CASE SERIES

Adjunctive Nd:YAG Laser Irradiation for Ridge Preservation and Immediate

Implant Procedures: A Consecutive Case Series
Alicia Y. Choi,∗ Caitlin M. Reddy,† Ryan T. McGary,∗ Richard B. Hill,∗ Dane T. Swenson,∗ Paul Seibel,‡ Justin M. Hoag,§
Joshua P. Berridge and Thomas M. Johnson∗

Introduction: Whether or not laser use provides any meaningful benefit at immediate implant and ridge preservation
sites remains an open question in periodontics. However, various lasers have been used in conjunction with tooth
extraction and immediate implant placement. Evidence supporting adjunctive laser irradiation at immediate implant and
ridge preservation sites is mostly limited to preclinical studies and a small number of case reports.
Case Series: Adjunctive neodymium–doped: yttrium, aluminum, garnet (Nd:YAG) laser irradiation was used at six
immediate implant sites and five ridge preservation sites. Three immediate implants were in maxillary incisor positions and
three were in premolar positions, two maxillary and one mandibular. All cases exhibited favorable healing and satisfactory
clinical outcomes.
Conclusions: Nd:YAG laser energy application with 650-µs pulse duration consistently supported rapid clot
formation and graft containment at immediate implant and ridge preservation sites. Histologic analyses and controlled
clinical trials comparing ridge preservation and immediate implant procedures with and without laser use are needed.
Because cellular responses and clinical outcomes may be exquisitely sensitive to irradiation parameters, studies should
report materials and methods in detail. Clin Adv Periodontics 2019;9:125–134.
Key Words: Allografts; cone-beam computed tomography; dental implants; hemostasis; lasers; tooth extraction.

∗ Department
of Periodontics, Army Postgraduate Dental School, Background
Uniformed Services University of the Health Sciences, Fort Gordon, Erbium, chromium–doped: yttrium, scandium, gallium,
GA garnet (Er,Cr:YSGG, 2,780 nm) and neodymium–doped:
† Department yttrium, aluminum, garnet (Nd:YAG, 1,064 nm) lasers
of Periodontics, United States Army Dental Health
Activity, Fort Riley, KS
 Department of Periodontics, United States Army Dental Health
‡ Department of Periodontics, United States Army Dental Health
Activity, Yongsan, Korea Activity, Fort Bragg, NC

§ Department of Periodontics, United States Army Dental Health Received September 13, 2018; accepted February 16, 2019
Activity, Fort Drum, NY
doi: 10.1002/cap.10059

Clinical Advances in Periodontics, Vol. 9, No. 3, September 2019 125

C A S E S E R I E S
FIGURE 1 Case 1. Baseline clinical appearance in maximum
intercuspation with provisional crown on tooth #7.
FIGURE 2 Case 1. Baseline CBCT image (sagittal view).
have been used clinically in conjunction with immedi-
ate implant placement.1–4 These lasers have very dif-
ferent absorption profiles5 and thus dissimilar intended
purposes in immediate implant procedures. Er,Cr:YSGG
laser output is highly absorbed in hydroxyapatite, allow-
ing efficient cutting of hard tissue.5,6 In dog mandibles,
Er,Cr:YSGG laser energy produced fine cuts with sharp
edges, smooth walls, and no evidence of melting or
carbonization.6 For this reason, one author recommended
Er,Cr:YSGG laser use at immediate implant sites for
sectioning teeth, troughing around roots to minimize
extraction-related trauma, and initiating precise implant
osteotomies.2 Other reports suggest Er,Cr:YSGG lasers
may aid in debridement of infected sockets before imme-
diate implant placement.3,4
Unlike Er,Cr:YSGG laser output, Nd:YAG laser
energy exhibits negligible absorption in water and
hydroxyapatite.5 As a result, the Nd:YAG is known
to be a penetrating rather than superficially-absorbed
laser.5 Nd:YAG laser output scatters within soft tissue
and exhibits modest absorption in chromophores such
as hemoglobin.5 The ensuing thermal denaturation of
126 Clinical Advances in Periodontics, Vol. 9, No. 3, September 2019
FIGURE 3 Case 1. 3a Immediate implant (ø3.5 × 13 mm)∗
and healing abutment (ø3.5 × 3 mm) in place with FDBA
applied in the peri-implant gap defect and between the healing
abutment and the facial mucosa. 3b Clot established over
the immediate implant site using an Nd:YAG laser. A 360-µm
optical fiber was inserted into the allograft and pressed firmly
against the socket wall. The laser was then activated while
withdrawing the fiber above the pooled blood surface. Fiber
insertion, laser activation, and withdrawal were repeated at ≈
ten locations circumferentially around the implant. Additional
blood pooled over the most superficial allograft particles and
the healing abutment. The optical fiber was inserted just below
the pooled blood surface and the laser was again activated at
≈ ten positions around the implant.
∗ Replace Select Tapered, Nobel Biocare, Kloten, Switzerland
proteins produces a robust coagulation layer along the
lased surface.5 Nd:YAG laser energy has been used at
an immediate implant site to facilitate containment of
freeze-dried bone allograft (FDBA) particles within a
peri-implant gap defect.1
A third laser type has been evaluated for possible ben-
eficial effects in peri-implant bone. In a rabbit model,
gallium-aluminum-arsenide (GaAlAs, 830 nm) diode laser
irradiation produced greater bone-to-implant contact
(BIC) compared with non-irradiated controls.7
The present case series demonstrates Nd:YAG laser irra-
diation at immediate and delayed implant sites to stabilize
blood clots and contain FDBA.
Clinical Presentation, Case
Management, and Clinical Outcomes
All patients presented to the Army Periodontics Program,
Fort Gordon, GA. Each patient provided an informed
consent involving verbal and written components.
Laser Use at Immediate Implant Sites

TABLE 1 Recommended technique for adjunctive Nd:YAG laser application at immediate implant and ridge preservation sites
Step Description
1 Deep insertion of optical
fiber
2 Superficial insertion of
optical fiber
3 Photobiomodulation
Case 1
In December 2016, a 42-year-old man presented for eval-
uation of a maxillary lateral incisor with history of post
and core failure (Figs. 1 and 2). Treatment options were
discussed, and the patient elected extraction with imme-
diate implant placement. Tooth #7 was extracted, and an
immediate implant¶ was stabilized within the socket. An
Nd:YAG laser (3.6 W, 650 µs, 20 Hz) was used to establish
a stable clot over FDBA# particles in the peri-implant gap
defect (Figs. 3a and 3b; Table 1). Total energy applied with
the optical fiber in contact with the socket, the allograft,
or pooled blood amounted to 65 J. Additionally, 305 J
(3.0 W, 100 µs, 20 Hz) were applied to the facial, occlusal,
and palatal aspects of the site, with the fiber located 2.5
to 3.5 cm above the tissue. Early healing was uneventful,
and minimal changes in facial alveolar ridge and mucosal
contours were observed from baseline to postoperative
week 6 (Fig. 4).
Three months following surgery, excess palatal mucosa
was excised, and laser energy (3.0 W, 100 µs, 20 Hz) was
again applied to all aspects of the implant site (214 J,
non-contact). Clinical and CBCT follow-up assessments
appeared favorable (Figs. 5 and 6). Ten additional cases
involving Nd:YAG laser use at tooth extraction are pre-
sented in Table 2 and Figs. 7 through 13.
Discussion
Nd:YAG laser output may positively influence hard and
soft tissue wound healing.8 – 11 Possible effects of Nd:YAG
¶ Replace Select Tapered, Nobel Biocare, Kloten, Switzerland
# OraGRAFT, Lifenet Health, Virginia Beach, VA
Choi et al.
C A S E S E R I E S
Technique
The optical fiber is inserted into the allogenic bone derivative and pressed
firmly against the socket wall (coronal portion of the alveolus). The laser is
activated in contact with alveolar bone and withdrawn over a period of ≈
one second (3.6 W, 650 µs, 20 Hz). Laser activation is terminated once
the optical fiber exits the extraction socket. The photoacoustic effect of
the laser will eject biomaterial particles during this step. An instrument is
used to gently condense the biomaterial particles into the alveolus as
needed. This process is repeated at ≈ six to ten locations around the
circumference of the site, depending upon socket dimensions.
Biomaterial particles are condensed following step 1 and additional blood is
allowed to pool over the socket orifice. The optical fiber is inserted just
below the pooled blood surface and activated for ≈ one second. This
process is repeated at ≈ six to ten locations around the circumference of
the site, depending upon socket dimensions.
The clot covering the socket orifice typically appears moist following step 2.
After the photobiomodulation step, the clot has a dry appearance. The
optical fiber is maintained ≈ 2.5 to 3.5 cm away from the site and
activated continuously (3.0 W, 100 µs, 20 Hz). The fiber is slowly moved in
overlapping circles over the facial, occlusal, and lingual aspects of the
extraction socket. The total energy applied in the photobiomodulation
step is limited to ≈ 200 to 325 Joules. Step 3 typically enhances clot
stability and graft containment.
laser energy, based on animal and in vitro studies, include
induction of preosteoblast bone morphogenetic protein-
2 expression,8 stimulation of osteoblast differentiation,9
and acceleration of bone regeneration.10 Nd:YAG laser
energy applied in human periodontal pockets suppressed
selected pathogens below culture detection limits in
85% of patients.12 Additionally, Nd:YAG laser irradi-
ation attenuated lipopolysaccharide-mediated inflamma-
tory responses of macrophages and endothelial cells in
vitro.13 Thus, at immediate implant and ridge preserva-
tion sites, Nd:YAG laser application possibly promotes
bone healing,8 – 10 suppresses bacteria,12 and modulates the
immune response.13
The present report provides no information regarding
potential stimulatory effects of the laser. Pulse duration,
pulse repetition rate (pulses per second), average power,
fiber diameter, target tissue, fiber-to-target distance,
number of laser energy applications, and total energy
applied are all alterable irradiation parameters with
potential to substantially influence the observed
effects.5,14 Confirmative biologic study is needed to
define optimal treatment parameters and understand
favorable cellular responses achievable with Nd:YAG
laser irradiation, if any occur. Even so, the present
report documents clinical effects that practitioners can
anticipate when Nd:YAG laser output is applied to
extraction sites with the described irradiation parameters.
The established blood clots unequivocally contained bone
allograft material in every case, and time required for
hemostasis was always minimal. A pale membranous
substance, presumably fibrin, was noted at follow-
up appointments covering the portion of the alveolus
not yet protected by keratinized mucosa. Exposed FDBA
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C A S E S E R I E S

particles were never observed at any follow-

up appointment. Whether the fibrin-like
material adequately protects the underlying
bone allograft prior to completion of
soft tissue healing is unknown. Bone
and mucosal contours achieved were
consistently favorable, albeit over short
follow-up periods.
Two pulse durations were used in the pre-
sented cases. When a 650-µs pulse duration
is used, the pulse is “on” 6.5× longer com-
pared with a 100-µs pulse. Thus, more time
is available during each pulse for the laser
energy to heat blood and establish a stable
clot.5,14 Conversely, when a 100-µs pulse
duration is used, the energy of the pulse is
delivered over a much shorter time period,
and the peak power (energy/time) attained
during each pulse is much higher.5,14
High-peak power during each pulse—1,500
W when the described photobiomodula-
tion (PBM) settings are used—results in
high intensity (power/area) light incident
on the target tissue.5,14 Modest superficial
absorption attenuates the energy but per-
mits intense laser light beyond the target tis-
sue surface.5,14 Practitioners should recog-
nize the potential for lateral thermal dam-
age with excessive or improper Nd:YAG
laser use, particularly when long pulse dura-
tions are used around dental implants.

FIGURE 4 Case 1. Alveolar ridge and peri-implant mucosal stability at early time points,
occlusal and facial views. 4a and 4b 1 week, 4c and 4d 2 weeks, 4e and 4f 4 weeks, and
4g and 4h 6 weeks.

128 Clinical Advances in Periodontics, Vol. 9, No. 3, September 2019 Laser Use at Immediate Implant Sites
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FIGURE 6 Case 1. CBCT image 9 months following surgery

demonstrating favorable horizontal and vertical dimensions of
facial bone as well as a high-density zone consistent with facial
cortex formation in the grafted area.

FIGURE 5 Case 1. 5a Provisional restoration in place 7 months

following immediate implant placement. 5b Assessment of peri-
implant mucosa and facial contour of the alveolar ridge at final
impression 7 months following immediate implant placement. 5c
Facial view of definitive restoration 8.5 months following surgery.

Choi et al. Clinical Advances in Periodontics, Vol. 9, No. 3, September 2019 129
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TABLE 2 Patient information and Nd:YAG laser exposure
C A S E

Laser energy Laser energy

Age Evaluation Procedure applied at applied at follow-up
Case Case type (years) Sex date Assessment/diagnosis date Implant Biomaterial extraction (Joules) (Joules)

1 Immediate 42 M 12/5/2016 Non-restorable tooth #7 1/5/2017 ø3.5 × 13 Allogenic bone 370 214 (3 months)
S E R I E S

implant (post and core failure, mm∗ derivative‡

insufficient remaining
tooth structure)
2 Immediate 51 M 11/16/2017 Non-restorable tooth #8 1/3/2018 ø4.1 × 15 Allogenic bone 348 548 (2 weeks)
implant (fracture) mm† derivative§ 203 (4 weeks)
3 Immediate 50 M 11/20/2017 Microdont tooth #10 4/19/2018 ø3.5 × 13 Allogenic bone 400 250 (2 weeks)
implant (poor esthetics and mm∗ derivative‡
crown-to-root ratio)
4 Immediate 30 F 11/30/2017 Over-retained primary 1/24/2018 ø4.1 × 13 Allogenic bone 382 204 (1 week)
implant tooth T with root mm† derivative§ 202 (2 weeks)
resorption

Clinical Advances in Periodontics, Vol. 9, No. 3, September 2019

5 Immediate 36 M 5/2/2018 Non-restorable tooth #5 6/4/2018 ø4.1 × 13 Allogenic bone 326 307 (2 weeks)
implant (insufficient remaining mm† derivative‡ 298 (6 weeks)
tooth structure)
6 Immediate 52 M 5/17/2018 Over-retained primary 5/21/2018 ø5 × 8.5 mm† Allogenic bone 446 294 (4 days)
implant tooth J with root derivative‡ 275 (10 days)
resorption and
defective restoration
7 Ridge 36 M 4/24/2018 Non-restorable tooth #12 4/24/2018 ø4.1 × 13 Allogenic bone 364 472 (2 weeks)
preservation (recurrent caries, mm† derivative‡ 285 (3 weeks)
vertical root fracture) 294 (4 weeks)
8 Ridge 32 M 6/5/2018 Non-restorable tooth #12 6/8/2018 Patient not Allogenic bone 474 302 (1 week)
preservation (vertical root fracture) available for derivative‡ 304 (2 weeks)
treatment 301 (4 weeks)
9 Ridge 39 M 6/15/2018 Non-restorable tooth #12 6/15/2018 Patient not Allogenic bone 456 298 (7 weeks)
preservation (vertical root fracture) available for derivative‡
treatment
10 Ridge 52 M 10/23/2017 Non-restorable tooth #13 11/20/2017 ø4.1 × 11.5 Allogenic bone 324 None
preservation (recurrent caries) mm† derivative‡
11 Ridge 49 M 4/10/2018 Osseointegration failure, 6/6/2018 ø5 × 11.5 Allogenic bone 311 None
preservation implant #14 area mm† derivative‡
(at explant
site)
∗
Replace Select Tapered, Nobel Biocare, Kloten, Switzerland.
†
Nanotite Tapered Certain, Zimmer Biomet, Warsaw, IN.
‡
OraGRAFT Freeze-Dried Bone Allograft, Lifenet Health, Virginia Beach, VA.
§
Puros Cortico-Cancellous Particulate Allograft, Zimmer Biomet, Warsaw, IN.

Laser Use at Immediate Implant Sites

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FIGURE 7 Additional esthetic-zone immediate implant sites (cases 2 and 3). 7a Case 2. Baseline appearance of non-restorable tooth #8. 7b
Case 2. Extraction socket. 7c Case 2. Immediate implant stabilized with FDBA in place. 7d Case 2. Immediate provisional restoration before
placement of additional FDBA particles between the provisional abutment and the facial peri-implant mucosa. Note the unfavorable baseline
position of the facial peri-implant mucosa. The provisional abutment and crown were undercontoured to encourage incisal migration of peri-
implant mucosal margin during healing. 7e Case 2. Immediate provisional restoration following placement of additional FDBA and Nd:YAG
laser use. 7f Case 2. Clinical appearance at 2 weeks. The facial peri-implant mucosal margin was incisally positioned compared with baseline.
7g Case 2. Clinical appearance at 3 weeks. Minimal additional improvement in the position of the facial mucosal margin was appreciated at
this time point. 7h Case 3. Baseline appearance of microdont tooth #10. 7i Case 3. Extraction socket. 7j Case 3. Immediate implant stabilized.
7k Case 3. FDBA was applied in the peri-implant gap defect and supracrestally to bolster the position of the facial mucosa. 7l Case 3. Clot
appearance following Nd:YAG laser use. 7m Case 3. Favorable contours noted at postoperative week 2. 7n Case 3. Clinical appearance of
provisional restoration ≈ 4 months following immediate implant placement.

FIGURE 8 Premolar immediate implant sites (cases 4 through 6). 8a Case 4. Baseline appearance of over-retained primary tooth T with
root resorption. 8b Case 4. Initial osteotomy for immediate implant. 8c Case 4. Immediate implant and healing abutment in place. 8d Case
4. Supracrestal FDBA supporting mucosal contours. Blood was allowed to pool on the surface of the allograft particles. 8e Case 4. Clot
appearance following Nd:YAG laser use. 8f Case 4. Clinical appearance at postoperative week 2. 8g Case 4. Definitive implant-supported
crown ≈ 8 months following immediate implant placement. 8h Case 5. Baseline appearance of non-restorable tooth #5. 8i Case 5. Initial
osteotomy for immediate implant. 8j Case 5. Immediate implant stabilized. 8k Case 5. Supracrestal FDBA supporting mucosal contours.
8l Case 5. Immediate provisional restoration in place. Nd:YAG laser energy was applied after the screw-retained restoration was secured.
8m Case 5. Clinical appearance at postoperative week 2 (buccal). 8n Case 5. Clinical appearance of peri-implant mucosa ≈ 13 weeks following
procedure. Buccal alveolar bone and mucosal contours exhibited minimal change compared with baseline. 8o Case 6. Baseline appearance of
over-retained primary tooth J. 8p Case 6. Extraction socket. 8q Case 6. Immediate implant stabilized. 8r Case 6. Supracrestal FDBA supporting
mucosal contours. 8s Case 6. Clot appearance following Nd:YAG laser use. 8t Clinical appearance at postoperative day 4. 8u Case 6. Clinical
appearance of abutment at postoperative week 15, before crown delivery. Buccal alveolar bone and mucosal contours exhibited minimal
change compared with baseline.

Choi et al. Clinical Advances in Periodontics, Vol. 9, No. 3, September 2019 131
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FIGURE 9 Ridge preservation sites (cases 7 through 11). 9a Case 7. Baseline appearance of non-restorable tooth #12. 9b Case 7. Extraction
socket. 9c Case 7. FDBA placed within the alveolus. Supracrestal FDBA placement supported the mucosal contours. 9d Case 7. Clot
appearance following Nd:YAG laser use. 9e Case 7. Clinical appearance at postoperative week 4. 9f Case 7. Peri-implant buccal bone thickness
>3 mm at implant placement, 4 months following ridge preservation. 9g Case 8. Baseline appearance of non-restorable tooth #13. 9h Case
8. Extraction socket. 9i Case 8. FDBA placed within the alveolus. Supracrestal FDBA placement supported the mucosal contours. One suture
was placed to stabilize the mesial papilla area. 9j Case 8. Clot appearance following Nd:YAG laser use. 9k Case 8. Clinical appearance at
postoperative week 2. 9l Case 8. Clinical appearance at postoperative week 4. 9m Case 9. Baseline appearance of non-restorable tooth #12.
9n Case 9. Extraction socket. 9o Case 9. FDBA placed within the alveolus. Supracrestal FDBA placement supported the mucosal contours.
9p Case 9. Clot appearance following Nd:YAG laser use. 9q Case 9. Clinical appearance at postoperative week 2. 9r Case 9. Clinical
appearance at postoperative week 7. 9s Case 10. Baseline appearance of non-restorable tooth #13. 9t Case 10. Extraction socket. 9u
Case 10. FDBA placed within the alveolus. Supracrestal FDBA placement supported the mucosal contours. 9v Case 10. Clot appearance
following Nd:YAG laser use. 9w Case 10. Clinical appearance at postoperative week 2. 9x Case 10. Clinical appearance at implant surgery,
≈ 5 months following ridge preservation. 9y Case 11. Early implant failure, tooth #14 position. Appearance of site following implant removal. The
failed implant had been placed in a healed alveolar ridge with concomitant sinus elevation (crestal approach). 9z Case 11. Fibrous encapsulation
tissue peeling away from the osseous walls. Striations in the fibrous encapsulation tissue corresponded with the locations of implant threads.
9aa Case 11. FDBA placed within the defect following thorough debridement. 9bb Case 11. Clot appearance following Nd:YAG laser use.
9cc Case 11. Clinical appearance at postoperative week 2. 9dd Case 11. Peri-implant buccal bone thickness >2 mm at implant surgery,
≈ 4 months following graft placement.

132 Clinical Advances in Periodontics, Vol. 9, No. 3, September 2019 Laser Use at Immediate Implant Sites

FIGURE 10 Case 7. Appearance of alveolar ridge at implant
surgery, 4 months following ridge preservation. Slight osteo-
plasty was required to reduce the vertical height of bone and
smooth a sharp buccal ledge. Temporal change in alveolar
ridge contour appeared negligible. Peri-implant buccal bone
thickness was >3 mm.
FIGURE 11 Case 10. Appearance of alveolar ridge at implant
surgery, ≈ 5 months following ridge preservation. Temporal
change in alveolar ridge contour appeared negligible. Peri-implant
buccal bone thickness was >2 mm.
Choi et al.
C A S E S E R I E S
FIGURE 12 Case 11. Appearance of alveolar ridge at implant
exposure (phase two), ≈ 8 months following ridge preservation
(4 months following implant placement). Peri-implant buccal bone
thickness was >2 mm.
FIGURE 13 Case 2. Example of non-contact Nd:YAG laser energy
application for photobiomodulation (PBM). Nd:YAG laser output
(1,064 nm) is in the near-infrared portion of the electromagnetic
spectrum and thus invisible. The red aiming beam illustrates the
approximate size of the irradiated area. The fiber is slowly moved
in overlapping circles over the facial, occlusal, and lingual aspects
of the extraction socket. Nine of the 11 patients in this case
series received PBM during at least one follow-up appointment. In
some instances, follow-up PBM was certainly too late to influence
cells producing bone matrix during early healing. Whether PBM
influences bone maturation is not known. Controlled studies are
warranted.
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Summary

Why are these cases new  Nd:YAG laser irradiation consistently produced clot stability and graft
information? containment without need for barrier membranes.

What are the keys to successful  The photobiomodulation step appears to desiccate the clot and rapidly
management of these cases? improve clot stability.

What are the primary limitations  The suggestion that Nd:YAG laser irradiation may positively influence
to success in these cases? peri-implant wound healing has not been validated in controlled clinical
studies.
 No permanent molar extraction sites were included in this case series.
Clot stabilization and graft containment may be more challenging when
extraction socket dimensions are larger.

Acknowledgments implants placed in post-extraction infected and non-infected sites

The authors report no conflicts of interest related to this
case series. The views expressed in this manuscript are
those of the authors and do not necessarily reflect the
official policy of the Department of Defense, Department
restored with cemented crowns: A 3-year prospective study. J Dent
2014;42:645-652.
5. Aoki A, Mizutani K, Schwarz F, et al. Periodontal and peri-implant
wound healing following laser therapy. Periodontol 2000 2015;68:
217-269.

of Army, US Army Medical Department, or Uniformed
Services University of the Health Sciences. The authors
gratefully recognize members of the US Army Advanced
Education Program in Prosthodontics, Fort Gordon, GA,
for restorative treatment in the presented cases: CPT
Nathan E. Kosiba and Dr. John S. Brousseau (case 1), CPT
Ryan J. Coello (case 2), CPT Jin J. Xue (cases 3 and 4),
COL Daniel D. Dunham (case 6), CPT Jenny J. Oh (case
7), and CPT Zachary D. Russell (case 10).
6. Kimura Y, Yu DG, Fujita A, Yamashita A, Murakami Y, Matsumoto
K. Effects of erbium, chromium: YSGG laser irradiation on canine
mandibular bone. J Periodontol 2001;72:1178-1182.
7. Khadra M, Rønold HJ, Lyngstadaas SP, Ellingsen JE, Haanæs HR.
Low-level laser therapy stimulates bone–implant interaction: An exper-
imental study in rabbits. Clin Oral Implants Res 2004;15:325-332.

8. Kim IS, Cho TH, Kim K, Weber FE, Hwang SJ. High power-pulsed
Nd:YAG laser as a new stimulus to induce BMP-2 expression in
MC3T3-E1 osteoblasts. Lasers Surg Med 2010;42:510-518.

9. Karoussis IK, Kyriakidou K, Psarros C, Lang NP, Vrotsos IA. Nd:YAG
laser radiation (1.064 nm) accelerates differentiation of osteoblasts to
osteocytes on smooth and rough titanium surfaces in vitro. Clin Oral
Implants Res 2017;28:785-790.

CORRESPONDENCE
Dr. Thomas M. Johnson, 320 East Hospital Road, Fort Gordon, GA 30905,
USA. E-mail: thomas.m.johnson34.mil@mail.mil
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134 Clinical Advances in Periodontics, Vol. 9, No. 3, September 2019 Laser Use at Immediate Implant Sites