Treatment of peri-implantitis with diode laser or mucosal flap surgery: A clinical randomized controlled trial.

Background: Peri-implantitis poses a major challenge as contemporary nonsurgical treatments show dissatisfactory results and mucosal flap surgery is often needed. Diode lasers can remove granulation tissue and submucosal bacteria, and if it achieves similar clinical results, then it could be used as a less invasive first approach. The aim was to compare the healing of peri-implantitis lesions 6 months after treatment with either diode laser or conventional mucosal flap surgery.

Methods: In this clinical randomized controlled trial, 26 patients with peri-implantitis were treated with either 970 nm diode laser (1.2 W, continuous wave) or mucosal flap surgery. Clinical variables, marginal bone level (MBL), inflammatory biomarkers, and submucosal pathogens were examined at baseline and 6 months after treatment. Patients graded their pain and discomfort at baseline, directly after treatment, after first week of healing (FWH), and after 6 months. The continued need of care was also noted after 6 months.

Results: Equivalence was not shown between treatments in probing pocket depth (PPD) and MBL. Only plaque index (PI) showed significant changes between groups (p = 0.023). There was a significant difference between surgery (-1.81 ± 0.94 mm) and laser (-0.83 ± 0.40 mm), among those that improved their PPD (p = 0.016). Pain and discomfort were rated low in both groups. Negligible differences were found regarding immunological markers and submucosal bacteria.

Conclusions: The proportion of patients with improved clinical outcomes was similar between the 2 treatment groups, albeit surgical treatment yielded greater pocket reduction. No differences were found in immunological or microbial outcomes.

Plain language summary: Replacing missing teeth with dental implants has become a popular treatment as it is a fixed solution compared to removable dentures. In some cases, the tissue surrounding the dental implant becomes inflected, which can lead to a breakdown of the bone in which the implant is attached; this disease is called peri-implantitis. Treating peri-implantitis has proven to be difficult. Few studies have previously investigated the treatment of peri-implantitis with infra-red laser. The goal was to compare if the healing of the peri-implantitis disease after treatment was comparable between infrared diode laser and conventional surgery, with emphasis on the patients' experiences. The healing was evaluated with clinical examination and assessment of surrounding bone on X-rays, as well as immune response and bacterial samples. We could not statistically confirm that the two treatments were equal in healing outcomes, but they had similar numbers of successful and unsuccessful healing patterns after six months. The surgery had some clinical advantages in the severe cases of peri-implantitis and the laser resulted in less discomfort during the first week of healing.