Hashim Dena, Courvoisier Delphine, Cionca Norbert
Division of Regenerative Dental Medicine and Periodontology, University Clinics of Dental Medicine, Faculty of Medicine, University of Geneva, 1 Rue Michel-Servet, CH-1211, Geneva 4, Switzerland.
University Hospitals of Geneva HUG, Rue Gabrielle-Perret-Gentil 4, CH-1205, Geneva, Switzerland.
Clin Oral Investig. 2025 Feb 19;29(2):142. doi: 10.1007/s00784-025-06204-9.
To evaluate the efficacy of non-surgical debridement with repeated diode laser application in comparison to surgical treatment for management of peri-implantitis.
Forty patients diagnosed with peri-implantitis were randomised into two groups. The test group received mechanical debridement and repeated diode laser therapy at Days 0, 7 and 14. The control group received mechanical debridement at Day 0 followed by surgical treatment at Day 14. Clinical evaluations were performed at baseline, 3 and 12 months.
Thirty-six participants (test n = 17, control n = 19) completed the 12-month observation period. Laser treatment failed in 4 cases (23.5%); of which 3 implants lost osseointegration and one necessitated surgical treatment due to progressively increasing probing depths (PD) and bone loss. In comparison, the control group showed a 100% survival rate with a statistically significant difference between the two groups (p = 0.04). Therefore, thirty-two participants were examined at the final evaluation (test n = 13, control n = 19). Twenty-two implants (57.9%) showed complete disease resolution without significant differences between the groups. The test group reported significantly lower post-operative discomfort on the visual analogue scale (VAS). At 3 months, both groups showed clinical signs of healing with reduction in probing depths (PD) and bleeding upon probing. Surgical treatment resulted in significantly lower PDs (control 3.7 mm [3.2, 4.0], test 4.5 mm [3.8, 4.8]), but recession was significantly higher (control 0.5 mm [0.3, 1.2], test 0 mm [0.0, 0.3]). At the final reevaluation, PD values remained significantly lower in the control group; 3.3 mm [3.1, 3.9] compared to 4.3 mm [3.7, 4.8] for the test group, but the difference in mucosal recession fell below the level of significance. Marginal bone levels improved after one year without significant differences between the two groups (Test = 3.5 mm [2.8, 4.6] at baseline and 1.5 mm [1.0, 4.4] at one year, Control = 2.8 mm [2.5, 3.1] at baseline and 1.4 mm [1.0, 2.6] at one year).
Surgical approaches for management of peri-implantitis demonstrated significant benefits over laser therapy in terms of treatment success and PD reduction. Nevertheless, diode laser therapy, as described in this study, could represent a minimally invasive alternative for treatment of non-advanced peri-implantitis defects.
评估与手术治疗相比，重复应用二极管激光进行非手术清创治疗种植体周围炎的疗效。
40例诊断为种植体周围炎的患者被随机分为两组。试验组在第0、7和14天接受机械清创和重复二极管激光治疗。对照组在第0天接受机械清创，在第14天接受手术治疗。在基线、3个月和12个月时进行临床评估。
36名参与者（试验组n = 17，对照组n = 19）完成了12个月的观察期。激光治疗失败4例（23.5%）；其中3枚种植体失去骨结合，1枚因探诊深度（PD）逐渐增加和骨吸收而需要手术治疗。相比之下，对照组的存活率为100%，两组之间存在统计学显著差异（p = 0.04）。因此，在最终评估时对32名参与者进行了检查（试验组n = 13，对照组n = 19）。22枚种植体（57.9%）显示疾病完全消退，两组之间无显著差异。试验组在视觉模拟量表（VAS）上报告的术后不适明显更低。在3个月时，两组均显示出愈合的临床迹象，探诊深度（PD）减小，探诊出血减少。手术治疗导致PD显著更低（对照组3.7mm[3.2, 4.0]，试验组4.5mm[3.8, 4.8]），但退缩明显更高（对照组0.5mm[0.3, 1.2]，试验组0mm[0.0, 0.3]）。在最终重新评估时，对照组的PD值仍然显著更低；试验组为4.3mm[3.7, 4.8]，对照组为3.3mm[3.1, 3.9]，但黏膜退缩的差异低于显著水平。一年后边缘骨水平有所改善，两组之间无显著差异（试验组基线时为3.5mm[2.8, 4.6]，一年时为1.5mm[1.0, 4.4]，对照组基线时为2.8mm[2.5, 3.1]，一年时为1.4mm[1.0, 2.6]）。
在治疗成功率和降低PD方面，手术治疗种植体周围炎比激光治疗显示出显著优势。然而，本研究中描述的二极管激光治疗可作为治疗非重度种植体周围炎缺损的一种微创替代方法。
