2020 Volume 63 Issue 1 Pages 96-104
Purpose: Several clinical reports have demonstrated benefits of minimally invasive surgical approaches for periodontal regenerative therapy. A novel modality using an erbium: YAG (Er: YAG) laser for blood coagulation during non-surgical and surgical periodontal procedures could expand the application of lasers in periodontal therapy. We report a case of using an Er: YAG laser in a modified minimally invasive surgical technique (M-MIST) for an intrabony defect.
Methods: A 57-year-old woman presented with an intrabony defect of 7-mm periodontal pocket depth (PPD) in the mesiopalatal region of the maxillary right first premolar. After the initial periodontal therapy, the PPD was 5-6 mm with bleeding on probing (BOP). To minimize surgical intervention, the buccal gingiva was raised without elevation of the interproximal papilla. Incision and debridement of the root surface and bony defect were performed using an Er: YAG laser, with a water coolant. Furthermore, hemostasis was effectively enhanced by coagulating the surface of blood within the defect using defocus laser irradiation without water spray. The flap was repositioned and sutured.
Results: No adverse events were observed, and the patient did not complain of pain in the healing period, except for the immediate postoperative pain, for which she received a single administration of an analgesic. After 11 postoperative months, PPD had reduced to 2 mm, with BOP (−) and a clinical attachment gain of 3-4 mm. Radiographically, the newly formed bone was observed in the intrabony defect as well. With supportive periodontal therapies performed every 3 months, the periodontal tissue was maintained for 7 years.
Conclusion: Er: YAG laser application in a surgical periodontal procedure with M-MIST was successfully used to treat an intrabony defect with filled bone and the periodontal tissue was maintained for 7 years. This case suggested that the combined use of minimally invasive surgery with Er: YAG laser may have potential for periodontal regeneration.
