Volume 7, Issue 10, October – 2022 International Journal of Innovative Science and Research Technology

ISSN No:-2456-2165

Clinical Efficacy of Laser Therapy in

Peri-Implant it is: A Review
Dr. Renuka Saini
BDS, SGT University, Gurugram

Abstract:- Dental Implantology has evolved into a Risk factors that increase a person's probability of
therapeutic option with an incredibly predictable developing peri implantitis, which shares many symptoms
outcome. It is used extensively in regular clinical practice with periodontitis, include prior periodontal disease, poor
and provides an effective treatment alternative for dental hygiene, smoking, hereditary factors, diabetes,
treating a wide range of patients. Pathological diseases in leftover cement, and occlusal overload.4The primary cause
the tissues around dental implants, such as "mucositis" of peri-implantitis is assumed to be microorganisms
and "peri-implantitis," can cause osseointegration residing on the implant surface. These bacteria establish a
problems over time. Despite the fact that a variety of biofilm that prevents bone cells from reattaching to the
treatments have been recommended for peri-implant implant surface and triggers a detrimental inflammatory
care, lasers have cemented themselves as the gold cascade in the host.5
standard for treating peri-implantitis and lowering
bacterial counts in the afflicted regions. Clinical evidence for PI includes bleeding post probing
in the peri implant area, an increase in probing depth, and
Keywords:- Lasers, peri implantitis, osseointegration, Er: marginal bone loss.6According to a review paper written by
YAG, Diode. Mombelli and his colleague, the prevalence of PI was
estimated at 10% of implants and 20% of patients five to ten
I. INTRODUCTION years following implant loading.7
Dental implantology has become a treatment option III. TREATMENT APPROACHES
harnessing a remarkably predictable outcome. It forms up a
large part of the daily clinical practice and offers a Even though a number of therapies have been
successful therapeutic option available for treating patients indicated for peri-implant care, the literature has not yet
who are partly or completely edentulous. 1Despite their documented a consensus on the approach that is the most
technical development taking place at the beginning of dependable, repeatable, and efficient. In order to
1960, when Branemarck's group introduced fresh and successfully treat PI, it is vital to decontaminate the
ground-breaking ideas based on their recognition of the implant components in addition to removing any inflamed
biological phenomena that took place at the interface soft tissue from the peri-implant region.8Various surgical
between bone and implant, implant-supported prosthetics in and non-surgical therapies are aimed in eliminating bacterial
dentistry only eventually started to be implemented. biofilms formed on dental implants for example mechanical
Osseointegration is the term used to refer to the debridement, disinfection with chemotherapeutic agents,
development of a rigid and functional bond between bone smoothing implant surface and laser therapy, which is the
and an implant fixture when both are being loaded by a new treatment modality employed.9
prosthetic device without the intervention of connective
tissue. Even yet, osseointegration errors may result from With carbon, plastic, titanium, ultrasonic scaling, or
pathological conditions to the tissues around dental implants powder air abrasion, mechanical debridement can be
over time. These pathological conditions, which are referred accomplished.10Tetracycline fibres, chlorhexidine
to as "mucositis" and "peri-implantitis" (PI) depending on digluconate, and minocycline microspheres all appear to
whether the inflammatory processes only affect the marginal possess powerful antibacterial properties. Due to resistant
gingiva or the deep peri-implant tissues, have risen in recent bacterial strains, restricted access to the inflamed region,
years in direct proportion to the use of dental implants. 2 and pharmacologic constraints like inadequate antibacterial
action or insufficient medication dose, the efficacy of
II. PERI- IMPLATITIS AND IMPLANT FAILURE mechanical or chemical modalities appears to be
constrained.11Additionally, mechanical techniques including
A complicated concept known as peri-implantitis (PI) metallic curettes, ultrasonic metal tip scalers, and air powder
affects the tissues surrounding an implant that is continually abrasion may cause an implant's surface to become rougher,
performing its intended function. An inflammatory cascade which in turn promotes bacterial colonisation and biofilm
that would initially affect the superficial peri-implant soft development.12
tissues (mucositis) and then progress into the deep layers,
with a loss of implant support bone that can be clinically and Recently, a discernible trend has compelled scientists
radiologically highlighted, could be brought on by a to use lasers to clean inflammatory periimplant tissue. Small
disadvantageous balance between pathogenic bacterial load portions of the implant surface that mechanical techniques
and host response (peri-implantitis).3 are unable to reach can be effectively irradiated by lasers.
The selective calculus removal, antibacterial, and hemostatic
actions of lasers all contribute to improved clinical

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Volume 7, Issue 10, October – 2022 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
results.13The effectiveness of Er:YAG (Erbium-Doped methodology (RCT) of test and control, Schwarz et al.
Yttrium Aluminum Garnet), CO2 (Carbon Dioxide Laser), conducted another study in 2006. The patients were
and Diode lasers in the high or even total removal of followed for up to 12 months. When compared to plastic
bacteria-loaded titanium discs has been demonstrated in in tools and chlorhexidine, Er:YAG significantly reduced BoP
vitro models.14Additionally, microscopic analyses have at 6 months, but at 12 months after treatment, there was no
confirmed that the titanium surface is not disturbed when discernible change in healing.28
these lasers are applied correctly.15,16
Using a test group (Er:YAG) and a control group as
Practitioners must make a number of choices when their comparison, Renvert et al. published a 6-month follow-
thinking about using lasers to treat peri implantitis. There up research (subgingival airborne glycine powder
are several different types of lasers, such as Er:YAG, CO2, polishing). Both at the beginning and six months, they
Diode, Er,Cr:YSGG (Erbium, Chromium doped Yttrium measured the BoP and pocket depth. Both treatment
Scandium Gallium Garnet), and diode lasers (810 nm, 940 modalities resulted in comparable recovery surrounding the
nm, and 980 nm) (NeodymiumDoped Yttrium Aluminium implants, they discovered.29Following the usage of the
Garnet). It could be necessary to combine laser therapy with Er:YAG laser for six months, Badran et al. reported on a
additional forms of treatment.17Thus the aim of this current single implant that had been identified with peri-implantitis.
review is to highlight the use of lasers in the treatment of After undergoing nonsurgical treatment, the patient had
peri implantitis and to review the efficacy of different lasers surgery. The findings revealed no BoP and a decrease in
in the treatment of the same. probing depth (2 to 5 mm), but an increase in gingival
recession (1 to 2 mm). The process of bone healing
IV. ER:YAG LASER FOR TREATMENT OF HUMAN surrounding the implant was effective.30Using the Er:YAG
PERIIMPLANTITIS laser alone to treat peri-implantitis without surgical
intervention was shown to be ineffective in one of the
Under the proper irradiation parameters, it has been studies included in a comprehensive review by Schwarz et
demonstrated that utilising the Er:YAG laser, contaminated al.31
abutments may be successfully cleaned of calculus and
plaque. This is accomplished while causing any surface V. ND:YAG LASER FOR TREATMENT OF HUMAN
damage to the titanium and without greatly raising the PERIIMPLANTITIS
temperature. It has been proven that using the Er:YAG laser,
contaminated abutments may be effectively cleared of Initially, the neodymium-doped yttrium-aluminum-
calculus and plaque under the right irradiation conditions garnet (Nd:YAG) laser (Nd:Y3Al5O12) was advised against
without titanium surface deterioration or considerable using it near implants because it caused morphologic
temperature rise.18 changes to the titanium surface, such as melting, cracking,
and cratering. Microorganism growth in those voids or
In light of the findings of earlier research and the porosities may be facilitated by changes in the surface
benefits of the Er:YAG laser in periodontal treatment, such topography.32,33
as its superior tissue ablation,19with high bactericidal,20 and
detoxification effects,21 the potential of Er:YAG laser On the other hand, Giannini et al. observed that the
application for the treatment of peri-implantitis would be Nd:YAG laser, when applied in vitro at low pulse energy,
expected.22When paired with local antibiotics, Er:YAG may had a bactericidal effect without causing any harm to the
lessen the clinical indications of inflammation when treating titanium surface.34No human studies have yet evaluated the
peri-implantitis without surgery, according to studies that effect of Nd:YAG laser therapy on peri-implantitis.
compared it to curettes and chlohexidine.23A systematic
review of laser treatment conducted by Kotsovilis et al., who VI. CO2LASER FOR TREATMENT OF HUMAN
came to the conclusion that Er:YAG combined with PERIIMPLANTITIS
mechanical debridement may be utilised for peri-
implantitis.24Three different laser types were reviewed by A gas-active medium laser, the CO2 laser uses an
Kotsakis et al., some of which were applied as a peri- electrical discharge current to pump a gaseous mixture
implantitis treatment adjunct, but no conclusion was drawn including CO2 molecules inside a sealed tube. The
as to which laser type was better than the others. 25Mailoa et versatility and accuracy needed for soft tissue surgical
al. reported on the use of two types of lasers (Er:YAG and operations are provided by the CO2 laser's capacity to
CO2) to treat peri-implantitis in both people and animals, deliver the requisite power in continuous and gated modes
but other laser types were left out of the review. 26 with focused or nonfocused hand-pieces. This wavelength,
which is nearly 1000 times more effective than erbium, has
The impact of the Er:YAG laser on peri-implantitis has the greatest hydroxyapatite absorption of any dental laser.
been shown in papers by Schwarz et al. Following therapy, To protect tooth structure from the incident laser beam at the
the patients came back six months later. Both the use of soft tissue surgery site, it is necessary. 35
Er:YAG and plastic tools resulted in appreciable
advancements in the healing process surrounding the Patients in a study by Deppe et al. were followed for 5
implant; however, the use of Er:YAG led to a higher years. Results obtained four months after treatment
decrease in BoP than the use of plastic instruments indicated that using a CO2 laser in conjunction with
alone.27In a different population and using the same research removing soft tissue may have sped up the healing process.
The CO2 laser and airborne-powder abrasion (Prophy-Jet,

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ISSN No:-2456-2165
Dentsply) did not vary in the long-term results for implant The diode laser also stimulates fibroblasts and
decontamination treatment.36The CO2 laser, in combination osteoblasts, which leads to an increase in RNA messenger
with augmentative approaches, may be a successful synthesis and considerable collagen creation during
treatment option for peri-implantitis, according to the periodontal tissue repair, potentially making it a viable
findings of a case series research by Romanos et al. that alternative strategy for the treatment of peri-implantitis.48
lasted 27 months.37
In one in vitro study, Stübinger et al. discovered that
Based on preliminary clinical results, Romanos et al. the removal of bacteria that cause peri-implantitis, such as
investigations from 2008 and 2009 concluded that CO2 laser Streptococcus sanguinis and Porphyromansgingivalis, was
was a useful technique for implant surface cleansing. In effective regardless of the implant material when using a
Romanos et al 2008's trial, BOP and PPD were greatly diode laser with an 810-nm wavelength, 3 W for 10 s, and a
decreased, and an adequate rate of bone fill was attained; 200-m fibre tip.47
nevertheless, the breadth of keratinized mucosa didn't
increase appreciably. It was unclear whether there had been Diode laser was employed by Schar et al. and Bassetti
any change in the pattern of healing because they had only et al. using the exact same protocols, including laser
compared the indices at baseline and final with a follow-up irradiation in conjunction with Phenothiazine chloride, 3
period of 27±17 months. Romano's 2009 study did not minutes after hand curettage, air powder abrasion, and
contain any soft tissue measurements, and evaluation was irrigation with hydrogen peroxide. One week after the initial
entirely based on radiographic signs of healing. 38,39 treatment, adjunctive PDT (Photodynamic Therapy) was
performed. In both investigations, the modified plaque index
VII. Er,Cr:YSGGLASER FOR TREATMENT OF was recorded, and at the final treatment checkups, it was
HUMAN PERIIMPLANTITIS significantly lower (6 and 12 months respectively). The laser
group had no plaque at month 6 according to Schar et al. 49,50
With a wavelength of 2.78 m, Er,Cr:YSGG lasers
belong to the family of erbium lasers and exhibit very IX. DISCUSSION
shallow tissue penetration, offering little thermal danger to
deeper tissues. Er,Cr:high YSGG's absorption in water has The major objectives of treating peri-implantitis are to
been linked to the morphological surface modifications it eradicate the inflammatory lesion, stop the disease's
promotes. In comparison to standard treatment protocol, the development, and preserve function with healthy peri-
use of the Er,Cr:YSGG laser as an adjuvant has reportedly implant tissues. The elimination of etiologic elements such
been found to be more successful in reducing bacterial adherent plaque, bacterial deposits, and diseased connective
growth.40 tissue inside intrabony defects around the implants have all
been recognised as crucial to achieving the desired outcome.
A low-energy Er:YAG laser appears to have However, due to their propensity for damaging the titanium
favourable effects when used to clean the implant surfaces of implants, conventional mechanical instruments
surfaces.41A single implant was monitored for 18 months’ like steel curets or ultrasonic scalers are not entirely suitable
time period in a study published by Azzeh in 2008. Using for the removal of granulation tissue and implant surface
Er,Cr:YSGG, the implant surface was decontaminated at the debridement. This could obstruct the process of bone
time of surgery followed by anorganic bovine bone grafting healing.As a result, mechanical tools like plastic curets and
in the defect location, and a resorbable membrane was carbon fibre curettes are typically used for implant
placed over the top. All probing depths were 2 mm 18 debridement.51
months after surgery, and the implant's surrounding osseous
tissue was found to be regenerating.42 The thorough debridement of the bone defect and the
contaminated implant surface, however, appears to be
VIII. DIODE LASER FOR TREATMENT OF inefficient using these procedures, and mechanical
HUMAN PERI IMPLANTITIS debridement is difficult and time-consuming.Because of
this, mechanical debridement in the case of peri-implantitis
Diode lasers are produced at a variety of wavelengths, has made it much harder to completely remove pollutants
including 810 nm, 940 nm, and 980 nm. They can be used in like bacteria and their byproducts and soft tissue cells from
gated pulse mode or continuous wave mode, which emits the rough surface, and the residual plaque biofilm may
energy as a steady beam (energy emitted as a constant but hinder the healing of the peri-implant tissues.52Novel
interrupted beam).43Gallium-aluminum-arsenide (810 nm) treatment techniques utilising lasers have received a lot of
and indium-gallium-arsenide (InGaAs) lasers are the two interest recently. Lasers have been used in periimplant
most often employed wavelengths in the treatment of peri- therapy as an additional or alternative treatment and are
implantitis (980 nm).44Since the peak water absorption will anticipated to alleviate the issues and challenges of the
help prevent a temperature increase at the implant surface, traditional mechanical treatment. According to the results of
the use of a 980-nm diode laser has been demonstrated to be the current review, only CO2, DIODE, and Er:YAG lasers
more favourable around dental implants, even at higher were utilised to effectively treat peri-implantitis lesions.
power levels.45The bactericidal impact of this wavelength on This could be explained by the fact that these two kinds of
implant surfaces has also been demonstrated in tests without lasers did not considerably raise the body temperature of the
altering the pattern of the implant surface. 46,47 implants while they were being used. 53

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An fascinating laser that has not been discussed in any [7.] Mombelli A, Müller N, Cionca N. The epidemiology
research is the neodymium: yttrium-aluminum-garnet of peri-implantitis. Clin Oral Implants Res.
(Nd:YAG) laser; one justification for this is that titanium is 2012;23:67-76.
abraded by Nd:YAG lasers independent of output energy. [8.] Esposito M, Grusovin MG, Kakisis I, Coulthard P,
The use of Nd:YAG for the treatment of periimplantitis Worthington HV. Interventions for replacing missing
might not be advised due to the high temperature and teeth: treatment of perimplantitis. Cochrane Database
titanium's propensity to melt.33Additionally, CO2 and Syst Rev. 2008;16:CD004970.
Er:YAG lasers were the only ones to be described as having [9.] Ntrouka VI, Slot DE, Louropoulou A, Van der
a variety of bactericidal effects on textured implant Weijden F. The effect of chemotherapeutic agents on
surfaces.54All periimplantitis patients in human clinical contaminated titanium surfaces: a systematic review.
studies who had surgical or non-surgical laser treatment for Clin Oral Implants Res. 2011;22:681-90.
their condition exhibited a decrease in PD and BOP. The [10.] Persson GR, Salvi GE, Heitz-Mayfield LJ, Lang NP.
laser group's lower PD and BOP scores might be attributed Antimicrobial therapy using a local drug delivery
to their strong bactericidal effects.55,56 system (Arestin) in the treatment of peri-implantitis.
I: Microbiological outcomes. Clin Oral Implants Res.
The elimination of lipopolysaccharides by laser 2006;17:386-93.
radiation and the antibacterial activities against [11.] Peters N, Tawse-Smith A, Leichter J, Tompkins G.
periodontopathic bacteria were also documented in various Laser therapy: the future of peri-implantitis
research.57 According to a prior study, employing CO2 management. Braz J Periodontol. 2012;22:23-9.
lasers along with bone grafting material resulted in a 40% [12.] Gosau M, Hahnel S, Schwarz F, Gerlach T, Reichert
increase in radiographic bone fill when compared to the TE, Bürgers R. Effect of six different peri-implantitis
control group.58 disinfection methods on in vivo human oral biofilm.
Clin Oral Implants Res. 2010;21:866-72.
X. CONCLUSION [13.] Matsuyama T, Aoki A, Oda S, Yoneyama T,
Nowadays, laser therapies offer a novel treatment Ishikawa I. Effects of the Er:YAG laser irradiation on
approach for peri implantitits and they are being integrated titanium implant materials and contaminated implant
along with conventional mechanical therapies.Er:YAG , abutment surfaces. J Clin Laser Med Surg.
Diode and CO2 Lasers have demonstrated better results as 2003;21:7-17.
compared to Nd:YAG Laser. A significant reduction in PPD [14.] Tosun E, Tasar F, Strauss R, Kıvanc DG, Ungor C.
and BOP was seen along with high bactericidal effects on Comparative evaluation of antimicrobial effects of
the implant surface. The results validate the efficacy of the Er:YAG, diode, and CO₂ lasers on titanium discs: an
laser irradiation in high decontamination of anaerobic experimental study. J Oral Maxillofac Surg.
bacteria and improving bone regeneration, therefore making 2012;70:1064-9.
the use of lasersan essential part of the treatment protocol [15.] Stubinger S, Etter C, Miskiewicz M, Homann F,
for peri- implantitis. Saldamli B, Wieland M, Sader R. Surface alterations
of polished and sandblasted and acid-etched titanium
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[50.] Bassetti M, Schär D, Wicki B, Eick S, Ramseier CA,
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