Laser Therapy for Adjunctive Treatment of Peri-Implant Disease

This course seeks to evaluate the effectiveness of implant surface decontamination therapies for treatment of peri-implant disease.

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 Prevalence data for peri-implant disease is heterogeneous, but estimates suggest that the prevalence of peri-implant mucositis and peri-implantitis range from 46-63% and 19-23%, respectively.⁷ 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.^8,9 There are several risk factors that can lead to inflammation, peri-implant mucositis, and, later, peri-implantitis.^4,10-12 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.^4,13,14 As bacterial plaque is the primary etiology for peri-implant disease, current therapies for peri-implantitis require dental plaque removal and implant surface detoxification as a critical step for successful surgical and/or nonsurgical treatment of peri-implantitis.^15,16 This surface detoxification has been accomplished with physical, chemical, laser therapy, and/or other means.

Treatment of peri-implantitis is unpredictable. It has been reported that even with strict supportive peri-implant therapy after active treatment for peri-implant disease, complete resolution of disease is not achieved in the majority of cases over the long term.^17,18 Given the paucity of evidence for efficacious treatments of peri-implant disease, it is imperative that clinicians monitor and prevent the development of inflammation and provide intervention at the earliest possible time in the disease process. Further, critical evaluation of available treatment modalities is imperative to understand best practices for treatment of implant diseases.