Second Stage Implant Randomized Controlled Trial Comparing Scalpel and Lasers

Objectives:  The aim of this randomized clinical split-mouth study was to evaluate patients’ perception of pain and healing and to quantify the amount of the inflammatory cytokines IL-1β and IL-6 after second stage implant uncovering by either scalpel or a diode laser.  Methods: Twelve patients who received bilateral implants were selected.  After appropriate healing time, implants were uncovered randomly using either a standard scalpel flap surgery (control) or a 970nm diode laser (experimental).  Patient satisfaction and pain were assessed by questionnaires and visual analog scales (VAS). Gingival crevicular fluid was collected around the implants at day 1 and 7, and IL-1β and IL-6 levels were measured with ELISA.  Results: All sites displayed uneventful healing.  Student T Test data analysis revealed lower average IL-1β levels in the laser group as compared to the control group at Day 1 (387.2 pg/mL vs. 456.2 pg/mL), p=0.02 and Day 7 (255.6 pg/mL vs. 328.83 pg/mL) p =0.36.  The experimental (laser) sites displayed lower average IL-6 levels at Day 1 (22.4 pg/mL vs. 25.1 pg/mL) p=0.24 and Day 7 (14.7 pg/mL vs. 19.1 pg/mL) p=0.1.  Although patients indicated slightly greater amounts of pain in laser sites over a seven day period, as assessed via VAS, the Global Health Questionnaire showed patients overwhelmingly preferred the laser.  VAS revealed no differences in patient perceived healing.  Wilcoxon Signed Ranks Tests revealed no differences in gingival inflammation or oral hygiene ability.  Conclusion: This study indicates that a diode laser is safe and efficacious to use for the uncovering of dental implants.  Even though a slightly greater amount of pain was perceived over seven days, patients significantly prefer the laser to the scalpel.  The diode laser may also decrease the post-operative inflammatory cytokine production of IL-1β and IL-6.