Assessment of pain when uncovering implants with Er:YAG laser or scalpel for second stage surgery

Abstract

Background. Different methods aimed at decreasing pain during some soft tissue procedures in dentistry are still under research. Modern devices as lasers could be a method to reduce the pain and duration of second stage implant surgery. Objectives. To assess the pain and the impression quality when uncovering implants with a laser and with a scalpel. Material and Methods. The analysis included 60 implants (Dentium SuperLine, Suwon, Korea) in 30 patients (23 women and 7 men) aged 25-69. In the experimental group, 30 implants were uncovered by means of an Er:YAG laser (LiteTouch®, Syneron Dental, Yokneam, Israel) with the following fixed operation parameters: 300 mJ, 18 Hz, water cooling at 40%, energy density per pulse: 38.21 J/cm2, tip size: 1.0 × 17 mm, distance: 2 mm, tip angle set at 70°, no anesthesia. As a control, 30 implants were uncovered using a scalpel and topical application of 20% benzocaine. An 11-point numeric pain rating scale (NRS-11) was used to evaluate the pain level. A 3-point prosthetic impression scale (PIS) designed by the authors was used to assess the quality of the impression of the implant emergence profile. Results. The mean value of pain assessed on the NRS-11 for the Er:YAG laser and scalpel were 2.6 and 6, respectively. The mean value of pain for the laser and scalpel at a supracrestal height of periimplant soft tissue (SHPST) ≤ 3 mm were 1.8 and 4.7 respectively, and for SHPST > 3 mm the values were 3.3 and 7.4, respectively. The implant emergence profile impression showed satisfactory or ideal quality in 26 cases. Conclusions. The use of Er:YAG laser reduces pain and allows minor surgical procedures to be carried out without anesthesia. The impression quality is satisfactory for the preparation of prosthetic reconstructions.