Er:YAG Laser in the Clinical Management of Severe Peri-implantitis: A Case Report
Peri-implantitis is bacterial infections of peri-implant supporting tissues, involving the peri-implant bone. Several treatment protocols have been tested in clinical practice with variable efficacy. The clinical management of peri-implantitis aims for elimination of plaque and calculus, decontamination of the failing implant surface, and regeneration of lost bone tissue. Surface decontamination is an important part of all suggested treatments. This can be accomplished with the use of chemical agents (eg, chlorhexidine) or mechanical (eg, ultrasonic) or photonic (eg, laser) devices. In this report, we present a case of severe peri-implantitis that was successfully managed with a combined nonsurgical and surgical approach. Implant surface debridement/decontamination of the implant surface was achieved with an erbium-doped yttrium aluminium garnet (Er:YAG) laser device.
Figure 1 . Initial examination. (a) Swelling and bleeding on probing around the left posterior implant. (b) Peri-implant bone loss involving more than 50% of the implant length. Figure 2. Nonsurgical scaling and debridement of failing implant. (a) Ultrasonic Teflon tip used for mechanical scaling and implant debridement. (b) Erbium-doped yttrium aluminium garnet (Er:YAG) laser debridement/decontamination of the subgingival implant surface. (c) Special beveled tip delivering direct and angulated laser beams.
Figure 3 . Surgical treatment: (a) Erbium-doped yttrium aluminium garnet (Er:YAG) laser debridement/decontamination. (b) Synthetic bone substitute. Figure 4. Six-month reevaluation. (a) Reduced swelling around the left posterior implant. (b) Peri-implant bone regeneration.
Pocket depth (a) at baseline, (b) 6 weeks after nonsurgical debridement, and (c) 6 months after surgical treatment. Red diamond: bleeding. Yellow diamond: suppuration.
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