Erbium, chromium-doped: yttrium, scandium, gallium, garnet and diode lasers in the treatment of peri‐implantitis: clinical and biochemical outcomes in a randomized-controlled clinical trial
“…The number of patients treated in the included studies ranged from 20 (10 subjects per group) to 63 (31–32 subjects per group), and their mean age ranged from 40.5 to 68.5 years. Three studies reported on the smoking status, two of which included non‐smokers (Alpaslan Yayli et al, 2022; Schwarz et al, 2006), while the third one included five (out of 25 subjects) smokers (Roccuzzo et al, 2022). Only one study reported on the periodontal status of the treated subjects who all had a history of treated periodontitis and were successfully attending a supportive periodontal care (SPC) programme (Roccuzzo et al, 2022).…”
Aim
To evaluate the efficacy of non‐surgical submarginal peri‐implant instrumentation with mechanical/physical decontamination compared to non‐surgical submarginal instrumentation alone or with placebo decontamination in patients with peri‐implantitis.
Materials and Methods
Three focused questions were addressed, and a systematic search for randomized controlled clinical trials (RCTs), controlled clinical trials, and prospective cohort studies with definitions of peri‐implantitis and a minimal follow‐up of 6 months was conducted. The main outcome variables were reduction in pocket probing depth (PD) and bleeding on probing (BOP). Suppuration on probing, marginal peri‐implant bone level changes, patient‐related outcomes and adverse events, implant survival, treatment success, and disease resolution were assessed as secondary outcomes.
Results
Out of 239 findings, full‐text articles were assessed for eligibility, and 9 (n = 9 RCTs) were included in the present review. Five studies evaluated the effects of various laser types, and in four studies efficacy of air‐abrasive mechanisms and of a novel ultrasonic device was determined. At 6 months, PD reductions were observed in nine studies but only Er, Cr:YSGG laser‐treated group showed statistically significant higher reductions compared to the control group. BOP was statistically significantly reduced at 6 months in two studies following the application of Er:YAG laser compared to controls. One study reported statistically significant reduction in BOP following application of air‐polishing device compared to control treatment. No statistically significant differences between treatment groups were reported for the secondary outcome variables. Owing to the large heterogeneity of study designs, no meta‐analysis was performed.
Conclusions
Available evidence on the efficacy of non‐surgical submarginal peri‐implant instrumentation with mechanical/physical decontamination is limited by the small number of controlled studies and the high heterogeneity of study protocols. Clinical and patient‐reported benefits remain to be demonstrated.
“…The number of patients treated in the included studies ranged from 20 (10 subjects per group) to 63 (31–32 subjects per group), and their mean age ranged from 40.5 to 68.5 years. Three studies reported on the smoking status, two of which included non‐smokers (Alpaslan Yayli et al, 2022; Schwarz et al, 2006), while the third one included five (out of 25 subjects) smokers (Roccuzzo et al, 2022). Only one study reported on the periodontal status of the treated subjects who all had a history of treated periodontitis and were successfully attending a supportive periodontal care (SPC) programme (Roccuzzo et al, 2022).…”
Aim
To evaluate the efficacy of non‐surgical submarginal peri‐implant instrumentation with mechanical/physical decontamination compared to non‐surgical submarginal instrumentation alone or with placebo decontamination in patients with peri‐implantitis.
Materials and Methods
Three focused questions were addressed, and a systematic search for randomized controlled clinical trials (RCTs), controlled clinical trials, and prospective cohort studies with definitions of peri‐implantitis and a minimal follow‐up of 6 months was conducted. The main outcome variables were reduction in pocket probing depth (PD) and bleeding on probing (BOP). Suppuration on probing, marginal peri‐implant bone level changes, patient‐related outcomes and adverse events, implant survival, treatment success, and disease resolution were assessed as secondary outcomes.
Results
Out of 239 findings, full‐text articles were assessed for eligibility, and 9 (n = 9 RCTs) were included in the present review. Five studies evaluated the effects of various laser types, and in four studies efficacy of air‐abrasive mechanisms and of a novel ultrasonic device was determined. At 6 months, PD reductions were observed in nine studies but only Er, Cr:YSGG laser‐treated group showed statistically significant higher reductions compared to the control group. BOP was statistically significantly reduced at 6 months in two studies following the application of Er:YAG laser compared to controls. One study reported statistically significant reduction in BOP following application of air‐polishing device compared to control treatment. No statistically significant differences between treatment groups were reported for the secondary outcome variables. Owing to the large heterogeneity of study designs, no meta‐analysis was performed.
Conclusions
Available evidence on the efficacy of non‐surgical submarginal peri‐implant instrumentation with mechanical/physical decontamination is limited by the small number of controlled studies and the high heterogeneity of study protocols. Clinical and patient‐reported benefits remain to be demonstrated.
“…In general, studies showed no additional benefit from the application of lasers at 6 months, in terms of either PD or BOP reductions. Only in one study did the adjunctive application of a Er,Cr:YSGG laser show statistically significantly larger PD reductions at 6 months, compared with sub‐marginal instrumentation alone (Alpaslan Yayli et al, 2022). An Er:YAG laser as monotherapy (Schwarz et al, 2005, 2006) led to statistically significant differences in BOP.…”
Background
The recently published Clinical Practice Guidelines (CPGs) for the treatment of stages I–IV periodontitis provided evidence‐based recommendations for treating periodontitis patients, defined according to the 2018 classification. Peri‐implant diseases were also re‐defined in the 2018 classification. It is well established that both peri‐implant mucositis and peri‐implantitis are highly prevalent. In addition, peri‐implantitis is particularly challenging to manage and is accompanied by significant morbidity.
Aim
To develop an S3 level CPG for the prevention and treatment of peri‐implant diseases, focusing on the implementation of interdisciplinary approaches required to prevent the development of peri‐implant diseases or their recurrence, and to treat/rehabilitate patients with dental implants following the development of peri‐implant diseases.
Materials and Methods
This S3 level CPG was developed by the European Federation of Periodontology, following methodological guidance from the Association of Scientific Medical Societies in Germany and the Grading of Recommendations Assessment, Development and Evaluation process. A rigorous and transparent process included synthesis of relevant research in 13 specifically commissioned systematic reviews, evaluation of the quality and strength of evidence, formulation of specific recommendations, and a structured consensus process involving leading experts and a broad base of stakeholders.
Results
The S3 level CPG for the prevention and treatment of peri‐implant diseases culminated in the recommendation for implementation of various different interventions before, during and after implant placement/loading. Prevention of peri‐implant diseases should commence when dental implants are planned, surgically placed and prosthetically loaded. Once the implants are loaded and in function, a supportive peri‐implant care programme should be structured, including periodical assessment of peri‐implant tissue health. If peri‐implant mucositis or peri‐implantitis are detected, appropriate treatments for their management must be rendered.
Conclusion
The present S3 level CPG informs clinical practice, health systems, policymakers and, indirectly, the public on the available and most effective modalities to maintain healthy peri‐implant tissues, and to manage peri‐implant diseases, according to the available evidence at the time of publication.
“…Comparable treatment outcomes were recently obtained following non‐surgical mechanical therapy of peri‐implantitis alone or with adjunctive diode laser application (Alpaslan Yayli et al, 2022). It should, however, be pointed out, that adjunctive diode laser with a higher wavelength (i.e., 940 nm) was applied in that study (Alpaslan Yayli et al, 2022).…”
Section: Discussionmentioning
confidence: 97%
“…In that study, implant sites were treated with soft tissue curettage to remove the granulation tissue followed by repeated application of diode laser with a wave length of 810 nm (Mettraux et al, 2016). More recently, comparable treatment outcomes were obtained following non‐surgical mechanical therapy of peri‐implantitis alone or with adjunctive diode laser application with a wave length of 940 nm (Alpaslan Yayli et al, 2022).…”
Objectives
The objective of this study is to investigate the outcomes following non‐surgical therapy of peri‐implantitis (PI) with or without adjunctive diode laser application.
Materials and methods
A double‐blinded randomized controlled clinical trial was carried out in 25 subjects with 25 implants diagnosed with PI. Following curettage of granulation tissue, test implants (T) were treated with adjunctive application of a diode laser for 90 s (settings: 810 nm, 2.5 W, 50 Hz, 10 ms), while at control implants (C) non‐activated adjunctive diode laser was applied. The entire treatment procedure was performed at days 0 (i.e., baseline), 7 and 14. The primary outcome measure was change in mean pocket probing depth (PPD). Clinical and microbiological outcomes, as well as host‐derived inflammatory markers were evaluated at baseline, 3 and 6 months, while radiographic outcomes were assessed at baseline and at the 6‐month follow‐up.
Results
No statistically significant differences with respect to baseline patient characteristic were observed. After 6 months, both test and control implants yielded statistically significant PPD changes compared with baseline (T: 1.28 and C: 1.47 mm) but without statistically significant difference between groups (p = .381). No statistically significant changes in peri‐implant marginal bone levels were detected (p = .936). No statistically significant differences between test and control implants were observed with respect to microbiological and host‐derived parameters (p > .05). At the 6‐month follow‐up, treatment success was observed in 41.7% (n = 5) of test and 46.2% (n = 6) of control patients, respectively (p = .821).
Conclusion
Repeated adjunctive application of diode laser in the non‐surgical management of PI failed to provide significant benefits compared with mechanical instrumentation alone.
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