September 5, 2018
by Ed Kusek, DDS
According to the Seventh European Workshop, 15-30% of all implants placed will develop peri-implantitis. Three million people have implants and this number is growing by 500,000 a year. Thus, peri-implantitis cases will grow up to 450,000 with an additional 75,000 which are expected to occur annually. 1 Clinicians will need to ﬁnd appropriate treatment modalities to solve this exponentially increasing problem.
Treatment modalities have traditionally consisted of treating with chemical means, phosphoric acid, citric acid and tetracycline. These means have produced inconsistent results at best. In 2006, Dr. Robert Miller published in “Implant Dentistry” on the use of Er,Cr:YSGG to disinfect the implant surface with the use of laser for disinfection. The use of laser therapy has shown to have a greater effect than chemical means. According to Miller’s publication, the demonstrated depth of disinfection to over 1000 microns is possible, compared to around 100 microns 2 when chemicals are used.
Treatment by dental laser has not produced consistent results by itself. On April 8th, 2017, the annual meeting of the Academy of Laser Dentistry invited companies to participate in developing a consensus on a treatment of peri-implantitis that can work consistently. Companies that were invited were: Convergent, Biolase, Lightscalpel, Fotona and Millenium. Companies that elected to participate were: Convergent, Biolase, Lightscalpel and Fotona. Various criteria were discussed, and the group gave treatment recommendations on using lasers as an adjunct for peri-implantitis.
A presentation using the 9300nm CO2 (Convergent dental, Boston, Massachusetts) laser featured Edward R Kusek. Dr. Kusek is a Diplomate of ABOI, FAAID MALD MAGD. Dr. Kusek presented the use of Oral DNA as a pre-determinate to ﬁnd pre-disposition for peri-implantitis/gum disease. Kusek showed two separate cases in which patients presented with advanced periodontal disease (Fig. 1), but their Oral DNA did not indicate a predisposition to periodontal disease.
Kusek reported a correlation between patients with high risk genotypes and higher pre-disposition for some type of peri-implant disease.
Kusek reported on a detailed study he had conducted in his ofﬁce using anaerobic swabs around infected implants. The study consisted of swabbing three different times. The ﬁrst swab was taken when the soft tissue was reflected around the granulation tissue. Second swab was taken after all granulation tissue was removed around the failing implants and a titanium brush had been used to clean the entire surface of exposed implant threads. The ﬁnal swab was completed after using irradiation from the 9300nm CO2 laser. The swabs were then taken to a local lab to plate. This lab was instructed to ﬁnd periodontal pathogens (Porphyromonas gingivalis, Prevotella intermedia, Beta Hemolytic streptococci, Cam-pylobacter-Wolinella, Capnocytophaga species, Fusobacterium, Peptostreptococcus microns, enteric gram-negative rods, Enterococcus species, Provetella melaninogenica and non-pigmented Prevotella.), if present around a failing implant. A majority of cases showed high levels of bacteria on the ﬁrst swab, moderate amounts on the second swab and all, but one, showed no bacterial growth on surfaces irradiated by the 9300nm CO2 laser (Fig. 2). The one of the four plated cases showing high amounts of bacterial growth was a heavy smoker (Fig. 3).
Kusek presented eight cases of patients treated with the CO2 laser set to different energy levels. Two cases demonstrated that treatment using lower energy values had treatment failures and recurrence of infection. When higher energy levels around 14 W were used for at least 40 seconds (over 550J of energy), all cases showed success. Subsequently, the two failed cases have been re-treated with higher energy values and are now successful, with one case having a post-op time of over one-year.
Laser-Assisted Peri-implantitis Treatment Protocol
Oral Health welcomes this original article.
About the Author
Dr. Edward R. Kusek is a Diplomate of American Board of Oral Implantology/Implant Dentistry, Fellow of American Academy of Implant Dentistry, Masterships in Academy of General Dentistry and Academy of Laser Dentistry, Recognized Course provider from Academy of Laser Dentistry since 2012. Diplomate of International Congress of Oral Implantology.
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