Laser Therapy for Adjunctive Treatment of Peri-implant Disease
Overview

The placement of endosseous dental implants is a well-accepted treatment option for edentulism as implants have demonstrated high survival rates over long periods of time.¹ Dental implants are a common and growing treatment modality and it is estimated that up to 5 million dental implants are placed each year.² While dental implant survival rates remain high, reports indicate that a significant proportion of dental implants will develop peri-implant mucositis and peri-implantitis.^3-6 Inflammatory implant diseases are progressive and it has been shown that the inflammatory lesions associated with peri-implant diseases are larger than those around teeth with similar clinical presentation.^7,8 There are several risk factors that can lead to inflammation, peri-implant mucositis, and, later, peri-implantitis.^4,9-11 Systemic and environmental factors may play a secondary role in disease progression and susceptibility, but peri-implant diseases are initiated by accumulation of bacterial biofilm.^4,12,13 As bacterial plaque is the primary etiology for peri-implant disease, current therapies for peri-implantitis focus upon dental plaque removal and implant surface detoxification as a critical step to surgical and/or nonsurgical treatment of peri-implantitis.^14,15 This surface detoxification has been accomplished with physical, chemical, and/or other means, including laser therapy. A variety of laser types have been used for implant surface detoxification including: Er:YAG, Nd;YAG, carbon dioxide, diode lasers, and photodynamic therapy.^14,16,17 As of yet, there are no definitive data on superiority of laser type or treatment modality in conjunction with either surgical or nonsurgical therapy.^18-20

Additionally, a recent consensus statement from the American Academy of Periodontology confirmed evidence for limited, short-term benefits to adjunctive laser use for peri-implant lesions, but no current definitive evidence regarding the long-term efficacy of this type of therapy.²¹ At present, there is insufficient evidence for the use of lasers of any type used as a monotherapy for the surgical or nonsurgical treatment of peri-implantitis.^21,22 As the number of endosseous dental implants placed continues to increase, the cumulative incidence of peri-implantitis is also increasing. This course seeks to evaluate the use of laser therapy as an adjunctive means of implant surface detoxification in conjunction with surgical and non-surgical therapies.