peri - implantitis is inflammation of the peri - implant supporting tissue , which can lead to progressive loss of supporting bone , if untreated . a history of periodontitis , poor oral hygiene , and smoking are considered risk factors for peri - implant diseases . it is of paramount importance to treat periodontitis of the residual dentition prior to implant placement . a higher implant failure rate and elevated number of sites with peri - implant bone loss were documented in periodontally compromised patients who did not adhere to comprehensive supportive periodontal therapy . customized and correctly performed supportive periodontal therapy is essential to enhance the long - term outcome of implant therapy . the outcome of non - surgical periodontal treatment ( nspt ) of peri - implantitis is unpredictable . although minor beneficial effects of laser therapy on peri - implantitis have been shown , this method requires further evaluation . the diode laser is not an ablative instrument and can directly contact the implant surfaces without inducing melting , cracking , or crater formation . the 810-nm diode laser , when used in accordance with appropriate parameters , does not damage titanium surfaces , which is useful when uncovering submerged implants , and can be used to treat bacterial induced peri - implantitis . the use of laser treatment in periodontal therapy is an emerging therapeutic option , although little reliable evidence suggests that it can effectively treat peri - implantitis . 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 [ figure 1 ] , 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 ) . clinical examination revealed 7-mm probing depths , circumferentially around a mandibular implant , bleeding on probing , and the presence of exudate and gingival inflammatory edema no occlusal trauma or parafunctional habits were detected . a periapical radiograph demonstrated bone loss of five fixture threads on the most distal mandibular left implant , when compared to the original radiograph [ figure 2 ] . periapical radiography shows bone loss for five fixture threads on the most distal mandibular left implant the 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 [ figure 3 ] . the patient was treated using an 810-nm diode laser to disinfect the area and facilitate bacterial biofilm removal by mechanical and manual periodontal instrumentation the 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 / cm . non - 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 . the 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 . periodontal indices were documented and intraoral periapical radiographs were taken at the 1-year [ figure 4 ] , and 2- , 3- , 4- , and 5-year [ figures 5 and 6 ] follow - up recall appointments . periapical radiograph : 1-year post - non - surgical treatment periapical radiograph : 5-year follow - up clinical probing depth : 5-year follow - up satisfactory 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 . at the 6 european workshop on periodontology , it was reported that mechanical non - surgical therapy with an adjunct of local antibiotics or laser application was effective longitudinally to reduce bleeding on probing and pds over a period of 6 - 12 months . however , the outcome is unpredictable due to possible re - infection related to the inability to completely remove bacterial deposits from titanium implant surfaces , thus interfering with new histological bone - to - implant contact . the primary objective of non - surgical treatment for peri - implantitis is to remove bacterial contaminants to allow resolution of the inflammatory lesion . to date , no critical probing depths in the therapy of peri - implant diseases have been defined to guide selection of a non - surgical or surgical approach . laser treatment may serve as an alternative or adjunctive treatment to conventional periodontal mechanical therapy or peri - implantitis . diode lasers have a bactericidal effect due to a localized increase in temperature , which has been verified in vivo using dna probes that detect periodontal pathogens . threaded implants have a different morphology than root surfaces ; therefore , debridement instruments might be different . the laser may be a valuable tool to detoxify the implant surface [ figure 7 ] , and significant bacterial reduction should lead to a more satisfactory recovery . it is possible to point the diode laser insert toward the wall of the ulcerated pocket epithelium to kill virulent periodontal pathogens . vaporization of granulomatous tissue seems to result in a more favorable effect compared to that of solo instrumentation . threaded implants have a different morphology than root surfaces ; therefore , debridement instruments may differ . the laser may facilitate detoxification of the implant surface the diode laser detoxifies root and implant surfaces by inactivating bacterial endotoxins . the thermal effect weakens calculus chemical adhesion to the root and/or implant , facilitating its removal by curette or ultrasonic devices . the diode laser also stimulates fibroblasts and osteoblasts , which , in turn , cause increased production of rna messengers , leading to significant collagen production during periodontal tissue healing . the patient experienced no postoperative discomfort and he was able to comply with home care procedures , such as debridement , after the surgery . in contrast , patients often have post - treatment discomfort , and compliance with home care procedures decreases because the recommended home care protocols for plaque control are painful ; this results in impaired healing . important changes were also detected in the patient : bleeding , a marker of inflammation with a high prognostic value , was compared at baseline and at 1 year after laser - assisted periodontal therapy , and was reduced significantly to < 20% . absence of bleeding has a negative predictive value . besides laser therapy , the following therapeutic interventions all of these combined may have contributed to healing , complicating isolation of the most effective modality . the laser has been used as an adjunct to many periodontal treatments , but it is not a replacement for conventional non - surgical treatment or proper home care with adequate patient compliance . the absence of attached gingiva may be an etiological factor in the development of peri - implantitis ; this issue is controversial . traditional protocols of non - surgical periodontal therapy , in conjunction with the use of an 810-nm diode laser , can be an effective alternative treatment modality for peri - implantitis . other treatment options may successfully enhance resolution of peri - implant soft and hard tissue inflammation , and preserve long - term periodontal health . regardless of the method used , correctly performed supportive periodontal therapy is a key factor in successful implant therapy .
an 810-nm diode laser was used to non - surgically treat a 7-mm pocket around an implant that had five threads of bone loss , bop+ , and exudate , and the patient was followed up for 5 years . 
 non - surgical treatment , home care reinforcement , clinical indices records , and radiographic examination were completed in two consecutive 1-h appointments within 24 h. the patient was monitored frequently for the first 3 months . 
 subsequently , maintenance debridement visits were scheduled at 3-month intervals . 
 the patient had a decreased probing pocket depth and a negative bop index compared to initial clinical data , and the results were stable after 1 year . 
 after 5 years of follow - up visits , there appeared to be rebound of the bone level radiographically . within the limits of this case report 
 , conventional non - surgical periodontal therapy with the adjunctive use of an 810-nm diode laser may be a feasible alternative approach for the management of peri - implantitis . 
 the 5-year clinical and radiographic outcomes indicated maintenance of the clinical improvement .