Please activate JavaScript!
Please install Adobe Flash Player, click here for download
ePaper created 2016-02-02, 09:24:34 | version 1.38.0
38 4_2015 laser 38 laser_research I research 12 I laser 3_2014 Of course, the laser tip/laser fibre used must en- sure that all decontaminated areas of the implant surface or the inflamed implant site in the alveolar bone can be reached precisely. In my practice, I use fibretips(Fig.2)aswellasacylindricalworkingend, which reflect the laser light via a bevel (phase) in an angleof45°(Fig.3),sothatpartsofthemacroscop- ically present implant screw threads are treated three-dimensionally. In easily accessible or exposed implant surfaces or defect areas of the alveolar bone, I like to use the so-called window hand piece, which allows an extensive laser-light application withahighenergydensitywithoutfibreorsapphire light wedge (Fig. 4). _Case presentation In the following patient case, the resective and regenerative treatment sections of the complex therapy concept are discussed only exemplarily for didactic reasons. Anamnesisandfindings Female patient, 56 years old, smoker, no general diseases,condition14yearsafterimplantinsertion, regular dental check-ups until 20 months ago, af- terwards neither prophylaxis or check-ups, treat- ment stop. Thepatientpresentedwithalossoftheimplant- supported metal-ceramic bridge 35–37 (Figs. 5 & 6, lateral and occlusal view). Clinical examination showed: mild loosening of implant regio 37 (grade 1), minimal bleeding on probing, minor pus release region 37. Contrarily, there was no bleeding on probing or pus release in implant 35. However, all in all no redness of the gingiva, no inflammatory infil- tration, swelling or loosening of implant 35, whose percussion sound was bright and clear, were de- tected. Radiologically,aperiimplantbrighteninginform of a significantly enlarged gap in the complete im- plant surface between implant and surrounding alveolar bone (Fig. 7) was noted. After a modified application of our therapy con- cept (Fig. 1), we attempted a prompt surgical treat- ment of the periimplant infection in implant regio 37 due to the loss of the bridge. The patient was in- formed about the limited prospects of success with regardtoimplantpreservationalreadyatthebegin- ning of the therapy. The alveolar process was ex- posed carefully under local anaesthesia after form- ing the mucoperiosteal flap in regio 36–38 and the bone defect was prepared in implant region 37 (Fig. 8). Granulation tissue is depicted in the cervical im- plantareainanoverviewoftheexposedoperational field (Fig. 9). The configuration of the bone defect made the application of various laser fibre tips nec- essary. We used an Er:YAG laser (KaVo KEY 3+ by KaVo GmbH, Germany). The programme selection already provides preconfigured settings for the therapy of “implantitis” (Fig. 10), which can be al- teredaccordingtotheexperienceandknowledgeof the user (Fig. 11). Thus, the first therapy step of laser Fig. 15_Uncovering the implant circularly, split-shaped bone loss. Fig. 16_Filling the four-wall bone defect with xenogeneic bone substitute. Fig. 17_Good success prospects after primary coverage of the defect. Fig. 18_Postoperative check-up after laser decontamination and augmentation with Bio-Oss® granulate of a particle size of 0.25–1 mm und coverage via Bio-Gide® membrane. Fig. 15 Fig. 16 Fig. 17 Fig. 18