Academy of Laser Dentistry

Lightwaves News
Featured in a
Special Section
The Official Journal of the Academy of Laser Dentistry 2011 • Vol. 19 No. 3
Preoperative Perioperative Six Months Postoperative
Dr. Khakhar and colleagues explore the advantages of using a 980-nm diode
laser in managing gingival pigmentation, page 283
• Academy News and Announcements
• 2012 Academy Award Recipients
• Case Report: 810-nm Diode Laser Decontamination of Implant Surfaces
• Clinical Case: Gingival Depigmentation with an Er:YAG Laser
• Clinical Case: Er:YAG Laser-Assisted Implant Therapy
• Clinical Review: Photobiomodulation
• Clinical Experience: Using Photobiomodulation on a Severe
Parkinson’s Patient
• Laser Safety: Signs of Change
• Research Abstracts: Laser Bactericidal Effects on Intraoral Implants
Academy of Laser Dentistry
9900 West Sample Road, Suite 400
Coral Springs, FL 33065

J O U R N A L O F L A S E R D E N T I S T R Y | 2 011 V O L . 19 , N O . 3
250
TA B L E O F C O N T E N T S
EDITOR’S VIEW
New Adventures and Past
Experiences with Lasers ................254
Stuart Coleton, DDS
PRESIDENT’S MESSAGE
Approaching ALD Prime ................255
Ana Triliouris, DDS
EXECUTIVE DIRECTOR’S
MESSAGE
ALD – A History of Values ............256
Gail Siminovsky, CAE
NOMINATIONS
Academy of Laser Dentistry’s 2012
Nominated Slate of Officers and
Directors ............................................258
Art Levy, DMD
AWARDS
ALD Award Recipients Announced
for 2012 ..............................................262
Glenda Payas, DMD
2012 CONFERENCE
Elevating Your Practice to New
Peaks! ..................................................264
John J. Graeber, DMD
CERTIFICATION
ALD Certification Program Planned in
Scottsdale March 29-31, 2012 ......266
Mel Burchman, DDS
STUDENT SCHOLARSHIPS
A Helping Hand................................267
Glenda Payas, DMD
CASE REPORT
Treatment of Periimplant Infection
in the Posterior Maxilla, with 810nm
Diode Laser Decontamination
of the Implant Surfaces: A Case
Report..................................................270
Ahmad Kutkut, DDS, MS; Sebastiano
Andreana, DDS, MS; Mohanad
Al-Sabbagh, DDS, MS
CLINICAL REVIEW AND
CASE REPORT
Peri-Implantitis Therapy with an
Er:YAG Laser ......................................276
Avi Reyhanian, DDS; Donald J. Coluzzi,
DDS
COVER FEATURE
CASE REPORTS
Advantages of 980-nm Diode Laser
Treatment in the Management of
Gingival Pigmentation....................283
Mihir Khakhar, BDS; Richa Kapoor,
BDS; N.D. Jayakumar, BDS, MDS; O.
Padmalatha, BDS, MDS; Sheeja S.
Varghese, BDS, MDS; M. Sankari, BDS,
MDS
CLINICAL CASE
Gingival Depigmentation with an
Er:YAG Laser: A Clinical Case with
Three-Year Follow-Up ....................286
Grace Sun, DDS
CLINICAL REVIEW AND
CASE REPORTS
Photobiomodulation: An Invaluable
Tool for All Dental Specialties......289
Gerry Ross, DDS
CLINICAL EXPERIENCE
Using Photobiomodulation on a
Severe Parkinson’s Patient to
Enable Extractions, Root Canal
Treatment, and Partial Denture
Fabrication..........................................297
Mel A. Burchman, DDS
LASER SAFETY
Signs of Change ..............................301
Raminta Mastis, DDS, FAGD, MALD
RESEARCH ABSTRACTS
Laser Bactericidal Effects on
Intraoral Implants ............................303
The Journal of Laser Dentistry
The mission of the Journal of Laser Dentistry
is to provide a professional journal that helps
to fulfill the goal of information dissemination
by the Academy of Laser Dentistry. The purpose
of the Journal of Laser Dentistry is to
present information about the use of lasers in
dentistry. All articles are peer-reviewed. Issues
include manuscripts on current indications for
uses of lasers for dental applications, clinical
case studies, reviews of topics relevant to laser
dentistry, research articles, clinical studies,
research abstracts detailing the scientific
basis for the safety and efficacy of the devices,
and articles about future and experimental
procedures. In addition, featured columnists
offer clinical insights, and editorials describe
personal viewpoints.
Journal of Laser Dentistry
The official journal of the
Academy of Laser Dentistry
Editor-in-Chief
Stuart Coleton, DDS
Chappaqua, NY scoleton@aol.com
Managing Editor
Gail S. Siminovsky, CAE, Executive Director
Coral Springs, FL siminovsky@laserdentistry.org
Consulting Editor
John G. Sulewski, MA
Huntington Woods, MI john.sulewski@we-inc.com
Publisher
Max G. Moses
Member Media
1844 N. Larrabee • Chicago, IL 60614
312-296-7864 • Fax: 312-896-9119
max@maxgmoses.com
Design and Layout
Diva Design
2616 Missum Pointe • San Marcos, TX 78666
512-665-0544 • Fax 609-678-0544
kkolstedt@austin.rr.com
Editorial Office
9900 West Sample Road, Suite 400
Coral Springs, FL 33065
Advertising
Nicole Synadinos
Association Services
727-942-4503
sales@fernmanagement.com
954-346-3776
Fax 954-757-2598
www.laserdentistry.org
laserexec@laserdentistry.org
The Academy of Laser Dentistry is a not-for-profit
organization qualifying under Section 501(c)(3) of
the Internal Revenue Code. The Academy of Laser
Dentistry is an international professional membership
association of dental practitioners and supporting
organizations dedicated to improving the
health and well-being of patients through the
proper use of laser technology. The Academy is
dedicated to the advancement of knowledge,
research and education and to the exchange of
information relative to the art and science of the
use of lasers in dentistry. The Academy endorses
the Curriculum Guidelines and Standards for
Dental Laser Education.
Copyright 2011 Academy of Laser Dentistry

Journal of Laser Dentistry: Guidelines for Authors
The Academy of Laser Dentistry Welcomes Your Articles for Submission
The Journal of Laser Dentistry publishes
articles pertaining to the art, science,
and practice of laser dentistry. Articles
may be scientific and clinical in nature
discussing new techniques, research,
and programs, or may be applicationsoriented
describing specific problems
and solutions. While lasers are our preferred
orientation, other high-technology
articles, as well as insights into marketing,
practice management, regulation,
and other aspects of dentistry that
may be of interest to the dental profession,
may be appropriate. All articles
are peer-reviewed prior to acceptance,
modification, or rejection.
These guidelines are designed to
help potential authors in writing and
submitting manuscripts to the Journal
of Laser Dentistry, the official publication
of the Academy of Laser Dentistry
(ALD). Please follow these instructions
carefully to expedite review and processing
of your submission. Manuscripts
that do not adhere to these instructions
will not be accepted for consideration.
The Academy of Laser Dentistry and the
editors and publisher of the Journal of
Laser Dentistry endorse the “Uniform
Requirements of Manuscripts Submitted
to Biomedical Journals” (www.icmje.org).
The Journal reserves the right to revise
or rescind these guidelines.
Authors are advised to read the more
comprehensive Guidelines for Authors
and required forms available by mail or
online at www.laserdentistry.org.
Manuscript Eligibility
Submitted manuscripts must be written
clearly and concisely in American
English and appropriate for a scholarly
journal. Write in active voice and use
declarative sentences. Manuscripts will
be considered for publication on the condition
that they have been submitted
exclusively to the Journal, and have not
been published or submitted for publication
in any part or form in another publication
of any type, professional or lay, or
in any language elsewhere, and with the
understanding that they will not be
reprinted without written consent from
both the managing editor and the author.
Permissions
Direct quotations of 100 or more words,
and illustrations, figures, tables, or
other materials (or adaptations thereof)
that have appeared in copyrighted
material or are in press must be accompanied
by written permission for their
use in the Journal of Laser Dentistry
from the copyright owner and original
author along with complete information
regarding source, including (as applicable)
author(s), title of article, title of
journal or book, year, volume number,
issue number, pages. Photographs of
identifiable persons must be accompanied
by valid signed releases indicating
informed consent. When informed consent
has been obtained from any
patient, identifiable or not, it should be
noted in the manuscript. The appropriate
Permission Letters must be submitted
with the manuscript. Suggested
template letters are available online.
Copyright
All manuscript rights shall be transferred
to the Journal of Laser Dentistry
upon submission. Upon submission of
the manuscript, authors agree to submit
a completed Copyright Transfer
Agreement form, available online. If the
manuscript is rejected for publication,
all copyrights will be retained by the
author(s).
Commercialism
ALD members are interested in learning
about new products and service
offerings, however ALD stresses that
submitted manuscripts should be educational
in nature. The emphasis is on
scientific research and sound clinical
and practical advice, rather than promotion
of a specific product or service.
Disclosure of Commercial Relationships
According to the Academy’s Conflict of
Interest and Disclosure policy, manuscript
authors and their institutions are
expected to disclose any economic or
financial support, as well as any personal,
commercial, technological, academic,
intellectual, professional, philosophical,
political, or religious interests
or potential bias that may be perceived
as creating a conflict related to the
material being published. Such conditions
may include employment, consultancies,
stock ownership or other equity
interests, honoraria, stipends, paid
expert testimony, patent ownership,
patent licensing arrangements, royalties,
or serving as an officer, director, or
owner of a company whose products, or
products of a competitor, are identified.
Sources of support in the form of contracts,
grants, equipment, drugs, material
donations, clinical materials, special
discounts or gifts, or other forms of support
should be specified. The roles of the
study or manuscript sponsor(s), if any,
are to be described. Disclosure statements
are printed at the end of the article
following the author’s biography.
This policy is intended to alert the audience
to any potential bias or conflict so
that readers may form their own judgments
about the material being presented.
Disclosure forms are to be
signed by each author. Manuscripts will
not be reviewed without the Journal
having this form on file.
The Academy of Laser Dentistry also
requires that authors disclose whether
any product discussed in their manuscript
is unlabeled for the use discussed
or is investigational.
The Disclosure Statement form is
available online and must be submitted
with the manuscript.
Manuscript Types
Submissions to the Journal should be
limited to one of the types indicated
below.
• Scientific / Technology / Clinical
Review
• Case Reports and Clinical Case
Studies
• Scientific / Clinical Research
• Randomized Clinical Trials
• Advances in Dental Products
• Trends
• Practice Management
• Guest Editorials and Essays
• Letters to the Editor
• Book Reviews
Manuscript Preparation and
Submission
Format
All submitted manuscripts should be
double-spaced, using 12 pt. font size
with at least 6 mm between lines.
Submit manuscripts in Microsoft Word
(.doc), using either the Windows or
Macintosh platform. Manuscripts must
be submitted electronically in this format.
Hard copy-only submissions will
not be accepted.
Unacceptable Formats
The following submission formats are
unacceptable and will be returned:
• Manuscripts submitted in desktop
publishing software
• PowerPoint presentations
• Any text files with embedded images
• Images in lower than the minimum
prescribed resolution.
Manuscript Components
Title Page
The title page of the manuscript should
include a concise and informative title
of the article; the first name, middle initial(s),
and last name of each author,
along with the academic degree(s), professional
title(s), and the name and
location (city, state, zip code) of current
institutional affiliation(s) and department(s).
Authors who are private practitioners
should identify their location
(city, state, and country). Include all
information in the title that will make
electronic retrieval of the article sensi-

tive and specific. Titles of case studies
should include the laser wavelength(s)
and type(s) utilized for treatment (for
example, “810-nm GaAlAs diode”).
Identify the complete address, business
and home telephone numbers, fax
number, e-mail address, and Web site
address (if any) for all authors. Identify
one author as the corresponding author.
Unless requested otherwise, the e-mail
address is published in the Journal.
Abstract
A self-standing summary of the text of
up to 250 words should precede the
introduction. It should provide an accurate
summary of the most significant
points and be representative of the
entire article’s content. Provide the context
or background for the article, basic
procedures, main findings and conclusions.
Emphasize new or important
aspects. Do not use abbreviations (other
than standard units of measurement) or
references in the abstract.
Author(s) Biography
Provide a brief, current biographical
sketch of each author that includes professional
education and professional
affiliations. For authors who hold teaching
positions, include the title, department,
and school. For authors who are
in federal service, include rank or title
and station.
References
References are to be cited in the text by
number in order of appearance, with
the number appearing either as a
superscript or in brackets. The reference
list should appear at the end of the
manuscript with references in order of
first appearance in the text of the manuscript.
The reference list must be
typed double-spaced on a separate page
and numbered in the same sequence as
the reference citations appear in the
text. Prior to submission, all references
are to be properly prepared in the correct
format, checked for completeness,
carefully verified against their original
documents, and checked for accurate
correspondence between references
cited in the text and listed in the
References section.
• For journal citations, include surnames
and all initials of all authors,
complete title of article, name of journal
(abbreviated according to the U.S.
National Library of Medicine
(www.nlm.nih.gov/services/
lpabbrev.html), year of publication,
volume, issue number, and complete
inclusive page numbers. If abstracts
are cited, add the abstract number
after the page number.
• For book citations, specify surnames
and initials of all authors, chapter
number and title (if applicable), editors’
surnames and initials, book
title, volume number (if applicable),
edition number (if applicable), city
and full name of publisher, year of
publication, and inclusive page numbers
of citation.
• For government publications or bulletins,
identify the author(s) (if given);
title; department, bureau, agency, or
office; the publication series, report,
or monograph number; location of
publisher; publisher; year of publication;
and inclusive page numbers.
• For articles published online but not
yet in print, cite with the paper’s
Digital Object Identifier (DOI) added
to the end of the reference.
• For Web citations, list the authors
and titles if known, then the URL
and date it was accessed.
• For presentations, list the authors,
title of presentation, indication that
the reference is a lecture, name of
conference or presentation venue,
date, and location.
Illustration Captions and Legends
All illustrations must be accompanied by
individual explanatory captions which
should be typed double-spaced on a separate
page with Arabic numerals corresponding
to their respective illustration.
Tables
Tables must be typewritten doublespaced,
including column heads, data,
and footnotes, and submitted on separate
pages. The tables are to be cited in
the text and numbered consecutively in
Arabic numerals in the order of their
appearance in the text. Provide a concise
title for each table that highlights
the key result.
Illustrations
Illustrations include photographs, radiographs,
micrographs, charts, graphs,
and maps. Each should be numbered and
cited in the text in the order of appearance
and be accompanied by explanatory
captions. Do not embed figures within
the manuscript text. Each figure and
table should be no larger than 8-1/2 x 11
inches. Digital files must measure at
least 5 inches (127 mm) in width. The
Illustration
Type
image must be submitted in the size it
will be printed, or larger. Illustrations
are to augment, not repeat, material in
the text. Graphs must not repeat data
presented in tables. Clinical photographs
must comply with ALD’s Guidelines for
Clinical Photography, available online.
Authors are to certify in a cover letter
that digitized illustrations accurately
represent the original data, condition, or
image and are not electronically edited.
Publisher and Copyright Holder
The Journal of Laser Dentistry is published
by Max G. Moses, Member
Media, 1844 N. Larrabee, Chicago, IL
60614, Telephone: (312) 296-7864; Fax:
(312) 896-9119. The Journal of Laser
Dentistry is copyrighted by The
Academy of Laser Dentistry, 9900 W.
Sample Road, Suite 400, Coral Springs,
FL 33065, Telephone: (954) 346-3776;
Fax: (954) 757-2598.
Articles, Questions, Ideas
Questions about clinical cases, scientific
research, or ideas for other articles may
be directed to Stuart Coleton, Editor-in-
Chief, by e-mail: scoleton@aol.com.
Submission of Files
by E-mail:
Send your completed files by e-mail
(files up to 10 MB are acceptable). If
files are larger than 10 MB, they may
be compressed or sent as more than one
file, with appropriate labels. Files
should be submitted to: Stuart Coleton,
Editor-in-Chief, by e-mail:
scoleton@aol.com.
By Federal Express or Other
Insured Courier:
If using a courier, please send the files
on a flash drive, include a hard copy of
your manuscript and also send a verification
by e-mail to Gail Siminovsky
(laserexec@laserdentistry.org).
Gail Siminovsky
Academy of Laser Dentistry
9900 W. Sample Road, Suite 400
Coral Springs, FL 33065
Phone: (954) 346-3776.
Summary of Illustration Types and Specifications
Definition and Examples
Preferred
Format
Required
Resolution
Line Art and Black and white graphic with no
EPS or JPG 1200 DPI
Vector Graphics shading (e.g., graphs, charts, maps)
Halftone Art
Combination
Art
Photographs, drawings, or painting
with fine shading (e.g., radiographs,
micrographs with scale
bars, intraoral photographs)
Combination of halftone and line
art (e.g., halftones containing
line drawing, extensive lettering,
color diagrams)
TIFF or
JPG
300 DPI (black &
white)
600 DPI (color)
EPS or JPG 1200 DPI

Editorial Policy
The Journal of Laser Dentistry is devoted to providing the Academy and its members with comprehensive clinical, didactic and
research information about the safe and effective uses of lasers in dentistry. All statements of opinions and/or fact are published
under the authority of the authors, including editorials and articles. The Academy is not responsible for the opinions expressed
by the writers, editors or advertisers. The views are not to be accepted as the views of the Academy of Laser Dentistry unless
such statements have been expressly adopted by the organization. Information on any research, clinical procedures or products
may be obtained from the author. Comments concerning content may be directed to the Academy’s main office by e-mail to
laserexec@laserdentistry.org.
Submissions
We encourage prospective authors to follow JLD’s “Instructions to Authors” before submitting manuscripts. To obtain a copy,
please go to our Web site www.laserdentistry.org/index.cfm/professionals/Media%20and%20Press. Please send manuscripts by email
to the Editor at
scoleton@aol.com.
Disclosure Policy of Contributing Authors’ Commercial Relationships
According to the Academy’s Conflict of Interest and Disclosure policy, authors of manuscripts for JLD are expected to disclose
any economic support, personal interests, or potential bias that may be perceived as creating a conflict related to the material
being published. Disclosure statements are printed at the end of the article following the author’s biography. This policy is
intended to alert the audience to any potential bias or conflict so that readers may form their own judgments about the material
being presented.
Disclosure Statement for the Academy of Laser Dentistry
The Academy of Laser Dentistry has no financial interest in any manufacturers or vendors of dental supplies.
Reprint Permission Policy
Written permission must be obtained to duplicate and/or distribute any portion of the Journal of Laser Dentistry. Reprints may
be obtained directly from the Academy of Laser Dentistry provided that any appropriate fee is paid.
Copyright 2011 Academy of Laser Dentistry. All rights reserved unless other ownership is indicated. If any omission or infringement
of copyright has occurred through oversight, upon notification amendment will be made in a future issue. No part of this publication
may be reproduced or transmitted in any form or by any means, individually or by any means, without permission from the
copyright holder.
The Journal of Laser Dentistry ISSN# 1935-2557.
JLD is published quarterly and mailed nonprofit standard mail to all ALD members. Issues are also mailed to new member
prospects and dentists requesting information on lasers in dentistry.
Advertising Information and Rates
Display rates are available at www.laserdentistry.org and/or supplied upon request. Insertion orders and materials should be sent to
Association Services, e-mail sales@fernmanagement.com, telephone 727-942-4503. The cost for a classified ad in one issue is $50 for
the first 25 words and $2.00 for each additional word beyond 25. ALD members receive a 20% discount. Payment must accompany ad
copy and is payable to the Academy of Laser Dentistry in U.S. funds only. Classified advertising is not open to commercial enterprises.
Companies are encouraged to contact Association Services for information on display advertising specifications and rates. The
Academy reserves the right to edit or refuse ads.
Editor’s Note on Advertising:
The Journal of Laser Dentistry currently accepts advertisements for different dental laser educational programs. Not all dental laser educational
courses are recognized by the Academy of Laser Dentistry. ALD as an independent professional dental organization is concerned that courses
meet the stringent guidelines following professional standards of education. Readers are advised to verify with ALD whether or not specific
courses are recognized by the Academy of Laser Dentistry in their use of the Curriculum Guidelines and Standards for Dental Laser Education.

J O U R N A L O F L A S E R D E N T I S T R Y | 2 011 V O L . 19 , N O . 3
254
E D I TO R ’ S V I E W
New Adventures and Past
Experiences with Lasers
Stuart Coleton, DDS, New York Medical College, Valhalla, New York,
and Westchester University Medical Center, Valhalla, New York
J Laser Dent 2011;19(3):254
As I prepare to take over the position
of Editor-in-Chief of the
Journal of Laser Dentistry (JLD), I
have this opportunity to say hello
and welcome you to the third issue
of volume 19.
Beginning with volume 20, you
will see some significant changes in
the Journal. We will once again
publish a separate Lightwaves
Newsletter so you all will be kept
up to the minute on what is
happening in the Academy. I am
establishing new goals for our
Journal which I will discuss with
you in the next issue.
This edition includes three new
case presentations by clinicians
from universities in Kentucky, New
York, and India as well as a private
practitioner from Pennsylvania.
Each article will be complemented
by noteworthy reports from
previous issues of the Journal for
added perspective.
• Dr. Ahmad Kutkut and
colleagues from the University of
Kentucky and the State
University of New York at
Buffalo discuss the adjunctive
use of a diode laser to disinfect
implant surfaces in the treatment
of periimplant infection.
• From volume 15 number 3 of the
Journal, we reprise the clinical
case by Dr. Avi Reyhanian and
Donald Coluzzi on treating periimplantitis
with an Er:YAG
Laser.
• Continuing with the theme of
periimplantitis therapy via laser,
the Research Abstracts from
volume 15 number 3 are again
Coleton
presented, and updated in this
issue with recent research in the
area of laser bactericidal effects
on intraoral implants.
• Dr. Mihir Khakhar and associates
from the Saveetha Dental
College in Chennai, India,
present a case report outlining
the advantages of diode laser
treatment in the management of
gingival pigmentation.
• Their successful treatment
compares with the favorable
results achieved by Dr. Grace
Sun, who described a clinical case
of gingival depigmentation using
an Er:YAG laser, reprinted from
volume 16 number 3 of the
Journal.
• The clinical review by Dr. Gerry
Ross on photobiomodulation
taken from volume 17 number 3
sets the stage for Dr. Mel
Burchman’s discussion of the use
of this technology to enable
dental treatment of a patient
with severe Parkinson’s disease.
• Dr. Raminta Mastis provides a
valuable review of the proper use
of laser safety signs in the dental
environment.
I trust you will find these articles
both informational and a
source of reference in the future.
Looking forward to this new adventure,
I remain,
As Always,
Stuart Coleton, DDS
Stuart Coleton, DDS
A U T H O R B I O G R A P H Y
Dr. Stuart Coleton is a Diplomate
of the American Board of
Periodontology and the American
Board of Oral Medicine. He is chief
attending periodontist at
Westchester Medical Center
University Hospital, holds the rank
of assistant professor in dental
medicine at New York Medical
College, and is the chief attending
in periodontics at the Metropolitan
Medical Center in New York City.
He is a past president of the
Academy of Laser Dentistry and is
a Recognized Course Provider. He
has been certified as having
Advanced Proficiency, Educator,
and Mastership status in lasers by
the Academy of Laser Dentistry.
His areas of special expertise are
periodontal diagnosis and treatment
as well as oral medicine. He
has taught didactic and clinical
laser therapy to both dental and
medical general practice residents.
Dr. Coleton may be contacted by
e-mail at Scoleton@aol.com.
Disclosure: Dr. Coleton is a stockholder
in Lantis Laser, Inc. nn

Approaching ALD Prime
J Laser Dent 2011;19(3):255
As we approach the end of our 19th
year as the premier, unbiased
dental laser education entity, I
would like to invite all our
members, as well as all of the
nonmember dentists that are just
discovering dental lasers, to join us
in Scottsdale, Arizona for our
Annual Conference and Exhibition.
The dates are March 29 to 31, 2012
and I look forward to meeting all
the attendees and to enjoy learning
from the excellent presentations.
I also want to share with you
our most recent news. We have a
new Editor-in-Chief, Dr. Stuart
Coleton. We welcome him with
open arms and look forward to
working with him for many years
to come. Also, in October the ALD’s
Board of Directors met at the
Radisson Fort McDowell, the venue
for our 2012 Annual Conference.
We are excited about the ALD’s
new direction that includes
creating educational materials
more easily accessible to all
members and creating a speakers
bureau and course options to be
offered to dental organizations and
to our members as well. We had a
Leadership Development Day that
was very successful. We worked
very hard and still had time to
have fun. The ADA-ALD Laser
Pavilion at the ADA Meeting in Las
Vegas last October was a great
success thanks to the hard work of
our Executive Director and one of
our past presidents, Dr. Don
Coluzzi, who again presented
dental lasers to all ADA members
that wished to be informed about
this technology. We are planning
even more joint programs for next
year’s ADA meeting. Our Web site
has been revamped and we are
striving to improve it regularly to
make it easier to navigate by all of
our members. The 2012 Annual
Conference Program is posted on
the Web site for all to see what a
great learning experience we will
have in Scottsdale.
Dr. Vipul Srivastava and a group
of very dedicated Indian Dentists
and Academicians from Lucknow,
India had been working with Dr.
Gabi Kessler since March 2011 to
I am happy to preside over a Board of Directors that
is working with a great sense of teamwork, dedication,
and commitment; this also includes our Committee
Chairs, and it is the best recipe for success.
organize a Standard Proficiency
Course in India. Dr. Srivastava and
his group also wanted to create an
ALD Affiliate Study Club in India.
They were successful and in
October our Board signed the
agreement to make it official. On
December 17 and 18 in New Delhi,
India and on December 19 and 20
in Lucknow, India Dr Gabi Kesler
presented Standard Proficiency
Courses which were very well
attended and represented the inauguration
of the ALD Affiliate India
Study Club. The President of the
Dental Council of India, Dr.
Dibyendu Mazumder, and other
P R E S I D E N T ’ S M E S S A G E
Ana Triliouris, DDS
Merrick, New York
ALD President 2011-2012
dignitaries of the Indian Dental
Community (including Dr. Anil
Chandra, Dr. A.P. Tikku, and Dr.
S.S. Ojha) were present. I was privileged
to have been invited by the
organizing group and enjoyed their
great hospitality as I represented
the Academy of Laser Dentistry. We
returned with 25 new members
and 10 registrations to our Annual
Conference in Scottsdale. We look
forward to welcoming the Indian
contingency at the Radisson Resort
this coming March.
I am happy to preside over a
Board of Directors that is working
with a great sense of teamwork,
dedication, and commitment; this
also includes our Committee
Chairs, and it is the best recipe for
success. I am looking forward to
celebrating our 20th Anniversary
in 2013 with the ALD at its prime.
Let’s continue moving forward and
resolve to be committed and dedicated
to the “ALD Prime.” I thank
all of you for your hard work.
Ana Maria Triliouris, DDS
President of the Academy of Laser
Dentistry nn
Triliouris
J O U R N A L O F L A S E R D E N T I S T R Y | 2 011 V O L . 19 , N O . 3
255

J O U R N A L O F L A S E R D E N T I S T R Y | 2 011 V O L . 19 , N O . 3
256
E X E C U T I V E D I R E C TO R ’ S M E S S A G E
ALD – A History of Values
Gail S. Siminovsky, CAE, Executive Director
J Laser Dent 2011;19(3):256-257
As we begin 2012, my sights are set
12 months from now when we will
be commemorating the Academy of
Laser Dentistry’s 20th Anniversary
during our 2013 Annual Conference
and Exhibition. As I think about
how we will celebrate, I pause to
reflect upon ALD’s journey as an
organization over the years under
the leadership of our past and
current Boards of Directors, and
through my own tenure as
Executive Director and the guidance
of my predecessors.
Our organizational values firmly
set the role of the Academy of
Laser Dentistry to serve dentistry
as the professional standardsetting
society that we are. These
values are the basis of our work
with state regulatory agencies,
dental associations, dental schools,
the professional community, and
our members.
Back in August 2002, ALD’s core
Siminovsky
values were set to guide our future
direction and policymaking. With
the help of the many voices of our
constituents, we identified a beginning
set of core values:
1. Care
2. Professional Happiness
3. Professional Community
4. Dental Family
5. Research and Education, and
6. Professional Values. 1-2
In 2004 during the development
of the Academy’s 2005-2010
Strategic Plan, key leaders of our
organization summarized those six
values into three general values:
Integrity, Innovation, and
Professional Community.
In 2010 our leadership developed
our current 2010-2013
Strategic Plan that we named
‘Governing in Uncertain Times.’ In
it we address the changing needs of
professional environment, changes
within our own leadership, and
THE ACADEMY OF LASER DENTISTRY
Core Values
ALD is committed to the organizational values of:
Integrity:
Being trustworthy and reliable; transparent and accountable;
objective and impartial
Innovation:
Being a knowledgeable and competent authority open to
new ideas; actively and courageously leading the evolution
of the body of knowledge
Professional Community:
Being an inclusive forum for dialogue among a variety of
interests and perspectives; supporting and encouraging
continuous participation in professional development
Gail S. Siminovsky, CAE, Executive Director
your needs as members, all the
while upholding our 3 general
values of Integrity, Innovation, and
Professional Community.
Our Academy’s values are essential
to our being. They help us to
achieve our mission and organizational
purpose, provide
fundamental policies, and determine
our future direction. They are
central to developing and fulfilling
our strategic plans. 3 These core
values are an integral part of who
we are as an organization and
remain so as we begin planning our
20th Anniversary celebrations.
As any organization evolves and
grows and matures, many changes
occur. Our biggest challenges
include addressing strategies to
fulfill our mission, vision, and goals
while keeping our core values everpresent.
Revisiting programs,
sun-setting what may no longer
work well, and developing new
ways to achieve our mission is challenging,
to say the least. It is part
of every organization’s life cycle. As
the economy has changed, ALD’s
financial position has changed, and
the years since 2009 have been
challenging for our small organization.
Our current strengthening
financial standing has not come
without sacrifice. It’s tough to
make tough decisions, especially
under such circumstances. Evolving
and addressing needed change is
courageous and hard to do well.
The real success is in adapting and
navigating through the difficult
times to brighter times. As is the
case with most organizations, not
everyone always agrees. Different
opinions are voiced. Building

consensus is a talent. I’m happy to
report we approach 2012 with
renewed spirit.
Our current leadership has a
strong sense of collegiality and we
are devoted to working hard to
become more inclusive, less rigid
and more agile, more welcoming of
new members, and more appreciative
of our volunteers, all at the
same time upholding our core
values and providing more educational
opportunities. We are
expanding our reach by collaborating
with other larger dental
associations like the American
Dental Association (ADA), the
Academy of General Dentistry
(AGD), and their various component
societies. We continue our
representation on the American
National Standards Institute
(ANSI) Accredited Standards
Committee (ASC) Z136 for Safe
Use of Lasers and its standards
subcommittee SSC-3 Safe Use of
Lasers in Health Care. We are
expanding our relationships with
dental schools, state boards of
dental examiners, and other organizations,
some of which are outlined
in the listing of 10 ALD Facts. We
have identified areas of member
services that can be improved, and
are working diligently to respond to
our member’s needs
We have taken our pulse and we
approach our 20th Anniversary
Year with enthusiasm, courage, and
commitment to our foundational
core values. We are excited for our
future and the future of lasers in
dentistry.
See you in Scottsdale in just a
few short weeks!
Sincerely,
Gail S. Siminovsky, CAE
Executive Director
10 ALD Facts
E X E C U T I V E D I R E C TO R ’ S M E S S A G E
1. ALD is a not-for-profit, independent organization that
determines that professional educational standards for
the safe use of lasers are met.
2. ALD is internationally recognized as a professional standard-setting
leader.
3. ALD has no commercial bias.
4. ALD is recognized by the ADA as an affiliated organization,
is an ADA CERP Continuing Education Recognized
Provider, and is an Academy of General Dentistry
approved program provider.
5. ALD is a member of the National Coalition of General
Dental Organizations.
6. ALD plays an integral role in the ANSI Standards with
the Laser Institute of America (LIA).
7. ALD is a member of the American Dental Editors
Association (ADEA).
8. ALD participates with the Nevada State Board of Dental
Examiners in reviewing dental laser educational courses.
9. The American Dental Education Association (ADEA) has
established a Special Interest Group on Lasers thanks to
members of the ALD.
10. ALD is represented on the ADA Standards Committee
on Dental Products Working Group on Dental Lasers
(ADA SCDP) and the ADA Standards Committee on
Dental Informatics (ADA SCDI).
R E F E R E N C E S
1. Siminovsky GS. Core values workshop
determines ALD’s future
direction. Wavelengths 2002;10(4):5.
2. Siminovsky GS. Values. J Acad
Laser Dent 2004;12(2):7.
3. Siminovsky GS. Values are the core
of ALD policy-making. J Acad Laser
Dent 2005;13(4):14-15. nn
Siminovsky
J O U R N A L O F L A S E R D E N T I S T R Y | 2 011 V O L . 19 , N O . 3
257

J O U R N A L O F L A S E R D E N T I S T R Y | 2 011 V O L . 19 , N O . 3
258
N O M I N AT I O N S
Academy of Laser Dentistry’s 2012 Nominated
Slate of Officers and Directors
Arthur B. Levy, DMD, Chester, New Jersey
As the final strains of Auld Lang
Syne drift into the distance and the
holidays become a fond memory,
the business of the Academy
returns to its place in the forefront
of our minds. The next year is a
busy one preparing for our 20th
Anniversary Year in 2013. Your
Nominating Committee has been
hard at work for the past few
months reviewing questionnaires
and evaluating the candidates
submitted by you, the members, for
positions on the Executive
Committee and Board of Directors.
We will be saying good-bye to some
members of the Board of Directors
and Officers, thanking them for
their tireless and irreplaceable
work for the Academy as well as
welcoming new members into new
positions in your Academy
Leadership. We are fortunate to
have such a dedicated and tireless
group to lead us and have had the
good fortune to be able to select
from a number of excellent choices.
Unfortunately, not all members
eligible and submitted can be
chosen due to the limits on the
positions placed in the Constitution
and Bylaws. However, we have
committee chair positions and
committee assignments that will
help us utilize the talent that we
have available.
As set forth in the Constitution
and Bylaws, the Membership
Meeting will take place on Friday,
March 30, 2012 at the Conference
taking place at the Radisson/Fort
McDowell Resort in Scottsdale,
Arizona. At that time the slate of
officers, presented below, will be
voted on for the 2012-13 Academy
Year.
Art Levy, DMD, Nominations
Committee Chairman
Characteristics and Attributes of an Ideal Academy of Laser Dentistry Board Member
Proven Performance
Leadership requires knowledge, talent, skill, vitality, and the
ability to make a difference. In the association environment,
that translates into a solid track record of contributing to the
success of programs, events, or projects.
Commitment
Serving as an association leader is both an honor and a
reward, but it requires a demonstrated commitment to the
organization and its mission and goals.
Time to Serve
Participating fully in association activities requires extra time to
prepare for travel and attend meetings.
Understanding of Teamwork
Many people contribute their efforts toward the realization of
an association’s goals and objectives – no one does it alone.
Well-developed interpersonal and communication skills are
essential to effective teamwork.
Sound Judgment and Integrity
In many instances, popularity brings potential leaders into the
The Nominations Committee has
selected the following nominees:
• President-Elect:
Glenda Payas, DMD
• Vice President:
Scott Benjamin, DMD
• Treasurer:
John Graeber, DMD
• Secretary:
Gabi Kesler, DMD.
limelight of an association. But popularity must be tempered
with good judgment and integrity. Decisions may need to be
made that are not popular with the members but still serve the
best interests of the organization as a whole.
Communication and “Teaching” Skills
By virtue of their position, current leaders serve as mentors
and teachers to future leaders. Enthusiasm – a zest for serving
the association – is an important ingredient that leaders must
be able to pass along to their successors.
Ability to Subordinate Special Interests
Leaders often emerge because of their special expertise or
effective representation of a specific constituency. Leadership,
however, may require subordinating those interests for the
greater good of the association.
Be Strategic Thinkers
Intuitive and interpretive skills enable leaders to understand the
people around them, internalize the data they receive, recognize
the relationships that exist between the systems within their
world, and integrate all these elements into a coherent whole.

P R E S I D E N T- E L E C T :
Dr. Glenda Payas
Dr. Glenda Payas maintains a
general dentistry practice in Tulsa,
Oklahoma. She is a charter
member of the Academy of Laser
Dentistry (ALD), and holds
Advanced Proficiency in CO 2 and
Er:YAG laser wavelengths. In 2007,
Dr. Payas received her Mastership
from the Academy of General
Dentistry and is a clinical
instructor for the Kois Center, in
Seattle, Washington. She currently
serves as Vice President on the
ALD Executive Committee after
having completed a 3-year term of
board service in 2009. She has held
the positions of Secretary and
Treasurer and is currently the
Chair of the ALD Awards and
Student Scholarship Committees as
well as the upcoming Chair of the
2013 Annual Conference. She was
awarded the “2011 Top 25 Women
in Dentistry” by Dental Products
Report. She was one of the first
dentists in the United States to use
a laser, starting in 1991. Dr. Payas
can be contacted at
drglendapayas@msn.com.
V I C E P R E S I D E N T :
Dr. Scott Benjamin
Dr. Scott Benjamin is a graduate
of the State University of New York
(SUNY) Buffalo, School of Dental
Medicine and has been in full-time
private practice in rural upstate
New York for more than 30 years.
Dr. Benjamin is an internationally
recognized authority on oral cancer
and a leader in computerized
dental technology and dental
lasers. He is a visiting professor at
the SUNY at Buffalo School of
Dental Medicine and is a research
associate at the New York
University (NYU) College of
Dentistry. He is an active member
of American Dental Association
Standards Committee on Dental
Informatics (ADA-SCDI), the
chairman of several separate
Working Groups, and was
appointed to the Task Force on the
National Healthcare Information
Infrastructure (NHII). Dr.
Benjamin is a past president of the
Sixth District Dental Society of the
New York State Dental Association,
has served on the ALD Board of
Directors and as the 2010 ALD
Chairman of General and Scientific
Sessions Committee for the Miami
Conference. Currently he holds an
Executive Committee position as
Treasurer. Dr. Benjamin may be
reached by e-mail at
sbenjamin@dentalaim.com.
T R E A S U R E R :
Dr. John J. Graeber
N O M I N AT I O N S
Dr. John J. Graeber maintains a
comprehensive, full-time general
practice in East Hanover, New
Jersey. He has been awarded
Mastership in the Academy of
General Dentistry and the
Academy of Laser Dentistry. He
holds Advanced Proficiency in the
Nd:YAG laser wavelength as well
as Educator status and is a
Recognized Course Provider. Dr.
Graeber is a visiting lecturer in
lasers at the University of
Medicine and Dentistry of New
Jersey, New York University
(NYU), and the University of
Minnesota Dental Schools. He
utilizes Nd:YAG, diodes, and
erbium laser wavelengths in his
practice. He has been teaching the
Standard Proficiency course since
1996 and has served two terms on
the ALD Board of Directors. In
2011 he holds the position as
Chairman of General and Scientific
Sessions for the 2012 Scottsdale
Conference along with the
Executive Committee position as
Secretary. Dr. Graeber may be
reached by e-mail at
hitekdr@mac.com.
J O U R N A L O F L A S E R D E N T I S T R Y | 2 011 V O L . 19 , N O . 3
259

J O U R N A L O F L A S E R D E N T I S T R Y | 2 011 V O L . 19 , N O . 3
260
N O M I N AT I O N S
S E C R E TA RY :
Dr. Gabi Kesler
Dr. Gabi Kesler is in private
general practice in Tel Aviv, Israel.
He is a lecturer in the Department
of Oral Rehabilitation at the Tel
Aviv University School of Dental
Medicine and is the coordinator of
the graduate and postgraduate
dental laser program. He has
Advanced Proficiency in CO 2 and
Er:YAG laser wavelengths, is an
ALD Recognized Course Provider,
and has ALD Educator status. He
received the Leon Goldman Award
for clinical excellence and has
published research papers on bone
healing. He established the Israeli
Chapter of the Academy of Laser
Dentistry, served as its first president
in 2005, and currently serves
as ALD’s Chairman of
International Relations. Previously
Dr. Kesler completed two 3-year
terms of leadership service on the
ALD Board of Directors. He is
nominated for the position of
Secretary 2012-13. Dr. Kesler
may be reached by e-mail at
drkeslerg@-12.net.il.
The offices of President, Dr. Art
Levy, and Immediate Past
President, Dr. Ana Triliouris, are
automatically filled, and are not
part of the voting process.
Dr. Art Levy automatically
assumes the role of President in
2012 and Dr. Ana Triliouris
moves into the position of
Immediate Past President.
P R E S I D E N T :
Dr. Arthur Levy
Dr. Arthur Levy maintains a
private practice in Chester, New
Jersey, and is a charter member of
the ALD. He holds Advanced
Proficiency in the Nd:YAG laser
wavelength. He has served two 3year
terms on the ALD Board of
Directors and has been active in
numerous committees including
International Relations,
Membership, Finance,
Nominations, and Awards since the
beginning of the Academy in 1993.
Dr. Levy currently serves as
President-Elect. Dr. Levy may be
contacted by e-mail at
lsrdocloft@embarqmail.com.
I M M E D I AT E PA S T
P R E S I D E N T :
Dr. Ana Maria Triliouris
Dr. Ana Maria Triliouris maintains
a private practice in Merrick,
New York, and is a charter member
of the ALD. She is among the very
few dentists that started using
lasers in 1990. She was the first
editor of ALD’s initial publication,
Wavelengths. She is an active
member of the ADA and its components
as well as the Academy of
General Dentistry and the
American Association of Women
Dentists. She is past Chair of the
Dr. Eugene Seidner Student
Scholarship Committee, past editor
of the newsletter Lightwaves, and
has held various other leadership
positions in the ALD. Dr. Triliouris
may be reached by e-mail at
amtdds@gmail.com.
2 012 - 2 015
N O M I N AT E D B OA R D
M E M B E R S
Following a successful election
during the General Membership
Meeting, these nominated members
will join the ALD Board of
Directors for a 3-year term starting
March 31, 2012.
Dr. Charles Hoopingarner
Dr. Charles Hoopingarner
attended the University of Texas
Health Science Center at Houston
(UTHSCH) Dental Branch, graduating
with a DDS in 1973. He has
maintained a private practice in
Houston, Texas since 1973. He was
an adjunct associate professor in
anatomical sciences at UTHSCH
Dental Branch for 11 years.
Currently he is adjunct clinical
faculty in the Restorative Dentistry
Department at UTHSCH and has
been a clinical instructor at the Las
Vegas Institute for Advanced
Dental Studies since 1997, teaching
advanced anterior aesthetics and
comprehensive aesthetic reconstruction
and laser dentistry. Dr.
Hoopingarner is a member of the
Board of Directors of the ALD and
has used dental lasers of various
wavelengths as integral parts of his
patient care delivery system for the
last 11 years. He is the ALD
Regulatory Affairs Committee
Chair and Vice Chair of the

Certification Committee. He holds
Advanced and Standard Proficiency
certifications in the Er:YAG and
diode laser wavelengths from the
ALD and has lectured internationally
on the safe use of laser
technology in the dental practice.
He is nominated for a second 3year
term of service on the ALD
Board. Dr. Hoopingarner may be
contacted by e-mail at
choop@swbell.net.
Dr. Edward Kusek
Dr. Edward Kusek is a 1984 graduate
of the University of Nebraska
School of Dentistry. He is in private
general practice in Sioux Falls,
South Dakota. He is a Diplomate of
the American Board of Oral
Implantology/Implantology/
Implant Dentistry, a Fellow of the
American Academy of Implant
Dentistry and Academy of Laser
Dentistry, has earned Mastership in
the Academy of General Dentistry
and World Clinical Laser Institute
(WCLI), and Advanced Proficiency
in the Academy of Laser Dentistry
in the Er,Cr:YSGG laser wavelength.
Dr. Kusek currently serves
on the Certification Committee. He
is an adjunct professor at the
University of South Dakota and
lectures nationally and internationally
on the erbium laser and dental
implants. He is nominated for a
3-year term of service on the ALD
Board of Directors. Dr. Kusek may
be reached by e-mail at
edkusek@me.com
Jeanette Miranda, RDH
Jeanette Miranda, RDH, has
practiced dental hygiene for 31
years and has worked with dental
lasers for 7 years. She currently
practices hygiene with Dr. Ed
Kusek. She has achieved diode
laser Standard Proficiency with the
WCLI and ALD, and diode laser
Fellowship status with the WCLI.
Ms. Miranda serves on the ALD
Laser Safety Committee and as
Vice Chair for the Auxiliary
Committee. In addition to lecturing
on periodontal treatment with
lasers, she teaches diode laser
courses with Dr. Edward Kusek
and Dr. Fred Margolis. Ms.
Miranda is nominated for a 3-year
term as the Auxiliary representative
on the ALD Board of Directors.
Jeanette may be reached by e-mail
at jmirand@sio.midco.net.
Dr. Steve Parrett
Dr. Steve Parrett is in the private
practice of general dentistry in
Chambersburg, Pennsylvania
where he is currently chairman of
the Department of Dentistry at
Chambersburg Hospital. He holds
Standard Proficiency in Er:YAG,
diode, and CO 2 laser wavelengths.
He is a member of the Dean’s
Faculty at the University of
Maryland Dental School, and has
N O M I N AT I O N S
served on the House of Delegates of
the ADA and Pennsylvania Dental
Association (PDA). He has achieved
Fellowship status in the Academy
of General Dentistry and has
served many years as a clinical
evaluator for Dr. Gordon
Christenson’s CRA independent
research organization. He serves on
the ALD’s Membership and
Regulatory Affairs Committees and
has served on the ALD
Communications Committee in the
past. Dr. Parrett currently serves
on the ALD Board of Directors and
is nominated for his second 3-year
term. Dr. Parrett may be reached at
drp@embarqmail.com.
2 011- 2 012 A L D
N O M I N AT I O N S
C O M M I T T E E
Art Levy, DMD, President-Elect,
Chester, NJ
Steven Burman, DMD, Immediate
Past President, Manalapan, NJ
Tony Hewlett, DDS, Stanwood, WA
Raminta Mastis, DDS, St. Clair
Shores, MI
Emile Martin, DDS, Syracuse, NY
Gail Siminovsky, CAE, Executive
Director, Coral Springs, FL nn
Academy of Laser Dentistry
to Hold General
Membership Meeting in
Scottsdale, Arizona on
March 30, 2012
The Academy of Laser Dentistry
will conduct its general membership
business meeting on March
30, 2012 during the 19th Annual
Conference and Exhibition. Dr. Art
Levy, Nominations Chair and
President-Elect, will explain the
selection process for ALD directors
and officers as well as the organizational
committee structure.
Eligible voting members present in
Scottsdale will be asked to vote to
accept the nominees to serve in
Board leadership positions for the
Academy of Laser Dentistry.
J O U R N A L O F L A S E R D E N T I S T R Y | 2 011 V O L . 19 , N O . 3
261

J O U R N A L O F L A S E R D E N T I S T R Y | 2 011 V O L . 19 , N O . 3
262
A WA R D S
ALD Award Recipients
Announced for 2012
Glenda Payas, DMD, Award Committee Chair
Many of the members of the
Academy of Laser Dentistry (ALD)
submerge themselves in the
dynamics of laser dentistry on a
day-by-day basis. They put in long
days at the office serving their
patients, and in their “free time”
they dedicate themselves in even
deeper ways. They spend time in
research developing new treatment
techniques, write journal articles,
teach at seminars, mentor
colleagues, and spend countless
hours volunteering on Academy
committees, and they do this
without the thought of being given
an award.
The ALD has three awards to
celebrate the hard work of its
members: The T.H. Maiman Award
for Excellence in Dental Laser
Research, The Leon Goldman
Award for Clinical Excellence, and
The Distinguished Service Award
for Outstanding Commitment and
Contributions to the Academy.
Because of the level of sacrifice
our members are committed to,
they understand the criteria it
takes when nominating another
member for one of these prestigious
awards. Their nominees are above
the standard and show such dedication
and passion.
As the Awards Committee Chair,
I present to you our 2012 award
recipients. I congratulate each of
these ALD members that are
honored here.
Our 2012 recipient of The Leon
Goldman Award for Clinical
Excellence is Dr. Mel Burchman.
He is an educator, clinician, and
pioneer in the usage of low-level
laser therapy (LLLT), particularly
in the treatment of the medically
compromised patient.
Dr. Burchman has used lasers in
his private practice since 1999 and
holds both Standard Proficiency
(SP) and Advanced Proficiency (AP)
certifications in multiple laser
wavelengths and has achieved
educator status in the Academy. He
has used Nd:YAG, diode, and
Er,Cr:YSGG laser wavelengths in
addition to
the work he
has done with
LLLT.
He is a
Master of the
Academy of
Laser
Dentistry and
Mel A. Burchman, DDS
has presented
Glenda Payas, DMD,
Awards Committee Chair
multiple times to both our
Academy and our Israeli chapter.
He is currently Chairman of the
Certification Committee while
being an examiner and a mentor to
our SP and AP candidates. Working
on medically compromised patients
in his private practice in Bucks
County, Pennsylvania, is the area of
which he is most proud.
Upon learning of his honor, Mel
remarked, “Working on medically
compromised patients is absolutely
the most rewarding phase of my
practice. Most of these patients have
been patients and friends for many
years. To know that you have helped
these people by avoiding another
hospitalization, changes in medications,
and additional expenses is
the best feeling you can have! I am
most grateful to be honored with
this award.”

For The T.H. Maiman Award
for Excellence in Dental Laser
Research our award recipient is
Dr. Sebastiano Andreana. Several
accomplishments must be met for a
person to be considered qualified as
a nominee for this prestigious
award. He or she should be a
researcher, a
professional
clinician, and
an academician;
must
have
published
papers; and
Sebastiano Andreana
not only be
involved but
contribute to
the goals and mission of ALD.
Dr. Sebastiano Andreana earned
his dental degree at the University
of Rome La Sapienza School of
Dentistry in 1990. He earned a
master of science degree in oral
sciences from the State University of
New York at Buffalo School of Dental
Medicine in 1995. He has been a
member of the International
Association for Dental Research
since 1991; an associate member
American Academy of Periodontology
since 2003; and is an active member
of New York Academy of Sciences.
He currently is Clinical Assistant
Professor in the Department of
Restorative Dentistry, School of
Dental Medicine, State University of
New York at Buffalo. He is a
reviewer of a several journals,
including the Journal of
Periodontology, Journal of the
American Dental Association, British
Dental Journal, Immunological
Investigations, and Journal of
Osseointegration. He is presently the
Senior Associate Editor of the
Journal Oral Implantology. He
currently serves the Academy of
Laser Dentistry as University and
Academia Relations Chair and has
served as Vice Chair of ALD’s
Science and Research Committee.
When he heard about his nomination,
Dr. Andreana responded by
saying, “I should admit I was very
surprised to hear about my nomination,
definitely unexpected! Within
our organization we have several
researchers that deserve the nomination
and I am surely honored to
be the one this year. Knowing that
my name will be in the same list of
some outstanding laser researchers
is truly an honor. I will do my best
to continue to work in this field, to
allow more clinicians and therefore
more patients to benefit from using
the laser technology in dentistry.”
And our recipient for The
Academy of Laser Dentistry
Distinguished Service Award
for Outstanding Commitment and
Contributions to the Academy is
Dr. Emile Martin.
A Past President and Board
member of the Academy of Laser
Dentistry, Dr. Martin has maintained a
private dental practice since 1975. He
is a graduate of the Temple University
School of Dentistry, and successfully
completed a 3-year participatory
program in Dental Implantology from
A WA R D S
the University
of
Pennsylvania.
He has
achieved
Educator and
Mastership
status in the
Dr. Emile Martin
ALD, and is a
Fellow of the
American Academy of Implant
Dentistry and a Diplomate of the
American Board of Oral
Implantology/Implant Dentistry. He
has served in various executive positions
with many professional dental
organizations, and has made
numerous presentations on laser and
implant dentistry at dental conferences
around the world. He has been
a reviewer for the Journal of the
American Dental Association,
Journal of Oral Implantology, and
the Journal of the Academy of Laser
Dentistry. He is a recipient of the
Academy of General Dentistry’s
Lifetime Learning and Service
Recognition Award.
When he heard about his
Distinguished Service Award, Dr.
Martin stated, “I have been privileged
to work in a leadership capacity in
several national dental organizations.
I have always enjoyed dental organizational
work. It is a way to give back
to the profession that I love, meet
people from all parts of the United
States and around the globe, and
learn something new at the same
time. I am humbled and grateful to
the Committee that has seen fit to
bestow this honor upon me.” nn
J O U R N A L O F L A S E R D E N T I S T R Y | 2 011 V O L . 19 , N O . 3
263

J O U R N A L O F L A S E R D E N T I S T R Y | 2 011 V O L . 19 , N O . 3
264
2 012 C O N F E R E N C E
Elevating Your Practice
to New Peaks!
John J. Graeber, DMD MAGD MALD FICD,
East Hanover, New Jersey
We have assembled many of the
best laser educators in the world to
conduct our Annual Scientific
Meeting!
As part of our preconference
certification program on Wednesday,
March 28, Dr. Will Gianni, Dr. Mitch
Lomke, and Angie Mott, RDH will
present this year’s Standard
Proficiency Course. New this year
will be Lasers 101 — a 3-hour introductory
course for nonusers led by
Dr. Chuck Hoopingarner.
World-famous physicist Dr.
Gregory Altschuler will be our
opening session keynote speaker on
Thursday. He will share his experiences
as a laser pioneer in the former
Soviet Union and his new projects in
developing the next generation of
lasers. The program on chromophores
by Dr. Bryant Cornelius and Dr.
Jeffery Cornelius promises to be very
enlightening. Mary Lynn Smith,
RDH will be sharing insights
comparing the use of 980-nm and
10,600-nm laser wavelengths in
nonsurgical perio dontal therapy.
Gloria Monzon, RDH will compare
the effects of 3 laser wavelengths on
one patient years apart.
Hands hurt? Cracked? Wonder
about gloves? Leslie Canham, CDA
will poke some fun into these topics.
Endo, anyone? Dr. Ron Porth will
share his ongoing study of the efficacy
of lasers in the canals. Dr. Roy
George of Australia will show us
W E I N V I T E YO U TO S C OT T S DA L E !
Your Conference Committee has devoted itself to making this
year’s ALD Annual Conference what you, the members, want:
You asked for clinically relevant presentations – You’ve got them!
30 CLINICAL PRESENTATIONS
You asked for meaningful hands-on experiences – You’ve got them!
11 WORKSHOPS
You asked for diode laser programs – You’ve got them!
11 PRESENTATIONS AND WORKSHOPS
You asked for some fun in the sun – You’ve got it!
LASER JEOPARDY, HANDS-ON HYGIENE
You asked for low-level science and applications – You’ve got them!
13 PRESENTATIONS
You asked for a dedicated Hygiene Day – You’ve got it!
OUR BEST HYGIENE EDUCATORS
You asked for specialist days – You’ve got them!
ORTHODONTICS AND PEDIATRIC DENTISTRY
Now y’all come to Scottsdale – and bring your friends!
John Graeber, DMD, General and
Scientific Sessions Committee Chairman
how newly modified fiber optics can
enhance our results. Popular
speakers Dr. Giovanni Olivi, Dr.
Felice Marmoro, Dr. Caterina
Faccin, and Dr. Guiseppe Bray (all
from Italy), and Dr. Enrico DiVito
(who is local to Scottsdale now) will
show us the advantages of photoacoustic
streaming. Dr. Mel
Burchman will describe an interesting
case of endodontic surgery on
a medically compromised patient.
Perio, anyone? Internationally
known periodontist Dr. Larry Nurin
will share his secrets of laser use
over the past 21 years of practice. We
will see how periodontal surgery is
performed in Japan by the renowned
Dr. Hisamori Hayashihara. Thursday
workshops will include DNA testing
by Dr. Doug Gilio, diode surgery by
Dr. Phil Hudson, and Keynote on
Mac by Dr. Larry Kotlow (bring your
Mac computer!).
Friday will begin with Past
President Dr. Kim Kutch giving a
keynote presentation on minimally
invasive dentistry. Our student
presenter, Jeema Dad, will share her
work in a study of bond strengths in
lased tooth structure. Dr. Sebastiano
Andreana and Jeanette Miranda,
RDH will describe the use of lasers
in implant dentistry. Dr. Chris
Walinski is going to show us how to
accomplish minimally invasive techniques
with erbium lasers. Dr. Gabi
Kesler from Israel will share bone
healing with erbium lasers. Dr.
Larry Kotlow will have some
provocative thoughts about why we
don’t get the most use out of our
lasers. Drs. Peter Pang and Rick
Cordoza will share their cosmetic

estorative cases with us. We finish
Friday with Dr. Paul Silver’s handson
diode laser practical, Dr. Mitch
Lomke’s laser-assisted crown lengthening
workshop, and an interactive
workshop with 20-year laser veteran
Dr. Phil Hudson on practice management
with lasers.
Also on busy Friday will be the
all-day Pediatric Dentistry program
with hands-on activities with Drs.
Larry Kotlow, Fred Margolis,
Giovanni Olivi, and Claudia
Caprioglio, and the new all-day
Orthodontists program with Drs.
Lou Chmura, Stephen Tracey, and
J. Courtney Gorman.
We hope your hygienists are
planning to attend our all-day
Hygienist Extravaganza. This will
be a one-day, separate ticketed event
for hygienists, both new and experienced.
The day will be headlined by
Dr. Chris Owens who has trained
thousands of practitioners, and ably
complemented by ALD Recognized
Course Providers Gloria Monzon,
RDH and Angie Mott, RDH, along
with Mary Lynn Smith, RDH. Dr.
Gerald Ross will discuss low-level
laser procedures by hygienists.
Saturday will feature an all-day
program on photobiomodulation –
an ALD first-time event! – as well
as programs in oral surgery. For the
photobiomodulation segment, we
will welcome members of the North
American Association for Laser
Therapy (NAALT): Dr. Praveen
Arany, Mr. James Carroll, Dr. John
Hendy, Dr. Mark Dincher, Mr. Steve
Liu, and Dr. Harry Whelan who will
be joined by international presenters
Drs. Juliana Barros and
Shalizeh Patel of the University of
Texas Health Science Center at
Houston, Dr. Masoud Mojahedi
from Germany, Dr. Claudia
Caprioglio from Italy, Dr. Shally
Mahajan from India, and moderator
Dr. Gerry Ross from Canada.
For Saturday’s oral surgery
program, Dr. Ed Kusek will present
on use of the erbium laser in softtissue
grafting. Dr. Nitin Agarwal
will show how to treat oral submu-
cosal fibrosis with diode, Er:YAG,
and Nd:YAG lasers. Dr. Claus
Neckel will present diode laser
cases for treatment of impacted
and displaced cuspids; Dr. Jay Sher
on clinical crown lengthening with
the CO 2 laser; Dr. Mike Kelly of
Scottsdale on depigmentation with
the CO 2 laser; and Dr. Larry
Kotlow on erbium and Nd:YAG
laser-assisted soft tissue surgery.
Last year’s hit program “Laser
Safety in Jeopardy!” promises us
lots more humor, produced by Dr.
Raminta Mastis and the Laser
Safety Committee.
2 012 C O N F E R E N C E
Don’t forget the Pioneers Panel
— past presidents Dr. Bob Pick, Dr.
Terry Myers, and Dr. Kim Kutsch
will join Dr. Gregory Altshuler as
they use their perspectives to peer
into the future for the next 20
years of lasers in dentistry. That
will lead us into our 20th anniversary
celebration in 2013.
Meet me there!
John Graeber, DMD nn
Final schedule is subject to change.
Join us in Philadelphia this June to enjoy the freedom of earning
an entire year’s worth of continuing education in one great location!
This year’s educational program includes:
� “Key Implant Position and Implant Number: A Biomechanical Rationale
to Treatment Planning,” Carl E. Misch, BS, DDS, MDS, PhD (hc)
� “Advanced Oral Surgery Techniques for Smoother, Easier, Less Stressful
Procedures,” Karl Koerner, DDS, FAGD, MS
� “What’s Hot and What’s Getting Hotter,” Howard S. Glazer, DDS, FAGD
� “The Occlusal Secrets You Should Have Learned in Kindergarten:
Or, How to Take Your Practice to the Next Level,” Irwin Becker, DDS
REGISTER TODAY!
www.agd.org/philadelphia
You’ll learn tips
and techniques
you can use as soon as you
get back to the office.
And don’t forget your staff —
we’ve planned a variety of
practical educational
opportunities
for them, too!
See the latest
dental equipment
and materials in our
Exhibit Hall with
more than
200 exhibitors!
J O U R N A L O F L A S E R D E N T I S T R Y | 2 011 V O L . 19 , N O . 3
265

J O U R N A L O F L A S E R D E N T I S T R Y | 2 011 V O L . 19 , N O . 3
266
C E R T I F I C AT I O N
ALD Certification Program Planned in
Scottsdale, March 29-31, 2012
Mel Burchman, DDS, Langhorne, Pennsylvania
G R E E T I N G S TO A L L M Y
F E L LO W A L D
M E M B E R S !
Our 19th Annual Conference in
Scottsdale, Arizona is approaching
quickly. However, there is still
ample time to sign up for a certification
examination. Last year’s
conference was tremendously
successful. We had 29 candidates
receive their Standard Proficiency, 3
candidates pass Advanced
Proficiency (AP) Online Review and
Written Examination and AP
Clinical Simulation Examination,
and one candidate complete AP
Case Study Examination. We’d like
to increase those numbers this year.
This has been a very busy time
Burchman
for the people on the Certification
Committee. We have been hard at
work analyzing the Academy’s certification
process and have made
some wonderful enhancements to
the program. We are trying our best
to make the journey to Advanced
Proficiency as candidate-friendly as
possible. People may now take AP
Online Review and Written Exam
or AP Clinical Simulation Exam at
the same time or in whichever order
they like. The time frame between
completing AP Online Review and
Written Exam and AP Clinical
Simulation Exam and being eligible
to test for the AP Case Study Exam
has been shortened to one year.
We are also in the process of
You are cordially invited to our
Advanced Proficiency Review Course
Launch of the Class of 2014
Wine and Cheese Reception
at
ALD’s 19th Annual Conference
Saturday March 31, 2012
3:00 - 4:30 pm
Radisson Fort McDowell, Room 111
Join us to find out more
about the AP program!
Mel Burchman, DDS, Certification
Committee Chairman
completing a totally new AP Online
Review. This could not have been
accomplished without the diligent
work and long hours of a subcommittee
composed of Ms. Angie Mott,
RDH, Dr. Ed Kusek, Dr. Charles
Hoopingarner, and myself.
Another subcommittee has been
formed to review and analyze the
Academy’s test question library.
Their job is to remove outdated or
ambiguous questions. A third
subcommittee has been formed to
analyze the AP process for specialists.
We want to make the
examination process fair to all. As
you can see, we have been listening!
Now it is up to you to participate.
The Certification Committee
would also like to recruit new
members. We want to keep listening
to new ideas. Also anybody interested
in signing up to be an Examiner or
Mentor please contact me at
mel712a@aol.com. Someone gave of
their time to help you, so please give
of yourselves to help our beginning
learners become the best they can be
and to help our Academy grow.
Thank you and hope to see you
in Scottsdale!
Mel Burchman, DDS nn

A Helping Hand
Glenda Payas, DMD, Tulsa, Oklahoma
I didn’t get to where I am without a
lot of help from others. When I was
young I had dreams, like most of
us, but our family lacked the
resources that might have made
those dreams easily come true. I
also grew up in the era in which
one rarely received an encouraging
word for a job well done.
Those factors put me on a path.
They could have put me on a path
where I felt defeated before I
started, but instead they put me on
a path to excel and succeed.
I worked hard, set goals, and
had a vision for where I wanted to
be someday. There were challenges
and disappointments along the way
but as I look back – there was
always someone there that reached
out to assure me that I would get
to my destination.
I still fondly remember those
people. There is no way they could
have known that the tiny seeds
that they were planting; a word, a
smile, a monetary gift, would have
produced such a generous harvest.
These people so impacted my life
that I decided I would, some day,
find others for whom I could do the
same.
As members of the ALD, we
have a great opportunity to sow
seeds within students that need
our reinforcement. We can reach
The future of lasers in dentistry will be built upon the
commitments we make today. The Academy of Laser
Dentistry’s goal is to establish a $100,000 endowment
fund. The interest from this fund will be used to support
the study of lasers by students and other eligible future
programs, while the principle will remain intact.
For more information visit
www.laserdentistry.org/prof/studentscholarship.cfm
or Email E-mail: laserexec@laserdentistry.org
S T U D E N T S C H O L A R S H I P S
Glenda Payas, DMD,
Awards Committee Chair
out to help them achieve their
goals. Through their education and
practice skills they will in turn
impact those lives that they touch
to have great dental health.
Please join us as we give to the
Eugene Seidner Scholarship Fund.
Glenda Payas, DMD, MAGD nn
Sponsored by Henry Schein Dental
J O U R N A L O F L A S E R D E N T I S T R Y | 2 011 V O L . 19 , N O . 3
267

SSee
ee
MMore
o r re
with
the t h he
BIOLASE BIOL
A ASE
DaVinci Da
Vi Vin
n ci
i IImaging
Imagi
i ing
DD3D
3D
The TThh
e Total TTo
otal
TTe
TTechnology
echnolo
nolo gy
SSolution
olu olution
ion
© 20 2011 11
BBIOLASE
IOLAS
S E |
wwww.Biolase.com
ww.Biolase.
com
| TToll-free
To oll-frr
ee
8888-424-6527
88-424-652
27
�
�
�
�
�
�
�
�
�
�
�
A DVA
ANCEED
D IMAA
GING
TE ECC
HNOLOGY:
Y:
D3 D DCBCT CT
ultip
le
field
of
f v
iew
systems
X X-r
r a
y l
o
w
e
r r
a
d i a t i o n d o s a g e
age-blurrin
g p patien
t moveme
nt
by
50%
,
s and
exposu
re
– no
restrai
nt
s o or
“ closed
-in”
feeli
ng
t,
ortho,
ora
l s surger
y,
3rd
molar
extractions,
n one
syste
m
or
high
defini
t tion
with
low
emissi
ons
m a g e s
rienta
tion
of
f c
ross
sectio
ns
ar nerve
n Hounsfield
u
nits
nal
panoram
ic
project
ions

DDo
o M MMore
ore
wwith
i ith
Wa WWaterLase
at
e erLase
iPlus iPl
l us
AAll
l l TTi
Tissue Tiis
s su sue
Laser Laserr
SSy
SSystem
ystem
INTUITIVE VEE & INTELLIGENT
GRAPHICAL GRAPHICA
RAPHICAL US USER INTERFACE
Fo For
eex
xa amp
p le,
, p perfo
ormm
in ng g a
Cl Claa ss
I Ca Caviity ty Pr Pre
ep p
th h e iiP
iiP iPl PPl
P l us s iis
iis
s a
a s ea e a as
s y a
s 11,
1,
2,
3 3.
.
Step Stee p 1 Select
“ Re
e storati
ve”
from
the
first
screen
Step Stee
p 2 Choose
“ C
lass
I”
from
the
next
screen
that
appears
s a
utomat
icall
y
Step Stee
p 3 Specif
y ot
t her
option
s such
as
patien
t
sensitivit
y
or bond
strength
Th That’ s it!
! SSt
Steep
p o on
tth
he
fo foot
peda
al,
, a
nd
staa
rt
work
kkii
ng g wwi
wit
th h n
o shot,
, n no
ddr
riilll
l!
BREAKS THE
SP
PEED BARRIER
� � Reduce
chair
r t
ime
by
avoidi
ng
needle
and
drill
�� Patent
ed
lase
e r techno
logy
deliv
ers
10
watts
of
p o ower
�� Up
to
100
pulses
/ sec.
for
superi
or
soft-t
issue
cut
t ting
�� Enables
multi-
quadra
nt
same-da
y procedu
res
ENA E BBL
BLES PAINLESS
BIOLOGICAL
DENTISTRY D
� � Painl
ess
– no
o s
hot
necessary
in
most
cases
�� No
micro-
frac
c tures
or
thermal
damage
�� Reduce
s the
e r
isk
of
cross
contam
inatio
n compar
e ed
to
d
�� More
precise
e , minimally
invasive
Call Ca all
8
888-424-6527 88-
- 424-6522
7 now
for
r de
details, tails,
oor
r fifind
nd
yyour
o our
BIOLASE
Territory TTe
er
r ritory
y Manager M
anager
at
BBIOLASE.com
IOLA
A SE.
com
uunder
nder
“
“ “Contact”. Con ontact”
.
R
2011
� � Adds
dual
wavelength
versatil
ity
and
conven
en ience
� � First
totally
y wireles
s dental
laser
� � 5 Watts
p e eak
power
with
ComfortPu
u lse
� � Battery
op
p erated
with
finger
switch
act
t ivation
� � Exclus
iv
e b bendable
tips
in
many
diameter
s & lengths
� �� S
i
ngl
l e us
e f
o r N O c cross
contamina
na tion
�
�
�
TOP 50
R
Technology
Pr Products oducts
iL i
940nm ASE ASE
DIODE
LASER
DOCKING OCKING STA ATION
PR PROVIDES
GGR
GREAT
RE RET
ETURN ON
INVE INVESTMENT
Increases
tr
r eatment
acceptance
of
day-to-day
restorat
ive
cases
Attracts
new
w p
atient
s
Increa
ses
produc
tivit
y and
enables
new
procedur
dur es

J O U R N A L O F L A S E R D E N T I S T R Y | 2 011 V O L . 19 , N O . 3
270
C A S E R E P O R T
Treatment of Periimplant Infection in the Posterior
Maxilla, with 810-nm Diode Laser Decontamination
of the Implant Surfaces: A Case Report
Ahmad Kutkut, DDS, MS, 1 Sebastiano Andreana, DDS, MS, 2 Mohanad Al-Sabbagh, DDS, MS 3
1University of Kentucky, College of Dentistry, Division of Restorative Dentistry, Lexington,
Kentucky, USA; 2State University of New York at Buffalo, School of Dental Medicine, Department
of Restorative Dentistry, Buffalo, NY, USA; 3University of Kentucky, College of Dentistry, Division
of Periodontology, Lexington, Kentucky, USA
J Laser Dent 2011;19(3):270-275
Ahmad Kutkut, DDS, MS
Sebastiano Andreana, DDS, MS
Mohanad Al-Sabbagh, DDS, MS
I N T R O D U C T I O N
The predictability of dental
implants has led to widespread
acceptance of this treatment
modality as an option for replacement
of missing teeth. Success rates
for dental implants are reported to
be 90% or higher. 1-2 However, complications
that may require immediate
Kutkut, Andreana, and Al-Sabbagh
A B S T R A C T
Dental implant therapy is considered a safe and predictable method of
replacing extracted or missing teeth. However, a number of complications may
occur in association with implant dentistry, one of which is periimplantitis.
Periimplantitis is defined as an inflammatory process affecting the tissue around
a dental implant; the condition is characterized by soft tissue inflammation and
loss of the bone supporting the implant.
The ultimate goal in treating periimplantitis is gaining reosseointegration of
the infected implant surfaces. Several methods have been used in an attempt
to achieve this goal, including conservative and regenerative treatment in
conjunction with several techniques for decontaminating (i.e., disinfecting) the
infected surfaces. One of the most recently reported techniques for achieving
dental implant decontamination and gaining reosseointegration in both animals
and humans is the use of a soft tissue surgical laser. The findings of several
studies suggest that the soft tissue surgical laser is an effective therapeutic
modality in the treatment of periimplantitis.
The aim of this paper is to report a case involving implant complications that
were treated with various methods aimed at enhancing the process of
reosseointegration.
K E Y W O R D S
Dental implant, periimplantitis, bone regeneration, osseointegration, laser
decontamination
intervention do occur. For the clinician,
the consequences of implant
retreatment may compromise the
ability to accomplish satisfactory
function and esthetics. For the
patient, this retreatment usually
involves further cost and additional
surgical procedures.
Implant complications may be
caused by several factors, including
early complications, overheating of
the bone, contamination and trauma
during surgery, poor bone quantity
or quality, lack of primary stability,
preexisting infection, and incorrect
immediate loading of the implant.
Other complications may appear
later, such as periimplantitis,
occlusal trauma, and overloading.
All of these conditions may compromise
the final treatment outcome. 3
Periimplantitis is defined as an
inflammatory process affecting the
supporting tissues around an
osseointegrated implant and
resulting in loss of adjacent bone.
Periimplant mucositis is defined as
reversible inflammatory changes of

the periimplant soft tissues without
any marginal bone loss. 4 The rate of
occurrence of periimplant mucositis
ranges from 8% to 44%, and the
rate of occurrence of periimplantitis
ranges from 1% to 19%. 4
However, because of the loss of
osseointegration and the exposure of
the roughened implant surface structure,
decontaminating the defected
surface with conventional nonsurgical
treatment options is clinically
difficult. 5 Recent clinical studies of
the use of a soft tissue surgical laser
to decontaminate (i.e., disinfect)
rough implant surfaces, combined
with surgical bone augmentation
maintained by resorbable collagen
membrane, have achieved good
results with long-term success of the
treated implants. 6
The objective of this paper is to
report a case of implant complications
that were treated with
various methods aimed at
enhancing reosseointegration. The
main outcome variables were
reduction in probing depth and
filling of the defect.
C A S E R E P O R T
A 55-year-old woman presented at
the specialty dental clinics of the
School of Dental Medicine at the
State University of New York at
Buffalo with a history of severe
sinusitis in her left maxillary
sinus. Because of the severity of the
infection, teeth #11 through #15
had been extracted at a private
dental office. The patient had also
been treated by an otolaryngologist
(ENT). Nine months postoperatively,
this patient presented at our
clinic with an ill-fitting removable
partial denture. The patient stated
that she would like to have the
missing teeth replaced with teeth
that were fixed in the mouth. She
was informed about possible
complications associated with
implants and about the methods of
treating those complications and
consented to the most appropriate
treatment option.
The treatment plan was initi-
ated with ENT consultation to
verify the elimination of the infection
related to the left maxillary
sinus. The ENT report stated that
no signs or symptoms of infection
existed. Therefore, the dental treatment
plan proceeded: 3 implants
were placed at sites #11, 12, and
14, and a sinus lift via the crestal
approach was performed concurrently
at site #14.
S U R G I C A L T R E AT M E N T
The patient began taking clindamycin
150 mg (four times a day
for 10 days) one day before the
surgical procedure. On the day of
the procedure, the patient’s vital
signs were recorded. After the
administration of local anesthesia
(injection of Xylocaine 2% injection
with 1:100,000 epinephrine), a
papilla-saving crestal incision was
made and a full-thickness flap
C A S E R E P O R T
Figure 1: Hard and soft tissue loss around implants at sites #11, 12, and 14
Figure 1a: Preoperative panoramic view
of the planned sites of future implant
placements at sites #11, 12, and 14
Figure 1b: Periapical radiograph of periimplantitis
and sinus tract associated with
implants at sites #11 and 12 during the
healing period
Figure 1c: Periimplantitis soft tissue loss
and exposure of cover screw of implant
at site #14
Figure 1d: Periimplantitis bone loss associated
with implants at sites #11 and 12
reflected. Osteotomies for the insertion
of implants (4.3 x 13 mm,
NobelReplace , Tapered Groovy,
Nobel Biocare ® USA, Yorba Linda,
Calif., USA) were prepared in an
apicocoronal direction according to
the implant recommendations of
the manufacturer. Three dental
implants were placed in sites #11,
12, and 14. Crestal-approach sinus
elevation was performed at site #14
before the implants were placed.
The prepared site was grafted with
allograft particulate bone substitutes
(alloOss , ACE Surgical
Supply, Brockton, Mass., USA)
mixed with medical-grade calcium
sulfate hemihydrate 7 (DentoGen ® ,
OrthoGen, Springfield, N.J., USA).
Cover screws were placed, and flaps
were secured in a tension-free
manner with 4-0 polytetrafluoro -
ethylene (PTFE) sutures (ACE
Surgical Supply). The patient was
advised to clean the surgical area
gently with a disposable oral swab
(Toothette ® Oral Swab, Sage
Products, Cary, Ill., USA) moistened
with 0.12% chlorhexidine gluconate
four times daily for two weeks.
Kutkut, Andreana, and Al-Sabbagh
J O U R N A L O F L A S E R D E N T I S T R Y | 2 011 V O L . 19 , N O . 3
271

J O U R N A L O F L A S E R D E N T I S T R Y | 2 011 V O L . 19 , N O . 3
272
C A S E R E P O R T
Fourteen days postoperatively,
at the time of suture removal, the
patient reported swelling and
tenderness at the surgical site. The
sutures were removed, and the site
was irrigated with saline. The
patient was advised to continue
cleaning the surgical area as
described above for 2 additional
weeks and to continue taking clindamycin
at the same dosage for
another 10 days.
At the 1-month follow-up evaluation,
the patient reported the
presence of a fistula related to the
implants at sites #11 and 12.
Severe bone loss was detected
around the implants at sites #11,
12, and 14; the pocket depths
varied from 6 to 8 mm (Figure 1).
Tooth #10 was vital, as confirmed
by a positive response to the electrical
pulp test. This recurrent
infection may have been associated
with the previously existing infection
in the left sinus area or in the
recently extracted infected teeth.
Preoperative radiographs from the
private dental office were not available
before the implant procedure
was performed. Retreatment at the
surgical site was planned for 2
months after placement of the
implants.
S U R G I C A L R E E N T RY
T R E AT M E N T A N D
L A S E R I M P L A N T
D E C O N TA M I N AT I O N
The patient began taking clindamycin
(150 mg four times daily)
one day before the surgery. The
patient’s vital signs were recorded.
After the administration of appropriate
local anesthetics, a
crestopalatal incision was made
over the implant area at sites #11
through 14, and a full-thickness
flap was reflected at the buccal side
to access the periimplant defect at
the location of the bone loss. All
granulation tissue in the defected
area was removed with hand
instruments. The threads were
carefully cleaned of the infected
tissue, and the exposed implant
Kutkut, Andreana, and Al-Sabbagh
Figure 2: Periimplantitis treatment
Figure 2a: Diode laser set in continuous
mode, 1.0 Watt in constant movement,
with a noninitiated tip approximately 5
mm away from the implant to decontaminate
the surfaces
Figure 2b: Tetracycline treatment paste
(250 mg in 2 ml sterile water) applied to
and left on the titanium surfaces for
approximately 2 minutes
surfaces were treated with an 810nm
diode laser (Odyssey ® 2.4G
Diode Laser, Ivoclar Vivadent,
Amherst, N.Y., USA), set in continuous
mode at 1.0 Watt, with a
400-micron diameter fiber and a
noninitiated tip used approximately
5 mm away from the
implant surfaces, with constant
movement. The total duration of
laser decontamination was approximately
4 minutes. Subsequently, a
tetracycline paste (250 mg in 2 ml
sterile water) was applied to the
titanium surfaces and left in place
for approximately 2 minutes; the
surfaces were then rinsed profusely
with sterile saline solution (Baxter
Healthcare, Deerfield, Ill., USA).
The defected surfaces were further
irrigated with an aqueous solution
Figure 2c: Bone graft. An allograft particulate
bone substitute, mixed with
medical-grade calcium sulfate hemihydrate,
placed in the defected areas
Figure 2d: Tension-free interrupted
nonresorbable sutures placed
of iodine and then irrigated with
saline. Tooth #10 was extracted
because of periodontal involvement
with grade C mobility. An allograft
of particulate bone substitute
(alloOss) was mixed with medicalgrade
calcium sulfate hemihydrate
and placed in the defected areas.
The grafted area was covered by a
resorbable collagen membrane
(conFORM ® , ACE Surgical Supply),
which was trimmed to cover the
defect completely. The flap was
sutured with nonresorbable sutures
(Cytoplast ® PTFE, Osteogenics
Biomedical, Lubbock, Texas, USA).
Submerged healing was allowed for
2 months (Figure 2).
Postoperatively, the patient was
advised to clean the surgical site as
described above twice daily for 2
weeks. For the first 3 days, the
patient took an antiinflammatory
drug (ibuprofen, 600 mg every 6
hours). The sutures were removed
after 14 days. Clinically, fixture

exposure, membrane exposure, and
the presence of mucosal craters
were recorded. At 4 months, after
radiographic assessment, local
anesthesia was achieved by local
infiltration of lidocaine. A minimal
incision was made over the
submerged fixture to expose the
cover screws. The cover screws
were removed, and the area was
cleaned with chlorhexidine
gluconate (1.2%) before the healing
abutments were placed.
C L I N I C A L O U TC O M E
No adverse effects were reported
after reentry treatment. Signs and
symptoms of infection were eliminated,
and the patient did not
report any other adverse events.
Soft and hard tissues regained
their natural appearance, and
primary stability was confirmed
with a reverse torquing technique.
The pocket depth was reduced to
less than 3 mm around the treated
implants, with a reduction of 5 mm
in the pocket. Definitive restoration
was initiated for a fixed partial
denture supported with a milled
bar substructure. After 1 year of
follow-up, no complications were
reported in the function of these
splinted implants (Figure 3).
D I S C U S S I O N
This case of periimplantitis was
treated with surgical open-flap
debridement and the placement of
a bone substitute in combination
with a resorbable membrane and
with a submerged healing situation
during the first few months. The
regenerative bone graft technique
with the use of barrier membranes
provided a successful treatment
technique.
After surgical exposure of the
contaminated implant surface,
mechanical, chemical, laser therapies
or any combination of the three
methodologies can be used to eliminate
infection, resolve
inflammation, and prepare the
implant surface for bone regeneration
and reosseointegration. Various
Figure 3: Clinical and radiographic outcome postoperatively
Figure 3a: Postoperative healing 4
months after treatment
Figure 3b: Postoperative radiograph
before final impression and fabrication of
the definitive restoration
methods have been advocated, such
as air powder abrasion, saline wash,
citric acid treatment, laser therapy,
peroxide treatment, ultrasonic and
manual debridement, and application
of topical medication, but no
definitive gold standard has been
established. These methods must be
used appropriately for cleaning
implant surfaces, and caution must
be exercised so that the implant
surfaces and the surrounding tissue
structures are not damaged. 8-13
A dog study comparing the effectiveness
of surgical debridement
using an Er:YAG laser, an ultrasonic
scaler, and plastic curettes plus local
application of metronidazole gel
with surgical debridement using
laser and plastic curettes plus
metronidazole gel found that ultrasonic
cleaning results in larger gains
in the clinical attachment level. 14
However, histologic studies demonstrated
that laser therapy resulted
in the greatest degree of reosseointegration
(44.8%) compared to
ultrasonic treatment (8.7%) or
debridement with a plastic curette
plus metronidazole gel (14.8%). The
laser produced better regenerative
results than did mechanical cleaning
of the implant surface. In addition,
C A S E R E P O R T
Figure 3c: Milled titanium bar substructure
for splinting the implants and
fabricating a fixed partial denture
Figure 3d: Definitive fixed partial denture
in function after 12 months
no signs of thermal damage to the
surrounding bone were found within
the laser parameters. 14
In this case report, the diode
laser was used in a noncontact,
noninitiated, continuous mode
fashion. The safe use of the diode
laser around implants has been
previously reported. 15-16
Investigation of the effect of
surface treatment, identified as the
machined surface, indicated that
this surface exhibited the lowest
degree of reosseointegration but
the greatest amount of bone filling
in the defect. It has been speculated
that the rougher surface may
provide support for the developing
coagulum after surgery and thus
facilitate greater bone healing and
maturation in contact with the
implant surface. 11
Collectively, the results of the
studies discussed above indicate
that all methods of surface debridement
achieve resolution of the
inflammatory lesion. However,
Kutkut, Andreana, and Al-Sabbagh
J O U R N A L O F L A S E R D E N T I S T R Y | 2 011 V O L . 19 , N O . 3
273

J O U R N A L O F L A S E R D E N T I S T R Y | 2 011 V O L . 19 , N O . 3
274
C A S E R E P O R T
metal curettes and ultrasonic tips
have been shown to damage the
surface of the titanium implant. 17
The optimal results of both
reosseointegration and bone fill
tend to occur when a combination
of guided bone regeneration (GBR)
and graft material is used along
with laser, chemical, and mechan-
6, 18
ical debridement.
C O N C LU S I O N
Resolution of periimplantitis can be
achieved with various treatment
methods of surface decontamination
in combination with guided bone
regeneration. However, evidence
indicates that this open debridement,
in combination with surface
decontamination and the use of the
soft tissue surgical laser, achieves
substantial reosseointegration with
new bone regeneration of the defects.
A U T H O R B I O G R A P H I E S
Dr. Ahmad M. Kutkut is a prosthodontist
and an assistant professor
at the University of Kentucky,
College of Dentistry, Department of
Restorative Dentistry, Division of
Prosthodontics. Presently he is a
reviewer for the Journal of Oral
Implantology, the official publication
of the American Academy of
Implant Dentistry and the
American Academy of Implant
Prosthodontics, and a reviewer for
Smile Dental Journal. Dr. Kutkut
lectures both nationally and internationally
and has published
numerous articles and abstracts. In
addition to his teaching, research,
writing, and lecturing, he has
presented several posters and table
clinics at major dental meetings
such as the Academy of
Osseointegration, Greater New
York Dental Meeting, American
College of Prosthodontics, American
Academy of Fixed Prosthodontics,
Northeast Implant Symposium,
and the Jordanian Dental Implant
Group. Dr. Kutkut may be
contacted by e-mail at
ahmad.kutkut@uky.edu.
Dr. Sebastiano Andreana is
Kutkut, Andreana, and Al-Sabbagh
director of implant dentistry and
associate professor, Department of
Restorative Dentistry in the School
of Dental Medicine at the University
at Buffalo. Currently he is a faculty
member at the Loma Linda
University/American Academy of
Implant Dentistry (LLU/AAID)
Loma Linda Maxi Course® and codirector
of the University at Buffalo
School of Dental Medicine (UBSDM)
Implant Study Club. He has served
as president of the American
Association for Dental Research,
Buffalo Chapter, and is a reviewer
for the Journal of Periodontology,
Journal of the American Dental
Association, Clinical Oral Implant
Dentistry and Related Research, and
Lasers in Medicine and Surgery. At
present he is senior associate editor
of the Journal of Oral Implantology,
and chair of the Academy of Laser
Dentistry’s (ALD’s) Science and
Research Committee and the
University and Academia Relations
Committee. He is also a member of
the ALD Board of Directors. Dr.
Andreana may be reached by e-mail
at andrean@buffalo.edu.
Dr. Mohanad Al-Sabbagh is
currently the division chief of perio -
dontology and the postdoctoral
program director at the University
of Kentucky College of Dentistry. He
has achieved significant national
and international recognition. He
has received a number of prestigious
awards and fellowships,
including the Bud and Linda
Tarrson Fellowship Award
(American Academy of
Periodontology), the FDI/Unilever
Research Award, the American
Academy of Periodontology
Educator Award (awarded for
outstanding teaching and mentoring
in periodontology), American
Academy of Periodontology Teaching
Fellowship Award (he was the first
recipient of this honor). He has
authored numerous peer-reviewed
articles abstracts. Dr. Al-Sabbagh
may be contacted by e-mail at
malsa2@uky.edu.
Disclosures: Dr. Ahmad-Kutkut and
Dr. Mohanad Al-Sabbagh have no
conflicting financial interests. Dr.
Sebastiano Andreana is a consultant
and trainer for Ivoclar Vivadent, manufacturer
of the Odyssey diode laser.
R E F E R E N C E S
1. Chiapasco M, Zaniboni M. Clinical
outcomes of GBR procedures to
correct peri-implant dehiscences and
fenestrations: A systematic review.
Clin Oral Implants Res
2009;20(Suppl 4):113-123.
2. Huynh-Ba G, Friedberg JR, Vogiatzi
D, Ioannidou E. Implant failure
predictors in the posterior maxilla:
A retrospective study of 273 consecutive
implants. J Periodontol
2008;79(12):2256-2261.
3. Levin L. Dealing with dental
implant failures. J Appl Oral Sci
2008;16(3):171-175.
4. Roos-Jansåker A-M, Renvert S,
Egelberg J. Treatment of periimplant
infections: A literature
review. J Clin Periodontol
2003;30(6):467-485.
5. Roos-Jansåker A-M, Renvert H,
Lindahl C, Renvert S. Submerged
healing following surgical treatment
of peri-implantitis: A case series. J
Clin Periodontol 2007;34(8):723-727.
6. Romanos GE, Nentwig GH.
Regenerative therapy of deep periimplant
infrabony defects after CO2 laser implant surface decontamination.
Int J Periodontics Restorative
Dent 2008;28(3):244-255.
7. Kutkut A, Andreana S. Medicalgrade
calcium sulfate hemihydrate
in clinical implant dentistry: A
review. J Long Term Eff Med
Implants 2010;20(4):295-301.
8. Roos-Jansåker A-M, Renvert H,
Lindahl C, Renvert S. Surgical
treatment of peri-implantitis using
a bone substitute with or without a
resorbable membrane: A prospective
cohort study. J Clin Periodontol
2007;34(7):625-632.
9. Claffey N, Clarke E, Polyzois I,
Renvert S. Surgical treatment of
peri-implantitis. J Clin Periodontol
2008;35(Suppl 8):316-332.
10. Persson GR, Samuelsson E, Lindahl
C, Renvert S. Mechanical non-

surgical treatment of peri-implantitis:
A single-blinded randomized
longitudinal clinical study. II.
Microbiological results. J Clin
Periodontol 2010;37(6):563-573.
11. Persson LG, Berglundh T, Sennerby
L, Lindhe J. Re-osseointegration
after treatment of peri-implantitis
at different implant surfaces. An
experimental study in the dog. Clin
Oral Implants Res 2001;12(6):595-
603.
12. Renvert S, Polyzois I, Maguire R.
Re-osseointegration on previously
contaminated surfaces: A systematic
review. Clin Oral Implants Res
2009;20(Suppl 4):216-227.
13. Bach G, Neckel C, Mall C, Krekeler
G. Conventional versus laserassisted
therapy of periimplantitis:
A five-year comparative study.
Implant Dent 2000;9(3):247-251.
14. Schwarz F, Jepsen S, Herten M,
Sager M, Rothamel D, Becker J.
Influence of different treatment
approaches on non-submerged and
submerged healing of ligature
induced peri-implantitis lesions: An
experimental study in dogs. J Clin
Periodontol 2006;33(8):584-595.
15. Andreana S, Nihlawi O, Beneduce C.
Temperature propagation on
implant cover-screw after diode
laser irradiation. J Dent Res
2010;89:Abstract 2536.
C A S E R E P O R T
16. Yeh S, Jain K, Andreana S. Using a
diode laser to uncover dental
implants in second-stage surgery.
Gen Dent 2005;53(6):414-417.
17. Schou S, Berglundh T, Lang NP.
Surgical treatment of peri-implantitis.
Int J Oral Maxillofac Implants
2004;19(Suppl):140-149.
18. Muller E, González YM, Andreana
S. Treatment of peri-implantitis:
Longitudinal clinical and microbiological
findings – A case report.
Implant Dent 1999;8(3):247-254. nn
Kutkut, Andreana, and Al-Sabbagh
J O U R N A L O F L A S E R D E N T I S T R Y | 2 011 V O L . 19 , N O . 3
275

J O U R N A L O F L A S E R D E N T I S T R Y | 2 011 V O L . 19 , N O . 3
276
C A S E R E P O R T
Peri-Implantitis Therapy with
an Er:YAG Laser
Avi Reyhanian, DDS, Natanya, Israel
Donald J. Coluzzi, DDS, Portola Valley, California
J Laser Dent 2011;19(3):276-281
S Y N O P S I S
The etiology of peri-implantitis and a treatment protocol using an
Er:YAG laser are described along with a clinical case study with a
successful outcome.
I N T R O D U C T I O N
Osseointegrated dental implants
have become a routinely recommended
procedure in the clinical
practice of dentistry. 1-4 Although
they can be highly successful
restorations, implant failure can
and does still occur. 5-8 Among the
many complications possible in the
procedure, one of the more common
postoperative ones is peri-implant
disease and, within this category,
peri-implantitis. 9
Three major factors contribute
to the failure and complications of
implants:
1. Patient-related factors
2. Iatrogenic (doctor/team) factors
3. Surgical equipment / manufacturer
problems.
Patient and iatrogenic factors
are more prevalent than implant
manufacturing problems.
Implant complications are
divided into two main categories:
Intraoperative and postoperative. 9
Peri-implantitis is a postoperative
complication.
Biofilms form on all hard,
nonshedding surfaces in a fluid
system, i.e., both on teeth and on
oral implants. As a result of the
bacterial challenge, the host
responds by mounting a defense
mechanism leading to inflammation
of the soft tissue. In the
implantomucosal unit this inflammation
is termed “mucositis” which
Reyhanian and Coluzzi
may develop into “peri-implantitis.”
9
Peri-implantitis is an inflammatory
reaction that is associated
with the presence of a submarginal
biofilm, with advanced breakdown
of soft and hard tissue surrounding
the endosseous implant: loss of the
bony support of the implant. 10
The etiology of the disease is
conditioned by the status of the
tissue surrounding the implant,
design of the implant, degree of
roughness, poor alignment of implant
components, external morphology,
and excessive mechanical load. 10
There are two major factors that,
separately or combined, contribute to
the formation of peri-implantitis:
1. Bacterial exposure, especially
gram-negative and anaerobic
species 11-12
2. Overload. 13-14
Clinical signs and diagnosis
include: Bleeding on probing, purulence,
bone loss, pocketing, dull
sound on percussion, peri-implant
radiolucent mobility of the implant,
fistula, and changes of color in the
gingiva and/or the mucosa. 10
Treatment involves either
implant removal, especially if the
fixture is mobile, or therapy,
usually involving surgery and
debridement techniques.
Conventional approaches include:
• Systemic administration of
antibiotics
A B S T R A C T
Peri-implantitis is one of the
complications possible in osseo -
integrated dental implants.
This article discusses the wisdom
and utility of employing an Er:YAG
laser for peri-implantitis therapy. A
clinical case study will demonstrate
how this procedure could replace
the gold standard for peri-implantitis
therapy. This technique using the
Er:YAG laser presents several advantages
vs. conventional treatment
methods, and there are minimal
postoperative complications coupled
with a high rate of success.
Key Words: antimicrobial agents;
bone grafting; bone tissue;
debridement; dental implants;
granulation tissue; guided tissue
regeneration; laser ablation
• Removal of supragingival bacterial
plaque
• Removal of granulation tissue
with plastic curettes
• Debridement of the exposed
surface by using mechanical
brushing, air powder abrasives,
citric acid, disinfectants like
chlorhexidine or topical tetracycline,
plaque inhibitor like
delmopinol, or low-intensity
ultraviolet radiation
• Removal of the peri-implant pocket
• Regeneration of peri-implant
hard tissue by means of guided
tissue regeneration
• Plaque control and oral hygiene.
The Use of the Er:YAG Laser in
Treatment of Peri-Implantitis
The Er:YAG laser interacts with
both hard and soft dental tissues,

and thus can be effectively utilized
for both surgery and debridement
of the infected implant area.
• The laser can make crestal,
intrasulcular, or vertical release
incisions in raising a flap. The
Er:YAG laser produces a wet
incision (some bleeding) as
opposed to the dry incision (no
bleeding) produced by other soft
tissue lasers. 15
• The laser easily vaporizes any
existing granulation tissue, with
a lower risk of overheating the
bone than those posed by the
current diode or CO2 lasers. 16-17
The Er:YAG laser wavelength’s
excellent ability to effectively
ablate soft tissue without
producing major thermal sideeffects
to adjacent tissue has
been demonstrated in numerous
studies. 18-20
• The implant surface can be
debrided by lasing directly on the
implant’s exposed screws with a
low-energy setting. Both the
target tissue and implant surface
are disinfected without damage. 21-25
• Ablating the bone with the
Er:YAG laser also ablates
necrotic bone, as well as contours
and reshapes the surrounding
osseous tissue. 26-28
• The laser is bactericidal. 29-30
C A S E S T U DY
This case describes treatment of
peri-implantitis with an Er:YAG
laser.
P R E T R E AT M E N T
A. Outline of Case
1. Clinical Examination
A 51-year old male presented with
no medical abnormalities. The
patient presented by referral four
months after having implants
inserted in the location of the lower
left and right lateral incisors.
2. Soft- and Hard-Tissue
Examination
Periodontal probing showed generalized
4 mm pockets with bleeding.
The patient had very ineffective
Figure 1: Patient condition upon presentation.
Note the buccal fistula from the
implant at tooth #25
Figure 2: A periodontal probe inserted
into the fistula
oral hygiene, and does not brush or
floss at all; consequently, all teeth
were covered with plaque. Both of
the implants were nonsubmerged
with abutments present. The lower
right implant presented a labial
fistula, the probing of which led to
the apical end of the implant
(Figures 1 and 2). The left implant
presented without complications.
The remaining soft tissue was
within normal limits.
3. Radiographic Examination
Panoramic and periapical X-rays
showed a large radiolucency area
surrounding about 70% of the right
implant, implying massive bone
loss (Figure 3).
4. Mobility Tests
The infected implant was stable
with no mobility.
B. Diagnosis and Treatment Plan
1. Provisional and Final Diagnosis
Advanced peri-implantitis with
massive bone loss around the
implant.
C A S E R E P O R T
Figure 3: X-ray image with gutta-percha
inside the fistula, pointing into the defect
Figure 4: The Er:YAG handpiece with the
200-micron sapphire tip ready for the
incision
2. Treatment Plan
An Er:YAG laser will be used for
flap incision, ablation of granulation
tissue around the implant,
remodeling, shaping and decortication
of the bone, debridement of
exposed implant screw and guided
bone regeneration (GBR) technique
for the bone loss.
3. Treatments Alternatives
Traditional scalpel, curettes, citric
acid, air flow, air abrasion, and
rotary tools.
T R E AT M E N T
A. Laser Operating Parameters
An intrasulcular incision was made
with an Er:YAG laser (OpusDuo
AquaLite, Lumenis Ltd.,
Yokneam, Israel) (2940 nm), using
Reyhanian and Coluzzi
J O U R N A L O F L A S E R D E N T I S T R Y | 2 011 V O L . 19 , N O . 3
277

J O U R N A L O F L A S E R D E N T I S T R Y | 2 011 V O L . 19 , N O . 3
278
C A S E R E P O R T
Figure 5: Intrasulcular and vertical
releasing incisions completed
Figure 6: After the flap is lifted, the defect
is probed
Figure 7: Granulation tissue exposed
a 200-micron sapphire tip in
contact mode with a water spray.
The power setting for the incision
was 450 mJ / 20 PPS (9 Watts)
(Figure 4).
B. Treatment Delivery
Sequence
The intrasulcular incision was
performed from the distal side of
the right cuspid to the mesial side
of the left implant. Then a vertical
incision for release was performed
at the mesial of the left implant
and a buccal flap was lifted (Figure
5). The defect was probed to determine
the extent of the lesion
(Figure 6). The infection had
Reyhanian and Coluzzi
Figure 8: The Er:YAG handpiece with a
1300-micron sapphire tip for granulation
tissue ablation
Figure 9: Laser soft tissue and osseous
ablation completed
Figure 10: Bio-Oss ® material placed for
guided tissue regeneration
engulfed the buccal side and
lingual side toward the apex of the
implant, with massive loss of bone
and a great deal of granulation
tissue, as shown in Figure 7.
The granulation tissue was
ablated with the laser in noncontact
mode using a 1300-micron
sapphire tip and a power setting of
700 mJ / 12 PPS (8.4 Watts) with a
water spray (Figure 8). Since the
buccal bone had not resorbed,
direct observation was impossible,
making it difficult to ablate the
granulation tissue inside and
around the implant. Therefore a
Figure 11: Bio-Gide ® absorbent bilayer
membrane placed
Figure 12: Immediately postoperative,
sutures in place. Note primary closure
small window of the buccal bone
was removed with the same laser
parameters to gain direct access to
the lesion. After removal of the
infected soft tissue (Figure 9), the
laser beam was aimed at the
surface of the exposed screws in a
low-energy setting of 150 mJ / 20
PPS (3 Watts), for debridement.
The next step was to ablate
necrotic bone, and to shape and
recontour the defect. The site was
filled with a xenograft bone substitute
(Bio-Oss ® , (Geistlich Pharma
AG Biomaterials Division,
Wolhusen, Germany) (Figure 10)
and then covered with an
absorbent bilayer membrane (Bio-
Gide ® , Geistlich Pharma AG
Biomaterials Division) (Figure 11).
The flap was sutured (silk 3-0),
with particular attention paid to
primary closure of the flap (Figure
12). An immediate postoperative
radiograph is shown in Figure 13.
C. Postoperative Instructions
The patient was prescribed clindamycin
150 mg x 50 tabs to avoid
infection. He was also given
ibuprofen 800 mg x 15 tabs for

Figure 13: Immediate postoperative radiograph
pain. He was instructed to rinse
with chlorhexidine 0.2%, starting
the next day, for 2 weeks 3 times a
day and was advised to maintain
good oral hygiene.
F O L LO W- U P C A R E
A. Assessment of Treatment
Outcome
The patient was called the next day,
and he reported moderate pain and
moderate swelling. He also said
that there was no tissue bleeding
and the site was closed. At 10 days
postoperative, the patient returned
for inspection and removal of
sutures (Figure 14). The patient
returned four days later and the
suture points had healed (Figure
15). The swelling had resolved,
there were no signs of fistula, and
healing was progressing well. After
six weeks the soft tissue was
completely healed without complications.
The soft issue was healing
over the bone and there were no
bony projections observed under the
soft tissue.
B. Prognosis
The prognosis is good. The twomonth
postoperative views and
radiograph show good healing
(Figures 16-18). It will be essential
Figure 14: Ten days postoperative, sutures
just removed
Figure 15: Two weeks postoperative,
suture areas healed
Figure 16: Two-month postoperative view
of treated implant
for the patient to maintain good oral
hygiene. It is important to note that
the lack of mobility of the infected
implant is very important for guided
tissue regeneration to be successful.
Conclusion
The Er:YAG laser can be employed
for debridement of implant surfaces
as well as regenerative osseous
surgery, and has been proven to be
effective and safe. The use of this
laser wavelength for these procedures
presents many advantages
vs. conventional methods, such as
reducing pathogens and patient
discomfort. This laser has become
an invaluable tool for many proce-
C A S E R E P O R T
Figure 17: Two-month postoperative view
of surgical area
Figure 18: Two-month postoperative radiograph
dures by simplifying treatment and
offering patients faster, less
stressful oral therapy with
enhanced outcomes.
A U T H O R B I O G R A P H I E S
Dr. Avi Reyhanian graduated from
the University of Bucharest,
Romania in 1988. He then participated
in a fellowship program at
the Oral & Maxillofacial
Department, Rambam Hospital in
Israel. He is a member of the
academic staff at the Institute of
Advanced Dental Education in
Haifa, Israel and he currently practices
general dentistry and oral
surgery in Natanya, Israel. Dr.
Reyhanian’s practice has employed
dental lasers since early 2002; he
currently uses Er:YAG (2940 nm),
CO2 (10,600 nm), and diode (830
Reyhanian and Coluzzi
J O U R N A L O F L A S E R D E N T I S T R Y | 2 011 V O L . 19 , N O . 3
279

J O U R N A L O F L A S E R D E N T I S T R Y | 2 011 V O L . 19 , N O . 3
280
C A S E R E P O R T
nm) lasers in his practice. He is a
member of the Academy of Laser
Dentistry and the Israel Society of
Dental Implantology. Dr.
Reyhanian presents lectures in
Israel, Europe, USA, and Asia on
the topic of dental lasers, and has
published several articles. Dr.
Reyhanian may be contacted by email
at avi5000rey@gmail.com.
Disclosure: Dr. Reyhanian is a
member of the academic staff at the
Institute of Advanced Dental
Education in Haifa, Israel, and is a
consultant to the Lumenis Company.
Dr. Donald Coluzzi, a 1970 graduate
of the University of Southern
California School of Dentistry, is an
associate clinical professor in the
Department of Preventive and
Restorative Dental Sciences at the
University of California San
Francisco School of Dentistry. A
charter member and past President
of the Academy of Laser Dentistry,
he has used dental lasers since
early 1991. He has Advanced
Proficiency in Nd:YAG and Er:YAG
laser wavelengths. He is the 1999
recipient of the Leon Goldman
Award for Clinical Excellence and
the 2006 Distinguished Service
Award from the Academy of Laser
Dentistry, and is a Fellow of the
American College of Dentists. Dr.
Coluzzi has presented about lasers
worldwide, co-authored two books,
and published several peerreviewed
articles.
Disclosure: Dr. Coluzzi is an occasional
presenter and trainer for Hoya
ConBio, and receives an honorarium
for that service.
R E F E R E N C E S
1. Adell R, Lekholm U, Rockler B,
Brånemark P-I. A 15-year study of
osseointegrated implants in the
treatment of the edentulous jaw. Int
J Oral Surg 1981;10(6):387-416.
2. Albrektsson T. A multicenter report
on osseointegrated oral implants. J
Prosthet Dent 1988;60(1):75-84.
Reyhanian and Coluzzi
3. Buser D, Mericske-Stern R, Dula K,
Lang NP. Clinical experience with
one-stage, non-submerged dental
implants. Adv Dent Res1999;13:153-
161.
4. Olsson M, Friberg B, Nilson H,
Kultje C. MkII – A modified selftapping
Brånemark implant: 3-year
results of a controlled prospective
pilot study. Int J Oral Maxillofac
Implants 1995;10(1):15-21; Erratum
in: Int J Oral Maxillofac Implants
1995;10(2):243.
5. Jaffin RA, Berman CL. The excessive
loss of Branemark fixtures in
type IV bone: A 5-year analysis. J
Periodontol 1991;62(1):2-4.
6. Esposito M, Hirsch J, Lekholm U,
Thomsen P. Differential diagnosis
and treatment strategies for biologic
complications and failing oral
implants: A review of the literature.
Int J Oral Maxillofac Implants
1999;14(4):473-490
7. Brisman DL, Brisman AS, Moses
MS. Implant failures associated
with asymptomatic endodontically
treated teeth. J Am Dent Assoc
2001;132(2):191-195.
8. Ayangco L, Sheridan PJ.
Development and treatment of
retrograde peri-implantitis
involving a site with a history of
failed endodontic and apicoectomy
procedures: A series of reports. Int J
Oral Maxillofac Implants
2001;16(3):412-417.
9. Reyhanian A, Coluzzi DJ. Er:YAG
laser-assisted implant periapical
lesion therapy (IPL) and guided
bone regeneration (GBR) technique:
New challenges and new instrumentation.
J Laser Dent
2007;15(3):135-141.
10. Sánchez-Gárces MA, Gay-Escoda C.
Periimplantitis. Med Oral Patol Oral
Cir Bucal 2004;9 Suppl:69-74; 63-69.
11. Albrektsson TO, Johansson CB,
Sennerby L. Biological aspects of
implant dentistry: Osseointegration.
Periodontol 2000 1994;4:58-73.
12. Meffert RM. Periodontitis and periimplantitis:
One and the same?
Pract Periodontics Aesthet Dent
1993;5(9):79-80, 82.
13. Uribe R, Peñarrocha M, Sanchis JM,
García O. Marginal peri-implantitis
due to occlusal overload. A case
report. Med Oral 2004;9(2):160-162,
159-160.
14. Isidor F. Loss of osseointegration
caused by occlusal load of oral
implants. A clinical and radiographic
study in monkeys. Clin
Oral Implants Res 1996;7(2):143-
152.
15. Watanabe H, Ishikawa I, Suzuki M,
Hasegawa K. Clinical assessments
of the erbium:YAG laser for soft
tissue surgery and scaling. J Clin
Laser Med Surg 1996;14(2):67-75.
16. Kreisler M, Al Haj H, d’Hoedt B.
Temperature changes at the
implant-bone interface during simulated
surface decontamination with
an Er:YAG laser. Int J Prosthodont
2002;15(6):582-587.
17. Sasaki KM, Aoki A, Ichinose S,
Yoshino T, Yamada S, Ishikawa I.
Scanning electron microscopy and
Fourier transformed infrared spectroscopy
analysis of bone removal
using Er:YAG and CO2 lasers. J
Periodontol 2002;73(6):643-652.
18. Ishikawa I, Aoki A, Takasaki AA.
Potential applications of
erbium:YAG laser in periodontics. J
Periodontal Res 2004;39(4):275-285.
19. Ishikawa I, Sasaki KM, Aoki A,
Watanabe H. Effects of Er:YAG
laser on periodontal therapy. J Int
Acad Periodontol 2003;5(1):23-28.
20. Schwarz F, Bieling K, Sculean A,
Herten M, Becker J. Laser und
ultraschall in der therapie periimplantärer
infektionen – Eine
literaturübersicht. [Treatment of
periimplantitis with laser or ultrasound.
A review of the literature.]
Schweiz Monatsschr Zahnmed
2004;114(12):1228-1235. German.
21. Schwarz F, Rothamel D, Becker J.
Einfluss eines Er:YAG-lasers auf die
oberflächen-struktur von Titanimplantaten.
[Influence of an
Er:YAG laser on the surface structure
of titanium implants.] Schweiz
Monatsschr Zahnmed
2003;113(6):660-671. French,
German.
22. Jovanovic SA. The management of
peri-implant breakdown around
functioning osseointegrated dental
implants. J Periodontol 1993;64(11
Suppl):1176-1183.

23. Matsuyama T, Aoki A, Oda S,
Yoneyama T, Ishikawa I. Effect of
the Er:YAG laser irradiation on titanium
implant materials and
contaminated implant abutment
surfaces. J Clin Laser Med Surg
2003;21(1):7-17.
24. Schwarz F, Rothamel D, Sculean A,
Georg T, Scherbaum W, Becker J.
Effects of an Er:YAG laser and the
Vector ultrasonic system on the
biocompatibility of titanium
implants in cultures of human
osteoblast-like cells. Clin Oral
Implants Res 2003;14(6):784-792.
25. Kreisler M, Kohnen W, Christoffers
AB, Götz H, Jansen B, Duschner H,
d’Hoedt B. In vitro evaluation of the
biocompatibility of contaminated
implant surfaces treated with an
Er:YAG laser and an air powder
system. Clin Oral Implants Res
2005;16(1):36-43.
26. Nelson JS, Orenstein A, Liaw LH,
Berns MW. Mid-infrared
erbium:YAG laser ablation of bone:
The effect of laser osteotomy on
bone healing. Lasers Surg Med
1989;9(4):362-374.
27. “Use Of the Dental Erbium Laser
(2940nm) For Contouring And
Resection Of Osseous Tissue (Bone)
And The Preparation Of Endodontic
Canals,” Copyright 2000 to 2002
Institute for Laser Dentistry,
www.laserdentistry.ca/erbium.html,
accessed May 24, 2008.
28. Rupprecht S, Tangermann K,
Kessler P, Neukam FW, Wiltfang J.
C A S E R E P O R T
Er:YAG laser osteotomy directed by
sensor controlled systems. J
Craniomaxillofac Surg
2003;31(6):337-342.
29. Folwaczny M, Mehl A, Aggstaller H,
Hickel R. Antimicrobial effects of
2.94 µm Er:YAG laser radiation on
root surfaces: An in vitro study. J
Clin Periodontol 2002;29(1):73-78.
30. Kreisler M, Kohnen W, Marinello C,
Götz H, Duschner H, Jansen B,
d’Hoedt B. Bactericidal effect of the
Er:YAG laser on dental implant
surfaces: An in vitro study. J
Periodontol 2002;73(11):1292-1298. nn
Editor’s Note: This article first
appeared in J Laser Dent
2008;16(2):69-74. nn
Reyhanian and Coluzzi
J O U R N A L O F L A S E R D E N T I S T R Y | 2 011 V O L . 19 , N O . 3
281

Unmatched Un
n match
e ed
Ve Versatility Vers
s a ati
ility
to
o MMeet
Meet
Your Yo ou
r DDiode
Diode
Laser Las
s er
NNeeds
eeddss
HE E FFIR
FIRS
ST
TO O OTA
ALLL
Y
WIR IRE ELL
ESSS
S D DDE
DENNT
TA AL
LLA
ASEERR
�
�
�
�
The
next
instru
u ment
for
your
tray
Affordable
and
d b
eyond
portable
Call Caa
ll
888-424-6527 888-424-6522
7 now for details, or find your BIOLASE
Territory Te e erritory
y MManager
anageer
r at at BIOLASE. BIOLASE.com .com under r “Contact”. “ Coontact
.
© 20 2011 11
BBIOLASE
IOLAS
S E |
wwww.Biolase.com
ww.Bi
.Biolase.
com
| TTo
Toll-free oll-frr
ee
8888-424-6527
88-424-652
27
�
�
�
�
“ “N NOO
C COMP
PR R ROMI
ISE SE” ”
L DIODE
S O OLUT
UTIO
ION
aximum
performanc
c e for
more
proced
ures
–
ludin
g surgica
l proc
c edures
Watt
peak
powe
r w with
ComfortPuls
e
A c l e a r e d f or t e m p or
a
r
y r
e
l
i
e
f o
f m
i
n
or p
a
i
n
perior
20-min
ut
e w whitening
solut
ion

C A S E R E P O R T S
Advantages of 980-nm Diode Laser Treatment
in the Management of Gingival Pigmentation
Mihir Khakhar, BDS, Postgraduate Student; Richa Kapoor, BDS, Postgraduate Student; N.D.
Jayakumar, BDS, MDS, Professor; O. Padmalatha, BDS, MDS, Professor; Sheeja S. Varghese, BDS,
MDS, Professor; M. Sankari, BDS, MDS, Assistant Professor
Department of Periodontics, Saveetha Dental College, Chennai, India
J Laser Dent 2011;19(3):283-285
Mihir Khakhar, BDS
I N T R O D U C T I O N
The color of the gingiva is determined
by several factors, including the
number and size of the blood vessels,
epithelial thickness, quantity of keratinization
and pigments within the
epithelium. Melanin, carotene,
reduced hemoglobin, and oxyhemoglobin
are the major pigments that
contribute to the normal color of the
oral mucosa. 1 Frequently, gingival
hyperpigmentation is caused by
heavy melanin deposition by
melanocytes located in the basal
layers of the epithelium. 2 Demand for
cosmetic therapy of gingival melanin
pigmentation is common and various
methods have been used for depigmentation,
each with its own merits
and limitations. With the recent
advances and developments in a wide
range of laser wavelengths and
different delivery systems, research
suggests that lasers could be applied
to periodontal, restorative, and
surgical treatments.
Lasers have the advantages of
easy handling, short treatment
time, hemostasis, and bactericidal
effects. They are used extensively
for soft tissue surgical procedures
such as gingivectomy, frenectomy,
sulcular debridement, and exci-
sional and incisional biopsies. In
the present case series an attempt
was made to compare the healing,
pain levels, and patient satisfaction
during the treatment of gingival
depigmentation using lasers,
scalpel surgery, and electrocautery.
Figure 1: Laser Depigmentation
Figure 1a: Preoperative view showing
diffuse melanin pigmentation
Figure 1b: Intraoperative view showing
de-epithelization performed with the
laser in the maxillary and mandibular
anterior region
Figure 1c: Six-month postoperative view
showing complete re-epithelization has
occurred
A B S T R A C T
Gingival pigmentation is an
aesthetic problem that often
requires surgical removal. Recently
there has been an increased use
of hard and soft tissue lasers in
the field of dentistry. In the
present case series, three cases
which have been treated for
gingival depigmentation using
laser, scalpel surgery, and electrocautery
techniques are presented.
Healing, pain levels, and patient
satisfaction in all three techniques
are evaluated and compared.
K E Y W O R D S
Depigmentation, melanin pigmentation,
electrocautery, laser
C A S E 1
A 25-year-old male presented with
melanin pigmentation (Figure 1a).
Topical anesthesia (lignocaine [lidocaine]
hydrochloride, Lox 2% jelly,
Neon Laboratories, India) was
applied in the maxillary and
mandibular anterior region.
Depigmentation was carried out
using a 980-nm diode laser
(SIROLaser, Sirona Dental
Systems, Bensheim, Germany) set
at a power of 2 W, in continuous
mode, with a 300-micron fiber. The
fiber tip was moved in a sweeping
motion continuously from one site
to another to avoid heat accumulation
which could cause a
postoperative burning sensation.
Care was taken to maintain the
physiologic contour of the gingiva
during the procedure. All
Khakhar, et al.
J O U R N A L O F L A S E R D E N T I S T R Y | 2 011 V O L . 19 , N O . 3
283

J O U R N A L O F L A S E R D E N T I S T R Y | 2 011 V O L . 19 , N O . 3
284
C A S E R E P O R T S
Figure 2: Scalpel Depigmentation Figure 3: Electrocautery Depigmentation
Figure 2a: Preoperative view showing
diffuse melanin pigmentation
Figure 2b: Intraoperative view showing
surface de-epithelization and exposed
underlying connective tissue
Figure 2c: Six-month postoperative view
showing healthy gingival tissues with no
areas of repigmentation
pigmented areas were removed; the
area was wiped with gauze soaked
in saline (Figure 1b). The entire
procedure took 30 minutes.
After 24 hours a white fibrin
slough was seen on the surgical
area which lasted for 1 week. Three
months postoperatively gingival
healing was complete with few
areas of repigmentation. At the end
of 6 months no further increase in
areas of repigmentation was
observed (Figure 1c).
Pain levels were evaluated
immediately after the procedure
and 1 week postoperatively using a
Visual Analog Scale (VAS). The
VAS consisted of a horizontal line
100 mm long, anchored at the left
by the descriptor “no pain” and at
the other end by “unbearable pain.”
The patient was asked to mark the
Khakhar, et al.
Figure 3a: Preoperative view showing
extensive melanin pigmentation
Figure 3b: Intraoperative view showing
de-epithelization in the maxillary anterior
region
severity of the pain. The distance
from the left end to the point
checked was recorded in millimeters
and used as the VAS score.
CASE 2
A 21-year-old female revealed
deeply pigmented gingiva (Figure
2a). Scalpel surgery was planned.
Local anesthesia (lignocaine [lidocaine]
hydrochloride with 1:200,000
adrenaline bitartrate, Lox 2%,
Neon Laboratories; 4 ml total, 2 ml
per arch) was infiltrated in the
maxillary and mandibular anterior
region. A scalpel (Bard-Parker
No. 15 blade) was used to deepithelize
the pigmented
epithelium along with a thin layer
of connective tissue. All remnants
of pigmented epithelium were
removed; the area was irrigated
with normal saline (Figure 2b). The
surgical area was covered with a
periodontal dressing. The entire
procedure lasted 25 minutes.
After 1 week, the periodontal
dressing was removed; the area
was irrigated with saline and
Figure 3c: Intraoperative view showing
de-epithelization in the mandibular anterior
region
Figure 3d: Three-month postoperative
view showing a few patchy areas of
repigmentation
repacked for another week. The
healing process was satisfactory
and the patient was asymptomatic.
At the end of 1 month, complete
re-epithelization was observed with
no postoperative pain and sensitivity.
At the end of 6 months, the
gingiva appeared healthy and no
further repigmentation was seen
(Figure 2c).
Similar to Case 1, pain levels
were evaluated using a Visual
Analog Scale.
CASE 3
A depigmentation procedure using
electrocautery was planned for a
22-year-old female (Figure 3a).
Following administration of local
anesthesia (lignocaine [lidocaine]
hydrochloride with 1:200,000 adrenaline
bitartrate, Lox 2%, Neon
Laboratories), a loop electrode was
used to de-epithelize the gingiva
from the right first premolar to the
left first premolar. It was used with
light brushing strokes and the tip

was kept in constant motion. Care
was taken to avoid keeping the tip
in one place as this would lead to
excessive heat buildup and cause
damage to the underlying bone
(Figures 3b-3c). The area was then
irrigated with normal saline to
remove the tissue debris. The entire
procedure was completed in 30
minutes. The 3-month postoperative
examination revealed well-epithelialized,
pink gingiva with few
remnants of pigmentation (Figure
3d). Similar to the other cases, pain
measurements were performed.
DISCUSSION
Three cases were treated for
gingival hyperpigmentation using
laser, scalpel surgery, and electrocautery.
Pain levels were evaluated
using a Visual Analog Scale immediately
after the procedure and 1
week postoperatively. As can be
seen in Table 1, immediately after
the procedure, the VAS score for
the patient treated with the laser
was lower compared to patients
treated with scalpel surgery and
electrocautery, indicating the laser
procedure produced less pain and
discomfort. It can be theorized that
this may be due to protein coagulum
that is formed on the wound
surface, which may act as a biological
wound dressing 3 and seal the
ends of the sensory nerves. 4
In all three patients, healing
was uneventful. A white fibrin
slough was seen in Case 1 after 24
hours; this is a normal characteristic
of a laser wound during the
first several days of healing. In this
case, the “hot tip” of the diode laser
produced a relatively thick coagulation
layer on the treated surface.
Bleeding that occurred during
scalpel surgery was eliminated
when laser and electrocautery were
used. This can be attributed to the
property of lasers and electrocautery
instruments to coagulate
bleeding vessels and thereby assist
in providing a relatively dry
surgical field.
At the end of 6 months, all three
treatment modalities provided
satisfactory results in terms of
healing, repigmentation, and
patient satisfaction. Few patchy
areas of repigmentation were
observed in the cases treated with
electrosurgery and laser. This could
be due to deeper pigmentation in
these cases.
CONCLUSION
Within the limitations of this study,
the use of a diode laser is shown to
be a safe and effective treatment
modality to provide optimal
esthetics and enhanced comfort
with reduced discomfort to the
patients during the treatment for
gingival hyperpigmentation. A
longitudinal investigation of
similar treatments in a larger
patient population would be helpful
to confirm these findings.
AUTHOR BIOGRAPHY
Dr. Mihir Khakhar received his
BDS from the Maharashtra
University of Health Science,
Nashik, India in 2008 and is
currently pursuing his MDS in peri-
C A S E R E P O R T S
Table 1: Visual Analog Scale (VAS) Scores for All Three Cases
VAS Scores
Immediately Postoperative 1-Week Postoperative
Case 1 8 3
Case 2 15 4
Case 3 10 3
odontics at Saveetha University in
Chennai, India. He has been a delegate
at various national conferences
on periodontics, implant dentistry,
and general dentistry and has
received awards for poster and
paper presentations. He is also
working on a research project
related to the molecular pathogenesis
of periodontal diseases. He can
be contacted via e-mail at
mihirkhakhar@gmail.com.
Disclosure: Dr. Khakhar has no
commercial affiliations or conflicts of
interest.
REFERENCES
1. Volker JF, Kenney JA Jr. The physiology
and biochemistry of
pigmentation. J Periodontol
1960;31(5):346-355.
2. Dummett CO. Overview of normal
oral pigmentations. J Indiana Dent
Assoc 1980;59(3):13-18.
3. Fisher SE, Frame JW, Browne RM,
Tranter RMD. A comparative histological
study of wound healing
following CO2 laser and conventional
surgical excision of canine
buccal mucosa. Arch Oral Biol
1983;28(4):287-291.
4. Schuller DE. Use of the laser in the
oral cavity. Otolaryngol Clin North
Am 1990;23(1):31-42. nn
Khakhar, et al.
J O U R N A L O F L A S E R D E N T I S T R Y | 2 011 V O L . 19 , N O . 3
285

J O U R N A L O F L A S E R D E N T I S T R Y | 2 011 V O L . 19 , N O . 3
286
C L I N I C A L C A S E
Gingival Depigmentation with an Er:YAG Laser:
A Clinical Case with Three-Year Follow-Up
Grace Sun, DDS, Los Angeles, California
J Laser Dent 2011;19(3):286-288
S Y N O P S I S
This clinical case study describes the removal of gingival hyperpig-
mentation using an Er:YAG laser. This benign condition was an
esthetic concern for the patient, and the laser procedure produced
good results. While the prognosis is good, the patient’s smoking can
stimulate melanin production and the coloration can reappear.
P R E T R E AT M E N T
A. Case Outline
A 43-year-old African American male
presented with normal medical, oral,
and dental health. The patient
reported that his four upper incisors
had a history of trauma, but he
would not supply any details. A clinical
examination revealed that those
four teeth had received endodontic
therapy and were then restored with
porcelain-fused-to-metal crowns. A
panoramic radiograph showed good
dental health (Figure 1). The patient
had been a cigarette smoker for 20
years, but had since quit smoking for
10 years. The patient had recently
finished adult orthodontic therapy
and was happy with the results; but
he expressed concern about the darkened
color of his gingival tissue on
both arches, as seen in Figure 2. He
was informed that pigmentation can
Figure 1: Panoramic radiograph
Sun
be a normal benign condition, but he
revealed that he was unhappy with
the esthetics. Furthermore, he
described the coloration to have had
a negative psychological impact on
him for the past 20 years.
B. Diagnosis
The diagnosis is hyperpigmentation
due to excessive melanin in the basal
layer of the epithelium. This condition
exists among all races, but is
more prevalent among the African
and South Asian population. It can
be exacerbated by smoking, since
chemicals such as nicotine can activate
melanocytes to produce melanin.
In fact, this benign increase in
melanin has been termed “smoker’s
melanin.” 1 The metal substrate of his
crowns appeared to be a precious
alloy, and this finding was important
since some nonprecious metals can
cause marginal gingival discoloration.
It was then determined that
the metal composition was not a
factor in the soft tissue coloration on
the maxilla and had no effect on the
mandibular arch. Periodontal probing
showed adequate biologic width
around all teeth, with normal pocket
depth and healthy tissue.
C. Treatment Options,
Precautions, and Informed
Consent
As per the patient’s request,
removal of the excessively
pigmented portion of the gingival
tissue will be performed.
The options for this elective
treatment were discussed, including
scalpel surgery, rotary abrasion,
cryotherapy, electrosurgery, and
laser ablation. The patient chose the
laser option. Multiple wavelengths
of dental lasers could be utilized to
ablate the basal epithelial layer
containing the melanin. Since prime
absorption of melanin and other
pigments occurs in the near-infrared
portion of the electromagnetic spectrum,
diode or Nd:YAG laser
wavelengths would be good choices
for efficiency. 2 Erbium and carbon
dioxide lasers could also be used,
since they are also effective for soft
tissue surgery. 3-5
The chief precaution is to control
the energy delivered to the tissue
to avoid potential collateral
damage. Depending on which laser
wavelength is chosen, underlying
connective tissue, periosteum, and
bone could suffer from the heat of
ablation if it were to extend beyond
the target tissue.
The second precaution is to
preserve as much of the thin
marginal tissue as possible, partic-

Figure 2: Preoperative full-smile view of
excessive pigmentation
ularly on the mandibular arch.
The author chose a fiber-delivered
Er:YAG laser because its
free-running pulse emission mode
provides some degree of thermal
relaxation, and it has a relatively
shallow depth of penetration. As
with other lasers with flexible
delivery systems, it permits accurate
placement of the tip. The
instrument can also be used with a
water spray for soft tissue surgery
to help cool the tissue and flush the
site of debris. While the Er:YAG
laser has limited hemostatic ability
on soft tissue, especially when coincidental
water spray is used, it was
felt that whatever bleeding might
occur in this moderately vascular
area could be readily controlled via
conventional means such as
compression. Moreover, efficient
high-volume evacuation and
enhanced visualization with magnification
will aid in the precision of
the procedure.
The patient gave his consent for
the procedure.
T R E AT M E N T
A. Treatment Objective
The objective was de-epithelization
to remove the melanin principally
located in the basal layer of the
epithelium.
B. Laser Operating Parameters
An Er:YAG laser (DELight, Hoya
ConBio, Fremont, Calif.), 2940-nm
wavelength with a fiber delivery
system was used with a 600-micrometer
80-degree tip. The parameters
were 30 Hz, 70 mJ, with a water
spray. This is a low power setting
Figure 3: Intraoperative view of maxillary
arch
(2.1 W), and some of the laser
energy will absorbed by the water
spray. The total treatment time was
2 hours and the laser exposure was
approximately 20 minutes.
C. Treatment
High-volume evacuation was in
place, and all laser safety precautions
were used. Visualization was
enhanced with 3.5x magnification.
Periodontal probing showed adequate
attached gingival width. Only topical
anesthetic (TAC 20% alternate gel –
tetracaine 4%, phenylephrine 2%,
lidocaine 20%) (Professional Arts
Pharmacy, Lafayette, La.) was used.
This topical cream is applied for 5
minutes onto an area of tissue. After
that time, good anesthesia is
obtained for 20-30 minutes.
The treatment area on the maxillary
arch extended from the right
first bicuspid to the left first
bicuspid and consisted of a 5-mmwide
band of excessive pigmentation
on thick gingival tissue. On the
mandible, the area extended from
cuspid to cuspid, and the pigmented
width varied from 2 to 7 mm, within
thin marginal tissue.
The first site selected was the
tissue above the upper right cuspid,
where the tissue thickness was
greatest. The laser energy was
directed at the tissue with very light
contact of the tip. The epithelium
was gradually ablated in very thin
layers. Ultimately, the basal layer
was exposed and carefully ablated,
and the pigmentation was removed.
When this area was completed, the
same parameters and procedures
continued toward the left cuspid
C L I N I C A L C A S E
area. Figure 3 shows an intraoperative
photograph, and the ablation
areas are apparent. The mandibular
tissue was treated with the same
parameters and protocol, once again
moving from right to left.
Some bleeding occurred in
various areas after the pigmentation
was removed. Hemostasis was
achieved by compression with wet
gauze and no complications arose.
The immediate postoperative view
is shown in Figure 3.
Upon completion of the procedure
in both arches, adequate free
gingival marginal tissue remained,
and bleeding was absent on the
ablated surfaces.
D. Postoperative Assessment
and Instructions
The patient did not experience any
discomfort during or after the
procedure, and there were no
complications. The postoperative
instructions were to eat a soft diet
and take over-the-counter medications
such as Motrin ® , Advil ® , or
Tylenol ® if necessary.
F O L LO W- U P C A R E
A. Treatment Assessment,
Prognosis, and Long-Term
Results
The healing was uneventful and the
early prognosis was good. The patient
returned for follow-up visits at 1
week, 2 weeks, 6 weeks, 3 months, 6
months, 1 year, 2 years, and 3 years.
Figures 4-9 show various postoperative
periods. The gingival tissues have
remained healthy, and the patient
liked the absence of the darkened
gingiva. At the 3-year-postoperative
visit, some slight repigmentation
appeared (Figure 9). Comparison of
photographic records confirmed this
reappearance. The patient reported
that he started smoking cigars, and
he was reminded that smoking can
contribute to excessive pigmentation.
B. Long-Term Prognosis and
Conclusion
The long-term prognosis is good. As
noted above, it is partially
Sun
J O U R N A L O F L A S E R D E N T I S T R Y | 2 011 V O L . 19 , N O . 3
287

J O U R N A L O F L A S E R D E N T I S T R Y | 2 011 V O L . 19 , N O . 3
288
C L I N I C A L C A S E
Figure 4: Two-week postoperative view of
maxillary arch
Figure 7: Three-month postoperative fullsmile
view
dependent on the patient’s smoking
habits. Moreover, he has a genetic
tendency to produce melanin.
The gingival depigmentation
procedure using the Er:YAG laser
was successful, with good patient
comfort, predictable healing, and
satisfaction.
R E F E R E N C E S
1. Brown FH, Housten GD. Smoker’s
melanosis. A case report. J
Periodontol 1991;62(8):524-527.
2. Coluzzi DJ, Convissar RA. Atlas of
laser applications in dentistry.
Chicago: Quintessence Publishing
Co., Inc., 2007:1-8.
3. Nakamura Y, Hossain M, Hirayama
K, Matsumoto K. A clinical study on
the removal of gingival melanin
pigmentation with the CO2 laser.
Sun
Figure 5: Two-week postoperative view of
mandibular arch
Figure 8: One-year postoperative fullsmile
view
Lasers Surg Med 1999;25(2):140-147.
4. Tal H, Oegiesser D, Tal M. Gingival
depigmentation by erbium:YAG
laser: Clinical observations and
patient responses. J Periodontol
2003;74(11):1660-1667.
5. Rosa DSA, Aranha ACC, Eduardo
Cde P, Aoki A. Esthetic treatment of
gingival melanin hyperpigmentation
with Er:YAG laser: Short-term clinical
observations and patient
follow-up. J Periodontol
2007;78(10):2018-2025.
A U T H O R B I O G R A P H Y
Dr. Grace Sun routinely utilizes
multiple wavelengths of dental
lasers. Her articles on dental lasers
have been published in Dental
Clinics of North America. Dr. Sun
is also certified as Advanced
Proficiency and was awarded
Figure 6: Six-week postoperative fullsmile
view
Figure 9: Three-year postoperative fullsmile
view
Educator status by the Academy of
Laser Dentistry where she was a
member of the Board of Directors.
She had lectured internationally on
the subjects of laser and cosmetic
dentistry. Dr. Sun is an accredited
Fellow with the American Academy
of Cosmetic Dentistry, a Fellow of
the International Congress of Oral
Implantologists, and is a Master of
the Academy of General Dentistry.
Dr. Sun may be contacted by e-mail
at gracesun@sundds.com.
Disclosure: Dr. Sun has no commercial
relationships relative to this
article.
Editor’s Note: This article first
appeared in J Laser Dent
2008;16(3):130-132. nn

C L I N I C A L R E V I E W A N D C A S E R E P O R T S
Photobiomodulation: An Invaluable Tool for All
Dental Specialties
Gerald Ross, DDS, Alana Ross, BScH, Tottenham, Ontario, Canada
J Laser Dent 2011;19(3):289-296
I N T R O D U C T I O N
Although low-level lasers are being
used successfully in many dental
clinics, the wide range of applications
is still largely unknown to
many practitioners, especially
dental specialists. In these fields,
there is the potential to see the
most definitive results of what laser
therapy can do to improve clinical
outcomes and patient satisfaction.
Photobiomodulation (PBM), also
commonly referred to as low-level
laser therapy (LLLT) or cold laser
therapy, uses light energy to elicit
biological responses from the cell
and normalize cell function.
Numerous studies have shown that
PBM affects the mitochondria of
the cell, primarily cytochrome-c
oxidase in the electron transfer
chain and porphyrins on the cell
membrane. 1-2 It has been proposed
that when light photons are
absorbed by these receptors, three
events occur: stimulation of adenosine
triphosphate (ATP) synthesis
by activation of the electron transport
chain; transient stimulation of
reactive oxygen species, which
increases the conversion of adenosine
diphosphate (ADP) to ATP;
and a temporary release of nitric
oxide from its binding site on
cytochrome-c oxidase. These factors
contribute to the clinical effects
seen with PBM, including tissue
repair, relief of inflammation and
pain, and repair of nerve damage. 3
Figure 1 depicts a flowchart
showing these interactions.
Studies have documented beneficial
effects of PBM, such as
stimulation of fibroblasts and
osteoblasts, as well a reduction of
the depolarization of nerve fibers. 4-6
From a clinical perspective, PBM
offers dental practitioners a nonin-
Figure 1: Summary of the primary mechanisms of photobiomodulation
vasive and nonthermal treatment
modality that can be used as an
adjunct to traditional therapies or
as a therapeutic tool on its own. 7
Examples of these clinical applications,
which will be discussed below,
include dental analgesia, treatment
of dentin hypersensitivity, healing of
soft tissue lesions, reduction of pain
and swelling after surgical procedures,
better integration of implants
into bone, and faster movement of
teeth during orthodontic procedures.
Determining the Appropriate
Dose
Treatment dose is probably the
most important variable in laser
treatment. Dose is measured in
joules per square centimeter (J/cm 2 )
and is a measure of the amount of
energy that is conducted into the
tissue. Clinical effects of the laser,
such as wound healing, pain relief,
or muscle relaxation, are all sensitive
to different irradiances or
doses. An example of this is the
stimulation of fibroblasts; a dose of
5 J/cm 2 will stimulate the cellular
activity of fibroblasts, whereas
higher doses inhibit cell viability
and proliferation. 8 Thus, for wound
healing, the clinician should ideally
use a dose lower than 5 J/cm 2 .
The biostimulatory and
inhibitory effects of lasers are
governed by the Arndt-Schultz
Law, which indicates that weak
stimuli will increase physiological
processes and strong stimuli will
inhibit physiological activity. A
therapeutic window, which includes
both biostimulatory and bioinhibitory
effects, is evident and is
the intended target for PBM treatments.
A depiction of the law, based
on Baxter, 9 is shown in Figure 2.
Ross and Ross
J O U R N A L O F L A S E R D E N T I S T R Y | 2 011 V O L . 19 , N O . 3
289

J O U R N A L O F L A S E R D E N T I S T R Y | 2 011 V O L . 19 , N O . 3
290
C L I N I C A L R E V I E W A N D C A S E R E P O R T S
Figure 2: Arndt-Schultz curve. The horizontal axis depicts an increasingly higher dose
from left to right, and indicates that biostimulation occurs with relatively smaller doses
when compared to the higher doses that cause bioinhibition
The importance of dose should
always be kept in mind when using
PBM; if the clinician is not
achieving the anticipated response
to laser treatment, the dose should
be re-evaluated to ensure it is
within the optimal range.
Additionally, treatments may need
to be modified over time to ensure
the practitioner is achieving the
ideal effect from the laser dose
(pain relief vs. wound healing).
Acute vs. Chronic Pain
Treatment dose and duration will
largely be governed by the status of
the injury. PBM can effectively
speed the resolution of acute
inflammation and pain, conditions
that should be treated frequently
(daily). The reverse applies to
chronic pain; treatments should be
done using lower doses over a
longer period of time (e.g., treat 2 to
3 times per week for 3 to 4 weeks).
CLINICAL APPLICATIONS OF
PHOTOBIOMODULATION IN
DENTAL SPECIALTIES
Oral Surgery
Dental surgeons can utilize PBM in
almost every facet of their practice.
Ross and Ross
Many procedures a dental surgeon
performs, especially extraction of
molars, create an acute inflammatory
response that can result in
edema, bruising, and pain.
Currently, the primary method of
dealing with the pain and discomfort
of the surgical procedures is
prescription of pain analgesics,
many of which carry side effects or
decreased mental alertness. Studies
have demonstrated that PBM in
acute pain reduction compares well
to standard non steroidal antiinflammatory
drug (NSAID)
treatment, with a better riskbenefit
profile. 10 Healing is also
accelerated by stimulation of fibroblasts
and osteoblasts, which
produce soft tissue and bone,
respectively, as noted in an animal
study conducted by Gerbi et al. 11
Post-Extraction
Following any surgical extraction,
laser irradiation is applied into the
socket immediately after the
surgery for reduction of pain and
inflammation and then after
suturing for soft tissue healing
(Figure 3).
Aras and Güngörmü¸s studied the
effect of PBM on trismus and facial
swelling following surgical extraction
of the third molar and found
that measurements of swelling
were about 5 mm less and measurements
of trismus (inter-incisal
opening) were about 5 mm greater
than in the placebo group on days 2
and 7. 12 In a meta-analysis of
studies investigating pain within 24
hours of surgery, Bjordal et al.
found that LLLT with red and
infrared wavelengths is effective in
reducing acute inflammatory pain
after molar extraction. 13
Dry Socket
Tunér and Hode describe the benefits
of PBM in helping to prevent
alveolitis after a tooth extraction. 14
The following case study illustrates
PBM treatment for a painful ‘dry
socket.’
Oral Mucositis
Oral mucositis, presenting as an
open sore over the oral soft tissue,
is a life-altering condition that is a
side effect of chemotherapy and
radiation therapy. Laser therapy
has been investigated as a preventative
application to mucositis and
as a treatment modality for healing
erupted sores, with positive
results. 15 A 2006 study by Corti et
al., using a light-emitting diode
device with an emission of 645 ± 15
nm, demonstrated that PBM accelerated
the healing rate of oral
mucositis by 117% to 164%. 16
Often, oral mucositis can be so
debilitating for patients that they
cannot continue their cancer treatments,
so a tool that can treat or
Figure 3: Application of low-level laser
energy into the socket immediately
following extraction

prevent the sores will have considerable
clinical importance.
Consultation with the oncologist
should always be done prior to
commencing laser treatments.
Fractures and Orthognathic Surgery
PBM accelerates healing of bone
after fractures or orthognathic
surgery through the stimulation of
osteoblasts. A 2005 study in rats
demonstrated that laser irradiation
resulted in an increase in bone
neoformation, with better quality
bone on the irradiated groups when
compared to the control group, who
received no radiation. 11
Soft Tissue Lesions
Soft tissue lesions, such as herpes
simplex, denture sores, and angular
cheilitis respond positively to lowlevel
laser irradiation. Schindl and
Neumann investigated the effect of
LLLT on recurrent herpes simplex
and demonstrated that 10 daily
irradiations significantly lowered
the incidence of local recurrence
and is a beneficial treatment alternative
to commonly used drugs
such as acyclovir and famciclovir. 17
Further, the author has clinically
observed that laser irradiation of
herpes simplex decreases the incidence
of lesion recurrence. Marei et
al. examined the effect of laser
irradiation on denture sores and
noted that LLLT eased the pain
caused by denture lesions, while at
4 weeks post-treatment the laserirradiated
areas showed clinically
superior healing, and histological
epithelialization and vascularization
of the lesion. 18 Tunér and Hode
report successful treatment of
angular chelitis with PBM, but
warn of its recurrence if the fundamental
cause is not dealt with. 19 It
is advantageous to treat any soft
tissue lesion in its most acute
stage. For example, herpetic lesions
are most susceptible to LLLT
during their prodromal stage.
Figure 4 demonstrates the treatment
of a lesion on the lip using an
830-nm PBM device.
C L I N I C A L R E V I E W A N D C A S E R E P O R T S
Dental Infections
For infections and edema, PBM has
been reported to dilate lymphatic
vessels and reduce the permeability
of blood vessels. 20 Figure 5 demonstrates
the application to the
lymph nodes using a PBM device.
Primary Tooth Restorations
A variety of factors contribute to
the analgesic effect produced by
PBM which allows dental practitioners
to perform many primary
tooth restorations without anesthesia.
Small animal studies show
that laser irradiation promotes a
release of endorphins and serotonin;
inhibits the conduction of
C fibers, the fibers that carry
pulpal pain; and increases oxygenation
and lymphatic drainage, which
are responsible for pain relief after
the first minutes of tissue irradia-
6, 21-22 tion.
Figure 4: LLLT treatment of a soft tissue
lesion
C A S E S T U DY : D RY S O C K E T
Treating Dentist: Dr. Gerald Ross
A 45-year-old male patient had a lower first molar extracted.
During the postoperative instructions, the patient (a smoker) was
advised to avoid smoking cigarettes for a minimum of 2 days. The
patient presented the following day with dry socket and admitted to
smoking the previous evening.
An 830-nm PBM device was used. The intraoral light guide was
placed in the socket and the socket was irradiated until pain relief
was felt by patient (in this case 48 J/cm 2 of energy was applied before
the patient started to experience a reduction in discomfort). A
dressing was placed into the socket and the patient was sent home
without any pain medications. The patient returned the next day for
a dressing change and the laser was applied into the socket using 4
J/cm 2 before application of the new dressing for stimulation of the
epithelium in the socket. The patient did not require any additional
treatments and the area healed in 7 days.
C A S E S T U DY : O R A L M U C O S I T I S
Treating Dentist: Dr. Gerald Ross
A 61-year-old female patient undergoing chemotherapy for terminal
cancer presented with numerous sores over the inside of her mouth.
The patient could not eat, drink, or swallow without extreme pain.
Treatments (mouth rinses) assigned by the oncologist had no effect
on healing of the sores. A visible red laser (660 nm) was applied
intraorally overlapping throughout the mouth for 2 days in a row.
When the patient came in on the second day, the pain was markedly
decreased and she was able to eat soup. By the fourth day, she was
able to eat normally. The patient passed away in the following month
but no sores returned during that time.
NOTE: Prior to laser treatment, the dentist contacted the oncologist
who was willing to try any treatment that could work on the
mucositis.
Ross and Ross
J O U R N A L O F L A S E R D E N T I S T R Y | 2 011 V O L . 19 , N O . 3
291

J O U R N A L O F L A S E R D E N T I S T R Y | 2 011 V O L . 19 , N O . 3
292
C L I N I C A L R E V I E W A N D C A S E R E P O R T S
Figure 5: Application of low-level laser to
the submandibular lymph nodes
Laser irradiation is applied to
the apex of each root for analgesia
and again after the tooth has been
prepared for reduction of pain and
inflammation, as shown in Figure
6. Distraction techniques are
recommended to help the patient
deal with the mental fears or
anxiety surrounding the dental
appointment. Dental analgesia does
not seem to be as effective in
permanent teeth because of the
increased size and sensitivity of the
dental pulp; however, it has been
shown clinically to be effective for
pain relief during crown cementations
and decreased sensitivity
during scaling appointments.
Nausea and Gagging
Application of the laser to the P6
(Pericard 6) acupuncture point on
the wrist can decrease or eliminate
the nausea and gagging some
patients feel during impressiontaking
or X-ray procedures. As
shown in Figure 7, the P6 is located
on the underside of the wrist,
approximately 1 inch from the
distal palmar crease (approximately
the width of the distal
thumb phalanx). 23 For patients who
are extremely nauseous or anxious,
application to three acupuncture
points in the wrist can be effective;
Ross and Ross
Figure 6: Promotion of analgesia via LLLT
for primary tooth restorations
H7, LU9, and P6 are the parasympathetic
calming points and
stimulation of these points can be
very effective in reducing anxiety.
A 1998 report in the British
Journal of Anaesthesia investigated
the effectiveness of laser irradiation
to the P6 acupuncture point on postoperative
vomiting. In the laser
stimulation group, the incidence of
vomiting was significantly lower
(25%) than in the placebo group
(85%), and the patients were quite
receptive to the painless procedure. 24
Uptake and Elimination of
Anesthesia
Based on the mechanisms of PBM
therapy’s ability to increase blood
circulation, 4 the author has found
that there is an increase in uptake
and elimination of anesthesia. PBM
is applied to the submandibular
lymph nodes and the site of injection
after the injection and upon
completion of the dental appointment,
for uptake and elimination,
respectively.
Implant Placement
Three papers indicate that PBM
can reduce inflammation following
implant placement, help speed the
integration of the implant into the
bone, and improve the quality of
the bone around the implant. A
study using rabbits utilized Raman
spectroscopy and electronic
microscopy to investigate the effect
of infrared light on the loading
time of dental implants, and found
Figure 7: A graphic diagram of three
parasympathetic calming acupuncture
points for reduction of nausea and
gagging. Courtesy of Donald J. Coluzzi, DDS.
Adapted from Atlas of acupuncture points. Point
locations [Internet]. Published by
www.AcupunctureProducts.com, 2007. [Cited
2009 Dec 28.] 39 p. Available from:
http://chiro.org/acupuncture/ABSTRACTS/
Acupuncture_Points.pdf.
a significantly greater amount of
mature bone, a better distribution
of bone, and more organization of
bone after laser irradiation, when
compared to the control group that
received no laser irradiation. 25
Another study used rats to
examine the effect of laser therapy
on bone and demonstrated that the
laser group had an abbreviated
initial inflammatory response and
a rapid stimulation of bone matrix
formation at 15 and 45 days. 26 An
earlier rabbit study showed that
bone healing is improved and those
authors concluded that it is
possible to reduce the loading time
of implants in the mandible of
humans from 4 months to approximately
2 months and 24 days, and
in the maxilla, from 6 months to 4
months and 6 days. 27
Orthodontics
Orthodontic treatments are lengthy
and often painful for many patients.
As mentioned previously, Gerbi et
al. have shown that PBM irradiation
on bone increases osteoblastic
proliferation, collagen deposition

and bone neoformation when
compared to non-irradiated bone. 11
A 2008 study investigating the
effect of laser therapy on orthodontic
movement showed that the velocity
of canine movement was significantly
higher in the laser-irradiated
teeth compared to teeth that
received no irradiation. In addition,
the pain intensity was also at a
lower level in the lased group
throughout the entire retraction
period. 28 Histological observations
made during another study on
rabbits showed that both osteoblasts
and osteoclasts remained more
active on the lased side which could
account for the accelerated movement.
29 Finally, Turnhani et al.
showed that a single application of
LLLT reduced the pain at 6 and 30
hours after banding treatment. 30
Periodontics
The use of PBM as a treatment
modality in periodontics is effective,
either as a treatment method
on its own or as an adjunct to the
increasingly popular surgical
lasers. A recent study investigated
the gingival inflammatory response
and dental plaque reduction
following scaling and root planing
combined with PBM in 60 patients.
The authors found a significant
decrease in the clinical indices
(plaque, gingival, and sulcular
bleeding), which they thought could
be beneficial in the treatment of
chronic advanced periodontitis. 31
Periodontal Surgery
Healing after periodontal surgery
is often a lengthy and painful
process. PBM has been shown to
stimulate fibroblasts for faster
regeneration of soft tissue, while
providing analgesia and a modulation
of the inflammatory chemicals
that cause pain and discomfort. A
2006 study showed a statistically
significant decrease in pocket depth
at 21 and 28 days post-surgery.
Moreover, the laser-treated wounds
presented with factors suggestive
of better healing, including color,
C L I N I C A L R E V I E W A N D C A S E R E P O R T S
contour, and mucosa healing when
compared with non-laser treated
area, which served as a control. 32 To
further exemplify these positive
responses, a study by Ozcelik et al.
demonstrated that LLLT enhanced
epithelialization and improved
wound healing after gingivectomy
and gingivoplasty operations. 33
Figure 8 shows an 830-nm PBM
device being used to irradiate a
closed incision.
Endodontics
PBM is effective for reducing pain
and inflammation after endodontic
treatments, for dentin hypersensitivity,
and as a diagnostic tool for
pulp hyperemia. 34
Figure 8: LLLT irradiation after flap surgery
Figure 9: Flowchart for endodontic diagnosis
Laser Therapy as a Diagnostic Tool
Occasionally, a patient will present
to a dental practitioner with excessive
tooth pain, the source of which
cannot be accurately identified.
Traditional diagnostic methods
such as thermal or electrical
stimuli often do not show any indication
of the problem, making the
diagnosis and treatment stressful
for both the patient and the doctor.
As stated previously, PBM irradiation
increases circulation, thus a
patient with a hyperemic pulp will
feel a sharp pain when the laser is
applied to a tooth. 35 Figure 9 shows
a diagnostic outline that could be
used in endodontics.
Dentin Hypersensitivity
A study by Marsilio et al. demonstrated
that LLLT treatment of
dentin hypersensitivity in two
different groups of patients was
effective for 86% to 88% of all the
participants. 36 Another study
compared LLLT to topical fluoride
varnish application for treatment
of dentinal hypersensitivity and
found that 86% of the laser irradiation
group achieved absence of pain
compared to 27% of the fluoride
group. 37
Ross and Ross
J O U R N A L O F L A S E R D E N T I S T R Y | 2 011 V O L . 19 , N O . 3
293

J O U R N A L O F L A S E R D E N T I S T R Y | 2 011 V O L . 19 , N O . 3
294
C L I N I C A L R E V I E W A N D C A S E R E P O R T S
TMJ and Facial Pain
When treating temporomandibular
joint (TMJ) or facial pain, PBM is a
useful tool to add to the therapeutic
arsenal. From simple acute cases
like facial pain after long appointments
to chronic TMJ cases, laser
therapy will help reduce pain and
inflammation, and significantly
resolve muscle trismus. In a systematic
review of postoperative pain
relief in patients after undergoing
third molar extraction, a PBM irradiation
was shown to be beneficial in
reducing acute inflammatory pain. 13
In a clinical study of 74 patients
complaining of TMJ pain, 64% were
pain-free or had improvement in
comfort after 12 PBM sessions over
a six-week period. 38 Pinheiro and
colleagues analyzed the effect of
PBM on maxillofacial disorders by
irradiating 141 female and 24 male
patients twice a week for 6 weeks.
At the end of the treatment 72% of
patients were aymptomatic and 15%
had improved considerably. 39
Neuropathic Pain
Neuropathic facial pain is a debilitating
condition for a patient that
results in their living with excruciating
pain or with a continuous
dose of prescription analgesics. As
stated above in the study by
Bjordal et al., 13 PBM permits many
patients to live a life free from
discomfort or with less pain.
C O N C LU S I O N
Although PBM has been available
to health care professionals since
the 1960s, low-level laser therapy
did not really begin to gain popularity
until the 1980s when
controlled and randomized studies
began to be published.
In 2007, Karu reported that the
effects of PBM are dependent on the
initial redox status of a cell. If a cell
is damaged, or in a reduced redox
state, the cellular response to PBM
will be stronger. Conversely, a cell
which is at an optimal redox potential
will have a weak or absent
cellular response to PBM. 2 Thus,
Ross and Ross
cells that are damaged will respond
to PBM better than cells that are
healthy and functioning normally.
However, there are precautions
all laser users should take and areas
to avoid treating when using PBM.
Specifically, those include avoiding
exposure to the thyroid gland, to
pregnant women, and to radiation
therapy patients. 40 Also important to
note is that the laser will be ineffective
if the patient has had a steroid
injection in the last six months. 41 All
laser users should consult their
laser manufacturer for any questions
regarding contraindications
and appropriate treatment doses, as
well as for instructions about safety
eyewear for everyone within the
nominal hazard zone of the beam.
Photobiomodulation is an
evolving technology. With every
passing day, more is being discovered
about the mechanisms of laser
therapy, doses, treatment locations,
and diseases in which a laser will
have an effect. At our hands is a
tool that can reduce pain, stimulate
wound healing, and modulate the
inflammatory response.
Photobiomodulation can be used
effectively in dental specialties to
better manage treatments that are
often deemed painful by patients,
without prescribing pharmaceuticals
that often have a number of
side effects. All healthcare professionals,
including dentists and
dental specialists, should further
investigate photobiomodulation to
enhance their clinical treatments
and outcomes.
C A S E S T U DY : T M J PA I N
Treating Dentist: Dr. Gerald Ross
A 55-year-old patient presented with pain in the left temporomandibular
joint and a limited ability to open the mouth. The
computed tomography (CT) tomogram (R = right, SMV = submental
vertex, L = left) showed degenerative joint disease (osteoarthritis) of
the left TMJ with no disc present.
Six applications of the laser were performed over a three-week period,
with treatment applications to the joint, joint capsule, and the lateral
pterygoid muscle. This treatment resulted in the patient being pain-free
for the last two years and with the ability to open the mouth wider.

C A S E S T U DY : N E U R O PAT H I C PA I N
Treating Dentist: Dr. Gerald Ross
A 61-year-old male patient presented with pain and felt it was coming
from the lower left molar. The tooth was extracted and the socket healed
uneventfully but the pain got worse. At that point, there were no other
problems with teeth in that quadrant, however the pain was worsening
and the patient was taking Tylenol ® No. 3 (30 mg) approximately 4 times
per day, every day. Laser irradiation was applied to the trigeminal nerve,
the molar site, and the trigeminal ganglion. After 1 application, the
patient said he was no longer taking Tylenol No. 3 and took only 2 Advil ®
at bedtime. Three days later a second application was done to the same
site, and the patient reported as pain-free and no longer needing medication.
The pain-free status has lasted for three months.
A U T H O R B I O G R A P H I E S
Dr. Gerald Ross has been practicing
dentistry for more than 30 years in
Tottenham, Ontario. He has been
using surgical and low-level lasers
clinically since 1990 and has
lectured extensively in Canada, the
United States, and internationally.
He holds Advanced Proficiency
status from the Academy of Laser
Dentistry and a fellowship from the
American Society of Laser Medicine
and Surgery. In 2008, Dr. Ross was
asked to present a paper and chair
the dental session at the World
Association for Laser Therapy
(WALT) meeting that was held in
South Africa. He is currently a board
member of the North American
Association for Laser Therapy
(NAALT) and is helping with
numerous studies on photobiomodulation.
Dr. Ross may be contacted by
e-mail at ddsross@rogers.com.
Alana Ross, BScH, graduated
with an honors degree in Biomedical
Science from the University of
Guelph in Ontario, Canada. In 2004,
Alana cofounded, and is currently
the executive director of, Laser Light
Canada, a company involved in the
distribution of and education
relating to low-level lasers and
phototherapy equipment in North
America. She has published
numerous articles on low-level laser
therapy and is presently overseeing
several clinical studies. Currently,
she is the chair of the NAALT 2010
Annual Conference committee,
C L I N I C A L R E V I E W A N D C A S E R E P O R T S
serves on the NAALT Board of
Directors, and is a member of the
NAALT membership committee.
Disclosures: Dr. Ross is the president
of Laser Light Canada, a company
which is involved in the distribution
and education related to low-level
lasers in dentistry. Ms. Ross is the executive
director of that company. None of
the manufacturers of the instruments
sold by Laser Light Canada had any
input into this article.
R E F E R E N C E S
1. Tafur J, Mills PJ. Low-intensity
light therapy: Exploring the role of
redox mechanisms. Photomed Laser
Surg 2008;26(4):323-328.
2. Karu TI. Low-power laser therapy.
Chapter 48 in: Vo-Dinh T, editor.
Biomedical photonics handbook.
Boca Raton, Fla.: CRC Press,
2003:48-1 – 48-25.
3. Hamblin MR, Demidove TN.
Mechanisms of low level light
therapy. In: Hamblin MR, Waynant
RW, Anders J, editors. Mechanisms
for Low-Light Therapy, January 22
and 24, 2006, San Jose, Calif. Proc.
SPIE 6140. Bellingham, Wash.:
SPIE – The International Society for
Optical Engineering, 2006:614001-1
614001-12.
4. Mester E, Mester AF, Mester A. The
biomedical effects of laser application.
Lasers Surg Med
1985;5(1):31-39.
5. Stein A, Benayahu D, Maltz L, Oron
U. Low-level laser irradiation
promotes proliferation and differen-
tiation of human osteoblasts in
vitro. Photomed Laser Surg
2005;23(2):161-166.
6. Wakabayashi H, Hamba M,
Mastumoto K, Tachibana H. Effect
of irradiation by semiconductor
laser on responses evoked in trigeminal
caudal neurons by tooth pulp
stimulation. Lasers Surg Med
1993;13(6):605-610.
7. Tunér J, Hode L. Laser therapy:
Clinical practice and scientific background.
Grängesberg, Sweden:
Prima Books AB, 2002: Chapter 11
The mechanisms (pp. 333-364).
8. Hawkins D, Abrahamse H. Effect of
multiple exposures of low-level laser
therapy on the cellular responses of
wounded human skin fibroblasts.
Photomed Laser Surg
2006;24(6):705-714.
9. Baxter GD. Principles and practice of
laser treatment. Chapter 7 in: Baxter
GD. Therapeutic lasers: Theory and
practice. Edinburgh, UK: Churchhill
Livingstone, 1994:187-220.
10. Bjordal JM, Johnson MI, Iversen V,
Aimbire F, Lopes-Martins RAB.
Low-level laser therapy in acute
pain: A systemic review of possible
mechanisms of action and clinical
effects in randomized placebocontrolled
trials. Photomed Laser
Surg 2006;24(2):158-168.
11. Gerbi MEM, Pinheiro ALB, Marzola
C, Limeira Júnior Fde A, Ramalho
LMP, Ponzi EAC, Soares AO,
Carvalho LCB, Lima HV, Gonçalves
TO. Assessment of bone repair associated
with the use of organic bovine
bone and membrane irradiated at
830nm. Photomed Laser Surg
2005;23(4):382-388.
12. Aras MH, Güngörmü¸s M. The effect
of low-level laser therapy on trismus
and facial swelling following
surgical extraction of a lower third
molar. Photomed Laser Surg
2009;27(1):21-24.
13. Bjordal JM, Tuner J, Iversen VV,
Frigo L, Gjerde K, Lopes-Martin
RAB. A systematic review of postoperative
pain relief by low level
laser therapy (LLLT) after third
molar extraction. In: The 1st
meeting of the European Division of
the World Federation for Laser
Dentistry, April 26-27, 2007, Nice,
Ross and Ross
J O U R N A L O F L A S E R D E N T I S T R Y | 2 011 V O L . 19 , N O . 3
295

J O U R N A L O F L A S E R D E N T I S T R Y | 2 011 V O L . 19 , N O . 3
296
C L I N I C A L R E V I E W A N D C A S E R E P O R T S
France. Lasers Med Sci
2007;22(4):303, abstract O50.
14. Tunér J, Hode L. Laser therapy:
Clinical practice and scientific background.
Grängesberg, Sweden:
Prima Books AB, 2002:204.
15. Brugnera Junior A, Zanin FAA,
Zanin T, Bissoli CZ, Carvalhosa AA,
Castro PHS. Prevention and treatment
of oral mucositis with diode
laser 660 nm in patients with head
and neck cancer submitted to radiotherapy
and/or chemotherapy.
Photomed Laser Surg
2007;25(4):366-367, Abstract 143.
16. Corti L, Chiarion-Sileni V, Aversa S,
Ponzoni A, D’Arcais R, Pagnutti S,
Fiore D, Sotti G. Treatment of
chemotherapy-induced oral
mucositis with light-emitting diode.
Photomed Laser Surg
2006;24(2):207-213.
17. Schindl A, Neumann R. Low-intensity
laser therapy is an effective
treatment for recurrent herpes
simplex infection. Results from a
randomized double-blind placebocontrolled
study. J Invest Dermatol
1999;113(2):221-223.
18. Marei MK, Abdel-Meguid SH,
Mokhtar SA, Rizk SA. Effect of lowenergy
laser application in the
treatment of denture-induced
mucosal lesions. J Prosthet Dent
1997;77(3):256-264.
19. Tunér J, Hode L. Laser therapy:
Clinical practice and scientific background.
Grängesberg, Sweden:
Prima Books AB, 2002:220.
20. Tunér J, Hode L. Laser therapy:
Clinical practice and scientific background.
Grängesberg, Sweden:
Prima Books AB, 2002:162.
21. Hagiwara S, Iwasaka H, Hasegawa
A, Noguchi T. Pre-irradiation of
blood by gallium aluminum arsenide
(830 nm) low-level laser enhances
peripheral endogenous opioid analgesia
in rats. Anesth Analg
2008;107(3):1058-1063.
22. Wakabayashi H, Hamba M,
Matsumoto K, Tachibana H. Effect
of irradiation by semiconductor
laser on responses evoked in trigeminal
caudal neurons by tooth pulp
stimulation. Lasers Surg Med
1993;13(6):605-610.
23. Kotlow L. Lasers and pediatric dental
care. Gen Dent 2008;56(7): 618-627.
Ross and Ross
24. Schlager A, Offer T, Baldissera I.
Laser stimulation of acupuncture
point P6 reduces postoperative
vomiting in children undergoing
strabismus surgery. Br J Anaesth
1998;81(4):529-532.
25. Lopes CB, Pinheiro ALB, Sathaiah S,
Da Silva NS, Salgado MAC. Infrared
laser photobiomodulation (λ 830 nm)
on bone tissue around dental
implants: A Raman spectroscopy and
scanning electronic microscopy study
in rabbits. Photomed Laser Surg
2007;25(2):95-101.
26. Pretel H, Lizarelli RFZ, Ramalho
LTO. Effect of low-level laser
therapy on bone repair: Histological
study in rats. Lasers Surg Med
2007;39(10):788-796.
27. Lopes CB, Pinheiro ALB, Sathaiah
S, Duarte J, Martins MC. Infrared
laser light reduces loading time of
dental implants: A Raman spectroscopic
study. Photomed Laser Surg
2005;23(1):27-31.
28. Youssef M, Ashkar S, Hamade E,
Gutknecht N, Lampert F, Mir M.
The effect of low-level laser therapy
during orthodontic movement: A
preliminary study. Lasers Med Sci
2008;23(1):27-33.
29. Sun X, Zhu X, Xu C, Ye N, Zhu H.
[Effects of low energy laser on tooth
movement and remodeling of alveolar
bone in rabbits.] Hua Xi Kou Qiang Yi
Xue Za Zhi [West China J Stomatol]
2001;19(5):290-293. Chinese.
30. Turhani D, Scheriau M, Kapral D,
Benesch T, Jonke E, Bantleon HP.
Pain relief by single low-level laser
irradiation in orthodontic patients
undergoing fixed appliance therapy.
Am J Orthod Dentofacial Orthop
2006;130(3):371-377.
31. Angelov N, Pesevska S, Nakova M,
Gjorgoski I, Ivanovski K, Angelova
D, Hoffmann O, Andreana S.
Periodontal treatment with lowlevel
diode laser: Clinical findings.
Gen Dent 2009;57(5):510-513.
32. Amorim JCF, de Sousa GR, de
Barros Silveira L, Prates RA, Pinotti
M, Ribeiro MS. Clinical study of the
gingiva healing after gingivectomy
and low-level laser therapy.
Photomed Laser Surg
2006;24(5):588-594.
33. Ozcelik O, Cenk Haytac M, Kunin A,
Seydaoglu G. Improved wound
healing by low-level laser irradiation
after gingivectomy operations:
A controlled pilot study. J Clin
Periodontol 2008;35(3):250-254.
34. Kert J, Rose L. Clinical laser
therapy: Low level laser therapy.
Reiss E, translator. Veksoe,
Denmark: Scandinavian Medical
Laser Technology, 1989:111-119.
35. Kutvolgyi I. Low level laser therapy
as a diagnostic tool in dentistry.
Laser Ther 1998;10:79-82.
36. Marsilio AL, Rodrigues JR, Borges
AB. Effect of the clinical application
of the GaAlAs laser in the treatment
of dentine hypersensitivity. J
Clin Laser Med Surg
2003;21(5):291-296.
37. Pesevska S, Nakova M, Ivanovski K,
Angelov N, Kesic L, Obradovic R,
Mindova S, Nares S. Dentinal
hypersensitivity following scaling
and root planing: Comparison of
low-level laser and topical fluoride
treatment. Lasers Med Sci. Epub
2009 Jun 1. DOI 10.1007/s10103-
009-0685-0.
38. Carvalho CM, de Lacerda JA, Dos
Santos Neto FP, Cangussu MCT,
Marques AMC, Pinheiro ALB.
Wavelength effect in temporomandibular
joint pain: A clinical
experience. Lasers Med Sci. Epub
2009 Jun 30. DOI 10.1007/s10103-
009-0695-y.
39. Pinheiro ALB, Cavalcanti ET,
Pinheiro TITNR, Alves MJPC,
Manzi CTA. Low-level laser therapy
in the management of disorders of
the maxillofacial region. J Clin
Laser Med Surg 1997;15(4):181-183.
40. Tunér J, Hode L. Laser therapy:
Clinical practice and scientific background.
Grängesberg, Sweden:
Prima Books AB, 2002: Chapter 8
Contraindications (pp 285-289).
41. Lopes-Martins RAB, Albertini R,
Lopes-Martins PSL, de Carvalho
FAS, Neto HCCF, Iversen VV,
Bjordal JM. Steroid receptor antagonist
mifepristone inhibits the
anti-inflammatory effects of
photoradiation. Photomed Laser
Surg 2006;24(2):197-201.
Editor’s Note: This article first
appeared in J Laser Dent
2009;17(3):117-124. nn

C L I N I C A L E X P E R I E N C E
Using Photobiomodulation on a Severe
Parkinson’s Patient to Enable Extractions, Root
Canal Treatment, and Partial Denture Fabrication
Mel A. Burchman, DDS, Langhorne, Pennsylvania
J Laser Dent 2011;19(3):297-300
Mel A. Burchman, DDS
I N T R O D U C T I O N
The objective of this presentation is
to demonstrate how low-level laser
stimulation of acupuncture points
may be used to temporarily relieve
the tremors of Parkinsonism,
thereby enabling various dental
treatments.
Acupuncture, as defined by the
American Academy of Medical
Acupuncture (AAMA), may be
defined as “a method of encouraging
the body to promote natural
healing and to improve functioning.
This is done by inserting needles
and applying heat or electrical
stimulation at very precise
acupuncture points.” 1 Lasers and
ultrasound are other means of
stimulating the acupoints.
Dorland’s Illustrated Medical
Dictionary states: “According to
traditional theory, the goal of
acupuncture is the prevention and
treatment of disease by correcting
disturbances in the flow of qi (“life
energy”); biologically, the effects of
acupuncture may result from the
release of neurotransmitters such
as endorphins and serotonin.” 2
The AAMA further explains how
acupuncture works: “The classical
Chinese explanation is that chan-
nels of energy run in regular
patterns through the body and over
its surface. These energy channels,
called meridians, are like rivers
flowing through the body to irrigate
and nourish the tissues. An
obstruction in the movement of
these energy rivers is like a dam
that backs up in others. The meridians
can be influenced by
stimulating the acupuncture
points.” 1
How light may be used to stimulate
such points is described by
Vargas, who reported that Russian
researchers from the Institute for
Clinical and Experimental
Medicine showed that “only certain
areas of the body were able to
transfer light beneath the surface,
and these areas corresponded to
acupuncture points. Furthermore,
the light was conducted within the
body along the acupuncture meridians.
It appears that the meridians
are a light transferal system within
the body somewhat like optical
fiber.” 3
Instead of using needles, heat,
electrical current, or ultrasound to
stimulate certain acupuncture
points, the present case describes a
method of photobiomodulation
using a combination of low-level
laser and light-emitting diode
instruments to enable dental treatment
of a patient with severe
Parkinson’s and positively affect
outcome.
So what do we know about
Parkinson’s disease? It is a degenerative
disorder of the central
nervous system that impairs motor
skills, speech, and other functions.
Primary symptoms, including
tremor of resting muscles, rigidity,
slowness of movement, and
impaired balance, are the result of
decreased stimulation of the motor
cortex by the basal ganglia,
normally caused by the insufficient
formation and action of dopamine.
Hence, Parkinson’s disease is
related to low levels of dopamine in
certain parts of the brain. An
increase in dopamine concentrations
in the brain is thought to
improve nerve conduction and to
assist in lessening the movement
disorders in patients with this
condition.
Dopamine is a neurohormone
released by the hypothalamus. Its
main function is to inhibit the
release of prolactin from the anterior
lobe of the pituitary gland.
Dopamine is a catecholamine and
an important neurotransmitter
(messenger) in the brain. Begley
states that dopamine is “the precise
chemical that is scarce in the brains
of Parkinson’s patients. Dopamine
… calms the chaotic neuronal firing
that causes the spasms and rigidity
of Parkinson’s … ” 4-5
The hypothalamus contains a
number of small nuclei with a
variety of functions. The most
important of these is to link the
nervous system to the endocrine
system via the pituitary gland. The
hypothalamus is located below the
thalamus, just above the brain
stem. Important to understanding
this case is the fact that the hypothalamus
is stimulated by light.
Choice of which light-emitting
instrument to use is guided by
Burchman
J O U R N A L O F L A S E R D E N T I S T R Y | 2 011 V O L . 19 , N O . 3
297

J O U R N A L O F L A S E R D E N T I S T R Y | 2 011 V O L . 19 , N O . 3
298
C L I N I C A L E X P E R I E N C E
depth of penetration of wavelength
and site of the acupuncture point.
As Naeser points out, the 600-700
nm wavelengths have a shallow
penetration, approximately 0.8
mm, and are used on acupuncture
points on the hand, foot, face, or
sometimes the ear. Deeper-penetrating
(up to 1 inch) wavelengths
of 800 to 1000 nm are used to treat
points on the limbs or back. 6
C L I N I C A L C A S E
This presentation represents one of
the most rewarding experiences I
have had in 35 years of dentistry.
Al, age 82 years, is one of my
delightful 30-year patients. He
used to be an auto worker, but now
has such severe Parkinson’s that he
can barely sit in the chair and read
a magazine without dropping it. He
walks with a tripod cane. The
extent of his condition is evident in
the number and frequency of his
Parkinson’s medications: he takes
three oral prescriptions (Requip ,
Sinemet , and Stalevo ® ) for a total
of 11 tablets daily. Al is also a
cancer patient, but that is irrelevant
to the case. He wears a full
upper denture that needs a considerable
amount of adhesive to stay
in place due to his severe tremors;
it is always coming out.
Al came in several weeks previously
as he had broken two lower
teeth (#20 and #21). I referred him
to an oral surgeon for general anesthesia
for their extraction, because
there was no way I thought I would
be able to extract them due to his
severe tremors. He came back a
couple weeks later complaining of
something sticking up from the
area and asked me to examine the
site. Unfortunately, part of the root
from tooth #20 was still present
and I told him to return to the oral
surgeon to get it taken care of, but
he did not want to go back there.
He wanted me to handle it and I
did, but it was really difficult due
to his constant movement. He
needed something done so that he
could eat and in my opinion extrac-
Burchman
Figure 1: Preoperative radiograph
showing the only remaining teeth, #24
through #27
tions and a full lower denture was
equivalent to a death sentence for
him. He could barely function with
a full upper; I couldn’t imagine him
trying to eat with a full lower with
his severe Parkinson’s. We decided
to extract teeth #24 and #26 (due to
his limited finances), provide root
canal treatment for #25 and #27,
and make a partial lower denture.
The preoperative film (Figure 1)
shows his only remaining lower
teeth, #24 through #27.
I decided to work the case at a
pace that Al could handle. At each
visit I would decide what to treat
based on what it appeared he could
handle. On this particular visit Al
was having a horrible day. After my
assistant seated him she came to
get me from another treatment
room. He had already cancelled
several appointments because of
how poorly he was feeling. He was
kicking his legs, swinging his arms,
and jerking his head. I looked at
him and remembered reading the
section on Parkinson’s in my
manual on low-level laser therapy
(LLLT). 7 It listed three acupuncture
points that were useful in calming
these patients: Gallbladder #20,
Bladder #60, and Bladder #55.
(Editor’s Note: For illustrations of
meridians and acupuncture points,
readers may consult standard
acupuncture references. One such
source is the Atlas of Acupuncture
Points. Point Locations. 2007,
published by
www.AcupunctureProducts.com and
available online as a PDF from
www.archive.org/details/Atlas_of_
Acupuncture_Point_Locations.
Accessed February 5, 2012.)
I decided to use a photobiomodulation
device (Q1000, 2035, Inc.,
Rapid City, S.D.) on Gallbladder
#20 because it is located at the
cervical atlas at the base of the
skull, the most stable part of his
body at the time. The other two
points are on the leg and the way
that Al was kicking it could be
dangerous to hold the instrument
in place. Specifically, the device
consists of a light-emitting diode
(LED) cluster with 8 LEDs and 12
diodes that emit wavelengths
between 470 and 940 mm. The unit
also comes with a separate 660-nm
diode laser probe and an 808-nm
diode laser probe. Al’s tremors were
so severe that I used the 660-nm
probe, power output 30 mW, for 3
minutes on both sides of his
cervical atlas (Figure 2).
The calming effects after treatment
were striking. Al’s tremors
stopped within 2 to 3 minutes after
laser irradiation of the acupuncture
point. He was amazed. Not only
were we able to do dental work, but
Al was able to walk to meet his
wife in the waiting room and to the
parking lot without using his cane.
His wife was similarly amazed.
When I called the next day to see
how Al was doing, she said, “He
was calmer for 2 to 3 hours afterward.”
When Al would come in for
subsequent dental treatment my
assistants would apply LLLT to
Figure 2: Irradiation of acupuncture point
Gallbladder #20 at the cervical atlas

Gallbladder #20 as soon as he was
seated. This enabled us to perform
the scheduled treatments (extraction,
endodontics, and partial
denture fabrication) during separate
appointments.
Among LLLT’s reported beneficial
effects are: (1) Stimulating cell
energy production, which aids in
the restoration of normal cell
morphology and function; (2)
Increasing lymphatic flow, which
decreases edema and swelling; (3)
Increasing endorphin release,
reducing conduction of C-Fibers,
and decreasing release of histamine,
bradykinins, and
acetylcholine to reduce the sensation
of postoperative pain; (4)
Stimulating osteoblasts, odontoblasts,
and fibroblasts to promote
the growth of bone, dentin, and soft
tissue; (5) Stimulating nerve regeneration;
(6) Increasing neutrophil
and macrophage activity. The
regime that I use takes advantage
of all of these benefits. I predose or
preload the area to be worked on to
stimulate these wanted effects, and
then use photobiomodulation again
postoperatively to enhance these
effects.
The regime I use for extractions
is as follows: For a maxillary tooth
I place the LED instrument (total
maximum power of 42 mW) for a
full 3-minute cycle on the outside of
face by the tooth to be extracted.
For a mandibular tooth I place it
for half a cycle outside the face and
half a cycle submandibular of the
tooth to be extracted. I repeat this
application postoperatively,
followed by a full cycle using my
660-nm probe on top of the extraction
socket.
The protocol I follow for
endodontic treatment is as follows:
For a tooth without a crown, I
apply the LED device for a full
cycle of 3 minutes outside the face,
and then the 660-nm probe for 1
minute on the buccal and lingual
apex and on the occlusal aspect
prior to beginning the endodontic
treatment. I then apply the 660-nm
Figure 3: Postoperative radiograph after
root canal treatment and extraction
probe to the cleaned and shaped
canal for a full cycle just prior to
placing the fillers. If there is a
large radiolucency I will also use
the 808-nm probe, 300 mW power
output, for 1 minute at the apex of
the tooth after the filler has been
placed. If the tooth has a crown,
after application of the LED cycle I
use the 660-nm probe for 1-1/2
minutes at the buccal and lingual
apices. Since I have been using this
regime, I have had to provide fewer
injections due to the analgesia
induced from the LLLT. I do almost
all my endodontics in one visit and
my patients report having no postoperative
pain.
Figure 3 shows the postoperative
results of extraction and root
canal treatment. I made Al a 3-unit
bridge from #25-27 (Figure 4) to
increase the stability of #25 and
#27, but did not charge him for
#26. Figure 5 depicts the placement
of Al’s 3-unit bridge and partial
lower denture.
Al’s dental prognosis is excellent.
He was thrilled that we were
able to complete the procedures,
and that I was able to keep seeing
him as a patient. Prior to this I had
referred him out for extractions to
be performed under general anesthesia,
and he did not like that
experience.
I don’t have a definitive answer
as to why photobiomodulation
C L I N I C A L E X P E R I E N C E
Figure 4: View of 3-unit bridge (#25-27)
in place
Figure 5: View of 3-unit bridge and
partial lower denture in place
worked so effectively in calming Al’s
tremors. Did it cause the production
of dopamine? Did it stimulate mitochondria
to produce more adenosine
triphosphate (ATP)? Did it improve
neurotransmission through the
hypothalamus? Or was it due to
some other reason?
Besides the three acupuncture
points mentioned above, I have also
found that Small Intestine
Meridian #3, located on the
knuckle of the little finger (in the
depression proximal to the head of
the fifth metacarpal bone), is also
very effective for patients with
Parkinson’s experiencing severe
spasms but whose arms are stable.
I place the 660-nm probe on the
side (left or right hand) that corresponds
to the side of the upcoming
dental treatment. If I get the
desired calming effect, then I do
not irradiate the other hand, but
occasionally I will apply the probe
on the other hand as needed. The
calming effects after a 3-minute
cycle with the 660-nm probe are
extraordinary.
Burchman
J O U R N A L O F L A S E R D E N T I S T R Y | 2 011 V O L . 19 , N O . 3
299

J O U R N A L O F L A S E R D E N T I S T R Y | 2 011 V O L . 19 , N O . 3
300
C L I N I C A L E X P E R I E N C E
Editor’s Note: This article
describes off-label use of the Q1000
device, which has received U.S. FDA
marketing clearance for providing
temporary relief of pain associated
with osteoarthritis of the hand
which has been diagnosed by a
physician or other licensed medical
professional.
A U T H O R B I O G R A P H Y
Dr. Mel Burchman has maintained
a private practice in Bucks County,
Pennsylvania for 35 years. He has
received ALD Standard Proficiency
certification in Nd:YAG, diode, and
Er:YAG laser wavelengths. He has
received Associate Fellowship from
the World Clinical Laser Institute
(WCLI) in Er,Cr:YSGG. In addition,
Dr. Burchman received Advanced
Proficiency in Nd:YAG in 2001 and
Burchman
became an ALD Certified Laser
Educator in 2005. In 2008, he
received a Master in Laser
Dentistry from ALD. Dr. Burchman
may be contacted by e-mail at
MEL712A@aol.com.
Disclosure: Dr. Burchman has no
commercial or financial interest relative
to this presentation.
R E F E R E N C E S
1. “Doctor, what’s this acupuncture all
about?” A brief explanation.
American Academy of Medical
Acupuncture website.
www.medicalacupuncture.org/acu_info
/articles/aboutacupuncture.html. No
date. Accessed February 5, 2012.
2. Dorland’s illustrated medical
dictionary. 31st ed. Philadelphia,
PA: Saunders, 2007:25.
3. Vargas JT. Low-level laser acupuncture.
Med Accupunct
2005;16(2):38-41.
4. Begley S. Hooked on a feeling. This
is your brain on a placebo. In
Newsweek magazine. The Daily
Beast website. May 20, 2009.
www.thedailybeast.com/newsweek/
2009/05/20/hooked-on-a-feeling.html.
Accessed February 5, 2012.
5. Begley S. Train your mind, change
your brain: How a new science
reveals our extraordinary potential
to transform ourselves. New York,
NY: Ballantine Books, 2007.
6. Naeser MA. Some general information
on painless, non-invasive,
low-level laser acupuncture.
Acupuncture.com website.
www.acupuncture.com/education/
theory/laseracu.htm. No date.
Accessed February 5, 2012.
7. Lytle L. Low level laser user’s
manual. 1st ed. Portland, OR:
Wowapi, Inc., 2003. nn

Signs of Change
Raminta Mastis, DDS, FAGD, MALD, St. Clair Shores, Michigan
J Laser Dent 2011;19(3):301-302
Raminta Mastis, DDS, Laser Safety
Committee Chairwoman
The proper display of signs is an
essential element in implementing
a successful laser safety program in
the workplace. Since many lasers,
when active, are invisible, they
pose a potentially hazardous environment.
Even small amounts of
laser light can cause permanent
eye injuries or skin burns. Signs
serve an important function in
identifying hazards, and in giving
directions for appropriate precautions,
warnings, and protection. The
purpose of this article is to provide
guidelines specified in ANSI
Z136.1-2007 American National
Standard for Safe Use of Lasers for
signs in order to properly warn
people of the potential laser-related
health hazards in your workplace.
In a dental laser treatment
setting there are two main types of
signs: equipment labels and area
warning signs. Equipment labeling
is primarily the responsibility of
the manufacturer. Dental lasers
sold in the USA must achieve U.S.
Food and Drug Administration
(FDA) marketing clearance, which
includes the permanent affixing of
various warning and information
labels on the laser equipment itself.
The operator and Laser Safety
Officer (LSO) should be aware of
these and understand their meanings.
These labels identify
protective features and potential
hazards if the laser is tampered
with. Equipment labels also iden-
tify the class of laser and degree of
hazards. The LSO should inspect
these labels to assure that they are
intact, legible, securely affixed, and
document such inspections in a
logbook or an annual checklist. If a
label becomes illegible or comes off,
the manufacturer should be
contacted for a replacement label.
Since area warning signs are
used to indicate a change of environment,
they demand more daily
attention in order to serve the
purpose of safety. Area warning
signs are the responsibility of the
LSO and/or the delegated team
members. The appropriate uses for
these signs of change are addressed
in ANSI 136.1-2007, Section 4.7.
Area warning signs are used to
control areas where lasers are being
used. In general, signs for Class 2
and 2M lasers will have the signal
word “Caution,” and will typically be
yellow. Signs for Class 3R, 3B, and 4
lasers will use the signal word
“Danger,” and will be in red. Most
manufacturers provide a preprinted
warning sign with the pertinent
information (type of laser, emitted
wavelength, pulse duration,
maximum output, laser class, and
special precautionary instructions
and protective actions) for use by the
operator. Additional signs can be
requested from the manufacturer,
photocopied, or downloaded from the
Internet (paper copy, which you may
want to laminate), or purchased
from various companies or Web sites
that offer laser safety signs (usually
plastic), such as Laser Institute of
America (www.lia.org).
The regulations require that
these area warning signs be
conspicuously displayed before the
entry into the controlled area,
which is determined by the specific
laser’s Nominal Hazard Zone
(NHZ). The regulations also require
L A S E R S A F E T Y
that these signs be covered or
removed when the laser is effectively
taken out of operation (which
should be interpreted as laser shutdown
and not just placed in
standby mode). Most dental lasers
are designed to be portable,
meaning that they can be used in
several treatment areas throughout
the day. If the laser is moved to
different locations (i.e., multiple
treatment areas), the signs should
be changed to clearly indicate
where and when a laser is in use in
order to appropriately warn at all
entries into the NHZ.
Accidents happen, often when
they are least expected. A trained
and experienced skydiver is more
likely to sprain his ankle by tripping
on a rug or a stair in his own
home than from jumping from a
perfectly good airplane over a mile
off the ground, while being
suspended by a strip of fabric (parachute).
The same analogy can be
applied in the dental office. Be
prepared for the unexpected. Be
alert to your environment. Be aware
of the stray traffic near the NHZ.
Traffic control within hazard
zones should be managed with
clear and standard operating procedures.
It is the responsibility of the
staff to manage stray traffic (such
as a concerned parent “peeking
in”). The staff should also be
trained to recognize that interruptions
for “just a quick question” are
inappropriate during laser procedures.
It is recommended that
other forms of inter-office communications,
such as text-messaging
systems, be included in the standard
operating procedures.
In addition to the appropriate
display of Caution and Danger
signs, there is a third type of sign
defined by ANSI to identify a
Temporary Laser Controlled Area.
Mastis
J O U R N A L O F L A S E R D E N T I S T R Y | 2 011 V O L . 19 , N O . 3
301

J O U R N A L O F L A S E R D E N T I S T R Y | 2 011 V O L . 19 , N O . 3
302
L A S E R S A F E T Y
This sign is designated with the
signal word “Notice,” and is typically
blue. This sign should be
conspicuously posted whenever
service is being done on a Class 3B
or 4 laser. The appropriate red
Danger Warning sign for the
specific wavelength must also be
displayed. It is more likely that an
equipment-associated hazard will
occur during service or maintenance
procedures, since protective
housings or other features may be
removed or disabled. Thus, particular
attention must be given in the
form of these additional signs.
Signs give you important information
about the regulations, warn
you about dangerous conditions,
and help you find your way. Signs
use different symbols, colors, and
shapes for easy identification. It is
important that all personnel are
adequately trained to identify
hazardous zones and understand
the various warning signs. It is also
important to document such
Mastis
training in a logbook or safety
checklist. When the environment
changes, signs should conspicuously
change. Understanding the
significance, meaning, and importance
of laser signs will help
improve the safety guidelines for
your workplace and help meet
regulation requirements.
A U T H O R B I O G R A P H Y
Dr. Raminta Mastis graduated from
the University of Illinois College of
Dentistry in 1987. She is a Master
of the Academy of Laser Dentistry.
She has Standard Proficiency certifications
in Er:YAG, diode,
Er,Cr:YSGG, and CO 2 laser wavelengths,
and has achieved Advanced
Proficiency in the Er:YAG wavelength.
She currently serves as the
chair of ALD’s Laser Safety
Committee, serves on the
Certification and Communications
Committees, and serves on the ALD
Board. She maintains a private
dental practice, Michigan Cosmetic
and Laser Dentistry, in St. Clair
Shores, Michigan. She has been
using lasers since 2000, and now
has 18 lasers of various wavelengths
in her practice. Her practice
is highlighted by implant surgery
and restoration, laser dentistry,
esthetic and cosmetic dentistry, and
integration of advanced technologies
into practice. Dr. Mastis may
be contacted by e-mail at
MiLaserDentist@comcast.net.
Disclosure: Dr. Mastis has no
commercial or financial interest relative
to this article.
R E F E R E N C E S
1. American National Standard for
Safe Use of Lasers, ANSI 136.1 –
2007, Section 4.7:48-51. Orlando, FL:
Laser Institute of America, 2007.
2. American National Standard for
Safe Use of Lasers in Health Care,
ANSI Z136.3 – 2011, Section 4.7:28-
29. Orlando, FL: Laser Institute of
America, 2011. nn

In their articles on the adjunctive use of lasers in
implantology, Dr. Kutkut et al. (270-275) and Drs. Avi
Reyhanian and Donald Coluzzi (276-281) mention the
bactericidal potential of laser irradiation of implant
surfaces. The notion of utilizing laser energy to reduce
surface bacteria on intraoral implants as a means to
help ensure successful osseointegration and reduce the
incidence of periimplantitis has been studied by a
number of researchers investigating a variety of wavelengths,
including excimer, diode, Nd:YAG, erbium, and
carbon dioxide lasers. Abstracts from a sampling of
published papers representing various wavelengths
appear below.
Most researchers to date have investigated the
antimicrobial effect, primarily due to heat generated by
various lasers, on implant surfaces in in vitro experiments.
Heinrich and colleagues take a different
approach: use a KrF excimer (248 nm) laser to promote
mucosal adhesion as a biological barrier against bacterial
infection. Another group (Dörtbudak et al.) studied
the effects of “soft” diode laser exposure on implants in
patients.
Overall, results are mixed. Certain lasers do appear to
have bactericidal potential on selected microorganisms
on certain types of implants under certain conditions.
Questions regarding the relative efficacy of laser vs.
conventional treatment remain, as do concerns related to
potential alteration of implant surface morphology,
thermal damage to adjacent tissues, and inability to
reestablish the biocompatibility of contaminated surfaces.
Nevertheless, the potential for laser application in
promoting long-term implant success via bacterial reduction
exists. Further study is warranted, especially to
determine effectiveness and safety in a clinical environment,
with special emphasis placed on appropriate
parameter settings and duration of laser exposure.
R E S E A R C H A B S T R A C T S
Editor’s Note: The following material is excerpted and expanded from the Research Abstracts of
the J Laser Dent 2007;15(3):156-160. These nine abstracts are offered as topics of current interest.
Readers are invited to submit to the editor inquiries concerning laser-related scientific topics
for possible inclusion in future issues. We’ll scan the literature and present relevant abstracts.
L A S E R B A C T E R I C I DA L E F F E C T S O N
I N T R A O R A L I M P L A N T S : A N U P DAT E
In order to more closely approximate a clinical situation
in their in vitro investigation, Hauser-Gerspach
and colleagues examined the microbicidal effect of 810nm
diode and CO 2 lasers on selected bacterial species
(Streptococcus sanguinis and Porphyromonas gingivalis)
adhering to dental implant materials and in
suspension (planktonic cells), “because a fraction of
peri-implant bacteria are present as floating cells.”
They point out that a key to success is adequately
controlling the laser energy density and dose, factors
that vary with the manual guidance and experience of
the operator; that is, having sufficient laser energy
present to promote a bactericidal effect without leading
to undesirable alterations of the implant surface can be
difficult to achieve, depending upon the laser wavelength
and how it is used. Even when significant
reductions in bacterial counts are realized through
laser irradiation, they conclude that “the question
remains unanswered whether a short-term drastic
reduction of P. gingivalis in the peri-implant pocket
achieved by low laser energy is sufficient for stable
clinical improvements. … In periodontitis therapy, a
statistically significant reduction of periodontopathogenic
bacteria does not guarantee clinical success
because reinfection from other oral sites may occur or
bacteria may survive intracellularly at the treated
site.”
For U.S. readers, no laser has been cleared by the
U.S. Food and Drug Administration for “decontaminating”
or inducing bactericidal effects on intraoral
implants.
As always, clinicians are advised to review the
specific indications for use of their lasers and to review
their operator manuals for guidance on operating
parameters before attempting similar techniques on
their patients. nn
J O U R N A L O F L A S E R D E N T I S T R Y | 2 011 V O L . 19 , N O . 3
303

J O U R N A L O F L A S E R D E N T I S T R Y | 2 011 V O L . 19 , N O . 3
304
R E S E A R C H A B S T R A C T S
L A S E R - M O D I F I E D T I TA N I U M I M P L A N T S F O R I M P R O V E D C E L L A D H E S I O N
Andreas Heinrich, Katrin Dengler, Timo Koerner,
Cornelia Haczek, Herbert Deppe, and Bernd Stritzker
Concerning dental implant systems, a main problem is
the adhesion of peri-implant mucosa in the cervical
region. The aim of the present study was to use a laser
for modifying titanium implants to promote mucosal
adhesion, which is indispensable as a biological barrier
against bacterial infection. By the use of a KrF excimer
laser, it was possible to induce a holey structure on the
polished area of the implant surface, which was
analysed by a scanning electron microscope. In addi-
Peri-implantitis is considered to be a multifactorial
process involving bacterial contamination of the
implant surface. A previous study demonstrated that a
combination of toluidine blue O (100 microgram/ml)
and irradiation with a diode soft laser with a wavelength
of 905 nm results in an elimination of
Porphyromonas gingivalis (P. gingivalis), Prevotella
intermedia (P. intermedia), and Actinobacillus actinomycetemcomitans
(A. actinomycetemcomitans) on
different implant surfaces (machined, plasma-flamesprayed,
etched, hydroxyapatite-coated). The aim of this
study was to examine the laser effect in vivo. In 15
patients with IMZ implants who showed clinical and
radiographic signs of peri-implantitis, toluidine blue
Universität Augsburg, Augsburg, Germany
Lasers Med Sci 2008;23(1):55-58
tion, the attachment of fibroblast cells to the created
structures was investigated with the aid of an environmental
scanning electron microscope. It turned out that
the cells preferentially attach to the holey structure.
Thereby, the cells form bridges inside, leading to a
complete covering of the hole. In this way, a more effective
biological barrier against bacteria can be created.
Copyright 2008 Springer nn
L E T H A L P H OTO S E N S I T I Z AT I O N F O R D E C O N TA M I N AT I O N O F I M P L A N T
S U R FA C E S I N T H E T R E AT M E N T O F P E R I - I M P L A N T I T I S
Orhun Dörtbudak, Robert Haas, Thomas Bernhart, Georg Mailath-Pokorny
University of Vienna, Vienna, Austria
Clin Oral Implants Res 2001;12(2):104-108
O was applied to the implant surface for 1 min and the
surface was then irradiated with a diode soft laser with
a wavelength of 690 nm for 60 s. Bacterial samples
were taken before and after application of the dye and
after lasing. The cultures were evaluated semiquantitatively
for A. actinomycetemcomitans, P. gingivalis, and
P. intermedia. It was found that the combined treatment
reduced the bacterial counts by 2 log steps on
average. The application of TBO and laser resulted in a
significant reduction (P < 0.0001) of the initial values
in all 3 groups of bacteria. Complete elimination of
bacteria was not achieved.
Copyright 2001 Blackwell Publishing and the European
Association for Osseointegration nn

A N T I M I C R O B I A L E F F I C A C Y O F S E M I C O N D U C TO R
L A S E R I R R A D I AT I O N O N I M P L A N T S U R FA C E S
Matthias Kreisler, Wolfgang Kohnen, Claudio Marinello,
Jürgen Schoof, Ernst Langnau, Bernd Jansen, Bernd d’Hoedt
Purpose: This study was conducted to investigate the
antimicrobial effect of an 809-nm semiconductor laser on
common dental implant surfaces. Materials and Methods:
Sandblasted and acid-etched (SA), plasma-sprayed (TPS),
and hydroxyapatite-coated (HA) titanium disks were
incubated with a suspension of S. sanguinis (ATCC
10556) and subsequently irradiated with a galliumaluminum-arsenide
(GaAlAs) laser using a 600-microm
optical fiber with a power output of 0.5 to 2.5 W, corresponding
to power densities of 176.9 to 884.6 W/cm 2 .
Bacterial reduction was calculated by counting colonyforming
units on blood agar plates. Cell numbers were
compared to untreated control samples and to samples
treated with chlorhexidine digluconate (CHX). Heat
development during irradiation of the implants placed in
bone blocks was visualized by means of shortwave thermography.
Results: In TPS and SA specimens, laser
irradiation led to a significant bacterial reduction at all
power settings. In an energy-dependent manner, the
Johannes Gutenberg University, Mainz, Germany
Int J Maxillofac Implants 2003;18(5):706-711
R E S E A R C H A B S T R A C T S
number of viable bacteria was reduced by 45.0% to 99.4%
in TPS specimens and 57.6% to 99.9% in SA specimens.
On HA-coated disks, a significant bacterial kill was
achieved at 2.0 W (98.2%) and 2.5 W (99.3%) only (t test,
P < .05). For specimens treated with CHX, the bacterial
counts were reduced by 99.99% in TPS and HA-coated
samples and by 99.89% in SA samples. Discussion: The
results of the study indicate that the 809-nm semiconductor
laser is capable of decontaminating implant
surfaces. Surface characteristics determine the necessary
power density to achieve a sufficient bactericidal effect.
The bactericidal effect, however, was lower than that
achieved by a 1-minute treatment with 0.2% CHX. The
rapid heat generation during laser irradiation requires
special consideration of thermal damage to adjacent
tissues. Conclusion: No obvious advantage of semiconductor
laser treatment over conventional methods of
disinfection could be detected in vitro.
Copyright 2003 Quintessence Publishing Co., Inc. nn
E L I M I N AT I O N O F B A C T E R I A O N D I F F E R E N T I M P L A N T S U R FA C E S T H R O U G H
P H OTO S E N S I T I Z AT I O N A N D S O F T L A S E R : A N I N V I T R O S T U DY
Robert Haas, Orhun Dörtbudak, Nikoletta Mensdorff-Pouilly, Georg Mailath
Microbiologic examinations of implants have shown that
certain microorganisms described as periodontal
pathogens may have an influence on the development
and the progression of peri-implant disease. This experimental
study aimed to examine the bactericidal effect of
irradiation with a soft laser on bacteria associated with
peri-implantitis following exposure to a photosensitizing
substance. Platelets made of commercially pure titanium,
either with a machined surface or with a hydroxyapatite
or plasma-flame-sprayed surface or with a corundumblasted
and etched surface, were incubated with a pure
suspension of Actinobacillus actinomycetemcomitans or
Porphyromonas gingivalis or Prevotella intermedia. The
surfaces were then treated with a toluidine blue solution
University of Vienna, Vienna, Austria
Clin Oral Implants Res 1997;8(4):249-254
and irradiated with a diode soft laser with a wavelength
of 905 nm for 1 min. None of the smears obtained from
the thus-treated surfaces showed bacterial growth,
whereas the smears obtained from surfaces that had
been subjected to only one type of treatment showed
unchanged growth of every target organism tested
(P < 0.0006). Electron microscopic inspection of the
thus-treated platelets revealed that combined dye/laser
treatment resulted in the destruction of bacterial cells.
The present in vitro results indicate that lethal photosensitization
may be of use for treatment of peri-implantitis.
Copyright 1997 Blackwell Publishing and the European
Association for Osseointegration nn
J O U R N A L O F L A S E R D E N T I S T R Y | 2 011 V O L . 19 , N O . 3
305

J O U R N A L O F L A S E R D E N T I S T R Y | 2 011 V O L . 19 , N O . 3
306
R E S E A R C H A B S T R A C T S
E F F E C T S O F T H E N D : YA G D E N TA L L A S E R O N P L A S M A - S P R AY E D
A N D H Y D R O X YA PAT I T E - C OAT E D T I TA N I U M D E N TA L I M P L A N T S :
S U R FA C E A LT E R AT I O N A N D AT T E M P T E D S T E R I L I Z AT I O N
The Nd:YAG dental laser has been recommended for a
number of applications, including the decontamination
or sterilization of surfaces of dental implants that are
diseased or failing. The effects of laser irradiation in
vitro (1) on the surface properties of plasma-sprayed
titanium and plasma-sprayed hydroxyapatite-coated
titanium dental implants, and (2) on the potential to
sterilize those surfaces after contamination with spores
of Bacillus subtilis have been examined. Surface effects
were examined by scanning electron microscopy, energy
dispersive spectroscopy, and X-ray diffraction after
laser irradiation at 0.3, 2.0, and 3.0 W using either
contact or noncontact handpieces. Controls received no
I N V I T R O E VA LU AT I O N O F T H E B I O C O M PAT I B I L I T Y O F
C O N TA M I N AT E D I M P L A N T S U R FA C E S T R E AT E D W I T H
A N E R : YA G L A S E R A N D A N A I R P O W D E R S Y S T E M
Matthias Kreisler, Wolfgang Kohnen, Ann-Babett Christoffers,
Hermann Götz, Bernd Jansen, Heinz Duschner, Bernd d’Hoedt
Titanium platelets with a sand-blasted and acid-etched
surface were coated with bovine serum albumin and
incubated with a suspension of Porphyromonas gingivalis
(ATCC 33277). Four groups with a total of 48 specimens
were formed. Laser irradiation of the specimens (n = 12)
was performed on a computer-controlled XY translation
stage at pulse energy 60 mJ and frequency 10 pps.
Twelve specimens were treated with an air powder
system. After the respective treatment, human gingival
fibroblasts were incubated on the specimens. The proliferation
rate was determined by means of fluorescence
activity of a redox indicator (Alamar Blue Assay) which is
reduced by metabolic activity related to cellular growth.
Proliferation was determined up to 72 h. Contaminated
and nontreated as well as sterile specimens served as
positive and negative controls. Proliferation activity was
Carl M. Block, John A. Mayo, Gerald H. Evans
Louisiana State University Medical Center, New Orleans, Louisiana
Int J Oral Maxillofac Implants 1992;7(4):441-449
Johannes Gutenberg-University Mainz, Mainz, Germany
Clin Oral Implants Res 2005;16(1):36-43
laser irradiation. Melting, loss of porosity, and other
surface alterations were observed on both types of
implants, even with the lowest power setting. For the
sterilization study, both types of implants were first
sterilized by exposure to ethylene oxide and then
contaminated with spores of B. subtilis. After laser irradiation,
the implants were transferred to sterile growth
medium and incubated. Laser irradiation did not sterilize
either type of implant. The spore-contaminated
implants in the control group were successfully sterilized
with ethylene oxide.
Copyright 1992 Quintessence Publishing Co., Inc. nn
significantly (Mann-Whitney U-test, P < 0.05) reduced on
contaminated and nontreated platelets when compared
to sterile specimens. Both on laser as well as air powdertreated
specimens, cell growth was not significantly
different from that on sterile specimens. Air powder
treatment led to microscopically visible alterations of the
implant surface whereas laser-treated surfaces remained
unchanged. Both air powder and Er:YAG laser irradiation
have a good potential to remove cytotoxic bacterial
components from implant surfaces. At the irradiation
parameters investigated, the Er:YAG laser ensures a reliable
decontamination of implants in vitro without
altering surface morphology.
Copyright 2005 Blackwell Publishing and the European
Association for Osseointegration nn

Background and Objective: The aim of this study was to
assess CO 2 laser ability to eliminate bacteria from titanium
implant surfaces. The changes of the surface
structure, the rise in temperature, and the damage of
connective tissue cells after laser irradiation were also
considered. Study Design/Materials and Methods:
Streptococcus sanguis and Porphyromonas gingivalis on
titanium discs were irradiated by an expanded beam of
CO 2 laser. Surface alteration was observed by a light,
and a scanning electron, microscope. Temperature was
measured with a thermograph. Damage of fibroblastic
(L-929) and osteoblastic (MC3T3-E1) cells outside the
R E S E A R C H A B S T R A C T S
I N F LU E N C E O F A N E R B I U M , C H R O M I U M - D O P E D Y T T R I U M ,
S C A N D I U M , G A L L I U M , A N D G A R N E T ( E R , C R : Y S G G ) L A S E R
O N T H E R E E S TA B L I S H M E N T O F T H E B I O C O M PAT I B I L I T Y
O F C O N TA M I N AT E D T I TA N I U M I M P L A N T S U R FA C E S
Frank Schwarz, Enaas Nuesry, Katrin Bieling, Monika Herten, Jürgen Becker
Background: The aim of the present study was to evaluate
the influence of an erbium, chromium-doped
yttrium, scandium, gallium, and garnet (Er,Cr:YSGG
laser [ERCL]) on (1) the surface structure and biocompatibility
of titanium implants and (2) the removal of
plaque biofilms and reestablishment of the biocompatibility
of contaminated titanium surfaces. Methods:
Intraoral splints were used to collect an in vivo
supragingival biofilm on sand-blasted and acid-etched
titanium disks for 24 hours. ERCL was used at an
energy output of 0.5, 1.0, 1.5, 2.0, and 2.5 W for the
irradiation of (1) noncontaminated (20 and 25 Hz) and
(2) plaque-contaminated (25 Hz) titanium disks.
Unworn and untreated nonirradiated, sterile titanium
disks served as untreated controls (UC). Specimens
were incubated with SaOs-2 osteoblasts for 6 days.
Treatment time, residual plaque biofilm (RPB) areas
(%), mitochondrial cell activity (MA) (counts per
Heinrich Heine University, Düsseldorf, Germany
J Periodontol 2006;77(11):1820-1827
B A C T E R I C I DA L E F F I C A C Y O F C A R B O N D I O X I D E L A S E R
A G A I N S T B A C T E R I A - C O N TA M I N AT E D T I TA N I U M I M P L A N T A N D
S U B S E Q U E N T C E L LU L A R A D H E S I O N TO I R R A D I AT E D A R E A
Taku Kato, Haruka Kusakari, Etsuro Hoshino
Niigata University, Niigata, Japan
Lasers Surg Med 1998;23(5):299-309
second), and cell morphology/surface changes (scanning
electron microscopy [SEM]) were assessed. Results: (1)
ERCL using either 0.5, 1.0, 1.5, 2.0, or 2.5 W at both 20
and 25 Hz resulted in comparable mean MA values as
measured in the UC group. A monolayer of flattened
SaOs-2 cells showing complete cytoplasmatic extensions
and lamellopodia was observed in both ERCL and
UC groups. (2) Mean RPB areas decreased significantly
with increasing energy settings (53.8 +/- 2.2 at 0.5 W to
9.8 +/- 6.2 at 2.5 W). However, mean MA values were
significantly higher in the UC group. Conclusion:
Within the limits of the present study, it was concluded
that even though ERCL exhibited a high efficiency to
remove plaque biofilms in an energy-dependent
manner, it failed to reestablish the biocompatibility of
contaminated titanium surfaces.
Copyright 2006 The American Academy of Periodontology nn
irradiation spot and adhesion of the cells to the irradiated
area were also estimated. Results: All the
organisms (10 8 ) of S. sanguis and P. gingivalis were
killed by the irradiation at 286 J/cm 2 and 245 J/cm 2 ,
respectively. Furthermore, laser irradiation did not
cause surface alteration, rise of temperature, serious
damage of connective tissue cells located outside the
irradiation spot, or inhibition of cell adhesion to the
irradiated area. Conclusion: CO 2 laser irradiation with
expanded beam may be useful in removing bacterial
contaminants from implant surface.
Copyright 1998 Wiley-Liss, Inc. nn
J O U R N A L O F L A S E R D E N T I S T R Y | 2 011 V O L . 19 , N O . 3
307

J O U R N A L O F L A S E R D E N T I S T R Y | 2 011 V O L . 19 , N O . 3
308
R E S E A R C H A B S T R A C T S
B A C T E R I C I DA L E F F E C T S O F D I F F E R E N T L A S E R S Y S T E M S
O N B A C T E R I A A D H E R E D TO D E N TA L I M P L A N T S U R FA C E S :
A N I N V I T R O S T U DY C O M PA R I N G Z I R C O N I A W I T H T I TA N I U M
Irmgard Hauser-Gerspach 1 , Stefan Stübinger 2 , Jürg Meyer 1
1 Institute of Preventive Dentistry and Oral Microbiology, School of Dental Medicine, University of Basel, Basel, Switzerland
2 Competence Center for Applied Biotechnology and Molecular Medicine, University of Zürich, Zürich, Switzerland
Objectives: The purpose of this study was to examine in
vitro the antibacterial efficacy of two different laser
systems (CO 2 and diode) applied to Streptococcus
sanguinis or Porphyromonas gingivalis cells in suspensions
or adhered to zirconia or titanium dental implant
materials, with two different surfaces each. Materials
and methods: Bacteria were irradiated at two different
power settings with either a CO 2 (λ = 10,600 nm) or a
diode laser (λ = 810 nm). The lower mode is used clinically
(for CO 2 100 J/cm 2 , diode 50 J/cm 2 ) and the higher
may alter the materials’ surface (for CO 2 1200 J/cm 2 ,
diode 150 J/cm 2 ). After irradiation, the number of viable
bacteria was determined by culture. Results: Planktonic
cells of both species were more resistant to the laser
irradiations than bacteria that adhered to surfaces.
Adhered P. gingivalis were effectively killed at both
Clin Oral Implants Res 2010;21(3):277-283
wavelengths λ = 10,600 and 810 nm even at the lower
settings, independent of the material. S. sanguinis cells
that adhered to either zirconia surface were effectively
killed by the CO 2 laser at the lower setting of 100
J/cm 2 . However, the higher settings of both lasers were
needed to reduce S. sanguinis that adhered to titanium
surfaces. The CO 2 laser at the lower setting and the
diode laser at the higher setting effectively reduced the
viability of S. sanguinis or P. gingivalis that adhered to
zirconia surfaces. Conclusions: Under irradiation conditions
known not to alter zirconia implant surfaces in
vitro, both CO 2 laser (100 J/cm 2 ) and the diode laser
(150 J/cm 2 ) effectively reduced the viability of adhered
S. sanguinis or P. gingivalis.
Copyright 2006 The American Academy of Periodontology nn

®
Dual Wavelength, Er:YAG & Nd:YAG All Tissue Laser
Optimize your laser investment and get the most for your Practice.
Technology4Medicine is proud to bring you the LightWalker. . . an amazing, hard & so� ALL tissue laser delivering
both Nd:YAG and Er:YAG laser wavelengths. The award-winning LightWalker encompasses the two superior proven
wavelengths in dentistry, at less than the price of one. Now you have the most advanced, Fast Cu�ing, Best in Class,
Erbium and ND:YAG, both at your finger tips. Revolutionize your practice with advanced Laser Periodontal Treatments,
Laser Endodontic Treatments (PIPS), as well as expanded so� and hard tissue applications. Doing more for each
patient while delivering a more gratifying experience for you, the dental professional.
CDA Meeting
#2619
#2621
ALD
Sco�sdale
Arizona
#109& #111
Hinman
Dental Meeting
#819& #918
Invest Less, Do More.
email: info@t4med.com
949.276.6650
May 3-5
March 29-31
March 22-24