Evidence suggests implants can be placed into sites with periapical and periodontal infections. The sites must be thoroughly debrided prior to placement. Guided bone regeneration is usually performed to fill the bone-implant gap and/or socket deficiencies. Although controversial, systemic antibiotics should be used until further controlled trials prove otherwise.
Case reports document successful use of a high-density polytetrafluorethylene membrane to augment horizontal defects associated with immediately placed implants. This membrane, which is designed to withstand exposure (not require primary closure) to the oral cavity because it is impervious to bacteria, reduces the need for advanced flap management to attain primary closure. Thus, the surgical aspect is less complex and the mucogingival architecture of the area can be maintained. These cases demonstrate successful use of this application and provide evidence for controlled clinical trials to further evaluate this technique.
Introduction
Immediate implants offer several advantages for patients, and evidence suggests they can be performed in sites with apical infection following thorough debridement. This report demonstrates the successful use of a unique erbium chromium‐doped:yttrium scandium gallium, and garnet (Er,Cr:YSGG) laser tip to degranulate a deep apical infection otherwise inaccessible to traditional instruments prior to implant placement.
Case Presentation
One case is presented where a failing mandibular left incisor with a deep peri‐apical infection was replaced with an immediate dental implant. Following removal of the tooth and debridement with conventional instruments, the socket was Er,Cr:YSGG laser‐ablated with a 26‐mm long radial firing tip. The granulation tissue was removed on the laser tip, and an immediate implant was placed which was successfully restored.
Conclusions
This report demonstrates a technique using an Er,Cr:YSGG laser with radial firing tip for debridement of extraction sites. It is a relevant, useful tool in the armamentarium as the laser energy is directed both apically and laterally. This provides a minimally invasive way to debride the site that does not entail osseous removal.
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