implants - international magazine of oral implantology

I overview been successfully used in conservative dentistry for manyyearsandistheonlywavelengththathasbeen scientifically backed, is suitable for practice and can be used to work on and prepare the hard-tooth sub- stance. The names Keller and Hibst are closely con- nectedtotheEr:YAGwavelength. We owe significant scientific studies of the Er:YAG laser to these two researchers from Ulm, Germany. In the past years, Keller and Hibst—after having fully re- searched the treatment of the hard tooth substance— turned their attention to further integrations with the Er:YAGlaser,includingstudiesregardingtheuseofthis laser for the treatment of periodontitis and periim- plantitis.Forthis,evenspecialchisel-shapedlaserlight applicatorsweremadeavailable.In2001,Schmelzeisen and Bach confirmed the suitability of the Er:YAG laser forremovingtartarandconcrementsfromtheimplant surface without damaging the implant surface. How- ever, this requires a non-contact procedure with a 30 milli-joule pulse and a PRP of 10–30 ppt for a max- imumof30seconds. –“Er:YAG—threshold” for PI treatment: The research group around Frank Schwarz (Düsseldorf, Germany) was finally the one who determined the “threshold value” that today is generally considered binding for ablativetreatmentofperiimplantitisusinganEr:YAG laser (irrespective of device and manufacturer): 13.1J/cm².Differentvaluescancausethermalorme- chanical damage. If Er:YAG light is applied correctly, however, it leaves a clean, homogenous and intact implantsurface. –Er,Cr:YSGG laser: First experiences were also gained withthelatestlaserwavelength,theEr,Cr:YSGGlaser that was introduced to dentistry in the treatment of periimplantitis. The names Henriot and Ritschel (Hamburg,Germany)especiallycometomindinthis context. They described multiple uses of the Er,Cr:YSGG laser, more widely known as Biolase, in soft-tissuesurgeryandinhardtissue.Therespective long-term experience and multi-centric studies are yettobeconfirmed. _Summary There are two options for using laser light in the treatmentofperiimplantitis: Puredecontamination,non-ablative Forthisapplication,diodelaserswithawavelength of 810 nm and CO2 gas lasers have gained acceptance. Solidscientificdataandlong-termstudiesareavailable for this form of diode laser light application which, however,requiresconventionalcleaningoftheimplant surfacepriortothelaserlightapplication. Ablative, possibly with additional decontaminating effect Er:YAG laser and the Er,Cr:YSGG laser are available forthisapplication.Theycanremoveconcrementsand tartar from the implant surface without changing its original morphology. However, strict and limiting pa- rameters must be observed with respect to perform- anceandtime.Regardingclinicalandlong-termexpe- rience, the ablative procedure has not yet reached the level of the purely decontaminating diode and CO2 lasers._ 24 I implants3_2013 Figs. 17–22_The hopeless case— the explantation: When looking at the initial clinical diagnosis (Fig. 17), only its unfavourable aesthetics might be noticeable. However, after creation of a soft-tissue flap, the “true extent of the horror” (Fig. 18) becomes visible: the defect extends all the way to the area of the implant apex. In particular, there is no bone left buccally (Fig. 19). Periimplantitis treatment does not appear very promising because of the extent of the osseous lesions. The artificial abutment tooth has to be removed, i.e. explanted (Fig. 20), leaving a profound defect. An augmentation is carried out to facilitate a new implantation at a later time, and a membrane is inserted (Fig. 21), followed by a saliva-proof suture (Fig. 22). Dr Georg Bach Rathausgasse 36 79098 Freiburg/Breisgau Germany Tel.:0761 22592 Fax:0761 2020834 doc.bach@t-online.de www.herrmann-bach.de _contact implants Fig. 17 Fig. 18 Fig. 19 Fig. 20 Fig. 21 Fig. 22