Er,Cr:YSGG Laser Application in Peri-implantitis
Condition: Peri-Implantitis
MeSH terms: Peri-Implantitis
Study type: Interventional

Summary: 
      In the present study, investigators, aimed to evaluate the effect of erbium,
      chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser application combined with
      mechanical debridement (MD) on clinical parameters and biochemical parameters such as
      receptor activator of nuclear factor-kappa B ligand (RANKL) and osteoprotegerin (OPG) in
      patients with peri-implant diseases.
    

Detailed description: 
      Peri-implantitis is a plaque-associated which involves the tissues around dental implants
      characterized by inflammation and progressive loss of the supporting alveolar bone. According
      to a meta-analysis and systematic review, the prevalence of peri-implantitis is about 22%.
      Biofilm, poor plaque control, and poor dental care after dental implant are implicated in the
      etiology of disease.

      Surface decontamination of the implant is the cornerstone of peri-implantitis treatment.
      However, there is no sufficient evidence to demonstrate the superiority of a specific
      decontamination protocol in the literature. Nevertheless, a review recommended the potential
      use of laser-assisted procedures as an adjunct to mechanical instrumentation and implant
      detoxification in both non-surgical and regenerative interventions for the treatment of
      peri-implant diseases. Several studies have examined the role of a variety of laser types in
      both periodontal and peri-implant treatments and laser application has been shown to play a
      central role in wound healing and tissue regeneration.

      Erbium lasers such as erbium, chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) use
      mid-infrared wavelengths which are highly absorbed by water and hydroxyapatite crystals and
      minerals. In a recent in vitro study, Er,Cr:YSGG laser has been shown to be a safe method in
      the treatment of peri-implantitis with the dual wavelength protocol. In the literature, there
      is a limited number of studies using Er,Cr:YSGG laser in the treatment of peri-implantitis in
      the in vivo setting. Although limited, favorable results have been described in a case report
      with 18-month follow-up, case reports of including 11 patients, and randomized-controlled
      clinical studies. Taken together, Er,Cr:YSGG laser seems to be an effective treatment
      modality in reducing clinical symptoms of peri-implantitis.

      The detection of specific biomarkers in the peri-implant crevicular fluid (PICF) is promising
      to objectively evaluate peri-implant inflammation at baseline and assess treatment efficacy.
      Biomarkers are host response molecules which reflect a biological state and help to
      distinguish healthy from diseased tissues or to evaluate disease and its severity.

      Recent discoveries regarding the receptor activator of nuclear factor-kappa B ligand (RANKL)
      and osteoprotegerin (OPG) receptor activator that induce and inhibit osteoclast
      differentiation have shown that both markers play a role in the molecular network of
      peri-implant bone resorption. The RANKL is a member of tumor necrosis factor (TNF)
      superfamily which interacts on osteoclastogenesis. It is secreted by osteoblasts,
      fibroblasts, and activated T cells and is associated with RANK as a surface-bound molecule
      which stimulates osteoclast activity. On the other hand, OPG is a soluble decoy receptor for
      RANKL and expressed by osteoblasts. It also inhibits the osteoclast differentiation and
      prevents the interaction between RANKL and RANK.

      Previous studies have shown high RANKL levels in the crevicular fluid of patients with
      periodontitis and peri-implantitis compared to healthy dental sites. However, there are
      controversial results regarding OPG. Several studies have reported significantly higher OPG
      and RANK levels at peri-implant disease sites compared to healthy implant sites. In addition,
      significantly higher RANKL protein levels and significantly lower OPG protein levels have
      been reported in periodontitis tissue. In a study, the PICF level of soluble RANKL was not
      significantly correlated with clinical parameters and OPG. However, the authors found a
      positive correlation between the total OPG level and PICF volume, bleeding on probing (BoP)
      and gingival index (GI).

      To the best of investigators' knowledge, there is no study investigating the effect of
      Er,Cr:YSGG laser as an adjunct to mechanical debridement (MD) on RANKL and OPG in the
      treatment of peri-implantitis. In the present study, investigators, therefore aimed to
      evaluate the effect of Er,Cr:YSGG laser application combined with MD on clinical parameters
      and biochemical parameters such as RANKL and OPG in patients with peri-implant diseases.
    

Intervention name(s): Er, Cr: YSGG laser-assisted non-surgical mechanical therapy; Non-surgical mechanical therapy
Intervention type(s): Device; Device
Intervention description(s): The laser group received mechanical therapy followed by Er;Cr;YSGG laser. Laser application was performed using the bottom-up technique. Therefore, the tip was retracted about 1 mm after it was placed on the bottom of the pocket and slowly moved in the coronal direction to the parallel to the implant surface.; Traditional non surgical mechanical therapy Mechanical instrumentation in all groups was made with titanium curettes.The curette was gently inserted into the peri-implant pocket and the mechanical therapy was completed with threads felt.
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Er:Cr:YSGG; biomarkers; laser; osteoprotegerin; peri-implantitis; RANKL