As implant treatment has been integrated in contemporary dental practice, complications with the forms of peri-implant mucositis and peri-implantitis have also increased in prevalence. Peri-implantitis is the more severe biological complication and is defined as an inflammatory disease affecting peri-implant tissues resulting in bone and eventually implant loss. In addition, the treatment of peri-implantitis has currently become a substantial global economic burden. In the current study, a search was conducted in several electronic databases using specific keywords relevant to the article’s main topic. An increasing number of scientific reports have investigated the etiopathology of peri-implant diseases, focusing mainly on peri-implantitis. Microbial biofilm consists an important etiological factor of peri-implant pathology analogous to periodontal diseases. Although several data confirm that peri-implant infections are dominated by gram-negative bacteria, similar to periodontal infections, there is evidence that some cases may harbor a distinct microbiota, including opportunistic microorganisms and/or uncultivable species. Additionally, data support that several parameters, such as genetic predisposition of individual patients, occlusal overload, and local factors such as titanium particles and excess cement, may be implicated in peri-implantitis pathogenesis. Simultaneously, the release of titanium metal particles and their biological consequences or the presence of excess cement in the adjacent peri-implant tissues have also been suggested as factors that contribute to peri-implant pathology. A specific line of research also indicates the role of foreign body response to implant installation. This narrative review aims to discuss the current concepts of etiopathogenetic factors implicated in peri-implantitis.
Purpose The aim of the present systematic review was to address the following focused question: In patients with generalized chronic periodontitis, what is the long-term effect of the Er:YAG or Er,Cr:YSGG lasers, as monotherapy or as adjuvant to mechanical therapy, on the following clinical outcomes: probing pocket depth (PPD), clinical attachment level (CAL), bleeding on probing (BOP), and gingival index (GI). Methods A thorough electronic search was performed in PubMed, Scopus, Cochrane, Web of Science, and Ovid databases according to PRISMA guidelines. The screening process and data extraction was conducted independently by two reviewers. A quality assessment using Cochrane Collaboration Methodology for randomized controlled trials (RCTs) was performed. Results Eight eligible RCTs fulfilled the criteria. Two RCTs utilising Er,Cr:YSGG laser, and six RCTs using Er:YAG laser in conjunction with non-surgical periodontal therapy. The primary outcome was PPD, while the secondary outcomes were CAL, BOP, and GI. When evaluating CAL benefits, two out of two of the included studies, which assessed Er:YAG as monotherapy in 24 months, indicated a significant difference in favor of Erbium lasers compared to SRP. It seems that Erbium lasers perform better in terms of PPD reduction compared to SRP in both 12-month and 24-month follow-up periods, especially with regard to moderate and deep periodontal pockets. The quality assessment revealed that four studies were presented with some concerns, while the rest of the studies were judged to be at low risk of bias. Conclusion It may be advocated that Er:YAG and Er,Cr:YSGG lasers as monotherapy or as adjunct to SRP seem to perform better in terms of CAL and PPD reduction in the long term, especially in deep pockets ≥ 7 mm; nevertheless, limited evidence for appropriate comparability is available in the existing literature.
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