The effects of Er:YAG on the treatment of peri-implantitis: a meta-analysis of randomized controlled trials

Abstract

The clinical effectiveness of the erbium-doped yttrium-aluminum-garnet (Er:YAG) laser in patients with peri-implantitis remains unclear. The aim of this meta-analysis was to investigate the efficacy and safety of Er:YAG laser (ERL) compared to subgingival mechanical debridement (SMD) for the treatment of peri-implantitis. A systematic electronic literature search was conducted to identify randomized clinical trials (RCTs), followed by a manual search. Results were expressed as weighted mean differences (WMDs) with accompanying 95 % confidence intervals (CIs). The primary outcome measurements were changes in clinical attachment level (CAL) and probing depth (PD). Secondary outcome measurements included changes in gingival recession (GR). The meta-analysis was performed with fixed-effect or random-effect model according to the heterogeneity assessed by I (2) test. Visual asymmetry inspection of the funnel plot, Egger's regression test, and the trim-and-fill method were used to investigate publication bias. At 6 months, significant difference in PD reduction (p = 0.018) was observed for Er:YAG laser compared to SMD treatment, while no significant differences were detected in CAL gain and GR change; at 12 months, no significant difference was observed for any investigated outcome. The findings of this meta-analysis suggest that use of the Er:YAG laser as alternative to SMD could potentially provide short-time additional benefits, while there is no evidence of long-time superior effectiveness. As all included studies were not at low risk of bias, and only four studies were included in the meta-analysis, future long-term and well-designed RCTs reporting clinical and microbiological outcomes, considering the cost/effectiveness ratio, and having a high methodological quality are needed to clarify the effectiveness of Er:YAG laser.

Methodological quality and risk‐of‐bias assessments in systematic reviews of treatments for peri‐implantitis

“…After full‐text evaluation, 11 articles did not meet our inclusion criteria and were excluded (Table ) . Finally, a total of 23 SRs formed the basis for this study …”

“…Interventions were assumed, as subjects in SRs were various, and broadly categorized into non‐surgical and surgical treatment. In 10 included SRs, the effects of both non‐surgical and surgical treatments were elucidated . Six SRs included only non‐surgical treatment, and seven focused on surgical treatment .…”

“…Five SRs were published from the same facility, and the senior author of these SRs published one more SR with researchers in other facilities . There were six SRs that included RCTs only . More than half of the SRs included case series, and two SRs included single case reports .…”

“…There was one SR that included not only clinical trials but also animal studies . Conventional meta‐analyses were conducted in 11 SRs, and network meta‐analyses were conducted in three SRs . Six SRs that conducted meta‐analysis included results obtained from clinical studies (CS) .…”

Can Periimplantitis Be Treated?

“…112 The use of lasers for nonsurgical debridement in the management of periimplantitis offered no additional benefits over conventional mechanical debridement with curettes. [113][114][115] There is no single superior antiinfective method available. 80 Surgical interventions achieved greater probing depth reduction and clinical attachment gain compared with nonsurgical interventions.…”