Soft and hard tissue changes around laser microtexture single tooth implants--a clinical and radiographic evaluation

An Update on the Use of Lasers in Prosthodontics

Lasers are employed in all fields of modern dentistry nowadays, including both surgical and non-surgical dental procedures. Prosthodontics, a branch of dentistry, has also embraced lasers as an invaluable addition to conventional methodologies. This helps improve the standard of care for patients and dentists due to its precise excision, quick healing, and enhanced tissue response after surgeries. In prosthodontics, the most commonly used lasers are carbon dioxide, argon, and yttrium-aluminum-garnet (YAG) lasers. Many reviews have been published in the literature regarding the use of lasers in dentistry; however, reviews on the use of lasers in the field of prosthodontics are limited. This review aims to explain the diverse applications and advancements of lasers in prosthodontics. Furthermore, it will highlight the integration of lasers in diagnostic protocols, treatment modalities, and the fabrication of prosthetic restorations.

Infrared diode laser enhances human periodontal ligament stem cells behaviour on titanium dental implants

Low level laser treatment (LLLT) is known for its photobiostimulatory and photobiomodulatory characteristics, which stimulate cell proliferation, increase cellular metabolism, and improve cellular regeneration. The objective of the present research was to assess the possible influence of infrared diode laser irradiation on the behaviour, attachment, and osteogenic differentiation of human periodontal ligament stem cells (hPDLSCs) seeded on different types of dental implants. Two distinct types of implants, one subjected to laser surface treatment and the other treated with acid etching, were longitudinally divided into two halves and submerged in six wells culture plates. Both implants were subjected to infrared diode laser treatment, and subsequently, the morphology and attachment of cells were examined using scanning electron microscopy (SEM) after 14 and 21 days. The behaviour of (hPDLSCs) towards two types of implants, when exposed to osteogenic medium and low-level laser therapy (LLLT), was assessed using quantitative real-time polymerase chain reaction to measure the expression of stemness markers and osteogenic markers. The scanning electron microscopy (SEM) demonstrated that the application of infrared diode laser irradiation substantially improved the attachment of cells to both types of implants. The stemness gene markers were significantly down regulated in cells seeded on both surfaces when challenged with osteogenic media in relation to control. At 14 days, early osteogenic markers, were upregulated, while late osteogenic markers, were downregulated in both challenged groups. At the 21-day mark, hPDLSCs seeded on an acid-etched implant exhibited increased expression of all osteogenic markers in response to stimulation with osteogenic media and infra-red diode laser, in contrast to hPDLSCs seeded on a laser surface treated implant under the same conditions. Finally, the findings of our research revealed that when subjected to infrared diode laser, human periodontal ligament stem cells cultured on both types of implants demonstrated improved cellular attachment and differentiation. This suggested that infrared diode laser enhanced the activity of the cells surrounding the implants. Hence, the use of infrared diode laser could be pivotal in improving and expediting the clinical osseointegration process around dental implants.

Estimation of Soft and Hard Tissue Revolutionization Surrounding Dental Implant: A 2-Year Retrospective Study

A dental implant is an idyllic mode of operandi for oral rehabilitation for complete and partially edentulous patients. The success of an implant is based on the health of its surrounding tissues. Therefore, the biological and clinical aspects of implant prosthesis and their surrounding tissues must persist to be investigated. A two-year retrospective clinical-radiological study was conducted to estimate peri-implant soft and hard tissue revolutionization after the placement of implants. A clinical-radiological investigation was carried out to determine the amount of soft and hard tissue revolutionization that occurred following the implantation of 200 implants. From October 2020 to March 2021, the research was carried out in the College of Dentistry at King Khalid University in Saudi Arabia. It was decided to conduct this study using a retrospective clinical record, which involved gathering information about patients who had previously received dental implants within the previous two years. Plaque index (PI), gingival index (GI), bleeding index (BI), peri-implant probing depth (PD), and peri-implant crestal bone level were measured at baseline and three months after implant placement in adult patients ranging in age from 20 to 50 years. The results were compared to the full-mouth index (FMI). Ethical clearance and written informed consent were obtained from all the study participants. The statistical analysis was done by using Statistical Package for Social Sciences (SPSS-23.0 version) (IBM; Chicago). The present study concluded that plaque accumulation, gingival bleeding, and probing depth were increased around implants during the follow-up, but it would not affect crestal bone loss. Still, it is essential to conduct a similar study with a larger sample size and a long follow-up period to give more precise results.

Effect of microthread design on the preservation of marginal bone around immediately placed implants: a 5-years prospective cohort study

Background

This study aimed to evaluate the effect of the microthread design at the implant neck on the preservation of marginal bone around immediately-placed implants in a 5-year follow up.

Methods

Thirty patients received 41 immediately placed implants which were randomly assigned to treatment groups with microthreaded implants (test group, n = 22) or threaded implants (control group, n = 19). Clinical and radiographic analyses were carried out after 1 and5 years. Plaque index, bleeding on probing, suppuration, probing depth and marginal bone loss were subject to evaluations. The results were analyzed with the T-test, Fisher’s exact test and Mann–Whitney U test.

Results

No implants failed; thirty-five implants (in 27 patients); 21 microthreaded and 14 threaded implants; completed the 5 year follow up. The mean values of the marginal bone loss in microthreaded and threaded groups were 1.12 ± 0.95 mm and 0.87 ± 0.78 mm, respectively during an observation period of 70.9 ± 10.4 months; the differences in marginal bone loss and other pre-implant parameters were not significant between groups (P > 0.05).

Conclusion

Both implant designs showed acceptable results in terms of the clinical parameters and marginal bone level. Within the limitation of this study, the results did not demonstrate any superiority of the microthread design compared to threaded one in marginal bone preservation around immediately placed implants over 5 years of loading.

Effectivity of homecare and professional biofilm removal procedures on initial supragingival biofilm on laser-microtextured implant surfaces in an ex vivo model

Background

The aim of the current study was the evaluation of initial biofilm adhesion and development on laser-microtextured implant collar surfaces and the examination of effectivity of different biofilm management methods.

Methods

Initial biofilm formation was investigated on hydrophobic machined and laser-microtextured (Laser-Lok) titanium surfaces and hydrophobic machined and laser-microtextured (Laser-Lok) titanium aluminium vanadium surfaces and compared to hydrophobic smooth pickled titanium surfaces, hydrophilic smooth and acid etched titanium surfaces, hydrophobic sandblasted large grid and acid etched titanium surfaces (titanium Promote) via erythrosine staining and subsequent histomorphometrical analysis and scanning electron microscopic investigations. After decontamination procedures, performed via tooth brushing and glycine powder blasting, clean implant surface was detected via histomorphometrical analysis.

Results

After 24 h mean initial plaque area was detected in the following descending order: smooth pickled titanium > titanium Promote > hydrophilic smooth and acid etched titanium > Laser-Lok titanium > Laser-Lok titanium aluminium vanadium. The same order was determined after 48 h of biofilm formation. After glycine powder blasting all samples depicted almost 100% clean implant surface. After tooth brushing, Laser-Lok titanium (67.19%) and Laser-Lok titanium aluminium vanadium (69.80%) showed significantly more clean implant surface than the other structured surfaces, hydrophilic smooth and acid etched titanium (50.34%) and titanium Promote (33.89%). Smooth pickled titanium showed almost complete clean implant surface (98.84%) after tooth brushing.

Conclusions

Both Laser-Lok surfaces showed less initial biofilm formation after 24 and 48 h than the other implant surfaces. In combination with the significant higher clean implant surfaces after domestic decontamination procedure via tooth brushing, both Laser-Lok surfaces could be a candidate for modified implant and abutment designs, especially in transmucosal areas.

Influence of Laser-Microtextured Surface Collar on Marginal Bone Loss and Peri-Implant Soft Tissue Response: A Systematic Review and Meta-Analysis

BACKGROUND

A laser-microtextured surface (LMS) dental implant collar appears to promote a more tooth-like gingival collagen fiber attachment, which may help to stabilize peri-implant tissues. The purpose of this systematic review is to assess the clinical effect of an LMS versus non-LMS collar on crestal bone level and peri-implant soft tissue response.

METHODS

Electronic and manual literature searches were performed by two independent reviewers for articles written in English up to December 2016. Studies were included if they were human clinical trials with the purpose of evaluating the impact of an LMS collar on peri-implant hard and soft tissues. Cumulative marginal bone loss (MBL), probing depth (PD), and survival rate (SR) with 95% confidence intervals (CIs) were calculated to show the performance of LMS implant collars. MBL, PD, and SR data were analyzed with a random effects model to compare the influence of LMS collars with non-LMS collars (e.g., roughened surface and machined surface).

RESULTS

Fifteen human clinical studies (three randomized controlled trials, six cohort studies, and six case series) with 772 implants met the inclusion criteria. For the overall data, the weighted mean MBL was 0.72 mm (95% CI: 0.59 to 0.85 mm), PD was 1.81 mm (95% CI: 1.13 to 2.49 mm), and SR was 0.97 (95% CI: 0.95 to 0.98). MBL around an LMS collar was significantly less than around machined-surface collars (weighted mean difference [WMD]: -0.77; 95% CI: -1.01 to -0.52; I2 = 95.2%; P <0.001). PD in the LMS group was significantly shallower than in the machined-surface group (WMD: -1.34; 95% CI: -1.62 to -1.05; I2 = 81.4%; P <0.001). However, no statistically significant difference was detected for MBL between the LMS and roughened-surface groups (WMD: -0.04; 95% CI: -0.16 to 0.08; I2 = 0.0%; P = 0.75). No statistically significant difference was found for SR between the LMS and non-LMS groups (risk ratio: 1.01; 95% CI: 0.97 to 1.04; I2 = 0.0%; P = 0.91).

CONCLUSIONS

Meta-analysis showed that an LMS collar can reduce the amount of MBL and PD compared with a machined-surface collar. Due to high heterogeneity between the included studies, results should be interpreted cautiously.

Optimizing Connective Tissue Integration on Laser-Ablated Implant Abutments

Focused Clinical Question: The integration of connective tissue (CT) to a laser-ablated abutment with a microgrooved surface at the apical millimeter (LL) has been documented in both animal and human studies. How should the healing be influenced to optimize the CT integration on abutment surfaces? Summary: When smooth machined titanium (ST) abutments were placed, epithelial attachment was found on abutments, but no CT integration was noted. On LL abutments, a zone of epithelial attachment and CT integration was noted. When an ST abutment was switched for an LL abutment, the soft tissue was inconsistent; however, when an LL abutment was placed after the removal of a prior LL abutment, CT integration was observed. Conclusions: Consistent CT integration was observed on LL abutment surfaces after implant placement. Switching LL abutments with new LL abutments consistently led to CT integration. This was not consistent when an ST abutment was switched for an LL abutment. Plaque and gingival indices were comparable between teeth and abutments. Probing depth (PD) was lower around teeth. There was no difference in PD between abutments. CT integration on LL abutments was optimized by initial healing occurring on an LL abutment or by creation of a CT wound before insertion of the abutment.