Laser therapy for treatment of peri-implant mucositis and peri-implantitis: An American Academy of Periodontology best evidence review

Background: Peri-implant diseases are prevalent, with numerous therapies studied in an attempt to combat this condition. The present review aims to systematically evaluate the effectiveness of laser therapy with non-surgical or surgical therapy in managing peri-implant mucositis and peri-implantitis. Methods: An electronic search of three databases and a hand search of peer-reviewed journals for relevant articles published (in English) from January 1980 to June 2016 were performed. Human clinical trials of 10 patients with peri-implant diseases, treated with surgical or non-surgical approaches and laser therapy, and a follow-up period of 6 months, were included. Random-effects meta-analyses were performed to analyze weighted mean difference (WMD) and confidence interval for the recorded variables according to PRISMA guidelines. Risk of bias assessment was also performed for randomized controlled trials included. Results: From 22 articles selected, 11 were included in the meta-analyses. The outcomes of using lasers as a monotherapy could not be evaluated since no controlled studies were identified. Therefore, all reported results were the outcomes of applying lasers as an adjunct to surgical/non-surgical treatment. For the non-surgical approach, WMD of probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), plaque index (PI), marginal bone level (MBL) and recession (REC) was 0.15 mm (P = 0.50), -0.10 mm (P = 0.32), 21.08% (P = 0.02), -0.07 (P = 0.002), -0.22 mm (P = 0.04) and -0.11 mm (P = 0.34), respectively. For the surgical approach with a long-term follow up, WMD of PD, CAL, BOP, and PI was 0.45 mm (P = 0.11), 0.22 mm (P = 0.56), 7.26% (P = 0.76) and -0.09 (P = 0.84), respectively. Conclusions: Current evidence shows laser therapy in combination with surgical/non-surgical therapy provided minimal benefit in PD reduction, CAL gain, amount of REC improvement, and PI reduction in the treatment of peri-implant diseases. Lasers when used as an adjunct to non-surgical therapy might result in more BOP reduction in the short term. However, current evidence allowed for analysis of only Er:YAG, CO2, and diode lasers. Studies on others failed to have controlled evidence supporting their evaluation.