implants - international magazine of oral implantology

I industry report Fig. 3_Removal of plaque biofilm and granulation tissue using the LiteTouch Er:YAG laser with its 1.3 x 1.4 mm sapphire tip. Fig. 4_The periapical radiograph revealed peri-implantitis with bone loss of > 5 mm (a). The abutment was removed and surgical treatment using the LiteTouch laser was performed. Bone grafting with a biomembrane followed the laser treatment (b). The periapical radiograph revealed bone regeneration after six months (c). ographs were analyzed by two of the study investi- gators after previous calibration. _Hygiene phase (non-surgical phase) Before treatment, the suprastructures were re- moved and the baseline measurements were taken. The goal of the initial phase was the reduction of as much tissue inflammation as possible. The patient moved on to the support phase once signs of im- provementandreductionofinflammationhadbeen observed. In case of persisting bleeding and pus dis- charge, a surgical procedure was planned. For this surgical phase, fifty-one of all sixty-eight patients with a total number of 100 implants were random- ized with a lottery assignment. _Surgical phase Iftherewasnosignificantimprovementafterthe non-surgical phase (in the second week), a surgical intervention was planned (surgical phase). Surgical interventionwasindicatedincasesinwhichthecon- ditionsaroundtheimplanthadfailedtoimproveaf- ter the initial phase, but plaque control was ade- quate, and there was a need to retain the contami- nated implant. The supraconstruction of the im- plants was removed in order to gain access and to preserve as much soft tissue as possible to cover the area after surgery. Patients were randomly assigned to one of the two treatment regimens. _Conventional mechanical therapy (Group I) Infiltrationlocalanesthesiawasusedduringtreat- ment. The first incision was an internal gingivectomy, directed towards the bony ridge, which separates the peri-implanttissuefromthemucosalflap.Theflapwas then raised to the level of the bony ridge, gaining ac- cesstotheentireimplantsurface.Thegranulationtis- sue around the implant was carefully removed with sharp curettes and the implant surface was inspected for calculus deposits. The implant surface was then carefullycleanedusinganultrasonicdeviceatlowset- tings(PItip,Piezon®ultrasonicunit,EMS).ThePItipwas placedandusedforapproximately60secondsaround the implant, ensuring coverage of the full circumfer- ence of the implant. Chemical debridement with a tetracycline solution was performed after ultrasound cleaning. In addition, bone augmentation was per- formed when required (21 patients; Bio-Oss, Geistlich Pharma; Dembone). During the study, all subjects re- ceivedindividualizedoralhygieneinstructions. _Laser-assisted surgical treatment (Group II) Underlocalanesthesia,gingivectomyandthesep- aration of the peri-implant tissue from the mucosa wereperformed.Theflapwasraisedtothelevelofthe bony ridge, gaining access to the entire implant sur- face. The granulation tissue around the implant was removedwiththeLiteTouchEr:YAGlaser(Fig.3).Tipof choicewas1,300micron,noncontactmode(distance between end of the tip and target tissue = 1.5mm). If calculusdepositswerefound,theimplantsurfacewas then carefully cleaned with laser. Decontamination with a non-contact, defocused Er:YAG laser was per- formed by systematically moving the laser tip along thesurface.Theareawasrinsedwithasterilesalineso- lution.Boneaugmentationwasperformedwhennec- essary (19 patients; Bio-Oss and Dembone with or without an absorbable biomembrane). The tips and settingsusedduringtreatmentaregiveninTable1. _Postoperative Instructions The patients were prescribed clindamycin 150mg x 50 tabs to avoid infection. They were also given ibuprofen800mgx15tabsforpain.Patientswerein- structedtorinsewithchlorhexidine0.2%,startingthe nextday,fortwoweeksthreetimesaday,andweread- visedtomaintaingoodoralhygiene. _Support phase The goal of the support phase was to maintain long-term treatment results. Regular examination of thesofttissue,plaquecontrol,radiographsandminor 32 I implants3_2013 Fig. 4a Fig. 4b Fig. 4c Fig. 3