Case Studies 1 & 2
In the cases here I have concentrated on implants but lasers are also very useful in periodontics and endodontics and of course in conservative treatments. For me lasers bring back excitement and a sense of fun into dentistry, meaning you can take on procedures that would be very difficult without a laser.
Case Study 1
Here we see the emergence profile created using a laser and then an impression taken of that profile in the soft tissue using a modified impression post to maintain the soft tissue shape at impression so the crown can be a ‘natural shape as it emerges from the gingivae (Figures 1 to 6).
Figure 1: Following tissue sculpting using laser and temporary immediate crown
Figure 2: Shaped impression post to maintain soft tissue shape at impression
Figure 3: CBCT scan of the same tooth pre xla. Note both the loss of the labial plate in some areas and also just how thin the labial plate is. It is obvious from this view just how fragile this area is and why, once lost, it is so hard to regain. There is nothing to graft to once it has gone. Lasers are one way of giving us an ‘edge’ here in the healing process.
Figures 4 and 5: Figure 4 shows the frontal view before the crown is fitted and the emergence profile created by the laser in order for the crown in Figure 5 to look almost the same as the natural tooth on the other side
Figure 6: Shows the use of a laser to debride the socket post extraction, to remove any granulation tissue and then to de corticate the bone – essentially making little holes in it to allow blood vessels to perfuse the area. This is very important in dense bone to get a blood supply to the implant supporting bone
Case Study 2
Here we see a complex multidisciplinary case, involving months of occlusal correction, removal of hopeless teeth, placement of implants, crowns and veneers (and a Michigan splint). Change of lifestyle to aid prevention was required and a laser was used at every stage. This enabled me to keep soft tissues and resulted in a natural look (Figures 7 to 13). As you can see splinting would not really have helped.
Figures 7 and 8: Complex case. CBCT planned implants plus crowns and veneers
Figures 9, 10 and 11: Case used some long term temps and tissue sculpting to help shape papillae
Figures 12 and 13: This is a ‘laser bandage, essentially de- epithelialisation of the area to stimulate new growth. In laser perio treatment it is supposed to inhibit downgrowth of the ‘wrong’ epithelium, allowing good connective tissue to form. It seems to work well
Case Study 3
Figures 14 and 15: This ongoing case illustrates the need for 3D imaging in implant cases. The first practitioner presented with this case was going to splint it and save it. Hockey ball to face – no mouthguard.
Figure 16: This slide shows the remnants removed, using a laser as a periotome. Socket preserved as far as possible, it was blown out buccally. We placed an immediate implant, a graft and a membrane and used a Maryland bridge as a temp.