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Laser-Assisted Implant Dentistry A new age of minimally invasive implant surgery


Laser-Assisted Implant Dentistry

Incisions for Traditional Implant Surgery

An improved alternative to the scalpel 1

Replace your scalpel with a DEKARM Smart™ CO2 Laser pulsed by UltraSpeed™ and revolutionize your implant practice. Maintain precision and reduce bleeding during the procedure while also improving patient comfort and enhancing healing postoperatively.

Bloodless surgical field1

Reduced surgical time1

Decontamination while cutting2

Minimal postoperative swelling2,3

Greatly reduced postoperative pain2

Significantly less myofiberblasts and scar tissue formation3

Lasers are easier to use in many areas of the mouth1

“I would rate the DEKA Smart CO2 Laser at the top of my ‘must have’ list for anyone seeking to excel in this profession.” Gary O’Brien, DDS Incision for sinus lift with DEKA surgical handpiece with 120˚ mirrored tip

Virtually bloodless surgical field after DEKA CO2 laser incision

Tissue Punch for Flapless Implant Surgery Achieve the ultimate minimally invasive implant surgery by utilizing the DEKA Smart CO2 laser for tissue punches.

“If I had to start handing in the technology used in my practice, my DEKA Smart CO2 laser would be the last to go.” Blair Losee, DDS

Initial tissue punch

Completing the osteotomy

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Gently sculpt tissue for ideal emergence profile on immediate temporaries •

Preservation of surrounding keratinized tissue

Minimally invasive approach

Little to no postoperative swelling

No need for sutures

Implant in place

Immediate temporization


The new age of minimally invasive soft tissue surgery is here!

Implant Uncovering With the proprietary UltraSpeed pulse, the DEKA Smart CO2 laser preserves surrounding tissue during implant uncovering and enables immediate impressions with proper emergence profile – saving you and your patient valuable chair time.

Minimally invasive approach

Immediate impression at the time of uncovering

Saves steps

Predictable soft tissue levels

Opportunity to sculpt interproximal tissue and develop proper emergence profile

Locate the implant for stage two surgery

Begin implant uncovering with handpiece with 120o mirror

Peri-Implantitis Treatment Rescue failing implants otherwise requiring extraction, bone grafting and replacement by decontaminating the implant surface with the DEKA Smart CO2 laser. It’s a simple way to enhance both patient care and implant practice profitability.

Minimizes patient postoperative discomfort

Place healing collar or take impression at stage two surgery to save chair time.

Decontaminates the implant surface6,7

Does not transmit heat into the implant8

Does not cause damage or surface modifications to the implant6,9,10,11

Results in new bone formation on the implant.12,13,14,15,16,17

Saves patients from extraction, bone grafting & replacement surgeries

Initial radiograph

Decontamination with DEKA Smart CO2 laser

60-day postoperative radiograph

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WHY DEKA? Powered by UltraSpeed DEKA’s proprietary UltraSpeed pulse combines power and gentleness for quick ablation with no charring – just a small band of coagulation that seals blood vessels, nerve endings and lymphatics.4 With a peak power of 150W, the DEKA Smart CO2 has a very quick and precise ablation of soft tissue. The UltraSpeed pulse creates a tail of energy after the short but intense peak pulse, designed with enough thermal relaxation time, to allow the surrounding tissue to dissipate the heat and go back to rest before the next pulse.5

Watt Peak Power Trend of temperature in the tissue

Average Power

t-on

t-off

Time (s)

T = 1/F

Duty Cycle (%) = t-on/T Average Power = Peak Power x Duty Cycle

For example, at 100 hertz (100 pulses per second) and Level 10 (10% duty cycle) the laser is only on (t-on) for 10% of each of the 100 pulses and off (t-off ) for 90% of each of the 100 pulses. The time off provides the thermal relaxation time needed by the irradiated tissue to lose 50% of the delivered energy (heat), without any heat conduction to the surrounding tissues.

Designed for Precision The proprietary design of the DEKA CO2 laser’s hand blown glass tube generates a pure TEM00 beam with a Gaussian distribution that directs the energy to a fine point for precise cutting – allowing for a wide range of treatments. The DEKA Smart CO2 laser ranges from a small spot size of 150 microns, for a deep and narrow incision, to a wide 300 micron spot size with a large depth of field for the gentle dehydration of tissue. This versatile handpiece allows for the broadest range of application. DEKA Smart CO2’s TEM00 beam with a Gaussian distribution


WHY CO2? 104 810-980 Diode

103

H2O

10

1

HbO2

CO2

Nd-YAG

10-1

Melanin

7000

5000

4000

3000

2000

1000

10-2

λ(nm)

10000

µa(cm-1)

102

For any laser to be therapeutic it must be well absorbed by the target tissue. Since oral soft tissue is 90-95% water, CO2 (10,600nm) is the preferred wavelength for soft tissue procedures because of its superior co-efficient characteristics into water and excellent homeostasis properties. CO2 ablates tissue very efficiently and virtually no energy penetrates beyond 0.1mm18 while Nd:YAG (1,064nm), with Melanin as its main chromophor, has a penetration depth of 3-4mm. The Erbium laser (2,940nm) has the highest co-efficient of absorption in water of any of the lasers used in dentistry, however there is so much absorption that there is no residual heat energy for coagulation in soft tissue. CO2 has a 98% absorption rate in soft tissue and the remaining 2% provides the lateral thermal spread that seals blood vessels, seals nerve endings and seals lymphatics. Like Nd:YAGs, diode lasers’ (810-980nm) main chomophor is melanin18. Diode lasers generally are “initiated” to be effective in soft tissue19. This is done by touching the fiber optic tip to a dark material like articulating paper and essentially blocks the laser energy from escaping, causing the tip of the fiber to heat up. The resulting effect on tissue is only conductive heat or photothermal reaction19.

810mm diode laser cut in soft tissue. Scale: 1.5mm

DEKA Smart CO2 laser pulsed by UltraSpeed incision in soft tissue. Scale: 1mm


References

1. Pick RM, Pecaro BC. The use of CO2 laser in soft tissue dental surgery. Lasers Surg Med. 1987; 7(2): 207-13. 2. Pick RM, Pecaro BC, Silberman CJ. The laser gingivectomy. The use of CO2 laser for the removal of phenytoin hyperplasia. J Periodontol 1985 Aug; 56(8): 492-6. 3. Israel M. Use of the CO2 laser in soft tissue and periodontal surgery. Pract Periodontics Aethetic Dent. 1994 Aug; 6(6): 57-64. 4. Goldman MP, Fitzpatrick RE. Cutaneous laser surgery: the art and science of selective photothermolysis. St. Louis: Mosby; 1994. 5. Choi B, Welch AJ. Analysis of thermal relaxation time during laser irradiation of tissue. Lasers Surg Med. 2001; 29(4): 351-9. 6. Kato T, Kusakari H, Hoshino E. Bactericidal efficacy of carbon dioxide laser against bacteria-contaminated titanium implant and subsequent cellular adhesion to irradiated area. Lasers Surg Med. 1998; 23(5): 299-309. 7. Romanos GE, Purucker P, Bernimoulin J, Nentwig G. Bactericidal efficacy of CO2 laser against bacterially contaminated sandblasted titanium implants. J Oral Laser Applic. 2002; 2(3): 171-4. 8. Ganz, CH. Evaluation of the safety of the carbon dioxide laser used in conjunction with root form implants: A pilot study. J Prosthet. Dent. 1994 Jan; 71(1):27-30. 9. Romanos GE, Everts H, Nentwig G. Alterations of the implant surface after CO2 or Nd:YAG-laser irradiation: A SEM examination J Oral Laser Applic. 2001; 1(1): 29-33. 10. Kreisler M, Götz H, Duschner H. Effect of Nd:YAG, Ho:YAG, Er:YAG, CO2 and GaAlAs laser irradiation on surface properties of endosseous dental implants. Int J Oral Maxillofac Implants. 2002 Mar-Apr; 17(2): 202-11. 11. Park CY, Kim SG, Kim MD, Eom TG, Yoon JH, Ahn SG. Surface properties of endosseous dental implants after Nd:YAG and CO2 laser treatment at various energies. J Oral Maxillofac Surg. 2005 Oct; 63(10): 1522-7. 12. Deppe H, Horch HH, Henke J, Donath K. Peri-implant care of ailing implants with the carbon dioxide laser. Int. J. Oral Maxillofac Implants. 2001 Sep-Oct; 16(5): 659-67 13. Persson LG, Mouhyi J, Berglundh T, Sennerby L, Lindhe J. Carbon dioxide laser and hydrogen peroxide treatment conditioning in the treatment of periimplantitis: An experimental study in the dog. Clin Implant Dent Relat Res. 2004; 6(4): 230-8. 14. Stübinger S, Henke J, Donath K, Deppe H. Bone regeneration after peri-implant care with the CO2 laser: A fluorescence microscopy study. Int J Oral Maxillofac Implants. 2005 Mar-Apr; 20(2): 203-10. 15. Romanos G, Crespi R, Barone A, Covani U. Osteoblast attachment on titanium disks after laser irradiation. Int J Oral Maxillofac Implants. 2006 Mar-Apr; 21(2): 232-6. 16. Deppe H, Horch HH, Neff A. Conventional versus CO2 laser-assisted treatment of peri-implant defects with the concomitant use of pure-phase beta tricalcium phosphate: A 5-year clinical report. Int J Oral Maxillofac Implants. 2007 Jan-Feb; 22(1): 79-86. 17. Romanos G.E, Nentwig GH. Regenerative therapy of deep peri-implant infrabony defects after CO2 laser implant surface decontamination. Int J Periodontics Restorative Dent. 2008 Jun; 28(3): 245-55. 18. Dederich DN. Laser/tissue interaction: what happens to laser light when it strikes tissue? J Am Dent Assoc. 1993 Feb; 124(2): 57-61. 19. Van As G. The diode laser – tip selection and initiation of the tip. Dentistry Today. 2011 May; 30(5): 152.

*5-06-13-0064*

5K-06-13-0064 Printed in the U.S.A. Copyright © 2013 Implant Direct Sybron International. All Rights Reserved.

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Laser assisted implant dentistry brochure