Laser-Assisted Nonsurgical Treatment And Reosseointegration Of Periimplantitis

This case report describes a combined laser-assisted treatment method involving Er:YAG laser and antimicrobial photodynamic therapy (aPDT) for periimplantitis, highlighting its potential as a minimally invasive therapeutic option. A 60-year-old female patient presenting with persistent gingival erythema, edema, and purulent discharge around dental implants lasting four months. Clinical and radiographic examination resulted in diagnoses of generalized Stage IV periodontitis (grade B), periimplantitis around implants 13, 15-17, 24, 26, 27, and peri-implant mucositis around implants 34-37. Nonsurgical therapy involved oral hygiene education, subgingival scaling, root planing, and application of aPDT with toluidine blue and a 635-nm diode laser (200 mW, continuous wave, 60 s, fluence 23.9 J/cm²). Implant surface debridement utilized an Er:YAG laser at 30 mJ energy, 30 Hz, with air/water spray using a 1.2-mm sapphire tip for 60 seconds (fluence 2.65 J/cm² per pulse). Periodontal maintenance continued every three months. At the three-year followup, significant improvements included reduced inflammation, probing depths decreased from 5.52 mm to 3.70 mm, and reosseointegration around the implants. Er:YAG laser selectively removes infected tissues without damaging surrounding healthy structures, effectively disinfecting implant surfaces. Concurrently, aPDT reduces microbial load and inflammation through photodynamic reactions. These synergistic treatments support peri-implant tissue healing and reosseointegration, offering an effective, conservative therapeutic approach. Laser-assisted therapy demonstrates significant potential for managing periimplantitis non-surgically, enhancing reosseointegration, and offering clinicians a valuable alternative to traditional surgical approaches.