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exposants/exhibitors14 JDIQ — 25 mai 2015 May 25, 2015 n As the number of dental implants being placed increases, reported cases of peri-implantitis are becoming more frequent. The available data suggest that one in five implant patients will develop peri-implantitis, an irreversible inflam- matory condition characterised by bone loss around the site of an implant, while four in five will exhibit peri-implant mucositis,anearlystageofthediseasein which the inflammatory reaction is still reversible.1 With peri-implant mucositis, the inflammationislimitedtotheperi-implant mucosa, while with peri-implantitis the infectionalsospreadstotheperi-implant bone. Both conditions include the pres- ence of bacterial plaque and calculus, oedema and redness of tissues, and involvebleedingonprobing.Inthemajor- ity of cases, classical treatment methods forperi-implantitisareinadequatedueto a number of complicating factors, includ- ing resistant bacterial strains, difficult debridement procedures and the pres- ence of biofilm on the implant surface.2 The most prevalent reason for the development of peri-implantitis appears to be poor occlusal load distribution, with either primary contacts or canti- lever bridges in implant-supported pros- theses.Goodoralhygieneonthepatient’s part is mandatory; however, the position anddesignofprosthesesthataredifficult to manage may limit the effectiveness of mechanical cleaning. Once the under- lying reason has been determined and recurrence is prevented, laser therapy can help to treat peri-implantitis. TwinLight peri-implantitis treatment A new laser treatment called TwinLight® from Fotona is proving to be one of the most effective methods for fighting peri-implantitis, successfully meeting the objectives of controlling infection by surface decontamination and halting the disease’s progression. TwinLight is a minimally invasive technique combin- ing dentistry’s two gold-standard laser wavelengths (Er:YAG and Nd:YAG) in a synergistic process designed to improve peri-implantitis treatment success rates and shorten healing time. With TwinLight, the Er:YAG laser is used in a non-surgical procedure to remove microbial composition and in a surgical procedure to treat the damaged alveolar bone around the implant. Using Er:YAG,itispossibletocleanthegranula- tiontissues,bothontheboneandimplant surfaces, and thoroughly decontaminate the site. Removal of granulation tissue from the alveolar bone and connective tissue with Er:YAG laser is highly effect- ive. The erbium laser targets the water content to remove the granulation tissue selectively, due to its long pulse duration and lower peak power, while ablating the microorganisms on the surface of the bone. The bactericidal effect of Er:YAG on the surgical site is effective against ipopolysaccharides, and the implant surface is completely cleaned without chemicals.ThesubsequentNd:YAGtreat- ment step promotes faster healing by bacterial reduction and biostimulation of the bone tissue. The same principles apply also with more severe treatments that require surgical therapy. TwinLight procedure The TwinLight procedure is performed according to the following five steps: Step 1: Removal of soft-granulation tissue with Er:YAG in LP mode (Fig. 1). Step 2: Removal of the bacterial bio- film on the implant surfaces with Er:YAG in MSP mode (Fig. 2). Step 3: Ablation of the infected bone with Er:YAG in QSP mode (Fig. 3a). Step4:Bacterialreductionofthe bone with Nd:YAG in MSP mode (Fig. 3b). Step 5: Biostimulation with Nd:YAG in VLP mode (Fig. 4). For treatment of peri-implant mucosi- tis, only step 2 is performed. Because the Er:YAG wavelength is used with an optimal modality, there is no danger of thermal damage to the highly fragile surrounding bone and no significantalterationsoftheimplantsur- face, as is frequently the case with other lasers.3,4 The effect of the laser energy on the implant surface is dependent on the amount of energy density, power and pulse duration. The parameters should be chosen cautiously — lowering the set- tings may make the procedure slower but safer for re-osseointegration. Non- surgical use of Er:YAG is also possible if the problem is not extensive. Clinical case In the accompanying clinical case, a removable prosthetic with two ball attachments was planned. Due to the patient’s request, the implants were immediately loaded, which most prob- 5 The Lightwalker AT from Fotona. According to Dr. Ilay Maden, PhD, ‘A new laser treatment called TwinLight from Fotona is proving to be one of the most effective methods for fighting peri-implantitis, successfully meeting the objectives of con- trolling infection by surface decontamination and halting the disease’s progres- sion.’ (Photo/Provided by National Dental Inc.) ably is the reason for the resorption seen aroundtheimplantontherightlowerjaw. The site was directly accessed to clean the granulation tissue and disinfect the implant surface with Er:YAG laser, while bacterial reduction and biostimulation were executed with Nd:YAG laser. The defect was augmented with synthetic bone substitute. After three years of follow up with very good healing, the patient requested a fixed prosthetic, which was delivered with an additional placement of implants in both jaws. Two more implants were placed distally when the patient could afford more treatments after one year. There are a number of advantages of using lasers in this type of case. One of themisthatthereisnomechanical,chem- ical or any other means of trauma while removing the granulation tissue around theimplant—neithertotheimplantnorto the bone tissue. In addition to being safe, both wavelengths are known to promote healing by bacterial reduction and bio- stimulation of the tissue. Shorter pulses are used on the surface of the implant to avoid thermal effects, but with lower energies,soastonothaveatoohighpeak power and thereby damage the surface. Withshortpulsesandhigherpeakpower By Dr. Ilay Maden, PhD, and Dr. Zafer Kazak (higher energy), we can create bleeding spots on the bone to improve healing of the augmentation material. The penetration of Nd:YAG through bone helps the achievement of bacter- ial reduction and biostimulation. Care should be taken to avoid contacting the implant surface with Nd:YAG because the absorption in titanium is high and could cause a rise in temperature. It is also important to use a fast, sweeping motion with high suction to avoid heat accumulation on one spot. Too much bleeding would block the penetration of the Nd:YAG laser. Nd:YAG can also be used on the inci- sion line, vestibular, the oral side of the surgical site and extraorally after suturing,andeveryseconddayforfaster and better healing, with less pain and swelling. Editorial note: Reprinted from Vol. 7, No. 1, 2015, issue of laser, the inter- national magazine of laser dentistry. References available from the publisher. Contact the author Dr. Ilay Maden, PhD, can be contacted at Seesaw Dental Education at 20 Halifax Road,3BoothroydsWF132NE,UK,orby email at ilaymaden@gmail.com. 5 (Photos/Provided by Dr. Ilay Maden, PhD) 5 Fig. 2 5 Fig. 3a 5 Fig. 3b 5 Fig. 4 5 Fig. 1 The TwinLight approach to peri-implantitisThe TwinLight approach to peri-implantitis Ici aux JDIQ Pour en savoir plus à propos le LightWalker AT et le TwinLight, visitez National Dental Inc. a le kiosque #100/102. Here at the JDIQ Learn more about LightWalker AT and the TwinLight treatment at the National Dental Inc. booth, No. 100/102.