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47 47 1_2016 laser laser_case report case report I Ontheonehand,thehighintensityofadiodelaser canremoveepithelialcellsfor2or3mmatthegingi- val crest and delay epithelial cell migration to the im- plant surface, preventing pocket formation around the implant and creating a sterile area for implant placement.Ontheotherhand,adiodelasercanoften besetatalowoutputtoperformbiostimulation(low- level laser therapy, LLLT), accelerating the healing process. Laser-assisted osseointegration without the useofanybonesubstitutesispresentedinthisarticle. _Anamnesis and diagnosis A 25-year-old female patient with the complaint ofarightincisorfracturepresentedfortreatment.The patient’smedicalhistoryshowednosystemicmedical problems, no allergic reaction, no medicaments and nohistoryofpastsurgicalprocedures,andthusitwas notnecessarytoreferthepatientformedicalconsul- tation. An oral and maxillofacial examination of the pa- tient found no temporomandibular joint or myofas- cial disturbances, as well as no functional or para- functionalhabits,butaClassIocclusionandpoororal hygiene. As shown by the clinical findings, the tooth was infected and a crown–root fracture was obvious (Fig. 1). The apical area showed the orifice of a fistula, but there was no pain or swelling. The radiographic examination showed a radiolu- centlesionattheapicalpartoftheinvolvedteeth.The toothwasdiagnosedasnotworthpreservingandthus the final decision was to perform an atraumatic ex- tractionfollowedbydentalimplantplacement(Fig.2). Theconsentformwascompletedandthepatient’s informationwasreviewed(examinationsheetandra- diograph, consent form, etc.). Thereafter, antibiotic prophylaxiswasprescribed(penicillinV500mg,q.i.d., orally, starting one day before extraction). _Initial treatment Afterthediagnosis,thetreatmentplanwastofirst extract the tooth and then accelerate wound healing using a laser device. The surgical area was anaes- thetised with infiltration of 1.8 ml of 2 per cent lido- cainewith1:100,000epinephrineinordertoperform an atraumatic tooth extraction. The controlled area was then defined and the laser warning signs placed properly to secure the operating room. Furthermore, eyeprotectionwasprovidedforthepatient,aswellas for the patient’s guardian and the assistant. Havingextractedthetooth(Figs.3&4),socketde- bridementandirrigationwithnormalsalinewereper- formed.Thelasersystemwasthencalibratedinorder toirradiatethetreatedareawithalow-intensitylaser (LLLT)foraccelerationofwoundhealing.Thelaserpa- rameterswereasfollows:wavelengthof980nm,out- put power of 1 W, irradiation time of 20 s, spot size of 3 mm, power density of 1.41 W/cm2 at the end of the low-levelhandpiece,socketdiameterof8mm,irradi- ation area of πr2 = 0.502.4 cm2 , power density of 0.199W/cm2 atthetargetsurface,doseof3.98J/cm2 , non-contactmode(1mmfromtheorifice)androtat- ing at the orifice of the socket, single dose. After the treatment, the patient was advised to keeptheareacleanandplaquefreewithgentlebrush- ing, continue using the antibiotic and take over-the- counter analgesics as needed. The next visit was scheduled for one week after the initial treatment in order to perform the implant placement. _Implant placement One week after the initial treatment, the implant wasplaced.Afterrevisionoftheconsentformandes- tablishing safe laser delivery conditions, the surgical area was anaesthetised with infiltration of 1.8 ml of 2 per cent lidocaine with 1:100,000 epinephrine. Fig. 3_Clinical view. Fig. 4_Atraumatic extraction. Fig. 5_De-epithelialization and implant site preparation. Fig. 6_Implant placement without any bone substitutes. Fig. 7 & 8_Two months after implant placement. I 21 laser 2_2015 Fig. 3 Fig. 4 Fig. 6 Fig. 7 Fig. 5