Nonsurgical Treatment of Peri-Implantitis Using Er:YAG Laser (2940 nm) and Photobiomodulation: A Randomized...

To evaluate the clinical, microbiological, and patient-reported outcome measures (PROMs) of Er:YAG laser and photobiomodulation (PBM) therapy compared with conventional mechanical debridement (MD) in the nonsurgical treatment of peri-implantitis.

Forty-five patients with peri-implantitis were randomly assigned to MD (control, n = 24) or Er:YAG laser followed by PBM (test, n = 21). Clinical parameters [probing depth (PD), bleeding on probing (BoP), clinical attachment level (CAL), plaque index, recession, suppuration] and levels of Porphyromonas gingivalis and Filifactor alocis were assessed at baseline and 3 months. Treatment success, defined as PD ≤ 5 mm, BoP at ≤ 1 site, and absence of suppuration, was assessed at 3 months. PROMs, including postoperative pain, analgesic use, anesthesia requirement, and satisfaction, were recorded during the first postoperative week.

Both groups showed significant clinical improvement (p < 0.001). The laser group demonstrated greater reductions in PD (-2.30 vs. -1.45 mm, p < 0.001), BoP (-73.0% vs. -42.4%, p = 0.004), and CAL (-2.56 vs. -1.47 mm, p = 0.001), with higher treatment success (81% vs. 42%, p = 0.007). P. gingivalis decreased significantly only in the laser group (p = 0.001), while F. alocis changes were not significant in both groups. PROMs favored the laser group, with lower postoperative pain, reduced analgesic use, and higher satisfaction (p < 0.05).

Adjunctive Er:YAG and PBM therapy improved clinical outcomes, reduced P. gingivalis, and enhanced patient experience compared with MD.

Er:YAG and PBM therapy may improve treatment success, enhance patient comfort, and support more predictable nonsurgical management of peri-implantitis.