Optimizing visualization and ergonomics. - Academy of Laser Dentistry

Reyhanian et al.
CLINICAL REVIEW AND CASE REPORT
Er:YAG Laser-Assisted Implant Periapical
Lesion Therapy (IPL) and Guided Bone
Regeneration (GBR) Technique:
New Challenges and New Instrumentation
Avi Reyhanian, DDS, Netanya, Israel; Donald J. Coluzzi, DDS, Redwood City, California
J Laser Dent 2007;15(3):135-141
SYNOPSIS
The etiology and predisposing factors of implant periapical lesions
are described and a case report of treatment using an Er:YAG laser is
presented.
INTRODUCTION
Osseointegrated implants have been
utilized as a successful treatment
modality over three decades, with a
high reported success rate, greater
than 90 percent. 1-4 The predictability
and high rate of success of dental
implants makes them a standard
treatment modality. Oftentimes in
spite of exacting planning and
precise placement accompanying the
procedure, implant failure can and
does still occur. 5-8 A small number of
implants fail because of operator
inexperience or clinically recognizable
cause. Their widespread use in
recent years has produced different
types of complications which can be
divided into two categories:
1. Intraoperative Complications
• Bleeding
• Nerve injury
• Mandibular fractures
• Implant displacements
• Accidental bone perforations
• Incomplete flap closure
2. Postoperative Complications
• Mucositis and peri-implantitis
• Implant periapical lesion (IPL)
• Surgical wound dehiscence
• Lesions on adjacent teeth
• Incomplete osseointegration.
Recent case reports introduced
the term retrograde peri-implantitis
as a lesion (radiolucency)
around the most apical part of an
osseointegrated implant. 9-11 It
develops within the first month
after insertion of the implant.
The Etiology of Implant
6, 9-10, 12-15
Periapical Lesion
1. Contamination of the implant
surface
10, 16-18
2. Overheating of bone
3. Overloading of the implant19 4. Presence of preexisting bone and
12, 16, 20
microbial pathology
5. Presence of residual root fragments
and foreign bodies in bone21 6. Implant placement in an infected
maxillary sinus
7. Implant placement in a poor
bone quality site22-23 8. Lack of biocompatibility
9. Excessive tightening of the
implant and compression of the
bone chips inside the apical hole,
16, 24
producing subsequent necrosis
9, 16
10. Contaminated implants.
Predisposing Factors 25
1. Patient characteristics: age,
medical history
ABSTRACT
Osseointegrated implants have
enjoyed a success rate of more
than 90 percent. There are several
reasons for failure including challenges
during placement and
postoperative complications.
This article will discuss one of
those failures, the implant periapical
lesion (IPL) which is an
accumulation of granulation tissue
around the apical area of an
implant. It is manifested as a radiographic
radiolucency, and results
in compromised osseous health
and often requires the removal of
the implant fixture.
The etiology and predisposing
factors of IPL will be enumerated,
and descriptions of the classification,
prevention, and treatment of
IPL will be elaborated.
A clinical case of IPL, treated
with an erbium:YAG laser, will be
presented. The detailed clinical
protocol will be described. The
seven-month postoperative clinical
and radiographic findings show
complete reversal of the lesion
and change the prognosis from
hopeless to good for the implant.
2. Recipient site: local bone quality
and quantity, cause of tooth loss 22,
26-27
3. Periodontal and endodontic
7, 28
conditions of neighboring teeth
4. Implant characteristics: length,
22, 29-32
surface characteristics
5. Surgical aspect: guided bone
regeneration, osseous fenestration,
or dehiscence. 10
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