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The clinical efficacy of Er:YAG lasers in the treatment of peri-implantitis: a systematic review and meta-analysis.

BACKGROUND
Erbium-doped yttrium aluminum garnet (ER:YAG) lasers have been used to treat peri-implant, but there are some disputes. To dispel these negative views, our study aims to compare the efficacy and safety of Er:YAG lasers versus conventional mechanical debridement in the treatment of peri-implantitis.


METHODS
Seven databases were used to search for relevant studies and full-text articles which evaluate the comparisons of Er:YAG lasers and mechanical debridement for patients with peri-implantitis. Review Manager 5.4 was employed to assess the effects of the results among the selected studies. Forest plots, subgroup analyses, and on the included articles were also completed. Cochrane risk of bias assessment tool was used to assess the risk of bias.


RESULTS
Our study focused on 10 previously conducted studies which included 294 patients with peri-implantitis and a total of 461 implants. No significant differences in clinical attachment level (CAL) (MD =0.17, P=0.25, at 6 months; MD =0.23, P=0.15, at 12 months), reduction in bleeding on probing (BOP) (MD =9.54%, P=0.18, at 6 months; MD =11.28%, P=0.24, at 12 months), or plaque index (PI) (MD =-0.02, P=0.75, at 6 months; MD =-0.07, P=0.66, at 12 months) were observed between the Er:YAG laser group and the mechanical debridement group. However, in reducing probing depth (PD) (MD =0.28, P=0.03, at 6 months; MD =0.35, P=0.002, at 12 months) and gingival recession (GR) changes (MD =-0.12, P=0.04, at 6 months; MD =-0.16, P=0.03, at 12 months), the Er:YAG laser group showed some advantages at 6-month and 12-month intervals following treatment. No significant publication bias existed in our meta-analysis by using funnel plot and Egger's test (PD: P=0.65; CAL: P=0.73).


DISCUSSION
Our research supported the premise that Er:YAG lasers offer health benefits to patients with peri-implantitis and can effectively reduce PD and GR. Due to the limitations of the included studies, further studies should be carried out to validate our findings.