Using Lasers to Treat Peri-Implantitis?

Whilst Laser use may be effective at removing granulation tissue , the only way to re prepare the implant surface is by using a prophy jet on the Implant being careful not to affect the surrounding bone.

Dear Collague, You can use Er-Yag laser for maneging periimplantitis together with open flap debridement with water effectively.Because Er-Yag laser is very well absorb both bone tissue(hydroxyapatitite) and water.And you can also clean iplant surfece.Lasers are also kills the bacteria during the cleaning of infected area.I have clinical experience and found very succecfull treatment option.Close tecnics are not very effective.You can look Dr.Schwarz F at al.literature.

Dr Charles Cobb in Kansas City can answer ANY questions about lasers. His email is cobb@umkc.edu Good guy

Dear friends, I have used the Er.Yag on the implant itself and it causes pitting of the implant and not effective on the removal of soft tissue granulation.. The CO2 pulsed or cotinous will be effective in removing the granulation and infected tissue. It will not cause overheating of the implant even if the laser beam hits on the implant within reasonable time and power settings. The yag will be absorbed by the implant and heat builds up and will cause thermal damage to the bone and loss of stability of the implants. The 960nm led laser at proper setting using the fiber optic delivery system can be used with caution to remove the infected tissues both on the implants and the periimplant tissues. Results are quite favourable . I like the CO2 to decotaminate the implants. Hope this will help some .

I published a paper in 2004 in Implant Dentistry entitled "Treatment of the Contaminated Implant Surface Using the Er,CR;YSGG laser. You can review my comments on lasers in oral implantology in the Osseonews website Interview section. Laser debridement is, hands down, the definitive protocol for debridement of the ailing dental implant prior to regrafting. We have multi-year follow-ups on many repair cases with outstanding success. Contrary to previous comments, the erbium based lasers, and specifically erbium,chromium at 2780 nm, do not heat the implant surface and therefore will not melt the titanium surface. The object is to have a "surgically clean" interface; one that is indistinguishable from the sterile implant when it was originally placed. The ablative laser is the only instrument that can accomplish this. And, to my friend Don Callan, Dr Cobb is NOT a proponent of lasers as evidenced by his position paper in the AAP journal several years ago.

I'm going to cut through some hyperbole...how exactly did you determined it was indistinguishable from a sterile implant? Statements like that do not support your case as it is not probable or likely even possible. How do you quantify "outstanding" success? Finally, there is no real difference between an erbium and erbium, chromium laser...is there any affiliation we should be aware of..have you used both? There was an article this month in the picture journal as I call it using a CO2...open flap procedures seem required...and there are proponents of the periolase for implants that are failing as well....however, a blinded controlled study to verify the clinical impression is difficult to find.

If you go to pubmed you will find 3 total studies that are RCTs, clinical trials, or meta-analysis: The aformentioned study with Schwartz did not show a difference between the laser or plastic currettes and peridex in the non-surgical treatment of peri-implantitis with the Er:YAG...there's this one from 2000: Conventional versus laser-assisted therapy of periimplantitis: a five-year comparative study.Bach G, Neckel C, Mall C, Krekeler G. Department of Periodontology, University of Freiburg/Breisgau, Germany. doc.bach@t-online.de Between 1994 and 1999, 50 patients were treated with either profound parodontopathy (30) or periimplantitis (20). Half of each of the two groups of patients was treated conventionally, and the other half was treated with laser support. Before the operation, microbiological examinations were carried out, in addition to registering the clinical findings and taking x-rays. These procedures were repeated after the operation, and again after 6, 12, 24, 36, 48, and 60 months. The surgical part of therapy for each half of the patient groups included surface decontamination with diode laser light (1-watt output, maximum of 20 seconds) in addition to conventional procedures. The values of the laser-supported therapy were lower than those specified in the relevant literature. The relapse rate of the two diseases (13% for the periimplantitis and 23% for the parodontopathy group) after 5 years was lower than the comparative values of researched literature where decontamination was not included in the therapy. We think that integrating diode laser light decontamination in the approved treatment schemes for periimplantitis and parodontitis contributes considerably to the success of this therapy. ...the other does not apply: If you accept case reports...you will find more hits of various wavelengths but note this: Conventional versus CO2 laser-assisted treatment of peri-implant defects with the concomitant use of pure-phase beta-tricalcium phosphate: a 5-year clinical report.Deppe H, Horch HH, Neff A. Department of Oral and Maxillofacial Surgery, Technical University of Munich, Germany. herbert.deppe@mkg.med.tum.de PURPOSE: Recently, histologic studies in the beagle dog model demonstrated that CO2 laser-assisted implant decontamination can result in reosseointegration. Consequently, the purpose of this study was to assess the efficacy of CO2 laser-assisted therapy as compared with conventional therapy, with the concomitant use of beta-tricalcium phosphate, in humans. MATERIALS AND METHODS: The study included 32 patients with 73 ailing implants. In the laser group, 22 implants were treated with soft tissue resection following laser decontamination; whereas in 17 implants, bone augmentation was performed. In the control group, soft tissue resection after conventional decontamination was performed in 19 implants, augmentation in 15 implants. Results were evaluated 4 months after surgery and in May 2004. RESULTS: Four months after therapy, there were no significant differences in distance from implant shoulder to the first bone contact (ie, DIB values) between implants undergoing laser decontamination and soft tissue resection and implants treated with conventional decontamination followed by soft tissue resection. At the end of the study, there was a statistically significant difference between these 2 groups. Four months after therapy, DIB values after laser decontamination and augmentation were significantly more favorable than after conventional decontamination and augmentation. This difference was no longer detectable at the end of the study. CONCLUSION: Based on the results of this study, it may be concluded that the treatment of peri-implantitis may be accelerated by using a CO2 laser concomitant with soft tissue resection. However, with respect to long-term results in augmented defects, there seems to be no difference between laser and conventional decontamination.

Cobb would be the last person I would contact regarding Lasers and implants. I recently listened to his lecture in Oregon and found that he has an agenda that, lets just say, was less than sincere.

i agree with robert miller entirely. we have treated several cases of peri implantitis with the 2790 nm wavelength for debridement ,degranulation and reducing the bacterial count .and then used dfdb with a gbr membrane. this protocol was followed and after 3 months we saw bone growth and osseointegration around the faiing implants

Ray Yukna presented at the International Osteology Symposium showing some great results with the Periolase for peri-implantitis. Yukna's poster shows a consistent increase in bone support for both natural teeth and dental implants following the procedure. See http://www.marketwire.com/press-release/laser-periodontal-therapy-with-the-lanapr-protocol-gets-international-recognition-1520734.htm