Prof. Takao Watanabe (Japan)
The role of Er:YAG laser in maintenance system using Cumulative Interceptive Supportive Therapy(CIST)
World-wide the average life span is increasing and, equally, implant treatment is being conducted as an alternative apparatus for missing teeth. Implants have been reported to have a high survival rate or success rate. However, peri-implant lesions have also been found to be a common clinical entity 9 to14 years after implant placement. If patients have a history of periodontal disease, they are at higher risk to develop peri-implantitis and to undergo additional treatment. Although at the present time methods on how to place implants, building new bone, and how to show esthetics are main themes, maintenance systems to keep implants in good condition for at least 30 years must be discussed.
Recently, a maintenance system termed Cumulative Interceptive Supportive Therapy (CIST) has been proposed by Dr. Lang. CIST aims to prevent and arrest the peri-implant disease by discussing various evaluation parameters, such as pocket probing depth, bleeding on probing, gingival and plaque scores, radiographic and mobility which should be used to assess the clinical status of the peri-implant environment. CIST continues to state that the detection and treatment of early pathogenic changes during follow-up implant maintenance visits can prevent peri-implant soft tissue inflammation and progressive bone loss. The CIST protocol includes mechanical antiseptic and antibiotic treatment to control ongoing infections followed by regenerative or resective surgical techniques to correct peri-implant bony lesions.
Other studies have reported that non-surgical periodontal treatment with Er:YAG lasers led to significant improvements in all clinical parameters of periodontal disease and may be an alternative treatment for reduction and control of the proliferation of microorganisms in persistent periodontitis.
There are several dental lasers on the market, but the benefits of Er:YAG lasers include its ability to disinfect and sterilize surfaces, not alter titanium surfaces, not rise or only slightly rise in temperature, not induce carbonization, and eliminate waste products created by periodontitis causing microbes. One Er:YAG lasers, LiteTouchTM developed by Syneron (Israel) has many aspects which allows ease of use. The benefits of LiteTouchTM includes; it does not use a fiber to guide the laser beam, it is very sturdy and the maintenance cost is low, the laser chamber is placed within the headpiece, and the laser beam streams to the hand-piece while drilling creating no loss in energy.
In this lecture, the use of the LiteTouchTM laser to maintain implants through a non-surgical periodontal therapy technique according to CIST will be presented as done at our clinic.