Effect of an Er,Cr:YSGG Laser on P. Gingivalis-Contaminated Titanium Alloy Dental Implant Surfaces In Vitro

Abstract

Implant dentistry has become a widely accepted modality to replace missing teeth. However, dental implants are susceptible to biofilm-mediated inflammatory lesions (peri-implant mucositis / peri-implantitis), similar to that seen around natural teeth (gingivitis / periodontitis). These lesions, in turn, threaten the longevity of implants as anchors for dental prostheses. Because of the similarity in etiology and presentation, comparable treatment modalities are applied to resolve peri-implant and periodontal inflammatory lesions. Such a shared treatment includes mechanical debridement, with or without surgical repositioning of the soft tissue complex. However, most contemporary dental implants feature threads to engage the alveolar bone and a micro/nano-textured surface to stimulate bone-implant contact (osseointegration). Therefore, when the implant threads become exposed and contaminated by biofilm, subsequent surface debridement / decontamination becomes considerably more complex than with that of a natural tooth, which is usually debrided using a metal curette or ultrasonic device. The micro/nano-textured surface of a dental implant is easily damaged by instrumentation using a metal curette. If an efficient method of dental implant surface decontamination could be established, then clinical protocols may be developed that effectively clean the implant surface to achieve peri-implant tissue health. To this end, lasers have been introduced; however, directly applied laser energy may also affect implant surface characteristics, including micro/nano-structure and composition, essential to osseointegration. Therefore, lasers may have disadvantageous clinical effects, in turn compromising peri-implant tissue consolidation and health: the very aspects its use is attempting to provide. Commercially available Er,Cr:YSGG lasers have been used to remove such implant-attached deposits, however the efficacy in removal of bacteria and the safety to the implant surface integrity have yet to be demonstrated quantitatively.