Preservation of keratinized gingiva around dental implants using a diode laser when uncovering implants for second stage surger

Abstract

Purpose:The aim of the present study was to assess if a 940-nm diode laser or a traditional scalpel approach is more effective in minimizing patient comfort and postoperative sequelae, preserving peri-implant keratinized mucosa, and in enhancing impression quality after uncovering dental implants.Materials and methods:We designed a prospective, split mouth, single blinded, randomi¬zed controlled trial with patients who needed uncovering of dental implants. Our analysis included 388 implants in 73 patients. Split mouth technique was used to compare two approaches for uncovering implants: laser study group vs. scalpel control group. Patients were evaluated for intra- and post-operative pain and bleeding. At 1, 2, and 3 weeks post procedure patients in both groups were rechecked for postoperative sequelae, keratinized mucosal thickness quality and quantity, and accuracy of the implant emergence profile.Results:The laser study group showed that there was a reduction in postoperative pain and bleeding that was statistically significant in comparison to the control group. There were also statistically significant differences in gingival color and presence or absence of soft tissue edema and in the gingival was emergency profile between the laser and scalpel sides at 1, 2, and 3 weeks’ post-procedure. Statistically significant differences (p< 0.001) were observed between the two groups in the criteria of ideal or satisfactory soft tissue projection in the gingival emergency profile, which indicates that impressions can be taken immediately or within 1 week after laser surgery.Conclusion:Uncovering dental implants using a diode laser operating at the wavelength of 940 ±10 nm, and a power output of 0.4-10 W is recommended for preparing an accurate implant emergence profile. Laser treatment can also effectively preserve keratinized mucosa around implants in comparison to the conventional scalpel technique.

High-power diode laser for second-stage implant surgery: a randomized pilot clinical trial

“…Although the Control Group showed a higher mean pain score on the seventh day, there was no difference between groups. This result appears not to be in accordance with the literature, in which HPLs has been supposed to reduce post-operative pain and discomfort (Al-Delayme, 2019;Arnabat-Domínguez et al, 2010;Kaur et al, 2018;Matys & Dominiak, 2016). Furthermore, a patient of the Control Group presented mucositis induced by biofilm on the seventh day, probably due to poor hygiene in response to local pain.…”

“…Another advantage of the laser-assisted technique over the scalpel use was bleeding control, as reported by other studies (Al-Delayme, 2019;Kaur et al, 2018). According to beam types and power density, HPLs have been thought to be able to seal blood vessels up to a 0.5mm diameter and achieve instantaneous hemostasis (Anderson et al, 2013).…”

“…The present study evaluated comparatively some clinical outcomes of an HPL and the conventional scalpel technique for second-stage implant surgery. Despite the use of different techniques for it (e.g., scalpels, electrosurgery, and HPLs) (Tunc et al, 2019), HPLs have provided similar results when compared to the traditional ones with scalpels (Al-Delayme, 2019;Fornaini et al, 2015). Many studies on the use of HPL for oral soft tissue surgery are available but few assessed this matter especially.…”

“…The authors believe the sample size was not sufficiently powered to detect differences between the groups concerning pain, need for pain medication, and peri-implant mucosa status, since some authorities have reported that HPLs have antiseptic properties related to the avoidance of postoperative secondary infections and a bio-modulating potential for healing improvement (Al-Delayme, 2019;Fornaini et al, 2015). Research, Society andDevelopment, v. 9, n. 7, e128974122, 2020 (CC BY 4.0) | ISSN 2525-3409 | DOI: http://dx.doi.org/10.33448/rsd-v9i7.4122 Besides the high price and specific operator training (Ibidem, 2015), HPL techniques have been thought to have some possible clinical disadvantages such as the need for sufficient adjacent keratinized tissues around the implant (Kaur et al, 2018) and previous knowledge of the implant localization (El-Kholey, 2014), direct damages to the implant surface topography (Bajaj et al, 2020), and bone overheating (Ibid, 2019).…”

Employment of U‐Shape Technique at Reentry Surgery for Papillae Coronal Migration on the Rehabilitation of Anterior Single Implant: 3‐Year Follow‐Up Case Report

“…When conventional or early load is executed, an interesting time for soft tissue manipulation is the second stage surgery. Several techniques (i.e., different flap designs and configurations, apically positioned partial‐thickness flap in combination with a free gingival graft or xenogeneic material, roll envelope flap, and partial thickness flap in combination with a subepithelial connective tissue graft) have been described to maintain or improve the quantity and quality of peri‐implant soft tissue, 7,8 among them, the U‐shape technique 9 . This technique, first described by Nemcovsky et al., 9 involves the performance of buccal incisions that are slightly divergent from each other, without reaching the papillae area and are connected by a small crestal incision.…”