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The effects of using erbium, chromium-doped:yttrium-scandium-gallium-garnet laser on the surface modification, bacterial decontamination, and cell adhesion on zirconia discs: an in vitro study

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Lasers in Medical Science Aims and scope


The use of zirconia for implants and abutments has become more prevalent in implant dentistry as an alternative to the commonly used titanium implants, and peri-implant disease can still affect them. The erbium, chromium-doped:yttrium-scandium-gallium-garnet (Er, Cr:YSGG) laser has emerged as a promising treatment modality. The purposes of this in vitro study were to (1) determine the effects of the laser on the surface roughness of zirconia discs; (2) determine the extent of removal of a single species biofilm, E. coli, on the zirconia discs after applying the laser; (3) determine the amount of cell adhesion and proliferation utilizing fibroblasts on zirconia discs after treatment with the laser. All treatments will be compared with the commonly used ultrasonic instrumentation and hand scalers. For the first aim, gross examination revealed noticeable surface damage on the discs when using ultrasonic and scalers but not for the laser group. For surface roughness, the mean roughness was Pa= 0.623±0.185 μm, 0.762±0.421 μm, 0.740±0.214 μm, and 0.724±0.168 μm for control discs, and discs treated with either the Er,Cr:YSGG laser, ultrasonic instrumentation, and hand scalers respectively. There was no statistical significance among the groups (p=0.628). For bacteria decontamination, there was a statistical significance among the groups (p< 0.0001). Statistical significance was seen between the control group and each of the three treatment groups, favoring the treatment groups (p< 0.0001). Statistical significance was seen when comparing ultrasonic instrumentation and hand scalers (p= 0.000) as well as when comparing the Er,Cr:YSGG laser to hand scalers (p= 0.007), favoring both the ultrasonic instrumentation and Er,Cr:YSGG laser. No significance between the Er,Cr:YSGG laser group and the ultrasonic instrumentation group was noted (p =0.374). When comparing the cell attachment following treatment in each of the three groups and also without treatment (control), there was a statistical significance among the groups (p<0.0001) in terms of total cell count, favoring the control and the laser groups. Further evaluations with SEM showed differences in cell morphology indicating more adherent cells on Er,Cr:YSGG laser–treated surfaces. In conclusion, gross examination of the discs show clear surface changes when using ultrasonic instrumentation and hand scalers compared to the Er,Cr:YSGG laser group. The Er,Cr:YSGG laser was able to effectively ablate bacteria from zirconia disc. Fibroblast attachment on the surfaces of the zirconia discs shows more adherence when treated with Er,Cr:YSGG laser.

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  1. Branemark PI, Hansson BO, Adell R, Breine U, Lindstrom J, Hallen O, Ohman A (1977) Osseointegrated implants in the treatment of the edentulous jaw. Experience from a 10-year period. Scand J Plast Reconstr Surg Suppl 16:1–132

    CAS  PubMed  Google Scholar 

  2. Berglundh T, Armitage G, Araujo MG, Avila-Ortiz G, Blanco J, Camargo PM, Chen S, Cochran D, Derks J, Figuero E, Hammerle CHF, Heitz-Mayfield LJA, Huynh-Ba G, Iacono V, Koo KT, Lambert F, McCauley L, Quirynen M, Renvert S, Salvi GE, Schwarz F, Tarnow D, Tomasi C, Wang HL, Zitzmann N (2018) Peri-implant diseases and conditions: consensus report of workgroup 4 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Periodontol 89(Suppl 1):S313–S318

    Article  Google Scholar 

  3. Lindhe J, Meyle J, D.o.E.W.o.P. Group (2008) Peri-implant diseases: consensus report of the Sixth European Workshop on Periodontology. J Clin Periodontol 35(8 Suppl):282–285

    Article  Google Scholar 

  4. Khoshkam V, Suarez-Lopez Del Amo F, Monje A, Lin GH, Chan HL, Wang HL (2016) Long-term radiographic and clinical outcomes of regenerative approach for treating peri-implantitis: a systematic review and meta-analysis. Int J Oral Maxillofac Implants 31(6):1303–1310

    Article  Google Scholar 

  5. Andersson B, Glauser R, Maglione M, Taylor A (2003) Ceramic implant abutments for short-span FPDs: a prospective 5-year multicenter study. Int J Prosthodont 16(6):640–646

  6. Scarano A, Piattelli M, Caputi S, Favero GA, Piattelli A (2004) Bacterial adhesion on commercially pure titanium and zirconium oxide disks: an in vivo human study. J Periodontol 75(2):292–296

    Article  Google Scholar 

  7. Hashim D, Cionca N, Courvoisier DS, Mombelli A (2016) A systematic review of the clinical survival of zirconia implants. Clin Oral Investig 20(7):1403–1417

    Article  Google Scholar 

  8. Hollander J, Lorenz J, Stubinger S, Holscher W, Heidemann D, Ghanaati S, Sader R (2016) Zirconia dental implants: investigation of clinical parameters, patient satisfaction, and microbial contamination. Int J Oral Maxillofac Implants 31(4):855–864

    Article  Google Scholar 

  9. Aoki A, Sasaki KM, Watanabe H, Ishikawa I (2004) Lasers in nonsurgical periodontal therapy. Periodontol 2000(36):59–97

    Article  Google Scholar 

  10. Ting CC, Fukuda M, Watanabe T, Aoki T, Sanaoka A, Noguchi T (2007) Effects of Er,Cr:YSGG laser irradiation on the root surface: morphologic analysis and efficiency of calculus removal. J Periodontol 78(11):2156–2164

    Article  Google Scholar 

  11. Natto ZS, Aladmawy M, Levi PA Jr, Wang HL (2015) Comparison of the efficacy of different types of lasers for the treatment of peri-implantitis: a systematic review. Int J Oral Maxillofac Implants 30(2):338–345

    Article  Google Scholar 

  12. Azzeh MM (2008) Er,Cr:YSGG laser-assisted surgical treatment of peri-implantitis with 1-year reentry and 18-month follow-up. J Periodontol 79(10):2000–2005

    Article  Google Scholar 

  13. Al-Falaki R, Cronshaw M, Hughes FJ (2014) Treatment outcome following use of the erbium, chromium:yttrium, scandium, gallium, garnet laser in the non-surgical management of peri-implantitis: a case series. Br Dent J 217(8):453–457

    Article  CAS  Google Scholar 

  14. Nevins M, Benfenati SP, Galletti P, Zuchi A, Sava C, Sava C, Trifan M, Piattelli A, Iezzi G, Chen CY, Kim DM, Rocchietta I (2020) Human histologic evaluations of the use of Er,Cr:YSGG laser to decontaminate an infected dental implant surface in preparation for implant reosseointegration. Int J Periodontics Restorative Dent 40(6):805–812

    Article  Google Scholar 

  15. Ercan E, Arin T, Kara L, Candirli C, Uysal C (2014) Effects of Er,Cr:YSGG laser irradiation on the surface characteristics of titanium discs: an in vitro study. Lasers Med Sci 29(3):875–880

  16. Chegeni E, Espana-Tost A, Figueiredo R, Valmaseda-Castellon E, Arnabat-Dominguez J (2020) Effect of an Er,Cr:YSGG laser on the surface of implants: a descriptive comparative study of 3 different tips and pulse energies. Dent J (Basel) 8(4)

  17. Park SH, Kim OJ, Chung HJ, Kim OS (2020) Effect of a Er,Cr:YSGG laser and a Er:YAG laser treatment on oral biofilm-contaminated titanium. J Appl Oral Sci 28:e20200528

    Article  CAS  Google Scholar 

  18. Strever JM, Lee J, Ealick W, Peacock M, Shelby D, Susin C, Mettenberg D, El-Awady A, Rueggeberg F, Cutler CW (2017) Erbium, chromium:yttrium-scandium-gallium-garnet laser effectively ablates single-species biofilms on titanium disks without detectable surface damage. J Periodontol 88(5):484–492

    Article  CAS  Google Scholar 

  19. Miranda PV, Rodrigues JA, Blay A, Shibli JA, Cassoni A (2015) Surface alterations of zirconia and titanium substrates after Er,Cr:YSGG irradiation. Lasers Med Sci 30(1):43–48

    Article  Google Scholar 

  20. Turkun M, Turkun LS, Celik EU, Ates M (2006) Bactericidal effect of Er,Cr:YSGG laser on Streptococcus mutans. Dent Mater J 25(1):81–86

    Article  Google Scholar 

  21. Gordon W, Atabakhsh VA, Meza F, Doms A, Nissan R, Rizoiu I, Stevens RH (2007) The antimicrobial efficacy of the erbium, chromium:yttrium-scandium-gallium-garnet laser with radial emitting tips on root canal dentin walls infected with Enterococcus faecalis. J Am Dent Assoc 138(7):992–1002

    Article  Google Scholar 

  22. Zitzmann NU, Abrahamsson I, Berglundh T, Lindhe J (2002) Soft tissue reactions to plaque formation at implant abutments with different surface topography. An experimental study in dogs. J Clin Periodontol 29(5):456–461

    Article  Google Scholar 

  23. Abrahamsson I, Berglundh T, Glantz PO, Lindhe J (1998) The mucosal attachment at different abutments. An experimental study in dogs. J Clin Periodontol 25(9):721–727

    Article  CAS  Google Scholar 

  24. Buser D, Weber HP, Donath K, Fiorellini JP, Paquette DW, Williams RC (1992) Soft tissue reactions to non-submerged unloaded titanium implants in beagle dogs. J Periodontol 63(3):225–235

    Article  CAS  Google Scholar 

  25. Mustafa K, Wennerberg A, Arvidson K, Messelt EB, Haag P, Karlsson S (2008) Influence of modifying and veneering the surface of ceramic abutments on cellular attachment and proliferation. Clin Oral Implants Res 19(11):1178–1187

    Article  Google Scholar 

  26. Cho YD, Shin JC, Yoon HI, Ku Y, Ryoo HM, Kim DJ, Kim DG, Han JS (2015) Characterization of human gingival fibroblasts on zirconia surfaces containing niobium oxide. Materials (Basel) 8(9):6018–6028

    Article  CAS  Google Scholar 

  27. Fischer NG, Wong J, Baruth A, Cerutis DR (2017) Effect of clinically relevant CAD/CAM zirconia polishing on gingival fibroblast proliferation and focal adhesions. Materials (Basel) 10(12)

  28. Zheng M, Yang Y, Liu XQ, Liu MY, Zhang XF, Wang X, Li HP, Tan JG (2015) Enhanced biological behavior of in vitro human gingival fibroblasts on cold plasma-treated zirconia. PLoS One 10(10):e0140278

  29. Esfahanizadeh N, Motalebi S, Daneshparvar N, Akhoundi N, Bonakdar S (2016) Morphology, proliferation, and gene expression of gingival fibroblasts on Laser-Lok, titanium, and zirconia surfaces. Lasers Med Sci 31(5):863–873

    Article  Google Scholar 

  30. Nevins M, Kim DM, Jun SH, Guze K, Schupbach P, Nevins ML (2010) Histologic evidence of a connective tissue attachment to laser microgrooved abutments: a canine study. Int J Periodontics Restorative Dent 30(3):245–255

    PubMed  Google Scholar 

  31. Nevins M, Nevins ML, Camelo M, Boyesen JL, Kim DM (2008) Human histologic evidence of a connective tissue attachment to a dental implant. Int J Periodontics Restorative Dent 28(2):111–121

    PubMed  Google Scholar 

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The study was part of the primary author’s (Charles Pham, HSDM) research thesis submitted in partial fulfillment of the requirements for the MMSc degree. Authors report no conflict of interest.

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Correspondence to David M. Kim.

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One sentence summary: Using the Er,Cr:YSGG laser for treatment of peri-implant disease does not cause gross surface damage, can effectively ablate bacteria, and allows for fibroblast adherence.

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Pham, C.M., Chen, CY. & Kim, D.M. The effects of using erbium, chromium-doped:yttrium-scandium-gallium-garnet laser on the surface modification, bacterial decontamination, and cell adhesion on zirconia discs: an in vitro study. Lasers Med Sci 36, 1701–1708 (2021).

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