Surgical laser use in implantology and endodontics

The Efficacy of a Diode Laser on Titanium Implants for the Reduction of Microorganisms That Cause Periimplantitis

The paper presents the optimisation of a safe diode laser irradiation process applied to the surface of titanium implants in order to reduce microbial numbers in the treatment of inflammation classified as periimplantitis. The study comprised isolation and identification of microorganisms inhabiting surfaces of dental implants, crowns, teeth and saliva from patients with fully symptomatic periimplantitis. Microorganisms were detected by a culture-dependent method and identified with the use of MALDI-TOF mass spectrometry. The isolated microorganisms were inoculated on the surface of a new implant and then irradiated by a diode laser (wavelength of 810 ± 10 nm) in one, two or three repetitions and biocidal efficacy was assessed. To evaluate impact of laser irradiation on roughness, morphology and structure of the implant surface, optical profilometry, scanning electron microscopy and optical microscopy were used. Examination of the tested surfaces and saliva revealed the presence of Gram-positive and Gram-negative bacteria and one fungal species. In all patients, cultures from the endosseous part of the implant revealed the presence of the pathogenic and pyogenic bacterium Streptococcus constellatus. In 13 out of 20 samples laser-irradiated in duplicate and triplicate, all microorganisms were eliminated. The irradiation used did not cause any changes in the properties of the implant surface.

Adjunctive Use of Lasers in Peri-Implant Mucositis and Peri-Implantitis Treatment: A Systematic Review

BACKGROUND

The aim of this systematic review is to compare the effectiveness of lasers in the treatment of implant mucositis and peri-implantitis compared to conventional treatment (non-surgical or surgical: resective or regenerative).

METHODS

Sources of PubMed, Cochrane and Google Scholar search engines were used on articles published from 1997 to 2020 in English, with selected keyword criteria applied. Nine randomized controlled trials (RCTs) were selected.

RESULTS

All included studies were considered of "high quality" according to the quality assessment scale. The comparative assessment of the RCTs was done twice for each RCT based on the type of treatment and according to wavelength. There is strong scientific evidence that, regarding non-surgical treatment, adjunct laser application can provide better results only in the short term (three months). Regarding the surgical approach, the method of decontamination plays a subordinate role. All wavelengths/applications presented similar results.

CONCLUSION

Within the limitations of this study, the adjunctive use of lasers in the treatment of peri-implant inflammation is effective for up to three months; there is no strong evidence regarding the long term benefit compared to conventional treatment.

Clinical comparison of the use of ER,CR:YSGG and diode lasers in second stage implants surgery

OBJECTIVES

To compare the effects of diode and erbium, chromium: yttrium-scandium-gallium-garnet (Er,Cr:YSGG) lasers in second-stage implant surgery applications.

METHODS

This is a cross-sectional study that was carried out on patients who received implant treatment at the Departments of Oral and Maxillofacial Surgery and Periodontology, Van Yuzuncu Yil University, Van, Turkey between January 2017 and January 2018. Implants of the patients in the first group (n=20) were exposed with 940 nm Ga-Al-As diode laser while the implants of the second group (n=20) were uncovered with 2780 nm Er,Cr:YSGG laser in the second-stage surgery. Visual analogue scale (VAS) values during day 0 and following the operation on days 1, 2, 3 intraoperative bleeding grades, number of analgesics used in the postoperative period, operation time per implant, and postoperative complications were recorded.

RESULTS

When gender, smoking, the presence of systemic disease, toothbrushing frequency, analgesic use, bleeding and complications observed at the control session were analyzed, no statistically significant relationship was found between the 2 groups. It was observed that males had statistically significant higher VAS values than females (p less than 0.05).

CONCLUSION

Since diode lasers are more economical, smaller, and can meet the clinical needs of clinicians, it is likely that these lasers may be the preferred choice of the clinicians in surgical procedures.

Can Antimicrobial Photodynamic Therapy (aPDT) Enhance the Endodontic Treatment?

In order to achieve a long-lasting effect, one of the main goals in root canal treatment is to eliminate the endodontic bacteria. Conventional chemomechanical debridement is considered as the basic treatment in root canal therapy, but adjunctive techniques such as antimicrobial photodynamic therapy (aPDT) can also be helpful. The aim of this study was to evaluate reports in the scientific literature that used different photosensitizers (PSs) for bacterial reduction. The literature search was conducted using databases including PubMed, Scopus, and Google Scholar with the keywords "photodynamic therapy," "antimicrobial photodynamic therapy," or "photoactivated disinfection" and "endodontic," "Enterococcus faecalis," or "root canal treatment," from 2000 to 2015. By evaluating different studies, it was concluded that aPDT should be applied in combination with conventional mechanical debridement and irrigants. However, it is also important to note that the success rate is critically dependent on the type of the PS, output power of the laser used, irradiation time, pre-irradiation time, and type of tips used.

The use of lasers for direct pulp capping

Direct pulp capping helps extend the life of a diseased tooth by maintaining tooth vitality. Nowadays, lasers are more frequently used during direct pulp capping in the clinic, but their use has not been previously reviewed. This review presents the basic properties of currently available lasers, scientific evidence on the effects of laser application on direct pulp capping, and future directions for this technology. An extensive literature search was conducted in various databases for articles published up to January 2015. Original in vitro, in vivo, and clinical studies, reviews, and book chapters published in English were included. Various laser systems have been increasingly and successfully applied in direct pulp capping. Lasers offer excellent characteristics in terms of hemostasis and decontamination for field preparation during direct pulp capping treatment; however, the sealing of exposed pulp with one of the dental materials, such as calcium hydroxide, mineral trioxide aggregates, and bonded composite resins, is still required after laser treatment. Clinicians should consider the characteristics of each wavelength, the emission mode, irradiation exposure time, power, type of laser tip, and the distance between the laser tip and the surface being irradiated.

Applications of Light Amplification by Stimulated Emission of Radiation (Lasers) for Restorative Dentistry

Light amplification by stimulated emission of radiation (laser) has been used widely in a range of biomedical and dental applications in recent years. In the field of restorative dentistry, various kinds of lasers have been developed for diagnostic (e.g. caries detection) and operative applications (e.g. tooth ablation, cavity preparation, restorations, bleaching). The main benefits for laser applications are patient comfort, pain relief and better results for specific applications. Major concerns for using dental lasers frequently are high cost, need for specialized training and sensitivity of the technique, thereby compromising its usefulness particularly in developing countries. The main aim of this paper is to evaluate and summarize the applications of lasers in restorative dentistry, including a comparison of the applications of lasers for major restorative dental procedures and conventional clinical approaches. A remarkable increase in the use of lasers for dental application is expected in the near future.

Different laser wavelengths comparison in the second-stage implant surgery: an ex vivo study

The implant surgery consists of two distinct techniques, the transmucosal, also known as "one-stage" and the "two-stage" technique. Lasers represent a possible aid in implant dentistry, especially in the two-stage technique and its main characteristics are represented by a decreased trauma to bone and soft tissues, a reduction of pain as well as a reduction of the risk of postoperative infections. The aim of this study was to analyze in an animal model the thermal elevation induced by four different laser wavelengths (diode, Nd:YAG, Er:YAG, KTP) during the implant uncovering. Four pig jaws were used to carry out this study. Five implants were placed in each anatomical specimen for a total of 20 fixtures. Four wavelengths (532, 810, 1,064 and 2,940 nm) were used to uncover the implants. Two thermocouples were used to measure temperature changes during laser irradiation at bone level, peri-implant tissues and on the fixture surface The thermocouples were connected with two probes of 1.5 mm in diameter, in order to simultaneously recording two temperature variations. Surface temperature was also checked during all procedures with a thermal camera (Thermovision A 800, Flyr Systems, Stockolm, Sweden) connected to a PC. The mean temperatures of each specimen (five fixtures) were calculated (TM1, mean temperature at the beginning; TM2, mean peak temperature). Furthermore, a record of the temperature at 1 min after the end of the surgical procedure was taken (mean: TM3). All the recorded values were statistically evaluated by one-way analysis of variance (ANOVA). The thermocouples recorded a lower increase in temperature for Er:YAG and KTP laser; Nd:YAG and diode laser produced similar increases characterized by higher values. The thermo-camera pointed out the lower increase for Er:YAG and higher for diode laser. KTP laser resulted faster in uncovering implants and diode laser was the one that needed more time. This ex vivo study showed that laser utilization with the recommended parameters gives no risks of dangerous thermal elevation to the tissues and implants.

Effectiveness of 980-mm diode and 1064-nm extra-long-pulse neodymium-doped yttrium aluminum garnet lasers in implant disinfection

OBJECTIVE

To evaluate the potential of 980-nm gallium aluminum arsenide (GaAlAs) and 1064-nm neodymium-doped yttrium aluminum garnet (Nd:YAG) lasers to reduce bacteria after irradiation of implant surfaces contaminated with Enterococcus faecalis and Porphyromonas gingivalis and on irradiated implant surface morphology.

BACKGROUND

Despite the frequency of implant success, some implant loss is related to peri-implantitis because of difficulty in eliminating the biofilm.

METHODS

Implants (3.75 x 13 mm) with machined surfaces, surfaces sand blasted with titanium oxide (TiO(2)), and sand-blasted and acid-etched surfaces were exposed to P. gingivalis and E. faecalis cultures and irradiated with 980-nm GaAlAs or 1064-nm Nd:YAG lasers. After laser treatments, the number of remaining colony-forming units and implant surface morphology were analyzed using scanning electron microscopy (SEM).

RESULTS

The Nd:YAG laser was able to promote a total contamination reduction on all implants irradiated. The results with the GaAlAs laser showed 100% bacteria reduction on the implants irradiated with 3 W. Irradiation with 2.5 W and 3 W achieved 100% of bacteria reduction on P. gingivalis-contaminated implants. Decontamination was not complete for the sand-blasted TiO(2) (78.6%) and acid-etched surfaces (49.4%) contaminated with E. faecalis and irradiated with 2.5 W. SEM showed no implant surface changes.

CONCLUSION

The wavelengths used in this research provided bacteria reduction without damaging implant surfaces. New clinical research should be encouraged for the use of this technology in the treatment of peri-implantitis.