Peri-implantitis Treatment Using Er:YAG Laser and Bone Grafting. A Prospective Consecutive Case Series Evaluation: 1 Year Posttherapy

Clem, Donald S.; Gunsolley, John C.

doi:10.11607/prd.4158

Cited by 16 publications

(47 citation statements)

References 6 publications

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“…Another case series published by Clem et al. reported an average PD reduction of 2.9 mm (3.5 mm in deep sites), 31 in line with the reported results of this study.…”

Section: Discussionsupporting

confidence: 92%

“…However, no standard deviation was reported and the peri-implant PD increased after 1 year follow-up. 30 Another case series published by Clem et al reported an average PD reduction of 2.9 mm (3.5 mm in deep sites), 31 in line with the reported results of this study.…”

Section: Discussionsupporting

confidence: 91%

“…Norton 30 used xenogenic bone particles, which has lower bone turnover, leading to higher radio-opacity in the radiographs. Clem et al 31 used allograft bone particles similar to present study, but provided limited information on how to assess their reported bone fill or standardization.…”

Section: Discussionmentioning

confidence: 98%

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

Wang

Ashnagar²,

Gianfilippo

et al. 2020

Journal of Periodontology

116

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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

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“…Another case series published by Clem et al. reported an average PD reduction of 2.9 mm (3.5 mm in deep sites), 31 in line with the reported results of this study.…”

Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 91%

See 1 more Smart Citation

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

Wang

Ashnagar²,

Gianfilippo

et al. 2020

Journal of Periodontology

116

View full text Add to dashboard Cite

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“… 64 Care should be used when using an Er:YAG laser 2940 nm wavelength to avoid adverse thermal effects on the implant surface. In a clinical study, Clem and Gunsolley 65 evaluated the effective treatment regime for peri-implantitis lesions with deep (≥ 6 mm) defects using an Er:YAG laser for implant surface decontamination, removing defect granulomatous tissues, and grafting therapy for bony defect resolution. They found that the mean PD was reduced by approximately 3.5 mm at 12 months and remained stable (mean 3.2 mm 12 months later).…”

Section: Peri-implantitis Treatmentmentioning

confidence: 99%

Peri-implantitis Update: Risk Indicators, Diagnosis, and Treatment

et al. 2020

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Despite the success rates of dental implants, peri-implantitis presents as the most common complication in implant dentistry. This review discusses various factors associated with peri-implantitis and various available treatments, highlighting their advantages and disadvantages. Relevant articles on peri-implantitis published in English were reviewed from August 2010 to April 2020 in MEDLINE/PubMed, Scopus, and ScienceDirect. The identified risk indicators of peri-implant diseases are plaque, smoking, history of periodontitis, surface roughness, residual cement, emergence angle >30 degrees, radiation therapy, keratinized tissue width, and function time of the implant, sex, and diabetes. Peri-implantitis treatments can be divided into nonsurgical (mechanical, antiseptic, and antibiotics), surface decontamination (chemical and laser), and surgical (air powder abrasive, resective, and regenerative). However, mechanical debridement alone may fail to eliminate the causative bacteria, and this treatment should be combined with other treatments (antiseptics and surgical treatment). Surface decontamination using chemical agents may be used as an adjuvant treatment; however, the definitive clinical benefit is yet not proven. Laser treatment may result in a short-term decrease in periodontal pocket depth, while air powder abrasive is effective in cleaning a previously contaminated implant surface. Surgical elimination of a pocket, bone recontouring and plaque control are also effective for treating peri-implantitis. The current evidence indicates that regenerative approaches to treat peri-implant defects are unpredictable.

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“…In addition, even with radiographic bone fill of the defect, the ultimate outcome is best determined by implant surface re-osseointegration, which informs the peri-implant pocket and attachment level measurements. As evidence of using probing depth reduction as a reproducible primary clinical marker for regenerative outcomes, the levels of peri-implant pocket depth reduction at 6 months show a significant positive correlation with the long-term treatment outcome 24 . Given the end-point timing of the study, we utilized probing depth reduction as the primary clinical parameter to assess the treatment outcome of the clinical trial.…”

Section: Discussionmentioning

confidence: 98%

Machine learning-assisted immune profiling stratifies peri-implantitis patients with unique microbial colonization and clinical outcomes

et al. 2021

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Rationale: The endemic of peri-implantitis affects over 25% of dental implants. Current treatment depends on empirical patient and site-based stratifications and lacks a consistent risk grading system. Methods: We investigated a unique cohort of peri-implantitis patients undergoing regenerative therapy with comprehensive clinical, immune, and microbial profiling. We utilized a robust outlier-resistant machine learning algorithm for immune deconvolution. Results: Unsupervised clustering identified risk groups with distinct immune profiles, microbial colonization dynamics, and regenerative outcomes. Low-risk patients exhibited elevated M1/M2-like macrophage ratios and lower B-cell infiltration. The low-risk immune profile was characterized by enhanced complement signaling and higher levels of Th1 and Th17 cytokines. Fusobacterium nucleatum and Prevotella intermedia were significantly enriched in high-risk individuals. Although surgery reduced microbial burden at the peri-implant interface in all groups, only low-risk individuals exhibited suppression of keystone pathogen re-colonization. Conclusion: Peri-implant immune microenvironment shapes microbial composition and the course of regeneration. Immune signatures show untapped potential in improving the risk-grading for peri-implantitis.

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Peri-implantitis Treatment Using Er:YAG Laser and Bone Grafting. A Prospective Consecutive Case Series Evaluation: 1 Year Posttherapy

Cited by 16 publications

References 6 publications

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

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

Peri-implantitis Update: Risk Indicators, Diagnosis, and Treatment

Machine learning-assisted immune profiling stratifies peri-implantitis patients with unique microbial colonization and clinical outcomes

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