Laser-Assisted Peri-Implantitis Treatment and Guided Bone Regeneration

Er,Cr:YSGG Laser-Assisted Peri-Implantitis Treatment and Guided Bone Regeneration
Walid Altayeb DDS, MSc, PhD
Discover how advanced laser technology and bone regeneration techniques can effectively treat peri-implantitis. This case study showcases a successful treatment approach for a 35-year-old male patient, combining Er,Cr:YSGG laser technology with osseous and gingival regenerative surgery.
Patient Presentation and Diagnosis
Clinical Signs
The patient presented with implant #8, placed four years ago, exhibiting gingival inflammation, pus discharge, and a minimal amount of attached gingiva on the buccal side
Radiographic Findings
Significant peri-implant bone loss and infrabony defects
Peri-Implant 
Peri-implant probing depths were assessed following removal of the ceramic crown
Treatment Planning
Guided Bone Regeneration
Utilization of a bone graft substitute (combination of allograft and xenograft) in conjunction with a titanium and resorbable collagen membrane.
Laser-Assisted Surgery
Incorporation of Er,Cr:YSGG laser (2780 nm) for precise tissue ablation, effective biofilm removal, and implant surface detoxification.
Laser Parameters and Surgical Procedure
Flap Incision
MT4 tip (average power 2.5 W, frequency 50 Hz, pulse duration 60 µs, W20/A20) in contact mode for intrasulcular internal bevel incision.
Granulation Tissue Ablation 
MZ6 tip (average power 3 W, frequency 30 Hz, pulse duration 60 µs, W80/A20).
Implant Debridement and Detoxification
RFPT5 tip (average power 2 W, frequency 30 Hz, pulse duration 60 µs, W80/A20) in non-contact mode.
Surgical Procedure Details
Anesthesia and Flap Elevation
Local anesthesia administered, flap raised for access to implant site.
Laser Debridement
Laser ablation of granulation tissue and osseous recontouring were achieved.
Implant Decontamination
Decontamination of the implant surface
Bone Grafting
Bone defects filled with graft mixture(combination of allograft and xenograft).
Bone Grafting
Graft was secured by titanium membrane and covered with resorbable collagen membrane.
Wound Closure
Flap sutured  to achieve primary closure.
Postoperative Care and Follow-up
Medication
Antibiotic prophylaxis (Amoxicillin/clavulanic acid 1g every 12 hours for 7 days), pain management (Ibuprofen 600 mg every 8 hours for 3 days). Chlorhexidine rinses twice daily for 10 days.
Follow-up Appointments
Scheduled at 7 days, 1 month, and 3 months post-surgery.
Provisional Restoration
Restoration of the implant was planned  after 3 months of the periodontal surgery
Treatment Outcomes
Healing 
Uneventful healing with minimal postoperative complications. Clinical examination at 3-month follow-up revealed healthy peri-implant tissues with no signs of recession, bleeding on probing, or implant mobility.
Radiographic Results
Significant bone fill and improved bone levels surrounding implants at 3-month follow-up .
Long-Term Clinical Outcomes
At 3 years of follow-up, the final prosthetic rehabilitation achieved satisfactory functional and esthetic results for both the patient and the clinician.
Conclusion & Future Implications
This case report demonstrates the successful application of Er,Cr:YSGG laser technology in peri-implantitis treatment. The laser's precise tissue ablation and decontamination capabilities in addition to the effective biofilm removal contributed to successful bone regeneration and improved clinical outcomes.
The advantages of this approach include improved precision, reduced tissue trauma, and enhanced biofilm removal without alteration of implant surface. For cases of peri-implantitis with moderate bone loss and stable implants, laser-assisted debridement and regenerative procedures can be a valuable treatment option to preserve the implant and improve long-term outcomes.
Walid Altayeb DDS, MSC, PhD
 President of Academy of Laser Dentistry 2024-2025 
• Master of Science in Periodontics in 2004 ,Doctorate of Philosophy PH.D in Periodontics in 2007, Master of Academy of Laser Dentistry in 2014
• Guest Professor Faculty of Dental Medicine, Istanbul Ayden University, Istanbul, Turkey
• Prof. a c at Master Laser Dentistry Università Cattolica del Sacro Cuore di Roma, Italy
• Over the last seven years, he has provided more than 1574 CPD hours in the field of Esthetic Periodontics, Implantology, and Laser Dentistry.
• Dr. Altayeb is working in private as Periodontist and Implantologist in Tamim Dental Polyclinic, Doha, Qatar & Dr. Imran Aestheticare Center, Dubai, UAE.
Walid Altayeb (@walidaltayeb) • Instagram photos and videos