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ePaper created 2016-02-02, 09:24:34 | version 1.38.0
40 4_2015 laser 40 laser_research I research Figs. 19 & 20_Probing depth of 2 to 2.5 mm. Figs. 21 & 22_Good agglomeration of the surrounding bone in implant regio 37. applications consisted of using a thin fibre (Fig. 2), which can also be applied in other surgical situa- tions in order to remove the soft granulation tissue from the slit-shaped bone defect and the implant surface (Figs. 12 & 13). Afterwards,aspecialcylindricalsapphiretipwas used (Fig. 3), which features a 45° bevel (phase), whichhelpsthelaserlightreachinghardlyaccessi- ble areas, for example the screw threads of the im- plants, by circular and lateral radiation in a 45° an- gle. For this, energy was increased to 350 mJ at a pulse rate of 15 Hz and 5.25 W. The figures show how the fibre tip is held parallelly in accordance with the implantsurface intothedepthoftheperi- implantbonedefect(Fig.14).Fig.15alreadydepicts a visible circular exposition of the implant with a split-shaped bone loss, which corresponds to class 4 according to Spiekermann 1993.11 After laser decontamination and cleansing of theimplantsurfaceviaEr:YAGlaserandphysiolog- ical NaCl solution, all the macroscopically present granulation tissue and the infected surface of the alveolar bone facing the implant were removed. This was followed by filling the four-wall bone de- fect with xenogeneic bone substitute, which was accumulated up to the implant region for minimal vertical augmentation (Fig. 16). An implant plastic with removal of the rough surface as was previ- ously described by other authors1,4 was not applied in order to avoid introducing titanium particles to the surrounding bone, which can be seen later in the X-ray. The procedure was discussed extensively with the patient beforehand and according to our experienceprovidesgoodprospectsofsuccess(Fig. 17). After covering the xenogeneic augmentation material by a collagen membrane and primary woundclosure,theimplantswerestabilisedfirstby a long-term temporary restoration in configura- tionwiththeformerbridge.Thislong-termtempo- rary solution, which was visibly reduced in its oc- clusal height, was used for temporary splintage for six weeks in order to stabilise the minimally loos- ened implant 37. Immediate postoperative control after laser decontamination and augmentation withBio-Oss®granulateofaparticlesizeof 0.25 to 1 mm and coverage via Bio-Gide® membrane was checked radiologically (Fig. 18). Afteraclinicallyuneventfulhealingperiodofsix weeks, the long-term temporary solution was ex- changed with the original definite bridge restora- tion.Treatmentsuccesswascheckedafterfourand, later,sixmonths.Professionalprophylaxiswasper- formed in addition. Clinical check-up four years after laser therapy andaugmentationinregion37presenteduswitha patientwhowas,subjectively,withoutanypainand a clinically stabile implant abutment in region 37. Neither bleeding on probing or pus were recorded. Probing depth was and is 2–2.5 mm (Figs. 19 & 20). Radiological check-up (Figs. 21 & 22) showed a good agglomeration of the surrounding bone in implant regio 37. 14 I laser 3_2014 Fig. 19 Fig. 20 Fig. 21 Fig. 22