Role of Laser in Oral Implantology

8/11/2019 Role of Laser in Oral Implantology

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Dated:-18-09-2013Lasers and Dental Implants: An Interview with Dr. Robert J. Miller

Introduction

Dr. Robert J. Miller is a graduate of the New Yor !niversit" #ollege of Dentistr" and $ompleted a general

pra$ti$e residen$" at %lushing &ospital and Medi$al #enter. 'rior to attending dental s$hool( Dr. Miller

earned )a$helor of Arts and Master of Arts degrees in biolog". &e is a board $ertified Diplomate of the

Ameri$an )oard of *ral Implantolog"+Implant Dentistr" and is in private pra$ti$e in Delra" )ea$h at ,he

#enter for Advan$ed Aestheti$ and Implant Dentistr". Dr. Miller serves as $hairman of the Department of

*ral Implantolog" at the Atlanti$ #oast Dental Resear$h #lini$ in 'alm )ea$h( %lorida. You $an find out

more about Dr. Miller at: http:++www.robertmillerdds.$om+

Interview

Osseonews:Dr. Miller( do "ou believe that lasers have a pla$e in implant dentistr"-

Dr. Miller:If we $ompare the use of lasers to the traditional surgi$al approa$h using $old surgi$al steel/(

lasers $learl" are the better $hoi$e. !sing a laser to perform implant surger" enables us to prepare the

implant site with minimal trauma to the hard and soft tissue. In fa$t( I would more properl" $hara$teri0e this

approa$h to surger" as atraumati$.

Osseonews: #ould "ou e1plain that a little further.

Dr. Miller:2ith a laser( I $an target the tissue to be removed. I will not disrupt or damage the surrounding

tissue. ,he removal of both soft and hard tissue is pre$ise and minimall" invasive. You $annot a$hieve the

same results with a s$alpel blade.

Osseonews:Do "ou use a surgi$al guide stent to guide "our laser-

Dr. Miller:,he patient gets a #one )eam 3olumetri$ ,omograhi$ s$an. I use this to generate a highl"

a$$urate surgi$al stent to pre$isel" guide the laser beam. ,his pro$edure is a$$urate to one tenth of amillimemter 45.65 mm7. ,his is minimall" invasive dentistr" at its best.

Osseonews: &ow does the surgeri0ed tissue respond-

Dr. Miller: Another great benefit of laser surger" is that it $ompletel" re8engineers the wound healing

pro$ess. 2e ablate onl" the target tissue. 2e do not unne$essaril" damage ad9a$ent tissue. ,his redu$es the

$ompli$ations of wound healing. Laser surger" dramati$all" redu$es or eliminates the inflammator"

response. It also promotes the release of en0"mati$ inhibitors of the inflammator" pro$ess. Lasers have

ba$teri$idal properties whi$h virtuall" eliminate the problems of infe$tion. %inall" it stimulates the healing

of hard and soft tissue. ,he end result of this t"pe of surger" is stellar wound healing. ,here is nothing else

in this league.

Osseonews: 2hat is the potential for $ompli$ations-

Dr. Miller: ver" surgi$al modalit" has the potential for $ompli$ations. )ut with this ind of laser surger"(

$ompli$ations are minimal be$ause we target spe$ifi$ tissue and sites with great a$$ura$".

%or e1ample( suppose I am doing an osteoplast" around the $ervi$al area of a tooth. If I inadvertantl" point

the laser at the tooth( I ma" affe$t the root surfa$e. I prevent this b" $arefull" dire$ting the laser energ". As in

the use of a high speed handpie$e( if "ou point the laser at non8target tissue( "ou will dire$t laser energ"

where "ou do not want it to go. 2ith $areful planning and 9udi$ious use( this 9ust does not happen.


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Osseonews: 2hat t"pes of lasers do "ou use-

Dr. Miller: I $urrentl" use three lasers:

810 nm Diode Laser

940 nm Diode Laser

2780nm Er,Cr;YSGG laser [Erbium,Chromium;Yrium,S!andium,Gallium,Garne"

,he r(#r:Y;


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After removing the implant and debriding the site( we $an stimulate the healing of the soft and hard tissues.

,he laser $onfers ultimate $ontrol of the operating field whi$h is $riti$al in $ases lie this.

Osseonews: 2hat is the best sour$e of training in laser dentistr"-

Dr. Miller: I re$ommend the 2orld #lini$al Laser Institute 42#LI7 at http:++www.learnlasers.$om+. ,his is

the largest laser training institute in the !nited ;tates. I would also re$ommend the A$adem" of Laser

Dentistr" at http:++www.laserdentistr".org+. It is important that "ou learn how to use the laser before "ou start

using it in $lini$al pra$ti$e. ,hese both offer e1$ellent training programs.

In urope I re$ommend the International ;o$iet" for *ral Laser Appli$ations http:++www.sola8int.org+. I am

a member of the ;*LA 1e$utive )oard.

OsseoNews:Dr. Miller( thans for "our time.

Interview conducted by:


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I L*3 the 'eriolase

) 6in%ba! 'm&lans and Lasers *he Denal 'm&lan /lo%

4) Dr. Mehdi Jafarisa(s

3u%us 2, 2007 a 820 am

,itanium as a metal e1hibits refle$tivit" to in$ident light energ". 2ith regard to the wavelengths of$urrent lasers( the refle$tivit" is lowest in the range H=58?55 nm( rising as the wavelength in$reases

towards 65(55 nm 4Re$hmann '( ;adegh &(


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ad9a$ent $orti$al bone than a laser in$ision through bone. ,his has also been shown in the literature

4loo up Bimura( 2ang( and a host of others7.

I would be $on$erned about $reating an osteotom" with a laser. Not from a thermal standpoint. More

from a pre$ision point of view.


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In $losing I applaud Dr. Miller for his innovations in the use of lasers in implantolog". &Is efforts

have made it mu$h easier( more predi$table( and far less un$omfortable to a$hieve e1$ellen$e in our

implant $ases.

8) johnddssa(s

3u%us 9, 2007 a 14 &m

DR ;tewart Rosenberg ;aid

,hat would not be the $ase with hot/ $utting lasers su$h as #*( Nd:YA


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A group of investigators studied the appli$ation of rbium: YA< lasers for se$ond8stage implant

surger". ,went" patients were studied with a total of 5 implants in whi$h osseointegration was

$omplete. ,he sub9e$ts were divided into two groups: a $ontrol group 465 patients with implants7(

sub9e$ted to $onventional se$ond stage surger" and a group of 65 sub9e$ts 4also with implants7

treated with the r: YA< lasers at se$ond stage implant surger". ,he use of r: YA< lasers obviated

the need for lo$al anesthesia and minimi0ed postoperative pain and time needed before starting the

se$ond stage. 2ith regard to surgi$al duration( ualit" of hemostasis( and su$$ess in implant

treatment( N* DI%%RN#; were reported. In the se$ond stage of implant surger"( different t"pes

of laser have been used( taing advantage of their ba$teri$idal effe$t disadvantages arise from

indu$ing damage to the implant surfa$e and adverse thermal effe$ts. ,he" $on$luded that advantages

afforded b" laser treatment in$lude te$hni$al simpli$it"( the possibilit" of obviating lo$al anesthesia(

absen$e of postoperative pain and edema( and $omplete tissue healing( thus fa$ilitating faster

prostheti$ rehabilitation( but the" insisted that the des$ribed te$hniue $an be used in all $ases

E#', situations where estheti$ $onsiderations prevail in anterior areas( or in the event of a la$ of

eratini0ed gingiva surrounding the implant. 4Josep Arnabat8DomPngue0( et al. IN, J *RAL

MAEILL*%A# IM'LAN,; 55F 6=:65@O667.

12) Dr. Mehdi Jafarisa(s

3u%us 1, 2007 a 12< am

,he appli$ation of high8energ" lasers in dentistr" reuires spe$ial $onsideration of potential riss of

inadvertent tissue and material damage. 2ith regard to the treatment of periimplantitis( the riss

relate to possible implant surfa$e alterations and e1$essive heat generation in the peri8implant bone.

,he diode laser is the onl" laser t"pe whi$h( irrespe$tive of the power densit"( does not adversel"

influen$e stru$tural implant surfa$e $hara$teristi$s 4Breisler( Me t al. 45567 ffe$t of the Nd: YA


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towards the fa$ial and then e1panding the ridge. 2ith regard to "our diode laser( the reason "our

patients need anaestheti$ is that "ou are using it in $ontinuous wave mode. 2ith the proper pulsed

mode( "ou will get thermal rela1ation( e1$ellent $utting( hemostasis( and a la$ of $arboni0ation

whi$h allows "ou to travel deeper in the tissue. Also( the sele$tion of diode wavelength 4=65( ?@5(

?=5nm7 will also mae a differen$e with regard to hemoglobin and o1"hemoglobin $ontaining

tissues. 2e use a ?@5nm for $utting and =65nm for photobiomodulation.

14) Robert J. Millersa(s

3u%us 1, 2007 a


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,he original Nd:YA< studies were done in a $ontinuous wave mode. 2hile this is fine for soft tissue

ablation( it has an e1tremel" high thermal $oeffi$ient on the implant surfa$e and $an fuse $over

s$rews to the implant bod" 4Roland Meffert( 2#*I( 55F7. %ortunatel"( the new ND:YA


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3irtuall" all of the peri8implantitis treatment we have performed over the last few "ears using lasers

has been on endosseous s$rews. ,he biologi$ pro$ess that leads to the ailing+failing implant $an

o$$ur regardless of the ar$hite$ture and surfa$e t"pe. &ow often do "ou see several millimeters of

$restal bone remodeling around healed implants- ,his atta$hment of soft tissue to the roughened

bod" predisposes the implant to further breadown well after healing. 2e are starting to see the first

big waves of failure of implants 8H "ears after full loading and fun$tion. ,he idea that peri8

implantitis is a thing of the past is an absurd notion. %or those of us who have been pla$ing implants

for an e1tended period of time( we are starting to see our late failures of our $ases. ,hese $ases( in the

earlier stages( $an be ideal $andidates for repair. Not addressing this slow(stead" progression of bone

loss is to $onsidered as supervised negle$t.


Se&ember 2, 2007 a 12< am

Just returned from the International ;o$iet" for *ral Laser Appli$ations 4;*LA7 in o$ember 11, 2007 a 81 am

I than "ou for the e1planation for the diode =65 nm. I have also an er8"ag laser and I am stimulated

b" "our interview to use this for rigde splitting(et$. ,ill now I 9ust used it to de$ontaminate implantsin $ase o peri8implantitis( removing third molars and rese$tion of the roottips( with ver" good

woundhealing in even infe$tiious sites. ,his is another well$ome treatment modalit". In m" $ountr"

lasers arent mu$h of a $hoi$e in treatments( but I love to use them.


>o$ember 11, 2007 a o$ember 1, 2007 a 1 &m
http://www.implantguide.com/http://www.osseonews.com/lasers-role-in-implant-dentistry-an-exclusive-interview/#comment-16168http://www.osseonews.com/lasers-role-in-implant-dentistry-an-exclusive-interview/#comment-19666http://www.implantguide.com/http://www.osseonews.com/lasers-role-in-implant-dentistry-an-exclusive-interview/#comment-19717http://www.osseonews.com/lasers-role-in-implant-dentistry-an-exclusive-interview/#comment-20019http://www.implantguide.com/http://www.osseonews.com/lasers-role-in-implant-dentistry-an-exclusive-interview/#comment-16168http://www.osseonews.com/lasers-role-in-implant-dentistry-an-exclusive-interview/#comment-19666http://www.implantguide.com/http://www.osseonews.com/lasers-role-in-implant-dentistry-an-exclusive-interview/#comment-19717http://www.osseonews.com/lasers-role-in-implant-dentistry-an-exclusive-interview/#comment-20019


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,o Dr Robert Miller(

what about the use of laser beam to remove the gingival h"perpigmentations -

27) drs. !sa(s

>o$ember 18, 2007 a 421 &m

2ith lasers "ou $an remove the h"perpigmentations. ,he diodelasers parti$ular rea$t ver" good withemelanine( but with the $orre$t settings "ou $an use other lasers as well


>o$ember 20, 2007 a 820 &m

I refer "ou to a the wor b" Dr.


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>o$ember 2


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De!ember , 2007 a 242 &m

I agree with dr. miller the use of diodlasers in endodonti$s is greatC )ut "ou need the right

wavelength. ,he diodlaser with =65 nm will appro1imatel" goes to the same depth as the ND8"ag

and gives "ou ver" good results. ,he ?=5nm diodlaser will not $ome ver" deep into the dentin. ;ee

some resear$h done on this topi$ b" dr


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Role of Laser in Oral Implantology

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