page 23DTà I mplant therapy has been an amazing breakthrough in restorative dentistry which has brought benefits to our patients. We are all aware of the high success rates of dental implants and that they will integrate given time. Over the past 10 years implant com- panies have been develop- ing the new implant surfaces to increase the amount of bone to implant contact and to reduce the time needed for the implant to be loaded. I suppose the ultimate goal for dental implants would be to completely emulate a tooth/ root. That is to achieve a true connective tissue attachment inserting into an implant sur- face thereby forming a true bi- ological width with a junction- al epithelium and connective tissue attachment protecting the bone. This has not been possible; Listgarten’s studies in the 1980’s showed that the connective tissue around an implant is parallel to the im- plant surface. A good friend of mine Ken Nicholson who is an implant dentist, in Northern Ireland and the academic lead in the Institute for Postgraduate Den- tal Education at the University of Central Lancashire, intro- duced me to Biohorizons den- tal implant over three years ago. I have enjoyed using this implant system for three years now. Two years ago Biohori- zons introduced a new implant Laser-lok. Biohorizons have been able to develop a true mi- crothread, the top 2mm of the implant is prepared utilising a laser to threads which are 8 and 12microns apart. Profes- sor Jack Ricci developed this laser technology in the 1990’s at New York University. He found that the microthreads could control the behaviour of the fibroblasts allowing the fi- broblasts to orient themselves on the Laser-lok surface. The Laser-lok surface has been shown to elicit a bio- logical response that includes the inhibition of epithelial downgrowth and the attach- ment of connective tissue. It has been suggested that this physical attachment produc- es a biological seal around the implant that protects and maintains the bone(Nevins,M et al. International Journal of Periodontics & Restora- tive Dentistry(IJPRD). vol.28, no.2, 2008)(Figure 1). Re- cently a study by Nevins et al IJPRD vol.30, no.3, 2010 has shown the use of Laser-Lok abutments to create a bio- logical seal. They showed a connective tissue attachment to the Laser-lok abutment which was above the implant abutment connection (Fig 2). The crestal bone levels was also seen to be higher than in standard abutments (Fig 3). A 51-year-old lady was re- ferred to me to by her den- tist. She had been suffering from abscesses from her up- per anterior bridge (Fig 4) for some years. She had decided that she wanted the bridge removed and replaced with dental implants. The bridge and retaining roots were ex- tracted and replaced with an upper partial denture. The tissues were left to heal for a period of 8 weeks before the dental implants were placed (Fig 5). A three sided flap was raised and the implants were placed in the UR1 and UL1 sites (Figure 6) at crestal level. As there was a buccal dehis- cence present, it was neces- sary to augment the site with a guided bone regeneration technique using a bovine bone graft and membrane (Fig 7,8) therefore a periosteal reliev- ing incision was made to allow for tension free wound closure and coronal mobilisation of the buccal flap. The flap was closed utilising resorbable su- tures (Fig 9). The healing was uneventful and the patient was reviewed a week later (Fig 10), the sutures were re- moved. The dental implants were left to integrate for a period of three months (Figure 11). The peri-implant tissue were pink and healthy, probing the peri implant tissues of the Laser- Lok implants, it was noted that the probe could not penetrate less than 1 mm (Fig 12). The implants were restored with a screw retained UR1 crown and a screw retained UL12 bridge (Fig 13). Interestingly a long cone periapical of the final res- torations and implants showed that the crestal bone had re- modelled to the correct level dictated by the Laser-Lok sur- face 12microns. You will note from the post-op radiographs the implants were placed at bone level (Fig 14). Another interesting point to make from this case is when I probed the peri-implant tissues you would expect the bone to be less than 1 mm away from the tip of the probe on a standard implant due to the parallel fibres of the connective tissue. Yet when the radiograph was taken the bone was further way. Implant surface technology is improving every year and maybe one day the dental im- plant will be able to emulate a tooth/root in every way, it might be that Laser-Lok sur- faces could be the start. DT Dental Implants: Laser-Lok a new technology Amit Patel presents an interesting case ‘The Laser-lok surface has been shown to elicit a biological response that includes the inhibition of epithelial downgrowth and the attachment of connective tissue’ Fig 1 Fig 2 Fig 3a Fig 3b Fig 4 21Implant TribuneJanuary 21-27, 2013United Kingdom EditionUnited Kingdom Edition