Influence of postoperative low-level laser therapy on the osseointegration of self-tapping implants in the posterior maxilla: A 6-week split-mouth clinical study

Abstract

Background/Aim. Low-level laser therapy (LLLT) has been proven to stimulate bone repair, affecting cellular proliferation, differentiation and adhesion, and has shown a potential to reduce the healing time following implant placement. The aim of this clinical study was to investigate the influence of postoperative LLLT osseointegration and early success of self-tapping implants placed into low-density bone. Methods. Following the split-mouth design, self-tapping implants (n = 44) were inserted in the posterior maxilla of 12 patients. One jaw side randomly received LLLT (test group), while the other side was placebo (control group). For LLLT, a 637 nm gallium-aluminum-arsenide (GaAlAs) laser (Medicolaser 637, Technoline, Belgrade, Serbia) with an output power of 40 mW and continuous wave was used. Low-level laser treatment was performed immediately after the surgery and then repeated every day in the following 7 days. The total irradiation dose per treatment was 6.26 J/cm² per implant. The study outcomes were: implant stability, alkaline-phosphatase (ALP) activity and early implant success rate. The follow-up took 6 weeks. Results. Irradiated implants achieved a higher stability compared with controls during the entire follow-up and the difference reached significance in the 5th postoperative week (paired t-test, p = 0.030). The difference in ALP activ- ity between the groups was insignificant in any observation point (paired t-test, p > 0.05). The early implant success rate was 100%, regardless of LLLT usage. Conclusion. LLLT applied daily during the first postoperative week expressed no significant influence on the osseointegration of self- tapping implants placed into low density bone of the posterior maxilla. Placement of self-tapping macro-designed implants into low density bone could be a predictable therapeutic procedure with a high early success rate regardless of LLLT usage.

Uvod/Cilj. Terapija laserom male snage (TLMS) stimuliše reparatorne sposobnosti kosti utičući na ćelijsku proliferaciju, diferencijaciju i adheziju, i ima potencijal da skrati vreme zarastanja kosti nakon ugradnje implantata. Cilj ove kliničke studije bio je da se ispita uticaj postoperativne primene TLMS na oseointegraciju i rani uspeh ugradnje samourezujućih implantata u kost male gustine. Metode. Prateći split- mouth dizajn, samourezujući implantati (n = 44) ugrađeni su u posteriorne regije gornje vilice 12 pacijenata. Slučajnim izborom, jednoj od strana vilice je dodeljena TLMS (test grupa), dok je druga strana bila placebo (kontrolna grupa). Za TLMS korišćen je galijum-aluminijum-arsenid (GaAlAs) laser (Medicolaser 637, Technoline, Beograd, Srbija) talasne dužine 637 nm, snage 40 mW, neprekidnog režima rada. Tretman laserom male snage sprovodio se neposredno po ugradnji, a zatim svakodnevno, tokom narednih sedam dana. Ukupna zračna doza po tretmanu bila je 6,26 J/cm² po implantatu. Praćeni su stabilnost implantata, aktivnost alkalne fosfataze (ALP) i procenat rane uspešnosti implantatne terapije. Period praćenja bio je šest nedelja. Rezultati. Zračeni implantati imali su veću stabilnost u odnosu na kontrolne tokom celog perioda praćenja, a statistički značajno veća stabilnost bila je u petoj postoperativnoj nedelji (t-test za vezane uzorke, p = 0.030). Razlika u aktivnosti ALP između grupa nije bila statistički značajna ni u jednoj tački posmatranja (t-test za vezane uzorke, p > 0.05). Procenat rane uspešnosti terapije implantatima bio je 100%, bez obzira na primenjenu TLMS. Zaključak. Svakodnevna primena TLMS u prvoj postoperativnoj nedelji nije pokazala značajan uticaj na oseointegraciju samourezujućih implantata u kost male gustine bočne regije gornje vilice. Primena implantata samourezujućeg makrodizajna u kosti male gustine mogla bi predstavljati predvidljivu terapijsku proceduru sa visokim procentom rane uspešnosti, bez obzira na primenjenu TLMS.