Optimising the non-surgical treatment of peri-implantitis: the contribution of the Er:YAG laser and PBM

The non-surgical treatment of peri-implantitis represents a major challenge in daily practice, as conventional mechanical debridement (MD) often shows its limitations in the effective decontamination of the implant surface and the resolution of deep pockets. This randomised study specifically addresses this therapeutic barrier by evaluating the contribution of laser technologies in the minimally invasive management of these pathologies.

The objective of this research was to compare the clinical and microbiological efficacy and patient-reported outcome measures (PROMs) between a standard mechanical debridement protocol and an approach combining Er:YAG laser followed by photobiomodulation (PBM) therapy. The study was conducted on 45 patients, divided into a control group (n=24, MD alone) and a test group (n=21, Er:YAG + PBM), with an evaluation at 3 months.

The authors tested the hypothesis that the synergy between the ablative effect of the Er:YAG and the biomodulatory action of PBM would achieve superior therapeutic success — defined by a probing depth (PD) ≤ 5 mm without suppuration — while significantly improving postoperative comfort and reducing the load of specific pathogens such as Porphyromonas gingivalis.

Experimental protocol and study design

This randomised clinical study was conducted on 45 patients presenting with peri-implantitis. The objective was to compare the efficacy of a laser approach combined with conventional mechanical debridement (MD). The participants were divided into two distinct groups:

• Control group (n = 24): Treatment with conventional mechanical debridement (MD) alone.
• Test group (n = 21): Use of the Er:YAG laser followed by a photobiomodulation (PBM) session.

The evaluation protocol included clinical measurements (probing depth [PD], bleeding on probing [BoP], clinical attachment level [CAL], plaque index, recession and suppuration) performed at inclusion (baseline) and at 3 months. In parallel, microbiological samples quantified the levels of Porphyromonas gingivalis and Filifactor alocis.

Therapeutic success at 3 months was defined according to three strict criteria: a PD ≤ 5 mm, BoP at a maximum of one site and the complete absence of suppuration. Finally, patient-reported outcome measures (PROMs) were recorded during the first postoperative week, including pain intensity, analgesic consumption, the need for anaesthesia and the overall satisfaction rate. Statistical analysis validated the significance of the results with a threshold of p < 0.001 for clinical improvements.

Results: A marked superiority of the Er:YAG Laser + PBM protocol

The 3-month analysis shows that, although both approaches induce a significant clinical improvement (p < 0.001), the test group (Er:YAG laser + PBM) consistently outperforms conventional mechanical debridement (MD) across all major periodontal parameters.

Clinical improvements and success rates

The combined laser and photobiomodulation treatment resulted in a probing depth (PD) reduction and a clinical attachment level (CAL) gain almost twice those of the control group. The therapeutic success rate, defined by a PD ≤ 5 mm, bleeding on probing (BoP) at a maximum of one site and the absence of suppuration, is significantly higher in the laser group.

Targeted microbiological impact

The study evaluated the bacterial load of two key pathogens. The results highlight a more selective decontaminating action of the laser:

• Porphyromonas gingivalis: A significant decrease in levels was observed only in the laser group (p = 0.001).
• Filifactor alocis: No significant changes were observed in either group, suggesting the resilience of this bacterial complex to non-surgical treatment.

Patient experience and postoperative outcomes (PROMs)

Beyond clinical measures, the laser protocol significantly improved postoperative comfort during the first week. Patients in the laser group reported:

• Lower postoperative pain (p < 0.05).
• Reduced analgesic consumption (p < 0.05).
• A higher level of overall satisfaction compared to conventional mechanical debridement (p < 0.05).

A qualitative leap in non-surgical treatment

The results of this study mark a turning point for the non-surgical management of peri-implantitis. Moving from a therapeutic success rate of 42 % with conventional mechanical debridement to 81 % by integrating the Er:YAG laser and photobiomodulation (PBM) is not a mere incremental improvement, it is a paradigm shift. The superior reduction in probing depth (-2.30 mm versus -1.45 mm) and bleeding on probing (-73 % versus -42.4 %) highlights the efficacy of this technological synergy.

Microbiologically, the study highlights a targeted action: only laser therapy achieved a significant reduction in Porphyromonas gingivalis. This suggests that the Er:YAG overcomes the physical limitations of mechanical instruments on complex implant surfaces. Furthermore, patient-reported outcome measures (PROMs) validate the approach: less postoperative pain, reduced analgesic consumption and increased satisfaction.

The weak point? A follow-up limited to 3 months on a sample of 45 patients. While these data are statistically robust (p < 0.001 for clinical gains), the long-term stability of these results remains to be confirmed. Nevertheless, for the clinician faced with the unpredictability of mechanical treatment alone, this laser protocol offers significantly greater immediate predictability.

Summary of results

This randomised study on 45 patients demonstrates that combining the Er:YAG laser with photobiomodulation (PBM) doubles the therapeutic success rate at 3 months (81% versus 42%, p = 0.007). The laser protocol outperforms mechanical debridement alone with a more marked reduction in pocket depth (-2.30 mm vs -1.45 mm) and bleeding on probing (-73% vs -42%), while more effectively eradicating P. gingivalis.

In practical terms, for the practitioner:

• Optimise your clinical outcomes: Integrate the Er:YAG laser to achieve pocket reduction and attachment gain significantly superior to conventional treatment in the non-surgical management of peri-implantitis.
• Improve patient experience: The addition of PBM reduces post-operative pain and analgesic consumption, ensuring better overall satisfaction.
• Target the recalcitrant biofilm: Favour this technological approach for a more predictable microbiological decontamination, particularly on major periodontopathic strains such as P. gingivalis.

Technical glossary of the study

Er:YAG (Laser): Erbium:Yttrium-Aluminium-Garnet laser (wavelength 2940 nm), used in this protocol for implant surface debridement due to its decontamination properties and its affinity for water.

Photobiomodulation (PBM): Application of low-intensity light aimed at stimulating tissue healing and reducing post-treatment inflammation, used here as an adjunct to the Er:YAG laser.

Porphyromonas gingivalis: Major anaerobic pathogenic bacterium associated with peri-implant diseases. The study specifically measured its reduction to evaluate the microbiological efficacy of the laser treatment.

Filifactor alocis: Anaerobic bacterial species identified as an important marker of peri-implant dysbiosis, whose concentration was monitored during the 3-month follow-up.

PROMs (Patient-Reported Outcome Measures): Patient-centred outcome assessments, including in this study perceived pain, overall satisfaction and the need for analgesics following the procedure.

Therapeutic success: Composite endpoint defined in the study by a probing depth (PD) ≤ 5 mm, bleeding on probing (BoP) at a maximum of one site and the complete absence of suppuration.

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