Pulsed Nd:YAG Laser Treatment for Failing Dental Implants Due to Peri-implantitis

Keywords:laser fiber, medical fibers,  Time:21-03-2016

We introduce a new indication for the application of the pulsed Nd:YAG laser for the successful treatment of the infectious disease, peri-implantitis and peri-mucositis. Pilot data are presented in the form of 16 clinical case reports that provide radiographic evidence of immediate disease reversal and gradual bone regeneration following treatment with the LAPIP protocol.

Peri-implantitis is an inflammatory disease in the bone and soft tissues that surround a dental implant. The tissues are colonized by pathogenic bacteria that gradually cause the degeneration of the alveolar bone that holds the implant in place1,2 Progression of the disease will result in loss of the implant.

It is estimated that annually about 1,000,000 dental implants are removed worldwide.5 The most common risk factor seems to be advanced periodontitis on prior or missing teeth.6,7 Current treatment options both surgical and non-surgical have at the most a 50-60% success rate8 and there appears to be no clear evidence to identify the most effective method of treatment nor is there a standard protocol for management of this  inflammatory process.

We have conducted this study in preparation to running a clinical trial to establish the efficacy of the LAPIP protocol. Before/after radiographs from 26 LAPIP case reports with a successful response to treatment were submitted by 21 dentists in private practices. The time course of the response to treatment is determined from radiographic evidence. A model is developed to estimate the rate of crestal bone deposition following this laser assisted peri-implantitis procedure. Reports were also examined to identify issues for consideration in designing inclusion/exclusion criteria.

The LAPIP protocol specifies application of laser energy around ailing and failing implants in a similar way as the LANAP protocol applies energy around natural dentition.  In both instances, device specific training and accumulated clinical judgment needs to be applied to adjust preset parameters and total dosimetry that is appropriate to the specific clinical presentation.  In LAPIP the light dose used around implants is approximately one third the energy applied around natural teeth, primarily due to less dissipation of heat in implants and the greater fragility of the tissue surrounding them.