Hard and soft tissue regeneration of severe peri-implantitis defects with the laser-assisted peri-implant defect regeneration technique: 3-year results

Abstract

Purpose This retrospective cohort study evaluates the regeneration of severe peri-implantitis deficiencies treated with the laser-assisted peri-implant defect regeneration (LAPIDER) approach within a 3-year follow-up. Methods Twenty-four implants with severe peri-implantitis in 18 patients were treated according to the LAPIDER technique. In contrast to classic techniques for reconstructive peri-implantitis surgery with a marginal incision, a buccal split-flap preparation avoiding papillae separation was used. After a coronal flap elevation and a laser-assisted peri-implant defect cleaning, connective tissue and autogenous bone grafting was performed. Primary outcomes were the changes of the marginal bone levels (MBL) and the buccal bone thickness. Secondary outcomes included implant survival, peri-implant probing depths (PPD), bleeding on probing (BOP), recession, width of keratinized mucosa (KMW), thickness of keratinized mucosa (KMT), soft tissue esthetics (PES), and implant success. Results MBL improved interproximal by 3.10 ± 2.02 mm (p < 0.001), buccal by 3.49 ± 2.89 mm (p < 0.001), and lingual by 1.46 ± 1.98 mm (p = 0.003); buccal bone thickness by 0.55 ± 0.60 mm (p = 0.005), and 1.01 ± 1.25 mm (p = 0.001) at 1 and 3 mm below reference level. Two implants were removed; 22 implants were still in function at a mean follow-up of 36 months. PPD changed from 5.05 ± 1.39 to 3.08 ± 0.71 mm (p < 0.001); recession was reduced from 2.07 ± 1.70 to 0.91 ± 1.13 mm (p = 0.001); KMW increased from 2.91 ± 1.81 to 4.18 ± 1.67 mm (p = 0.006); KMT improved from 1.73 ± 0.50 to 2.44 ± 0.43 mm (p < 0.001); PES changed from 7.7 ± 2.8 to 10.7 ± 1.9 (p < 0.001). 45.8% to 54.2% of the implants met the criteria of implant success. Conclusions The favorable results document the proof of principle for the regeneration of severe peri-implant hard and soft tissue deficiencies by the LAPIDER treatment approach.

Bone regeneration as treatment of peri‐implant disease: A narrative review

“…A vertical bone regeneration of 4.7 mm was found around implants treated with the combination of autogenous bone and membrane, 4 mm at sites with autogenous bone alone, 3 mm at sites with a membrane alone, and 1.9 mm at the control sites 15 . A cohort study of 24 implants with a new approach for surgical peri‐implantitis treatment using a modified buccal access to the defect, grafting the peri‐implantitis bony lesions with autogenous connective tissue, and autogenous bone chips led to a significant radiographic bone regeneration of 3.1 mm at the interproximal and 3.5 mm at the buccal aspect 16 …”

“…For the coagulation of the blood clot and bone graft, no water spray was used 68 . In a cohort study, 24 implants were treated for severe peri‐implantitis with the new LAPIDER approach 16 . An Er:YAG laser was used for removal of the inflamed tissues and the implant surface decontamination.…”

“…This technique allows in one surgical treatment step the resolution of the peri‐implant infection, a significant circumferential bone regeneration and an improvement of the width and thickness of the keratinized peri‐implant mucosa. The 3‐year results document a significant vertical bone regeneration, and a reduction of the recession as well as an increase in width and thickness of the keratinized mucosa 16 . Comparative studies on this concept are under preparation and the impact of laser decontamination, autologous bone, and CTG have to be evaluated additionally.…”

“…15 A cohort study of 24 implants with a new approach for surgical peri-implantitis treatment using a modified buccal access to the defect, grafting the periimplantitis bony lesions with autogenous connective tissue, and autogenous bone chips led to a significant radiographic bone regeneration of 3.1 mm at the interproximal and 3.5 mm at the buccal aspect. 16 In many studies on augmentation procedures, the biological potential of autogenous particulated bone is used alone or in conjunction with biomaterials. 17 In vitro and in vivo, the addition of autologous bone chips has proven to be beneficial for bone metabolism.…”

“…68 In a cohort study, 24 implants were treated for severe peri-implantitis with the new LAPIDER approach. 16 An Er:YAG laser was used for removal of the inflamed tissues and the implant surface decontamination. The defects were grafted with autogenous bone chips and CTGs and revealed, after a mean follow-up period of 36 months, significant MBL improvements of 3.1-3.5 mm while PPD and REC were reduced significantly.…”