Non-surgical treatment of peri-implantitis with the adjunctive use of an 810-nm diode laser
A 45-year-old male presented with pain and swelling at a mandibular implant site (Nobel Biocare, SW). Clinical examination revealed a deep pocket [7-mm pocket depth (PD)] and bleeding on probing [], with suppuration and gingival inflammatory edema at the implant site. The patient was in good general health, did not take any medications, and was an occasional smoker (4-5 cigarettes/day).\nNo occlusal trauma or parafunctional habits were detected.\nA periapical radiograph demonstrated bone loss of five fixture threads on the most distal mandibular left implant, when compared to the original radiograph [].\nThe patient was eventually scheduled for periodontal surgery to treat the inflammatory lesion, but emergency intervention was indicated to disinfect the area by removing the bacterial biofilm and alleviating pain using an 810-nm diode laser []. No local anesthesia or systemic antibiotics were administered.\nThe patient was asked to rinse with undiluted chlorhexidine 0.2% for 1 min. After insertion of the optical fiber parallel to the long axis of the implant 1 mm from the most apical portion of the pocket, the diode insert was moved in an apico-coronal and mesio-distal direction for 30 sec at each inflamed implant site. It was used at a power of 0.5 W in a continuous wave (cw) [equivalent to 1 W in pulsating mode (pw) for 30 s] in duplicate on each site, for a total time of 360 sec with a fluence of 1.96 J/cm2.\nNon-surgical periodontal instrumentation was performed with hand instrumentation using a titan curette (Roncati Implant Care, by Martin KLS) and a piezoelectric ultrasonic device with plastic fused to a metal insert (Piezon Master 700, EMS, PI insert), as needed. Finally, a 0.5% chlorhexidine gel was deposited into the sulcus with a disposable syringe and a blunt needle.\nThese procedures were repeated the following day.\nThe area was checked for plaque removal and home care compliance for the first month on a weekly basis and was followed by routine supportive periodontal therapy at 3-month intervals. The adjunctive use of the diode laser was included in the conventional periodontal maintenance every 6 months for the following 3 years.\nPeriodontal indices were documented and intraoral periapical radiographs were taken at the 1-year [], and 2-, 3-, 4-, and 5-year [Figures and ] follow-up recall appointments.\nSatisfactory results were obtained by the application of laser-assisted non-surgical peri-implant therapy. Periodontal pocket depth was reduced from 7 to 3 mm with no bleeding upon probing. Intraoral periapical radiographs, taken for up to 5 years post-non-surgical treatment, provide evidence of some improvement of the bone level. The reduction of periodontal pockets is probably due to re-epithelialization, with formation of a long junctional epithelial attachment.