Er,Cr:YSGG and Diode Lasers in the Treatment of Peri-implantitis
Condition: Peri-Implantitis
MeSH terms: Peri-Implantitis
Study type: Interventional

Summary: 
      In this study, 940 nm diode laser and 2780 nm erbium, chromium doped: yttrium, scandium,
      gallium, garnet (Er, Cr: YSGG) laser were used in the non-surgical treatment of peri-implant
      diseases in addition to mechanical treatment. And the effects of dental lasers on clinical
      parameters and matrix metalloproteinase 9 (MMP-9) and tissue inhibitors of matrix
      metalloproteinases-1 (TIMP-1) levels in peri-implant crevicular fluid were evaluated.
    

Detailed description: 
      With the widespread use of dental implants, there is an increase in technical and biological
      complications. These complications are called peri-implant diseases in general terms. When
      peri-implant diseases are not treated, a process that progresses to the loss of the affected
      implant may develop, but there is still no accepted consensus on their treatment.When
      performing treatment procedures, it is recommended not only to remove inflamed tissues but
      also to decontaminate infected implant surfaces.Recently, with the development of laser
      technologies, the use of dental lasers in implant surface detoxification has come to the
      fore. Dental lasers attract increasing attention due to their anti-infective properties, easy
      handling and haemostatic effects against periodontal pathogens.Diode lasers attract attention
      with their safety when used directly on the implant surface, soft tissue penetration,
      antibacterial and biostimulating properties. They detoxify implant surfaces by killing
      pathogenic bacteria through photothermal effects and neutralizing bacterial endotoxins.
      Erbium lasers also show promising results in implant treatment due to their advantageous
      properties such as soft and hard tissue ablation and decontamination. Er, Cr: YSGG lasers
      have the ability to debride microstructured surfaces of dental implants without causing
      mechanical damage, thanks to their ability to work with water.Today, many researchers
      investigate the effectiveness of dental lasers in the treatment of peri-implant diseases, but
      it has not yet been proven whether they have an additional contribution. It is observed that
      studies mostly focus on clinical parameters. However, it is stated that periodontal probing
      and radiographs, which are used as common diagnostic methods, may give erroneous results.
      These methods refer only to pre-existing destruction rather than current disease activity. A
      model predicting the course of peri-implant disease has not yet been defined, but biomarkers
      may offer considerable potential for disease activity.Biomarkers are widely used in medicine
      to objectively determine disease state or responses to a therapeutic intervention. Gingival
      fluid (GCF) biomarkers have moderate diagnostic validity in periodontitis. It is stated that
      biomarkers in peri-implant groove fluid (PICF) also give promising results in terms of
      diagnosis and prognostic values. MMP-8 and MMP-9, the two main collagen degrading enzymes in
      GCF, are secreted from neutrophils during disease activation and are responsible for
      extracellular matrix degradation. TIMP-1, a major inhibitor of MMPs, has been reported to be
      released at high levels in inflamed gums.

      In the literature review, it has been observed that there are quite a limited number of human
      clinical studies investigating the effect of dental lasers of different wavelengths on
      treatment results in the treatment of peri-implant disease at the clinical and molecular
      level. The aim of this study is to investigate the effects of 940 nm diode laser and 2780 nm
      Er, Cr: YSGG laser-assisted non-surgical mechanical treatment on clinical parameters and
      MMP-9 and TIMP-1 levels in PICF in individuals with peri-implant disease.
    

Intervention name(s): Traditional non surgical mechanical therapy; Diode laser assisted non-surgical mechancal therapy; Er, Cr: YSGG laser-assisted non-surgical mechanical therapy
Intervention type(s): Device; Device; Device
Intervention description(s): Mechanical instrumentation in all groups was made with titanium Gracey curettes (8mm in diameter, Langer ½, item code: 7103, Kohler Medizintechnik, GmbH & Co, Ltd, Stockach, Germany).; One week after mechanical treatment, a 940 nm diode laser (Ezlase®, Biolase Technology, Inc., San Clemente, CA) with a 300 µm diameter optical fiber tip applied approximately 1 mm above the most apical part of the peri-implant pocket, parallel to the implant surface (E3-9 mm).; 1 week after mechanical treatment, 2780 nm Er, Cr: YSGG laser (Waterlase®, Biolase Technology, Inc., San Clemente, CA), short pulse '' H '' with 500 µm diameter fiberoptic periodontal tip (RFPT5-14 mm) mode has been applied.
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Peri-implant disease; laser therapy; Er,Cr:YSGG; Diode; MMP-9; TIMP-1