Case3
“The Bridge to Nowhere”
James Rynar, DMD
A 53 year old male presented in October of 2014 for evaluation and treatment of a failing implant prosthesis which had been in place since 2007. Medical history was non-contributory and the patient , upon presentation , had bleeding upon probing and suppuration from the sites in question. The prosthesis , not mobile , was removed prior to LAPIP treatment for 360 degree treatment access and upon doing so, the fixture in #19 site exfoliated on it own.
Pre-op probing depths ranged from 5 to 10 mm’s with the area of greatest depth on the #’s 19-20 area. An infra- bony defect was noted on the mesial aspect of the middle fixture.
LAPIP was performed and the energetics totaled 324j @3 Watts for the entire span of the bridge. The prosthesis was replaced back on the remaining fixtures and the occlusion carefully adjusted. Post-operative healing was uneventful and the patient had routine follow-up.
In April of 2015 which was 6 months post-op , the patient presented and the area was probed and depths were all wnl, with 3 mm’s being the deepest depth noted . There was no concomitant bleeding. Follow-up periapical x-rays were taken and the areas as seen below have healed in. The defect created by loss of the fixture has remodeled and the defect on the mesial aspect of the middle fixture has diminished in size.
Although this is unusually rapid and complete healing , particularly of a site this large, there are a few factors that are worth noting. Ideally ( as was in this case ) the crowns / prosthesis should be removed prior to treatment to allow for the laser energy to completely circumnavigate the implant in question. More-so than with natural teeth, the implants require as close to possible for the energy to be directed along the long axis of the surface. This is obviated by the metallic nature of the fixture and that it is essentially a “heat -sink” of its own given both its color and its physical properties. In addition to this , the ability to ligate all of the implants back together during the initial post-LAPIP time frame stabilized the initial fibrin clot allowing for unimpeded healing.
It’s often not possible to treat patients in the ideal manner given the type of restoration and or esthetic zone concerns, but having an “ ideal “template from which to extrapolate often serves as a reminder that if we follow sound principles, we can expect to achieve consistent positive clinical outcomes.