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

Review Article
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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,Cr:YSGG laser (2780 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 that focused on the antibacterial effect of Er,Cr:YSGG laser (2780 nm) in the treatment of peri-implantitis and their effects on implant surfaces. This literature search was limited to ten years (January 2007–March 2017).

Results

The favorable settings of Er,Cr:YSGG laser which can be used significantly to treat peri-implantitis without titanium surface characteristic alteration or increase of temperature based on reviewed articles are in a non-contact mode (0.5 mm distance) at 1 and 1.5 W, 10 and 30 Hz, and 60 and 120 s, respectively, under air and water flow for refrigeration.

Conclusion

Er,Cr:YSGG laser with specific parameters is an effective tool in the treatment of peri-implantitis without negative effect on the implant surfaces.

Keywords

Dental implant Er,Cr:YSGG laser Laser treatment Laser therapy Periimplantitis Peri-implantitis Periimplant Dental implant surface Decontamination Disinfection Antibacterial effect Bactericidal effect 

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, and 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 the 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 implants 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, and 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 (Table 2) [29, 30, 31].
Table 2

The abbreviations which had been used in this review

Icon

Meaning

Icon

Meaning

Icon

Meaning

W

Watt

GR

Gingival recession

μm

Micrometer

PD

Pocket depth

TID

Titanium implant disks

S

Second

BOP

Bleeding on probing

SLA

Sand blasted, large grit, acid-etched

N info

No information

PI

Plaque index

Y-TZP

Yittrium-stabilized tetragonal zirconia polycrystal

μs

Microsecond

Ti

Titanium

Cap

Calcium phosphate nano-coated

ms

Millisecond

AN

Anodized

RGT

Removal of granulation tissue

M

Machined

AP

Application time

ISD

Implant surface debridement

IST

Implant surface treatment

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, 940, 980 nm), CO2 laser, several wavelengths used in photodynamic therapy.

Er,Cr:YSGG laser is a solid-state laser which belongs to the mid-infrared area and emits a laser beam in a free running pulsed with a wavelength of 2780 nm. It is highly absorbed in water and hydroxylapatite (Fig. 1). Similar to the Er:YAG laser, the absorption of Er,Cr:YSGG wavelength in water makes it safe for use around implants and can treat peri-implantitis and mucositis safely [32, 33]. The Er,Cr:YSGG laser is highly efficient and effective in terms of decontaminating the implant body [34]. In addition, the Er,Cr:YSGG laser was effective at removal of supragingival plaque biofilm from the implant surfaces (decreased from 53.8 ± 2.2% at 0.5 W to 9.8 ± 6.2% at 2.5 W, in an energy dependent manner) [35]. Er,Cr:YSGG laser as Er:YAG laser considered cool laser; therefore, they prevent burning, charring, and coagulation at the site of interaction and rate safe to use directly on titanium surface [36]. However, specific parameters such as irradiation distance, duration, frequency, and power should be taken into consideration while using this wavelength to treat peri-implantitis, in order to avoid negative side effects such as cracks, grooves, and melting of the implant surface [34], and it is preferred to use Er,Cr:YSGG with a water spray to avoid increase in temperature as what stated in a study that the apical temperature increase was recorded in cases of different types of implant surfaces of Er,Cr:YSGG without refrigeration and with power settings (1.5 W, 20 Hz, 12% air, 65% water, angle of 90°, 60 s with a tip of 600 μm), but when the water spray was used, a decrease in a temperature was observed in all implants [36]. Electronic microscopic analysis of the osteoblastic attachment on titanium surfaces when irradiated by Er,Cr:YSGG laser demonstrated a good proliferation of osteoblasts, as well as an attachment on different types of implant surfaces; this in turn may explain the reosseointegration after implant surface detoxification using this type of laser [7, 37]. Romanos et al. [38] investigated that the attachment of osteoblasts to the titanium surface and cell proliferation as well as new bone formation were observed after irradiation with Er,Cr:YSGG laser with a power of 1.25 W.
Fig. 1

Absorption coefficient of laser wavelengths [39]

Materials and methods

Search strategy

The PubMed and Google Scholar had been used to search for articles that focused on the antibacterial effect of Er,Cr:YSGG Laser (2780 nm) in the treatment of peri-implantitis and their effects on implant surfaces. This literature search was limited to ten years (January 2007 ــ March 2017).

Search words

The keywords which was used in the search are the following: dental implant, periimplantitis, peri-implantitis, periimplant, dental implant surface, decontamination, disinfection, antibacterial effect, bactericidal effect. All these words are followed by Er,Cr:YSGG laser, laser treatment, and laser therapy.

Inclusion criteria

  • Articles published in English language

  • Limited to ten 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, Er:YAG laser, diode lasers, 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,Cr:YSGG laser on the implant surface itself (Fig. 2)

Fig. 2

Number of articles used in the review (in general, in vivo, and in vitro)

Results

In vivo, the antibacterial effect of Er,Cr:YSGG in the treatment of peri-implantitis is shown in Table 3.
Table 3

Antibacterial effect of Er,Cr:YSGG in the treatment of peri-implantitis, in vivo

Author and year

Study type

Laser type and parameters

PD, PI, and GR

BOP pus discharge mobility

Bone level

Finding

Efeoglu et al. [40] 2008

A case report

Er,Cr:YSGG

2780 nm, 0.5 W, 20 Hz, 10%, water, 11% air, 25 J/cm2, Z3, non-contact mode, AT(?).

N info

N info

N info

The decontamination of implant surfaces was provided significantly by Er,Cr:YSGG 2780 nm without temperature increase on the irradiated area.

Manal M. Azzeh [41] 2008

A case report

Er,Cr:YSGG

2780 nm.

-1.5 W, 20 Hz, 10% water, 20% air, G6 tip of 600 μm tip of, in contact mode for RGT. AT (?).

-1.75 W, 20 Hz, 15% water, 30% air, G4 tip of 600 μm, AT (?), 5 mm distance for ISD.

PD reduced from7 to 2 mm.

GR reduced from 2 to < 1 mm.

No BOP

No pus oozing

No Mobility

Improved

Er,Cr:YSGG laser enabled regenerative osseous surgery around an implant without complications and with no signs of inflammation.

Tihomir Georgive [42] 2009

In vivo

Er,Cr:YSGG

2780 nm.

-4 W, 60% air, 20–30% water, defocused mode AT(?) for IST.

-5 W, 11% air, no water, AT(?) for sterilization.

N info

N info

N info

The successful treatment of peri-implantitis was 90%.

R. Al-Falaki et al. [43] 2014

In vivo

Er,Cr:YSGG 2780 nm, 1.5 W, 30 Hz, 50 mJ/pulse, 140 μs pulse duration, 50% water, 40% air 500  μm radial firing periodontal tip.

PD reduced from 6.64 ± 1.48 to 3.29 ± 1.02 mm at 2 months and at 6 months to 2.97 ± 0.7 mm.

BOP reduced from 88 to 18% at 2 months and to 10% at 6 months.

Some bone infill was observed.

-Significant reduction of PD and BOP at 6 months follow-up.

-Recession occurred after treatment with exposure of implant surface and threads in many cases but reduced later on with time (14 months observation).

In vitro, the antibacterial effect of Er,Cr:YSGG in the treatment of peri-implantitis is shown in Table 4.
Table 4

Antibacterial effect of Er,Cr:YSGG in the treatment of peri-implantitis, in vitro

Author and year

Laser type and parameters

Type of implant material and properties

Finding

Scarano et al. [44] 2012

Er,Cr:YSGG 2780 nm, 1.5 W, 10 Hz,1 min, truncated cone tip fiber, water irrigation, 0.5 mm from the implant surface and perpendicular.

Titanium.

-No bacteria were found on the implant surfaces.

-No surface alteration.

Strever et al. [45] 2016

Er,Cr:YSGG 2780 nm, (0 W, 0.5 W,1 W, 1.5 W), 30 Hz, 120 s, 50% air and water irrigation, RFPT5-14 mm, 0.5 mm distance from surface.

TID (2 mm thickness and 6 mm diameter) having modification including SAL, CaP, AN, and M.

≥ 95% of P. gingivalis were removed from surfaces when the power setting between 1 to 1.5 W was used, with no changes in surface temperature and surface roughness.

In vitro, the effect of Er,Cr:YSGG on the dental implant surfaces is shown in Table 5.
Table 5

Effect of Er,Cr:YSGG on the implant surfaces, in vitro

Author and year

Laser type and parameters

Type of implant material and properties

Finding

Scarano et al. [44] 2012

Er,Cr:YSGG 2780 nm, 1.5 W, 10 Hz, 1 min, truncated cone tip, water irrigation, 0.5 mm from the implant surface and perpendicular

Titanium

No surface alteration

Park et al. [46] 2012

Er,Cr:YSGG, 2780 nm, 20 Hz, 30 s, at (1, 2, 3, 4 and 5 W) power, (17.7, 35.4, 53.1, 70.7, and 88.4 J/cm2) energy density, air/water (10, 15, 20, 25, and 30), respectively, non-contact mode (1.5 mm distance), and 600 μm zirconia tip in 90° angle.

Titanium disks (machined and anodized).

-No changes at 1 and 2 W.

-Melting, coagulation, and microfracture at 3 W for machined Ti disks.

-Exfoliation of the coated surface at 3 W for anodized Ti disks.

-Melting, coagulation, and microfracture at 4 and 5 W for anodized Ti disks.

-Ra values increased in both surfaces at above 3 W.

Cassoni et al. [47] 2013

Er,Cr:YSGG, 2780 nm, 1.5 W, 20 Hz, 30 s, 67 J/cm2, 600 μm, 90° angle,

focused mode, 1 mm distance, 25% water and 80% air (G1)

Er,Cr:YSGG, 2780 nm, 1.5 W, 20 Hz, 30 s, 67 J/cm2, 600 μm, 90° angle, focused mode, 1 mm distance, 0% water and 80% air (G2)

Yittrium-stabilized tetragonal zirconia polycrystal (Y-TZP).

-G2 exhibited a higher temperature than G1.

-G1 = −1.4 °C and G2 = 21.4 °C

Ercan et al. [34] 2014

Er,Cr:YSGG, 2780 nm

R1: 1 W, 20 Hz, 15 s, 2 mm distance.

R2: 1 W, 25 Hz, 30 s, 4 mm distance.

R3: 1 W, 30 Hz, 45 s, 6 mm distance.

R4: 2 W, 20 Hz, 45 s, 4 mm distance.

R5: 2 W, 25 Hz, 15 s, 6 mm distance.

R6: 2 W, 30 Hz, 30 s, 2 mm distance.

R7: 3 W, 20 Hz, 30 s, 6 mm distance.

R8: 3 W, 25 Hz, 45 s, 2 mm distance.

R9: 3 W, 30 Hz, 15 s, 4 mm distance.

G4 fiber tip, 15% water and 30% air.

Titanium disks.

-NO changes at R3 and R5.

-Minor cracks and grooves at R1, R2, R4, and R7.

-Melting, flattering, and deep cracks at R6 and R8.

-The lowest Ra surface at R8.

Ercan et al. [48] 2015

Er,Cr:YSGG, 2780 nm

R1: 1 W, 20 Hz, 15 s, 2 mm distance.

R2: 1 W, 25 Hz, 30 s, 4 mm distance.

R3: 1 W, 30 Hz, 45 s, 6 mm distance.

R4: 2 W, 20 Hz, 45 s, 4 mm distance.

R5: 2 W, 25 Hz, 15 s, 6 mm distance.

R6: 2 W, 30 Hz, 30 s, 2 mm distance.

R7: 3 W, 20 Hz, 30 s, 6 mm distance.

R8: 3 W, 25 Hz, 45 s, 2 mm distance.

R9: 3 W, 30 Hz, 15 s, 4 mm distance.

G4 fiber tip, 15% water and 30% air.

Titanium disks.

-No observable changes at R3, R5, and R7.

-Melting and flattering at R6.

-Melting, flattering, and cracks at R8.

Kirmali et al. [49] 2015

Er,Cr:YSGG, 2780 nm, power of (1, 2, 3, 4, 5, and 6 W), 140–200 μs, 20 Hz, 600 μm fiber tip, 10 mm distance, 55% water, and 65% air.

Zirconia

-The highest Ra of the surfaces at 6 W and the lowest Ra surfaces at 1 W.

-Small pits, micro-cracks, and irregularity were observed more at 6, 5, and 4 W, and less at 3, 2, and 1 W.

Miranda et al. [50] 2015

Er,Cr:YSGG, 2780 nm, 1.5 W, 20 Hz, 30 s, air/water (80/25%).

Disks of Y-TZP and SLA Ti.

Er,Cr:YSGG alters the surface roughness of Y-TYP and SLA Ti with superficial cracks of SLA Ti surface.

Strever et al. [45] 2016

Er,Cr:YSGG, 2780 nm, power of (0 W, 0.5 W, 1 W, 1.5 W), 30 Hz, 120 s, 50% air and water irrigation, RFPT5-14 mm, non-contact mode (0.5 mm distance).

TID (2 mm thickness and 6 mm diameter) having modification including SAL, CaP, AN and M.

No changes in surface temperature and surface roughness when irradiated with power output between 1 to 1.5 W and under water spray.

Er,Cr:YSGG ablate ≥ 95% of biofilm from surfaces when an average power from 1 to 1.5 W.

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, 50]. 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 [37]. 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 14 of published paper investigating the use of Er,Cr:YSGG laser in peri-implantitis.

Ten of the reviewed studies [34, 40, 41, 42, 43, 44, 45, 46, 47, 48] suggested that a 2780-nm Er,Cr:YSGG laser is an effective tool for tissue debridement and decontamination of the implant surfaces during peri-implantitis treatment without any visible alteration in the characteristic of the implant surfaces or even increase of a temperature, whereas Efeoglu et al. [40] reported that the decontamination of implant surfaces was provided significantly by Er,Cr:YSGG 2780 nm wavelength with an average power of 0.5 W, 20 Hz, 50 ms application time (by calculation), 10% water, and 11% air without temperature increase on the irradiated area. Manal M. Azzeh [41] found that Er,Cr:YSGG treats significantly a peri-implantitis within 18 months with the settings of an average power 1.5–1.75 W, repetition rate 20 Hz, water 10–15%, and air 20–30%, but the application time did not mention. On the other hand, Miranda et al. [50] stated that the Er,Cr:YSGG laser with 1.5 W average power, 20 Hz repetition rate, and air-water cooling of 80–25% alters the surface characteristic of the titanium and zirconium implants with superficial cracks on the titanium surfaces. This negative result is possible as a result of operation mode which may be contact or near contact where it did not mention by the author. Moreover, a minor crack and grooves were observed when an average power of 1 W, 20 Hz repletion rate for 15 s application time, and 140 μs pulse duration and 2 mm distance from the titanium surface are used as stated by Ercan et al. [34, 48]. In addition, no changes of titanium surface characteristic were observed when 2780 nm Er,Cr:YSGG wavelength in non-contact mode (6 mm from the implant surface) with an average power of 1 and 2 W, 30 and 25 Hz repetition rate for 45 and 15 s irradiation time respectively and 140 μs pulse duration, water of 15%, and air of 30% for both [34, 48]. However, 6 mm distance from the surface may be not possible to be applied clinically except in combination with a surgical therapy in an anterior region for treatment of peri-implantitis. Tihomir Georgive [42] found that a successful treatment of peri-implantitis was 90% by using 2780 nm Er,Cr:YSGG wavelength with an average power 4 and 5 W, air 60% and 11%, with water of 20–30% and without water for decontamination and sterilization, respectively. Nevertheless, these settings lead to increase of temperature, melting, microfracture, and microcrack on the implant surfaces of titanium or zirconium as proven in two studies by Park et al. [46] and Kirmali et al. [49]. But at the same time, Park et al. [46] found also that the titanium surface did not changed by using 2780 nm Er,Cr:YSGG wavelength with an average power 1 or 2 W, 50 or 100 mJ/pulse respectively for 30 s, 20 Hz under air and water cooling. Scarano et al. [44] and Strever et al. [45] reported that complete or more than 95% of bacteria such as P. gingivalis was eliminated from the implant without titanium surface characteristic alteration or increase of temperature by using 2780 nm Er,Cr:YSGG wavelength in the non-contact mode (0.5 mm distance) with an average power of 1 or 1.5 W, 10 and 30 Hz repetition rate, and 60 and 120 s, respectively, under air and water flow for refrigeration. The air and water refrigeration play a major role to avoid increase of temperature and alteration of the implant surface characteristics as reported by Cassoni et al. [47] where they found that a high temperature (21.4 °C) was recorded on the zirconium surface when 2780 nm Er,Cr:YSGG wavelength in a non-contact mode (1 mm distance from surface) with an average power 1.5 W for 30 s and 20 Hz repetition rate without water cooling and 80% air; however, when these settings were used with 80% air and 25% water, the temperature was decreased (− 1.4 °C).

From those studies, it is difficult to find the perfect parameters for treatment of peri-implantitis with an Er,Cr:YSGG (2780 nm wavelength) without any alteration of implant surfaces because of the absence of some settings such as irradiation time or pulse duration in some of them and the repetition rate or mode of operation in others where these setting values play a major role in the effectiveness of laser and understanding of what the difference between a positive effect of one study with specific parameters and a negative one with the same settings. In addition, there are settings which in turn did not increase a temperature above the critical threshold (10 °C) of the implant surface [47]; nevertheless, the same settings cause surface alteration of titanium and zirconium surfaces [34, 48, 50]. Moreover, the type of bacteria causing a peri-implantitis is not specified in most of reviewed articles. Despite, we can conclude that the settings which can be used significantly to treat peri-implantitis without titanium surface characteristic alteration or increase of temperature based on reviewed articles are 2780 nm Er,Cr:YSGG wavelength, non-contact mode (0.5 mm distance) with an average power of 1 and 1.5 W, 10 and 30 Hz, and 60 and 120 s, respectively, under air and water flow for refrigeration.

Conclusion

We cannot exactly conclude appropriate settings of Er,Cr:YSGG (2780 nm) laser to treat peri-implantitis without negative effect on the implant surfaces due to the absence of some important parameters such as pulse duration or an application time. Moreover, some studies have been aimed to achieve bactericidal effect of Er,Cr:YSGG laser with certain settings without considering the effect of it on the implant surface; in the same time, there are other studies that had negative results of Er,Cr:YSGG laser on the implant surface with the same settings without considering an antibacterial effect. Despite, 2780 nm Er,Cr:YSGG wavelength in non-contact mode (0.5 mm distance) with an average power of 1 and 1.5 W, 10 and 30 Hz, and 60 and 120 s, respectively, under air and water flow for refrigeration can be used to treat peri-implantitis without titanium surface characteristic alteration or increase of temperature.

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

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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