16 May 2021

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Laser-assisted surgical regenerative therapy for peri-implantitis

Lara Figini

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Peri-implantitis has been defined as a “pathological condition” that occurs in the tissues around dental implants, characterized by inflammation of the peri-implant connective tissue and by progressive loss of the supporting bone beyond the initial physiological remodeling. The treatment of peri-implantitis is still considered unpredictable and currently there is no standardized protocol available to manage this problem. Guided bone regeneration (GBR) of intrabony defects for peri-implantitis has been documented as one of the most promising treatment modalities. One of the main challenges during the surgical approach in regeneration therapy is to achieve the best and most effective disinfection of the contaminated implant surface. There is currently no gold standard to adequately decontaminate the implant surface. The application of the laser, in particular the erbium laser, for example, has been studied for the treatment of peri-implantitis in vitro and in vivo with promising results. 

Materials and methods
 In a pilot clinical study, published on Journal of Periodontology, March 2021, the authors evaluated the additional benefits of Er: YAG laser irradiation in the regenerative surgical therapy of bone defects associated with peri-implantitis. Twenty-four patients with radiographic diagnosis of peri-implantitis and with an intraosseous defect were randomly assigned to one of two groups, test group and control group. Both the test group and the control group received the following treatment:

 - mechanical cleaning with open flap,

 - supracrestal implantoplasty,

 - bone grafting using a mixture of human allograft with demineralized bovine matrix, then

 - covering with acellular dermal matrix membrane. 

The only difference between the two groups was that the Er: YAG laser was also used in the test group to modulate and remove inflammatory tissue and to decontaminate the implant surface. Pocket depth (PD), clinical attachment level (CAL), and gingival index (GI) were clinically assessed by blinded examiners up to 6 months after surgery. Standardized radiographs were also taken to assess gain and filling of the bone defect. Student's t-tests were used to analyze clinical parameters. 

Results
Significant reductions in PD, GI, and CAL gain occurred over time in both groups. The test group demonstrated significantly higher PD reductions at the implant site than the control group (2.65 ± 2.14 versus 1.85 ± 1.71 mm; test versus control, P = 0.014). There were no statistical differences in CAL gain, GI reduction, radiographic linear bone gain, or proportional reduction in defect size. There was a positive trend for patients in the test group in narrow intrabony defects to PD reduction and CAL gain. Membrane exposure negatively compromised the overall treatment, the result of the CAL gain and the reduction of PD in the test group. 

Conclusions 
From the data of this pilot study, which must be confirmed in other similar studies, it can be concluded that the use of laser irradiation during the regenerative therapy of peri-implantitis can help in the reduction of PD periodontal pockets. 

Clinical implications
Er: YAG laser irradiation provides additional clinical benefits for the regenerative surgical treatment of peri-implantitis. However, studies with a larger sample size and longer follow-up to confirm are needed.

For additional information: Laser-assisted regenerative surgical therapy for peri-implantitis: A randomized controlled clinical trial