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Table of Contents
REVIEW ARTICLES
Year : 2020  |  Volume : 8  |  Issue : 1  |  Page : 11-13

Lasers and implant dentistry: An update


1 Department of Periodontology, Sharavathi Dental College and Hospital, Shivamogga, Karnataka, India
2 Department of Prosthodontics, Vokkaligara Sangha Dental College & Hospital, Bengaluru, Karnataka, India
3 Department of Prosthodontics, A. J. Institute of Dental Sciences, Mangalore, Karnataka, India
4 Department of Prosthodontics, College of Dentistry, Al Zulfi, Majmaah University, Saudi Arabia
5 Department of Pediatric and Preventive Dentistry, A. J. Institute of Dental Sciences, Mangalore, Karnataka, India
6 Department of Periodontology, Faculty of Dentistry, MAHSA University, Jenjarom, Malaysia

Date of Submission12-Feb-2020
Date of Acceptance16-Feb-2020
Date of Web Publication20-Mar-2020

Correspondence Address:
Bharathi Poojary
Department of Periodontology, Sharavathi Dental College and Hospital, NH 206, Alkola, T. H. Road, Shivamogga 577204, Karnataka.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/INJO.INJO_5_20

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  Abstract 

Lasers have various advantages as compared to the conventional techniques in the field of implant dentistry. The use of laser in any field, including implant dentistry, leads to a better clinical experience and better results as compared to the conventional implant dentistry from a patient’s perspective as well. In this article, we have made an attempt to briefly discuss the use of the lasers in the field of implant dentistry.

Keywords: Implant dentistry, laser, low-level laser, therapy, photobiomodulation


How to cite this article:
Poojary B, Raj B, Upadhya M, Kumari V, Muralikrishna B, Thomas B. Lasers and implant dentistry: An update. Int J Oral Care Res 2020;8:11-3

How to cite this URL:
Poojary B, Raj B, Upadhya M, Kumari V, Muralikrishna B, Thomas B. Lasers and implant dentistry: An update. Int J Oral Care Res [serial online] 2020 [cited 2020 Jun 3];8:11-3. Available from: http://www.ijocr.org/text.asp?2020/8/1/11/281143




  Introduction Top


Lasers are acronym, which stands for light amplification of stimulated emission radiation. They are focused light beams that can be used to alter or remove tissue in small amounts. In the field of dentistry, laser can be used for various surgical and nonsurgical procedures. Dentists are choosing to use dental lasers as it is possible to successfully treat many common dental conditions in a gentle, minimally invasive way. The neodymium-doped yttrium aluminum garnet (Nd:YAG) (1064nm), one of the first dental lasers, offered advantages of soft-tissue ablation, hemostasis, and bacterial control.[1] Research conducted by various authors into the use of this laser drew conclusions that penetrating and high peak heat energy produced transmission of heat to the bone from the heated implant surface, potential for pitting and melting, and the porosity of the implant surface. The implant material, titanium as a metal, shows reflectivity to incident light energy, which is lowest in the range 780–900nm, rising as the wavelength increases toward 10,600nm. In such scenarios, the use of the carbon dioxide (CO2) wavelength minimizes the risk of resultant temperature-induced tissue damage.[1],[2],[3] The erbium family of lasers is similar to the CO2 wavelength in some respects. According to the results of study conducted by Chryssikopoulos,[4] erbium:yttrium-aluminum-garnet (Er:YAG) laser showed precise cuts in the oral mucosa by dry ablation using small diameter tips and pulse repetitions of 8–10 Hz, thus warranting its use during soft-tissue procedures. However, hemostatic capability of the erbium family of lasers is lesser unlike CO2 or Nd:YAG.[4] The diode wavelength group, deliver in low-power CW values (1–2 W average power), causes minimal damage to the implant[5] or surrounding bone[6],[7] and could be regarded as the instrument of choice for osseous procedures.

The clinical application of lasers can be broadly categorized into two modalities: nonsurgical use (laser-welded titanium framework technology, laser micropatterning of dental implants, computer-assisted laser-cured surgical template, and laser-oriented recording on dental prostheses) and surgical use (removal of granulation tissue, miomodulation, implant placement, second-stage recovery and gingival management, treatment of peri-implantitis, and low-level laser therapy [LLLT]).


  Laser-welded Titanium Framework Technology Top


Laser-welded technology can be considered as an alternative to the conventional lost wax-casting technique in the field of implant dentistry. The titanium has various properties that are advantageous for its use in bar superstructures.[8],[9] In addition, the laser energy allows for a much stronger, passively fitting superstructure.[8],[9] Evidence reported that titanium frameworks compared favorably with cast-alloy frameworks with no statistical significance in implant loss, framework fractures, component fit, or margin bone loss.[8] According to the results of study conducted by Ortorp et al.,[10] success of laser-welded titanium frameworks parallels cast-alloy frameworks. Jackson[11] reported a favorable application of laser-welded titanium frameworks in the treatment of three totally edentulous patients but he pointed out prosthetic veneer fracture from the superstructure as a possible complication, stressing on the need for a disciplined, predictable approach to the fabrication of such superstructures.


  Laser Micropatterning of Dental Implants Top


Laser peening is a form of cold working, produces a surface with refined grain structures, compressive residual stresses, and increased hardness in metallic materials.[12],[13] It is performed using precision laser micromachining (excimers or Nd:YAG laser) on implant surface, which creates a controlled surface roughness and has shown to stimulate bone growth at the surface. Evidence suggests that laser peening can achieve more significant surface enhancement than grit blasting.[14]


  Computer‑aided Laser-cured Surgical Template Top


Surgical guides in the placement of implants provide more accuracy than freehand placement.[15] Rapid prototyping techniques allow in the production of physical models on the basis of virtual computational models. The various rapid prototyping technologies that are currently in use are stereolithography (SLA), inkjet‑based system (three-dimensional printing), selective laser sintering (SLS), and fused deposition modeling, of which the SLA uses an ultraviolet laser to “laser cure” cross sections of a liquid resin. SLS models are opaque as compared to SLA models that are translucent.[16] Fabrication of surgical templates using SLA has been proven to benefit from high precision by several well‑documented researches.[17]


  Removal of Granulation Top


Lasers are used for the removal of granulation tissue and disinfection of the surgical area after extraction. Erbium lasers can be used for this purpose. Due to significant differences in water content, the erbium laser can be used to only remove soft tissue by setting the parameters correctly (energy density and pulse duration). The thermal side effects on the bone are lesser with these type of lasers,[4] and they also increase the comfort to the patient while disinfecting the surface,[18] as no force is applied, unlike with curettes. The lasers allow for safe cleaning of very fragile bone due to their noncontact or pseudo-contact mode.[19]


  Implant Placement Top


The hard-tissue lasers such as Er:YAG can be used to obtain the initial bed for implant placement rather than using micromotor. A laser removes the soft tissue and the cortical plate of bone in a circular pattern to approximately 2–3mm. The remainder of the osteotomy site can be prepared using a handpiece drill. The laser offers the advantages such as quick healing time, fast integration, minimal patient discomfort, and superior bone‑to‑implant contact; it eliminates the need for trauma during flap elevation and suture placement.[18] However, the entire osteotomy site cannot be prepared using lasers.


  Uncovering Implants in the Second Stage Top


The different wavelengths of laser can be used to uncover implants in stage-II implant surgery.[19] The most commonly used lasers in this case are the CO2 lasers, and Er:YAG lasers are used with success, whereas Nd:YAG laser is contraindicated as this causes temperature buildup around the implants and also melting of the implant surface. Laser-treated tissue margins do not recede after healing. The laser is tipped at a 45° angle toward the implant. The advantages of laser used in this procedure are hemostasis; it facilitates easier visual access to the cover screw, production of a protective coagulum––an aid to healing and patient comfort during and after treatment, and allows impression procedures to be carried out in the same appointment.


  Management of Peri‑implantitis Top


The lasers can be used for debridement, and degranulation of failing and ailing implants can be performed using a laser wavelength that is noninjurious to bone. The CO2 lasers, diode lasers, and Er:YAG were more effective in the removal of plaque and calculus on implant abutments without injuring their surfaces.[19] On the contrary, Nd:YAG lasers are contraindicated for use in the treatment of peri‑implantitis as they cause an increase in the surface temperature and also changes of the implant surface.


  Low‑level Laser Therapy/Phototherapy/Photobiomodulation Top


The low‑level laser was pioneered by Endre Mester in Budapest in the late 1960s. He showed an increase in collagen synthesis in skin wounds. LLLT is based on biostimulation of the tissues with monochromatic light. The LLLT has the ability to accelerate osseointegration, as shown by its effects on bone repair.[18],[19] Laser therapy improves bone matrix production because of the improved vascularization and anti‑inflammatory effects.


  Conclusion Top


Laser provides the dentist with a variety of advantages in the field of dental implants. Evidence-based practice with respect to the use of different wavelengths of laser has the potential to improve the patient experience and to provide better results clinically as well.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Parker S. Surgical laser use in implantology and endodontics. Br Dent J 2007;202:377-86.  Back to cited text no. 1
    
2.
Winkler M. Lasers in dental implantology. Dent Clin N Am 2004;48:999-1015.  Back to cited text no. 2
    
3.
Walsh LJ. The use of lasers in implantology: An overview. J Oral Implantol 1992;18:335-40.  Back to cited text no. 3
    
4.
Chryssikopoulos SA. Er:YAG and CO2 lasers in oral implantology: A study on 83 implants. J Oral Laser Appl 2003;3:102.  Back to cited text no. 4
    
5.
Romanos GE, Everts H, Nentwig GH. Effects of diode and Nd:Yag laser irradiation on titanium discs: A scanning electron microscope examination. J Periodontol 2000;71:810-5.  Back to cited text no. 5
    
6.
Kreisler M, Al Haj H, D’Hoedt B. Temperature changes induced by 809-nm GaALAs laser at the implant-bone interface during simulated surface decontamination. Clin Oral Implants Res 2003;14:91-6.  Back to cited text no. 6
    
7.
Kreisler M, Schoof J, Langnau E. Temperature elevations in endosseous dental implants and the peri-implant bone during diode-laser-assisted surface decontamination. Proc SPIE 2002;4610:21-30.  Back to cited text no. 7
    
8.
Jemt T. Three-dimensional distortion of gold alloy castings and welded titanium frameworks. Measurements of the precision of fit between completed implant prostheses and the master casts in routine edentulous situations. J Oral Rehabil 1995;22:557-64.  Back to cited text no. 8
    
9.
Jemt T, Linde′n B. Fixed implant-supported prostheses with welded titanium frameworks. Int J Periodont Restor Dent 1992;12:177-84.  Back to cited text no. 9
    
10.
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.  Back to cited text no. 10
    
11.
Jackson BJ. The use of laser-welded titanium framework technology: A case report for the totally edentulous patient. J Oral Implantol 2005;31:294-300.  Back to cited text no. 11
    
12.
Lu JZ, Luo KY, Zhang YK, Cui CY, Sun GF, Zhou JZ, et al. Grain refinement of LY2 aluminum alloy induced by ultra‑high plastic strain during multiple laser shock processing impacts. Acta Mater 2010;58:3984-94.  Back to cited text no. 12
    
13.
Zhang XC, Zhang YK, Lu JZ, Xuan FZ, Wang ZD, Tu ST. Improvement of fatigue life of Ti–6Al–4V alloy by laser shock peening. Mater Sci Eng A 2010;527:3411-15.  Back to cited text no. 13
    
14.
Peyre P, Scherpereel X, Berthe L, Carboni C, Fabbro R, Beranger G, et al. Surface modifications induced in 316L steel by laser peening and shot‑peening. Influence on pitting corrosion resistance. Mater Sci Eng A 2000;280:294‑302.  Back to cited text no. 14
    
15.
Park C, Raigrodski AJ, Rosen J, Spiekerman C, London RM. Accuracy of implant placement using precision surgical guides with varying occlusogingival heights: An in vitro study. J Prosthet Dent 2009;101:372-81.  Back to cited text no. 15
    
16.
Berry E, Brown JM, Connell M, Craven CM, Efford ND, Radjenovic A, et al. Preliminary experience with medical applications of rapid prototyping by selective laser sintering. Med Eng Phys 1997;19:90‑6. Eriksson AR, Albrektsson T. Temperature threshold levels for heat‑induced bone tissue injury: A vital‑microscopic study in the rabbit. J Prosthet Dent 1983;50:101‑7.  Back to cited text no. 16
    
17.
Lal K, White GS, Morea DN, Wright RF. Use of stereolithographic templates for surgical and prosthodontic implant planning and placement. Part I. The concept. J Prosthodont 2006;15:51‑8.  Back to cited text no. 17
    
18.
Kusek ER. Use of the Ysgg laser in dental implant surgery: Scientific rationale and case reports. Dent Today 2006;25:98, 100, 102-3.  Back to cited text no. 18
    
19.
Kreisler M, Kohnen W, Marinello C, Götz 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.  Back to cited text no. 19
    




 

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  In this article
   Abstract
  Introduction
   Laser-welded Tit...
   Laser Micropatte...
   Computer‑a...
   Removal of Granu...
  Implant Placement
   Uncovering Impla...
   Management of Pe...
   Low‑level ...
  Conclusion
   References

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