Infrabony Defects Research Articles

Cone beam computed tomography (CBCT) in periodontal diseases: a Systematic review based on the efficacy model

BackgroundPeriodontal diseases are prevalent among adult populations. Its diagnosis depends mainly on clinical findings supported by radiographic examinations. In previous decades, cone beam computed tomography has been introduced to the dental field. The aim of this study was to address the diagnostic efficacy of cone-beam computed tomographic (CBCT) imaging in periodontics based on a systematic search and analysis of the literature using the hierarchical efficacy model.MethodsA systematic search of electronic databases such as PubMed, Scopus, Web of Science, and Cochrane was conducted in February 2019 to identify studies addressing the efficacy of CBCT imaging in Periodontics. The identified studies were subjected to pre-identified inclusion criteria followed by an analysis using a hierarchical model of efficacy (model) designed for an appraisal of the literature on diagnostic imaging modality. Four examiners performed the eligibility and quality assessment of relevant studies and consensus was reached in cases where disagreement occurred.ResultsThe search resulted in 64 studies. Of these, 34 publications were allocated to the relevant level of efficacy and quality assessments wherever applicable. The overall diagnostic accuracy of the included studies showed a low or moderate risk of bias and applicability concerns in the use of CBCT. In addition, CBCT is accurate in identifying periodontal defects when compared to other modalities. The studies on the level of patient outcomes agreed that CBCT is a reliable tool for the assessment of outcomes after the treatment of periodontal defects.ConclusionCBCT was found to be beneficial and accurate in cases of infra-bony defects and furcation involvements.

The adjunctive use of host modulators in non-surgical periodontal therapy. A systematic review of randomized, placebo-controlled clinical studies.

Considering the role of the inflammatory host response in the pathogenesis of periodontitis, different host modulators have been proposed to enhance the outcomes of non-surgical periodontal therapy (NSPT), but their efficacy has not been fully clarified. This systematic review investigated the efficacy of host modulators combined with NSPT in reducing probing pocket depth (PPD) in periodontitis patients. Placebo-controlled RCTs with ≥6months follow-up were searched. Meta-analysis was conducted when ≥5 studies using the same host modulator were identified. Fifty eight studies met the inclusion criteria. After 6months, local administration of 1.2% statin gels as adjuncts to NSPT significantly improved PPD reduction (1.83mm) in infrabony defects and systemic administration of sub-antimicrobial dose doxycycline (SDD) in addition to NSPT improved PPD reduction of deep pockets. Administration of probiotics conferred limited clinical benefits. Local bisphosphonate and metformin gels showed potential for clinical use in infrabony defects, which needs to be confirmed. Local delivery of statins in infrabony defects and systemic SDD for deep pockets may confer additional clinical benefits to NSPT. Their long-term effectiveness and safetyneed to be confirmed in independent multi-centred studies. Further studies are needed to confirm the benefit of otherhost modulators.

Evaluation of PRF Efficiency in the Treatment of Infrabony Defects.

The present study aimed to investigate the effectiveness of PRF in the treatment of infrabony defects in patients with chronic periodontitis by evaluating the clinical outcome through periodontal depth, clinical attachment level at the baseline, 6 and 9 months post operatively. Sixty infrabony defects with probing depth ≥ 5 mm were treated. The inclusion criterion was the necessity for surgical bilateral maxillary treatment. By using split-mouth study design, each patient had one side treated with conventional flap surgery and the other side with conventional flap surgery and PRF. Clinical parameters, such as probing depth (PD) and clinical attachment lost (CAL), were recorded in both groups at baseline, 6 and 9 months post operatively. Positive effects for all clinical and radiographic parameters were evident in the group with PRF. Mean PD reduction demonstrated statistically significant greater results in the test group (4.00±1.07 mm) compared to the control one (4.83±0.99 mm), p = 0.003 after 9 months postoperatively. After 9 months, there were better results in the test group compared to the control group for CAL (5.60±1.61 mm, 6.20±1.58 mm), but statistically not significant. Additional use of PRF in the conventional surgical treatment of infrabony defects demonstrated better parameters than the open flap debridement alone.

Evaluation of Bio-Stimulatory Effect of Low Intensity Laser on Platelet Rich Fibrin System and Bone Graft in Treatment of Infra-Bony Defect

Purpose: The current clinical study was done to examine clinical and biochemical changes of Vascular Endothelial Growth factor (VEGF) biomarker present in (GCF) in response to LLLT combined with Platelet Rich Fibrin (PRF) & bovine xenograft to treat infra-bony defects. Material and methods: The current study was conducted on twenty (20) sites from ten (10) patients. A spilt-mouth design used, sites were randomly selected from each patient, into two groups: laser group; ten (10) sites received PRF system without irradiation, and control group; ten (10) sites received PRF system and it will be irradiated with low level laser. Clinical parameters including probing pocket depth (PPD), clinical attachment level (CAL), Plaque index (PI), and gingival index (GI). ELISA quantification analysis of VEGF was done. Results: comparison between the groups at 6 months showed significant difference between both Probing depth and clinical attachment level, while Plaque index and Gingival index showed a significance difference starting from 2 weeks postoperatively. VEGF revealed no significant difference among groups. Conclusion: The using of low intensity laser with PRF system showed an improvement in the outcome of infra bony defects treatment.

Different Regenerative Responses of Two Platelet Concentrates in the Treatment of Human Periodontal Infrabony Defects: A Clinico-Radiographic Study.

Background:Platelet concentrates usage in the treatment of intrabony defects has been improved due to advancement of research. Many generation of platelet concentrates were used, but research regarding advanced platelet-rich fibrin (A-PRF) regarding periodontal treatment is scanty.Aim:The purpose of the study was to evaluate and compare PRF and A-PRF in the treatment of human periodontal infrabony defects (IBDs) both clinically and radiographically.Materials and Methods:Twenty-eight patients having IBDs were divided into Group A (PRF) and Group B (A-PRF). Clinical parameters such as plaque index, gingival index, probing pocket depth (PPD), and clinical attachment level (CAL) were recorded at baseline and 3 and 6 months and radiographic examination at baseline and 6 months were also recorded to evaluate defect fill, resolution, and change in the alveolar crest height. Then, all the data were tabulated in a Microsoft Excel sheet and subjected to statistical analysis. Mean and standard deviations of the clinical and radiographic parameters were calculated, and unpaired t-test was performed to assess intergroup comparison at different time intervals.Results:Intragroup comparison showed statistically significant improvement in PPD and CAL at 3 and 6 months while statistically significant improvement was observed in mean defect fill and resolution in Group B.Conclusion:Individually, both the materials have shown promising results. However, statistically, PRF group (Group A) showed better treatment outcome in terms of bone fill and A-PRF group (Group B) in terms of soft tissue healing.

A case of tissue attachment therapy focusing on angle and width of infrabony defects

A case of tissue attachment therapy focusing on angle and width of infrabony defects

Accuracy of paralleling technique in measuring the depth of approximal infrabony pocket

To assess the accuracy of paralleling technique in measuring the depth of approximal infrabony pocket after periodontal flap surgery by comparing the measured and actual depths. The study population included 26 patients with infrabony defects who had undergone periodontal flap surgery, bone graft surgery, and guided tissue regene-ration. The measured and actual depths of approximal infrabony pocket after periodontal flap surgery were compared. The 26 infrabony defects were categorized into the following groups according to tooth position: anterior teeth, premolar, and molar groups, and according to type of infrabony pocket: one-walled, two-walled, and three-walled infrabony pocket groups. Paired t-test was used to detect the difference between the two values. Depth measurements of the approximal infrabony pocket depth of the anterior teeth and premolar were not significantly different (P>0.05), whereas those of the molar group were significantly different (P<0.05). In addition, depth measurements in one-walled and two-walled infrabony pocket groups showed no significant differences (P>0.05), whereas those in the three-walled infrabony pocket group were significantly different (P<0.05). Paral-leling technique can accurately measure the depth of approximal infrabony pockets of anterior teeth and premolar teeth that are one- or two-walled. However, this method cannot accurately measure the approximal infrabony pockets of molar teeth and three-walled infrabony pockets as indicated by significant differences in their depth measurements.

Baseline probing depth and interproximal sites predict treatment outcomes of non-surgical periodontal therapy

Background/purposeThe efficacy of non-surgical periodontal therapy (NSPT) has been well discussed. The aim of this study was to investigate whether the baseline clinical periodontal parameters, radiographic defect angle, and interproximal site predict the treatment outcome of NSPT. Materials and methodsA total of 39 patients who were diagnosed with generalized chronic periodontitis and met the inclusion criteria were enrolled in this study. All patients received full-mouth periodontal examination by two well-trained periodontists. Clinical periodontal parameters, including probing depth (PD), recession (Rec), and clinical attachment level (CAL), were recorded, and vertical bitewing radiographs were taken as baseline data. Revaluation was performed after 4 weeks of non-surgical periodontal treatment. Pearson's correlation coefficient and multivariate logistic regression were performed to examine the association between favorable treatment outcome (PD reduction ≥ 3 mm) and various clinical parameters. ResultsA significant improvement was observed in PD reduction and CAL gain after NSPT. The radiographic defect angle was strongly correlated with baseline Rec, baseline CAL, and interproximal sites in teeth with a deeper PD. Baseline PD and interproximal sites emerged as significant prediction factors for favorable treatment outcome with a PD reduction of ≥3 mm. ConclusionOur study is the first to report that distal sites show wider radiographic angles with shallow infrabony defects and that pocket reduction is more obvious at distal sites than at mesial sites. These data provide evidence that baseline PD and interproximal sites may predict the treatment outcome of NSPT.

Clinical performance of minimally invasive periodontal surgery in the treatment of infrabony defects: Systematic review and meta-analysis.

To assess the effectiveness, in terms of clinical performance and patient perception, of minimally invasive periodontal surgeries (MIPSs), and to compare MIPSs to traditional surgery in the treatment of periodontal infrabony defects. An electronic search and a manual search were carried out to identify studies investigating clinical (CAL, PPD, REC), radiographic (bone fill) and patient's centred (VAS) outcomes at least 6months after MIPSs. A linear mixed-effect model was used for meta-analysis. Subgroup analyses were performed according to the study quality (RCT or case series). A meta-analysis assessing differences in clinical parameters between MIPSs and traditional flaps was also performed. Meta-analysis from the 18 included studies revealed a PPD reduction of 4.24mm (95% CI=3.79-4.69mm), a CAL gain of 3.89mm (95% CI=3.42-4.35mm), a REC increase of 0.44mm (95% CI=0.11-0.77mm), a radiographic bone fill gain of 58.25% (95% CI=42.30%-74.21%) and a VAS value of 1.16 (95% CI=0.78-1.54). Based on 2 RCTs, MIPSs are more effective than traditional surgery for PPD reduction (0.93mm, 95% CI=1.71-0.15) and CAL gain (1mm, 95% CI=1.75-.24). Minimally invasive periodontal surgeries may be considered for the treatment of periodontal infrabony defects. However, the real effect cannot be systematically evaluated due to the paucity of studies comparing MIPSs to traditional flap for periodontal reconstructive surgery.

Regeneration of Peri-implantitis Infrabony Defects: Report on Three Cases.

This paper presents a surgical treatment protocol known as EP-DDS (etiology identification, primary wound closure, debridement, decontamination, and stability of wound). The treatment protocol can be achieved in five steps. First, identify etiologic factors associated with peri-implantitis to determine whether or not the defects can be treated with this protocol. Second, in order to achieve primary wound coverage, ensure there is undisturbed wound healing, which may involve using procedures such as removing an existing prosthesis and performing tension-releasing flap design. Third, perform proper debridement of the inflamed granulomatous tissues to ensure the wound is free of any inflamed remnants. Fourth, conduct implant-surface decontamination by using a titanium brush or lasers. And finally, place appropriate space fillers (bone grafts and membrane) for wound stability. The three cases that have been successfully treated with the EP-DDS surgical protocol suggest it is a feasible surgical approach to obtain good infrabony defect bone fill (5.5-mm average) around the defects (buccal, mesial, lingual, and distal). Nonetheless, future randomized clinical trials with larger sample sizes and longer follow-ups are needed to further validate this treatment protocol.

Does adding autologous platelet concentrates to surgical treatment improve outcomes for people with periodontal infrabony defects?

Does adding autologous platelet concentrates to surgical treatment improve outcomes for people with periodontal infrabony defects?

One-Year Results Evaluating the Effects of Concentrated Growth Factors on the Healing of Intrabony Defects Treated with or without Bone Substitute in Chronic Periodontitis.

BackgroundThe restoration of damaged periodontium, especially one-wall intrabony defects, is a major challenge for clinicians. Concentrated growth factors (CGF) are a 100% autologous fibrin with multiple concentrated growth factors. The rigid fibrin structure of CGF makes it possible to preserve or reconstruct the initial bone volume. The aim of this study was to evaluate the clinical healing patterns after surgical application of CGF with and without a Bio-Oss graft in one-wall infrabony defects.Material/MethodsWe randomly divided 120 one-wall intrabony defects in 54 patients into 4 groups: flap surgery alone (Group 1), flap surgery with autologous CGF (Group 2), flap surgery with Bio-Oss (Group 3), and flap surgery with CGF+Bio-Oss (Group 4). Clinical parameters such as probing depth (PD) and clinical attachment level (CAL) change were recorded at baseline and at 6 and 12 months postoperatively.ResultsAt 12 months postoperatively, Group 2 showed significant improvement in clinical parameters over Group 1 (P<0.05) and the results were significantly greater in Groups 3 and 4 compared to the other groups (P<0.05). Although no significant difference was noted between Groups 3 and 4 in clinical parameters (P>0.05) compared to Group 3, the mean change of CAL at 6–12 months in Group 4 was not significant (P>0.05).ConclusionsCGF reduced periodontal intrabony defects depth and, when mixed with Bio-Oss, CGF showed better results in the early period and the effect was more stable.

Application of Periodontal Ligament-Derived Multipotent Mesenchymal Stromal Cell Sheets for Periodontal Regeneration.

Periodontitis is a chronic inflammatory disorder that causes destruction of the periodontal attachment apparatus including alveolar bone, the periodontal ligament, and cementum. Dental implants have been routinely installed after extraction of periodontitis-affected teeth; however, recent studies have indicated that many dental implants are affected by peri-implantitis, which progresses rapidly because of the failure of the immune system. Therefore, there is a renewed focus on periodontal regeneration aroundnatural teeth. To regenerate periodontal tissue, many researchers and clinicians have attempted to perform periodontal regenerative therapy using materials such as bioresorbable scaffolds, growth factors, and cells. The concept of guided tissue regeneration, by which endogenous periodontal ligament- and alveolar bone-derived cells are preferentially proliferated by barrier membranes, has proved effective, and various kinds of membranes are now commercially available. Clinical studies have shown the significance of barrier membranes for periodontal regeneration; however, the technique is indicated only for relatively small infrabony defects. Cytokine therapies have also been introduced to promote periodontal regeneration, but the indications are also for small size defects. To overcome this limitation, ex vivo expanded multipotent mesenchymal stromal cells (MSCs) have been studied. In particular, periodontal ligament-derived multipotent mesenchymal stromal cells are thought to be a responsible cell source, based on both translational and clinical studies. In this review, responsible cell sources for periodontal regeneration and their clinical applications are summarized. In addition, recent transplantation strategies and perspectives about the cytotherapeutic use of stem cells for periodontal regeneration are discussed.

Autologous platelet concentrates for treating periodontal infrabony defects.

Data sources Medline, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Oral Health's Trials Register, LILACS BIREME Virtual Health Library, the US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform. Searches were conducted with no limitations on the language or date of publication.Study selection Parallel and split-mouth randomised controlled trials (RCTs) conducted on patients with infrabony defects requiring surgical treatment were considered. Studies needed to compare a specific surgical technique with and without the use of with autologous platelet concentrates (APC).Data extraction and synthesis Two reviewers independently extracted data and assessed risk of bias with data being analysed using standard Cochrane methodology. Changes in probing pocket depth (PD), clinical attachment level (CAL) and radiographic bone defect filling (RBF) were the primary outcomes assessed. Changes in PD and CAL were reported as mean difference (MD) millimeters and 95% confidence intervals with RBF as MD percentage change (5). Data was organised in four groups related to specific surgical techniques, 1. APC + Open Flap Debridement (OFD) versus OFD, 2. APC + OFD + Bone Grafting (BG) versus OFD + BG, 3. APC + Guided Tissue Regeneration (GTR) versus GTR, and 4. APC + Enamel Matrix Derivative (EMD) versus EMD.Results Thirty eight RCTs evaluating 1402 defects were included. Twenty-two trials used a split-mouth design and sixteen a parallel approach. Most studies (36) had a high overall risk of bias with two having an unclear risk. Twelve studies (510 infrabony defects) were included for the comparison between APC + OFD versus OFD alone providing evidence of an advantage in using APC globally from split-mouth and parallel studies for all three primary outcomes.PD (MD) = 1.29 mm (95%CI; 1.00 to 1.58 mm); CAL (MD) = 1.47 mm (95% CI; 1.11 to 1.82 mm); RBF (MD) = 34.26% (95% CI; 30.07% to 38.46%).Seventeen studies (569 infrabony defects) were included for the comparison between APC + OFD + BG versus OFD + BG. When all follow-ups, as well as 3 to 6 months and 9 to 12 months are considered, there is very low-quality evidence of an advantage in using APC from both split-mouth and parallel studies for all three primary outcomes; PD (MD) = 0.54mm (95% CI; 0.33 to 0.75 mm); CAL (MD) = 0.72 mm (95% CI; 0.43 to 1.00 mm); and RBF (MD) 8.10% (95% CI 5.26% to 10.94%)For the comparison APC + GTR versus GTR alone seven studies (248 infrabony defects) were included Considering all follow-ups, there is very low-quality evidence of a probable benefit for APC for both PD (MD) = 0.92 mm (95% CI; -0.02 to 1.86 mm) and CAL (MD) 0.42 mm (95% CI; -0.02 to 0.86 mm). As confidence intervals are wide there is a possibility of a slight benefit for the control. For 3 to 6 months and a 9 to 12 months follow-up no benefits were evidenced, except for CAL at 3 to 6 months MD = 0.54 mm (95% CI; 0.18 to 0.89 mm). No RBF data were available.Only two studies (75 infrabony defects) were included in the comparison of APC + EMD versus EMD. There was insufficient evidence of an overall advantage of using APC for all three primary outcomes: A survival rate of 100% for the treated teeth was reported in all studies for all groups, while no complete pocket closure was reported. It was not possible to perform a quantitative analysis regarding patients' quality of life. Conclusions For two types of treatment, open flap debridement and open flap debridement with bone graft there is very low-quality evidence that the adjunct of APC when treating infrabony defects may improve probing pocket depth, clinical attachment level, and radiographic bone defect filling. There was insufficient evidence of an advantage in using APC for GTR or EMD.

WITHDRAWN: Guided tissue regeneration for periodontal infra-bony defects.

WITHDRAWN: Guided tissue regeneration for periodontal infra-bony defects.

Five-year stability of clinical attachment after regenerative treatment of infrabony defects compared to controls.

To evaluate the stability of attachment achieved in infrabony defects by regenerative treatment over 60±12months compared to control teeth. Patients treated regeneratively in at least one infrabony defect between 2004 and 2010 were screened for this retrospective cohort study. Complete examinations available for baseline, 12 and 60±12months after surgery, and a respective control tooth without treatment, provided eligibility for analysis. Twenty-seven patients (age 58±11.7years; 12 females, five smokers) were included, each contributing one infrabony defect and one control tooth. Regenerative therapy resulted in significant attachment gain (2.7±1.6mm; p<0.001) after 1 and (3.0±2.2mm; p<0.001) 5years. Control teeth were stable (vertical probing attachment level [PAL-V] change: 1year: 0±0.8mm; 5years: -0.2±1.2mm). The study did not detect any significant change of PAL-V from 1 to 5years after surgery for regenerative (-0.3±2.4mm) and control teeth (-0.2±1.4mm). Multivariate analysis associated smoking and generalized recurrence of periodontitis (amount of sites with PPD>5mm) with attachment loss. PAL-V achieved by regenerative therapy in infrabony defects is as stable over 5years as periodontally reduced but gingivally healthy or gingivitis sites. Smoking and periodontitis recurrence are associated with attachment loss.

Infrabony defects 20 years after open flap debridement and guided tissue regeneration.

Evaluation of 20-year results after open flap debridement (OFD) and guided tissue regeneration (GTR) of infrabony defects in a randomized controlled trial. In originally 16 periodontitis patients (baseline examination), periodontal surgery was performed in 44 infrabony defects. Polylactide acetyltributyl citrate barriers were randomly assigned to 23 out of these 44 defects (parallel). Ten of these patients (GTR) exhibited a second, contra-lateral defect (OFD) each (split-mouth). At baseline, 12, 120 and 240±12months after surgery probing depths, attachment level, bleeding on probing as well was Plaque Index, Gingival Bleeding Index and plaque control record were obtained. Twelve patients contributing 38 defects were available at 240months. At 12, 120 and 240±12months, both groups showed significant (p<0.01) attachment gain (split-mouth: OFD: 12months: 4.15±2.93mm; 120months: 3.35±2.37mm, 240months: 3.60±2.55mm; GTR: 12months: 3.50±2.47mm; 120months: 3.90±2.76mm, 240months: 3.80±2.69mm; parallel: OFD: 12months: 3.53±2.04mm; 120months: 3.59±2.54mm, 240months: 3.53±2.50mm; GTR: 12months: 4.07±2.88mm; 120months: 3.13±2.22mm, 240months: 3.13±2.22mm). Seven teeth (3 OFD, 4 GTR) were lost. Only 1 patient out of 12 was kept in regular supportive periodontal therapy (SPT) over 20years. The study failed to show significant attachment gain differences between both groups after 240months. Twenty years after OFD and GTR in infrabony defects in a population with lack of regular SPT attachment gains at 12months after surgery were stable. About 82% of the initially included teeth were still in place.

A Comparative Study of The Effect of Demineralized Bone Matrix with and Without Low Level Laser Therapy on The Treatment of Periodontal Infra-Bony Defects (Randomized Clinical Trial)

Objective: This study aimed at comparing clinically and radiographically the therapeutic effect of low level laser therapy and demineralized bone matrix, used in management of periodontal intrabony defect. Subjects and methods: Thirty two non-smoking patients aged between 28-51 years with severe chronic periodontitis participated in this randomized clinical study. Patients were randomly assigned into one of 2 groups (16 patients each): demineralized bone grafting alone of the intrabony defect, control group (Group I), demineralized bone grafting and the application of low level laser therapy (LLLT) (Group II). Clinical and radiographic parameters including plaque index, bleeding index, probing depth, clinical attachment level (CAL) and intrabony defect depth were reassessed at 6 months after surgery. Results: Specifically, LLLT treated sites (Group II) showed statistically significant differences regarding pocket depth and CAL compared with Group I. Intrabony defect depth was significantly reduced for LLLT group compared to that of Group I control. Conclusion: The use of LLLT as an adjunct with demineralized bone matrix (DBM) in the treatment of intrabony defects was more significant in improving the probing depth, CAL and intrabony defect depth than using DBM alone.

Clinical and Radiographic Assessment of Periodontal Infrabony Defect Depth and Width and Their Correlation

Brief Background There is preliminary evidence of periodontal defect depth, number of walls and the width of infrabony defects exerting influence on the regenerative potential of particular therapeutic modality. Aim: To assess defect width and defect depth and their influence on pretreatment defect angle in patients affected with periodontal disease. Materials and Methods 60 untreated severe chronic or aggressive periodontitis patients were selected for the study. Digital intraoral periapical radiograph of defects in all patients were taken using RVG. First auxiliary line was drawn to represent tooth axis (AUX1). Perpendicular to this, a second auxiliary line (AUX2) was drawn that ran through most coronal margin of defect (M3). The depth of defect was measured as the distance between the base of bony defect and AUX2. The width of defect was the distance from coronal margin of bony defect to the root surface perpendicular to AUX1. Results In a total of 67 defects, the radiographic defect depth, defect width and defect angle for maxillary arch was 3.19 ± 1.19 mm , 2.82 ± 0.63 mm and 37.34 ± 9.47 ° respectively while these values for mandibular sites were 3.69 ± 0.92 mm, 2.87 ± 0.76 mm and 35.62 ± 7.08 ° respectively. Multilevel regression analysis revealed narrow defect angles to be related to deep infrabony defects, whereas the width of the interdental space to wide defects. Summary and Conclusion Defect dimensions are determined by the radius of action of microbial biofilm and the baseline defect angle of an infrabony defect would be a function of defect depth. Key Words: Periodontitis, periodontal therapy, vertical defects, radiography

Photothermal Effects of Defocused Initiated Versus Noninitiated Diode Implant Irradiation.

Background: Diode lasers have been used for implant decontamination. However, the use of initiated or noninitiated tips remains unevaluated to verify potential photothermal risks. Objective: To assess the photothermal effects of defocused-initiated versus noninitiated irradiation. Materials and methods: A dental implant (3.5 × 11 mm) was placed into an artificial bone, an infrabony defect was created to simulate a four-wall peri-implant defect. Irradiation was performed using pulsed diode lasers of 940, 975, and 980 nm. The laser tips were positioned parallel to the implant (maximum 2W pulsed mode). The implant was irradiated for 30 sec using noninitiated, cork-, and blue paper-initiated tips. Temperature differences were observed at the apical and coronal regions of the implant. The data were statistically evaluated and compared using one-way analysis of variance and Tukey tests. Results: The average temperature increase and the amount of time that it took to yield the critical temperature were comparable at the coronal level for the 940 and 975 nm diode lasers (p > 0.05). For the 980 nm laser, blue-initiated tip had the highest temperature increase (22.4°C), followed by cork (18.8°C) and noninitiated tip (17.3°C). The critical threshold at the coronal portion for the 980 nm laser was reached in 11.5, 8.79, and 6.46 sec for the blue paper-, cork-, and noninitiated tips, respectively. The 975 and 980 nm lasers had average temperature increases, comparable among the blue paper-, cork-, and noninitiated tips at the apical level (p > 0.05). Apically, for the 940 nm, the noninitiated tip had the highest temperature increase (5.57°C), followed by the cork- (4.96°C) and blue paper-initiated tip (4.54°C). Conclusions: The initiator does not affect the temperatures produced during implant decontamination although noninitiated diode lasers may overheat (within 30 sec) than initiated tips. There is minimal risk of overheating at the apical portion. It seems that the 940 nm diode is the safest of the evaluated laser systems.