Oral Surgery Seville March 2008

Oral surgery and perioral laser applications

Seville, March 2008

Curriculum Vitae • Geb.: 1963 in Erlangen • 1982-87: study • 1988/89: oral surgery Prof. Weiss • 1990 : clinic near Nuremberg • 1991: Nd:YAG Laser d Lase 300 • 1992 : first laser assisted implant • 1993-2002 worldwide workshops on all wavelengths

• 2001/2 lsds development • March 2002 diplomate ICOI • 2002 Prof. Seville • 2003 Prof.a.c. Padova • 2004-06 MSc Lasers in Dentistry • 2006/07 Msc Implantology • 2008 lcdl transmission

Why laser in oral surgery? • • • • •

Less bleeding Better overview More safety for patient and surgeon Less pain Better result

Advances in oral surgery mean:

• Reaching more value for the patient • Goal of our doing is: the goal of the patient People do not value big surgery

They do not want pain, long treatment time (Cooper 2001)

Actual laser systems in our clinic • Nd- YAG- Laser 1064 nm • CO 2- Laser 10600 nm • Argon Laser 480/510nm • Er- YAG Laser 2780 nm • Diode Laser 980nm • Diode Laser 810 nm

Implant exposure

Diode laser 980 nm 2w cw

Ball attached lower jaw denture at a 74 year old heart patient Quick 26 at exposure

Locating and marking the implants Friday 2:15 pm

Implant exposure and ball attachment Friday 2:35 pm

Fixation of the attachment Friday 3:10 pm

Finished denture after polishment Friday 3:45 pm

Dalbo attachments Friday 3:50 pm

Monday 8:00 am

OPG 05/2006 alio loco

Implant exposure 75 year old female patient CO 2 Laser 3w cw

OPG 10/2003

Situation, Implant Locator, UDS forte 0.1ml/ Implantat

CO2 Laser mirror beam, 3 w cw, non kontakt 20 sec pro Implantat

Magnetic attachments

4 days after exposure

Situation 3 years later

OPG 05/2006

Esthetic case

Female patient 27 years old Insertion 2 Implantats 11/21 (jeweils Hi-Tec 16mm SR 4,2mm) after traumatic loss of the teeth

Röntgenausgangsbefund Fremd OPG vom 14.11.2005

Planning models

Situation

Surgery

After Implant surgery 13.04.2006

Implant exposure, Er-YAG laser 30 hz 100mj pulsewidth 300 µs

Crowns

Try in,18th july 2006

12th October 2006

3rd January 2007

3rd January 2007

Er:YAG 600µs pw 15 hz 300 mj

Er:YAG 1000µs pw 15 hz 300 mj

Periimplantitis 24,25 55 year female patient

ER:YAG Laser 300µs pulse width 300 µm contact handpiece

I

Extraction24,25, immediate implant, 30 th January,2005

x-ray 23th July 2005

23 th July 2005 pocket 5mm 26, pocket 4 mm 5, bleeding, tension of the cheek

Cut and flap: ER:YAG 30 hz 100 mj/ Puls

Vaporisation of the infected tissue

Cleaning of the implant surface

Nano Bone after refreshment of the bone ER:YAG 25 hz 250 mj

Nano Bone

Naht Vicryl rapid 4.0

Vestibuloplasty ER:YAG 30 hz 100 mj/Puls

Fixierung Vicryl rapid Naht 4.0

7 days after

Fibrin on the surface

X-ray 29 th of May 2006

29 th of May 2006

Missing attached gingiva 15 year old girl Vestibuloplasty Lower front ER:YAG no spray pw 1000 µs

15 th July 2003

Vestibuloplasty Er- YAG 15 Hz 400 mJ 1000µs, very small bleding, gain of attachment 10 mm, peri pac

16th July 2003 ugly photo, but painless

21st of July Fibrin covers the wound

28th August 2003 7mm vestibulum

31st May 2006 5mm attached gingiva

Mesiodens 8 year old patient Mesiodens palatinal 11/21 ER:YAG 300 µs

OPG 03/2006

Mesiodens

Oral Situation Protruded 21 frenulum Palatinal 11 mesiodens

Soft tissue

ER:YAG Laser 300 µs 30 hz 100 mj/Pulse Saphir Tip 300 µm Spray 15ml/min Luft 3 bar

Bone surgery Bone surgery ER:YAG 300µs Saphir Tip 300 µm 25 hz 300 mJ/Puls Spray 2 min Extraction

Mesiodens/ seam 2-0

1 day after

Fibroma under denture ER:YAG 300 µs 30hz 100 mj/ Pulse Spray 15 ml/min Air pressure 4 bar

Clinical Situation(1)

Clinical Situiation(2)

Contact hand piece 300 µm

After removal

Fibroma

1 week after

Scars Nd:YAG VSP 100 hz 5 Watt

OPG 2002

Set of instruments

Laser applications • Substitition for Scalpel ?! - better overview - higher precision - less pain and scar • Excision of benign tumors • Frenectomy and vestibuloplasty • Leukoplakia • Patients with anticoagulant therapy • Vascular lesions • Biostimulation

Incision with Nd-YAG laser

Excision of fibroma of the tongue

Adenoma of the palate

Papillomatosis of the hard palate

Large fibroms upper jaw

Epulis granulomatosa

Hydantion caused hyperplasia

Epulis granulomatosa

Mucocele

Ranula

Vestibuloplasty upper jaw

Vestibuloplasty Edlan-Mejchar

Fibroma CO ² laser

Excision of fibroma spray cooled

Steps for excision of fibroma with fiber

Recovery of impacted canine Cool pro 980 nm

Spray cooled recovery

Frenulum of the tongue

Frenulum of the tongue

Frenulum of the tongue

Frenectomy CO ² laser

Frenectomy diode laser

Vestuloplasty cool pro 980 nm

3 months after

Leukoplakia 1

Leukoplakia 2

Leukoplakia 2

Vascular lesions 1

Vascular lesions 2

Salivary calculus