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ePaper created 2016-07-29, 16:53:04 | version 1.38.0
| industry 18 laser 2 2016 Materials and methods Astandardirradiationprotocolwasusedineachin- stance for the clinical series presented here. In all cases, an Nd:YAG laser (LightWalker ATS, Fotona, Ljubljana, Slovenia) was used in conjunction with a flat-tophandpiece(Genovahandpiece,Fotona,Slove- nia).ThelaserwasusedinMSPmode,whichproduces individual pulses with a width of 100 microseconds. An average power of 0.5 watts and a pulse repetition rate of 10 pulses per second were used in each case, and irradiance was calculated as 0.5 W/cm2 . Therapy sessionsoccurredeveryotherday,withthetotalnum- ber of sessions varying in accordance with clinical judgement and the characteristics of the particular tissue target. Case 1 A52-year-oldfemalepresentedwithaggressivelo- calised periodontitis. After stabilisation of the acute inflammation,thepatientwascheckedandadeepin- frabony defect was evident on the distal aspect of tooth #23 (Fig. 1). The flap design aimed also to cor- rect the pre-existent gingival recession (Fig. 2). A careful debridement of the granulation tissue was done (Fig. 3) and, afterward, a graft with inorganic bovine-derived hydroxyapatite was placed (Fig. 4). After the surgery (Fig. 5), the area was irradiated withNd:YAGlaser(LightWalkerATS,Fotona,Slovenia) with the flat-top Genova handpiece every other day fortendays(fiveapplications)withthefollowingpa- rameters: 0.5 W, 10 Hz in MSP modality, and 60 sec- onds per point (Fig. 6). The healing was uneventful, with minimal pain and swelling. A control after six months showed a good stability of both the bone graft and the soft tissue (Fig. 7). Case 2 A 41-year-old male patient presented with trau- maticseveregingivalrecessionsonthelowerincisors. After a careful consultation, the patient was sched- uled for the mucogingival surgery (Fig. 8). Due to the lack of keratinised tissue and the shallow vestibule, the only possible treatment was to harvest a free gingival graft for the root coverage procedure. The recipient bed was created with a partial-thick- ness flap and all of the epithelial part was removed (Fig. 9). The graft was completely stabilised on the areawithatightsutureinordertoavoidtheformation of a thick layer of exudate, which could jeopardise the final outcome of the procedure (Fig. 10). Biomodulation was performed every other day for 14 days (seven sessions) with the flat-top handpiece in MSP modality, 10 Hz, 0.5 W (LightWalker ATS, Fotona, Slovenia), and 60 sec per point. After the ini- tial phase of 14 days (Fig. 11) and for the whole mat- uration stage of 42 days (Fig. 12), the graft appeared successful and the root coverage was achieved. Case 3 A 65-year-old female patient showed a fracture of an implant in the frontal area and missing teeth from Fig. 18 Fig. 20 Fig. 19 Fig. 21 Fig. 18: Biomodulation spots after suturing. Figs. 19 & 20: Situation after three months. Fig. 21: Stable tissue after six months. 22016