implants - international magazine of oral implantology

I industry report Table 3_Proportional changes in bone height between baseline and six months, defined at the implant level based on the mean value of changes in mesial and distal bone height. implant surface and with re- specttosurroundingsofttis- sues. Numerous methods for the decontamination of im- plantsurfaceshavebeensug- gested,eitheraloneorinvar- ious combinations, as part of the surgical treatment of peri-implantitis. The litera- turedatarevealedthatmeth- ods as cleaning with metal curettes and impropriate ul- trasonic tips or irradiation with Nd:YAG laser can dam- age the implant surface and could compromise the resid- ual implant stability.9,20 Air- powderabrasiveunitsareoftenrecommendedforthe surgical treatment of peri-implantitis. A recent study aimedatevaluatingtheinfluenceofdifferentair-abra- sive powders on cell viability at biologically contami- nated titanium dental implant surfaces revealed that nosurfacetreatmentsledtomitochondrialcellactivity values comparable to the sterile control group.33 Citric acid application and sandblasting have also been rec- ommended.18 However, implant decontamination us- ing sandblasting units have been associated with risks suchassofttissuesdamageandemphysema.34 Er:YAG lasers are seen as the most promising new technicalmodalitiesoftreatingfailingdentalimplants, sincetheirperformanceoftissueablationisaccompa- niedbyahighbactericidalanddetoxificationeffect.26,32 WhenconsideringtheuseofEr:YAGlasersinthetreat- mentofperi-implantitis,thereare somecrucialpoints with clinical importance. Power settings are variable, andtheclinicianmustalsochooseasettingthatwillef- fectivelydisinfecttheimplantwhilenotdamagingthe surface.Anarrowrangeofpowersettings(100mJ/per pulse) was described in the literature.21,27,30,31,32 Only one study used a higher power setting of 120mJ per pulse.1 The frequency was set at 10Hz for each of the mentionedstudies,however,neitherthedistancefrom whichthelaserwasapplied,northetimeofapplication to each implant was stated. In the present study, the settingsusedforimplantsurfacedecontaminationare 150mJ/45Hz, at non-contact mode and constant movement.Anotherimportantpointistheinteraction betweenlaserlightandmetalsurfaces.Thisinteraction is mainly determined by the degree of absorption and reflection.Withareflectancecapacityofabout71%,19 titanium implant surfaces do not absorb irradiation. Consequently, there is no increase in temperature which could damage the implant surface. Several in- vestigations have reported on the promising ability of theEr:YAGlasersinimplantsurfacedebridementwith- outproducingthermalside-effectsonimplantsurface and adjacent tissues.14,35 Treatment of peri-implantitis usingEr:YAGlasertherapyhasbeeninvestigatedbefore and appears to result in a more effective reduction in bleeding around implants than surgical debridement withhandinstrumentsandsub-gingivalapplicationof chlorhexidine.1,27,30,31 Irradiation with this specific wavelength seems to have a bactericidal effect on pe- riodontopathic bacteria and remove bacterial biofilm. However, in order to treat the implants with the laser device in the present study, the suprastructures were removed,allowingtheaccesstotheimplantsurfacesto improve.Thus,theresultsofthepresentstudyarelim- ited to implants where the suprastructures can be re- movedduringtreatment. _Conclusion Among lasers used in the field of dentistry, the Er:YAGlaserseemstopossessthecharacteristicsmost suitable for peri-implantitis treatment because of its abilitytoablatebothsoftandhardtissue,aswellasbac- terial biofilm and calculus, without causing thermal damage to the adjacent tissues and implant surfaces. The decontamination effects of Er:YAG laser are also beneficial regarding peri-implantitis pathogenesis. In thepresentstudy,theuseoftheLiteTouchEr:YAGlaser hasbeenproposedforthetreatmentofperi-implanti- tis and the results indicate that the laser-assisted sur- gical therapy may lead to significant clinical improve- mentssuchasBoPandPPDreductionaswellasagain in clinical attachment. From a clinical point of view, these results advocate the Er:YAG laser as an alterna- tive treatment modality to conventional mechanical therapy._ WiththecollaborationofDrKe,DrYu,DrLu,Taiwan; DrKennyChiu,HongKong;DrsKanbayashi,Takahashi, Ikeda&Kamiya,Japan. For more information about the LiteTouch™—the fiber-freeEr:YAGlaser,pleasevisit: www.synerondental.com Editorial note: A list of references is available from the publisher. 34 I implants3_2013 Prof.Tzi Kang Peng DDS,MS,PhD,FICD Professor and Chair of the Department of Dentistry Cheng Hsin General Hospital Taipei,Taiwan Assoc Prof.Georgi Tomov DDS,MS,PhD Associate Professor and Chair of the Department of Oral Pathology,Faculty of Dental Medicine Medical University of Plovdiv,Bulgaria _contact laser Radiographic changes in bone height LAS (%) CMT (%) Decrease (loss in mm) 1.1–2.0 12.2 35.4 0.1–1.0 37.1 39.5 Unchanged (mm) 0.0 29.3 4.2 Increase (gain in mm) 0.1–1.0 17.4 12.5 1.1–2.0 4.9 2.1 2.1–3.0 7.1 6.3