Diode Laser and S100A8 in Peri-Implantitis

Effect of 940 nm Diode Laser as an Adjunct to Mechanical Debridement on S100A8 Levels and Clinical Parameters in Peri-Implantitis Treatment

Purpose: The aim of this study was to compare the effectiveness of diode laser and combined treatment protocols, applied in addition to mechanical debridement, in the treatment of peri-implantitis on clinical periodontal parameters and S100A8 levels in peri-implant sulcus fluid (PISF).

Methods: A total of 39 patients diagnosed with peri-implantitis were divided into three groups based on the treatment protocols used: Mechanical Debridement, Diode Laser, and Combined Treatment. Probing depth, clinical attachment level, modified plaque index, gingival index, and PISF volume measurements were recorded at baseline and at weeks 4 and 12. S100A8 levels in PISF samples were measured by ELISA.

Study Overview

• Status: Completed
• Conditions: Biomarkers; Calprotectin; Periimplant Diseases; S100A8

Detailed Description

This study included 39 functional implants in patients aged 30-65 diagnosed with peri-implantitis (PD ≥6 mm, no clinical mobility). Participants were assigned to three groups (n=13 per group) using simple randomization (coin toss) performed by an independent researcher: Group 1 (Mechanical debridement only), Group 2 (940 nm diode laser monotherapy), and Group 3 (Combined mechanical debridement and diode laser). Exclusion criteria consisted of systemic diseases, smoking or alcohol consumption, pregnancy/lactation, parafunctional habits, and recent use of antibiotics (within 6 months) or peri-implant treatment (within 3 months). At baseline, clinical parameters were recorded and peri-implant sulcular fluid (PISF) samples were collected. Specifically, probing depth (PD) and clinical attachment level (CAL) were measured at 6 sites per implant, while the modified plaque index (mPI) and gingival index (GI) were assessed at 4 sites per implant.

Prior to PISF sampling, supragingival plaque was removed using sterile curettes, and the area was isolated and air-dried. Samples were collected from mesial and distal sites using paper strips (Ora Flow) inserted 1 mm into the sulcus for 30 seconds; contaminated strips were discarded. PISF volume was measured in microliters using a Periotron 8000 device, and samples were stored at -80°C until analysis. Treatment protocols included: mechanical debridement with titanium curettes for Group 1; decontamination using a 940 nm diode laser (2.5 W, CP2 mode, 400 μm fiber tip) for 30 seconds for Group 2; and a sequential combination of both treatments for Group 3. Following treatment, all pockets were irrigated with 10% povidone-iodine. Clinical parameters and PISF samples were evaluated at baseline (T0), week 4 (T1), and week 12 (T2). For biochemical analysis, S100A8 levels were determined via ELISA at 450 nm and calculated as ng/mL using a standard curve.

• Study Type: Observational
• Enrollment (Actual): 39

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Kırıkkale
    • Kırıkkale, Kırıkkale, Turkey (Türkiye), 71100
      • Kırıkkale University, Faculty of Dentistry

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

• Sampling Method: Probability Sample

Study Population

The study population consists of systemically healthy, non-smoking individuals aged 30-65 years who have at least one functional dental implant diagnosed with peri-implantitis (probing depth ≥ 6 mm, no clinical mobility). Participants are selected from patients admitted to the Kırıkkale University Faculty of Dentistry, Department of Periodontology for routine follow-up or treatment.

Description

Inclusion Criteria:

• Individuals aged 30-65 years.
• Presence of at least one functional dental implant with no clinical mobility
• Diagnosis of peri-implantitis with a probing depth (PD) of ≥ 6 mm.
• Ability to provide informed consent and attend follow-up visits.

Exclusion Criteria:

• Systemic diseases that may interfere with wound healing (e.g., uncontrolled diabetes).
• History of radiation or chemotherapy.
• Pregnancy or lactation.
• Smoking or alcohol consumption.
• Parafunctional habits (e.g., bruxism).
• Use of systemic antibiotics within the last 6 months.
• Periodontal or peri-implant treatment in the relevant area within the last 3 months.

Study Plan

How is the study designed?

Number of groups / cohorts

3

Cohorts and Interventions

Group / Cohort
Mechanical Debridement Group; 13 participants. Procedure: Subgingival mechanical debridement using sterile titanium curettes to remove biofilm and deposits from the implant surfaces. Collection of PISF samples.
Diode Laser Monotherapy Group; 13 participants. Procedure: Decontamination using a 940 nm diode laser (2.5 W, CP2 mode) to remove biofilm from the implant surfaces. Collection of PISF samples.
Combined Group; 13 participants. Procedure: Sequential application of subgingival mechanical debridement followed by 940 nm diode laser decontamination. Collection of PISF samples.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in S100A8 levels in Peri-Implant Sulcular Fluid (PISF)	S100A8 levels will be measured using an ELISA kit (ng/mL) to evaluate the inflammatory response.	Baseline (Day 0), 28 days (Week 4), and 84 days (Week 12)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Probing Depth (PD)	Distance from the gingival margin to the bottom of the sulcus/pocket measured at six sites per implant/tooth. Unit of Measure: Millimeters (mm)	Baseline (Day 0), 28 days (Week 4), and 84 days (Week 12)
Clinical Attachment Level (CAL)	Distance from the cemento-enamel junction (CEJ) to the bottom of the pocket.Unit of Measure: Millimeters (mm)	Baseline (Day 0), 28 days (Week 4), and 84 days (Week 12)
Modified Plaque Index (mPI)	Assessment of plaque accumulation on the implant/tooth surfaces. Unit of Measure: Score on a scale (0 to 3)	Baseline (Day 0), 28 days (Week 4), and 84 days (Week 12)
Gingival Index (GI)	Assessment of gingival inflammation and bleeding tendency. Unit of Measure: Score on a scale (0 to 3)	Baseline (Day 0), 28 days (Week 4), and 84 days (Week 12)

Collaborators and Investigators

• Sponsor: Kırıkkale University
• Investigators: Principal Investigator: Akif Nalbant, Specialist in Periodontology, Kirikkale University Faculty of Dentistry

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2025
• Primary Completion (Actual): June 1, 2025
• Study Completion (Actual): October 10, 2025

Study Registration Dates

• First Submitted: April 1, 2026
• First Submitted That Met QC Criteria: April 6, 2026
• First Posted (Actual): April 13, 2026

Study Record Updates

• Last Update Posted (Actual): April 13, 2026
• Last Update Submitted That Met QC Criteria: April 6, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: biomarkers; inflammation; Peri-implantitis; calprotectin
• Additional Relevant MeSH Terms: Periodontal Diseases; Mouth Diseases; Stomatognathic Diseases; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Inflammation; Peri-Implantitis
• Other Study ID Numbers: 2024.12.21

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No