparatus20operated to deliver RF energy to the contact surface152in order to avoid unintended damage to the underlying tissue. In some embodiments, in the scraping step, a lateral edge126is used to scrape away or remove tissue that has been coagulated by the ablation step, such as collagen from the treated gum tissue that has become gelatinized.

In some embodiments, the system10and electrode100are operated in a wiping mode to remove gum tissue from the surgical region using the insert104(or other insert) mounted in the socket125, as discussed above. The extensions104A may be used to wipe ablated, coagulated or otherwise loosened gum tissue from the patient. Typically, the electrode100is used to wipe tissue with the electrode100non-energized. In particular, the wiping step may be employed to remove gum tissue that has been desiccated, coagulated, cut or scraped by the gum brushing step and the gum scraping step as described above. In some embodiments, in the wiping step, the insert104is used to wipe away or remove tissue that has been coagulated by the ablation step, such as collagen from the treated gum tissue that has become gelatinized.

The operator may make multiple brush strokes with the electrode100as needed to ablate a desired region of the gum tissue. For example, the operator may continue to brush a target region RT (demarcated by dashed lines inFIG. 10) of tissue (“offending tissue”) bounded by restricted regions RR of tissue (“non-offending tissue”) until most or substantially all of the target region RT has been ablated as described. Scraping and wiping steps as described above may be executed between brush strokes to remove residual tissue in order to clear the surgical field for further ablation or inspection. The operator may alternate between the brushing, scraping and wiping steps as needed to progressively ablate and clear the target region RT.

For example, in procedures according to some embodiments, the operator uses the brushing, scraping and wiping steps and techniques described above as follows:

a) The operator prepares the system10, including installing the electrode100in the handpiece30;

b) With the electrode100energized, the operator brushes surface gum tissue in the target region RT with the contact surface152to thereby vaporize and ablate the contacted tissue. The operator may take care not to unintentionally contact and ablate tissue in the restricted regions RR by monitoring the position of the working portion120using visual observation of the lateral edges126, as discussed above. The operator may control the depth of ablation using visual observation of the planar surface132, as discussed above;

c) With the electrode100de-energized, the operator scrapes volatilized residual tissue from the ablative process (e.g., coagulated collagen or other tissue) from the target region RT using the edges126, as described above;

d) With the electrode100de-energized, the operator inserts the wiping insert104into the socket125and wipes volatilized residual tissue from the ablative process from the target region RT using the end sections104A, as described above. The wiped residual tissue may include residual tissue loosened by the scraping step;

e) The procedure may include executing a plurality of brush strokes over the gum tissue to create a controlled and uniform depth of gum tissue removal by ablation. The operator can brush the electrode100in both the direction B and the opposite direction. The operator may repeat steps a), b) and c) as needed to progressively ablate and clear the target region RT. The operator may remove the dirtied wiping insert104from the electrode and replace it with a new, clean wiping insert104to use in subsequent wiping steps.

The electrode100can be used to conduct cosmetic ablative procedures on the gums. According to some embodiments, the electrode100and the electrosurgical gum treatment methods described above are used to treat gingival hyperplasia. In this condition, the patient has an excess of gingival tissue growth and discoloration of the gums. The brushing step is used to ablate the epithelium layer (corresponding to layer GK1), and the scraping and wiping steps are used to remove the remaining residual tissue from the ablation.

The electrode100can be used to conduct cosmetic ablative procedures on the gums. According to some embodiments, the electrode100and the electrosurgical gum treatment methods described above are used to treat racial pigmentation. In this condition, the patient has uneven or undesirably dark coloration of the gums. The brushing step is used to ablate the epithelium layer (corresponding to layer GK1), and the scraping and wiping steps are used to remove the remaining residual tissue from the ablation.

The system10may further include a family or set of a plurality of brush electrodes100of different widths. The operator can then select the brush electrode or electrodes from the set having the desired width(s) for the intended procedure. For example, the width of electrode may be chosen dependent on the constraints of the surgery.

Electrodes according to embodiments of the present invention can overcome various problems that may otherwise be encountered when electrodes of known shapes (e.g., spherical ball electrodes) are pressed into service to ablate tissue. As compared to such known electrodes, electrodes of the present invention can provide shorter surgical times, more complete removal of offending tissue, more even depth of tissue removal, reduced heat transfer (which may cause undesirable tissue damage) to the tissue, improved visualization of the surgical field, and an overall better aesthetic outcome.

Systems and methods as disclosed herein can enable an operator (e.g., a physician) to efficiently and precisely perform ablative treatments with less time, less cost, fewer follow-up procedures, less collateral tissue damage, and less bleeding compared to known electrosurgery apparatus and procedures. For example, while it is known to ablate gum tissue by contacting a sphere electrode with gum tissue in a repeated “pecking” motion, the pecking method is slow and imprecise, leading to numerous drawbacks in execution and result.

In some embodiments, at least the working portion120of the electrode member110is formed of a metal core (e.g., brass or molybdenum) surrounded by a cladding (e.g., a silver alloy). Suitable materials of this type are disclosed in U.S. Published Patent Application No. 2007/0055226, the disclosure of which is incorporated herein by reference. A cladding of silver alloy can provide less surface damage, less pain and suffering, faster healing time, and a smoother brush stroke with less coagulative tissue clinging to the working portion120and obscuring the surgical field.