Academy of Laser Dentistry

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
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