Peri implantitis is becoming a major issue for dental implants and it is important to be aware of this when embarking on implant treatment to replace missing teeth. The term relates to a number of factors around implants but the main issues are:

1. Inflammation of the surrounding mucosa ( gum )

2. Increased pocket depths around the dental implant

3. Bleeding on probing

4. Suppuration ( pus oozing from the tissues)

5. Loss of bone around the implant either in a horizontal , vertical or both directions. 

This differs from peri implant mucositis where there is bleeding on probing, possible swelling and inflammation and increase in pocket depths BUT there is NO loss of bone around the implants. Peri implant mucositis is reversible but peri implantitis is irreversible. Diagnosis is essential and the earlier the treatment, the better the diagnosis. Often, the disease may go un noticed, very much like gum disease, but once symptoms develop it is often too late to prevent bone loss. It is essential that regular dental and hygiene visits are maintained after dental implant treatments so that any problems can be spotted at an early stage. In general, we would advise twice yearly appointments or quarterly hygiene appointments if there has been past gum disease present.
 

Our case of the month is one which involves our amazing Waterlase i Plus laser. This laser has a multitude of benefits and one of those is removing composite restorations and tooth decay without having to use a drill. For some patients, the dental drill is a dreaded object which fills them with dread and fear. For others, there may a medical issue at hand such as tinnitus which may be made worse by the vibrations of the drill. In these cases, the Waterlase i Plus laser could be the answer.
 

Article written by Beata Knysak for dentists, dental hygienists and therapists.

Periodontal disease is a major public health concern due to its high prevalence. According to the data severe periodontitis is the sixth-most prevalent condition in the world [1]. In the United Kingdom, 62% of adults under 40 years of age are affected by moderate periodontal disease [2] and throughout the Covid-19 pandemic we have seen an immense increase in the number of patients with periodontal tissue breakdown and tooth loss.

While there is an increase in life expectancy and a significant decrease in tooth loss, periodontal disease puts a burden on the national healthcare systems across the globe.

Although bacteria arising from plaque is the main aetiological factor of periodontal disease, the host’s immune inflammatory response is accountable for the majority of the destructive changes seen in periodontal tissues. Even in healthy periodontium, host immune cells are continuously present, supporting the balance between microbial plaque and the host [6]. Any interactions between the host and oral microbiota will either support the homeostasis or results in dysbiosis within the community of pathogenic microorganisms [7].

Periodontal health-associated commensals are vital in protecting this equilibrium by for example inhibiting the growth of periopathogenic microorganisms. However, quantitative and qualitative changes within subgingival plaque biofilm may lead to disturbed homeostasis, which subsequently leads to the onset of the periodontal disease with various degrees of periodontal tissue breakdown.

This is not a continuous process but alternates between a period of inactivity and aggravation and it can be affected by local and systemic factors [3&4]:

• Microbial plaque-biofilm burden
• Patient’s age, ethnicity, genetic predisposition and patient’s immune response
• Systemic diseases i.e., Diabetes Mellitus, Osteoporosis
• Tooth morphological factor: i.e., defective restoration, malocclusion, bulbous crowns and dental bridge that unbales the patient to perform an adequate oral hygiene routine
• Patient’s socio-economic factors i.e., education and access to dental care
• Life-style choices i.e., smoking, obesity, poor diet, stress, sleeping pattern,
• Deficiencies in patient’s oral hygiene routine.

If not treated, periodontal disease leads to connective tissue destruction and alveolar bone resorption that eventually results in tooth loss [5]. It negatively affects patient’s chewing function and aesthetics, it is a source of social inequality, and significantly impairs their quality of life.

The main objectives of non-surgical periodontal therapy (NSPT) are to provide the least invasive treatment that gives the patient the best and most predictable outcomes through the promotion of periodontal tissue regeneration and restoration of tooth function. After successful treatment, periodontal ligament (PDL) cells (fibroblasts) migrate and attach to the microorganism free root surface. They proliferate, differentiate and synthesise extracellular matrix proteins to form collagen fibres. It is crucial to obtain newly formed PDL to prevent apical migration of junctional epithelium and to allow regeneration of PDL, cementum and alveolar bone; therefore, the application of laser irradiation has been proposed to allow for the compatibility of root surfaces with regenerative processes.

An increasing number of studies have demonstrated the benefits of adjunctive laser therapy in conventional NSPT due to its reported ability to significantly reduce pathogens, promote healing and to suppress the inflammatory cytokine cascade through to surgical ablation of diseased tissues [8]. As a result of its deeper penetration, diode laser has not only had bactericidal effects but also bio-stimulatory effects on periodontal ligament stem cells, osteoblasts and fibroblasts [9]. The Erbium Chromium: Yttrium Scandium Gallium Garnet (Er,Cr:YSGG) laser, however, allows selective subgingival biofilm and calculus ablation without causing any thermal side effects (carbonisation) or morphologic changes to the root surface to allow the attachment of these cells [10]. Also, when compared with conventional hand instrumentation, Er,Cr:YSGG laser therapy was not only found to promote PDL fibroblast cell migration and attachment, but it also increased the number of cells that differentiate in periodontal regeneration [11,12,13].

Although in the treatment of periodontal disease, surgical interventions (with the use of osseous graft material, barrier membranes or application of a biologically active material) deem to have more predictable outcomes than conventional NSPT, they may however, possess multiple shortfalls including high cost, painful healing and post-operative complications. Also, with regard to the application of local or systemic antibiotic there are multiple side-effects including antibiotic resistance, gastrointestinal complications or drug interactions.
 

Fibroepithelial polyps are commonly seen in the mouth on the lip, cheek, gum line and tongue. There are a small mass of tissue that usually form in response to trauma such as lip biting or cheek chewing. Although, in the main, polyps are pain free and benign, they can be irritating especially if you keep catching them whilst eating which could cause ulcers or inflammation. Here is a common appearance of a fibroepithelial polyp on the lip:
 

As our name suggests, we are a forward thinking and innovative practice. In modern day life, technology is evolving at an almost alarming rate. Most of the changes are an improvement and enhance our quality of life. Dental care should be no different. Modern day dentistry is a world apart from the days of dreaded dental care. For example, laser dentistry. We have invested in the Waterlase i Plus 2.0 which has replaced the scalpel in our practice. Here is what Dr Nissit Patel has to say about the Waterlase i Plus: 'Since we have acquired the Waterlase i Plus, I have not needed to use a scalpel for my surgical work. The laser is far less invasive, there is far less bleeding and the recovery time is much reduced. The feedback from patients is overwhelmingly positive. I have recently used the laser to place a dental implant and did not need to use any stitches at all. Here is a photograph of the dental implant immediately after placement:
 

We have invested in the very latest laser dentistry at Progressive Dentistry- the Waterlase i Plus 2.0 and the Epic 10. Both have different wavelengths and hence complement each other or can be used as stand alone lasers. We think that both lasers are magic! Having now used lasers within dentistry for over five years, these two lasers are certainly the most sophisticated and advanced we have seen. 

One application of the Epic 10 is low level laser therapy LLLT. The aim of this is to aid healing, pain relief and regeneration. We have successfully used LLLT to treat incredibly painful jaw problems, ulcers, cold cores, post surgical pain and non healing extraction sockets. This is just the tip of the iceberg. Future studies will provide exact protocols for specific treatments. LLLT can do no harm and hence it should be used in most aspects of dentistry.

Please contact us if you are interested in laser dentistry and low level laser therapy. It could change your life!

We have invested in the very latest technology- the Waterlase i Plus 2.0. With this amazing dental laser we are able to provide drill free dentistry. Yes, that is correct; dentistry without drilling! Due to the incredible properties of the laser, almost 80% of dental filling cases can be treated without any anaesthetic- so no needles! However, there is more to the laser than simply replacing the dental drill. We can perform all soft tissue procedures using the laser meaning that the traditional scalpels are no longer required, which means less trauma and quicker recovery. There's more! The laser wavelength disinfects as it works, eliminating bacteria, viruses and major pathogens. This in turn provides a major turning point in regeneration of tissues. This has a major impact on all forms of dentistry especially periodontal and implant dentistry. If you detest the dental drill, have a severe needle phobia, want to destroy bacteria in your mouth, have improved outcomes, regenerate tissue and simply enjoy your dental care, contact us today. 

Laser dentistry is at Progressive Dentistry.

We are very pleased to announce that laser dentistry is available at our practice. The Power Pen Laser allows us to perform a number of procedures which were otherwise very invasive and involved significant treatment. The procedures include the use in conventional dentistry, endodontics, periodontics, surgery, treatment of ulcers, wisdom tooth pain, tooth whitening and much more! If you are interested in laser dentistry, please do not hesitate to contact us today. Tel 020 773 11162.