Patent ID: 9597160
Date: 2017-03-21
CPC Classifications: A61B,A61C,A61M,A61N

Claim:
1. A laser-assisted peri-implant mucositis and peri-implantitis bone regeneration and re-osseointegration procedure using a free-running (FR) pulsed neodymium yttrium aluminum garnet (Nd:YAG) laser device with a 1,064-nanometer wavelength and operating over a preferred parameter range which includes duty cycles between 0.2 and 1.3 percent (preferably at 100 to 650 microseconds at 100 hertz or less, preferably 20 hertz); average power of less than 10 Watts, preferably between 3.0 Watts and 3.6 Watts, 150 millijoules and 180 millijoules; peak power of between 231 Watts/pulse and 1800 Watts/pulse; energy densities of between 147 J/cm 2 and 177 J/cm 2 ; and power densities of between 2947 Watts/cm 2 and 3537 Watts/cm 2 , the procedure comprising: a) anesthetizing mucogingival tissues corresponding to a targeted implant of a patient, the implant having an implant surface; b) bone-sounding in a pocket around the targeted implant using a periodontal probe, and recording the depths of all bony defects in the soft tissue at 6 sites around the implant and to bone, from an upper gingival margin to the extent of the accessible bony defect; c) recording the sum total of all 6 probe depths/bone soundings and multiplying by 4 so as to obtain a total light dose estimation in units of Joules to be delivered; d) ablating, denaturing and vaporizing the inner diseased, inflamed, infected, ulcerated epithelial lining of the pocket, implant corrosion products and granulomatous tissues so as to photothermally alter, disrupt, denature, dehydrate and destroy hard calcified calculus and concrements on the implant surface, to the soft tissue extent of the pocket on all sides of the implant to prepare a new and coronal crestal connective tissue and osseointegrative surface, wherein said step of ablating, denaturing and vaporizing comprises application of ⅔ of the total light dose estimation using a quartz optical fiber having a small diameter of less than or equal to 400 microns and fed through a handpiece and an annealed stainless steel cannula, while operating the FR Nd:YAG laser device within the preferred parameter range; e) lasing the implant surface to destroy and denature lipopolysaccharides (LPS) of gram-negative bacteria; f) cleaning the implant surface of all foreign matter, calculus, cement to the full depth of the pocket on all sides of the implant from crestal margin to bony defect base, wherein said step of cleaning comprises application of a laser and/or preferentially piezo-electric ultrasonic device with water lavage and 20,000 to 30,000 hertz and use of appropriate tips operating at 8 to 10 watts; g) decorticating the crestal and marginal ridge bone to perform an osteotomy and/or ostectomy, and to initiate angiogenesis; h) irrigating the pocket with a bactericidal solution, preferably chlorhexidine 0.12%; i) lasing to intentionally irradiate the bone at the base of the bony defect in the 6 separate pocket depth measurement locations to initiate hemostasis from the medullary bone, stimulate and upregulate the release of growth factors such as IGF-I and IGF-II, TGF-beta 1, TGF-beta 2, BMP-2, and stimulate and upregulate fibroblasts and stem cells, warm the blood in the pocket to thermolytically cleave fibrinogen thereby converting the blood into fibrin (thrombin catalyzes the conversion of fibrinogen to fibrin), create a stable fibrin clot, and create angiogenesis; remove and/or denature any remaining residual granulomatous tissue and inflamed, infected and diseased epithelial lining, intentionally leaving granulation tissue in place inclusive of stem cells, capillaries, fibroblasts, but disinfected, and disinfect, assist in hemostasis, cauterize free nerve endings, and seal lymphatics of the pocket tissue surface, and prepare the pocket tissue surface for adhesion; j) lasing the pocket tissue surface to adapt the pocket tissue surface for tissue adhesion; wherein said steps (i) and (j) of lasing comprise application of the remaining ⅓ of the total light dose estimation using small diameter quartz optical fiber fed through a handpiece and annealed stainless steel cannula, while operating the FR Nd:YAG laser device within the preferred parameter range with the differentiated exception of average power of 3.0 to 4.0 (not 3.6) Watts and a duty cycle of 150 (not 100) to 650 microseconds at 20 hertz; k) approximating the pocket tissue surface with the implant surface; l) maintaining the pocket tissue surface in contact with the implant surface to advance adhesion; and m) eliminating occlusal interferences.