Laser therapy as an adjunct treatment for peri-implant mucositis and peri-implantitis provides no extra benefit for most clinical outcomes Author links open overlay panelClovis MarianoFaggionJr.

Journal of Evidence Based Dental Practice

Available online 6 May 2019

Summary

Selection Criteria

This systematic review evaluated the effectiveness of laser therapy as an adjunct to non-surgical and surgical therapies for managing peri-implant diseases. Lasers as monotherapy could not be evaluated, since no controlled studies were identified. As selection criteria, the authors chose human retrospective and prospective studies in the form case series (CS), non-randomized controlled trials (CCTs), and randomized controlled trials (RCTs). The searches for literature were restricted to the period from January 1980 to June 2016, and only studies published in English were included. The searches were conducted in 3 databases (Ovid MEDLINE, EMBASE, and Dentistry and Oral Sciences Source), printed journals, and the references of included papers, as well as the related systematic reviews, resulting in an initial number of 453 documents. The quality of the selected RCTs was assessed using modified criteria from the Cochrane Collaboration's tool for evaluating risk of bias (RoB) and the CONSORT statement. Random effects meta-analyses were applied to deal with the heterogeneity of studies. The final sample included 22 studies in the qualitative analysis and 11 studies in the quantitative analysis.

Key Study Factors

Of the 22 selected studies, 13 were focused on non-surgical therapies and 9 on surgical therapies. Eleven studies were RCTs, 3 were CCTs, 7 were CSs, and 1 study was a “pilot” study. Six studies were pooled in the short-term (≤ 12 months) meta-analyses of non-surgical therapies in combination with lasers. Two studies were pooled in both short and long-term (≥48 months) meta-analyses of surgical therapies in combination with lasers.

Main outcome measures

The outcome measures evaluated in this systematic review were probing depth (PD) reduction, clinical attachment level (CAL) gain, percentage of bleeding on probing (BOP), plaque index (PI), recession (REC), and marginal bone level (MBL).

Main results

Non-surgical treatments: Short-term results showed that the greatest PD reduction was with a weighted mean difference (WMD) of 0.24 mm (95% confidence interval [CI] = −0.38 to 0.85 mm, P = .45) for the diode laser, although no statistical difference was found between the test and control groups. Regarding CAL, the treatment in the control group was favored in relation to the diode laser (WMD of −0.12 mm, 95% CI = −0.33 to 0.09 mm, P = .25), although the difference was not statistically significant. For BOP, inclusion of diode and Er:YAG lasers in the meta-analysis as the same test group resulted in a BOP reduction of 21.08% (95% CI = 3.61% to 38.55%, P = 0.02) favoring the test group, and this difference was statistically significant. Regarding the PI reduction, 2 studies compared the use of a diode laser with conventional non-surgical therapy. The results yielded a WMD of −0.07 (95% CI = −0.12 to −0.03, P = .002) favoring the control. For MBL, comparison of the diode laser to conventional therapy in 2 studies gave a WMD of −0.23 mm (95% CI = −0.50 to 0.04 mm, P = .10), and these results were not statistically significant. Regarding REC, comparison of the use of a diode laser to conventional therapy gave a WMD of −0.17 mm (95% CI = −0.44 to 0.11 mm, P =.24), and again the differences were not significant. Overall comparison (diode + Er:YAG lasers) resulted in statistically significant MBL loss (-0.22 mm, 95% CI = -0.43 to -0.001, P = .04).

Surgical treatments: For PD reduction, short-term results yielded an overall WMD of 0.08 mm (95% CI = −1.28 to 1.44 mm) between the laser treatment group and the conventional treatment group, with no statistical significance (P = .91). In terms of CAL gain, an overall WMD of −0.03 mm (95% CI = −1.13 to 1.07 mm, P = .96) was found, but without statistical significance. An overall WMD of 9.88% (95% CI = −26.46% to 46.21%) was also determined, but with no statistical significance (P = .59), for the BOP reduction. No meta-analysis was performed with the other clinical endpoints. Long-term results regarding surgical treatments in combination with laser did not reveal any statistical differences between the test and control groups regarding the assessed clinical endpoints.

Conclusions

Based on the meta-analysis of only 2 studies, the BOP reduction in the short term was more significant in the laser group. No statistical difference was evident, however, between the control and test groups when the other clinical endpoints were assessed in non-surgical and surgical comparisons.