Academy of Laser Dentistry

J O U R N A L O F L A S E R D E N T I S T R Y | 2 011 V O L . 19 , N O . 3
276
C A S E R E P O R T
Peri-Implantitis Therapy with
an Er:YAG Laser
Avi Reyhanian, DDS, Natanya, Israel
Donald J. Coluzzi, DDS, Portola Valley, California
J Laser Dent 2011;19(3):276-281
S Y N O P S I S
The etiology of peri-implantitis and a treatment protocol using an
Er:YAG laser are described along with a clinical case study with a
successful outcome.
I N T R O D U C T I O N
Osseointegrated dental implants
have become a routinely recommended
procedure in the clinical
practice of dentistry. 1-4 Although
they can be highly successful
restorations, implant failure can
and does still occur. 5-8 Among the
many complications possible in the
procedure, one of the more common
postoperative ones is peri-implant
disease and, within this category,
peri-implantitis. 9
Three major factors contribute
to the failure and complications of
implants:
1. Patient-related factors
2. Iatrogenic (doctor/team) factors
3. Surgical equipment / manufacturer
problems.
Patient and iatrogenic factors
are more prevalent than implant
manufacturing problems.
Implant complications are
divided into two main categories:
Intraoperative and postoperative. 9
Peri-implantitis is a postoperative
complication.
Biofilms form on all hard,
nonshedding surfaces in a fluid
system, i.e., both on teeth and on
oral implants. As a result of the
bacterial challenge, the host
responds by mounting a defense
mechanism leading to inflammation
of the soft tissue. In the
implantomucosal unit this inflammation
is termed “mucositis” which
Reyhanian and Coluzzi
may develop into “peri-implantitis.”
9
Peri-implantitis is an inflammatory
reaction that is associated
with the presence of a submarginal
biofilm, with advanced breakdown
of soft and hard tissue surrounding
the endosseous implant: loss of the
bony support of the implant. 10
The etiology of the disease is
conditioned by the status of the
tissue surrounding the implant,
design of the implant, degree of
roughness, poor alignment of implant
components, external morphology,
and excessive mechanical load. 10
There are two major factors that,
separately or combined, contribute to
the formation of peri-implantitis:
1. Bacterial exposure, especially
gram-negative and anaerobic
species 11-12
2. Overload. 13-14
Clinical signs and diagnosis
include: Bleeding on probing, purulence,
bone loss, pocketing, dull
sound on percussion, peri-implant
radiolucent mobility of the implant,
fistula, and changes of color in the
gingiva and/or the mucosa. 10
Treatment involves either
implant removal, especially if the
fixture is mobile, or therapy,
usually involving surgery and
debridement techniques.
Conventional approaches include:
• Systemic administration of
antibiotics
A B S T R A C T
Peri-implantitis is one of the
complications possible in osseo -
integrated dental implants.
This article discusses the wisdom
and utility of employing an Er:YAG
laser for peri-implantitis therapy. A
clinical case study will demonstrate
how this procedure could replace
the gold standard for peri-implantitis
therapy. This technique using the
Er:YAG laser presents several advantages
vs. conventional treatment
methods, and there are minimal
postoperative complications coupled
with a high rate of success.
Key Words: antimicrobial agents;
bone grafting; bone tissue;
debridement; dental implants;
granulation tissue; guided tissue
regeneration; laser ablation
• Removal of supragingival bacterial
plaque
• Removal of granulation tissue
with plastic curettes
• Debridement of the exposed
surface by using mechanical
brushing, air powder abrasives,
citric acid, disinfectants like
chlorhexidine or topical tetracycline,
plaque inhibitor like
delmopinol, or low-intensity
ultraviolet radiation
• Removal of the peri-implant pocket
• Regeneration of peri-implant
hard tissue by means of guided
tissue regeneration
• Plaque control and oral hygiene.
The Use of the Er:YAG Laser in
Treatment of Peri-Implantitis
The Er:YAG laser interacts with
both hard and soft dental tissues,