10th Dental Facial Cosmetic International Conference

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Laser Treatment in Peri.Implantitis

Abstract

Peri-implantitis is a disease related to dental implant due to persistent bacterial infection. Peri-implantitis if not treated may lead to bone and soft tissue lost. It is latent and often diagnosed at late stage, but it is important to detect it at early stage in order to treat it and prevent bone loss. Several strategies have been used to treat peri-implantitis including surgical and non-surgical methods. Both methods aim to eliminate the bacterial biofilm and infection as well as decrease swelling and inflammation to maintain a healthy state of periodontuim. Recently, laser therapy has been used as adjective therapy to conventional treatments in peri-implantitis. Introduction: Peri-implantitis is a gradual, irreversible infectious disease involving the soft and hard tissue around the implant, accompanied by decreased osseointegration, increased pocket depth, bleeding on probing (BOP) and purulent discharge. It presents 20% of all implanted patients with 6 times higher incidence in patients with a history of periodontitis [1]. Radiographic examination and soft tissue evaluation including swelling, BOP, color changes, suppuration, deep pocket depth and bone resorption are very important steps in diagnosing the peri-implantitis. Its treatment depends on removing the causative bacterial biofilm. The decontamination can be performed by disinfection using chemotherapeutic agents, mechanical debridement, smoothing implant surface and surgeries as well as laser therapy. Recently, the laser therapy was shown to be effective in the elimination of bacterial smear layer and in the treatment of peri-implantitis as an alternative or adjunctive to conventional mechanical therapy. There are several types of laser used in the treatment of peri-implant diseases, they include CO2, Diode, Er:YAG (erbium-doped: yttrium-aluminum-garnet) Er,Cr:YSGG- (erbium, chromium-doped: yttrium scandium-gallium-garnet) and Nd:YAG (Neodymium-Doped Yttrium Aluminium Garnet). Also they are used in the maintenance of peri-implantitis. Using CO2 laser 308 nm leads to efficient results against anaerobic bacteria spectrum showing no significant increase neither in temperature of the implant nor alteration of its surface [2]. It leads to increased osteoblast attachment to implant surfaces which trigger healing process and cause bone formation [3]. On the other hand, using of CO2 lasers at continuous and pulsed settings cause increase in temperature of the implant, which may cause bone necrosis [4]. Also, Diode lasers (DLs) have been grown and evolved as soft-tissue hand pieces, because of their usefulness in being used around implants without creating any high temperature or iatrogenic damage. DLs inactivate bacterial endotoxins resulting detoxification of implant surfaces. It stimulates fibroblast and osteoblast, causing an increase in RNA messenger production, leading to a significant collagen formation without harming the Titanium surface. In addition, the hard-tissue erbium family lasers include Er:YAG and Er,Cr:YSGG, are able to remove effectively biofilms and calculus by 90% and calculus from implant surfaces without injuring implant surfaces. On contrast, when ND: YAG lasers are used, a rise in implant’s temperature was reported which may lead to melting of the titanium implant surfaces, physical change of the hydroxyapatite coating, cracks and porosity loss. Therefore, it is contraindicated in the treatment of peri-implantitis [5]. Furthermore, the photodynamic therapy (PDT) is considered as one of the advanced methods to get rid of bacteria in periodontal sulcus of implant. It takes place by generating reactive oxygen species when photo-sensitizers like toluidine or methylene blue absorb a specific wavelength of light such as diode lasers in the presence of oxygen. This process generates bactericide effects against both aerobic and anaerobic bacteria. PDT has high target specificity with healthy human cells and low probability of microbial resistance, low risk of chemical and thermal side effects respectively [6]. 

Materials & Methods

We used scientific websites such as PubMed, Google Scholar and Research Gate to get related articles about this subject. The research process involved specific key words " peri-implantitis”- laser therapy”- peri-implantitis treatments" to find more articles about the subject. We were more concerned about English published articles only which published from 2005 to 2017. Results: Our initial research yielded 63 articles and excluded 38 articles because they were unrelated to our subject. Only 25 articles were included in our systematic review. Most of them were review articles, original studying articles and case reports. To identify the nature of the disease, we divided the subjects into several points, including the definition, symptoms, prevalence, and diagnosis of peri-implantitis as well as treatment strategies, which involve laser treatment. Several types of laser were found and we reviewed the options of laser treatment to identify the best option for peri-implantitis treatment. This review revealed that clinical parameters and indices were different in some cases, thus a clear and reliable inference could not be made. Some studies used a combination of laser therapy and other procedures. The relative effect of the laser application could therefore not be assessed. The most important part that should be concerned is that a healthy periodontuim surrounding the implant is required to achieve desirable treatment outcomes. It was indicated that the use of diode lasers in combination with nonsurgical periodontal therapy seemed to be an effective alternative treatment strategy for peri-implantitis, and superior to other lasers as it has the ability to sterilize implant surface and stimulate mesenchymal stem cells surrounding bone and soft tissue resulting better healing. 

Conclusion

We concluded that the golden key for the peri-implantitis treatment is early diagnosis, depending on the removal of bacteria that cause infection and inflammation. However, Laser therapy is considered as one of the most effective modalities, especially when combined with conventional mechanical debridement therapy. ER, CO2 and diode lasers can eliminate bacteria without harming the implant surface while ND laser is not suitable for treatment as it causes an increase in the implant’s temperature, hence the dentist should consider several parameters when using laser treatment including laser type, wave length, time of exposure and distance. 

References

• Mombelli A, Muller N and Cionca N.The epidemiology of peri-implantitis. Clin Oral Implant Res; 2012: 23:67–76. • Romanos G. Point of Care. J Can Dent Assoc; 2005 : 71( 2):117-122. • Romanos, G., Crespi, R., Barone, A and Covani, U. Osteoblast attachment on titanium disks after laser irradiation. Int. J. Oral Maxillofac. Implants ; 2006:21:232–236. • Geisinger ML, Holmes CM, Vassilopoulos PJ, Geurs NC and Reddy MS. Is Laser Disinfection an Effective Adjunctive Treatment to Bone Augmentation for Peri-Implantitis? A Review of Current Evidence. Clin Adv Perio; 2014:4(4):274-279. • Gupta S and Mahapatra N. A Review of Perimplantitis and Lasers. IOSR-JDMS; 2015:14(3):01-04. • Alshehri FA. The role of lasers in the treatment of peri-implant diseases: A review. S Dent J; 2016:28: 103–108.

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