Laser‐assisted regenerative surgical therapy for peri‐implantitis: A randomized controlled clinical trial

Abstract

Background

Different surgical approaches have been proposed to treat peri‐implantitis defects with limited effectiveness and predictability. Laser has been proposed as an effective tool to assist in bacterial decontamination and modulating peri‐implant tissue inflammation. The aim of this pilot clinical trial was to evaluate the adjunctive benefits of Er:YAG laser irradiation for regenerative surgical therapy of peri‐implantitis‐associated osseous defects.

Methods and Materials

Twenty‐four patients diagnosed with peri‐implantitis with a radiographic infrabony defect were randomized into two groups. Both test and control groups received the following treatment: open flap mechanical debridement, supracrestal implantoplasty, bone grafting using a mixture of human allograft with demineralized bone matrix human allograft putty, and then covered with acellular dermal matrix membrane. The only difference in the test group was the adjunctive use of Er:YAG laser to modulate and remove inflammatory tissue as well as to decontaminate the implant surface. Clinical assessments, including pocket depth (PD), clinical attachment level (CAL), and gingival index (GI) were performed by calibrated masked examiners for up to 6 months following surgery. Standardized radiographs were also taken to evaluate linear bone gain and defect bone fill. Student t‐tests were used to analyze those clinical parameters.

Results

Both groups showed significant reductions in PD, GI, and CAL gain overtime. The test group demonstrated significantly higher PD reductions at the site level compared to the control group (2.65 ± 2.14 vs. 1.85 ± 1.71 mm; test vs. control, p = 0.014). There were no statistical differences found in CAL gain (1.90 ± 2.28 vs. 1.47 ± 1.76 mm; test vs. control), GI reduction (‐1.14 ± 1.15 vs. ‐1.04 ± 0.89; test vs. control), radiographic linear bone gain (1.27 ± 1.14 vs. 1.08 ± 1.04 mm; test vs. control) or proportional defect size reduction (‐ 24.46 ± 19.00% vs. ‐15.19 ± 23.56%; test vs. control). There was a positive trend for test patients on PD reduction and CAL gain found in narrow infrabony defects. Major membrane exposure negatively impaired the overall treatment outcome of CAL gain (2.47±1.84 vs. 1.03±1.48 mm; no/minor vs. major exposure, p = 0.051) and PD reduction in the test group (‐3.63±2.11 vs. ‐1.66±1.26 mm, p = 0.049).

Conclusion

This pilot study indicated using laser irradiation during peri‐implantitis regenerative therapy may aid in better probing pocket depth reduction. Nonetheless, a larger sample size and longer follow‐up is needed to confirm if Er:YAG laser irradiation provides additional clinical benefits for peri‐implantitis regenerative therapy (Clinicaltrials.gov: NCT03127228)

This article is protected by copyright. All rights reserved

from
https://aap.onlinelibrary.wiley.com/doi/abs/10.1002/JPER.20-0040?af=R