Adjunctive efficacy of diode laser in the treatment of peri‐implant mucositis with mechanical therapy: A randomized clinical trial

Anti-biofilm activity of 445 nm and 970 nm diode laser on mixed species colonies of- aggregatibacter actinomycetemcomitans and porphyromonas gingivalis cultured on titanium discs -an in vitro study

To assess and compare the anti-microbial efficacy of 445 nm and 970 nm diode laser on mixed species biofilm of Aggregatibacter actinomycetemcomitans [A.a] and Porphyromonas gingivalis [P.g] cultured on machined pure titanium discs. A total of 65 machined pure titanium discs with no surface modifications with a 10-mm diameter and a 2-mm height were sterilized by autoclaving at 121 °C for 15 min and incubated with the commercially available bacterial strains ATCC(American Type Culture Collection- P.g 33277 and A.a 29522)mixture of Aggregatibacter actinomycetemcomitans(A.a) and Porphyromonas gingivalis(P.g).After a 2-week incubation period with the mixture of bacteria to develop a mixed species biofilm, the discs were divided into three groups: (1) no treatment (control), (2) 445 nm laser (test), (3) 970 nm laser (test). For each laser wavelength (445 and 970 nm), the discs were exposed to 1.0 W and 2.0 W in continuous wave mode for the times points of 15, 30, and 60 s. The antimicrobial efficacy was assessed by qPCR. A significant reduction in the levels of both species of bacteria was observed between control and the laser intervention groups. A higher efficacy for the 445 nm diode laser against Porphyromonas gingivalis and a similar efficacy against Aggregatibacter actinomycetemcomitans was observed as compared to the 970 nm group. 445 nm wavelength represents a potential and effective laser wavelength which can be used for the management of peri-implant infection. The present study findings also need to be further validated through clinical interventional trials.

Erythritol powder airflow for the treatment of peri-implant mucositis: A randomized controlled clinical trial

OBJECTIVES

Peri-implant mucositis is a biofilm-related, reversible inflammatory disease that can evolve into peri-implantitis if not adequately treated. The aim of the present randomized controlled clinical trial was to evaluate the efficacy of air-abrasive powder as compared to chlorhexidine (CHX) for the treatment of peri-implant mucositis, in terms of clinical and patient-reported outcomes (PROMs) and occurrence of peri-implantitis 12 months after treatment.

METHODS

In the control group, full-mouth calculus and plaque removal was performed with ultrasound and manual devices, and a 1.0% CHX gel was applied; in the test group, supra- and subgingival biofilm removal was performed using erythritol powder with a dedicated nozzle and calculus removal was performed with ultrasonic instruments if needed. Bleeding and plaque indexes, peri-implant probing depth and tissue level were measured at 1 week, and 1, 3, 6 and 12 months after treatment, while PROMs were evaluated up to 7 days after treatment.

RESULTS

Among 80 included implants, 70 were analysed at 12 months follow-up (30 in the test group, 40 in the control group, and 20 subjects). Success rates (implant-level) in terms of bleeding index were significantly different between the test (96.7%) and control group (92.5%); as for PROMs, only taste sensation was significantly better in the test group. The test group was significantly correlated to the smallest changes in peri-implant probing depth between baseline and 3 months.

CONCLUSIONS

The study showed that both treatment strategies are effective. This suggests that the use of air-abrasive powders could be used as an alternative biofilm removal method instead of adjunctive treatments with antiseptics.

A novel investigational preclinical model to assess fluence rate for dental oral craniofacial tissues

OBJECTIVE

Photodynamic Therapy (PDT) and Photobiomodulation (PBM) are recognized for their potential in treating head and neck conditions. The heterogeneity of human tissue optical properties presents a challenge for effective dosimetry. The porcine mandible cadaver serves as an excellent model and has several similarities to human tissues of the dental oral craniofacial complex. This study aims to validate a novel modeling system that will help refine PDT and PBM dosimetry for the head and neck region.

METHODS AND MATERIALS

Light transmission was analyzed through several tissue combinations at distances of 2 mm to 10 mm. Maximum light fluence rates (mW/cm2) were compared across tissue types to reveal the effects of tissue heterogeneity.

RESULTS

The study revealed that light fluence is affected by tissue composition, with dentin/enamel showing reduced transmission and soft tissue regions exhibiting elevated values. The porcine model has proven to be efficient in mimicking human tissue responses to light, enabling the potential to optimize future protocols.

CONCLUSION

The porcine mandible cadaver is a novel model to understand the complex interactions between light and tissue. This study provides a foundation for future investigations into dosimetry optimization for PDT and PBM.

The Efficacy of Ten Different Adjunctive Measures in Patients with Nonsurgically Treated Peri-Implant Disease: A Network Meta-Analysis of Randomized Controlled Trials

Objective: This study aimed to evaluate the impact of 10 adjunctive measures on non-surgical therapy outcomes for peri-implant disease. Methods: We formulated the study question and keywords following the Population, Intervention, Comparator, Outcome framework. Randomized controlled trials were identified through searches in PubMed, Embase, the Cochrane Library, and the Web of Science. Two researchers assessed the quality of included literature according to the Cochrane Risk of Bias Assessment Tool. Data analysis and ranking were performed using Stata 15.0 software. Results: This study, involving 51 pieces of literature and 2660 samples, conducted a network meta-analysis (NMA), which revealed that photodynamic therapy (PDT) significantly reduced probing pocket depth values in patients with peri-implant mucositis (SUCRA = 96.3%) and peri-implantitis (SUCRA = 96.7%). In addition, it showed an improvement in bleeding on probing (BOP) values for peri-implantitis (SUCRA = 91.6%). Furthermore, diode lasers improved BOP values for peri-implant mucositis (SUCRA = 76.5%). Conclusions: According to the NMA results and the surface under the cumulative ranking curve (SUCRA), PDT and diode laser outperform other adjuncts in peri-implant disease.

Periodontal Disease Monitoring by Raman Spectroscopy of Phosphates: New Insights into Pyrophosphate Activity

(1) Background: The intent of this survey was to investigate the quality of the alveolar bone by revealing the different phases for calcified tissues independent of the medical history of the patient in relation to periodontal disease by means of Raman spectroscopy and then to correlate the results by suggesting a possible mechanism for the medical impairment; (2) Methods: The investigation was mainly based on Raman spectroscopy that was performed in vivo during surgery for the selected group of patients. The targeted peaks for the Raman spectra were according to the reference compounds (e.g., calcium phosphates, other phosphates); (3) Results: The variation in the intensity of the spectrum correlated to the specific bone constituents' concentrations highlights the bone quality, while some compounds (such as pyrophosphate, PPi) are strongly related to the patient's medical status, and they provide information regarding a physiological process that occurred in the calcified tissues. Moreover, bone sample fluorescence is related to the collagen (Col) content, enabling a complete evaluation of bone quality, revealing the importance of collagen matrix acting as a load-bearing element for Calcium phosphate (CaP) deposition during the complex bone mineralization process; (4) Conclusions: We highlight that Raman spectroscopy can be considered a viable investigative method for in vivo and rapid bone quality valuation through oral health monitoring.

Evaluation of the adjunctive use of Er:YAG laser or erythritol powder air-polishing in the treatment of peri-implant mucositis: A randomized clinical trial

AIM

To assess the efficacy of Er:YAG laser (ERL) and erythritol powder air-polishing (AP) in addition to the submarginal instrumentation in the non-surgical treatment of peri-implant mucositis (PM).

MATERIALS AND METHODS

Patients with at least one implant diagnosed with PM were included in the present 6-month randomized clinical trial (RCT). Implants were randomly assigned to one of the three treatment groups after submarginal instrumentation: AP (test 1 group), ERL (test 2 group) or no adjunctive methods (control group). The primary and secondary outcomes were, respectively, bleeding on probing (BoP) reduction and, complete disease resolution (total absence of BoP) and probing pocket depth (PPD) changes. The patient and the implant were considered the statistical unit. A multivariate logistic regression analysis was performed.

RESULTS

A total of 75 patients were enrolled in the study. At each time point, significant BoP and PPD reductions were observed within each group. Intergroup analysis did not show statistically significant differences. Complete disease resolution ranged between 29% and 31%. The logistic regression showed that supramucosal restoration margin, PPD < 4 mm and vestibular keratinized mucosa (KM) significantly influenced the probability to obtain treatment success.

CONCLUSION

The adjunctive use of AP and ERL in PM non-surgical therapy does not seem to provide any significant or clinically relevant benefit in terms of BoP and PPD reductions and complete disease resolution, over the use of submarginal instrumentation alone. Baseline PPD < 4 mm, presence of buccal KM and supramucosal restoration margin may play a role in the complete resolution of PM.

Evaluation of the effectiveness of diode laser therapy in conjunction with nonsurgical treatment of peri-implantitis

PURPOSE

Peri-implantitis (PI) is an inflammatory condition associated with the destruction of bone tissue around a dental implant, and diode lasers can be used to treat this disease. In this study, we aimed to evaluate the effectiveness of a 940-nm diode laser for the nonsurgical treatment of PI.

METHODS

Twenty patients (8 women and 12 men) were enrolled in a split-mouth randomized controlled study. In the control group (CG), mechanical debridement with titanium curettes accompanied by airflow was performed around the implants. The test group (TG) was treated similarly, but with the use of a diode laser. Clinical measurements (plaque index, gingival index [GI], probing pocket depth [PPD], bleeding on probing [BOP], clinical attachment level, and interleukin-1β [IL-1β] in the peri-implant crevicular fluid) were evaluated and recorded at baseline and 3 months. IL-1β levels were determined using the enzyme-linked immunosorbent assay method.

RESULTS

The symptoms were alleviated in both groups at 3 months as assessed through clinical measurements. GI, BOP, and PPD were significantly lower in the TG than in the CG (P<0.05). The IL-1β level increased post-treatment in both groups, but this increase was only statistically significant (P<0.05) in the CG.

CONCLUSIONS

The diode laser enabled improvements in clinical parameters in the peri-implant tissue. However, it did not reduce IL-1β levels after treatment. Further studies about the use of diode lasers in the treatment of PI will be necessary to evaluate the effects of diode lasers in PI treatment.

Is Laser Therapy an Adjuvant in the Treatment of Peri-Implant Mucositis? A Randomized Clinical Trial

(1) Background: Early diagnosis and treatment of peri-implant mucositis may reduce inflammatory markers and halt the progression of the condition to peri-implantitis. Adjunctive laser treatment may have therapeutic benefits that are not yet well known. The aim of this study was to determine the advantages and limitations of laser therapy as an adjuvant in the treatment of peri-implant mucositis. (2) Methods: A total of 42 patients with at least 2 implants situated in different hemiarches were included in this study and divided into two groups: G1 (received laser therapy) and G2 (no laser therapy). Periodontal health status indices were recorded at the initial moment (T0), and all patients underwent non-surgical debridement therapy accompanied by oral hygiene training. In patients from group G1, one implant site received adjuvant laser therapy (subgroup IL), and the other one did not receive active laser light (IC). The plaque index (PI), probing pocket depth (PPD), and bleeding on probing (BOP) values recorded after 3 months (T1) and 6 months (T2) were analyzed and compared with those at T0. (3) Results: PI values considerably reduced at moment T1 and T2 for both G1 and G2 (p = 0.0031). PPD was also reduced, but the difference between the groups and the three recording moments was not statistically significant. Statistically significant differences were found when comparing the BOP values between G1 IL and G1 IC for T0/T1 (p = 0.0182) and T1/T2 (p < 0.0001), but there was no significant difference between G2 and G1 IL or G1 IC. (4) Conclusions: Laser therapy as an adjunct to conventional treatment of peri-implant mucositis leads to a statistically significant reduction in bleeding on probing at 3-month and 6-month re-evaluations. Moreover, it leads to an evident reduction in probing depth but with no statistical significance. These results should be interpreted with caution, and more in-depth research should be performed to create a complete laser therapy protocol for peri-implant mucositis.

Comparative evaluation of the antibacterial activity of red diode laser therapy and 0.2% chlorhexidine against Aggregatibacter actinomycetemcomitans on implant healing abutments: An ex vivo study

Aims

The intraoral microbiota has a high potential to undergo dysbiosis, causing inflammatory changes with respect to the tissues surrounding either a natural tooth or an implant. Thus, the longevity of implant prosthesis depends on a thorough implant decontamination protocol. Among all the techniques available for doing so, laser is garnering increasing popularity, owing to minimal bleeding, high efficiency, and faster healing. However, limited literature exists regarding the superiority of lasers over chlorhexidine (CHX), the indisputable gold standard antibacterial chemical agent. The aim of this study was to compare the percentage of bacterial reduction of Aggregatibacter actinomycetemcomitans from implant healing abutments post red diode laser therapy versus 0.2% CHX treatment.

Settings and Design

The current study had an ex vivo, observational, case-control design.

Materials and Methods

Patients reporting for the second stage of the implant surgery were taken as the source of data and the healing abutments, the clinical samples. Eleven patients were chosen with one intraoral implant serving as the test site for laser treatment and another, the control site for CHX treatment. Microbiological analysis was performed via quantitative real time polymerase chain reaction to compare the bacterial reduction percentage after each treatment.

Statistical Analysis Used

Repeated measures ANOVA and independent sample t test were used.

Results

The mean bacterial viability of the test group (laser) was 1.2%-1.6%, and 0.6%-1.4% for the control group (CHX). The former caused a mean bacterial reduction of 96.1% while the latter, 96.3%. Both the treatments caused a highly statistically significant reduction of viable bacterial counts (P = 0.001). However, when compared, there was no statistically significant difference in the bacterial reduction, when compared in between the two (P = 0.902).

Conclusion

Laser treatment is at par with chemical implant surface decontamination. It can help bypass the complications of CHX and revolutionize the protocols for implant surface decontamination.

Diode Laser as an Adjunctive Treatment for Peri-implant Mucositis: A Systematic Review and Meta-analysis

The early detection and management of peri-implant mucositis may help in reducing inflammatory parameters and arrest disease progression to peri-implantitis. The potential therapeutic benefits of different adjunctive therapies, such as the diode laser, are still not completely understood. The objective of this systematic review and meta-analyses was to assess the outcomes of using diode laser on the management of peri-implant mucositis in terms of changes in periodontal parameters. Electronic databases were searched to identify randomised controlled trials (RCTs) that compared the combined use of mechanical debridement and diode laser with mechanical debridement alone. A specific risk-of-bias tool was used to assess the risk of bias. Data were analysed using a statistical software programme. In total, 149 studies were found. A meta-analysis of 3 RCTs showed no statistically significant differences in probing pocket depths (mean difference [MD], -0.36; 95% confidence interval [CI], -0.88 to 0.16; P = .18) or bleeding on probing (MD, -0.71; 95% CI, 1.58-0.16; P = .11) between the 2 groups at 3 months. In the management of peri-implant mucositis, the combined use of diode laser and mechanical debridement did not provide any additional clinical advantage over mechanical debridement alone. Long-term, well-designed RCTs are still needed.

A comparative evaluation of lasers and photodynamic therapy in the nonsurgical treatment of peri-implant diseases: A Bayesian network meta-analysis

PURPOSE

We conducted this Bayesian network meta-analysis (NMA) to evaluate the safety and efficacy of different lasers and PDT compared to conventional mechanical debridement (CMD) for peri-implant treatment.

METHODS

The Web of Science, Cochrane Library and PubMed databases were searched for randomized clinical trials (RCTs) assessing the clinical effectiveness of adjunctive PDT, different lasers, and CMD until January 1st, 2022. Clinical outcomes were the changes in pocket probing depth (PPD), marginal bone loss (MBL), and clinical attachment level (CAL).

RESULTS

Twenty-three studies, including 4 types of lasers, were included. Compared to that with CMD alone, PPD reduction was significantly more efficient in the diode laser (LD)+CMD groups (MD, 0.53; 95%CI, 0.13-0.93) and the PDT+CMD groups (MD, 0.83; 95%CI, 0.32-1.34) than in the CMD group in the follow-up period. Moreover, PDT+CMD treatment also showed a significantly better marginal bone level gain (MD, 0.32; 95%CI, 0.06-0.57). No significant effect on ΔCAL was observed among the different treatment strategies. Despite no differences in PPD reduction, MBL and CAL gains were found among the adjunctive laser treatment groups, PDT+CMD had the highest ranking probability of the most effective treatment in these clinical indices of periodontitis. The certainty of evidence for all outcomes was judged as very low to moderate.

CONCLUSIONS

Within the limits of this NMA, we found that adjunctive PDT achieved a small additional benefit on PPD reduction and MBL gain compared with CMD alone and had the highest probability of being ranked first on the changes in PPD, MBL and CAL. PDT+CMD may represent an alternative method for peri‑implant treatment. Further high-quality RCTs are needed to assess the influence of potential confounders on the efficacy of lasers and PDT.

Soft tissue features of peri‐implant diseases and related treatment

BACKGROUND

The need for soft tissue grafting at implant sites for preventing and treating peri-implant diseases is a currently investigated and debated topic.

PURPOSE

The aim of this manuscript is to explore the inflammatory mechanisms at the peri-implant soft tissue compartment, to distinguish the structural components of the peri-implant soft tissue phenotype and their role on peri-implant health, and to appraise the clinical indications and expected outcomes of soft tissue augmentation procedures at peri-implant diseased sites.

MATERIALS AND METHODS

This narrative review depicts the inflammatory biomarkers and mediators in the peri-implant crevicular fluid utilized to diagnose peri-implant disease and that have been shown to be associated with peri-implant soft tissue phenotype modification and disease resolution. The impact of the peri-implant soft tissue phenotype, involving keratinized mucosa (KM) width, attached mucosa (AM), mucosal thickness (MT), and supracrestal tissue height (STH), on peri-implant health, esthetic, patient's comfort and disease prevention are discussed. The manuscript also illustrates the use of ultrasonography for the detection of peri-implant health/disease and the evaluation of the treatment outcomes following surgical therapies.

RESULTS

Current evidence indicates that soft tissue phenotype modification at implant sites with inadequate KM width, AM and MT can be beneficial for promoting peri-implant health and improving patient's comfort and hygiene procedures. Treatment approaches and outcomes from the available literature on soft tissue phenotype modification in combination with conventional techniques at sites with peri-implant mucositis or peri-implantitis are presented and discussed in detail.

CONCLUSIONS

Soft tissue grafting can be beneficial in preventing and treating peri-implant diseases. Clinical recommendations based on the disease, soft tissue phenotype characteristics and bone defect morphology are provided for a comprehensive hard- and soft-tissue-oriented treatment of peri-implant disease.

Clinical, microbiological and immunological effects of 3- or 7-day systemic antibiotics adjunctive to subgingival instrumentation in patients with aggressive (stage III/IV grade C) periodontitis: a randomized placebo-controlled clinical trial

AIM

To evaluate the clinical non-inferiority of a 3-day-protocol of systemic antibiotics adjunctive to subgingival instrumentation (SI) compared to a 7-day-protocol in patients with stage III/IV grade C periodontitis.

METHODS

50 systemically healthy patients (32.7±4.3 years) with aggressive periodontitis (stage III/IV grade C periodontitis) were treated by SI and adjunctive amoxicillin and metronidazole randomly assigned to group A: (n=25) 500mg antibiotics 3-times-daily for 3 days, followed by placebo 3-times-daily for 4 days, or group B: (n=25) 500mg AB 3-times-daily for 7 days. Clinical, microbial and immunological parameters were assessed at baseline, 3 and 6 months, and patient-related outcomes after 2 weeks. The primary outcome variable was the number of residual sites with PD≥6mm at 6 months.

RESULTS

For the primary outcome variable (the number of residual sites with PD≥6mm at 6 months), the null hypothesis was rejected and demonstrated the non-inferiority of the 3d AB protocol compared to 7d AB (the upper limits of the 95%CI for ITT: [-2.572; 1.050] and PP: [-2.523; 1.318] were lower than the assumed margin of Δ=3.1). Comparable clinical improvements were obtained for all parameters with both antibiotic protocols (p>0.05). All investigated periodontopathogens and pro-inflammatory host-derived markers were statistically significantly reduced, without differences between the treatments (p>0.05).

CONCLUSION

These findings indicate that in patients with aggressive periodontitis (stage III/IV grade C periodontitis), a 3-day systemic administration of amoxicillin and metronidazole adjunctive to SI may lead to non-inferior clinical outcomes after 6-months with fewer adverse events compared to a 7-day-protocol.

The effectiveness of adjunctive measures in managing peri-implant mucositis: an umbrella review

OBJECTIVES

The purpose of this umbrella review was to gather and summarize the data from published systematic reviews (SRs) that compared non-surgical mechanical debridement (NSMD) with and without the use of adjunctive treatments on the management of peri-implant mucositis (PIM).

MATERIALS AND METHODS

A protocol was developed and registered in PROSPERO (CRD42021254350) before the systematic search for the SRs. Seven electronic databases, including Cochrane Library, Embase (via Ovid), MEDLINE (via Pubmed), Proquest, Prospero, Scopus and Web of Science, were searched for published reviews. The search for unpublished and informally published reviews was further attempted in the last four databases. The methodological quality of the included reviews was assessed using AMSTAR 2.

RESULTS

Twelve included SRs assessed clinical studies published between 2014 and 2020, including a total of seventeen primary clinical trials. All SRs summarized data from individual studies and provided a narrative conclusion regarding the effectiveness of the adjunctive treatments. Only six SRs performed a meta-analysis (MA) of additional benefits of the adjunctive therapy for PIM, with results indicating no significant difference between the different treatment modalities. The overall confidence was adjudged ranging from critically low to low using AMSTAR 2 and significant additional benefits of any adjunctive treatments in comparison with NSMD were not apparent.

CONCLUSION

Overall, the reviewed evidence did not support the use of adjunctive treatments for improvement of clinical outcomes in PM management as compared to NSMD alone.

Evaluation of Adjuvant Systems in Non-Surgical Peri-Implant Treatment: A Literature Review

Can the use of lasers, ozone, probiotics, glycine and/or erythritol, and chlorhexidine in combination with non-surgical peri-implant treatment have additional beneficial effects on the clinical parameters? Objectives: The non-surgical treatment of peri-implant pathologies is based on mechanical debridement to eliminate bacterial biofilm and reduce tissue inflammation; some additional therapies have been studied to achieve more detailed clinical results. Materials and methods: A literature search for publications until January 2022 was conducted. The research question is formulated following the Problem, Intervention, Comparison/Control, and Outcome. Studies investigating adjunctive therapies were included. Results: In total, 29 articles were included. Most of the studies did not show any additional benefit of these therapies in the evaluation of bleeding on probing, probing pocket depth, or plaque index; among the proposed treatments, the use of laser was the one most studied in the literature, with the achievement of a reduction of bleeding and pocket depth. More studies would be needed to assess the benefit of other therapies. Conclusions: This review showed no significant improvements in the state of health in support of mechanical debridement therapy. However, the few benefits found would deserve to be considered in new clinical studies.

Evaluation of Adjuvant Systems in Non-Surgical Peri-Implant Treatment: A Literature Review

Can the use of lasers, ozone, probiotics, glycine and/or erythritol, and chlorhexidine in combination with non-surgical peri-implant treatment have additional beneficial effects on the clinical parameters? Objectives: The non-surgical treatment of peri-implant pathologies is based on mechanical debridement to eliminate bacterial biofilm and reduce tissue inflammation; some additional therapies have been studied to achieve more detailed clinical results. Materials and methods: A literature search for publications until January 2022 was conducted. The research question is formulated following the Problem, Intervention, Comparison/Control, and Outcome. Studies investigating adjunctive therapies were included. Results: In total, 29 articles were included. Most of the studies did not show any additional benefit of these therapies in the evaluation of bleeding on probing, probing pocket depth, or plaque index; among the proposed treatments, the use of laser was the one most studied in the literature, with the achievement of a reduction of bleeding and pocket depth. More studies would be needed to assess the benefit of other therapies. Conclusions: This review showed no significant improvements in the state of health in support of mechanical debridement therapy. However, the few benefits found would deserve to be considered in new clinical studies.

Efficacy of alternative or adjunctive measures to conventional non-surgical and surgical treatment of peri-implant mucositis and peri-implantitis: a systematic review and meta-analysis

Purpose

To evaluate the efficacy of alternative or adjunctive measures to conventional non-surgical or surgical treatment of peri-implant mucositis and peri-implantitis.

Material and methods

Prospective randomized and nonrandomized controlled studies comparing alternative or adjunctive measures, and reporting on changes in bleeding scores (i.e., bleed0ing index (BI) or bleeding on probing (BOP)), probing depth (PD) values or suppuration (SUPP) were searched.

Results

Peri-implant mucositis: adjunctive use of local antiseptics lead to greater PD reduction (weighted mean difference (WMD) = − 0.23 mm; p = 0.03, respectively), whereas changes in BOP were comparable (WMD = − 5.30%; p = 0.29). Non-surgical treatment of peri-implantitis: alternative measures for biofilm removal and systemic antibiotics yielded higher BOP reduction (WMD = − 28.09%; p = 0.01 and WMD = − 17.35%; p = 0.01, respectively). Surgical non-reconstructive peri-implantitis treatment: WMD in PD amounted to − 1.11 mm favoring adjunctive implantoplasty (p = 0.02). Adjunctive reconstructive measures lead to significantly higher radiographic bone defect fill/reduction (WMD = 56.46%; p = 0.01 and WMD = − 1.47 mm; p = 0.01), PD (− 0.51 mm; p = 0.01) and lower soft-tissue recession (WMD = − 0.63 mm; p = 0.01), while changes in BOP were not significant (WMD = − 11.11%; p = 0.11).

Conclusions

Alternative and adjunctive measures provided no beneficial effect in resolving peri-implant mucositis, while alternative measures were superior in reducing BOP values following non-surgical treatment of peri-implantitis. Adjunctive reconstructive measures were beneficial regarding radiographic bone-defect fill/reduction, PD reduction and lower soft-tissue recession, although they did not improve the resolution of mucosal inflammation.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40729-021-00388-x.

Erbium, chromium-doped: yttrium, scandium, gallium, garnet and diode lasers in the treatment of peri-implantitis: clinical and biochemical outcomes in a randomized-controlled clinical trial

This study aims to evaluate the effects of 940 nm diode laser and 2780 nm erbium, chromium-doped: yttrium, scandium, gallium, garnet (Er,Cr:YSGG) laser used in addition to mechanical therapy in the non-surgical treatment of peri-implantitis on clinical parameters and matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of metalloproteinase-1 (TIMP-1) levels in the peri-implant crevicular fluid. A total of 50 patients with peri-implantitis were randomized into three groups to receive peri-implant treatment. The control group (n = 17) only received conventional non-surgical mechanical therapy. The trial groups [(diode group (n = 16) and Er,Cr:YSGG group (n = 17)] received dental laser in addition to mechanical therapy. Gingival index (GI), plaque index (PI), bleeding on probing, probing depth (PD), MMP-9, and TIMP-1 levels were assessed at baseline (T0) and at 6 months after treatment (T1). The GI, PI, and PD significantly decreased in all groups at T1, compared to T0 (p < 0.05). The decrease in the PD was similar between the control and diode groups with Er,Cr:YSGG providing more reduction (1.16 ± 0.64 mm) than either method (p = 0.032). A significant intra-group decrease in MMP-9 level was only observed in the Er,Cr:YSGG group (p = 0.009). The decrease in TIMP-1 level from T0 to T1 was similar between the control and the diode groups (p > 0.05) and it was significantly lower than the decrease in the Er,Cr:YSGG group (p < 0.05). Addition of diode laser to non-surgical mechanical therapy does not provide any additional benefit for treatment outcomes. The Er,Cr:YSGG laser seems to be more efficient both at clinical and molecular levels. ClinicalTrials, ID: NCT04730687. Registered 13 April 2021. Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04730687.

Ozonized Water Administration in Peri-Implant Mucositis Sites: A Randomized Clinical Trial

Peri-implant mucositis represents an inflammatory lesion of the mucosa surrounding an endosseous implant, without the loss of the supporting peri-implant bone. Considering its reversible nature, every effort should be made to contrast it, thus avoiding the eventual progression towards peri-implantitis. The aim of the present randomized clinical trial is to evaluate the efficacy of the ozonized water against peri-implant mucositis. A total of 26 patients diagnosed for this latter clinical condition were randomly divided according to the professional oral hygiene protocol performed on the pathological sites at baseline, at T1 (1 month), and T2 (2 months). Group 1 underwent an ozonized water administration (experimental treatment), whereas Group 2 underwent a pure water one (control treatment). Both administrations were performed with the same professional irrigator (Aquolab® professional water jet, Aquolab s.r.l. EB2C S.r.l., Milano, Italy) with no differences in color or taste between the two substances delivered. At each appointment, the following indexes were assessed: the Probing Pocket Depth (PPD), Plaque Index (PI), Bleeding on Probing (BoP), and Bleeding Score (BS). As regards intragroup differences, in Group 1 ozonized water significantly and progressively reduced all the clinical indexes tested, except for PI in the period T1–T2, whereas no significant differences occurred within the control group. Despite this, no significant intergroup differences were generally detected between the two treatments. Accordingly, the role of ozone for the management of peri-implant mucositis deserves to be further investigated.

Short-term efficacy of a gel containing propolis extract, nanovitamin C and nanovitamin E on peri-implant mucositis: A double-blind, randomized, clinical trial

OBJECTIVE

To determine the efficacy of a gel containing propolis extract, nanovitamin C and nanovitamin E as adjuvant to mechanical debridement in the treatment of peri-implant mucositis (PM).

BACKGROUND

Propolis has anti-inflammatory and antibacterial effect that may improve peri-implant health.

METHODS

A randomized, double-blind study was performed on patients with at least one implant with PM. Participants received a professional prophylaxis and were instructed to use either test or a control gel as toothpaste three times/day for 1 month. Clinical and microbiological parameters were evaluated. PM resolution was considered in absence of bleeding on probing (BOP). Data were analysed with Mann-Whitney U, Wilcoxon signed-rank and chi-square tests.

RESULTS

Forty-six patients participated (23 in each group). After treatment, 26.1% of test patients showed complete PM resolution versus 0% in control group (p = .02). Significant reductions were observed in plaque index (p = .03), BOP (p = .04) and probing depths (p = .027) in test compared with control group. The reduction in Tannerella forsythia was statistically greater in test than in control group at 1-month follow-up (p = .02). Porphyromonas gingivalis was statistically reduced in test group from baseline to 1-month follow-up (p = .05).

CONCLUSION

Test gel clinically improved PM and showed certain antimicrobial effect after 1 month in comparison with control group. Further long-term clinical trials are required to confirm these results.

The diode laser as coadyuvant therapy in the non-surgical conventional treatment of peri-implant mucositis: A systematic review and meta-analysis

Background

The present study systematically reviewed randomized controlled trials (RCT) to investigate the effect of diode laser therapy in the management of peri-implant mucositis.

Material and Methods

The electronic databases were searched until January 2020. Outcome measures were bleeding on probing (BOP), plaque index (PI) and probing depth (PD). The addressed PICO question was: Is the diode laser therapy effective reducing the signs of inflammation as an adjunctive element in the non-surgical treatment of peri-implant mucositis?.

Results

Eight randomized clinical trials (RCTs) were included in the systematic review for qualitative synthesis and three in the meta-analysis for quantitative synthesis. All studies included in the quantitative synthesis have low risk of bias according to the Cochrane collaborations’ tool. Diode laser as coadyuvant therapy significantly reduced plaque index (SMD: -1.24; -0.47/-1.53) but not in bleeding on probing (SMD: -0.84; -0.31/-1.53) or probing pocket depth (SMD: -1.36; -0.28/-1.69). Non-statistically significant reductions in peri-implant bleeding on probing and in probing pocket depth were also observed in the test groups of most studies included in the meta-analysis.

Conclusions

The results should be interpreted cautiously due to the great heterogeneity in the methodology of the studies included in the systematic review. However the meta-analysis suggests that the use of diode lasers, as an adjunct in conventional non-surgical treatment of peri-implant mucositis, is promising in reducing the clinical signs of peri-implant mucositis, especially reducing the perii-implant plaque index.

Key words:Peri-implant diseases, peri-implant mucositis, laser therapy, diode laser.

Efficacy of different lasers of various wavelengths in treatment of peri-implantitis and peri-implant mucositis: A systematic review and meta-analysis

Aim

Peri implant diseases lead to pathological changes in the peri implant tissues and loss of osseointegration. The purpose of this analysis is to evaluate the effect of various lasers and photodynamic therapy (PDT) on peri implant diseases compared to conventional procedures.

Setting and Design

This meta analysis was conducted as per the Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines.

Materials and Methods

A systematic search of the electronic databases such as PubMed, ICTRP, CT.gov, Embase, and Cochrane Library was done additional to manual search of peer review article on peri-implant diseases. Eleven randomized control clinical trials were included in which laser therapy and PDT were used as an interventional procedure.

Results and Statistical Analysis Used

Review Manager 5.03 (RevMan, Nordic Cochrane Center, Copenhagen, Denmark), and random effects model were used to assess mean difference (MD). Bivariate differential mean statistic was used in intergroup estimate with 95% confidence interval (CI). I2 test statistics was applied for heterogenity and P < 0.05 was considered significant statistically. The literature search yielded a total of 113 articles among which 11 articles were included for quantitative analysis. The selected outcome PD reported MD -0.01 with 95% CI (-0.13, 0.16), P = 0.84, and CAL reported MD -0.09 with 95% CI (-0.32, 0.14), P = 0.45, respectively.

Conclusion

Laser treatment as an adjunctive therapy or monotherapy in peri implantitis does not show any superior effects than conventional measures as per evidence. However, cases with peri implant mucositis have shown far more promising results with laser therapy compared to peri implantitis.

Current Approaches for the Non-surgical Management of Peri-implant Diseases

Purpose of the Review

Peri-implant diseases are inflammatory reactions to bacterial infections affecting osseointegrated dental implants. In recent years, scientific interest on this topic has increased, as demonstrated by the appearance of a large number of protocols for treating peri-implant mucositis (PIM) and peri-implantitis (PI). The aim of the present narrative review is to provide an overview of the recent (e.g., 2014–present) published protocols for the non-surgical treatment of peri-implant diseases.

Recent Findings

Several adjunctive measures for mechanical debridement have been proposed and investigated to achieve implant surface decontamination and resolution of mucosal inflammation. However, none of the adjunctive measures has been shown to significantly improve peri-implant conditions compared with non-surgical mechanical debridement alone.

Summary

Non-surgical approaches for the treatment of peri-implant diseases have been proved to be reliable in reducing clinical signs of peri-implant inflammation (e.g., BoP), although with limited capability to achieve complete disease resolution. Due to the limited benefits from the use of currently proposed adjunctive methods (e.g., chlorhexidine, lasers, photodynamic therapy, systemic probiotics) their application is not recommended until further investigations prove their clinical utility.

Adjunctive Use of Lasers in Peri-Implant Mucositis and Peri-Implantitis Treatment: A Systematic Review

BACKGROUND

The aim of this systematic review is to compare the effectiveness of lasers in the treatment of implant mucositis and peri-implantitis compared to conventional treatment (non-surgical or surgical: resective or regenerative).

METHODS

Sources of PubMed, Cochrane and Google Scholar search engines were used on articles published from 1997 to 2020 in English, with selected keyword criteria applied. Nine randomized controlled trials (RCTs) were selected.

RESULTS

All included studies were considered of "high quality" according to the quality assessment scale. The comparative assessment of the RCTs was done twice for each RCT based on the type of treatment and according to wavelength. There is strong scientific evidence that, regarding non-surgical treatment, adjunct laser application can provide better results only in the short term (three months). Regarding the surgical approach, the method of decontamination plays a subordinate role. All wavelengths/applications presented similar results.

CONCLUSION

Within the limitations of this study, the adjunctive use of lasers in the treatment of peri-implant inflammation is effective for up to three months; there is no strong evidence regarding the long term benefit compared to conventional treatment.

Evaluation of adjunctive efficacy of diode laser in the treatment of peri-implant mucositis: a randomized clinical trial

Peri-implant disease may affect survival of dental implants. The aim of the study is to analyze the effectiveness of diode laser as a supportive modality to the non-surgical conventional treatment of peri-implant mucositis (PiM) and initial peri-implantitis (PI). Twenty-three patients with single implants suffering from PiM or initial PI were selected and randomly divided into two groups; control group (CG) received non-surgical conventional treatment, and test group (TG) received non-surgical conventional treatment and diode laser application with wavelength of 980 nm. Probing pocket depth (PPD) and bleeding on probing (BOP) were recorded at baseline (T0) and at 3 months follow-up (T1). The average of PPD value for TG was 4.04 ± 0.54 mm at T0 and it was 2.98 ± 0.70 mm at T1. In the CG, PPD average was 3.8 ± 1.24 mm at T0 and was 3.54 ± 0.35 mm at T1. In TG, the BOP was positive in 44 sites at T0 and in 6 sites at T1. In CG, the BOP was positively observed in 52 sites at T0 and in 28 sites at T1. The 980-nm diode laser may be considered an adjunct to the conventional non-surgical treatments of PiM and initial PI.

One-year clinical outcomes following non-surgical treatment of peri-implant mucositis with adjunctive diode laser application

BACKGROUND

Limited information is available on the application of diode laser in the treatment of peri-implant diseases. The aim of this study was to investigate the clinical efficacy of the adjunctive application of diode laser in the non-surgical treatment of peri-implant mucositis during a 12-month follow-up period.

METHODS

The sample was composed of 73 systemically healthy patients with one implant diagnosed with peri-implant mucositis (bleeding on probing [BoP] with no loss of supporting bone). Implants were randomly assigned to mechanical debridement with hand and powered instruments and 980-nm diode laser application (test group, N.=38) or mechanical debridement alone (control group, N.=35). At the completion of active treatment patients were included in a periodontal maintenance program. Recalls were provided every three months in both treatment groups for reinforcement in oral hygiene instructions and professional implant cleaning with rubber cups. Baseline parameters were repeated at 3 and 12 months postoperatively.

RESULTS

Intragroup analysis showed that plaque index, BoP and probing depth presented statistically significant improvements when compared with baseline values (all P<0.001). No statistically significant difference in clinical outcomes was observed between treatment groups at each time point. At 12 months no significant difference in the percentage of sites showing BoP resolution was observed between test (60.9%) and control treatment (52.6%), as well.

CONCLUSIONS

Based on the present results, the adjunct use of diode laser showed little but not statistically significant additional benefits in the treatment of peri-implant mucositis after an observation period of one year.

Clinical effect of diode laser on peri-implant tissues during non-surgical peri-implant mucositis therapy: Randomized controlled clinical study

Background

The aim of this study is to evaluate the response to the non-surgical treatment of peri-implant mucositis using the diode laser as an adjuvant therapy in patients with implant-supported restorations, in terms of clinical variables, with respect to those patients in whom conventional non-surgical therapy is used.

Material and Methods

Randomized controlled clinical trial with simple blind 3 months follow-up. Two groups of patients were established, the non-surgical mechanical debridement of the affected implants was performed in the control group (n = 34) and the diode laser therapy was also performed in the test group (n = 34). The implant was considered the study subject; the variables considered were plaque index, bleeding on probing depth, depth of probing and recession of the peri-implant mucosa. The t-Student test was used to establish the intergroup statistical differences and the analysis of variance (ANOVA) was used to measures intragroup differences over time.

Results

In the revaluation at 6 weeks, we observed statistically significant differences (p<0.05) between the variables of plaque index and depth of probing between both groups. The test group obtained an average of 0.248 ± 0.3155 in plaque index and 0.833 ± 0.374mm in the depth of probing compared to the results obtained in the control group that was 0.558 ± 0.526 and 1,137 ± 0.222mm respectively. In the 3-month reevaluation, was also obtained great statistical significance between both groups for bleeding on probing (p<0.001), with values of 0.568 ± 0.282 for the control group and 0.480 ± 0.336 for the test group.

Conclusions

The use of diode laser as an adjunctive therapy to the conventional treatment of peri-implant mucositis showed promising results, being more effective reducing the inflammation of the peri-implant tissue, positioning itself as a valuable tool for the treatment of peri-implant pathologies. Key words:Peri-implant diseases, peri-implant mucositis, laser therapy, diode laser, biostimulation.