Dental Tribune Italian Edition

26 Speciale Laser Tribune Italian Edition - Maggio 2014 << pagina 25 The diode laser can be used for gin- givectomies to safely remove and re- contour the excess tissue and healing can be remarkable in a very short pe- riod of time (Figs. 2-4). Ability to work around dental implants safely Various laser wavelengths that are available today can offer the clinician who needs to expose an implant dur- ing second stage surgery an alterna- tive to traditional methodologies. The ability of the diode laser to ablate tis- sue,attimeswithouttheneedforlocal anesthetic, while controlling hemo- stasis, provides the clinician a great view of the surgical site. In addition, the diode wavelength, like all laser wavelengths, provides for decontam- ination of the implant site through its antibacterial actions. Bacterial re- duction with the diode laser can lead to an almost sterile operative field (98 percent reduction of pathogenic bacteria). Finally, there is a growing body of evidence that suggests that lasers used at lower energy settings can have a biostimulatory effect on tissue which in turn can reduce post- operative discomfort, improve heal- ing and shorten healing times while even improving early osseointegra- tion.8-12 As an aside, there have been clinicians who routinely use monop- olar electrosurgery units to expose implants. It is imperative to realize thatalthoughmoreexpensivebipolar (two electrodes) electrosurgery units can be used safely around implants, that the more commonly purchased single electrode (monopolar) units may damage the implant surface and can cause complete loss of osseointe- gration with resulting implant failure with contact times as short as three seconds.13,14 Lasers, in contrast, can be used safely with tremendous coagu- lation and a reduction in pain post- operatively for the patient15 (Figs. 5,6). Diode lasers are also useful when it comes time to seat the final abutment and restoration. Tissue management around dental implant restorations can be difficult, be it for the initial cementation or, even worse, if an im- plant-restored crown comes loose. Tissue quickly slumps onto the abut- ment, and subgingival margins can be almost impossible to retrieve with traditional methodologies. The laser can truly be a “life-saver” for these situations where soft tissue must be safely and quickly removed to allow for ideal cementation of the implant retained crowns onto the abutments (Figs. 7-12). Reduced need for anesthetic Monopolar electrosurgery units do not have the ability to be used rou- tinelywithoutlocalanesthetic.Incon- trast, diode lasers can often be used either with low wattages or in pulsed modes to remove minor to moderate amounts of soft tissue with only topi- calanesthetics.Althoughattimesthis may not seem significant to the clini- cian, there are many instances where soft tissue acts as a barrier to ideal re- storative treatment, and if local anes- thetic can be eliminated it becomes a big selling point to patients. >> pagina 27 Fig. 10 - Picasso Lite diode laser removing tissue on abutment margins. Fig. 12 - Final crowns cemented onto abutments without soft tissue impingement. Fig. 14 - Topical gel placed on soft tissue prior to gingivectomy to uncover soft tissue. Fig. 16 - Brackets in place on both canines – immediate post-op view. Fig. 18 - After recontouring of lateral incisors and laser crown troughing for tissue management prior to impressions. Fig. 11 - Note tissue off the margins of abutments after diode use. Fig. 13 - Partially exposed canine requires orthodontic bracket. Fig. 15 - Pulsed mode at 1.4 w shows removal of attached tissue to expose canine. Fig. 17 - Pre-op prior to maxillary incisor veneers. Fig. 19 - Immediate postoperative result for four Emax veneers.