Effect of Laser Patterned Microcoagulation on Keratinized Mucosa Width and Gingival Thickness Around Dental Implants
Main Article Content
Abstract
Introduction: Although there is no consensus on the influence of sufficient keratinized mucosa width (KMW) on the success of dental implantation, the majority of practitioners recommend achieving at least 2 mm KMW in the peri-implant zone. Additional trauma and specific complications of tissue augmentation techniques require the development of less invasive methods of increasing KMW. Previous studies report on the possibility of using diode lasers for this purpose. Thus, this study aimed to evaluate the effect of laser patterned microcoagulation (LPM) on values of peri-implant KMW, gingival thickness (GTH), and microcirculation. Materials and methods: The study was conducted on 22 patients with a total of 48 sites of insufficient KMW. A total of four LPM sessions were performed on the DIOMAX® (KLS MartinGroup, Tuttlingen, Germany) 1550 nm diode laser. Microcirculation parameters were evaluated using laser doppler flowmetry (LDF). The values were obtained at the initial examination and two weeks after each LPM session. Results: Measurements demonstrated a gradual increase of KMW (2.21 ± 0.17 mm) and GTH (1.36 ± 0.21 mm) under the effect of LPM sessions (p<0.05). In addition, the manipulations had a positive influence on the local hemodynamics and resulted in improved blood supply. Conclusion: Within the study limitations, the data showed that LPM could be applied to achieve a sufficient KMW value without additional soft tissue augmentation. Also, the effect of gingiva thickening can expand the area of LPM application and be the basis for new clinical studies.
Downloads
Article Details
References
Cardaropoli D, Casentini P. *Soft Tissues and Pink Esthetics in Implant Therapy.* London: Quintessence Publishing Co, Inc.; 2022.
Roccuzzo M, Grasso G, Dalmasso P. Keratinized mucosa around implants in partially edentulous posterior mandible: 10-year results of a prospective comparative study. *Clin Oral Implants Res.* 2016;27(4):491–6. [https://doi.org/10.1111/clr.12563](https://doi.org/10.1111/clr.12563).
Canullo L, Peñarrocha-Oltra D, Covani U, Botticelli D, Serino G, Penarrocha M. Clinical and microbiological findings in patients with peri-implantitis: a cross-sectional study. *Clin Oral Implants Res.* 2016;27(3):376–82. [https://doi.org/10.1111/clr.12557](https://doi.org/10.1111/clr.12557).
Wennström JL, Derks J. Is there a need for keratinized mucosa around implants to maintain health and tissue stability? *Clin Oral Implants Res.* 2012;23(Suppl 6):136–46. [https://doi.org/10.1111/j.1600-0501.2012.02540.x](https://doi.org/10.1111/j.1600-0501.2012.02540.x).
Adibrad M, Shahabuei M, Sahabi M. Significance of the width of keratinized mucosa on the health status of the supporting tissue around implants supporting overdentures. *J Oral Implantol.* 2009;35(5):232–7. [https://doi.org/10.1563/AAID-JOI-D-09-00035.1](https://doi.org/10.1563/AAID-JOI-D-09-00035.1).
Hosseini M, Worsaae N, Gotfredsen K. Tissue changes at implant sites in the anterior maxilla with and without connective tissue grafting: A five-year prospective study. *Clin Oral Implants Res.* 2020;31(1):18–28. [https://doi.org/10.1111/clr.13540](https://doi.org/10.1111/clr.13540).
Lops D, Stellini E, Sbricoli L, Cea N, Romeo E, Bressan E. Influence of abutment material on peri-implant soft tissues in anterior areas with thin gingival biotype: A multicentric prospective study. *Clin Oral Implants Res.* 2017;28(10):1263–8. [https://doi.org/10.1111/clr.12952](https://doi.org/10.1111/clr.12952).
Zucchelli G, Felice P, Mazzotti C, et al. 5-year outcomes after coverage of soft tissue dehiscence around single implants: A prospective cohort study. *Eur J Oral Implantol.* 2018;11(2):215–24.
Tavelli L, Barootchi S, Avila-Ortiz G, Urban IA, Giannobile WV, Wang HL. Peri-implant soft tissue phenotype modification and its impact on peri-implant health: A systematic review and network meta-analysis. *J Periodontol.* 2021;92(1):21–44. [https://doi.org/10.1002/JPER.19-0716](https://doi.org/10.1002/JPER.19-0716).
Linkevicius T, Apse P, Grybauskas S, Puisys A. The influence of soft tissue thickness on crestal bone changes around implants: A 1-year prospective controlled clinical trial. *Int J Oral Maxillofac Implants.* 2009;24(4):712–9.
Zucchelli G. *Mucogingival Esthetic Surgery.* Chicago: Quintessence; 2012.
Agudio G, Nieri M, Rotundo R, Cortellini P, Pini Prato G. Free gingival grafts to increase keratinized tissue: A retrospective long-term evaluation (10 to 25 years) of outcomes. *J Periodontol.* 2008;79(4):587–94. [https://doi.org/10.1902/jop.2008.070414](https://doi.org/10.1902/jop.2008.070414).
Thoma DS, Buranawat B, Hämmerle CH, Held U, Jung RE. Efficacy of soft tissue augmentation around dental implants and in partially edentulous areas: A systematic review. *J Clin Periodontol.* 2014;41(Suppl 15):S77–S91. [https://doi.org/10.1111/jcpe.12220](https://doi.org/10.1111/jcpe.12220).
Bassetti RG, Stähli A, Bassetti MA, Sculean A. Soft tissue augmentation procedures at second-stage surgery: A systematic review. *Clin Oral Investig.* 2016;20(7):1369–87. [https://doi.org/10.1007/s00784-016-1815-2](https://doi.org/10.1007/s00784-016-1815-2).
Romanos GE, Gladkova ND, Feldchtein FI, et al. Oral mucosa response to laser patterned microcoagulation (LPM) treatment: An animal study. *Lasers Med Sci.* 2013;28(1):25–31. [https://doi.org/10.1007/s10103-011-1024-9](https://doi.org/10.1007/s10103-011-1024-9).
Bogdan Allemann I, Kaufman J. Fractional photothermolysis—an update. *Lasers Med Sci.* 2010;25(1):137–44. [https://doi.org/10.1007/s10103-009-0734-8](https://doi.org/10.1007/s10103-009-0734-8).
El Shenawy HM, Nasry SA, Zaky AA, Quriba MA. Treatment of gingival hyperpigmentation by diode laser for esthetical purposes. *Open Access Maced J Med Sci.* 2015;3(3):447–54. [https://doi.org/10.3889/oamjms.2015.071](https://doi.org/10.3889/oamjms.2015.071).
Gladkova ND, Karabut ММ, Kiseleva ЕB, Ostrovskaya YuV, Muraev АА, Balalaeva IV, Feldstein FI. In vivo control of oral mucosa regeneration after fractional laser photothermolysis using cross-polarization optic coherence tomography. *Sovrem Tekhnol Med.* 2012;(2):13.
Hantash BM, Bedi VP, Kapadia B, et al. In vivo histological evaluation of a novel ablative fractional resurfacing device. *Lasers Surg Med.* 2007;39(2):96–107. [https://doi.org/10.1002/lsm.20468](https://doi.org/10.1002/lsm.20468).
Belikov AV, Ermolaeva LA, Korzhevsky DE, Sergeeva ES, Semyashkina YV, Antropova MM, Fedotov DY, Soldatov IK. Research of oral mucosa regeneration after fractional treatment by diode laser with 980 nm wavelength. *Sci Tech J Inf Technol Mech Opt.* 2018;18(5):719–26. [https://doi.org/10.17586/2226-1494-2018-18-5-719-726](https://doi.org/10.17586/2226-1494-2018-18-5-719-726).
Yaremenko AI, Zernitskiy AY, Zernitskaya EA. Clinical study of gingiva regeneration in implantation zone by LPM technology. *Parodontologiya.* 2018;24(3):59–63. [https://doi.org/10.25636/PMP.1.2018.3.10](https://doi.org/10.25636/PMP.1.2018.3.10).
Shantipriya R. *Essentials of Clinical Periodontology & Periodontics.* New Delhi: Jaypee; 2018.
Kelendzheridze YM. The state of microcirculation in the periodontal tissues of the supporting teeth in the orthopedic treatment of a limited defect of the dentition. *Stomatologiia.* 2007;1:18–23.
Shomurodov K, Mirkhusanova R. Application of the soft tissue expanding technique before guided bone regeneration of an atrophic alveolar ridge. *JUMMEC.* 2023;26(1):170–8. [https://doi.org/10.22452/jummec.vol26no1.23](https://doi.org/10.22452/jummec.vol26no1.23).
Manstein D, Herron GS, Sink RK, Tanner H, Anderson RR. Fractional photothermolysis: a new concept for cutaneous remodeling using microscopic patterns of thermal injury. *Lasers Surg Med.* 2004;34(5):426–38. [https://doi.org/10.1002/lsm.20048](https://doi.org/10.1002/lsm.20048).
Laubach HJ, Tannous Z, Anderson RR, Manstein D. Skin responses to fractional photothermolysis. *Lasers Surg Med.* 2006;38(2):142–9. [https://doi.org/10.1002/lsm.20254](https://doi.org/10.1002/lsm.20254).
Grischke J, Karch A, Wenzlaff A, Foitzik MM, Stiesch M, Eberhard J. Keratinized mucosa width is associated with severity of peri-implant mucositis: a cross-sectional study. *Clin Oral Implants Res.* 2019;30(5):457–65. [https://doi.org/10.1111/clr.13432](https://doi.org/10.1111/clr.13432).
Hsiao FC, Bock GN, Eisen DB. Recent advances in fractional laser resurfacing: new paradigm in optimal parameters and post-treatment wound care. *Adv Wound Care (New Rochelle).* 2012;1(5):207–12. [https://doi.org/10.1089/wound.2011.0323](https://doi.org/10.1089/wound.2011.0323).
Belikov AV, Ermolaeva LA, Korzhevsky DE, Sergeeva ES, Semyashkina YV, Antropova MM, Fedotov DY, Sufieva DA. Histological examination of oral mucosa regeneration after fractional diode laser treatment with a wavelength of 980 nm. *Proc SPIE.* 2018;10685:1068526. [https://doi.org/10.1117/12.2309563](https://doi.org/10.1117/12.2309563).
Yaremenko A, Zernitskiy A, Zernitckaia E, Stolyarova A. Laser modification of the soft tissues in dental implantation zone. In: *25th EACMFS Congress.* Paris, France; 2021.