Numerical study on the three-dimensional temperature distribution according to laser conditions in photothermal therapy of peri-implantitis.

PURPOSE: Dental implants have been successfully implemented as a treatment for tooth loss. However, peri-implantitis, an inflammatory reaction owing to microbial deposition around the implant, can lead to implant failure. So, it is necessary to treat peri-implantitis. Therefore, this numerical study is aimed at investigating conditions for treating peri-implantitis. METHODS: Photothermal therapy, a laser treatment method, utilizes photothermal effect, in which light is converted to heat. This technique has advantage of selectively curing inflamed tissues by increasing their temperature. Accordingly, herein, photothermal effect on peri-implantitis is studied through numerical analysis with using Arrhenius damage integral and Arrhenius thermal damage ratio. RESULTS: Through numerical analysis on peri-implantitis treatment, we explored temperature changes under varied laser settings (laser power, radius, irradiation time). We obtained the temperature distribution on interface of artificial tooth root and inflammation and determined whether temperature exceeds or does not exceed 47℃ to know which laser power affects alveolar bone indirectly. We defined the Arrhenius thermal damage ratio as a variable and determined that the maximum laser power that does not exceed 47℃ at the AA' line is 1.0 W. Additionally, we found that the value of the Arrhenius thermal damage ratio is 0.26 for a laser irradiation time of 100 s and 0.50 for 500 s. CONCLUSION: The result of this numerical study indicates that the Arrhenius thermal damage ratio can be used as a standard for determining the treatment conditions to help assisted laser treatment for peri-implantitis in each numerical analysis scenario.

Efficacy of laser in re-osseointegration of dental implants-a systematic review.

Despite their high success rates, peri-implantitis can affect the stability and function of dental implants. Various treatment modalities have been investigated for the treatment of peri-implantitis to achieve re-osseointegration. An electronic literature search was performed supplemented by a manual search to identify studies published until January 2022. Articles that evaluated re-osseointegration in peri-implantitis sites in animal models following laser therapy or antimicrobial photodynamic therapy (aPDT) were included. Case reports, case series, systematic reviews, and letters to the editor were excluded. Risk of bias and GRADE assessment were followed to evaluate the quality of the evidence. Six studies out of 26 articles identified on electronic search were included in this review. The studies included animal studies conducted on canine models. Four out of six studies reported a higher degree of re-osseointegration following treatment of implants with laser therapy. The findings suggest that laser decontamination shows potential in enhancing re-osseointegration, particularly with the Er: YAG laser, which effectively decontaminated implant surfaces. However, conflicting outcomes and limitations in the evidence quality warrant caution in drawing definitive conclusions. Based on the limited available evidence, laser therapy may show a higher degree of re-osseointegration of implants than mechanical debridement.

The Use of 810 and 1064 nm Lasers on Dental Implants: In Vitro Analysis of Temperature, Surface Alterations, and Biological Behavior in Human Gingival Fibroblasts.

Objective: The primary objective of this study was to evaluate the safety of 810 and 1064 nm laser treatment on dental implants. Background: Peri-implantitis is a challenge for clinicians and researchers. Methods: A pig mandible model was used to evaluate temperature increases during laser irradiation. Surface alterations on processed pure titanium discs were analyzed via scanning electron microscopy and measurement of surface contact angles. Processed titanium discs were cocultured in vitro with human gingival fibroblasts; subsequently, cell proliferation was measured. Results: The maximum temperature and time to reach each threshold were comparable. No surface alterations were detected after 810 nm laser irradiation, whereas surface cracks were observed after 1064 nm laser irradiation under the parameter setting of 31.84 W/cm2. Compared with unaltered processed pure titanium discs, the proliferation of human gingival fibroblasts was significantly greater on altered processed pure titanium discs. Conclusions: The use of either 810 or 1064 nm laser treatments may increase the risk of thermal damage in terms of increased temperature if the parameter setting is not warranted. In addition, the use of 1064 nm laser treatment could lead to changes in pure titanium discs that do not negatively affect cell proliferation. Further investigations of laser-assisted therapy are necessary to improve guidelines concerning the treatment of peri-implantitis. Clinical trial registration number: 2021-P2-098-01.

Temperature limits during irradiation in laser-assisted treatment of peri-implantitis - labo-ratory research.

INTRODUCTION: Peri-implantitis is a relatively new and difficult disease that is becoming more common. Of the different therapeutic options to manage this condition, lasers show certain advantages over other therapeutic alternatives because of their antibacterial potential. AIM: The aim of the present study was to investigate the temperature rise of implant surfaces, soft tissues, and bone during irradiation with diode, CO2, and Er:YAG lasers. MATERIALS AND METHODS: Ten implants inserted in biological models were irradiated with three laser systems with different parameters: a diode laser (980 nm) with power levels of 0.75 W and 1.6 W; a CO2 laser (10600 nm) with power levels of 252 W and 241 W; and an Er:YAG laser (2940 nm) with power levels of 1.5 W, 6.8 W, and 7.5 W. The temperature rise was measured using a specially designed thermal probe (type K thermocouple) with accuracy of ±0.1°C over the range from 20°C to 80°C. The temperature was measured at 5 points - in the implant body, in the mucosa, in the middle part of the implant, in the implant apex, and in the bone around the implant apex. Measurements were obtained at 1 minute working interval. RESULTS: Diode and CO2 lasers with both parameters used increased significantly the temperature of more than 46°C, whereas the temperature in the Er:YAG laser group was less than 30°C. There was a statistically significant difference between diode, CO2, and Er:YAG lasers in favor of the erbium laser. CONCLUSIONS: The Er:YAG laser demonstrates the best thermal properties during irradiation of the implant surface. The three working modes tested - 1.5 W, 6.8 W, and 7.5 W - provide safe intervention on both the soft and bone tissues of the implant interface and on the implant itself.

Efficacy of Er:YAG laser for the peri-implantitis treatment and microbiological changes: a randomized controlled trial.

The aims of this study were to identify the microbiological changes in the periodontal pockets following an Er:YAG laser (ERL) irradiation and mechanical debridement to compare the effectiveness of ERL irradiation to mechanical debridement for peri-implantitis treatment through randomized controlled trials. Twenty-three patients with peri-implantitis lesions were treated in either a test group, ERL set at energy level of 100 mJ/pulse, frequency of 10 Hz, pulse duration was 100 µs, and irradiated by three passages, or a control group, with mechanical debridement using an ultrasonic scaler. An examiner measured the following clinical parameters at different stages (a baseline and at 3- and 6-month post-treatment): probing depth (PD), bleeding on probing (BOP), marginal bone loss (MBL), and anaerobic bacteria counts. Linear regression, with generalized estimation equations, was used to compare the clinical parameters and anaerobic bacterial counts at different stages and between groups. The anaerobic bacterial counts significantly decreased within the control group during the follow-ups. At the 6-month follow-up, both groups showed a significant reduction in PD (test group: mean difference of 0.84 mm; control group: mean difference of 0.41 mm), and the test group showed a significantly higher PD reduction on the buccal site (1.31 mm) compared to that of the control group (0.25 mm). Both ERL and mechanical debridement treatments led to significant improvements in PD. When mechanical debridement therapy was used, significant anaerobic bacterial count reductions were observed. Future treatment of peri-implantitis should involve a combination of both of these therapies.

Impact of Laser Therapy on Periodontal and Peri-Implant Diseases.

Objective: In the last few decades, lasers in dentistry have encompassed all branches in dentistry, with more focus in periodontology. In recent years, the use of lasers against periodontitis and peri-implantitis has undergone a decisive development that has involved various operational areas. The broadest applications were probably found in the clinical approach to soft tissues. Methods: Laser therapy is a novel technique that may provide further beneficial effects to conventional periodontal and peri-implant therapies. However, clinical evidence for the improvement of periodontal wound healing and tissue regeneration through laser treatment is still limited. Results: This review is aimed at assessing the advantages and disadvantages of the use of lasers in dental procedures and pathologies, focusing more on protocols for the management of periodontal and peri-implant diseases. Conclusions: The adjuvant action of laser therapy, in addition to conventional therapies for the management of periodontal and peri-implant disease, could induce benefits, but further investigation would be necessary to standardize better the protocols applied and to understand the actual tissue response to laser therapy.

Adjunctive Diode Laser Therapy and Probiotic Lactobacillus Therapy in the Treatment of Periodontitis and Peri-Implant Disease.

Periodontal and peri-implant diseases are plaque-induced infections with a high prevalence, seriously impairing people's quality of life. The diode laser has long been recommended as adjunctive therapy in treating periodontitis. However, the optimal combination of usage mode (inside or outside periodontal pocket) and application regimen (single or multiple sessions of appointment) has not been described in detail. Meanwhile, probiotic Lactobacillus is regarded as a potential adjuvant in the management of the peri-implant disease. Nonetheless, a detailed protocol for an effective probiotic application is lacking. This article aims to summarize two clinical protocols. For periodontitis, the optimal collaboration of laser usage mode and application regimen was identified. Regarding peri-implant mucositis, a combined therapy containing professional topical use and home administration of probiotic Lactobacillus was established. This updated laser protocol clarifies the relationship between the treatment mode (inside or outside the periodontal pocket) and the number of laser appointments, further refining the existing diode laser therapy. For inside pocket irradiation, a single session of laser treatment is suggested whereas, for outside pocket irradiation, multiple sessions of laser treatment provide better effects. The improved probiotic Lactobacillus therapy resulted in the disappearance of swelling of the peri-implant mucosa, a reduced bleeding on probing (BOP), and an obvious reduction and good control of plaque and pigmentation; however, probing pocket depth (PPD) had limited improvement. The current protocol should be regarded as preliminary and could be further enhanced.

Utilización de láser diodo en el tratamiento de la peri-implantitis: reporte de 3 casos / Use of diode laser in peri-implantitis treatment: report of 3 cases

Los implantes dentales son ampliamente usados para el reemplazo de piezas dentarias y se han convertido en el "gold standard" de las terapias protésicas en odontología. Dado el mayor uso de éstos, las investigaciones epidemiológicas recientes han demostrado elevadas tasas de prevalencia de enfermedad periimplantaria. En el presente estudio se presentan tres casos clínicos diagnosticados con periimplantitis. Todos los casos presentaron aumento de la profundidad al sondaje periimplantario en relación a controles anteriores, supuración, sangramiento al sondaje y pérdida ósea confirmada a través de tomografía computada cone beam. El tratamiento indicado para todos los casos fue una terapia conjunta entre un tratamiento mecánico mediante ultrasonido con la utilización de puntas plásticas (P.I EMS®, Suiza) y la terapia con láser. Para la laserterapia se utilizó un equipo de láser diodo de 940 nm (Biolase®, USA) con una potencia de 2 W en modo CW, utilizando una punta de 300 µm. El láser de diodo no daña la superficie de titanio y es capaz de descontaminar las superficies rugosas de los implantes. En este reporte, el uso de una terapia combinada mecánica y láser fue efectiva en todos los casos. En los controles clínicos, la mucosa periimplantaria no presentó signos de supuración ni sangramiento, y la profundidad al sondaje también se vió disminuída. El nivel óseo se controló a través de una tomografía computada cone beam y no se evidenciaron cambios significativos. En la actualidad, la evidencia clínica para el tratamiento periimplantario mediante la fototerapia todavía es limitada. Sin embargo, el láser ofrece un enfoque técnico novedoso que es completamente diferente de los instrumentos mecánicos y tiene varios efectos beneficiosos, por lo que puede desempeñar un papel importante, en la resolución de la peri-implantitis.

Dental implants are widely used for the replacement of teeth and have become the "gold standard" of prosthetic therapies in dentistry. Given the increased use of these, recent epidemiological investigations have shown high prevalence rates of peri-implant disease. In the present study, three clinical cases diagnosed with peri-implantitis are presented. All cases presented increased depth to peri-implant probing in relation to previous controls, suppuration, bleeding and bone loss confirmed by cone beam computed tomography. The treatment indicated for all cases was a joint therapy between a mechanical ultrasound treatment with the use of plastic tips (P.I EMS®, Switzerland) and laser therapy. For laser therapy, a 940 nm diode laser equipment was used (Biolase®, USA) with a power of 2W in continuous laser beam mode, using a 300 µm tip. The diode laser does not damage the titanium surface and is capable of decontaminating the rough surfaces of the implants. In this report, the use of a combined mechanical and laser therapy was effective in all cases. In clinical controls, the peri-implant mucosa did not show signs of suppuration or bleeding, and the depth on probing was decreased. The bone level was controlled through a cone beam computed tomography and no significant changes were evidenced. At present, the clinical evidence for peri-implant treatment using phototherapy is still limited. However, the laser offers a novel technical approach that is completely different from mechanical instruments and has several beneficial effects, so it can play an important role in the resolution of peri-implantitis.

First Investigation of Dual-Wavelength Lasers (2780 nm Er,Cr:YSGG and 940 nm Diode) on Implants in a Simulating Peri-Implantitis Situation Regarding Temperature Changes in an In Vitro Pocket Model.

Objective: This study aimed to investigate the temperature changes and question the safe laser settings and protocols for laser-assisted peri-implantitis treatment in an in vitro environment. Materials and methods: Three types of implants (Neoss, Dentegris, and Camlog) were implanted in an artificial bone model (n = 15). The model was placed into a 37°C water bath to simulate the in vivo oral condition. Throughout the laser irradiation, K-type thermocouples were used to record the real-time temperature measurements at different anatomically important locations in the artificial bone. Results: In all of the temperature measurements, no temperature rise above the critical safe limit, that is, >47°C, was observed. Conclusions: Within the limitations of this in vitro study, the use of the dual-wavelength protocol [Er,Cr:YSGG (1 and 1.5 W, 25, 50, 75 Hz)] and the 940 nm diode (peak power 2 W, duty cycle 50%) can be considered a safe method in the treatment of peri-implantitis, regarding its thermal safety.

Effect of Various Laser Wavelengths on Temperature Changes During Periimplantitis Treatment: An in vitro Study.

PURPOSE: This study aimed to investigate and compare temperature change during implant decontamination with different laser types (carbon dioxide [Co2]/diode/neodymium-doped yttrium aluminum garnet [Nd:YAG]/erbium-doped yttrium aluminum garnet [Er:YAG]/antimicrobial photodynamic therapy [aPDT]). MATERIAL AND METHODS: Sixty implants were inserted into a bone block cut from a sheep's mandible. A 3 × 8 mm vertical lesion was made at the buccal of each implant. The bone block was placed into a 37°C water bath to simulate the in vivo oral condition. A K-type thermocouple was placed in contact with the implant to register temperature changes at 3 points (apical/middle/coronal). RESULTS: In the entire laser irradiations, the mean of temperature changes remains below 10°C. The apical temperature rise was higher than the coronal and middle regions (P < 0.05), and the apical temperature took longer time to reach the initial temperature (37°C) (P < 0.001). Temperature changes over 10°C occurred at the apical point of the implants with the Co2, Nd:YAG, and diode laser irradiations; however, only the Co2 laser reached the statistical significance in this regard (P < 0.05). CONCLUSION: Our findings indicate the promising results of Er:YAG laser and aPDT in implant decontamination. Precaution should be taken in the application of Nd:YAG, diode, and especially Co2 lasers.

Effect of photodynamic and laser therapy in the treatment of peri-implant mucositis: A systematic review.

BACKGROUND: The present study systematically reviewed the literature to investigate the effect of photodynamic therapy (PDT) or laser therapy (LT) in the management of peri-implant mucositis (p-iM). METHODS: The electronic databases were searched until October 2017. Outcome measures were bleeding on probing (BOP), plaque index (PI), or probing depth (PD). The addressed PICO question was: "Is PDT and LT effective in the management of p-iM?" RESULTS: A total of five studies included in the qualitative analysis, two of which had a low risk of bias. Three studies used PDT while two studies used LT. All studies reported a significant improvement in clinical peri-implant inflammatory parameters in p-iM. For PDT, one study demonstrated a significant reduction for PDT group as compared to manual debridement (MD), while one study indicated comparable outcomes when tested with probiotics at follow-up. One study used PDT alone and indicated significant improvements in peri-implant parameters at follow-up. However, in the studies using LT, one study demonstrated a significant improvement in peri-implant parameters as compared to scaling and root planing alone, while other study indicated comparable outcomes when compared with manual debridement/chlorhexidine group at follow-up. CONCLUSION: This systematic review demonstrated inconclusive findings to show the effect of PDT or LT in the management of p-iM due to methodological heterogeneity such as non-standard control groups, laser parameters and short follow-up period. The results of this review should be considered preliminary and further, more robust, well-designed studies with long-term follow up and standardized comparators with laser parameters are warranted.

Effects of Two Diode Lasers With and Without Photosensitization on Contaminated Implant Surfaces: An Ex Vivo Study.

OBJECTIVE: The aim of this ex vivo study is to assess decontamination potential of two different diode laser wavelengths, with or without the aid of photodynamic therapy, on dental implant surfaces and to evaluate the harmful potential of temperature increase during laser irradiation. MATERIALS AND METHODS: One hundred thirty-two machined sterile implants were placed into sterile porcine bone blocks with standardized coronal angular bony defects and inoculated with Streptococcus sanguinis. Four different treatment protocols were used: 810 or 980 nm laser, with or without photosensitization. Two nontreated control groups were used, one with samples coated with indocyanine green dye. Samples were rinsed and plated on agar plates for subsequent colony count. Irradiation was repeated without contamination at room temperature and in a 37°C water bath monitoring the temperature variation. RESULTS: There is a statistically significant decontamination effect when the laser is used. Both wavelengths minimize contamination. There was modest improvement given by the photosensitization being more marked in the 810 nm groups, but was not statistically significant compared to laser only. A critical temperature increase was never observed when the sample was in a 37°C water bath. CONCLUSIONS: The use of both diode laser wavelengths in implant surface decontamination was efficacious regardless of the use of photosensitization and without dangerous increase of temperature.

Laser-activated transforming growth factor-ß1 induces human ß-defensin 2: implications for laser therapies for periodontitis and peri-implantitis.

BACKGROUND: There is increasing popularity of high-power lasers for surgical debridement and antimicrobial therapy in the management of peri-implantitis and periodontal therapy. Removal of the noxious foci would naturally promote tissue healing directly. However, there are also anecdotal reports of better healing around routine high-power laser procedures. The precise mechanisms mediating these effects remain to be fully elucidated. This work examines these low-dose laser bystander effects on oral human epithelial and fibroblasts, particularly focusing on the role of human ß-defensin 2 (HBD-2 or DEFB4A), a potent factor capable of antimicrobial effects and promoting wound healing. MATERIAL AND METHODS: Laser treatments were performed using a near-infrared laser (810 nm diode) at low doses. Normal human oral keratinocytes and fibroblast cells were used and HBD-2 mRNA and protein expression was assessed with real time polymerase chain reaction, western blotting and immunostaining. Role of transforming growth factor (TGF)-ß1 signaling in this process was dissected using pathway-specific small molecule inhibitors. RESULTS: We observed laser treatments robustly induced HBD-2 expression in an oral fibroblast cell line compared to a keratinocyte cell line. Low-dose laser treatments results in activation of the TGF-ß1 pathway that mediated HBD-2 expression. The two arms of TGF-ß1 signaling, Smad and non-Smad are involved in laser-mediated HBD-2 expression. CONCLUSIONS: Laser-activated TGF-ß1 signaling and induced expression of HBD-2, both of which are individually capable of promoting healing in tissues adjacent to high-power surgical laser applications. Moreover, the use of low-dose laser therapy itself can provide additional therapeutic benefits for effective clinical management of periodontal or peri-implant disease.

Temperature evaluation of dental implant surface irradiated with high-power diode laser.

The prevalence of peri-implantitis and the absence of a standard approach for decontamination of the dental implant surface have led to searches for effective therapies. Since the source of diode lasers is portable, has reduced cost, and does not cause damage to the titanium surface of the implant, high-power diode lasers have been used for this purpose. The effect of laser irradiation on the implants is the elevation of the temperature surface. If this elevation exceeds 47 °C, the bone tissue is irreversibly damaged, so for a safety therapy, the laser parameters should be controlled. In this study, a diode laser of GaAsAl was used to irradiate titanium dental implants, for powers 1.32 to 2.64 W (real) or 2.00 to 4.00 W (nominal), in continuous/pulsed mode DC/AC, with exposure time of 5/10 s, with/without air flow for cooling. The elevation of the temperature was monitored in real time in two positions: cervical and apical. The best results for decontamination using a 968-nm diode laser were obtained for a power of 1.65 and 1.98 W (real) for 10 s, in DC or AC mode, with an air flow of 2.5 l/min. In our perspective in this article, we determine a suggested approach for decontamination of the dental implant surface using a 968-nm diode laser.

Estado atual da peri-implantite / Current status of periimplantitis

Os implantes osseointegrados vêm sendo utilizados com grande frequência na prática odontológica, mostrando uma alta taxa de sucesso. No entanto, atreladas a essa alta previsibilidade de sucesso, estão as suas complicações. Dentre elas está a peri-implantite, que se apresenta como uma infecção microbiana que compromete os tecidos peri-implantares, afetando tecidos moles e duros, levando à reabsorção óssea e consequentemente à perda do implante. Várias modalidades de tratamento têm sido propostas para a peri-implantite, no entanto, não existe ainda na literatura um protocolo bem definido. Sendo assim, o objetivo do presente artigo é fazer uma revisão da literatura acerca do estado atual da peri-implantite, no que diz respeito à etiologia, prevenção e tratamento dessa patologia peri-implantar (AU).

Osseointegrated implants are being used with great frequency in dentistry practice, showing a high success rate. However linked to this high success predictability are its complications. Among them is periimplantitis, that is presented as a microbial infection which affects the peri-implant tissues affecting soft and hard tissues, leading to bone resorption and therefore to implant loss. Many treatment modalities have been proposed to periimplantitis, however, until now, it does not exist a well-defined protocol in literature. Thus the purpose of this article is to review the literature about periimplantitis current status, regarding the etiology, prevention and treatment of this peri-implant disease (AU).

A randomized clinical trial of an adjunct diode laser application for the nonsurgical treatment of peri-implantitis.

OBJECTIVE: In this radiographic and microbiologic split-mouth clinical trial, efficacy of a diode laser as an adjunct to conventional scaling in the nonsurgical treatment of peri-implantitis was investigated. BACKGROUND DATA: Eradication of pathogenic bacteria and infected sulcular epithelium presents a significant challenge in the nonsurgical treatment of peri-implantitis. MATERIALS AND METHODS: Ten patients (mean age, 55.1 years; SD, 11.4) with 48 two piece, rough-surface implants and diagnosed with peri-implantitis were recruited (NCT02362854). In addition to conventional scaling and debridement (control group), crevicular sulci and the corresponding surfaces of 24 random implants were lased by a diode laser running at 1.0 W power at the pulsed mode (λ, 810 nm; energy density, 3 J/cm(2); time, 1 min; power density, 400 mW/cm2; energy, 1.5 J; and spot diameter, 1 mm); (laser group). Healing was assessed via periodontal indexes (baseline and after 1 and 6 months after the intervention), microbiologic specimens (baseline and after 1 month), and radiographs (baseline and after 6 months). RESULTS: Baseline mean pocket depths (4.71, SD, 0.67; and 4.38, SD 0.42 mm) and marginal bone loss (2.71, SD 0.11; and 2.88, SD 0.18 mm) were similar (p = 0.09 and p = 0.12) between the control and laser groups, respectively. After 6 months, the laser group revealed higher marginal bone loss (2.79, SD 0.48) than the control groups (2.63, SD 0.53) (p < 0.0001). However, in both groups, the microbiota of the implants was found unchanged after 1 month. CONCLUSIONS: In this clinical trial, adjunct use of diode laser did not yield any additional positive influence on the peri-implant healing compared with conventional scaling alone.

Periodontal and peri-implant wound healing following laser therapy.

Laser irradiation has numerous favorable characteristics, such as ablation or vaporization, hemostasis, biostimulation (photobiomodulation) and microbial inhibition and destruction, which induce various beneficial therapeutic effects and biological responses. Therefore, the use of lasers is considered effective and suitable for treating a variety of inflammatory and infectious oral conditions. The CO2 , neodymium-doped yttrium-aluminium-garnet (Nd:YAG) and diode lasers have mainly been used for periodontal soft-tissue management. With development of the erbium-doped yttrium-aluminium-garnet (Er:YAG) and erbium, chromium-doped yttrium-scandium-gallium-garnet (Er,Cr:YSGG) lasers, which can be applied not only on soft tissues but also on dental hard tissues, the application of lasers dramatically expanded from periodontal soft-tissue management to hard-tissue treatment. Currently, various periodontal tissues (such as gingiva, tooth roots and bone tissue), as well as titanium implant surfaces, can be treated with lasers, and a variety of dental laser systems are being employed for the management of periodontal and peri-implant diseases. In periodontics, mechanical therapy has conventionally been the mainstream of treatment; however, complete bacterial eradication and/or optimal wound healing may not be necessarily achieved with conventional mechanical therapy alone. Consequently, in addition to chemotherapy consisting of antibiotics and anti-inflammatory agents, phototherapy using lasers and light-emitting diodes has been gradually integrated with mechanical therapy to enhance subsequent wound healing by achieving thorough debridement, decontamination and tissue stimulation. With increasing evidence of benefits, therapies with low- and high-level lasers play an important role in wound healing/tissue regeneration in the treatment of periodontal and peri-implant diseases. This article discusses the outcomes of laser therapy in soft-tissue management, periodontal nonsurgical and surgical treatment, osseous surgery and peri-implant treatment, focusing on postoperative wound healing of periodontal and peri-implant tissues, based on scientific evidence from currently available basic and clinical studies, as well as on case reports.

Comparison of the efficacy of different types of lasers for the treatment of peri-implantitis: a systematic review.

PURPOSE: To evaluate the efficacy of various types of lasers (neodymium-doped yttrium-aluminum-garnet [Nd:YAG], carbon dioxide [CO2], diode, erbium/chromium-doped yttrium-scandium-gallium-garnet [Er,Cr:YSGG], and erbium-doped yttrium-aluminum-garnet [Er:YAG]) in the treatment of peri-implantitis and their use in surgical and nonsurgical procedures. MATERIALS AND METHODS: Human studies for the treatment of peri-implantitis with laser therapy, published between 2002 and January 2014, were collected utilizing the electronic databases PubMed, Ovid, MEDLINE, Cochrane, and Google Scholar. Two reviewers conducted the study selection, data collection, and validity assessment. RESULTS: Eight hundred twelve studies were selected in the initial title search; 13 studies were then chosen for this review. No human studies evaluated the effect of the Nd:YAG laser on peri-implantitis. The CO2 laser is reported to be safe and able to enhance bone regeneration. The diode laser (980 nm) seems to be effective in its bactericidal effect without changing the implant surface pattern. The Er,Cr:YSGG laser was reported to obtain bone regeneration around a failing implant in one case, while the Er:YAG laser exhibits a strong bactericidal effect against periodontopathic bacteria at a low energy level. CONCLUSION: Although lasers have shown promising results in reducing clinical signs of peri-implantitis, because of the limited sample sizes and short follow-up periods, no firm conclusion can be drawn at this moment. Hence, there is a need for more well-designed, longitudinal, randomized controlled clinical trials.