Recommendations for treating stage I-III periodontitis in the Taiwanese population: A consensus report from the Taiwan Academy of Periodontology.

BACKGROUND/PURPOSE: Based on the fundamental of the S3-level clinical practice guideline (CPG) for treating stage I-III periodontitis developed by the European Federation of Periodontology (EFP), this consensus report aimed to develop treatment recommendations for treating periodontitis in the Taiwanese population. METHODS: The report was constructed by experts from the Taiwan Academy of Periodontology. The following topics were reviewed: (a) the prevalence of periodontitis in Asia and current status of treatment in Taiwan; (b) specific anatomical considerations for treating periodontitis in Asians; (d) educational and preventive interventions and supragingival plaque control; (d) subgingival instrumentation and adjunctive treatment; (e) surgical periodontal therapy; and (f) maintenance and supportive periodontal care. Recommendations were made according to the evidences from the EFP CPG, the published literature and clinical studies in Asians, and the expert opinions. RESULTS: The treatment recommendations for the Taiwanese population were generally in parallel with the EFP CPG, and extra cautions during treatment and maintenance phases were advised due to the anatomical variations, such as shorter root trunk, higher prevalence of supernumerary distolingual root and lingual bony concavity in mandibular posteriors, and thinner anterior labial plate, of the Asian population. CONCLUSION: The EFP CPG could be adopted for treating periodontitis and maintaining periodontal health of the Taiwanese population, and anatomical variations should be cautious when the treatment is delivered.

Biomechanical effect of implant design on four implants supporting mandibular full-arch fixed dentures: In vitro test and finite element analysis.

BACKGROUND/PURPOSE: Impact of the implant shape on the biomechanical performance of all-on-four treatment of dental implant is still unclear. This study evaluated the all-on-four treatment with four osseointegrated implants in terms of the biomechanical effects of implant design and loading position on the implant and surrounding bone by using both in vitro strain gauge tests and three-dimensional (3D) finite element (FE) analyses. METHODS: Both in vitro and 3D FE models were constructed with placing NobelSpeedy and NobelActive implants as well as a titanium framework in an edentulous jawbone based on the concept of all-on-four treatment. Three types of loads were applied: at the central incisor area (loading position 1) and at the molar regions with (loading position 2) and without (loading position 3) the denture cantilever. For the in vitro tests, the principal bone strains were recorded by rosette strain gauges and statistically evaluated using Wilcoxon's rank-sum test. The 3D FE simulations analyzed the peak von-Mises stresses in the implant and surrounding cortical bone. RESULTS: The peak stress and strain in the surrounding bone were typically 36-62% (3D FE analysis) and 47-57% (in vitro test) (p < 0.001)higher for loading position 3 than for loading positions 1 and 2. Between those two implant designs, the bone strains and bone stresses did not differ significantly. CONCLUSION: For all-on-four treatment with four osseointegrated dental implants, altering the implant design does not appear to affect the biomechanical performance of the entire treatment, especially in terms of the stresses and strains in the surrounding bone.

Effects of implant length and 3D bone-to-implant contact on initial stabilities of dental implant: a microcomputed tomography study.

BACKGROUND: The influences of potential bone-to-implant contact (BIC) area (pBICA), BIC area (BICA), and three dimensional (3D) BIC percentage (3D BIC%; defined as BICA divided by pBICA) in relation to the implant length on initial implant stability were studied. Correlations between these parameters were also evaluated. METHODS: Implants with lengths of 8.5, 10, 11.5, and 13 mm were placed in artificial bone specimens to measure three indexes of the initial implant stability: insertion torque value (ITV), Periotest value (PTV), and implant stability quotient (ISQ). The implants and bone specimens were also scanned by microcomputed tomography, and the obtained images were imported into Mimics software to reconstruct the 3D models and calculate the parameters of 3D bone-to-implant contact including pBICA, BICA, and 3D BIC%. The Kruskal-Wallis test, Wilcoxon rank-sum test with Bonferroni adjustment, and Spearman correlations were applied for statistical and correlation analyses. RESULTS: The implant length affected ITV more than PTV and ISQ, and significantly affected pBICA, BICA, and 3D BIC%. A longer implant increased pBICA and BICA but decreased 3D BIC%. The Spearman coefficients were high (>0.78) for the correlations between the three 3D BIC parameters and the three indexes of the initial implant stability. CONCLUSIONS: pBICA, BICA, and 3D BIC% are useful when deciding on treatment plans related to various implant lengths, since these 3D BIC parameters are predictive of the initial implant stability.

Biomechanical evaluation of one-piece and two-piece small-diameter dental implants: In-vitro experimental and three-dimensional finite element analyses.

BACKGROUND/PURPOSE: Small-diameter dental implants are associated with a higher risk of implant failure. This study used both three-dimensional finite-element (FE) simulations and in-vitro experimental tests to analyze the stresses and strains in both the implant and the surrounding bone when using one-piece (NobelDirect) and two-piece (NobelReplace) small-diameter implants, with the aim of understanding the underlying biomechanical mechanisms. METHODS: Six experimental artificial jawbone models and two FE models were prepared for one-piece and two-piece 3.5-mm diameter implants. Rosette strain gauges were used for in-vitro tests, with peak values of the principal bone strain recorded with a data acquisition system. Implant stability as quantified by Periotest values (PTV) were also recorded for both types of implants. Experimental data were analyzed statistically using Wilcoxon's rank-sum test. In FE simulations, the peak value and distribution of von-Mises stresses in the implant and bone were selected for evaluation. RESULTS: In in-vitro tests, the peak bone strain was 42% lower for two-piece implants than for one-piece implants. The PTV was slightly lower for one-piece implants (PTV = -6) than for two-piece implants (PTV = -5). In FE simulations, the stresses in the bone and implant were about 23% higher and 12% lower, respectively, for one-piece implants than those for two-piece implants. CONCLUSION: Due to the higher peri-implant bone stresses and strains, one-piece implants (NobelDirect) might be not suitable for use as small-diameter implants.

Biomechanical investigations of the expanded platform-switching concept in immediately loaded small diameter implants.

STATEMENT OF PROBLEM: Use of a small diameter implant may increase the stress on bone around the implant neck; however, an expanded platform design may mitigate these stress concentrations. To date, no study has compared the biomechanical effect of regular platform and extended platform designs on an implant. PURPOSE: The purpose of this in vitro study was to evaluate the biomechanical effects of an expanded platform-switching design for immediately loaded small diameter implants on bone strains. MATERIAL AND METHODS: Three groups of artificial jawbone models were prepared for small diameter (3.25-mm) and standard diameter (4.0-mm) implants with expanded or regular platform designs. Platform-switching implant design was implemented by assembling implants with a smaller connected abutment. Specimens were tested under both vertical and lateral static loads at 190 N. Peak values of the principal microstrain of bone were recorded and analyzed statistically with Kruskal-Wallis test and multiple comparisons Bonferroni test (α=.05). The initial stability of each implant was also measured for 3 types of implant. RESULTS: Under vertical loading, the bone strain was lowest for the regular type of immediately loaded small diameter implant. Under lateral loading, peak bone strain around the expanded platform small diameter implant with platform switched abutment was up to 74.9% lower than that of the regular type of small diameter implant. Increasing the implant diameter from 3.25 mm to 4.0 mm on the expanded platform implants reduced the bone strain by approximately 10% and 30% under lateral and vertical loading, respectively. The initial implant stability did not vary significantly among the implants tested. CONCLUSIONS: Using the expanded platform small diameter implant with a platform-switched abutment may decrease the marginal bone strains around immediately loaded small-diameter implants under lateral loading.

Two anterior wide-diameter implants using the All-on-4 concept in a predictable maxillary rehabilitation: A clinical report.

The quality of maxillary bone is generally lower than that of mandibular bone; consequently, complete arch immediate implant-loading treatment is not as predictable in the maxillary as in the mandibular arch. The All-on-4 concept has proven to be an effective and successful treatment protocol. However, the survival rate of All-on-4 implants in the maxilla is lower than of those in the mandible. In this report, 2 anterior wide-diameter implants were used with the All-on-4 concept for a maxillary rehabilitation to provide biomechanical benefits with better primary stability while still achieving a functional and esthetic result. The clinical challenges of using wide-diameter implants in the anterior region are also discussed and should be considered during treatment planning.

All-on-4 concept implantation for mandibular rehabilitation of an edentulous patient with Parkinson disease: A clinical report.

Parkinson disease (PD) is a progressive neurologic disorder. Compromised voluntary and involuntary muscle control of the orofacial-pharyngeal muscles of patients with PD may lead to difficulty in mastication, dysphagia, and tremor of the mouth and chin. All of these problems represent major challenges for the clinician with respect to the oral rehabilitation. This clinical report describes the use of the All-on-4 concept implantation for mandibular rehabilitation with a fixed detachable dental prosthesis in an edentulous patient with PD. The treatment steps, outcome, and limitations are discussed.

Biomechanical effects of the implant material and implant-abutment interface in immediately loaded small-diameter implants.

OBJECTIVE: Small-diameter implants have been available since the 1990s, but few studies have analyzed their mechanical properties. This study evaluated the effects of the implant material and the implant-abutment connection designs on the primary stability and the marginal bone strain of small-diameter implant subject to immediate loading. MATERIALS AND METHODS: Insertion torque value (ITV), implant stability quotient (ISQ), and Periotest value (PTV) of three implant systems with four parameters (titanium, titanium alloy, internal and external hexagon connections) were measured after placing implants into artificial type 2 jaw-bone models. Specimens were tested under both vertical and oblique static loads at 190 N. Peak values of the principal bone strain were recorded and analyzed statistically by the Kruskal-Wallis test and multiple-comparisons Bonferroni test. RESULTS: PTV and ISQ were higher for the NIOSM311 (internal-hex and Ti alloy) and FOSM311 (external-hex and pure Ti) implants, respectively, than for the NOSM311 (external-hex and Ti alloy) implant. Under vertical loading the peak value of peri-implant bone strains did not differ significantly among these three implant systems. However, the peak bone strains were at least 32 % lower for the NIOSM311 and FOSM311 implants than for the NOSM311 implant under lateral loading. CONCLUSIONS: The implant material and the implant-abutment connection design significantly influence the peri-implant bone strain of immediately loaded small-diameter implants, but barely affect their primary stability. CLINICAL RELEVANCE: A commercially pure titanium implant with an internal connection has the potential to reduce the risk of implant failure of small-diameter implant related to biomechanical complications.

An in vitro biomechanical evaluation of a new commercial titanium-zirconium alloy dental implant: a pilot study.

BACKGROUND: The study compared the implant mobility and surrounding bone strain between the titanium-zirconium (Ti-Zr) alloy and the commercial pure (CP) Ti implants. METHODS: The mobility--quantified as the implant stability quotient (ISQ) and Periotest value (PTV)--of implants constructed from Ti-Zr alloy and CP Ti placed into artificial type-2 jawbone models were measured. Specimens were tested by applying 190 N vertically or at 30 degrees laterally. Peak values of the principal strains of bone were recorded by rosette strain gauges with a data acquisition system and were analyzed statistically using Wilcoxon rank-sum test. RESULTS: PTV and ISQ values did not differ significantly between the Ti-Zr and CP Ti implants (P > 0.01). Under vertical loading, the peak bone strains did not differ significantly between the Ti-Zr and CP Ti specimens (P > 0.006). However, the peak strains were 52% lower around the Ti-Zr implant than around the Ti implant on the buccal side of bone under lateral loading (P < 0.001). CONCLUSIONS: The implant material (Ti-Zr alloy vs CP Ti) had no effect on the mobility of small-diameter dental implants. However, using Ti-Zr alloy as an implant material decreased the periimplant bone strain under lateral loading in this pilot study.

Reverse Torque Value of Angulated Screw Channel Abutment before and after Cyclic Loading: An In Vitro Study.

This in vitro experiment aimed to understand the difference in preload acting on an abutment screw under different angles of angulated screw-retained crown and the performance after cyclic loading. In total, thirty implants with angulated screw channel (ASC) abutments were divided into two parts. The first part consisted of three groups: a 0° access channel with a zirconia crown (ASC-0) (n = 5), a 15° access channel with a specially designed zirconia crown (sASC-15) (n = 5), and a 25° access channel with a specially designed zirconia crown (sASC-25) (n = 5). The reverse torque value (RTV) was measured at 0° for each specimen. The second part consisted of three groups: a 0° access channel with a zirconia crown (ASC-0) (n = 5); a 15° access channel with a zirconia crown (ASC-15) (n = 5), and a 25° access channel with a zirconia crown (ASC-25) (n = 5). The manufacturer's recommended torque was applied to each specimen, and baseline RTV was measured before cyclic loading. Each ASC implant assembly was cyclically loaded at 0 to 40 N with 1 million cycles at 10 Hz. RTV was measured after cyclic loading. Kruskal-Wallis test and Jonckheere-Terpstra test were used for statistical analysis. All specimens were examined under a digital microscope and scanning electron microscope (SEM) to observe the wear of the screw head before and after the whole experiment. A significant difference in the different percentages of straight RTV (sRTV) between the three groups was found (p = 0.027). The angle of ASC to the different percentages of sRTV showed a significant linear trend (p = 0.003). No significant differences were found in RTV difference after cyclic loading among the ASC-0, ASC-15, and ASC-25 groups (p = 0.212). The ASC-25 group had the most serious degree of wear based on a digital microscope and SEM examination. The ASC angle will affect the actual preload acting on a screw: the larger the ASC angle, the smaller the preload. The performance of the angled ASC groups in RTV difference was comparable to that of 0° ASC after cyclic loading.

Biomechanical Analysis of Titanium Dental Implants in the All-on-4 Treatment with Different Implant-Abutment Connections: A Three-Dimensional Finite Element Study.

The type of implant-abutment connection is one of the factors influencing the distribution of occlusal forces. This study aims to investigate the biomechanical performance of the mandibular all-on-4 treatment with different implant-abutment connections. Two connection types with 30° abutments and 18-mm implant fixtures were chosen for the posterior implants of the all-on-4 assembly. For the external hexagon connection (EHC) group, the implants with 4 mm in diameter were used. For the internal hexagon connection (IHC) group, we selected implants with 4.3 mm in diameter. A vertical force of 190 N was applied to the cantilever region. The FEA results indicated that the most stressed region in the two groups was prosthetic screws, followed by multi-unit abutments (MUAs). The lowest values of von Mises stress were both observed on the bone. The peak stress value of the implant screw and implant fixture in the EHC group were 37.75% and 33.03% lower than the IHC group, respectively. For stress distribution patterns, the load force tended to be concentrated at locations where components were interconnected. The EHC and IHC are clinically durable under the tested loading conditions, but the prosthetic screws and MUAs can be the weak point on the posterior implant within the mandibular all-on-four assembly. The peak stress values of implant screw and implant fixture in the EHC groups were lower than the IHC group.

Relation between insertion torque and bone-implant contact percentage: an artificial bone study.

OBJECTIVES: The purpose of this study was to determine the correlation between the peak insertion torque value (ITV) of a dental implant and the bone-implant contact percentage (BIC%). MATERIAL AND METHODS: Dental implants were inserted into specimens comprising a 2-mm-thick artificial cortical shell representing cortical bone and artificial foam bone representing cancellous bone with four densities (groups 1 to 4--0.32, 0.20, 0.16, and 0.12 g/cm(3)). Each specimen with an inserted implant was subjected to micro-computed tomography (micro-CT) scanning, from which the 3D BIC% values were calculated. Pearson's correlation coefficients (r) between the ITV and BIC% were calculated. RESULTS: The ITVs in groups 1 to 4 were 56.2 ± 4.6 (mean±standard deviation), 45.6 ± 0.9, 43.3 ± 4.3, and 38.5 ± 3.4 N cm, respectively, and the corresponding BIC% values were 41.5 ± 0.5%, 39.0 ± 1.0%, 30.8 ± 1.1%, and 26.2 ± 1.6%. Pearson's correlation coefficient between the ITV and BIC% was r = 0.797 (P < 0.0001). CONCLUSION: The initial implant stability, quantified as the ITV, was strongly positively correlated with the 3D BIC% obtained from micro-CT images. CLINICAL RELEVANCE: The ITV of a dental implant can be used to predict the initial BIC%; this information may provide the clinician with important information on the optimal loading time.

Biomechanical Evaluation of Bone Atrophy and Implant Length in Four Implants Supporting Mandibular Full-Arch-Fixed Dentures.

Residual alveolar ridge resorption often occurs after tooth extraction, which causes issues requiring further prothesis rehabilitation. A treatment concept referred to as all-on-four, involving fixed dentures supported with four implants, was recently developed. The current study aimed to determine the effect of changing bone atrophy and implant length in all-on-four treatments on stress and strain in the surrounding bone of the implant. A three-dimensional finite element method was used in this research. The stress analysis was conducted with von Mises stress values. Two types of synthetic jawbone models with mild and moderate atrophy were used. Furthermore, two different implant lengths with a similar implant design and diameter were selected, and they were classified into eight models. Then, the bone model was assessed via a computed tomography (CT) scan and was transformed into a virtual model in Geomagic and SolidWorks with implant rebuilding. After modifying bone atrophy, the von Mises stresses in the surrounding bone of the implant were as follows: mild type 2 < mild type 3 < moderate type 3 < moderate type 4. The bone quantity change rate increased more than when bone conditions were limited. Compared with changes in implant lengths, the stresses in the peri-implant surrounding bone were generally higher in the 9 mm implant length group than in the 11.5 mm group. However, the results did not significantly differ. In conclusion, the von Mises stress and strain increased in the models with moderate atrophy and low-density trabecular bone. Hence, bone atrophy and its presurgical diagnosis in long-term implant prognosis are crucial.

Effect of Marginal Bone Integrity and Aftermarket Abutment Screws on Dental Implant Systems-A Preliminary Study with Finite Element Method.

Bone resorption around implants is quite common, and the maturity and popularization of computer-aided design and computer-aided manufacturing (CAD/CAM) technology have made the use of aftermarket abutment screws more widespread. This study aimed to explore the biomechanical influence of these two common factors on the internal stress of an implant system using three-dimensional finite element analysis (3D FEA). The FEA results indicated that under the same loading conditions, the use of an aftermarket screw had the greatest impact on the screw itself among the three components of the implant system, while the maximum stress increased by 6.3% and 10.5% in the bone integrity and bone loss models, respectively. Moreover, the marginal bone loss models had the greatest impact on the implant fixture, with a maximum stress increase of 51.8% on average. Evidently, the influence of bone loss might be far greater than that of the aftermarket screw; however, any factor could be enough to cause clinical failure. Therefore, we should pay more attention to the maintenance of the long-term peri-implant marginal bone integrity.

Comparing the Fracture Resistance and Modes of Failure in Different Types of CAD/CAM Zirconia Abutments with Internal Hexagonal Implants: An In Vitro Study.

Three groups of zirconia abutments (n = 5) consisting of different connection designs or manufacturers were investigated (All-Zr, ASC-Zr, and AM-Zr groups). All-electric dynamic test instruments were used to place static loading on a specimen with a crosshead speed set at 1 mm/min. A Kruskal-Wallis test and a post hoc Mann-Whitney U test were used for statistical evaluation. The mean fracture resistance was 252.37 ± 82.79 N for the All-Zr group, 384.62 ± 45.24 N for ASC-Zr group, and 361.83 ± 90.31 N for the AM-Zr group. The difference of fracture resistance between the three groups was marginally significant (Kruskal-Wallis test, p = 0.054), with the ASC zirconia abutment tending to have higher fracture resistance than the full zirconia abutment. The modes of failure among the three types of abutments are different. The All-Zr group showed an oblique fracture line starting from the buccal aspect at the region of the implant platform. While the ASC-Zr and AM-Zr groups showed a relatively horizontal fracture line with a greater distance from the implant platform. The titanium inserts cannot significantly improve the fracture resistance of the zirconia abutment. However, they may alter the modes of failure, allowing buccal fracture surfaces of the zirconia abutments to be placed away from the implant platform, thereby protecting the implant-abutment connection.

A Retrospective Analysis of Implants with Low Insertion Torque in Immediately Loaded Full-Arch Fixed Prostheses with Corresponding Occlusal Schemes.

PURPOSE: Poor alveolar bone quality and quantity may cause low insertion torque during implant placement; therefore, a delicate occlusal design is important for the immediate loading procedure. This retrospective clinical study aimed to investigate (1) the proportion of implants with a low insertion torque between the maxilla and mandible, (2) factors affecting implants with a low insertion torque, and (3) survival rates of implants with a low insertion torque value (< 35 Ncm) using different occlusal designs with full-arch fixed prostheses supported by immediately loaded implants. MATERIALS AND METHODS: Between 2013 and 2017, patients who received full-arch reconstructions were treated with immediately loaded one-piece fixed prostheses supported by four to six implants. Full-arch fixed prostheses with at least one immediately loaded regular implant with a low insertion torque value were included in this study. The fixed provisional acrylic prosthesis with a rigid framework was delivered within 3 to 5 days after surgery. According to the distribution of implants with low insertion torque, provisional prostheses were divided into three groups with different occlusal schemes. Definitive prostheses were fabricated after 3 months of loading. RESULTS: A total of 144 patients were treated; 608 and 304 regular implants were inserted in 118 maxillae and 76 mandibles, respectively. Moreover, 42 patients (11 men and 31 women) with 39 maxillae and 4 mandibles were included in this study. The proportion of implants with low insertion torque values in the maxilla was significantly greater than that in the mandible (10.5% vs 1.6%, respectively, P < .001). Implant length and low insertion torque value had no significant correlation (P = .948). Implants with a 3.3-mm diameter (narrow platform) had a greater proportion of low insertion torque values than 4-mm-wide implants (P = .002). Implants placed in a fresh socket had a greater proportion of insertion torque values ≥ 35 Ncm (P = .023). The overall cumulative implant survival rate was 98.6%. Groups 1, 2, and 3 had 14, 23, and 6 provisional prostheses, respectively. The survival rates for implants with insertion torque values < 35 Ncm and ≥ 35 Ncm were 98.4% and 98.7%, respectively, and were not significantly different (P = .866). All prostheses were still functioning during the mean follow-up of 3.7 ± 1.2 years. CONCLUSION: The high cumulative implant survival rate indicated that implants with a low insertion torque in immediately loaded full-arch provisional prostheses did not jeopardize the outcomes after a corresponding occlusal scheme was used.

Effects of Marginal Bone Loss Progression on Stress Distribution in Different Implant-Abutment Connections and Abutment Materials: A 3D Finite Element Analysis Study.

Peri-implantitis is a common implant-supported prosthesis complication, and marginal bone loss affects the stress distribution in implant systems. This three-dimensional finite element analysis study investigated how bone loss affects the implant assembly; in particular, models including two implant systems with different connection systems (external or internal hexagon), abutment materials (titanium or zirconia), and bone loss levels (0, 1.5, 3, or 5 mm) were created. We observed that the maximum von Mises stress distinctly increased in the groups with bone loss over 1.5 mm compared to the group without bone loss, regardless of the connection system or abutment material used. Moreover, the screw stress patterns with bone loss progression were determined more by the connection systems than by the abutment materials, and the magnitude of the stress on the fixture was affected by the connection systems with a similar pattern. The highest stress on the screw with the external hexagon connection system increased over 25% when bone loss increased from 3 to 5 mm, exceeding the yield strength of the titanium alloy (Ti-6Al-4V) when 5 mm bone loss exists; clinically, this situation may result in screw loosening or fracture. The highest stress on the fixture, exceeding the yield strength of pure titanium, was noted with the internal hexagon connection system and 1.5 mm bone loss. Titanium and zirconia abutments-both of which are clinically durable-presented similar screw and fixture stress patterns. Therefore, clinicians should pay more attention to maintaining the peri-implant bone to achieve the long-term stability of the implant-supported prosthesis.

The Effect of an Er, Cr: YSGG Laser Combined with Implantoplasty Treatment on Implant Surface Roughness and Morphologic Analysis: A Pilot In Vitro Study.

Although laser irradiation and implantoplasty (IP) are both treatment options for peri-implantitis, no studies have yet combined these two treatment solutions. The aim of this study was to identify the effect of an Er, Cr: YSGG laser on the IP surface. In experiment 1, TiUnite anodized surface implants were treated with an Er, Cr: YSGG laser at 0.5 to 2 W on the panel energy setting and 20 Hz under water irrigation. In experiment 2, all implant surfaces were treated with the IP procedure first, then irradiated with the Er, Cr: YSGG laser. All samples were analyzed by stereomicroscopy, scanning electron microscopy (SEM), energy dispersive X-ray spectroscopy (EDS), and surface topography. Stereomicroscopy and SEM revealed no obvious surface change at any energy setting once the surface was polished with the IP procedure, whereas damage was caused to the TiUnite original implant surface when the Er, Cr: YSGG laser panel energy was set at 1 W or higher. EDS showed no significant difference in element composition once the surface was polished with the IP procedure, while a compositional change was detected when the Er, Cr: YSGG laser panel energy was set to 0.5 W or higher to irradiate the original TiUnite surface. Surface roughness may be related to laser irradiation energy, but no significant changes occurred following IP. These results indicated that the Er, Cr: YSGG laser may have little effect on the post-IP surface compared with the virgin TiUnite surface.