Adjunctive Implant Surface Decontamination for Treatment of Peri-Implant Disease
Course Number: 696
Course Contents
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.
Table 2. Laser types commonly used to treat peri-implant diseases and their properties.
Laser Type | Wavelength | Chromophore | Classification |
---|---|---|---|
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 |
Adjunctive use of laser therapy has been shown to result in decreases in clinical signs of inflammation at 3 months136-139 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.