|Year : 2012 | Volume
| Issue : 1 | Page : 22-25
Lasers in dental implantology
Smita I Musani1, Nikhil V Jain1, Ramandeep J Dugal1, Iqbal E Musani2
1 Department of Prosthodontics and Implantology, M.A. Rangoonwala College of Dental Sciences and Research Centre, Pune, Maharashtra, India
2 Department of Pedodontics, M.A. Rangoonwala College of Dental Sciences and Research Centre, Pune, Maharashtra, India
|Date of Web Publication||15-Sep-2012|
Nikhil V Jain
102, A - Adinath Apts, 281, Tardeo Road, Mumbai - 400 007, Maharashtra
Source of Support: None, Conflict of Interest: None
Advances in implant designs, materials and techniques have led to predictable success in their application, and several types of implants are now available for use in rehabilitation of different clinical problems. In the last 15 years, a number of laser wavelengths have been brought to the profession for various procedures. The CO2, Nd:YAG, diode, argon, and holmium wavelengths are primarily soft tissue lasers. The introduction of the erbium family of wavelengths, with its ability to safely remove hard tissue, has stimulated a new wave of interest in laser therapy in the dental profession. The parallel in the expansion of implant dentistry and laser dentistry in clinical practice is apparent. As advocates for laser dentistry continue to seek new ways to use the technology and as more practitioners become involved in implant dentistry, it is logical to see the concurrent use of both technologies in clinical practice. The aim of this article is to describe a second stage surgery using a dental laser and enumerates its uses with advantages.
Keywords: Lasers, dental Implants, Nd:YAG Dental Laser, second stage surgery
|How to cite this article:|
Musani SI, Jain NV, Dugal RJ, Musani IE. Lasers in dental implantology. J Dent Lasers 2012;6:22-5
| Introduction|| |
The goal of modern dentistry is to restore normal contour, function, comfort, esthetics, speech, and health, regardless of the atrophy, disease, or injury of the stomatognathic system. However, the more teeth a patient is missing, the more arduous this goal becomes with traditional dentistry. As a result of research, advances in implant designs, materials and techniques have led to predictable success in their application, and several types of implants are now available for use in rehabilitation of different clinical problems.
Lasers were brought to general practice in 1989 by Drs. William and Terry Myers, who modified an ophthalmic Nd:YAG laser for dental use. This unit pioneered the development of lasers dedicated to the field of dentistry rather than medicine. In the last 15 years, since a number of laser wavelengths have been brought to the profession for various procedures. The CO 2 , Nd:YAG, diode, argon, and holmium wavelengths are primarily soft tissue lasers. The introduction of the erbium family of wavelengths, with its ability to safely remove hard tissue, has stimulated a new wave of interest in laser therapy in the dental profession. Continuing research on all of these wavelengths has brought new opportunities for use in the clinical environment.
The parallel in the expansion of implant dentistry and laser dentistry in clinical practice is apparent. As advocates for laser dentistry continue to seek new ways to use the technology and as more practitioners become involved in implant dentistry, it is logical to see the concurrent use of both technologies in clinical practice.
| Case Report|| |
A case involving a 40-year-old female patient reported to the department of Prosthodonics and Implantology at the M.A. Rangoonwala College of dental sciences and research centre, with a missing mandibular left first molar.
On oral examination the mesio - distal and bucco - lingual width of the edentulous space was found to be adequate. Orthopantamograph was evaluated and the size of the implant determined. Her systemic medical history was uneventful. Routine blood investigations revealed that all the values were in the normal reference range.
A mucoperiosteal flap was raised using interdental and crevicular incisions. Osteotomy was performed using a stent, starting with the pilot drill, and then the depth of the osteotomy was assessed using the depth gauge. The site was gradually enlarged using reamers with progressively increasing diameters. The implant (Uniti Implant, Equinox, D 4.3mm L 10mm) was then placed.
Four months later [Figure 1], the second stage surgery was performed [Figure 2] using a dental soft tissue laser in order to replace the cover screw with a gingival former [Figure 3]. Nd:YAG was the laser of choice as it is a soft tissue laser, providing a bloodless field of surgery and results in rapid healing and suturing is avoided. Nd:YAG laser with a 300μm fiber tip was used for the above mentioned purpose at power settings of 3W/50Hz (Fotona Fidelis). The patient was recalled after 24 hours, 3 days, 6 days and healing was observed [Figure 4].
| Discussion|| |
Uses of laser technology in implant dentistry -
Second stage surgery
The advantages of using lasers in second stage surgery are the same as for any other soft tissue dental procedure.
These advantages include increased hemostasis, minimal damage to the surrounding tissue, reduced swelling, reduced infection, and reduced pain postoperatively.
Due to the hemostasis provided by lasers, there is the significant advantage of improved visibility during surgery. 
Decontamination of infected and ailing implant bodies
Diode lasers were used in a study by Bach et al who found a significant improvement in the five-year survival rate when integrating laser decontamination into the approved treatment protocol.
Dortbudak et al found that the use of low-level laser therapy with a diode soft laser on the contaminated surface reduced the counts of bacteria by a minimum of 92%. This reduction was a significant improvement, but complete elimination of bacteria was not achieved with this wavelength.
CO 2 lasers have been successful in decontaminating implant surfaces. Kato et al found that this wavelength did not cause surface alteration, rise of temperature, or serious damage of connective tissue cells located outside the irradiation spot or cause inhibition of cell adhesion to the irradiated area. They concluded that irradiation with an expanded beam may be useful in removing bacterial contaminants from implant surfaces.
The Er:YAG laser also has been proposed for surface decontamination of dental implants. Kreisler et al,  after evaluating 72 titanium blocks in vitro with three different surfaces, concluded that even at low energy densities, the Er:YAG laser has a high bactericidal potential on common implant surfaces, with no morphologic implant surface alterations detected.
Kreisler et al performed a study on various wavelengths including Nd:YAG, Ho:YAG, Er:YAG, CO2, and gallium-aluminum-arsenide for implant surface decontamination. They concluded that Nd:YAG and Ho:YAG lasers are not suitable for decontamination of dental implant surfaces at any power output.
With Er:YAG and CO2, the power output must be limited so as to avoid surface damage. The gallium-aluminum- arsenide laser seems to not cause any surface alterations.
Although there is little concern in the literature about possible contamination of the osteotomy site by the use of drills in the oral cavity, there is the potential benefit of the laser sterilizing the bone as it penetrates and creates an osteotomy site.
It has been proposed by some clinicians who use lasers that it is possible to create the entire osteotomy site for conventional-sized implants. Although it may be possible on an individual-case basis, it has yet to be shown that this would be a superior technique to be used in everyday practice.
Placement of mini implants
A patient with potential bleeding problems could be treated with a laser to provide essentially bloodless surgery in the bone. This practice could be particularly useful in the placement of mini-implants. Using the autoadvance technique advocated by Balkin et al,  a small opening could be placed into the soft tissue and approximately 3 mm into the bone. These mini-implants, 1.8 mm in diameter with a self-tapping thread, can be rotated slowly and autoadvanced into the soft cancellous bone.
Laser welding of titanium components
One of the hallmarks of the osseointegration technique is a passive fit of the prosthesis on the implants. 
It has been proposed that one of the ways to obtain a true passive fit is by the elimination of the casting technique.
The expansion and contraction during casting can lead to a nonpassive fit of the implant prosthesis when placed onto multiple implants.
To that end, the proposed laser welding of titanium components has been advocated and used with some mixed success.
Iglesia and Moreno  stated that the aim of the use of a Nd:YAG laser welder technique is to allow the use of titanium as the best suited material. They concluded that by using high-precision machined abutments and titanium bars to connect the abutments with a laser welding machine, a passive fit was achieved.
Bergendal and Palmqvist  found that there was a tendency for more fractures of artificial teeth and acrylic resin in the titanium-welded framework group. They also believed that one of the issues was the learning curve for the technicians and that as familiarity with the procedure increased, success rates improved.
In a recent study, Jemt et al concluded that except for a minor tendency for small chips of porcelain veneers, laser-welded titanium frameworks presented an overall similar clinical performance to conventional, cast frameworks in implant-supported, fixed partial denture situations after five years.
Reidy et al concluded that the laser-welded framework exhibited a more precise fit than the one-piece casting. In a study done by Ortorp et al it was concluded that the cast frameworks had a higher overall success rate, but the titanium framework treatment results were well in accordance with the results of the control group. Their assessment was that laser-welded frameworks were a viable alternative in the edentulous mandible.
| Summary|| |
It is clear from the available data that dental lasers can be useful in the practice of implant dentistry. The challenge for the practitioner is the same as for any other area of dentistry: Knowing when, where, and what armamentarium to use in any given situation. Not every dental laser wavelength is necessarily useful for all dental implant situations. After clinicians know the characteristics of the wavelengths available to them, the application of this technology to the specific situation certainly is warranted. Dental implant surfaces and geometry also may affect the success of lasers in an attempt to bring ailing implants back to health. A comprehensive knowledge of these implant characteristics also is needed. As dental laser therapy continues to expand into the mainstream of dental practice, practitioners will examine the use of lasers in more procedures, which in turn will provide new impetus for further research into these fields to provide more and better therapy for dental patients.
| References|| |
|1.||Miserendino LJ, Pick RM. Lasers in dentistry. Chicago: Quintessence Publishing; 1995. |
|2.||Bach G, Neckel C, Mall C, Krekeler G. Conventional versus laser-assisted therapy of peri-implantitis: A five-year comparative study. Implant Dent 2000;9:247-51. |
|3.||Dortbudak O, Haas R, Bernhart T, Mailath-Pokorny G. Lethal photosensitization for decontamination of implant surfaces in the treatment of peri-implantitis. Oral Implants Res 2001;12:104-8. |
|4.||Kato T, Kusakari H, Hoshino E. Bactericidal efficacy of carbon dioxide laser against bacteria-contaminated titanium implant and subsequent cellular adhesion to irradiated area. Lasers Surg Med 1998;23:299-309. |
|5.||Kreisler M, Kohnen W, Marinello C, Gotz H, Duschner H, Jansen B, et al. Bactericidal effect of the Er:YAG laser on dental implant surfaces: an in vitro study. J Periodontol 2002;73:1292-8. |
|6.||Kreisler M, Gotz H, Duschner H. Effect of Nd:YAG, Ho:YAG, Er:YAG, CO2, and GaAIAs laser irradiation on surface properties of endosseous dental implants. Int J Oral Maxillofac Implants 2002;17:202-11. |
|7.||Balkin BE, Steflik DE, Naval F. Mini-dental implant insertion with the auto-advance technique for ongoing applications. J Oral Implantol 2001;27:32-7. |
|8.||Branemark PI, Zarb GA, Albrektsson T. Tissue-integrated prostheses: osseointegration in clinical dentistry. Chicago: Quintessence Publishing; 1985. |
|9.||Iglesia MA, Moreno J. A method aimed at achieving passive fit in implant prostheses: case report. Int J Prosthodont 2001;14:570-4. |
|10.||Bergendal B, Palmqvist S. Laser-welded titanium frameworks for fixed prostheses supported by osseointegrated implants: A 2-year multicenter study report. Int J Oral Maxillofac Implants 1995;10:199-206. |
|11.||Jemt T, Henry P, Linden B, Naert I, Weber H, Wendelhag I. Implant-supported laser-welded titanium and conventional cast frameworks in the partially edentulous law: A 5-year prospective multicenter study. Int J Prosthodont 2003;16:415-21. |
|12.||Reidy SJ, Lang BR, Lang BE. Fit of implant frameworks fabricated by different techniques. J Prosthet Dent 1997;78:596-604. |
|13.||Ortorp A, Linden B, Jemt T. Clinical experiences with laser-welded titanium frameworks supported by implants in the edentulous mandible: a 5-year follow-up study. Int J Prosthodont 1999;12:65-72. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4]