Clinical, Radiographic and Microbiological Evaluation of High Level Laser Therapy, a New Photodynamic Therapy Protocol, in Peri-Implantitis Treatment; a Pilot Experience

Abstract

Aim. Endosseous implants are widely used to replace missing teeth but mucositis and peri-implantitis are the most frequent long-term complications related with dental implants. Removing all bacterial deposits on contaminated implant surface is very difficult due to implant surface morphology. The aim of this study was to evaluate the bactericidal potential of photodynamic therapy by using a new high level laser irradiation protocol associated with hydrogen peroxide in peri-implantitis. Materials and Methods. 10 patients affected by peri-implantitis were selected for this study. Medical history, photographic documentation, periodontal examination, and periapical radiographs were collected at baseline and 6 months after surgery. Microbiological analysis was performed with PCR Real Time. Each patient underwent nonsurgical periodontal therapy and surgery combined with photodynamic therapy according to High Level Laser Therapy protocol. Results. All peri-implant pockets were treated successfully, without having any complication and not showing significant differences in results. All clinical parameters showed an improvement, with a decrease of Plaque Index (average decrease of 65%, range 23–86%), bleeding on probing (average decrease of 66%, range 26–80%), and probing depth (average decrease of 1,6 mm, range 0,46–2,6 mm). Periapical radiographs at 6 months after surgery showed a complete radiographic filling of peri-implant defect around implants treated. Results showed a decrease of total bacterial count and of all bacterial species, except for Eikenella corrodens, 6 months after surgery. Conclusion. Photodynamic therapy using HLLT appears to be a good adjunct to surgical treatment of peri-implantitis.

Is Antimicrobial Photodynamic Therapy Effective for Microbial Load Reduction in Peri‐implantitis Treatment? A Systematic Review and Meta‐Analysis

“…2016 reported the values of 810, 690 and 660 nm, respectively. The times used for activation of the photosensitizer were also reported heterogeneously, ranging from 10 to 60 s .…”

“…The singlet oxygen is an oxygen free radical that determines bacterial cell death. In many of the studies, the results showed a decrease in total bacterial count (7,8,14,16,(25)(26)(27)(28)(29). The great majority of bacteria investigated were of Gram-negative and were affected by aPDT (7,8,16).…”

“…Toluidine blue (TBO) has been widely used in association with aPDT and, just like H 2 O 2, appears to result in the formation of singlet oxygen and could show a high reduction percentage (95.2%) of anaerobic bacteria with regard to the total initial bacterial count (16) (7) and Raka sević et al 2016 (8) reported the values of 810, 690 and 660 nm, respectively. The times used for activation of the photosensitizer were also reported heterogeneously, ranging from 10 to 60 s (7,8,16,25,27).…”

“…The current systematic review and all clinical studies consulted highlight the need for an individualized oral hygiene support program based on the motivation and instruction of the patient, associated with professional cleaning (1,(4)(5)(6)(7)(8)14,16,25,27).…”

In vitro Assessment of Peri-implantitis Treatment Procedures: A Review

“…However, mechanical curettage has been found to be insufficient for implant surface decontamination due to the presence of bacteria in surface micro-irregularities, and new therapeutic strategies have been developed to improve treatment outcomes [7]. For instance, laser treatments, antiseptics, and antibiotics have been reported as curative alternatives [8]. To develop and evaluate potential periimplantitis treatment procedures, several in vitro studies have been and are still conducted.…”