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Lasers in Dental Science

, Volume 2, Issue 4, pp 201–211 | Cite as

Antibacterial effect of Er:YAG laser in the treatment of peri-implantitis and their effect on implant surfaces: a literature review

  • Khaled Smeo
  • Riman Nasher
  • Norbert Gutknecht
Review Article
  • 235 Downloads

Abstract

The aim

The present study aims to conduct a descriptive analysis by reviewing in vivo and in vitro studies concerned with the antibacterial effect of Er:YAG laser (2940 nm) and their effects on implant surfaces at different parameters for peri-implantitis treatment.

Materials and methods

The PubMed and Google Scholar had been used to search for articles focused on the antibacterial effect of Er:YAG laser (2940 nm) in the treatment of peri-implantitis and their effects on implant surfaces. This literature search was limited to 10 years (January 2007–March 2017).

Results

The safe settings of Er:YAG laser (2940 nm) which may be used as an antibacterial effect without surface alteration or increase of temperature in the treatment of peri-implantitis are 100 mJ/pulse, 1 W, 10 Hz, and 12.74 J/cm2 for 60 s.

Conclusion

A consideration should be taken when Er:YAG laser 2940 nm wavelength is used to avoid a negative thermal and characteristic effect on the implant surfaces, where the favorable settings which can be used in the treatment of peri-implantitis are 100 mJ/pulse, 1 W, 10 Hz, and 12.74 J/cm2 for 60 s.

Keywords

Dental implant Periimplantitis Peri-implantitis Periimplant Dental implant surface Decontamination Disinfection Antibacterial effect Bactericidal effect Er:YAG laser Laser treatment and laser therapy 

Abbreviations

ERL

Er;YAG laser

TPS

Titanium plasma sprayed

PW

Pulse wave

MR

Mucosal recession

HA

Hydroxyapatite

s

Second

PD

Pocket depth

SLA

Sand blasted, large grit, acid-etched

μs

Microsecond

PI

Plaque index

Y-TZP

Yittrium-stabilized tetragonal zirconia polycrystal

ms

Millisecond

BOP

Bleeding on probing

CPS

Cotton pellets + plastic curets + sterile saline

μm

Micrometer

LS-LPS

Low-power setting

HS-HPS

High power setting

CAL

Clinical attachment level

TiO2

Fluoride modified

SAE

Sandblasted and acid-etched

AO

Anodic oxidized

N info

No information

M

Machined

Ra

Roughness

Introduction

A dental implant is a metal anchor that is placed into the jaw bone to support a dental prosthesis such as a crown, bridge, denture or to act as an orthodontic anchor [1, 2]. Dental implant is an ideal option for people in a good oral health who have a loss of tooth or teeth due to periodontal disease, an injury or other reasons [1]. However, there are many factors which affect the success of dental implant and its fusion with bone (osseointegration). These factors include the following: misunderstanding the anatomy and the dental implant fundamentals, in addition to factors related to the patient such as uncontrolled diabetes, cancer, radiation to the jaw, smoking, alcoholism, uncontrolled periodontal disease [3].

There are risks and complications related to implant therapy which are divided into three stages based on their time of occurrence:
  1. 1.

    Risks and complications during surgery include infection, excessive bleeding, and necrosis of the tissue flap around the implant [2, 4].

     
  2. 2.

    Risks and complications in the first 6 months include infection, excessive bleeding, flap breakdown, and loss of secondary stability [2, 4].

     
  3. 3.
    Long-term complications (biological and mechanical complications):
    • Biological complications include mucositis, peri-implantitis, and peri-implant abscess [2, 4].

    • Mechanical complications include fracture of implant, loosening of screw, and loss of retention [2, 4].

     

Shortly after implant are placed, glycoproteins from saliva adhere to exposed titanium surfaces with concomitant microbiological colonization [5], forming a biofilm which plays a significant role in the initiation and progression of peri-implant diseases [5, 6] and is essential for the development of infections around dental implants. On the other hand, the process of creating implant surface roughness, such as by sandblasting or titanium spraying, improves the bone implant contacts but also causes an increase in bacterial adherence [7]. Moreover, peri-implant diseases have been associated with Gram negative anaerobic bacteria (such as Staphylococcus aureus which may be an important pathogen in the initiation of peri-implantitis) similar to those found around natural teeth in patients with severe chronic periodontitis [5].

Generally, it is accepted that peri-implant mucositis is the precursor of peri-implantitis as it is accepted that gingivitis is the precursor of periodontitis. However, peri-implant mucositis does not necessarily progress to peri-implantitis when effectively treated [5].

Peri-implantitis is an inflammatory process affecting the soft and hard tissues surrounding an implant. This inflammatory process is associated with the loss of supporting bone, deep probing depth, bleeding on probing, and occasionally suppuration from the peri-implant space [7, 8].

There are many risk factors which have been identified that may lead to the establishment and progression of peri-implantitis, the following are some of those factors [5, 9, 10, 11].
  • Previous history of periodontal disease [12, 13].

  • Poor plaque control or oral hygiene [14, 15].

  • Residual cement stagnation in or around the gingiva after implant prosthesis cementation [16, 17].

  • Smoking [18, 19, 20].

  • Genetic factors [21].

  • Occlusal overload [22].

  • Systemic disease such as poorly controlled diabetes, cardiovascular disease, osteoporosis [14, 23].

  • Potential emerging risk factors including alcohol consumption, tobacco, and rheumatoid arthritis with concomitant connective tissue disease [24, 25].

Peri-implantitis can be classified into three categories based on the pocket depth and bone loss (Table 1) [26].
Table 1

Classification of peri-implantitis

Early

Probing depth ≥ 4 mm (bleeding and/or suppuration on probing).

Bone loss < 25% of the implant length.

Moderate

Probing depth ≥ 6 mm (bleeding and/or suppuration on probing).

Bone loss 25 to 50% of the implant length.

Severe

Probing depth ≥ 8 mm (bleeding and/or suppuration on probing).

Bone loss > 50% of the implant length.

Peri-implantitis can be diagnosed early or once clear clinical evidence has developed. The most common signs and symptoms of peri-implantitis are color changes in keratinized gum tissue or in the oral mucosa, bleeding on probing, increased probing depth of peri-implant pocket, suppuration, peri-implant radio-transparency, and progressive loss of bone height around the implant [27].

The primary objective for treating peri-implant diseases (peri-implant mucositis and peri-implantitis) is to eliminate the biofilm from the implant surface and decontaminate it [28].

Both surgical and non-surgical approaches have been evaluated for the management of peri-implantitis. The treatment approach employed is determined by the probing depth and defect characteristics. A non-surgical approach involves surgical detoxification using mechanical, chemical, lasers, and antibiotic therapy (locally and/or systematically). Surgical approach includes access flap, as well as respective and regenerative surgical techniques. In addition, lasers have been used in combination with a surgical therapy [29, 30, 31].

Laser therapy has been used as a non-surgical treatment of peri-implantitis. The laser wavelengths which may be used in the treatment of peri-implantitis include the following: Er:YAG laser, Er,Cr:YSSG laser, diode lasers (810 nm, 940 nm, 980 nm), CO2 laser, and several wavelengths were used in photodynamic therapy.

Er:YAG laser is a solid state laser, typically emits a wavelength of 2940 nm which lies in the mid- infrared region. This laser wavelength is highly absorbed in water (approximately 300% more than Er,Cr,YSGG laser, 15 times more than CO2, and 20,000 times higher than Nd:YAG laser) [32, 33] and hydroxylapatite [34] (Fig. 1), and not absorbed by the titanium surface. Due to those biophysical properties, Er:YAG laser can be safely used around implants and can be a beneficial tool in treating peri-implantitis and mucositis [34, 36]. Studies have found that the reduction of bacteria (anaerobic bacteria such as Staphylococcus aureus in particular, which play a predominant role in the development of a peri-implantitis [31, 37]) can reach up to 99.51% on implant surface using 60 mJ/pulse, and 99.94% with 120 mJ/pulse without causing excessive temperature elevation, and without causing morphological changes of the implant surfaces [37, 38, 39, 40]. Other studies have shown that a complete bacterial decontamination by using Er:YAG laser was only consistently achieved at 90 mJ/pulse and 10 Hz in short pulse mode (SP) [41]. Stübenger et al. [42] demonstrated that the implant surfaces were altered when using Er:YAG laser after 10 s of irradiation at 300–500 mJ/pulse and 10 Hz depending on implant type and characteristic of the implant. When Er:YAG laser is used for degranulation and debridement of implant surfaces in surgical peri-implantitis treatment, it produces up to 69.7% re-osseointegration and with a statistically significant higher percentage of bone to implant contact than that with conventional methods [39, 43]. Er:YAG laser has no risk of local damage to the adjacent tissue and does not cause changes to titanium surface, and its radiation does not influence the attachment rate of osteoblasts if used with appropriate energy settings [32]. In addition, Er:YAG laser is effective for removal of calculus and plaque on contaminated abutments and of biofilms grown on sand blasted implant surfaces [32]. Treatment of contaminated rough titanium surfaces resulted in similar fibroblast proliferation when compared with sterile implants [44]. Previous studies noticed that Er:YAG laser yielded significant advantages in terms of bleeding on probing, pocket depth, and clinical attachment level [45, 46, 47].
Fig. 1

Absorption coefficient of laser wavelengths [35]

Materials and methods

Search strategy

The PubMed and Google Scholar had been used to search for articles focused on the antibacterial effect of Er:YAG laser (2940 nm) in the treatment of peri-implantitis and their effect on implant surfaces. This literature search was limited to 10 years (January 2007–March 2017).

Search words

The keywords which were used in the search are the following: (1) dental implant, (2) periimplantitis, (3) peri-implantitis, (4) periimplant, (5) dental implant surface, (6) decontamination, (7) disinfection, (8) antibacterial effect, (9) bactericidal effect. All these words followed by Er:YAG laser, laser treatment, and laser therapy.

Inclusion criteria

  • Articles published in English language.

  • Limited to 10 years (January 2007–March 2017).

  • In vivo Studies.

  • In vitro Studies.

  • Human research.

Exclusion criteria

  • Studies in animals.

  • Literature reviews, systemic reviews, and histological studies.

  • Carbon dioxide laser, diode lasers, Er,Cr:YSGG laser, Nd:YAG laser studies, low-level laser therapy, and photodynamic laser therapy studies.

  • Studies not related to the antibacterial effect, bactericidal effect, and decontamination or disinfection of implant surface in the treatment of peri-implantitis.

  • Studies not related to the effect of Er:YAG laser on the implant surface itself.

Search outcomes

Totally, 1677 articles were screened based on a title reading, abstract reading, and full-text reading, where 29 articles (in vivo and in vitro) were selected in this review (Smeo Fig. 2).
Fig. 2

Twenty-nine articles were selected in this review. Whereas, seven articles related to the antibacterial effect of Er:YAG laser in vivo, four articles related to the antibacterial effect of Er:YAG laser in vitro, and 18 articles related to the effect of Er:YAG laser on the implant surfaces in vitro

Results

The antibacterial effect of Er:YAG laser (2940 nm) in the treatment of peri-implantitis in vivo and in vitro are shown in Tables 2 and 3, respectively. The effect of Er:YAG laser (2940 nm) on the implant surfaces in vitro is shown in Table 4.
Table 3

Antibacterial effect of Er:YAG laser in the treatment of peri-implantitis, in vivo

Author and year

Study type

Laser type and parameters

PD, PI, MR, and CAL.

BOP suppuration mobility

Bone level

Findings

Schwarz et al. [45] 2011

A randomized controlled clinical study

ERL, 2940 nm, 100 mJ/pulse 11.4 J/cm2, 10 Hz, 100 ms, 1 W, water, contact mode

PD and CAL were reduced, but at 6 months, both PI and MR were increased.

BOP reduced

Comparable bone fill

At 6 months, ERL failed to reveal higher reduction in BOP, PD, and CAL when compared with CPS with increase of PI and MR.

Persson et al. [48] 2011

A randomized clinical trial

ERL, 2940 nm, 1 W, 100 ms, 12.7 J/cm2, 10 Hz, 100,100 mJ/pulse

PD reduced

BOP and suppuration reduced

N info

ERL failed to reduce bacterial counts at 6 months follow-up.

Renvert et al. [49] 2011

A randomized clinical trial

ERL, 2940 nm, 1 W, 12.7 J/cm2, 10 Hz, 100 ms, 100 mJ/pulse

PD reduced

BOP and suppuration reduced

No bone loss in 44% of the implants after ERL treatment

In 44% of treated implants were found that PD reduction ≥ 0.5 mm and no bone loss after ERL irradiation.

Badarn et al. [50] 2011

A case report

ERL, 2940 nm, 120 mJ, 10 Hz, 1.2 W, water, 60 s for each site, 10–15° working angle

PD reduced from 5–9 to 0–2 mm at 3 months after surgical treatment.

No BOP no suppuration at 3 months after surgical treatment

Bone formation after 6 months of surgical treatment

Positive clinical results were observed at 3 and 6 months of surgical treatment of peri-implantitis.

Schwarz et al. [51] 2012

A 2-year clinical follow-up report

ERL, 2940 nm, 11.4 J/cm2, 10 Hz.

PD, PI, and CAL reduced, but MR increased at 12 months and decreased at 24 months.

BOP reduced

N info

Positive clinical results were observed at 24 months of surgical treatment of peri-implantitis.

Schwarz et al. [52] 2013

A 4-year clinical follow-up report

ERL, 2940 nm, 11.4 J/cm2, 10 Hz.

PD and CAL reduced, but MR almost unchanged, PI increased and remained stable (at 48 months).

BOP reduced

N info

Positive clinical results were observed at 48 months of surgical treatment of peri-implantitis.

Schwarz et al. [53] 2015

A prospective case series

ERL, 2940 nm, 100 mJ/pulse, 1 W, 12.7 J/cm2, 10 Hz, 100 ms, contact mode

PD and PI reduced

BOP reduced

N info

Positive clinical results were observed at 6 months of non-surgical treatment of peri-implantitis.

Table 4

Antibacterial effect of Er:YAG laser in the treatment of peri-implantitis, in vitro

Author and year

Laser type and parameters

Type of implant material and properties

Findings

Hauser-Gerspach et al. [54] 2011

ERL, 2940 nm, 100 mJ/pulse, 10 Hz, 10 s, 12.74 J/cm2 (LPS)

Titanium disks (Polished and SLA)

ERL at HPS was more strongly bactericidal to Streptococcus sanguinis. Adhered Porphyromonas gingivalis cells were very sensitive to ERL irradiation.

ERL, 2940 nm, 500 mJ/pulse, 10 Hz, 10 s, 63.69 J/cm2 (HPS)

Scarano et al. [55] 2016

ERL, 2940 nm, 10 Hz, 1 min, 75 mJ (0.75 W), water irrigation 0.5 mm distance from implant surface.

Titanium implants

No bacteria were found in any area of the implant.

No surface alteration.

Chen et al. [56] 2016

ERL, 2940 nm, 100 mJ, 10 Hz, 1 W, 1 min, 12.7 J/cm2

Titanium implants

Most of E. coli was not found on the implant surface after ERL irradiation.

No visible damage on implant surfaces.

Al-Hashedi et al. [57] 2016

ERL, 2940 nm, 100 mJ/pulse, 20 Hz, C600F fiberoptic tip at 45° angle, 0. 5–1 mm distance from the implant surface, 5 ml/min water

Machined titanium disks

ERL was effective in killing biofilm bacteria, whereas the lowest live to dead bacterial ratio (0.3 ± 0.1) was observed.

Table 5

Effect of Er:YAG laser on implant surfaces, in vitro

Author and year

Laser type and parameters

Type of implant material and properties

Findings

Stübinger et al. [58] 2008

ERL, 2940 nm, 10 Hz, 10 s, at (100, 300, 500, and 1000 mJ/pulse) energy and energy density of (12.74, 38.22, 63.69, 127.39 J/cm2), respectively. 1000-um fiber tip in 0.5 to 1 mm from the surface.

Yittrium-stabilized tetragonal zirconia polycrystal (Y-TZP)

No Y-TZP surface alteration but damage to the material behind the disk was reported because laser beam penetrates the material.

Duarte et al. [59] 2009

ERL, 2940 nm, 10 Hz, 10 s, 120 mJ/pulse, 8. 4 J/cm2, slight contact with prismatically glass tip in 45° angle with the surface, continuous water.

Titanium disks. (machined or SLA)

No morphological and roughness changes of smooth and rough surfaces, except a minor mechanical damage by the tip contact

Cavalcanti et al. [60] 2009

ERL, 2940 nm, 10 Hz, 5 s, at (200, 400, and 600 mJ/pulse) energy and energy density of (25.48, 50.96, and 76.43 J/cm2), respectively.1000-um fiber tip in contact mode and 90° with the surface.

Yittrium-stabilized tetragonal zirconia polycrystal (Y-TZP). (cercon ceramic and procera zirconia)

200 mJ/pulse provided mild alteration. 400 and 600 mJ/pulse increased surface roughness and provided significant morphological changes.

Kim et al. [61] 2010

ERL, 2940 nm, 10 Hz, at (100, 140, and 180 mJ/pulse) energy and (1, 1.5, and 2 min application time) for each, truncated cone tip in near contact mode under water irrigation and 90° with surface.

Titanium implants

HA-coated implant surface was not altered at 100 mJ/pulse and 1 min. Local areas of melting and cracks were observed at 100 mJ/pulse and 1.5 and 2 min. 140 and 189 mJ/pulse had surface melting and peeling of HA particles.

(HA-coated)

Stübinger et al. [62] 2010

ERL, 2940 nm, 10 Hz, 10 s, at (100, 300, 500, and 1000 mJ/pulse) energy and energy density of (12.74, 38.22, 63.69, 127.39 J/cm2), respectively.1000-um fiber tip in 0.5 to 1 mm from the surface.

Titanium disks

At 300 mJ/pulse alter SLA surface. At 500 mJ/pulse alter polished surface. At 100 mJ/pulse, no changes for both surfaces. At 500 mJ/pulse, both surface roughness increased.

(polished and SLA)

Lee et al. [63] 2011

ERL, 2940 nm, 10 Hz, at (100, 140, and 180 mJ/pulse) energy and (1, 1.5, and 2 min application time) for each, truncated cone tip in near contact mode under water irrigation and 90° with surface.

Titanium implants (SLA)

At 140, 180 mJ/pulse for all irradiation times and 100 mJ/pulse for 2 min, surface changes were observed. At 100 mJ/pulse for 1 and 1.5 min, no surface changes were observed.

Galli et al. [64] 2011

ERL, 2940 nm, at (150 mJ/pulse 16.1 J/cm2, 10 Hz, 1.5 W) and (200 mJ/pulse, 22.5 J/cm2, 10 Hz, 2 W), fiber tip in 1 mm distance in 90° angle and under water irrigation.

Titanium disks

No morphological changes on machined and TPS, while fusion and collapse of titanium peaks on SAE disks were observed.

(machined, SAE, TPS)

Shin et al. [65] 2011

ERL, 2940 nm, 10 Hz, at (100, 140, and 180 mJ/pulse for SLA) and (60, 100, and 140 mJ/pulse for AO) energy and application time of (1, 1.5, and 2 min) for each, truncated cone tip in near contact mode under water irrigation and 90° with the surface.

Titanium implants

In AO surface, the oxidized layer peeled off the surface and cracks appeared at 100 and 140 mJ/pulse.

(SLA and AO)

In SLA surface, no significant changes at 100 and 140 mJ/pulse, (< 2 min). Decreased surface roughness of both surfaces.

Kim et al. [66] 2011

ERL, 2940 nm, 10 Hz, at (100, 140, and 180 mJ/pulse) energy and (1, 1.5, and 2 min application time) for each, truncated cone tip in near contact mode under water irrigation and 90° with the surface.

Titanium implants

No surface changes at 100 mJ/pulse for 1, 1.5, and 2 min. No melting and cracking. Reduced sharpness of ridge structure was observed at 140 and 180 mJ/pulse.

(double acid-etched)

Minor decrease of surface roughness was also observed.

Geminiani et al. [67] 2011

ERL, 2940 nm, 20 Hz, 60 s, 100, and 250 mJ/pulse, fiber tip in non-contact mode and with just air spray or with air and water spray.

Titanium implant

After 10 s, ERL cause increase in temperature above the critical threshold (10°).

Park et al. [68] 2012

ERL, 2940 nm, 20 Hz, 30 s, at (1, 2, 3, 4, and 5 W) average power, (25.5, 50.9, 76.4, 101.9, and 127.3 J/cm2) energy density, (50, 100, 150, 200, 250 mJ/pulse) pulse energy and air/water (10, 15, 20, 25 and 30) respectively. 500 μm zirconia tip in 90° angle and 1.5 mm distance from the surface.

Titanium disks

Surface changes were observed when both implant surface types irradiated with more than 2 W of power.

(machined or anodized)

Roughness values of machined surface increased at more than 2 W, while at 3 W of anodized surface.

Yamamoto et al. [69] 2013

ERL, 2940 nm, 20 Hz, 15 s, 50, 100, and 200 mJ/mm2, quartz fiber tip of 600 μm and 400 μm in a distance of 0.05 mm from the surface with water at a rate of 5 ml/min

TiUnite implants

At 200 mJ/pulse, complete remove of TiUnite layer, melting of the newly exposed surface was observed.

At 100 mJ/pulse, ERL can effectively remove a contaminated titanium oxide layer from the implant. With water spray at 100 mJ/10 Hz and 50 mJ/pulse 20 Hz, a maximum increase of temperature was 3 °C. Without water spray at 100 mJ/10 Hz and 50 mJ/20 Hz, a temperature increased to 30 °C and 33 °C, respectively.

ERL, 2940 nm, 15 s, at (100 and 50 mJ/pulse) pulse energy with a frequency of (10 and 20 Hz) respectively, with and without water irrigation.

Shin et al. [70] 2013

ERL, 2940 nm, 10 Hz, 250 μs pulse duration, at (100, 140, and 180 mJ/pulse) pulse energy and application time of (1, 1.5, and 2 min) for each, 540 μm fiber tip, 0.5 mm distance, under water irrigation and 90° with the surface.

Titanium implants

Surface alteration of both surfaces at 100 mJ/pulse for 1.5 min but no surface alteration for 1 min was observed.

(HA-coated and fluoride modified TiO2)

Greater surface alteration including flattening and microfracture was observed when the pulse energy and irradiation time increased.

Taniguchi et al. [71] 2013

ERL, 2940 nm, 30 Hz, 60 s, 200 μs pulse duration, at (30, 40, and 50 mJ/pulse), 200 μs, 600 um quartz tip (used and unused), with and without water.

Titanium implants

For unused tip: no surface changes with water spray except for anodized, but without water, surface changes were found.

Double acid-etched and anodized

For used tip: surface was preserved when irradiated at 30 and 40 mJ, but at 50 mJ a morphological change was observed.

Turp et al. [72] 2014

ERL, 2940 nm, 10 Hz, 20 s, 10 W, (100, 200, and 300 mJ/pulse) pulse energy and pulse duration of (50, 100, 300, and 600 μs) for each, sapphire optical fiber tip in non-contact mode under water irrigation.

Zirconia disk

Surface roughness increased at lower energy level and shorter pulse duration, while at higher energy level and longer pulse duration, a shallow pits, smoother areas, and fewer undercuts were observed as a result of surface melting.

Arami et al. [73] 2014

ERL, 2940 nm, 10 Hz, 10 s, 230 μs pulse duration, average power of (1.5, 2, and 2.5 W) and energy density of (4.39, 5.85, and 7.32 J/cm2), respectively. Non-contact mode under air water spray.

Yittrium-stabilized tetragonal zirconia polycrystal (Y-TZP)

At 1.5 W, a surface roughness was created, but increased and become more uniform at 2 W.

At 2.5 W, a surface roughness and depth of irregularities decreased.

Markazi et al. [74] 2015

ERL, 2940 nm, 10 Hz, 60 s, 100 mJ/pulse, 230 μs, 12.8 J/cm2, contact mode under water spray.

Titanium disks. (SLA)

Surface roughness decreased.

Wettability increased.

Enhanced of SaOs-2 cells proliferation on titanium disks was enhanced.

Caglar et al. [75] 2016

ERL, 2940 nm, 10 Hz, 15 s, 2 W, 230 μs, 129.98 J/cm2, sapphire tip 1 mm distance from the surface under air and water spray.

Yittrium-stabilized tetragonal zirconia polycrystal (Y-TZP)

Morphological surface changes (smooth areas surrounded by cracks on surfaces were observed).

Discussion

The biofilm plays a significant role in the initiation and progression of peri-implant diseases such as peri-implantitis which is characterized by inflammation of the implant surrounding tissues and loss of bone [5, 6]. The main goal of peri-implantitis treatment is to remove the biofilm from the implant surfaces and decontaminate it, in addition to reduce or eliminate the signs of inflammation and pocketing such as BOP, PD, suppuration, and bone loss [28]. The most common method for treatment of peri-implantitis is a mechanical debridement of implant surface using curettes, ultrasonic devices, and air abrasive devices, but it is not sufficient to remove bacteria and improve the healing [28, 29, 30]. Recently, a laser therapy is used alone or in combination with a mechanical method in the treatment of peri-implantitis, whereas, it has been suggested as an alternative or an adjunctive tool to the conventional mechanical method. The laser has a bactericidal effect, which achieves complete or almost complete elimination of bacteria from the implant surfaces without altering the surface characteristic itself [40, 49]. The decontamination capability of all areas of implant surfaces even within threads can be explained by the physical properties of each laser wavelength and its interaction with tissues and implant surface [43]. Among the most common laser types which are used in the treatment of peri-implantitis are diode laser, Er:YAG laser, and Er,Cr:YSGG laser. In the present study, we reviewed 29 of published papers investigating the use of Er:YAG laser in peri-implantitis.

The reviewed studies have different results depending on the laser settings which are used in the treatment of peri-implantitis and the type of bacteria, in addition if the therapy is in combination with surgical or non-surgical treatment, as that investigated by Badarn et al. [50] where the inflammatory signs decreased in a case of non-surgical treatment with an average power of 1.2 W, 120 mJ/pulse, and 10 Hz repetition rate for 60 s for each site under water irrigation, but after surgical treatment in about 3 months with the same settings, they found that is no BOP, PD reduced of 0–2 mm and after 6 months a bone formation was observed, and also Schwarz et al. [51, 52] found that BOP, PD, CAL reduced after 24 and 48 months when a 2940 nm, 11.4 J/cm2, and 10 Hz are used in a combination with a surgical peri-implantitis treatment (application time, average power, and pulse energy were not specified by the author). One study by Persson et al. [48] failed to reduce a bacterial count such as Fusobacterium nucleatum nucleatum, Porphyromonas gingivalis, Pseudomonas aeruginosa, Staphylococcus anaerobius, Staphylococcus aureus when irradiated with 2940 nm wavelength, 1 W, 12,7 J/cm2, 10 Hz, 100 ms, and 100 mJ/pulse. This negative effect may be as a result of many factors such as very short application time or individual host response and confounding factors in the healing mechanism of the peri-implant alveolar bone, but in the same time a BOP, PD, suppuration, and bone formation reduced with the same settings as reported by Persson et al. [48] Renvert et al. [49], and Schwarz et al. [53]. On the other hand, most of Escherichia coli was not found and no visible damage on implant surface with the same settings in non-contact mode (2 mm distance) for 60 s which is demonstrated by Chen et al. [56]. In addition, Schwarz et al. [53] achieved his results in a contact mode which may lead to a minor mechanical damage of the surface by tip contact as investigated by Durate et al. [59]. A contact mode must be avoided when solid objects like implants are dealt with Er:YAG laser to avoid a negative effect on the surfaces, where a water layer (which is important for cooling and ablation [76]) between the tip and the surface should be present. On the other hand, Hauser-Gerspach et al. [54] found that P. gingivalis cells inactivated to below detection limit with the same settings for 10 s and also found that these settings with an average power 5 W (500 mJ/pulse) had strong bactericidal effect to Streptococcus sanguinis; however, a crack formation was observed by Stübinger et al. [62] when a polished and SLA titanium implant surfaces irradiated with 500 mJ and 63.69 J/cm2 in non-contact mode under water irrigation, in addition, no surface changes for both surfaces at 100 mJ/pulse. Al-Hashedi et al. [57] found that the Er:YAG 2940 nm laser with an average power of 2 W, 100 mJ/pulse, and 20 Hz in non-contact mode (0.5–1 mm distance) under water flow is effective in eliminating the biofilm bacteria but these settings with 2 W will affect the titanium implant as reported by Park et al. [68]. No bacteria was found in any area of titanium implants without surface alteration when irradiated with 2940 nm with an average power 0.75 W, 75 mJ/pulse, 10 Hz for 60 s in non-contact mode (0.5 mm distance) under water refrigeration as demonstrated by Scarano et al. [55]. A study by Schwarz et al. [45] demonstrated that CPS reduce BOP, PD, and CAL in a higher level than ERL with 2940 nm wavelength, 10 Hz and 11.4 J/cm2, 100 mJ/pulse, 1 W, and 100 ms application time without determining if the therapy is in surgical or non-surgical approach. ERL 2940 nm wavelength cause no surface changes of polished, SLA, HA, double acid-etched, HA, SLA, AO, and fluoride-modified TiO2 titanium surfaces when irradiated with 1 W, 100 mJ/pulse, 12.74 J/cm2, 10 Hz, and 1–2 min in non-contact mode (0.5–1 mm) under water irrigation as demonstrated by Kim et al. [61, 66], Lee et al. [63], and Shin et al. [65, 70], and also no surface changes of machined and anodized titanium surfaces when irradiated with 50 mJ/pulse, 1 W for 30 s in non-contact mode (0.5 mm) under water irrigation as that reported by Park et al. [68]. In addition, a collapse of SLA and a fusion of TPS surfaces were observed when irradiated with 1.5 and 2 W, 150 and 200 mJ/pulse, 16.1 and 22.5 J/cm2 respectively and 10 Hz but no morphological changes of TPS and machined titanium surfaces, Galli et al. [64]. Used and non-used tips have a significant effect on the titanium surfaces after laser irradiation, whereas no double acid-etched titanium surface changes occur when irradiated with 2940 nm wavelength, 30, 40, or 50 mJ/pulse, 30 Hz, 200 μs under water irrigation and with non-used tip. A morphological change of the surface does not occur when irradiated with used tip and with the same settings except in a case of pulse energy of 50 mJ/pulse [71]. On the other hand, a water refrigeration is necessary to avoid increase of surface temperature, as lasing without water irrigation will increase a temperature above the critical threshold (10 °C) after just 10 s of irradiation [67, 69]. Two thousand nine hundred forty-nanometer ERL laser has a negative effect on the zirconia surfaces or the materials behind it where morphological changes will occur even when the surface is lased in a non-contact mode with 100 mJ/pulse, 10 Hz repetition rate for 10 to 20 s [58, 60, 72, 73, 75].

From those, we must take in consideration that an average power of 2 W or more may have an excellent antibacterial effect but it will lead to a negative result on the implant surfaces itself. On the other hand, we can consider that the safe settings of Er:YAG laser 2980 nm wavelength which may be used as an antibacterial effect without titanium surface alteration or increase of temperature above the critical threshold in the treatment of peri-implantitis according to the authors are 100 mJ/pulse, 1 W, 10 Hz, and 12.74 J/cm2 for 60 s and in non-contact mode.

Conclusion

A consideration should be taken when Er:YAG laser 2980 nm wavelength is used to avoid a negative thermal and characteristic effect on the implant surfaces, where the favorable settings which can be used in the treatment of peri-implantitis are 100 mJ/pulse, 1 W, 10 Hz, and 12.74 J/cm2 for 60 s.

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Misch CE (2007) Contemporary implant dentistry, 3rd edn. Mosby, St. Louis, pp 3–25Google Scholar
  2. 2.
    Greenstein G, Cavallaro J, Romanos G, Tarnow D (2008) Clinical recommendation for avoiding and managing surgical complications associated with implant dentistry. A review. J Periodontol 79:1317–1329.  https://doi.org/10.1902/jop.2008.070067 CrossRefPubMedGoogle Scholar
  3. 3.
    Porter JA, von Fraunhofer JA (2005) Success or failure of dental implants? A literature review with treatment considerations. Gen Dent 53(6):423–432PubMedGoogle Scholar
  4. 4.
    Malet J, Mora F, Bouchard P (2012) Implant dentistry at a glance, 1st edn. Wiley-Blackwell, Chichester, pp 24, 25, 102, 103, 106–108Google Scholar
  5. 5.
    Rosen P, Cochran D, Froum S, McAllister B, Renvert S, Wang H-L (2013) Peri-implant mucositis and peri-implantitis: a current understanding of their diagnosis and clinical implications. J Periodontol 84:436–443.  https://doi.org/10.1902/jop.2013.134001 CrossRefGoogle Scholar
  6. 6.
    Figuero E, Graziani F, Sanz I, Herrera D, Sanz M (2014) Management of peri-implant mucositis and peri-implantitis. Periodontol 66:255–273CrossRefGoogle Scholar
  7. 7.
    Romanos GE, Gupta B, Yunker M, Romanos EB, Malmstrom H (2013) Laser use in dental implantology. Implant Dent 22:282–288.  https://doi.org/10.1097/ID.0b013e3182885fcc CrossRefPubMedGoogle Scholar
  8. 8.
    Scott Froum DDS (2011) Review of the treatment protocols for peri-implantitis. online article available at website http://www.dentistryiq.com/articles/2011/10/review of the treatment protocols for peri-implantitis.html.
  9. 9.
    Alshehri FA (2016) The role of lasers in the treatment of peri-implant diseases: a review. Saudi Dent J 28:103–108CrossRefPubMedGoogle Scholar
  10. 10.
    Javed F, Romanos GE (2009) Impact of diabetes mellitus and glycemic control on the osseointegration of dental implants: a systematic literature review. J Periodontol 80:1719–1730.  https://doi.org/10.1902/jop.2009.090283 CrossRefPubMedGoogle Scholar
  11. 11.
    Renvert S, Quirynen M (2015) Risk indicators for peri-implantitis. A narrative review. Clin Oral Implants Res 26:15–44.  https://doi.org/10.1111/clr.12636 CrossRefPubMedGoogle Scholar
  12. 12.
    Maruyama N, Maruyama F, Takeuchi Y, Aika- wa C, Izumi Y, Nakagawa I (2014) Intraindividual variation in core microbiota in peri-implantitis and periodontitis. Sci Rep 4:6602.  https://doi.org/10.1038/srep06602 CrossRefPubMedCentralPubMedGoogle Scholar
  13. 13.
    Heitz-Mayfield LJ, Lang NP (2010) Comparative biology of chronic and aggressive periodontitis vs. peri-implantitis. Periodontol 53:167–181.  https://doi.org/10.1111/j.1600-0757.2010.00348.x CrossRefGoogle Scholar
  14. 14.
    Renvert S, Polyzois I (2015) Risk indicators for peri-implant mucositis: a systematic literature review. J Clin Periodontol 42:172–186.  https://doi.org/10.1111/jcpe.12346 CrossRefGoogle Scholar
  15. 15.
    Lang NP, Berglundh T (2011) Periimplant diseases: where are we now?—consensus of the seventh European workshop on periodontology. J Clin Periodontol 38:178–181.  https://doi.org/10.1111/j.1600-051X.2010.01674.x CrossRefPubMedGoogle Scholar
  16. 16.
    Linkevicius T, Puisys A, Vindasiute E, Linke-viciene L, Apse P (2013) Does residual cement around implant-supported restorations cause peri-implant disease? A retrospective case analysis. Clin Oral Implants Res 24:1179–1184.  https://doi.org/10.1111/j.1600-0501.2012.02570.x CrossRefPubMedGoogle Scholar
  17. 17.
    Dalago HR, Schuldt Filho G, Rodrigues MA, Renvert S, Bianchini MA (2016) Risk indicators risk indicators for peri-implantitis. A cross sectional study with 916 patients. Clinical Oral Implants 00:1–7.  https://doi.org/10.1111/clr.12772 CrossRefGoogle Scholar
  18. 18.
    Strietzel FP, Reichart PA, Kale A, Kulkarni M, Wegner B, Kuchler I (2007) Smoking interferes with the prognosis of dental implant treatment: a systematic review and meta-analysis. J Clin Periodontol 34:523–544.  https://doi.org/10.1111/j.1600-051X.2007.01083.x CrossRefPubMedGoogle Scholar
  19. 19.
    Klokkevold PR, Han TJ (2007) How do smoking, diabetes, and periodontitis affect outcomes of implant treatment? Int J Oral Maxillofac Implants 22:173–202PubMedGoogle Scholar
  20. 20.
    Rinke S, Ohl S, Ziebolz D, Lange K, Eickholz P (2011) Prevalence of peri-implant disease in partially edentulous patients: a practice based cross sectional study. Clin Oral Implants Res 22:826–833.  https://doi.org/10.1111/j.1600-0501.2010.02061.x CrossRefPubMedGoogle Scholar
  21. 21.
    Laine ML, Leonhardt A, Roos-Jansa ker AM et al (2006) IL1RN gene polymorphism is associated with periimplantitis. Clin Oral Implants Res 17:380–385.  https://doi.org/10.1111/j.1600-0501.2006.01249.x CrossRefPubMedGoogle Scholar
  22. 22.
    Fu J-H, Hsu Y-T, Wang H-L (2012) Identifying occlusal overload and how to deal with it to avoid marginal bone loss around implants. Eur J Oral Implantol 5:91–103Google Scholar
  23. 23.
    Oates TW, Dowell S, Robinson M, McMahan CA (2009) Glycemic control and implant stabilization in type 2 diabetes mellitus. J Dent Res 88:367–371.  https://doi.org/10.1177/0022034509334203 CrossRefPubMedCentralPubMedGoogle Scholar
  24. 24.
    Krennmair G, Seemann R, Piehslinger E (2010) Dental implants in patients with rheumatoid arthritis: clinical outcome and peri-implant findings. J Clin Periodontol 37:928–936.  https://doi.org/10.1111/j.1600-051X.2010.01606.x CrossRefPubMedGoogle Scholar
  25. 25.
    Galindo-Moreno P, Fauri M, Avila-Ortiz G, Fernandez Barbero JE, Cabrera-Leon A, Sanchez-Fernandez E (2005) Influence of alcohol and tobacco habits on peri-implant marginal bone loss: a prospective study. Clin Oral Implants Res 16:579–586.  https://doi.org/10.1111/j.1600-0501.2005.01148.x CrossRefPubMedGoogle Scholar
  26. 26.
    Froum SJ, Rosen PS (2012) A proposed classification for peri-implantitis. Int J Periodontics Restorative Dent 32:533–540PubMedGoogle Scholar
  27. 27.
    Bobia F, Pop RV (2010) Periimplantitis. Aetiology, diagnosis, treatment. A review from the literature. Curr Health Sci J 36:171–175Google Scholar
  28. 28.
    Algraffee H, Borumandi F, Cascarini L (2011) Peri-implantitis (review). Br J Oral Maxillofac Surg 50:689–694.  https://doi.org/10.1016/j.bjoms.2011.11.020 CrossRefPubMedGoogle Scholar
  29. 29.
    Prathapachandran J, Suresh N (2012) Management of peri-implantitis. Dent Res J (Isfahan) 9:516–521CrossRefGoogle Scholar
  30. 30.
    Roncati M, Lucchese A, Carinci F (2013) Non-surgical treatment of peri-implantitis with the adjunctive use of an 810 nm diode laser. J Indian Soc Periodontol 17:812–815CrossRefPubMedGoogle Scholar
  31. 31.
    Smeets R, Henningseng A, Jung O, Heiland M, Hammächer C, Stein JM (2014) Definition, etiology, prevention and treatment of peri-implantitis, a review. Head Face Med 10:4–8.  https://doi.org/10.1186/1746-160X-10-34 CrossRefGoogle Scholar
  32. 32.
    Meyle J (2012) Mechanical, chemical and laser treatments of the implant surface in the presence of marginal bone loss around dental implants. Eur J Oral Implantol 5:71–81Google Scholar
  33. 33.
    Khandge N, Pradhan S, Doshi Y, Kulkarni A (2013) Comparison of the effects of different laser wavelengths on implants surfaces. Int J Laser Dentistry 3:14–18CrossRefGoogle Scholar
  34. 34.
    Convissar RA (2015) Principles and practice of laser dentistry, 2nd edn, pp 107–109Google Scholar
  35. 35.
    Dr. rer. Medic. René Franzen lectures. Module 5, 24-30.10.2016. Master of science in laser in dentistry, EN2015, Aachen universityGoogle Scholar
  36. 36.
    Dr. rer. Medic. René Franzen lectures. Module 3, 14-18.03.2016. Master of science in laser in dentistry, EN2015, Aachen UniversityGoogle Scholar
  37. 37.
    Bader C, Krejci I (2006) Indication and limitation of Er:YAG laser applications in dentistry. Am J Dent 19:181Google Scholar
  38. 38.
    Kreisler M, Kohnen W, Marinello C, Götz H, Duschner H, Jansen B, D'Hoedt B (2002) Bactericidal effect of the Er:YAG laser on dental implant surface: an in vitro study. J Periodontol 73:1292–1298.  https://doi.org/10.1902/jop.2002.73.11.1292 CrossRefPubMedGoogle Scholar
  39. 39.
    Takasaki AA, Aoki A, Mizutani K, Kikuchi S, Oda S, Ishikawa I (2007) Er:YAG laser therapy for peri-implant infection: a histological study. Lasers Med Sci 22:143–157.  https://doi.org/10.1007/s10103-006-0430-x CrossRefPubMedGoogle Scholar
  40. 40.
    Yan M, Liu M, Wang M, Yin F, Xia H (2015) The effects of Er:YAG on the treatment of peri-implantitis: a meta-analysis of randomized controlled trials. Lasers Med Sci 30:1843–1853.  https://doi.org/10.1007/s10103-014-1692-3 CrossRefPubMedGoogle Scholar
  41. 41.
    Kamel MS, Khosa A, Tawse-Smith A, Leichter J (2014) The use of laser therapy for dental implant surface decontamination: a narrative review of in vitro studies. Lasers Med Sci 29:1977–1985.  https://doi.org/10.1007/s10103-013-1396-0 CrossRefPubMedGoogle Scholar
  42. 42.
    Stübinger S, Etter C, Miskiewicz M, Homann F, Saldamli B, Wieland M, Sader R (2010) Surface alteration of polished and sandblasted and acid-etched titanium implants after Er:YAG, carbon dioxide, and diode laser irradiation. Int J Oral Maxillofac Implants 25:104–111PubMedGoogle Scholar
  43. 43.
    Romanos GE, Gutknecht N, Dieter S, Schwarz F, Crespi R, Sculean A (2009) Laser wavelengths and oral implantology: Review Article. Lasers Med Sci 24:961–970CrossRefPubMedGoogle Scholar
  44. 44.
    Friedmann A, Antic L, Bernimoulin J-P, Purucker P (2006) In vitro attachment of osteoblasts on contaminated rough titanium surfaces treated by Er:YAG laser. J Biomed Mater Res 79A:53–60.  https://doi.org/10.1002/jbm.a.30699 CrossRefGoogle Scholar
  45. 45.
    Schwarz F, Sahm N, Iglhaut G, Becker J (2011) Impact of the method of surface debridement and decontamination on the clinical outcome following combined surgical therapy of peri-implantitis: a randomized controlled clinical study. J Clin Periodontol 38:276–284.  https://doi.org/10.1111/j.1600-051X.2010.01690.x CrossRefPubMedGoogle Scholar
  46. 46.
    Wang Y, Zhang Y, Miron RJ (2015) Health, maintenance, and recovery of soft tissues around implants. Clin Implant Dent Relat Res 18:618–634.  https://doi.org/10.1111/cid.12343 CrossRefPubMedGoogle Scholar
  47. 47.
    Takasaki AA, Mizutani K, Schwarz F et al (2009) Application of antimicrobial photodynamic therapy in periodontal and peri-implant diseases. Periodontol 51:109–140.  https://doi.org/10.1111/j.1600-0757.2009.00302.x CrossRefGoogle Scholar
  48. 48.
    Rutger Persson G, Roos-Jansaker A-M, Lindahl C, Renvert S (2011) Microbiologic results after non-surgical erbium-doped:yttrium, aluminum, and garnet laser or air-abrasive treatment of peri-implantitis: a randomized clinical trial. J Periodontol 82:1267–1278.  https://doi.org/10.1902/jop.2011.100660 CrossRefPubMedGoogle Scholar
  49. 49.
    Renvert S, Lindahl C, Roos Jansaker A-M, Persson GR (2011) Treatment of peri-implantitis using Er:YAG laser or an air-abrasive device: a randomized clinical trial. J Clin Periodontol 38:65–73.  https://doi.org/10.1111/j.1600-051X.2010.01646.x CrossRefPubMedGoogle Scholar
  50. 50.
    Badran Z, Bories C, Struillou X, Saffarzadeh A, Verner C, Soueida A (2011) Er:YAG laser in the clinical management of severe peri-implantitis: a case report. J Oral Implantol.  https://doi.org/10.1563/AAID-JOI-D-09-00145.1 CrossRefPubMedGoogle Scholar
  51. 51.
    Schwarz F, John G, Mainusch S, Sahm N, Becker J (2012) Combined surgical therapy of peri-implantitis evaluating two methods of surface debridement and decontamination. A two-year clinical follow up report. J Clin Periodontol 39:789–797.  https://doi.org/10.1111/j.1600-051X.2012.01867.x CrossRefPubMedGoogle Scholar
  52. 52.
    Schwarz F, Hegewald A, John G, Sahm N, Becker J (2013) Four-year follow-up of combined surgical therapy of advanced peri-implantitis evaluating two methods of surface decontamination. J Clin Periodontol 40:962–967.  https://doi.org/10.1111/jcpe.12143 CrossRefPubMedGoogle Scholar
  53. 53.
    Schwarz F, John G, Hegewald A, Becker J (2015) Non-surgical treatment of peri-implant mucositis and peri-implantitis at zirconia implants: a prospective case series. J Clin Periodontol 42:783–788.  https://doi.org/10.1111/jcpe.12439 CrossRefPubMedGoogle Scholar
  54. 54.
    Hauser-Gerspach I, Mauth C, Waltimo T, Meyer J, Stübinger S (2014) Effects of Er:YAG laser on bacteria associated with titanium surfaces and cellular response in vitro. Lasers Med Sci 29:1329–1337.  https://doi.org/10.1007/s10103-013-1303-8 CrossRefPubMedGoogle Scholar
  55. 55.
    Scarano A, Nardi G, Murmura G, Rapani M, Mortellaro C (2016) Evaluation of the removal bacteria on failed titanium implants after irradiation with erbium-doped yttrium aluminium garnet laser. J Craniomaxillofac Surg 27:1202–1204.  https://doi.org/10.1097/SCS.0000000000002735 CrossRefGoogle Scholar
  56. 56.
    Chen C-J, Ding S-J, Chen C-C (2016) Effects of surface conditions of titanium dental implants on bacterial adhesion. Photomed Laser Surg 34:379–388.  https://doi.org/10.1089/pho.2016.4103 CrossRefPubMedGoogle Scholar
  57. 57.
    Al-Hashedi AA, Laurenti M, Benhamou V, Tamimi F (2016) Decontamination of titanium implants using physical methods. Clin Oral Implants Res 00:1–9.  https://doi.org/10.1111/clr.12914 CrossRefGoogle Scholar
  58. 58.
    Stübinger S, Homann F, Etter C, Miskiewicz M, Wieland M, Sader R (2008) Effect of Er:YAG, CO2 and diode laser irradiation on surface properties of zirconia endosseous dental implants. Lasers Surg Med 40:223–228.  https://doi.org/10.1002/lsm.20614 CrossRefPubMedGoogle Scholar
  59. 59.
    Duarte PM, Reis AF, de Freitas PM, Ota-Tsuzuki C (2009) Bacterial adhesion on smooth and rough titanium surfaces after treatment with different instruments. J Periodontol 80:1824–1832.  https://doi.org/10.1902/jop.2009.090273 CrossRefPubMedGoogle Scholar
  60. 60.
    Cavalcanti AN, Pilecki P, Foxton RM, Watson TF, Oliveira MT, Gianinni M, Marchi GM (2009) Evaluation of the surface roughness and morphologic features of Y-TZP ceramics after different surface treatments. Photomed Laser Surg 27:473–479.  https://doi.org/10.1089/pho.2008.2293 CrossRefPubMedGoogle Scholar
  61. 61.
    Kim S-W, Kwon Y-H, Chung J-H, Shin S-I, Herr Y (2010) The effect of Er:YAG laser irradiation on the surface microstructure and roughness of hydroxyapatite-coated implant. J Periodontal Implant Sci 40:276–282.  https://doi.org/10.5051/jpis.2010.40.6.276 CrossRefPubMedCentralPubMedGoogle Scholar
  62. 62.
    Stübinger S, Etter C, Miskiewicz M, Homann F, Saldamli B, Wieland M, Sader R (2010) Surface alterations of polished and sandblasted and acid-etched titanium implants after Er:YAG, carbon dioxide, and diode laser irradiation. Int J Oral Maxillofac Implants 25:104–111PubMedGoogle Scholar
  63. 63.
    Lee J-H, Kwon Y-H, Herr Y, Shin S-I, Chung J-H (2011) Effect of erbium-doped: yttrium, aluminium and garnet laser irradiation on the surface microstructure and roughness of sand-blasted, large grit, acid-etched implants. J Periodontal Implant Sci 41:135–142.  https://doi.org/10.5051/jpis.2011.41.3.135 CrossRefPubMedCentralPubMedGoogle Scholar
  64. 64.
    Galli C, Macaluso GM, Elezi E, Ravanetti F, Cacchioli A, Gualini G, Passeri G (2011) The effects of Er:YAG laser treatment on titanium surface profile and osteoblastic cell activity: an in vitro study. J Periodontol 82:1169–1177.  https://doi.org/10.1902/jop.2010.100428 CrossRefPubMedGoogle Scholar
  65. 65.
    Shin S-I, Min H-K, Park B-H, Kwon Y-H, Park J-B, Herr Y, Heo S-J, Chung J-H (2011) The effect of Er:YAG laser irradiation on the scanning electron microscopic structure and surface roughness of various implant surfaces: an in vitro study. Lasers Med Sci 26:767–776.  https://doi.org/10.1007/s10103-010-0819-4 CrossRefPubMedGoogle Scholar
  66. 66.
    Kim J-H, Herr Y, Chung J-H, Shin S-I, Kwon Y-H (2011) The effect of erbium-doped: yttrium, aluminium and garnet laser irradiation on the surface microstructure and roughness of double acid-etched implants. J Periodontal Implant Sci 41:234–241.  https://doi.org/10.5051/jpis.2011.41.5.234 CrossRefPubMedCentralPubMedGoogle Scholar
  67. 67.
    Geminiani A, Caton JG, Romanos GE (2011) Temperature increase during CO2 and Er:YAG irradiation on implant surfaces. Implant Dent 20:1.  https://doi.org/10.1097/ID.0b013e3182310d57 CrossRefGoogle Scholar
  68. 68.
    Park J-H, Heo S-J, Koak J-Y, Kim S-K, Han C-H, Lee J-H (2012) Effects of laser irradiation on machined and anodized titanium disks. Int J Oral Maxillofac Implants 27:265–272PubMedGoogle Scholar
  69. 69.
    Yamamoto A, Tanabe T (2013) Treatment of peri-implantitis around TiUnite-surface implants using Er:YAG laser Microexplosion. Int J Periodontics Restorative Dent 33:21–29.  https://doi.org/10.11607/prd.1593 CrossRefPubMedGoogle Scholar
  70. 70.
    Shin S-I, Lee E-K, Kim J-H, Lee J-H, Kim S-H, Kwon Y-H, Herr Y, Chung J-H (2013) The effect of Er:YAG laser irradiation on hydroxyapatite-coated implants and fluoride-modified TiO2-blasted implant surfaces: a microstructural analysis. Lasers Med Sci 28:823–831.  https://doi.org/10.1007/s10103-012-1162-8 CrossRefPubMedGoogle Scholar
  71. 71.
    Taniguchi Y, Aoki A, Mizutani K, Takeuchi Y, Ichinose S, Takasaki AA, Schwarz F, Izumi Y (2013) Optimal Er:YAG laser irradiation parameters for debridement of microstructured fixture surfaces of titanium dental implants. Lasers Med Sci 28:1057–1068.  https://doi.org/10.1007/s10103-012-1171-7 CrossRefPubMedGoogle Scholar
  72. 72.
    Turp V, Akgungor G, Sen D, Tuncelli B (2014) Evaluation of surface topography of zirconia ceramic after Er:YAG laser etching. Photomed Laser Surg 32:533–539.  https://doi.org/10.1089/pho.2014.3730 CrossRefPubMedGoogle Scholar
  73. 73.
    Arami S, Tabatabae MH, Namdar SF, Chiniforush N (2014) Effects of different lasers and particle abrasion on surface characteristics of zirconia ceramics. J Dent, Tehran University of Medical Sciences 11:233–241Google Scholar
  74. 74.
    Ayobian-Markazi N, Karimi M, Safar-Hajhosseini A (2015) Effects of Er:YAG laser irradiation on wettability, surface roughness, and biocompatibility of SLA titanium surfaces: an in vitro study. Lasers Med Sci 30:561–566.  https://doi.org/10.1007/s10103-013-1361-y CrossRefPubMedGoogle Scholar
  75. 75.
    Caglar I, Yanıkoglu N (2016) The effect of sandblasting, Er:YAG laser, and heat treatment on the mechanical properties of different zirconia cores. Photomed Laser Surg 34:17–26.  https://doi.org/10.1089/pho.2015.3980 CrossRefPubMedGoogle Scholar
  76. 76.
    Prof. Dr. med. dent. Norbert Gutknecht lectures. Module 3. 14-20.03.2016. Master of science in laser in dentistry. Aachen University. “EN2015”Google Scholar

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Authors and Affiliations

  1. 1.Department of Periodontology and Preventive Dentistry, Faculty of DentistryAl Asmarya UniversityZlitenLibya
  2. 2.Department of Conservative Dentistry, Periodontology and Preventive DentistryRWTH Aachen University HospitalAachenGermany

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