Soft Tissue Laser for Stage 2: Recommendations?

i would not use a diode around an implant. sparks will fly. use an erbium like the biolase or the lares lightwalker. you can safely remove tissue directly over the implant with no issues.

Respectfully disagree with Dr. Lewis. I've never seen any sparks, or other problems, with diode laser around implants. Radiosurgical units are a problem, diode laser ok. One thing to think about is whether or not you want to sacrifice some attached tissue by excising it with laser. Incision w/blade and slightly undermining the tissue will preserve the AG.

Hi Dr. B: it's not that you cannot use a diode laser to uncover implants; it is easier with an ErCr laser but you can do this with a diode tip with some limitations. The didode laser will have difficulty cutting into fibrous tissue that is more than 2mm deep. The highest reasonable wattage is 2.0-2.5w continuous wave; above that you are not ablating tissue, you are necrotizing tissue. Diodes are a hot tip laser. ErCr lasers are a cold cut and have higher watts, cut as deep as you want and have tips up to 1200u wide if needed. Your diode will have a 400u fiber available. To uncover most implants with a diode, I would make a horizontal incision to depth M-D over the implant and then spread the tissue to uncover and then place a flared healing abutment to form a nice cuff and emergence profile for an abutment and crown. This technique will also spare attached gingiva which is usually very narrow in width on many sites. The diodes have really come down in price in the last several years. Most are good, get a retractable fiber or one that has changeable tips such as EZ Lase. Picasso is good. Just know the lasers are priced by total watt output. The higher the total watts, the longer they will last. You will seldom if ever take a diode above 2 watts. Sincerely Leonard

You guys Are aware that lasers imprecisely vaporize soft tissue . So in my hands, saving as much attached gingiva around implants is paramount. Just because we have a laser doesn't mean you have to use it. I also discourage tissue punches. Cold steel and sunshine is still the best way to uncover an implant in my opinion. There are plenty of applications for lasers. I use mine at least 4 times a week. Bv

Lets do it the easy way. Take your diode laser (ezlase 940) make a small piolet hole to check your positioning. You should be able to find the cover screw hex hole. Good. Now take your latch drive tissue punch, the same diameter as the healing cap you are about to use,than at 800-2000 rpm…zip..zip you are done. Try it,it’s fast, clean and as a bonus the hole is round!

And zip, zip , that much attached tissue is stuck in your suction. I agree with efficiency , but agree more with the restorative guy who suggest sparing non of the keratinized attached tissue. As some one preached before, it’s an imperfect world. All the small details, get us closer. Bv

Bv I am confused. I don’t understand. Why it is good idea in a one stage implant to make a nice clean hole with a tissue punch, place implant and healing cap AND a BAD idea to make a clean circular hole to your implant in a two stage implant? I have never had a patient with tissue attachment to their cover screws,the tissue always came out as a nice clean “plug”, but I must be using wrong implants. Perhaps my patients don’t get enough Vitamin C. Next time a flap and sutures.

It’s a matter of saving every bit of attached mucosa I can. Just a preference maybe, but when evidence prooves that a certain thing improves long term outcome I tend to go overboard in an effort to satisfy that scenario. I will not perform a simple sedation without a full h/p with the exception of a rectal or pelvic exam. Sarcasm aside, it isn’t a perfect world, as I continue to be reminded. Bv

By the way that tissue covering your screw is keratinized. It can’t attach to titanium, but it will re- attach to bone. When I see my third molar cases one week post- op the mucosa is not attached to the alveolar bone, but once the bone has spontaneously regenerated the tissue once again becomes attached . No need for vitamin c, just common sense! Bv

Dear dr, As you know diode lasers are between 810-980 nM wave lenght lasers.It means they are well adsorb pigmented tissue.If you have pigmentation or well blood supply you could have good adsorbtion and well ablation ability for diode.If not you have to incrise your power setting but this time you also increase lateral termal demage risk..(3-5 watts)So Diodes are not suitible for implant uncovery..Er-Yag or Er-Cr-ycgg or Co2 lasers are my more suitable for this purpose…because penetration depth of these lasers are not more than 0.2 mm ..ıt means they are quite safe and fast instrument..and generally no needs local anesthesic..

I agree with B Vinci, tough it may be much cleaner and easier, use the tissue you have and push it to the buccal on the upper and equal buccolingual on the lower. Ok its a bit more involved and messy, but I spend so much time putting soft tissue back that the thought of just losing it is an anathema to me.

Hi I may not have experience in lasers but I guess overall the usage of lasers has it's advantages and disadvantages. And I feel a clinician must have the knowledge in knowing when to use them and when not. When come in dealings with soft tissues there are areas which one might want to consider maintaining it rather than laser it off or cut it off. One may consider having expensive tools in their practices but in implant dentistry, sound knowledge in bone biology and soft tissues is paramount.

To baker vinci: try to use your laser in this way: make a little cut with you diodelaser or er-yag laser a little on the palatal side of the coffersrew. You almost lose as much tissue as whit a knife, but no bleeding. you can see the coffersrew and be able to take it out with a little effort, then put in you healing cap pressing away all the attached gingiva left untouched. This is the way to do it with lasers. You get a quick healing respons and a treatment with no bleeding! Your patient will like it. Is it the first time make instead of a cut a little ovoid shape cut but not wider then 2mm and a the palatal direction to get some experience with it. Not a lot of attachment loss in this way!