Purpose: evaluate the influence of an erbium, chromium: yttrium, scandium, gallium, garnet (Er,Cr:YSGG) laser using multiple tip types, on the removal of retained cement on a titanium implant surface.
Methods: Nine titanium dental implants were coated with a non-eugenol resin composite implant cement. An Er,Cr:YSGG device at a wavelength of 2,780 nm was fitted sequentially with three laser fiber tips: (1) 6 mm long, 600 µm diameter end-firing, quartz; (2) 9 mm long, Radial-Firing Perio Tip, 500 µm diameter, quartz; and (3) 18 mm long Side-Firing Tip, 800 µm x 300 µm, sapphire. Irradiation on the implant surfaces was performed in short pulse mode (140 µsec pulse duration) with output power of 1.5 W, 50% water, 40% air, and either: (1) 15 Hz, 100 mJ/pulse; (2) 30 Hz, 50 mJ/pulse; or (3) 40 Hz, 37.5 mJ/pulse. Three trials each were completed for each of three different fiber tip types for a total of 27 trials (three trials for each of the nine groups).
Results: All samples in Groups 1-6 demonstrated complete removal of cement from the implant surface. SEM inspection revealed a high degree of melting of the resin composite cement on the implant surface in all samples treated with 100 mJ/pulse (Groups 1, 2, 3). At 50 mJ/pulse (30 Hz), the results of the end-firing and side-firing tips improved remarkably, with clean implant surfaces and comparatively little melting. The side-firing fiber at 50 mJ/pulse and 30 Hz provided the best overall combination of cement removal and least amount of residual melted material on the implant surface. Based on the limitations of this study, the most appropriate method of removing residual cement from a TiUnite coated titanium implant surface is by using an Er,Cr:YSGG laser device fitted with a side-firing laser tip. Laser parameters of 50 mJ/pulse and 30 Hz (1.5W average power), with at least 50% water and 40% air in the aerosolized water spray are ideal.
Clinical significance: As the presence of peri-implantitis continues to increase in numbers and severity, it is imperative to have a predictable treatment protocol to address the large number of ailing and failing implant cases. This study offers one solution to the problem of peri-implantitis, especially if caused by retained cement. Optimal laser settings are proposed for surface decontamination and treatment.
Copyright©American Journal of Dentistry.