- Continuing Education
Peri-implantitis has been defined as an inflammatory process that affects the soft and hard tissues surrounding an osseointegrated implant in function demonstrating loss of supporting marginal bone.4,23 Peri-implantitis is, in many ways, an analogous disease to periodontitis, in that it affects the hard and soft tissues around implants and it is initiated by oral bacterial biofilms.9,24,25 The definitive treatment of peri-implantitis may be more challenging than that of periodontitis. In a recent review of studies examining peri-implantitis treatment with at least a one-year follow up, peri-implantitis was shown to be difficult to fully resolve with up to 100% of cases recurring with some treatment modalities.14 This indicates that frequent monitoring and retreatment of this chronic disease may be necessary. Furthermore, a practitioner’s ability to effectively treat peri-implantitis may differ based upon the severity of the presenting levels of attachment loss and the treatment modality used for treatment.11,14,26,27, Based upon this, early intervention and preventive therapy of peri-implant diseases should be an integral part of therapy to maintaining implants in health and function.11,28
There are several risk factors that can lead to inflammation, peri-implant mucositis, and, later, peri-implantitis.4,6,9 These include dental plaque accumulation, smoking, patients’ systemic health conditions, implant design, surgical technique, prosthetic design/procedures, and occlusal forces.9-11 While these systemic and environmental factors certainly play a role in disease progression and susceptibility, peri-implant diseases are initiated by accumulation of bacterial biofilm.4,12,13 Therapies to treat peri-implant diseases have focused upon dental plaque removal and implant surface detoxification as a part of surgical and/or nonsurgical treatments.11,15 Many methods have been used to remove bacteria from dental implant surfaces and the surrounding inflamed tissues. These include: mechanical debridement, chemical detoxification, and laser therapy.16,29-31 Laser is an acronym for “light amplification by stimulation of emission radiation.” The energy generated from the laser is delivered to the target, in this case bacteria, and the components of target tissues are vaporized. Lasers that have been used to perform implant surface detoxification include: Er:YAG, Nd;YAG, carbon dioxide, and diode lasers with or without photodynamic therapy. Currently, however, the data are not robust enough at this juncture to fully assess the efficacy all of these laser treatment modalities.4,14,16,17,21-23 While human clinical studies have investigated the use of laser therapy as an adjunct to non-surgical and surgical therapies to treat peri-implantitis, recent reviews do not draw a definitive conclusion about the long-term efficacy of laser therapy.17,18 As the number of endosseous dental implants placed continues to increase, the cumulative incidence of peri-implantitis is also increasing. It is thus critical to evaluate the current literature, scientific method of action, and determine adjunctive benefits of laser therapy in patients with peri-implantitis who may seek treatment.