Laser‐assisted regenerative surgical therapy for peri‐implantitis: A randomized controlled clinical trial

Abstract

Background: Different surgical approaches have been proposed to treat periimplantitis defects with limited effectiveness and predictability. Laser has been proposed as an effective tool to assist in bacterial decontamination and modulating peri-implant tissue inflammation. The aim of this pilot clinical trial was to evaluate the adjunctive benefits of Er:YAG laser irradiation for regenerative surgical therapy of peri-implantitis-associated osseous defects. Methods: Twenty-four patients diagnosed with peri-implantitis with a radiographic infrabony defect were randomized into two groups. Both test and control groups received the following treatment: open flap mechanical debridement, supracrestal implantoplasty, bone grafting using a mixture of human allograft with demineralized bone matrix human allograft putty, and then covered with acellular dermal matrix membrane. The only difference in the test group was the adjunctive use of Er:YAG laser to modulate and remove inflammatory tissue as well as to decontaminate the implant surface. Clinical assessments, including pocket depth (PD), clinical attachment level (CAL), and gingival index (GI) were performed by calibrated masked examiners for up to 6 months following surgery. Standardized radiographs were also taken to evaluate linear bone gain and defect bone fill. Student t-tests were used to analyze those clinical parameters. Results: Both groups showed significant reductions in PD, GI, and CAL gain overtime. The test group demonstrated significantly higher PD reductions at the site level compared to the control group (2.65 ± 2.14 versus 1.85 ± 1.71 mm; test versus control, P = 0.014). There were no statistical differences found in CAL gain (1.90 ± 2.28 versus 1.47 ± 1.76 mm; test versus control), GI reduction (-1.14 ± 1.15 versus-1.04 ± 0.89; test versus control), radiographic linear bone gain (1.27 ± 1.14 versus 1.08 ± 1.04 mm; test versus control) or proportional defect size reduction (-24.46 ± 19.00% versus-15.19 ± 23.56%; test versus control). There was a positive trend for test patients on PD reduction and CAL gain found in narrow infrabony 378

Implantoplasty- provoking or reducing inflammation? – a systematic scoping review

“…The studies from Schwarz et al [18,[32][33][34] and Wang et al [36] have a randomised controlled study design (RCT), but are randomised with respect to treatment with Er:YAG laser or control treatment in the intrabony aspect of the periimplant defect prior to regenerative therapy. In these two studies, implantoplasty was conducted in the supracrestal compartment in all subjects.…”

“…Of the 14 studies with uniqe study populations included in this scoping review, 3 were controlled studies randomised with respect to adjunctive implantoplasty; Romeo et al [16,17]; Lasserre et al [45]; Dalago et al [46], 8 prospective studies [18,[32][33][34][36][37][38][39][40]42,43], 2 retrospective studies [35,44], and 1 retrospective case-control study [41] (Figure 1) (Table 2).…”

Impact of surface decontamination and systemic antimicrobials for surgical treatment of peri-implantitis: A systematic review and meta-analysis of randomized clinical trials

“…Sample size varied from 17 to 100. All trials were carried out in European Universities, except from one that was performed at the Yonsei Dental Hospital of Seoul, 36 one at the University of Michigan, 37 and one in a private practice in Saudi Arabia. 38 Diagnosis of peri-implantitis followed the last update of the World Workshop on the Classification of Periodontal and Peri-Implant Diseases 39 only in two studies; 36, 40 but was consistent across all studies except for minor differences (either MBL ≥ 2 or 3 mm together with PD ≥5 or 6 mm and BoP/SUP).…”

“…41–43 Mean age of patients ranged from 54.3 to 71.7 years, while the proportion of females varied from 25% to 80.9%. In three studies smokers were excluded; 33, 36, 37 two studies did not report any information on smoking habits; 32, 44 while the remaining trials included a variable number of smokers, ranging from 14.2% to 50%. Five studies presented implants with machined surface, with proportions ranging from 1.3 to 35%; four studies did not treat turned implant surfaces, 32, 33, 36, 37 without this being a specific exclusion criteria; while for seven studies this information was not available.…”

“…17, 21, 32, 33, 36–38, 44 Systemic antibiotics were administered prior to the surgical treatment in two RCTs; 21, 45 in six studies they were prescribed on the day of the surgery; 17, 36–38, 42, 43 while in the other eight studies no systemic antimicrobials were used. Eight studies reported decontaminating protocols applied to OFD; 17, 21, 32, 33, 36, 38, 44, 46 five studies to reconstructive or combined procedures; 37, 40–43 and three studies to apically positioned flap and osseous resective surgery (ORS). 34, 35, 45 Five RCTs used mechanical decontamination, 17, 32, 33, 41, 44 two studies chemical decontamination, 34, 35 while nine studies a combination of both.…”