Friday, January 27, 2012

The Joy of Tech - Lasers & Implants

Nd-YAG in Hand.jpg

 

I had a great case yesterday that I really need to tell you about.

 

One of my favorite patients in the whole world is ready to have an implant restored in the space where #9 (FDI 21) once resided.  If you are in dentistry, you know how in a normal situation this type of appointment is really pretty straight forward.  That is not to say that anterior implants are simple… they are not.  They require meticulous planning and attention to detail.  However, if you've done all of that, you reap the reward by simplifying the appointments as treatment progresses.

 

And yet, dentistry is life and in life, sometimes even the best plans can require some fine tuning on down the road. That's the whole point of this post. That even when treatment requires some revisions, having the right training and equipment can greatly simplify the process when corrections are needed. Today I was confronted by a fair amount of tissue overgrowth around the implant. In many cases, when this situation presents itself tissue re-contouring frequently necessitates that after the re-contouring is completed it's necessary to give the tissue a few weeks to heal. The drawback to this is that it delays placement of the final restoration and the patient must endure a longer span of time with whatever appliance has been used to maintain aesthetics.

 

In today's situation however, I was able to use a laser to perform the re-contouring. In this particular situation using a laser at low power allowed me to remove excess tissue and to contour the tissue for the exact aesthetics that the case required. For this case I used an Nd:YAG laser at 2W and 20Hz.   This setting allowed me to basically “melt” the tissue with no visible thermal damage which would have created tissue shrinkage upon  healing. Also, soft tissue lasers such as the Nd:YAG  and the diode have a high affinity and absorption for hemoglobin which allows them to not only remove tissue but do so in a bloodless environment since they coagulate any open vessels as they remove the tissue.

 

This means that I could carefully remove the excess tissue overgrowth and re-contour  for proper aesthetics in a clean field. Also since the laser was being used at such a low power, no thermal damage was imparted to the tissue which means the contours that I created today will be there with no changes at the delivery appointment.  Careful orientation of the fiberoptic tip kept the laser energy away from the implant and directed toward the tissue.

 

The laser allowed me to make necessary changes to the tissue architecture without the need for additional healing time. That means we've kept to our original schedule for the patient despite the fact that nature triedto change our plans. We accomplished re-contouring and the final impression at the same appointment without sacrificing aesthetics. Lasers have completely changed the way I practice and I'm confident they can do the same for you.

 

Feel free to leave your questions in the comments section.

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