Comparative effectiveness of novel laser-assisted technologies for treating peri-implantitis : A network meta-analysis of randomized controlled trials
- 1Department of Oral and Maxillofacial Surgery, Wuxi Stomatology Hospital, Wuxi, Jiangsu Province, China
- 2Wanshun Outpatient Department, Wuxi Stomatology Hospital, Wuxi, Jiangsu Province, China
- 3Department of Periodontics, Wuxi Stomatology Hospital, Wuxi, Jiangsu Province, China.
Abstract
Background:: Peri-implantitis impairs dental implant survival. Though new laser-assisted therapies are promising, their relative efficacy remains unclear. This Bayesian network meta-analysis compared photodynamic therapy (PDT), diode laser (DL), erbium:YAG laser (Er:YAG), and conventional non-laser control (CON).
Methods:: Following PRISMA guidelines, we retrieved relevant randomized controlled trials from PubMed, Embase, Web of Science, MEDLINE, and China National Knowledge Infrastructure up to May 31, 2025. Primary outcomes included bleeding on probing (BOP), probing depth (PD), and plaque index; secondary outcomes covered clinical attachment level, crestal bone loss, gingival index, and bleeding index (BI). We calculated odds ratios and standardized mean differences with 95% credible intervals and P-values via Stata 14. Treatments were ranked using the surface under the cumulative ranking curve, combined with effect estimates and evidence quality for result interpretation.
Results:: Thirty-three randomized controlled trials with 1825 participants were included. PDT ranked best overall, with significant improvements in PD, plaque index, crestal bone loss, gingival index, and BI versus CON. No therapy yielded significant differences in BOP and clinical attachment level. DL showed no clinical advantages over CON, while Er:YAG only improved BI significantly. Surface under the cumulative ranking curve rankings of DL and Er:YAG only indicated probability order, not definite therapeutic effects.
Conclusion:: PDT exerted the most stable short-term efficacy for peri-implantitis. DL and Er:YAG had limited valid benefits. Due to insufficient long-term data, the sustained effects of these treatments and their roles in preventing lesion recurrence and maintaining implant survival are still undetermined. A network meta-analysis of 33 RCTs found that photodynamic therapy (PDT) had the most consistent statistically supported benefits, with significant improvements versus CON in PD, PI, CBL, GI, and BI, but not in BOP or CAL. Although PDT also showed the most favorable SUCRA based ranking profile, SUCRA reflects ranking probability rather than effect magnitude, certainty of evidence, or definitive clinical superiority. DL did not show statistically significant superiority over CON, and Er:YAG showed a significant benefit versus CON only for BI. These findings support considering PDT as a minimally invasive adjunct to mechanical debridement when clinically appropriate, while emphasizing that treatment selection should be guided by statistically robust effects, CrI precision, patient-specific factors, and the limitations of the underlying evidence network. Importantly, the current evidence mainly reflects short term clinical response. Whether PDT provides sustained disease control, reduces recurrence, or improves long term implant survival remains to be confirmed in well powered trials with longer follow-up.
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BibTeX
@article{wang2026comparative,
title = {{Comparative effectiveness of novel laser-assisted technologies for treating peri-implantitis : A network meta-analysis of randomized controlled trials}},
author = {Zhe Wang and Jing Wen and Haoyang Li and Jiaying Xu and Furong Mao},
journal = {Medicine},
year = {2026},
month = oct,
doi = {10.1097/md.0000000000051256},
url = {https://europepmc.org/article/PMC/PMC13727279},
note = {CC BY},
}
RIS
TY - JOUR
TI - Comparative effectiveness of novel laser-assisted technologies for treating peri-implantitis : A network meta-analysis of randomized controlled trials
AU - Zhe Wang
AU - Jing Wen
AU - Haoyang Li
AU - Jiaying Xu
AU - Furong Mao
PY - 2026
DA - 2026/10/30
JO - Medicine
DO - 10.1097/md.0000000000051256
UR - https://europepmc.org/article/PMC/PMC13727279
AB - Background:: Peri-implantitis impairs dental implant survival. Though new laser-assisted therapies are promising, their relative efficacy remains unclear. This Bayesian network meta-analysis compared photodynamic therapy (PDT), diode laser (DL), erbium:YAG laser (Er:YAG), and conventional non-laser control (CON). Methods:: Following PRISMA guidelines, we retrieved relevant randomized controlled trials from PubMed, Embase, Web of Science, MEDLINE, and China National Knowledge Infrastructure up to May 31, 2025. Primary outcomes included bleeding on probing (BOP), probing depth (PD), and plaque index; secondary outcomes covered clinical attachment level, crestal bone loss, gingival index, and bleeding index (BI). We calculated odds ratios and standardized mean differences with 95% credible intervals and P-values via Stata 14. Treatments were ranked using the surface under the cumulative ranking curve, combined with effect estimates and evidence quality for result interpretation. Results:: Thirty-three randomized controlled trials with 1825 participants were included. PDT ranked best overall, with significant improvements in PD, plaque index, crestal bone loss, gingival index, and BI versus CON. No therapy yielded significant differences in BOP and clinical attachment level. DL showed no clinical advantages over CON, while Er:YAG only improved BI significantly. Surface under the cumulative ranking curve rankings of DL and Er:YAG only indicated probability order, not definite therapeutic effects. Conclusion:: PDT exerted the most stable short-term efficacy for peri-implantitis. DL and Er:YAG had limited valid benefits. Due to insufficient long-term data, the sustained effects of these treatments and their roles in preventing lesion recurrence and maintaining implant survival are still undetermined. A network meta-analysis of 33 RCTs found that photodynamic therapy (PDT) had the most consistent statistically supported benefits, with significant improvements versus CON in PD, PI, CBL, GI, and BI, but not in BOP or CAL. Although PDT also showed the most favorable SUCRA based ranking profile, SUCRA reflects ranking probability rather than effect magnitude, certainty of evidence, or definitive clinical superiority. DL did not show statistically significant superiority over CON, and Er:YAG showed a significant benefit versus CON only for BI. These findings support considering PDT as a minimally invasive adjunct to mechanical debridement when clinically appropriate, while emphasizing that treatment selection should be guided by statistically robust effects, CrI precision, patient-specific factors, and the limitations of the underlying evidence network. Importantly, the current evidence mainly reflects short term clinical response. Whether PDT provides sustained disease control, reduces recurrence, or improves long term implant survival remains to be confirmed in well powered trials with longer follow-up.
SN - 0304-5412
SN - 1536-5964
SN - 0025-7974
ER -