Laser Therapy Around Ailing Failing Dental Implants
Although the long-term success of dental implants is relatively high and their function and utility have been widely documented, peri-implant diseases, including peri-implant mucositis and peri-implantitis, are common and can prove to be a clinical conundrum for practitioners. Laser, which is an acronym for “light amplification through stimulation of emission radiation”, therapy may be one of the therapeutic approaches to treat peri-implant disease as an adjunct to nonsurgical or surgical periodontal therapy.21 Commercially available lasers that have been used for implant surface disinfection include: carbon dioxide (CO2), diode, erbium yttrium aluminum garnet (Er:YAG), and neodymium yttrium aluminum garnet (Nd:YAG).21,107-109 Each laser generally has a fixed wavelength that determined the properties of the laser beam and its effects on tissues, materials, and microbes (Figure 4). For example, certain laser types are utilized and designed to target certain substances or tissues, known as chromophores.109 These may include: water, blood, pigmentation, cell types, collagen, bone, minerals, and/or bacteria (Table 2).
Figure 4. Laser beam wavelength is one complete oscillation of the wave above the velocity axis. The most common range of wavelengths for lasers used in periodontology and implant dentistry ranges from 400 – 10,600 nm.
Table 2. Laser types commonly used to treat peri-implant diseases and their properties.
|Diode||450-1064 nm||Melanin, hemoglobin||Hot; soft tissue|
|Neodymium yttrium aluminum garnet (Nd:YAG)||1064 nm||Melanin, hemoglobin||Hot; soft tissue|
|Erbium yttrium aluminium garnet (Er:YAG)||2940 nm||Water, hydroxyapatite||Cold; hard or all tissue|
|Carbon dioxide (CO2)||9300 to 10,600 nm/td>||Water, hydroxyapatite||Hot or cold; soft or all tissue|
Positive treatment outcomes have been recorded in many investigations of laser therapy for peri-implant diseases, confounding risk factors, short follow up periods, and lack of homogeneity and/or transparency in the laser therapy protocols may not allow generalizability of the current data. Benefit of adjunctive laser therapy for peri-implantitis has been demonstrated out to 3 months, but longer term benefits have not been fully elucidated.110 Current evidence also demonstrates inconsistent data regarding laser reduction of bacterial loads on tooth surfaces beyond that achieved with nonsurgical periodontal therapy alone.110-112 While further controlled, long-term studies are necessary to determine the overall efficacy of laser therapy in the treatment of peri-implant diseases, there is data regarding the short-term benefit of laser therapy.18,19