(MD,DDS) President of International Academy of Innovative Technology (IAID) and Chair of ALD Italy Study Club.
MODERATORS: Claudia Cotca, Giovanni Olivi
The successful treatment of periodontal problems and peri-implantitis is greatly related with the control of bacteria. The aim of this lecture was to compare the efficacy of different photosensitizers on reduction of bacteria involved in periodontitis and peri-implantitis. The anti-bacterial efficacy with anti-microbial photodynamic therapy (aPDT) with indocyanine green, Toluidine blue, Methylene blue, Phycocyanin and curcumin activated different light sources will be assessed. This new approach of using aPDT with natural and chemical photosensitizer with potential biological activities can be beneficial as an adjunct to conventional therapy.
Photobiomodulation therapy (PBMT) is based on the application of laser or LED to trigger photochemical changes within cellular structures. The principle behind the application of PBMT is the direct application of light energy with biomodulatory capacity on body cells. Wound healing can be achieved by photobiomodulation effect on cell proliferation, migration, and differentiation. Higher collagen synthesis and vascular proliferation an increase in cell division in epithelial cells are also considered. The effect of PBMT on healing of wound after periodontal surgeries can show different effects depending on such factors as wavelength, output power, time of irradiation, energy density, and number of treatment sessions.
Excessive gingival display “gummy smile” seems to be one of the main esthetic feature of the periodontium that plays an important role on oral health-related quality of life and can have an adverse effect on the patient’s perception of attractiveness and self-confidence. Altered passive eruption APE is one of the causal factors of Excessive gingival display. Esthetic crown lengthening surgery could be considered a predictable protocol for APE and achieving more harmonious and symmetrical smiles.
Clinical Implications: Esthetic crown lengthening surgery to manage APE could include gingivectomy and/or apically repositioned full-thickness ﬂap, with/without ostectomy. The width of keratinized gingiva, the position of the gingival margins, the location of the buccal alveolar crest, the location of the mucogingival junction, and the likelihood of concomitant restorative therapy are all factors that collectively determine the esthetic crown lengthening approach. Clinical application of lasers in periodontal surgery has continued to expand in the last decade and the concept of minimally invasive dentistry can be achieved by choosing laser treatment. The ability of erbium lasers to ablate both hard and soft tissues with excellent surgical precision and minimal collateral effects creates the opportunity for a minimally invasive flap and flapless, resulting in decreased tissue damage, minimize the bleeding, causing less inflammation, less post-operative discomfort, and may prevents collateral tissue damage that could occur with conventional methods. In conclusion, Laser-assisted aesthetic crown lengthening is a predictable procedure, less traumatic, faster uneventful wound healing, and overall a positive experience for the patients.
Periodontal inflammation around teeth and implants is associated with specific periodontal pathogens. The increasing number of infections, the negative impact on systemic diseases and evidence of complications during implant treatment, highlight the need for dentists to search for cause-and-effect relationships to identify efficacious treatment(s).
One of the main causes of periodontal complications is the interaction between specific bacterial biofilms and the associated host inflammatory response. To ensure long-term success and a highly predictable outcome of the treatments, dentists should be heedful of the first signs of inflammation and perform effective treatments. To achieve an effective treatment, periopathogens need to be eliminated. Usually, conventional treatments are complemented with additional antibacterial therapy with the use of antiseptics. However, research has so far proven the efficacy of laser therapy, as an adjunct to the conventional treatment. Laser technology, despite of the controversy, is becoming increasingly popular in every day dental practice because it provides predictable treatment outcomes and it is well accepted by patients. Laser treatment is used for the decontamination of periodontal tissue and the cementum on the root surfaces. It is a non invasive medical treatment as it relies on the strong bactericidal and detoxifying properties of the laser. During the lecture we will consider the novelty of using laser therapy in combination with antiseptics as an alternative treatment protocol.
The author will show the evolution of his patented laser guided method from the first cases, performed wirh Er,Cr:YSGG laser to the last powerful Er:YAG laser equipped with a scanner. Twenty years of laser-implantology, completely ”drill free”, in human, live are presented with videos, images and long-term x-ray controll. The influence of power density on total osteotomy time, The influence the quality and quantity of the spray on the ablation, as well as the laser optical properties are discussed. A comparison between traditional dental implants shape vs oval shape is also presented.