Laser Implant Surface Decontamination

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).^132-135 The specific functions and targets of these lasers are summarized in Table 2.

Adjunctive use of laser therapy has been shown to result in decreases in clinical signs of inflammation at 3 months^136-139 and bleeding on probing at six months after treatment, but the effect on other clinical parameters demonstrated minimal benefit.¹³⁶ 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.^136,140 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.¹⁴¹

Additionally, given the current evidence, only Er:YAG, diode, and CO2 lasers can be reliably assessed.^{140,142, 143} 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.