2.6.23 Zimmer_New Technologies Airflow Laser

Question 1

What are the particle sizes of Airflow powders (Sodium bicarbonate, Glycine, Erythritol)?

Answer 1

Sodium Bicarbinate: 40 µm = SupraG, heavy stain
Glycine: 25 µm = SubG biofilm, light to moderate stain, perio/implant maintenance
Erythritol: 14 µm = For subG biofilm, light to moderate stain, perio/implant maintenance

Question 2

Is Airflow effective in the nonsurgical treatment of periodontitis?

Answer 2

Flemmig ‘12
RCT comparing glycine powder vs scaler in patients for nonsurgical periodontits treatment with PPD 4-9 mm in 34 patients and postop at 3 months.
NSSD between both groups for BOP and PPD at 3 months.
Bacterial counts in the glycine group wer sign lower at 10 days postop, but returned to baseline for both groups at 3 months. P. gingivalis was sign lower in the glycine group at 3 months (73% vs 93%).

Question 3

How effective is Airflow for the nonsurgical tx of peri-implantitis?

Answer 3

Duarte ‘09
In vitro study evaluating surface roughness and bacterial adhesion on smooth and rough titanium surfaces after treatment with plastic curettes, metal curette, Er:YAG laser, or sodium bicarbonate powder.
In terms of roughness on smooth surfaces,** metal curettes produced the roughest surface.** Plastic curettes, Er:YAG laser, and sodium bicarbonate produced similar rougness on the polished surface. On the rough titanium, no sign. differences were nited between all 4 groups. There was no sign difference between bacterial adhesion on the smopth surfaces after treatment comparing all 4for groups. Treatment of rough surfaces with natrium bicarbonate had sign lowest bacterial adhesion.

Matsubara ‘19
20 implants (bone level coated with red ink in bone defect (6x9 mm) in vitro; Comparison of 3 different types of abrasive powders: Sodium bicarbonate vs. glycine vs erythritol (applied for 60 seconds)
Sign. Differences in % of cleaned surfaces:
SB 49.3%, glycine 33.1%, erythritol 25.1%
Sign. Increase in implant roughness (polished implant collar, and rough threads):
SB

Hentenaar at al., 2021
RCT comparing erythritol vs piezoelectric scaling in 80 patients, 139 implants with peri-implantitis with non-surgical approach and 6, 9, and 12 months postop.
No sign. difference in BOP (%), PI (%), PPD (mm), and marginal bone loss (mm).

Aloy-Prosper ‘20
RCT comparing Curettes + ultrasound vs. cruettes + glycine in 34 patients, 70 implants with peri-implantitis at 3 weeks postop.
Sign difference in decrease of plaque index (PI) and bleeding index (BI) in favor of glycine group.

Question 4

How effective is Airflow for the surgical tx of peri-implantitis?

Answer 4

Lasserre ‘20
RCT comparing implantoplasty vs glycine in surgical treatment of 31 patients, 42 implants with peri-implantitis with 3- and 6-months postop
Implantoplasty vs glycine:
Reduction of BOP (66% vs. 61%), PPD (3.0 mm vs. 3.3 mm), and bone loss (0.3 mm vs. 0.5 mm)at 6 months. But no sign. differences between both groups.

Toma ‘19
RCT comparing surgical treatment with plastic curette vs. glycine vs. titanium brush in 47 patients 70 implants with 3- and 6-months post-op.
Sign. clinical resolution of disease (PPD ≤ 5 mm, no BOP, and no additional bone loss ≥ 0.5 mm): 22% (plastic curettes) vs 27% (glycine) vs 33% (titanium brush)

Dr Wang says: If you have a buccally placed implant, don’t do GTR because “it will not work.” Do implantoplasty. Implantoplasty can correct implant position issues.

Question 5

Is Airflow good for perio maintenance?

Answer 5

Al Ghazal et al., 2017
RCT comparing peri-implant maintenance glycine vs titanium curettes in 25 patients, at every 3 months for 1 year.
NSSD in BOP. Similar PD for both groups. = Airflow works great for maintenance

Question 6

What laser is also called “Waterlase?” What is the wavelength?

Answer 6

Er,Cr:YSGG
2790 nm
High level of water absorption, along with Er:YAG

Question 7

What is the wavelength and clinical application of Er:YAG?

Answer 7

2940 nm
Hard & soft tissues (due to high absorption by water and hydroxyapatite)

Question 8

Is laser effective in the nonsurgical tx of peri-implantitis?

Answer 8

Alqutub ‘22
RCT comparing the non-surgical treatment of peri-implantitis Er,Cr:YSSGG + curette vs photodynamic therapy + curette vs curette only in 95 patients with 109 implants with 3, and 6 months follow-up.
At 6 months, bleeding index was comparable in all 3 groups. But PD sign lower in both laser groups than in curette- only group:
PD (mm range): 3.0 vs 3.0 vs 4.0

Yayli ‘22
RCT comparing Er,Cr:YSGG + titanium curettes vs diode laser + titanium curettes vs titanium curetets only in non-surgical treatment of peri-implantitis in 50 patients with 6 months post-op.
**Er,Cr:YSGG group had highest sign decrease of PPD (1.16 mm) than other groups. **Decrease of TIMP-1 level was highest in Er,Cr:YSGG group as well. Sign. decrease of MMP-9 levles was only observed in Er,Cr:YSGG group.

Mattar ‘20
Systematic review evaluation the effectiveness of adjunct diode laser to scaling in non-surgical treatment of peri-implantitis with 6-months to 1-year follow-up.
No additional benefits could be found.

Question 9

How effective are lasers in the surgical treatment of peri-implantitis?

Answer 9

Wang ‘20
RCT comparing OFD, supracral implantoplasty, bone grafting with acellular detmal matrix membrane with and without Er:YAG laser in surgical treatment for peri-implantitis in 24 patients with 3 months and 6 months post-op.
Sign higher PD reduction in laser group (2.65 mm) than in control group without laser (1.85 mm) after 6 months.

Schwarz et al., 2011
RCT comparing Er:YAG laser vs plastic curette in surgical treatment of peri-implantitis with implantoplasty and bone graft with collagen membrane in 32 patients, with 6 months post-opo-
Comparable radiographic bone fill in both groups. No sign difference in PD reduction of laser group (1.7 mm) and curette group (2.4 mm).

Question 10

What are the wavelengths of Er:YAG, Er,Cr:YSGG, Diode, CO2

Answer 10

Er:YAG: 2940 nm
Er,Cr: YSGG: 2790
Both hard & soft tissues. Highest water absorption

Diode: 655 – 980
Soft tissue only
Can be used by hygienists

CO2: 9600-10600
Nd:YAG: 1064
Soft tissue only

Question 11

Describe the Laser “STAR” phenomenon

Answer 11

Scattering, Transmission, Absorption, reflection,

Question 12

What angle is Airflow the most effective?

Answer 12

Keim (?)
45 - 60 degrees

Question 13

Is there a benefit to Nd:YAG lasers for treatment of periodontitis?

Answer 13

Strauss ‘21
RCT with 20 patients and 36 implants comparing Nd:YAG laser only vs curette only in non-surgical treatment of peri-implantitis with 12-months post-op.
No sign differences of PPD reduction and bone level at 12 months.

Question 14

Is LANAP and LAPIP effective?

Answer 14

Procedure:
The procedure is supposed to treat a deep periodontal pocket with an intrabony defect and regenerate new periodontal attachment. It utilized an Nd:YAG laser to vaporize bacteria, diseased tissue and pathologic proteins (see picture above). Then ultrasonic scaler and hand instruments are used to remove root surface accretions. Then, bone is modified. The laser is then used for coagulation. And occlusal trauma is adjusted (acc. To MILLENIUM Dental Tachnologies, Inc)

Scientific evidence:
The evidence of LAPIP refers to a histological study with 12 hopeless teeth to be extracted in 8 patietns, that were treated accordingly. They showed periodontal regeneration wth new cementum, periodontal fibers, and alveolar bone in 5 teeth, 4 teeth healed via long junctional epithelium (Nevins et al, 2012)

LAPIP (Laser Assisted Peri-implantitis Procedure)
More recently, the same concept was applied to treatment of peri-implant diseases. Essentially, this is a non-surgical tx for peri-implantitis, thorough cleaning of the infected surfaces within the pocket using lasers, and controlling the occlusion. However, limited evidence on is available to scientifically prompt this technique.

Question 15

Who invented LANAP, LAPIP, ENAP?

Answer 15

LANAP: Yukna
LAPIP: Paul Rosen
ENAP: Yukna

Question 16

What are the 5 ways to obtain regeneration?

Answer 16

1. Interdental denudation
2. GTR with barrier membrane
3. bone graft
4. CAF
5. root conditioning (citric acid & tetracycline)

Question 17

What is photodynamic therapy?

Answer 17

The principles of PDT involve the use of a non-toxic light-sensitive dye called a photosensitizer combined with harmless visible light of the appropriate wavelength to match the absorption spectrum of the photosensitizer. This procedure stimulates the dye to form free radicals of singlet oxygen that will act as toxic agents to the bacteria/cell. As a result, photodynamic therapy can be employed easily in sites that are difficult to reach with mechanical instruments due to anatomical and surface topography. Regarding photosensitizing agents, touuidine blue and methylene blue are the most common used days (Monke et al. 2022)

Question 18

Is photodynamic therapy effective in the nonsurgical tx of peri-implantitis?

Answer 18

Bassetti ‘13
RCT comparing PDT + titanium curettees + glycine vs titanium curettes + glycine + local minocycline in 40 patients non-surgical treatment for peri-implantitis with 12-month outcomes.
No sign difference in clinical and microbial parameters between both groups at 12 months.

Alqutub ‘22
RCT comparing the non-surgical treatment of peri-implantitis Er,Cr:YSSGG + curette vs photodynamic therapy + curette vs curette only in 95 patients with 109 implants with 3, and 6 months follow-up.
At 6 months, bleeding index was comparable in all 3 groups. But PD sign lower in both laser groups than in curette- only group:
PD (mm range): 3.0 vs 3.0 vs 4.0

Question 19

Is photodynamic therapy effective for the surgical treatment of peri-implantitis?

Answer 19

Rakaševic et al., 2016
RCT in 52 implants comparing surgical treatment of peri-implatntitis graphite curette + PTD vs graphite curette + 1% CHX gel with 3 months follow-up.
Sign difference in BOP in test group compared to CHX group: 17.9% vs 50%
NO sign difference in PD reduction comparing both groups. Both groups showed comparable decontamination effects regarding cultivable anaerobic bacteria after 3 months

Albaker et al., 2018
RCT in 24 patients comparing ultrasonic scaler vs ultrasonic scaler + PDT in surgical therapy of peri-implantitis with and 6 and 12 months postop.
No sign differences in BOP, PPD and marginal bone loss between both groups at 12 months.

Question 20

Describe implantoplasty

Answer 20

For the decontamination method of Implantoplasty the implant rough surface is smoothened and polished with rotary instruments or titanium brushes. This renders the implant surface less plaque retentive and is supposed to reduce the recurrence of disease. A smooth implant surface exposed to the oral cavity will also facilitate the patient’s oral hygiene measures. Concerns of the procedure are the reduction of strength if the implant body due to narrowing of the implant diameter, the release of titanium particles, and the increase if temperature of the implant body (Monje et al., 2022).

Question 21

How effective is implantoplasty?

Answer 21

Bianchini et al., 2019
23 patientts with 32 implants treated with resective-implantoplasty therapy for peri-implantitis and followed up ≥ 2 years.
Disease resolution (implant level) was 87%, peri-implant marginal bone levels were stable in 87% of treated implants, BOP was absent in 89%.

Romeo et al., 2004a
Romeo et al., 2006b
RCT comparing resective surgery + implantoplasty vs resective surgery only in 17 patients with peri-implantitis and follow up for 6, 12, 24 and 36 months.
Imlantoplasty group vs non-implantoplasty group: Cumulative survival rate 100% vs 87.5%,
sign. difference in PPD (mean) 3.48 vs 5.6 PPD and bleeding index 0.5 vs 2.33a
No marginal bone loss in implantoplasty group, sign marginal bone loss in non-implantoplasty group (1.5 mm) over 3 years.b

Lasserre et al., 2020
RCT comparing implantoplasty vs glycine in surgical treatment of 31 patients, 42 implants with peri-implantitis with 3- and 6-months postop.
Implantoplasty vs glycine:
Reduction of BOP (66% vs. 61%), PPD (3.0 mm vs. 3.3 mm), and bone loss (0.3 mm vs. 0.5 mm)at 6 months. But no sign. differences between both groups.

Ravida et al., 2020
Retrospectove study comparing postsurgical outcomes of resective treatment of peri-implantitis with and without implantoplasty in 41 patients, 68 implants and followed up for 42 months (mean).
Survival rates were not significant, with 90% (implantoplasty) vs 81.6% (non-implantoplasty). Statistical analysis revealed that the survival rate of the implants was primarily influenced by the amount of initial bone loss.

Question 22

By how much does the temperature increase when doing implantoplasty?

Answer 22

Sharon ‘11
1.5 degrees Celcius

Question 23

What is the goal for implantoplasty reduction?

Answer 23

Chan - need to add more details & double check the accuracy of this one
< 4.0 mm (goal is 3.75)
That is the same diameter as the original Branemark implant

Question 24

How do you decide to remove or treat a peri-implantitis implant?

Answer 24

Dr. Wang says:
Remove if:
* Cannot control/remove etiology
* Wrong implant position
* Not willing to remove prosthesis & wait for surgery
* Not ideal regenerative defects (e.g., horizontal defects),
* cannot disinfect surface
* Surgeon skills
* Younger patient - if < 30, Dr. Wang will remove the implant & redo

To regenerate:
** * Identify & remove etiologies
* Willing to remove prosthesis**
* Feasible defects for regeneration
* Proper implant surface detoxification
* Capable surgeon
* understanding patient
* older individuals

Question 25

Describe the Electrolyte method (GalvoSurge) for peri-implantitis treatment

Answer 25

The electrolytic method has been indicated for surgical decontamination in the management of peri-implantitis. The implant is loaded negatively with a voltage and a maximum current of 600 mA. This is achieved by a dental implant cleaning device (see above)(GS 100, GalvoSurge Dental, Widnau, Switzerland) providing the voltage and pumping a sodium formiate solution though a spray head, which is pressed into the implant to achieve an electrical contact. The current splits water into hydrogen anions and cations that penetrate the biofilm. The hydrogen bubbles are supposed to disrupt the biofilm on the implant surface (Monje et al., 2022)

Question 26

Describe the clinical studies on the Electrolyte method (GalvoSurge) for peri-implantitis treatment

Answer 26

Bosshardt et al., 2022
Case report with four implants treated with electrolytic cleaning and GBR for peri-implantitis and analyzed clinically and histologically.
All implants demonstrated radiographic and histologic bone gain, and reduced PD and BOP. The percentace of re-osseointegration for the four implants was 21.0%, 36.9%, 5.7% and 39%.

Schlee et al., 2021a,
Schlee et al., 2021b
RCT comparing electrolytic cleaning vs erytritol airflow + electrolytic method and later GBR with autogenous bone from ramus + deproteinized bovine bone mineral (50:50) and collagen membrane in 24 patients, 24 implants with peri-implantitis with 6-a, and 18-months follow-up.

Significant radiographic bone gain was demonstrated at 6 months: 2.7 mm (electrolyte method only) vs 2.8 mm (electrolyte method + airflow) with no sign difference. Complete regeneration of bone was achieved in 12 implants. fill and improvement of clinical parameters were demonstrated at 6- months. The 18 months post-op showed continuous radiographic bone gain, as well as PD and BOP reduction.