implants - international magazine of oral implantology

The proponents of ablative treatment argue that they “kill two birds with one stone” by removing any contamination from the implant surface, by smoothing it and possibly eliminatinganybacteriaandmicroorganisms.Theproponentsofpuredecontamination, ontheotherhand,pointouttherisksofunwantedeffectsontheimplantsurface,which wouldcomplicateormightevenpreventthere-appositioningofthebone,andtheexcel- lentlong-termresultsofpuredecontamination. Inthiscontext,theyalsoacceptthat,in theirnon-ablativeformoflasertreatmentforperiimplantitis,theimplantsurfacesmust becleanedwithsuitablemanualinstrumentspriortolaserlightapplication. _Technique for both of the two treatment options 1. Decontamination without ablative effect or morphological changes on the implant surfaceinthesenseofapuredecontamination The term “decontamination” was coined by the Freiburg Laser Research Group Bach/KrekelerandMallin1994-1995.Theyintroducedthediodelasertodentistry,which had been unknown until then. For decontamination, the diode laser light (810 nm) is ap- pliedtotheimplantsurfacewiththelargestpossiblefiber(usually600µm)undercontact andwithconstantmovement.TheauthorsfromFreiburgindicatedamaximumpowerof 1 W and an application time of no more than 20 seconds for the laser light treatment. A 30-secondwaitingperiodisnecessaryifthereisaneedforfurtherlaserlightapplication onthesameimplant.Inclinicalapplications,awaitingperiodof20secondshasprovento becompletelysufficient.Ifanimplantshowsasurfacethatisexposedfromtheboneand that requires an application of laser light in excess of 20 seconds, the prognosis for this artificial abutment tooth should be categorised as unfavourable and the periimplantitis treatmentconsideredquestionableifnotexperimental. Bach/Krekeler and Mall expressly caution against exceeding the time-time values, whichwouldinevitablycauseaheatbuild-upintheimplantandintheperiimplantbone, andthusleadtodestruction.Theparametersmentionedbytheseauthors(1.0W/max.20 seconds of laser light application) have been impressively confirmed by other authors (Sennhenn-Kirchneretal.,Moritzetal.)and/oracceptedbythedevicesuppliersandman- ufacturersontheflourishingdiodelasermarket. Romanosetal.describedtheoptionofworkingwithNd:YAGlaserswithoutchanging the surface. However, there are no long-term and clinical results yet. The above-men- tioned diode laser research group in Freiburg, on the other hand, submitted a ten-year study in 2005, proving a reduction in the recurrence rate from previously 30% (without laser)tonow11%(withdiodelaser).Theseauthorscalledforanintegrationofdiodelaser decontaminationasastandardprocedureintotriedandprovenschemesforperiimplant treatment. Long-term clinical findings for laser treatment of periimplantitis were also achievedwithafurtherwavelength:CO2 (gas)lasershavebeenusedforthetreatmentof periimplantitissincetheworkofDeppe,Horchandcolleagues(universityofMunich)was completed. Prof. Dr Herbert Deppe and his co-authors were able to prove that the use of the gas laser,whichhadbeenregardedcriticallyforthetreatmentofperiimplantitisuntilthen,is appropriate here and will later—after the periimplant infection subsides—yield a favourable starting point for the regeneration of the supporting tissue. Deppe suggests the use of the CO2 laser in continuous-wave (cw) mode with 2.5 W of power for 10 sec- onds. He works with a scanner and, if necessary, also with a dental powder jet and post- operative application of a membrane. A five-year study (Deppe and Horch, 2005) is also available. 2. Procedurewithablativeeffect(lasercurettage)andpossiblyanadditionaldecontam- inatingeffect –Er:YAGlaser:Comparedtothelaserlightdecontaminationproceduredescribedabove, the ablative laser light procedure uses additional wavelengths: This laser with ablative effectusedforthetreatmentofperiimplantitisistheEr:YAGlaser.Thiswavelengthhas Degradable Solutions AG A Company of the Sunstar Group Wagistrasse 23 CH-8952 Schlieren/Zurich www.easy-graft.com Ingenious: Simple handling and accelerated osteocon- duction for long-term volume preservation. easy-graft® CRYSTAL bionicstickygranule AD