By Dr. Robert Levine - Aug 8, 2021
and Uncovering Un-erupted Teeth
Using Laser Technologies
Laser Technologies have been available to help support Implant Recovery for many years. The issue is which laser to use???. We should understand that some lasers are more highly absorbed by Titanium than others . So understanding the science each laser is essential prior to use. It is very important to keep the laser energy away the Titanium surface( All Lasers). Lasers that are great coagulators are my choice.
The Diode lasers are contact lasers that works in a hot tip mode . Excellent coagulator. When being used in a hot tip activated mode , the Implant is not exposed to highly absorbed laser photon energy of the Diode . Thus high absorption of Diode energy by Titanium is not a factor. Only potential excessive heat if this tip contacts the implant surface!!!
CO2 lasers are excellent coagulators and have very low absorption levels by the Titanium Implant. We do not want to cause any collateral damage to surrounding bone of implant. Minimizing excessive heat around implant surface is critical!!!
Ideally, we want to work with a premade surgical stent that allows us to go in the correct axial plane of the implant. I prefer a punch and then use the laser to remove any accessory tissue tabs and control bleeding. Touching the healing cap with the Diode laser should have no effect on the Implant surface as long as you work quickly. Using light water spray is a good idea. Both CO2 and Diode
For all other uncovering situations, such as cases with minimal attached tissue, I recommend an open flap to find the implants. Searching out implants without a guide, when using a laser can lead to unnecessary soft tissue damage.
Now we can discuss how lasers can help in the uncovering of un-erupted teeth. CO2 Lasers have a strong affinity for Hydroxy-Appatite and should be carefully used when approaching uncovering from the buccal aspect. I have no problem using them in the palatal uncovering area. Very low chance of effecting facial surface of impacted tooth. Working in the Super-Pulsed Mode allows us remove tissues in a very controlled manner.
Diodes are my Laser of choice when uncovering buccally impacted teeth , which are usually Cuspids . Clean bloodless access allows for the immediate placement of ortho brackets usually required in bringing the teeth into position. Diodes when used properly will not effect the enamel surface of unerupted teeth. The only issue would be excessive heat when the energy is not applied properly.
Again light water spray will help minimize this potential issue.