Diode laser for treatment of peri-implantitis

Introduction: Prosthetic implant rehabilitations for partial or complete edentulous patients are increasing, sometimes followed by failure due to peri-implantitis, irreversible disease characterized by tissue inflammation, bleeding, probing pocket depth ≥4 mm, bone loss, with/out purulent exudate. Therefore, there are many clinical studies about treatment possibilities. Decontamination of peri-implantitis pockets is one of diode laser applications in dentistry. Despite there is no standardized protocol, the Literature has reported the effectiveness of diode laser decontamination, because of its photothermal effect and photochemical action, and it is suggested as a non-surgical supportive modality for the treatment of peri-implantitis. Materials and methods: This study was carried out on 22 patients of MoMax unit at the Department of Oral and Maxillofacial Sciences of “Sapienza” University of Rome, from March 2016 to July 2017. Inclusion criteria were: age between 20 and 80 years old, presence of at least one single implant, Probing Pocket Depth (PPD) ≥4 and <6 mm, positive Bleeding On Probing (BOP) at implant site and good compliance. Patients were divided into two equal groups: Control Group (CG) and Test Group (TG). Clinical and radiographic examination with ortho-panoramic x-ray and professional oral hygiene were performed in both groups. Only in TG, the sulcus of each implant was divided into 6 sites, and decontamination of the infected pockets was performed by diode laser with wavelength of 980 nm (Raffaello®, Dental Medical Technologies, Lissone, Italy), spot diameter of 0,3 mm, power of 1 W, and energy density of 14,1 J/cm2, in pulsed mode, Ton=10 ms, Toff =50 ms. Laser was applied in the sulcus for 10 seconds on each site. At last, 2% chlorohexidine gel was applied in the sulcus for 5 minutes. The PPD and BOP were evaluated at 12 weeks for both TG and CG. T Student test was used for the statistical analysis of BOP and PPD averages. Results: In the TG, the PPD reduction average was 1.06±0.54 mm at follow-up while BOP was decreased by 83%. In the CG, PPD reduction average was 0.26±0.2 and BOP was decreased by 33±8.06%. A significant statistical difference was found between two groups (p <0.000001). Conclusions: We can conclude that diode laser can be a supportive modality for the non-surgical conventional therapy, as it accelerates the healing process in cases of severe peri-implantitis. Larger cohorts of patients are needed to have more reliable results.