Effects of PBM on implant and bone grafting after sinus elevation

Dr Kevin Ng and Dato’ Dr How Kim Chuan discuss the use of photobiomodulation (PBM) device with 42 LED cores producing 650nm wavelength light in shortening treatment time and improving surgical outcome.

Maxillary bone resorption after extraction of posterior teeth could cause severe bone loss and greatly reduce bone height and volume at the sinus base area if the edentulous sites were not loaded for a long period. It may not show apparent sign and symptoms and not cause any concerns to patient; however, the resorption process is irreversible unless treatment is performed. Eventually, it will become an obstacle in placing dental implants and the average treatment time to graft and gain bone is usually long to achieve satisfactory results.

These factors have been bothering dentists and patients since treatment outcomes may not always be successful if implant stability is not achieved. To assist graft, bone healing, growth and at the same time enhance patient cooperation and compliance, photobiomodulation (PBM) can be utilised to reduce pain and shorten treatment time.

Although different clinicians hold different views regarding to the application of PBM to influence bone regeneration and outcomes, the following case showed satisfactory patient feedback and acceptable clinical result.

The PBM device

The bite plane device consists of 42 LED cores and the power input is 4.2V. The current of each LED core is 7mA. The LED cores produce light of 650nm wavelength to stimulate the target sites. The energy absorbed after six minutes stimulation per arch is about 306.5 joules (Figs. 1-3). The manufacturer claims the science of PBM mechanism is to enhance the biological activities at cellular level of the treatment area and improve the healing of bone and soft tissues and further enhance bone growth and repairs.

Case report

A 55-year-old male patient presented with severe bone loss at the upper right molar region (teeth 15, 16, 17 area) with only 2-3mm remaining bone height (Figs. 4a-b). The patient experiences difficulty chewing on the right side and requested for dental implant. The medical history is clear and he had received implants before at tooth 45 and 46.

Sinus floor elevation was performed by external window and 2cc of graft were placed with membrane protection. PBM was prescribed to patient for 5-6mins daily. Pain thresholds were recorded for two weeks post-operatively. Two dental implants were placed at teeth 16 and 17 areas five weeks after the graft with insertion torques of 40N, that were achieved with ISQ 65, 68. PBM was continued for 5mins daily in another five weeks before ISQ 70 were recorded for both implants and successfully loading with two splinted crowns restoration.

The total treatment time was 10 weeks, and the patient reported that the chewing function was satisfactory after the splinted crowns were constructed. The PBM device was utilised for 5mins daily and the patient was advised to return to clinic monthly to check stability of implant and ensure good oral hygiene. At the same time, the patient was also informed to record the degree of pain or discomfort in the given form during treatment. The feedback pain scores were two to three for the whole period. OPG was taken after treatment revealing uneventful healing with no sign of infection (Figs. 5a-b, 6a-b).

Continue reading here. Published in Dental Asia September/October 2022 issue.

About the authors

Dr Kevin Ng is a specialist in community dentistry, a visiting professor at Guangzhou Medical University, and was a Hon a/clinical professor at the University of Hong Kong from 2017 to 2019.                   
Dato’ Dr How Kim Chuan is the president of ICD Section XV and the Osseointegration Society of Malaysia, and a visiting professor at Zhejiang Chinese Medical University; a visiting associate professor at both the Air Force University and Hong Kong University.