Lasers as an Adjunct to Non-surgical and Surgical Peri-implant Therapy

A variety of peri-implant treatments have been proposed including: nonsurgical therapy, open flap debridement, resective and regenerative procedures, implantoplasty, lasers for implant surface decontamination, and a combination of these therapies.¹¹³ It has been shown that peri-implant mucositis can be treated using non-surgical treatment,^55,94 but peri-implantitis generally requires surgical interventions.^45,114,115 Adjunctive use of laser therapy has been shown to result in decreases in clinical signs of inflammation at 3 months¹¹⁰ and bleeding on probing at six months after treatment, but the effect on other clinical parameters demonstrated minimal benefit.^18,19 While the preponderance of the current literature body presented does not present definitive findings demonstrating a clinical or microbiological improvement after adjunctive laser therapy, laser therapy with appropriate wavelength and settings can be used effectively to detoxify titanium surfaces without alteration of the surface morphology.^20,116-118 Additionally, some of the risks of laser therapy may be mitigated by the use of photodynamic therapy (PDT), which uses low-level laser therapy to perform surface decontamination. Recent in vitro studies have indicated that PDT may be more efficient than standard laser disinfection protocols without many of the associated risks.¹¹⁹ Additionally, given the current evidence, only Er:YAG, diode, and CO₂ lasers can be reliably assessed.^18,19,120 Given the decreased risk of damage to tissues and implants with the use of appropriate time, wavelength, presence of cooling and laser power and the ability of the lasers to detoxify titanium surfaces, they may be a viable adjunctive therapy with nonsurgical and surgical implant treatment, although additional investigations are necessary to standardize protocols and classify expected outcomes.