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Lasers in dental implantology – Deborah Lyle

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  Posted by: The Probe      18th April 2019

For many, the word laser (originally an acronym for “light amplification by stimulated emission of radiation”) still tends to conjure to mind science-fiction associations and images. However, the first laser was constructed almost sixty years ago, and the technology now sees common use in everything from measuring devices to videogame consoles. In recent years lasers are seeing increasing use in the field of dental implantology, with a wide variety of indications proposed.[1]

Within implant dentistry lasers are broken down into two basic types, soft tissue lasers or hard tissue lasers. Under these broad categories there are numerous different wavelengths currently in use, each with their own absorption characteristics. For example, CO2lasers are reflected away from metal, which can be a useful property as it minimises the chance of causing damage to the implant, but is less suited to osseous procedures.[2]

Lasers have a number of general advantages over conventional surgical tools, including: increased haemostasis, which in turn improves visibility of the surgical site, reduced swelling, reduced damage to surrounding tissue, and potentially a decreased chance of infection thanks to the photo sterilisation effect.[3]The use of lasers can also result in less post-operative pain for the patient.1Lasers are considered a minimally invasive mode of treatment – unlike a dental drill, a laser does not produce the uncomfortable vibrations and sounds that can often be distressing to patients. Additionally, laser tips are less prone to slipping than a conventional drill handpiece. In some cases, the use of a laser may even render anaesthesia unnecessary.3The above advantages make lasers attractive for implantology for obvious reasons, though care must be taken not to accidentally destroy the gingiva.2

It is important to note that while lasers do present numerous attractive benefits, they do not make conventional tools redundant. The density of cortical bone available for implant placement varies in different regions, which prevents the preparation of the entirety of the osteotomy site via laser, necessitating a drill at certain depths.3

Decontamination

Lasers have promise in maintaining and even saving dental implants. In conjunction with a suitable dye, lasers have been used to successfully eradicate drug-resistant bacteria.[4]With antibiotic resistance increasing at an alarming rate and no sign that this trend will abate, adjuncts and alternatives that help reduce the initial chance of infection are more vital than ever.[5]  

There are various types of dental implant in use today, each with different microscopic surface properties that have an effect on bacterial colonisation. Moreover, these surface differences can influence how effective mechanical debridement and chemical surface treatments are, or in some cases these methods can alter and damage the surface of the implant. Lasers have been employed to try to safely debride implant surfaces, while avoiding damage to the dental implant surface that could delay or prevent bone regrowth, or alter it in ways that promote bacterial growth.[6]Earlier types of laser used for this purpose (such Nd:YAG, Ho:YAG, GaAlAS, and CO2) generally accomplished this through vaporisation. However, the relatively high temperatures involved could still result in harmful alterations to the dental implant surface. There was also some risk of charring tissue, which could delay healing. More recently the Er,Cr:YSGG laser has been found to avoid these short-comings. It was found to cause no change in surface morphology at the highest power setting, even when used on a soft grade titanium implant. Additionally, laser ablation was found to be a more effective technique than the traditional use of an acid wash for debridement, as it completely eliminated the organic smear layer.10

Peri-implantitis, an inflammatory reaction around osseointegrated implants leading to loss of supporting bone tissue, is a leading cause of implant failure. Lasers can be used as a non-surgical treatment option for peri-implantitis lesions.[7]A literature review of studies on the usage of laser treatment for peri-implantitis found significant positive results six months after treatment. However, the researchers cautioned that longer-term success was contingent on maintaining plaque control.[8]

Plaque control

While lasers offer exciting treatment possibilities and promising results, they are not a panacea. In the fight against peri-implantitis continued control and maintenance of patient’s oral health is critical. 

The Waterpik®Ultra Professional Water Flosser is an easy to use, efficient and comfortable means of flossing – in fact it is more effective for interdental cleaning than traditional string floss.[9],[10]The Waterpik®Water Flosser will benefit any patient, but for those at risk of peri-implantitis the included Plaque Seeker®Tip can be invaluable thanks to its ability to deal with stubborn and difficult to reach plaque.

As dentists use more and more advanced technologies, it is important to never lose sight of the basics of good dental care. Patients must be educated and monitored to ensure the long-term success of treatments, no matter how effective the tools, without this human element they will not be fully successful.

For more information on Waterpik®please visit www.waterpik.co.uk. Waterpik®products are available from Amazon, Asda, Costco UK, Boots.com 
and Superdrug stores across the UK and Ireland.


[1]Francis L., Pillai S. Lasers in implant dentistry. Journal of Dental Implants. 2017; 7(2): 41-45. http://www.jdionline.org/text.asp?2017/7/2/41/225408December 6, 2018. 

[2]Martin E. Lasers in dental implantology. Dental Clinics of North America.2004; 48(4): 999-1015. https://europepmc.org/abstract/med/15464562December 6, 2018.

[3]Soodan K., Kalsi H., Priyadarshni P. Advantages of lasers in implantology. Modern Research in Dentistry.2018; 2(5): e550. https://crimsonpublishers.com/mrd/fulltext/MRD.000550.phpDecember 6, 2018.

[4]JuričI., AnićI. The use of lasers in disinfection and cleanliness of root canals: a review. ACTA Stomatologicia Croatica. 204; 48(1): 6-15. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4872808/December 6, 2018.

[5]Zaman S., Hussain M., Nye R., Mehta V., Mamun K., Hossain N. A review of antibiotic resistance: alarm bells are ringing. Cureus.2017; 9(6): e1403. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5573035/December 6, 2018.

[6]Miller R. Treatment of the contaminated implant surface using the Er,Cr:YSGG laser. Implant Dentistry. 2004; 13(2): 165-170. https://www.ncbi.nlm.nih.gov/pubmed/15179093December 6, 2018.

[7]Prathapachandran J, Suresh N. Management of peri-implantitis. Dental Research Journal. 2012; 9(5): 516-521. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3612185/December 6, 2018.

[8]Ashnagar S., Nowzari H., Nokhbatolfoghahaei H., Yaghoub Zadeh B., Chiniforush N., Choukhachi Zadeh N. Laser treatment of peri-implantitis: a literature review. Journal of Lasers in Medical Sciences. 2014; 5(4): 153-162. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4281989/December 6, 2018.

[9]Barnes C.M et al. Comparison of irrigation to floss as an adjunct to tooth brushing: effect on bleeding, gingivitis and supragingival plaque. J Clin Dent, 2005; 16(3): 71-77. 

[10]Goyal C., Lyle D., Qaqish J., Schuller R. Evaluation of the plaque removal efficacy of a water flosser compared to string floss in adults after a single use. Journal of Clinical Dentistry. 2013; 24(2): 37-42. https://www.ncbi.nlm.nih.gov/pubmed/24282867Accessed November 8, 2018.


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