A Comparative Study of Mid-Crestal Incision and Diode Laser Shaped Incision to Assess Papilla Level in Second Stage Dental Implant Surgery.

Objectives: To assess papilla level using different techniques in a second stage dental implant surgery. Materials and
Methods: Thirty patients who received 45 dental implants were equally divided into 3 groups of 10 each. Group I patients were operated with a scalpel with mid-crestal incision. In group II, dental implants were exposed with a gallium-aluminum-arsenide diode laser. In group III, dental implants were exposed with I shaped incision using a scalpel. Assessment of modified gingival index (mGI), modified plaque index (mPI), and Jemt index were performed at baseline, 3 months, and 6 months. The measurement of FAJI, FAJAdj, ST height, and CP Bone crest was performed.
Results: A significant difference in crestal bone level of FAJ- I, FAJ- adj, ST height, and CP Bone crest was recorded at baseline, 3 months, and 6 months among groups I, II, and III (P < 0.05). At 6 months, both groups II and III exhibited >60% of papilla fill as compared to group I.
Conclusion: Diode laser offers maximum papillary fill and resulted in less crestal bone loss as compared to mid-crestal and I shaped incision during a second stage surgery. Copyright:

INTRODUCTION

Factors such as soft tissue around a dental implant, marginal bone, esthetics as well as prosthetic part affect the survival rate of a single dental implant.[1] Interdental papilla acts as a hindrance to foreign particles and prevents food accumulation. It is in harmony with the alveolar crest bone.[2] The papilla position is important, especially around dental implants, and factors such as bone between tooth and dental implant greatly affect it.[3]

Regeneration of dental papilla in a Second stage dental implant therapy may be affected by various factors. Surgical methods such as punch technique, diode laser, and scalpel are widely used for uncovering implant in a two stage surgery.[4]

This research study was undertaken with the aim to assess papilla level using different techniques in a second stage dental implant surgery.

Material and Methodology

A total of thirty patients who received 45 dental implants were selected for the study after considering inclusion and exclusion criteria. This study was commenced with approval from institutional review and ethical committee.

A simple stratified random sampling was followed where 30 patients were equally divided into 3 groups of 10 each. Group I patients were operated with a scalpel with mid-crestal incision continued with intrasulcular incisions at the adjacent teeth in a second stage implant surgery. In group II, dental implants were exposed with a gallium–aluminum–arsenide diode laser. In group III, dental implants were exposed with shaped incision using a scalpel.

Assessment of modified gingivalindex (mGI), modified plaque index (mPI), and Jemt index was performed at baseline, 3 months, and 6 months.

Using digital radiographs, a horizontal assessment of the implant shoulder at the fixture abutment junction (FAJ) was done. The vertical distance from the most coronal part of bone contacting the implant and implant shoulder (FAJ) was labelled as FAJ I. The vertical distance from the most coronal part of bone facing the adjacent tooth and implant shoulder was labelled as FAJ Adj. ST height was measured from implant shoulder to level of coronal papilla level. The vertical distance from the crest of the bone to the contact point (CP) was labelled as CP Bone crest. Statistical analysis was performed using the one-way ANOVA test.

RESULTS

Graph 1 shows a significant difference in crestal bone level of FAJ-I, FAJ-adj, ST height, and CP Bone crest recorded at baseline, 3 months, and 6 months among groups I, II, and III (P < 0.05). Table 1 shows that both groups II and III exhibited >60% of papilla fill at 6 months as compared to group I. However, the difference was nonsignificant (P > 0.05).

Graph 1

Measurement of crestal bone level in all groups

Table 1

Comparison of papillary fill score (Jemt)

Groups	Jemt	Mesial side			Distal side			P
		Baseline	3 months	6 months	Baseline	3 months	6 months
Group I	0	-	-	-	-	-	-	0.02
	1	2	2	2	2	2	2
	2	6	8	8	6	8	8
	3	2	-	-	2	-	-
Group II	0	-	-	-	-	-	-	0.01
	1	1	1	1	1	1	1
	2	2	3	3	3	4	4
	3	7	6	6	6	5	5
Group III	0	-	-	-	-	-	-	0.05
	1	-	-	-	-	-	-
	2	4	4	4	4	5	5
	3	6	6	6	6	5	5

DISCUSSION

Papilla preservation technique is a universally adopted technique, which overcomes the drawback of full-thickness flap.[5] Maintaining the biological width is an essential parameter, which ensures crestal bone height. Successful dental implant therapy demands sufficient crestal bone.[6]

Shahidi et al.[7] found no difference of probing pocket depth (PPD), Plaque Index, Gingival Index, Bleeding on Probing, thickness of soft tissue, or overall bone level measurements between both groups (new uncovering technique (test) with that of the conventional uncovering technique (control)). Yeh et al.[8] found that a soft tissue laser was effective for uncovering dental implants in a second stage surgery in the study conducted on 2 patients who required 4 dental implants. Gastaldo et al.[9] found that 3 mm is the ideal distance from the base of the contact point to the bone crest between adjacent implants and 3 mm to 5 mm between a tooth and an implant.

The deficiency of the study is a smaller sample size. Patients were followed for a shorter period of time. Inclusions of more different techniques could have shown different and interesting results.

CONCLUSION

It was observed that a diode laser offers maximum papillary fill and resulted in less crestal bone loss as compared to mid-crestal and I shaped incision during a second stage surgery.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.