Preservation of keratinized gingiva around dental implants using a diode laser when uncovering implants for second stage surgery

Year 2019, Volume: 53 Issue: 3, 106 - 112, 01.10.2019

Ra’ed Mohammed Ayoub Al-delayme

Abstract

Purpose: The aim of the present study was to assess if a 940-nm diode laser or a traditional scalpel approach is more effective in minimizing patient comfort and postoperative sequelae, preserving peri-implant keratinized mucosa, and in enhancing impression quality after uncovering dental implants.
Materials and methods: We designed a prospective, split mouth, single blinded, randomi¬zed controlled trial with patients who needed uncovering of dental implants. Our analysis included 388 implants in 73 patients. Split mouth technique was used to compare two approaches for uncovering implants: laser study group vs. scalpel control group. Patients were evaluated for intra- and post-operative pain and bleeding. At 1, 2, and 3 weeks post procedure patients in both groups were rechecked for postoperative sequelae, keratinized mucosal thickness quality and quantity, and accuracy of the implant emergence profile.
Results: The laser study group showed that there was a reduction in postoperative pain and bleeding that was statistically significant in comparison to the control group. There were also statistically significant differences in gingival color and presence or absence of soft tissue edema and in the gingival was emergency profile between the laser and scalpel sides at 1, 2, and 3 weeks’ post-procedure. Statistically significant differences (p< 0.001) were observed between the two groups in the criteria of ideal or satisfactory soft tissue projection in the gingival emergency profile, which indicates that impressions can be taken immediately or within 1 week after laser surgery.
Conclusion: Uncovering dental implants using a diode laser operating at the wavelength of 940 ±10 nm, and a power output of 0.4-10 W is recommended for preparing an accurate implant emergence profile. Laser treatment can also effectively preserve keratinized mucosa around implants in comparison to the conventional scalpel technique.

Keywords

Dental implants, diode lase, emergence profile, scalpel approach, keratinized gingiva

Supporting Institution

The author declared that this study has received no financial support.

References

• 1- Gellrich N, Rahlf B , Zimmerer R, Pott Ph and Rana M A new concept for implant-borne dental rehabilitation; how to overcome the biological weak-spot of conventional dental implants? Head & Face Medicine (2017) 13:17
• 2- Fornaini C , Merigo E , Vescovi P, Bonanini M , Antonietti W , Leoci L, Lagori G &Meleti M Different laser wavelengths comparison in the second-stage implant surgery: an ex vivo study Lasers Med Sci (2015) 30:1631–1639
• 3- Matys J, Flieger R, Dominiak M Effect of diode lasers with wavelength of 445 and 980 nm on a temperature rise when uncovering implants for second stage surgery: An ex-vivo study in pigs. Adv Clin Exp Med. 2017 Jul;26(4):687-693.
• 4- Bednarz W: The thickness of periodontal soft tissue ultrasonic examination – current possibilities and perspectives. Dent Med Probl 2011, 48, 3, 303–310.
• 5- Hoelscher DC, Simons AM: The rationale for soft-tissue grafting and vestibuloplasty in association with endosseous implants: A literature review. J Oral Implantol 1994, 20, 282–291.
• 6- Kan JYK, Rungcharassaeng K, Lozada JL, Zimmerman G: Facial gingival tissue stability following immediate placement and provisionalization of maxillary anterior single implants: A 2- to 8-year follow-up. Int J Oral and Max Impl 2011, 26, 179–187.
• 7- Hsu YT, Shieh CH, Wang HL: Using soft tissue graft to prevent mid-facial mucosal recession following immediate implant placement. J Int Acad Periodontol 2012, 14, 76–82.
• 8- Cosyn J, Hooghe N, de Bruyn H: A systematic review on the frequency of advanced recession following single immediate implant treatment. J Clin Periodontol 2012, 39, 582–589.
• 9- Bornstein E (2003) Combining multiple technologies to perform minimally invasive laser-assisted dental implant surgery. Dent Today 22(6):52–5
• 10- Yeh S, Jain K, Andreana S (2005) Using a diode laser to uncover dental implants in second-stage surgery. J Dent 53(6):414–7
• 11- Arnabat-Domínguez J, España-Tost AJ, Berini-Aytes L, Gay EC (2003) Erbium: YAG laser application in the second phase of implant surgery: a pilot study of 20 patients. Int J Oral Maxillofac Implants 18(1):104–12
• 12- Dörtbudak O, Haas R, Mallath-Pokorny G (2000) Biostimulation of bone marrow cells with a diode soft laser. Clin Oral Implants Res 11(6):540–5
• 13- Schwarz F, Aoki A, Sculean A, Becker J. (2009) the impact of laser application on periodontal and peri-implant wound healing. Periodontol; 51:79–108.
• 14- Usumez A, Cengiz B, Oztuzcu S, Demir T, Aras MH, Gutknecht N. Effects of laser irradiation at different wavelengths (660, 810, 980, and 1,064 nm) on mucositis in an animal model of wound healing. Lasers Med Sci. 2014;29(6):1807–1813.
• 15- Elanchezhiyan S, Renukadevi R, Vennila K. Comparison of diode laser-assisted surgery and conventional surgery in the management of hereditary ankyloglossia in siblings: A case report with scientific review. Lasers Med Sci. 2013;28(1):7–12.
• 16- Sagar K, Kaur A, Patel P, Kumar V, Narang S, Ranga P. Diode laser as an established tool in periodontics – a review. American Journal of Oral Medicine and Radiology. 2015;2:54–60.
• 17- Aoki A, Mizutani K, Schwarz F, et al. Periodontal and periimplant wound healing following laser therapy. Periodontol 2000. 2015;68(1):217–269.
• 18- Matys J, Botzenhart U, Gedrange T, Dominiak M. Thermodynamic effects after Diode and Er: YAG laser irradiation of grade IV and V titanium implants placed in bone – an ex vivo study. Preliminary report. Biomed Eng. 2016;5:499–507.
• 19- Heinemann F, Hasan I, Kunert-Keil C, et al. Experimental and histological investigations of the bone using two different oscillating osteotomy techniques compared with conventional rotary osteotomy. Ann Anat. 2012;194(2):165–170.
• 20- Eriksson AR, Albrektsson T. Temperature threshold levels for heatinduced bone tissue injury: A vital-microscopic study in the rabbit. J Prosthet Dent. 1983;50(1):101–107.
• 21- Eriksson AR, Albrektsson T, Magnusson B. Assessment of bone viability after heat trauma. A histological, histochmeical and vital microscopic study in the rabbit. Scand J Plast Reconstr Surg Hand Surg. 1984;18(3):261–268.
• 22- Lekholm U, Zarb GA. Patient selection and preparation. Branemark PI, Zarb GA, Albrektsson T, editors. , eds. Tissue-integrated prostheses; osseointegration in clinical dentistry. Chicago: Quintessence; 1985
• 23- Webert KE, Cook RJ, Sigouin CS et al. The risk of bleeding in thrombocytopaenic patients with acute myeloid leukaemia. Haematologica 2006;91:1530- 1537
• 24- Al-Delayme RMA, Awazli LG (2017) Evaluation of the effectiveness of 940nm Diode Laser in second-stage Dental Implant Surgery compared with the Conventional Scalpel Procedure: An in vivo Study. Int J Oral Craniofac Sci 3(2): 039-045.
• 25- El-Kholey KE. (2013) Efficacy and safety of a diode laser in secondstage implant surgery: a comparative study. Int J Oral Maxillofac Surg. 6. pi:S0901-5027 (13) 01113-2
• 26- Matys J., Dominiak M.Assessment of Pain When Uncovering Implants with Er:YAG Laser or Scalpel for Second Stage Surgery Adv Clin Exp Med 2016, 25, 6, 1179–1184
• 27- Gabrić Pandurić D, Sušić M, Brozović J, Smojver I, Vučićević V, Katanec D: Diode and Er:YAG laser vs. conventional technique for second stage surgery. Clin Oral Impl Res 2014, 25, 397.
• 28- Kissa J. , El Kholti W. , Laalou Y., El Farouki M. Augmentation of keratinized gingiva around dental implants J Stomatol Oral Maxillofac Surg 118 (2017) 156–160
• 29- Fornaini C., Merigo E., Vescovi P., Bonanini M., Antonietti W., Leoci L. Lagori G., Meleti M Different laser wavelengths comparison in the second-stage implant surgery: an ex vivo study Lasers Med Sci (2015) 30:1631–1639
• 30- Andeson M. , Andrisan C. , Lico S., Silvestre F.,Gargari M.5, Arcuri C. increasing volume of vestibular soft tissues in flapless implant surgery through a modified connective punch technique: a controlled clinical trial Oral & Implantology - anno IX - n. 3/2016