.bmp)
Lasers and Dental Implants: An Interview with Dr. Robert J. Miller
Introduction
Dr. Robert J. Miller is a graduate of the New York University College of Dentistry and completed a general practice residency at Flushing Hospital and Medical Center. Prior to attending dental school, Dr. Miller earned Bachelor of Arts and Master of Arts degrees in biology. He is a board certified Diplomate of the American Board of Oral Implantology/Implant Dentistry and is in private practice in Delray Beach at The Center for Advanced Aesthetic and Implant Dentistry. Dr. Miller serves as chairman of the Department of Oral Implantology at the Atlantic Coast Dental Research Clinic in Palm Beach, Florida. You can find out more about Dr. Miller at: http://www.robertmillerdds.com/Interview
Osseonews: Dr. Miller, do you believe that lasers have a place in implant dentistry?
Dr. Miller: If we compare the use of lasers to the traditional surgical approach using “cold surgical steel”, lasers clearly are the better choice. Using a laser to perform implant surgery enables us to prepare the implant site with minimal trauma to the hard and soft tissue. In fact, I would more properly characterize this approach to surgery as atraumatic.
Osseonews: Could you explain that a little further?
Dr. Miller: With a laser, I can target the tissue to be removed. I will not disrupt or damage the surrounding tissue. The removal of both soft and hard tissue is precise and minimally invasive. You cannot achieve the same results with a scalpel blade.
Osseonews: Do you use a surgical guide stent to guide your laser?
Dr. Miller: The patient gets a Cone Beam Volumetric Tomograhic scan. I use this to generate a highly accurate surgical stent to precisely guide the laser beam. This procedure is accurate to one tenth of a millimemter (0.10 mm). This is minimally invasive dentistry at its best.
Osseonews: How does the surgerized tissue respond?
Dr. Miller: Another great benefit of laser surgery is that it completely re-engineers the wound healing process. We ablate only the target tissue. We do not unnecessarily damage adjacent tissue. This reduces the complications of wound healing. Laser surgery dramatically reduces or eliminates the inflammatory response. It also promotes the release of enzymatic inhibitors of the inflammatory process. Lasers have bactericidal properties which virtually eliminate the problems of infection. Finally it stimulates the healing of hard and soft tissue. The end result of this type of surgery is stellar wound healing. There is nothing else in this league.
Osseonews: What is the potential for complications?
Dr. Miller: Every surgical modality has the potential for complications. But with this kind of laser surgery, complications are minimal because we target specific tissue and sites with great accuracy.
For example, suppose I am doing an osteoplasty around the cervical area of a tooth. If I inadvertantly point the laser at the tooth, I may affect the root surface. I prevent this by carefully directing the laser energy. As in the use of a high speed handpiece, if you point the laser at non-target tissue, you will direct laser energy where you do not want it to go. With careful planning and judicious use, this just does not happen.
Osseonews: What types of lasers do you use?
Dr. Miller: I currently use three lasers:
810 nm Diode Laser
940 nm Diode Laser
2780nm Er,Cr;YSGG laser [Erbium,Chromium;Yttrium,Scandium,Gallium,Garnet]
The Er,Cr:YSGG laser (Biolase Technologies) cuts hard and soft tissue. It primarily targets tissue that contains water or hydroxyapatite. You can use this for many purposes including soft/hard tissue surgery, preparing teeth for restorations, endodontics, and treatment of periodontal pockets. This accounts for about 80% of the market share for high level lasers.
Diode lasers target pigmented tissue or tissue containing hemoglobin or oxyhemoglobin. It has little effect on hard tissue. The 940 nm Diode laser cuts soft tissue like a scalpel blade and can be used without an anaesthetic. The 810 nm Diode laser is also a soft tissue laser and can be used to biostimulate soft and hard tissue. In published studies, laser treated osteotomies heal more quickly and demonstrate a greater percentage of bone to implant contact.
Osseonews: Dr. Miller, can you give us an idea of some of the more important uses of lasers in dentistry?
Dr. Miller: My pleasure to do so. I hope that I can give your readers some idea of how useful lasers are in many areas of dentistry.
Uncovering implants in Stage II surgery. This procedure is atraumatic and helps to prevent crestal bone remodeling
Recontouring gingival tissue and sculpting emergence profile for prosthetic components
Raising surgical flaps
Osseous recontouring
Creating parabolic tissue architecture. This can be done pre-operatively or post-operatively after implant placement
Bone harvesting for block grafts
Lateral wall sinus graft windows
Ridge splitting for expansion
Distraction osteogenesis
Debriding extraction sites for immediate implant placement. Since laser surgery is bactericidal, infected implant sites can be relieved of pathogenic bacterial load and apical granulomas
Ablating diseased junctional epithelium
Biostimulation for soft and hard tissue healing
Removing calculus and plaque from implant surfaces without damaging the implant fixture or components.
Treatment of peri-implantitis
Osseonews: Can the laser be used to remove failing implants?
Dr. Miller: This is a very important use for lasers. In cases like this we want to remove the implant with minimal damage to the adjacent soft and hard tissues. This is far better than using the traditional approach of trephining the implant body.
It is important to note that the laser approach will be atraumatic. We will not damage the adjacent bone or soft tissue. We will not overheat the surrounding bone which would cause problems postoperatively. The site will not be contaminated with titanium fragments or filings because we are not going to cut the implant or grind it. The laser energy has bactericidal properties which will eliminate pathogenic bacteria from the site. After removing the implant and debriding the site, we can stimulate the healing of the soft and hard tissues. The laser confers ultimate control of the operating field which is critical in cases like this.
Osseonews: What is the best source of training in laser dentistry?
Dr. Miller: I recommend the World Clinical Laser Institute (WCLI) at http://www.learnlasers.com/. This is the largest laser training institute in the United States. I would also recommend the Academy of Laser Dentistry at http://www.laserdentistry.org/. It is important that you learn how to use the laser before you start using it in clinical practice. These both offer excellent training programs.
In Europe I recommend the International Society for Oral Laser Applications http://www.sola-int.org/. I am a member of the SOLA Executive Board.
OsseoNews: Dr. Miller, thanks for your time.
Interview conducted by:
Gary J. Kaplowitz, DDS, MA, M Ed, ABGDEditor-in-Chief, www.osseonews.com
No hay comentarios:
Publicar un comentario