YAG laser combined with mechanical debridement enhances pain relief and inflammation control in the management of periodontitis with peri-implantitis

Abstract

Objective: To evaluate the efficacy of Er: YAG laser combined with mechanical debridement in treating periodontitis with peri-implantitis.

Methods: A retrospective analysis was conducted on 292 patients treated between 2018 and 2024. The patients were divided into an observation group (n=139, Er: YAG laser + mechanical debridement) and a control group (n=153, mechanical debridement only). Outcome measures included Visual Analog Scale (VAS) scores, periodontal probing depth (PD), clinical attachment level (CAL), bleeding index (BI), gingival index (GI), and TNF-α/IL-6 levels. Clinical efficacy and risk factors for treatment failure were analyzed using logistic regression.

Results: The observation group exhibited a significantly higher total efficacy rate than the control group (89.21% vs. 64.71%, P<0.001). Additionally, VAS scores, PD, CAL, BI, GI, and TNF-α/IL-6 levels were significantly lower at 1 week, 2 weeks, and 1 month post-treatment in the observation group (all P<0.05). Multivariate logistic regression identified age (OR=1.12, 95% CI: 1.07-1.18, P<0.001), smoking (OR=6.21, 95% CI: 2.96-13.82, P<0.001), and diabetes (OR=5.74, 95% CI: 2.71-12.94, P<0.001) as independent risk factors for treatment failure, while postprandial gargling (OR=0.28, P=0.002) was identified as a protective factor.

Conclusion: Er: YAG laser combined with mechanical debridement significantly reduced pain and inflammation, improving peri-implant health. Smoking, diabetes, and age increased treatment failure risk, while postprandial gargling was protective, underscoring the importance of personalized treatment strategies.

Keywords: Er: YAG laser; inflammation; mechanical debridement; pain; peri-implantitis; periodontitis.

Figure 1

Clinical and radiographic images of a typical case before and after treatment. A. Preoperative clinical view showing peri-implantitis associated with chronic periodontitis, with a peri-implant pocket depth of 13 mm, accompanied by bleeding and exudate; B. Preoperative radiograph revealing a severe circumferential bone defect around the implant (indicated by the arrow); C. Postoperative clinical view at 1 month showing improved peri-implant soft tissue condition, with the pocket depth reduced to approximately 3 mm and no bleeding on probing; D. Preoperative clinical view of early peri-implantitis associated with periodontitis, with a peri-implant pocket depth of 15 mm; E. Preoperative radiograph displaying a bone defect around the implant; F. Postoperative clinical view at 1 month demonstrating improved peri-implant soft tissue recovery, with the pocket depth decreased to 4.5 mm and minimal bleeding on probing.

Figure 2

Comparison of VAS scores between the two groups before and at 1 day, 1 week, 2 weeks, and 1 month after surgery. Note: VAS, Visual Analogue Scale; ns P>0.05, ***P<0.001.

Figure 3

Nomogram, ROC Curve, and Calibration Curve for predictive efficacy. A. Nomogram illustrating the contribution of predictive factors to clinical efficacy; B. ROC curve; C. Calibration curve showing the agreement between predicted and observed outcomes (Sum of squared errors =36.35, P=0.850). The solid line represents the model’s predicted value, while the dashed line indicates ideal calibration. Note: ROC, Receiver Operating Characteristic; AUC, Area Under the Curve.