Dental

Lasers Med Sci. 2016 Nov 24. [Epub ahead of print]

Laser and LED phototherapy on midpalatal suture after rapid maxilla expansion: Raman and histological analysis.

Rosa CB1, Habib FA1, de Araújo TM2, Dos Santos JN1, Cangussu MC1, Barbosa AF1, de Castro IC1, Pinheiro AL3,4.

Author information

  • 1Center of Biophotonics, School of Dentistry, Federal University of Bahia, Av. Araújo Pinho, 62, Canela, Salvador, BA, CEP 40110-150, Brazil.
  • 2Orthodontics, School of Dentistry, Federal University of Bahia, Av. Araújo Pinho, 62, Canela, Salvador, BA, CEP 40110-150, Brazil.
  • 3Center of Biophotonics, School of Dentistry, Federal University of Bahia, Av. Araújo Pinho, 62, Canela, Salvador, BA, CEP 40110-150, Brazil. albp@ufba.br.
  • 4National Institute of Optics and Photonics, Physics Institute of São Carlos, University of São Paulo, São Carlos, SP, 13560-970, Brazil. albp@ufba.br.

Abstract

The aim of this study was to analyze the effect of laser or LED phototherapy on the acceleration of bone formation at the midpalatal suture after rapid maxilla expansion. Forty-five rats were divided into groups at 7 days (control, expansion, expansion and laser irradiation, and expansion and LED irradiation) and into 14 days (expansion, expansion and laser in the 1st week, expansion and LED in the 1st week, expansion and laser in the 1st and 2nd weeks, expansion and LED in the 1st and 2nd weeks). Laser/LED irradiation occurred every 48 h. Expansion was accomplished with a spatula and maintained with a triple helicoid of 0.020-in stainless steel orthodontic wire. A diode laser (?780 nm, 70 mW, spot of 0.04 cm2, t=257 s, SAEF of 18 J/cm2) or a LED (?850±10 nm, 150±10 mW, spot of 0.5 cm2, t=120 s, SAEF of 18 J/cm2) was applied in one point in the midpalatal suture immediately behind the upper incisors. Raman spectroscopy and histological analyses of the suture region were carried and data was submitted to statistical analyses (p 0.05). Raman spectrum analysis demonstrated that irradiation increases hydroxyapatite in the midpalatal suture after expansion. In the histological analysis of various inflammation, there was a higher production of collagen and osteoblastic activity and less osteoclastic activity. The results showed that LED irradiation associated to rapid maxillary expansion improves bone repair and could be an alternative to the use of laser in accelerating bone formation in the midpalatal suture.

Laser Ther. 2016 Jun 29;25(2):121-129.

A randomized clinical trial comparing the efficacy of bite wafer and low level laser therapy in reducing pain following initial arch wire placement.

Bayani S1, Rostami S1, Ahrari F2, Saeedipouya I2.

Author information

  • 1Department of Orthodontics, School of Dentistry, Kerman University of Medical Sciences, Kerman, Iran.
  • 2Dental Research Center, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran.

Abstract

Background and aims: This study aimed to evaluate the efficacy of ibuprofen, bite wafer and low power red and infrared lasers in orthodontic pain management.

Subjects and methods: One hundred subjects were randomly assigned to 5 groups of 20 each. The patients in each group received one of the following treatments after the placement of fixed orthodontic appliances: 1. placebo medication, 2. ibuprofen, 3. bite wafer, 4. irradiation from a low level red laser (LLRL; 660 nm, 200 mW, 1 J/point, 6 points), 5. irradiation from a low level infrared laser (LLIL; 810 nm, 200 mW, 1 J/point, 6 points). A Visual Analogue Scale (VAS) was used to record pain intensity while chewing, biting, fitting front teeth, and fitting back teeth at 2 hours, 6 hours, bedtime, 24 hours, 2 days, 3 days and 7 days following arch wire placement.

Results: Significant between-group differences were found in pain at chewing, biting, fitting front teeth and fitting back teeth at all time points (p<0.001). Generally, VAS scores in the LLIL, ibuprofen and bite wafer groups were close to each other and significantly lower than those in the LLRL and control groups (p<0.05), which showed comparable pain level at most intervals. The infrared laser group (LLIL) showed significantly lower pain than all other groups at some points over the experiment (p<0.05).

Conclusions: A single irradiation from a low level infrared laser proved to be the best strategy for orthodontic pain control. Alternatively, chewing on a bite wafer could be recommended. These methods should be considered as suitable alternatives for ibuprofen in orthodontic patients.

J Clin Diagn Res. 2016 Jan;10(1):ZC67-70. doi: 10.7860/JCDR/2016/13218.7140. Epub 2016 Jan 1.

Clinical Evaluation of Low Level Diode Laser Application For Primary Teeth Pulpotomy.

Uloopi KS1, Vinay C1, Ratnaditya A2, Gopal AS3, Mrudula KJ4, Rao RC1.
Author information
1Professor, Department of Pediatric Dentistry, Vishnu Dental College , Bhimavaram, Andhra Pradesh, India .
2Reader, Department of Pediatric Dentistry, Vishnu Dental College , Bhimavaram, Andhra Pradesh, India .
3Former Resident, Department of Pediatric Dentistry, Vishnu Dental College , Bhimavaram, Andhra Pradesh, India .
4Resident, Department of Pediatric Dentistry, Vishnu Dental College , Bhimavaram, Andhra Pradesh, India .
.
Abstract
INTRODUCTION:
In spite of latest advances in the materials and techniques practiced for the treatment of pulpally infected teeth with better reported success rate, still the question arises for safety and effectiveness of these medicaments.
.
AIM:
The objective of the present study was to compare the effectiveness of the Low Level Laser Therapy to Mineral Trioxide Aggregate (MTA) when used for pulpotomy in vital human primary molars.
.
MATERIALS AND METHODS:
The sample consisted of 40 primary molars from 29 children aged four to seven years. The teeth were selected based on clinical, radiographic criteria and randomly allocated to two groups. All the 40 primary molars were subjected to standard pulpotomy procedure, where in 20 molars received MTA (Group I) and 20 molars received LLLT (Group II) pulpotomy. Children were recalled at 3, 6 and 12 months intervals and pulpotomised molars were examined clinically and radiographically. Data was analysed using chi-square test.
.
RESULTS:
MTA showed 94.7% success rate at all the three intervals, where as LLLT showed a success of 95% at three months, which decreased gradually to 85% at six months and 80% at 12 months. Intergroup comparisons were not significant.
.
CONCLUSION:
Low level laser therapy can be considered for primary teeth pulpotomy and its success is comparable to MTA pulpotomy technique.
Lasers Med Sci. 2014 Jul;29(4):1313-9. doi: 10.1007/s10103-013-1300-y. Epub 2013 Mar 14.

Comparison of the influence of ozone and laser therapies on pain, swelling, and trismus following impacted third-molar surgery.

Kazancioglu HO1, Ezirganli S, Demirtas N.
Author information
1Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Bezmialem Vakif University, 34093, Fatih, Istanbul, Turkey, dt_oguz@yahoo.com.
Abstract
This study aims to evaluate the efficacy of the ozone and laser application in the management of pain, swelling, and trismus after third-molar surgery. Sixty consecutive patients with asymptomatic impacted mandibular third molars were recruited into the study. Patients were randomized into three treatment groups of 20 patients each: two study groups (group 1?=?low-level laser therapy (LLLT), group 2?=?ozone therapy) and a control group (no-LLLT or ozone therapy). Twenty teeth extractions were performed in each group. Evaluations of postoperative pain, the number of analgesics tablets taken, trismus, swelling, and quality of life (Oral Health Impact Profile-14 questionnaire) were made. The sample consisted of 28 female and 32 male patients, whose total mean age was 23.5?±?3.4 (range, 18-25)?years. The pain level and the number of analgesics tablets taken were lower in the ozonated and LLLT applied groups than in the control group. This study showed that ozone and low power laser therapies had a positive effect on the patients’ quality of life. Trismus in the LLLT group was significantly less than in the ozonated and control groups (p?=?0.033). Ozone application showed no superiority in regards of postoperative swelling; however, LLLT group had significantly lower postoperative swelling. This study demonstrates that ozone and laser therapies are useful for the reduction of postoperative pain and they increase quality of life after third-molar surgery. Although the ozone therapy had no effect on postoperative swelling and trismus after surgical removal of impacted lower third molars, LLLT had a positive effect.
Medicine (Baltimore). 2015 Oct;94(42):e1724.

Periodontal Treatment Elevates Carotid Wall Shear Stress in the Medium Term.

Carallo C1, Franceschi MS, Tripolino C, Iovane C, Catalano S, Giudice A, Crispino A, Figliuzzi M, Irace C, Fortunato L, Gnasso A.
 
Author information
1From the Department of Chemical Engineering, Imperial College London, London, United Kingdom (CC, SC); Department of Clinical and Experimental Medicine, Institute of Dentistry, “Magna Graecia” University (MSDF, CI, AG, AC, MF, LF); and Department of Clinical and Experimental Medicine, Metabolic Disease Unit, “Magna Graecia” University, Catanzaro, Italy (CC, MSDF, CT, CI, AG).
 
Abstract
Periodontal disease is associated with endothelial dysfunction of the brachial artery and hemodynamic alterations of the common carotid artery. Periodontal therapy improves endothelial function. It is not known if it is able also to improve the hemodynamics of the carotid artery. The aim of the current study was to evaluate the efficacy of 2 different periodontal treatments on carotid hemodynamics: scaling and root planing (SRP) alone or together with low-level laser therapy (LLLT). Forty patients were recruited and randomly treated with SRP (n=20) or SRP + LLLT (n=20). Periodontal indices (plaque, gingival, and probing depth indices) were measured before and 5 months after treatment. Blood viscosity, common carotid wall shear stress, circumferential wall tension, and Peterson elastic modulus were evaluated before, soon after and 5 months after treatment. It was found that the periodontal indices improved in both groups, but significantly more so for SRP + LLLT than for SRP (decrease in gingival index 69.3% versus 45.4%, respectively, P=0.04). In the SRP + LLLT group, after a transient reduction by 5% immediately after therapy, shear stress increased by 11% after 5 months. In SRP only group, however, shear stress variations were less marked. No significant changes were found for the other hemodynamic parameters in either of the groups. Periodontal disease treatment by SRP + LLLT can therefore be said to improve common carotid wall shear stress. This suggests a possible mechanism by which the treatment of periodontal disease has beneficial effects on the cardiovascular system.
Angle Orthod. 2015 Jul 1. [Epub ahead of print]

Evaluation of the use of low-level laser therapy in pain control in orthodontic patients: A randomized split-mouth clinical trial.

Farias RD1, Closs LQ2, Miguens SA Jr3.

Author information

  • 1a? Master’s Student, Graduate Program in Dentistry, Universidade Luterana do Brasil (ULBRA), Canoas, RS, Brazil.
  • 2b? Professor, Department of Orthodontics, Universidade Luterana do Brasil (ULBRA), Canoas, RS, Brazil.
  • 3c? Professor, Department of Oral Medicine, School of Dentistry, Universidade Luterana do Brasil (ULBRA), Canoas, RS, Brazil.
Abstract
OBJECTIVE:
? To evaluate the effect of using low-level laser therapy (LLLT) to control pain and discomfort during orthodontic treatment.
MATERIALS AND METHODS:
? A randomized, split-mouth clinical trial was conducted with 30 volunteers in need of orthodontic treatment, of both genders, aged between 18 and 40 years, who were randomly divided into two groups. One hemiarch was considered the exposed group (EG) and the other, the placebo group (PG). Both groups had elastic separators placed mesially and distally to the first molars of the two hemiarches at different times. The EG received an AIGaAs diode LLLT (810 nm, 100 mW, 2J/cm2) application for 15 seconds per point (interdental papilla at the mesial, distal, and near the root apex) immediately after separator placement on the maxillary right side. The PG also had elastics placed around the maxillary right molars, but received only simulated LLLT application. The elastics were left in place for 5 days, and after a waiting period of 1 week, they were inserted on the left side in both groups; however, the order of laser application was changed. While the separator remained in place, the patient marked his degree of perceived discomfort on a Visual Analog Scale (VAS) at 5 minutes (T0), 24 hours (T1), and 120 hours (T2), after LLLT application.
RESULTS:
? A statistically significant difference was observed (P < .005) in reducing discomfort in the exposed group compared with the placebo group. This reduction of discomfort in the EG was observed at all time intervals.
CONCLUSIONS:
? A sincle AIGaAs diode LLLT application may be indicated for the control or reduction of pain in the early stages of orthodontic treatment.
Laser Ther. 2015 Mar 31;24(1):39-46. doi: 10.5978/islsm.15-OR-05.

Efficacy of LLLT in swelling and pain control after the extraction of lower impacted third molars.

Merigo E1, Vescovi P1, Margalit M1, Ricotti E1, Stea S2, Meleti M1, Manfredi M1, Fornaini C1.

Author information

  • 1Unit of Oral Pathology, Medicine and Laser Surgery, Department of Biomedical, Biotechnological and Translational Sciences (S.Bi.Bi.T), University of Parma, Italy.
  • 2Maria Cecilia Hospital, Cotignola, Italy.

Abstract

INTRODUCTION AND AIM:

Low Level Laser Therapy (LLLT) can facilitate wound healing stimulating a more rapid resolution and an earlier start for the proliferation phase. The purpose of this study is to evaluate the effects of LLLT on postoperative pain and oedema following the removal of impacted lower third molars.

MATERIALS AND METHODS:

Fifty-nine patients, who were to undergo surgical removal of their lower third molars, were studied. Patients were randomly allocated to one of three groups: 17 patients LLLT + traditional drug treatment17 patients traditional drug treatment as control group25 patients treated with LLLT only on one side+traditional drug treatment. The laser we have used for this study is a diode laser, GaAs, which delivers both in the infrared band at the wavelength of 910 nanometers (pulsed and superpulsed source), and in the visible (continuous source) at the wavelength of 650 nanometers (red). LLLT was performed just after the intervention and approximately 12 hours after surgery delivering 240 J in 15 minutes with theoretical fluence values of 480 J/cm(2) and 31 J/cm(2) for every minute of irradiation. We considered and signed with a label constant landmarks on both sides of the face of each patient; measurements were taken: before the surgery, after the surgery right after the 1st laser treatment, after approximately 24 hours after the 2(nd) laser treatment.

RESULTS:

We collected all the values of the oedema measurements and the VAS reports and performed a statistical analysis by means One-way Analysis of Variance (ANOVA) test: for the evaluated values (X, Y, Z) an extremely significant difference was found with p values of 0.003 for Y at the first evaluation (pre-12 hours) and less than 0.001 for the other evaluations. A significant result was obtained for VAS recorded at hospital discharge (p<0.0001).

CONCLUSIONS:

This study demonstrates that LLLT is effective on postoperative pain and oedema accelerating healing time and reducing patients distress.

Med Oral Patol Oral Cir Bucal. 2015 Feb 7. [Epub ahead of print]

Comparison of the effect of low level laser therapy with alvogyl on the management of alveolar osteitis.

Eshghpour M1, Ahrari F, Najjarkar NT, Khajavi MA.

Author information

  • 1Dental Research Center, School of Dentistry, Mashhad University of Medical Sciences, Vakilabad Boulevard, Mashhad, Iran, Farzaneh.Ahrari@gmail.com.

Abstract

Objectives: This study investigated the efficacy of low level laser therapy (LLLT) for managing alveolar osteitis (AO). Study Design: Sixty patients with alveolar osteitis of mandibular third molars were randomly divided into three groups. In group 1, socket irrigation was followed by alvogyl placement, and the treatment was repeated 48 hours later. In group 2, socket was irradiated with a low power red laser for 3 consecutive days (200 mW, 30 seconds on each of the buccal and lingual surfaces and 30 seconds at the middle of the socket, 6 J per area). The subjects in group 3 underwent treatment with a low power infrared laser with the same parameters as group 2. A visual analogue scale (VAS) was used to record the degree of pain at the morning (T0, before intervention) and at 6 (T1) and 12 (T2) hours later for 3 days.

Results: Pain was significantly lower in the alvogyl group than the other groups at T1 and T2 points on day 1 and at T0 and T1 points on day 2 (p<0.05). At T2 point on day 2 and on day 3, VAS became significantly lower in the red laser group compared to the other groups (p<0.05). The infrared laser was not more efficacious than the other groups at any of the treatment intervals, but it reduced VAS to an acceptable level.

Conclusions: LLLT displayed good results in this study for treatment of alveolar osteitis and should be further investigated as an alternative to alvogyl for AO management.

J Periodontal Implant Sci. 2014 Dec;44(6):280-7. doi: 10.5051/jpis.2014.44.6.280. Epub 2014 Dec 31.

Effects of adjunctive daily phototherapy on chronic periodontitis: a randomized single-blind controlled trial.

Jung GU1, Kim JW2, Kim SJ2, Pang EK3.

Author information

  • 1Department of Periodontology, Ewha Womans University Mokdong Hospital, Seoul, Korea.
  • 2Department of Oral and Maxillofacial Surgery, Ewha Womans University Medical Center, Seoul, Korea.
  • 3Department of Periodontology, Ewha Womans University Mokdong Hospital, Seoul, Korea. ; Department of Periodontology, Ewha Womans University Graduate School of Medicine, Seoul, Korea.

Abstract

PURPOSE:

The purpose of this randomized single-blind controlled trial was to elucidate the clinical and antimicrobial effects of daily phototherapy (PT) as an adjunct to scaling and root planing (SRP) in patients with chronic periodontitis.

METHODS:

The study was conducted from December 2013 to May 2014 at Ewha Womans University Mokdong Hospital, Seoul, Korea. Forty-one patients with mild to moderate chronic periodontitis were randomly divided into two therapeutic groups in a 1:1 ratio: SRP+PT and SRP (control) groups. All participants underwent full-mouth SRP. PT was performed thrice a day for a month by using electric toothbrushes with embedded light-emitting diodes. Plaque index, gingival index, probing pocket depth (PPD), clinical attachment level (CAL), and bleeding on probing were assessed before (baseline) and four weeks after (follow-up) the treatment. Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Prevotella intermedia, Fusobacterium nucleatum, Parvimonas micra, Campylobacter rectus, Eikenella corrodens, Streptococcus mutans, and Streptococcus sobrinus levels were detected by a real-time polymerase chain reaction at the same points in time.

RESULTS:

The clinical parameters improved in both the groups. At the follow-up assessment, PPD was significantly decreased in the SRP+PT group (P=0.00). Further, PPD and CAL showed significantly greater changes in the SRP+PT group than in the SRP group (PPD, P=0.03; CAL, P=0.04). P. gingivalis and T. forsythia levels decreased in this group, but no significant intergroup differences were noted.

CONCLUSIONS:

Adjunctive PT seems to have clinical benefits, but evidence of its antimicrobial effects is not sufficient. Long-term studies are necessary to develop the most effective PT protocol and compare the effectiveness of PT with and without exogenous photosensitizers.

Lasers Med Sci. 2014 May 24. [Epub ahead of print]

The effect of low-level laser therapy (810 nm) on root development of immature permanent teeth in dogs.

Fekrazad R1, Seraj B, Ghadimi S, Tamiz P, Mottahary P, Dehghan MM.

Author information

  • 1Laser Research Center in Medical Sciences, AJA University of Medical Sciences, Tehran, Islamic Republic of Iran.

Abstract

Traumatic injuries and dental caries can be a big challenge to immature teeth. In these cases, the main purpose of treatment is to maintain the pulp vitality. The purpose of this study was to investigate the effect of low-level laser therapy on accelerating the rate of dentinogenesis in pulpotomy of immature permanent teeth (apexogenesis). Three dogs, 4-6 months old, were used in this study. One jaw in each dog was randomly assigned to laser irradiation group. All selected teeth were pulpotomized with mineral trioxide aggregate (MTA) and restored with amalgam. In the laser group, the Ga-Al-As laser (810 nm, 0.3 W, 4 J/cm2, 9 s) was used on buccal and lingual gingiva of each tooth in 48 h intervals for 2 weeks. In order to observe the newly formed dentine, tetracycline was injected on the 1st, 3rd, 7th, and 14th day after the operation. Then, ground sections of teeth were observed under a fluorescence microscope. The data was analyzed with Generalized Estimating Equations (GEE) test. The mean distance between the lines of tetracycline formed on the 1st and 14th day was significantly higher in the laser group (P?=?0.005). Within the limitation of this study, irradiation of Ga-Al-As laser (810 nm) can accelerate the rate of dentinogenesis in apexogenesis of immature permanent teeth with MTA in dogs.

Gen Dent.  2012 Nov-Dec;60(6):540-3.

Five-year retrospective study of laser-assisted periodontal therapy.

Kusek ER, Kusek AJ, Kusek EA.

Source

University of South Dakota Hygiene School, Vermillion, SD, USA.

Abstract

This article outlines a five-year retrospective study involving a diode dental laser used on periodontally infected teeth. The present study utilized a specific protocol: scaling and root planing, light ultrasonic scaling, and the use of a diode laser. In 80% of cases, pocket depth of 3 mm or less was maintained.

J Cosmet Laser Ther.  2013 Feb 5. [Epub ahead of print]

Evaluation of low-level laser therapy in rabbit oral mucosa after soft tissue graft application: A pilot study.

Kara C, Demir T, Ozbek E.

Source

Department of Periodontology, Faculty of Dentistry, Ordu University , Ordu , Turkey.

Abstract

The aim of the present study was to assess the histopathological effects of low-level laser therapy (LLLT) on healing of the oral mucosa after soft tissue graft operations. The alterations at the end of healing in normal and LLLT-applied oral mucosa were studied in two healthy adult New Zealand white rabbits by taking specimens for light microscopic inspection. There was no adverse event reported in the study and no post-operative complications, such as swelling, bleeding, or edema, were observed in the rabbits. Complete wound healing was faster in the LLLT-applied rabbit. Compared to the normal rabbit oral mucosa, thickening of the stratum corneum (hyperkeratosis) was found in the epithelia of the rabbits. A significant increase in the epithelial thickness was found in the samples of rabbits, suggesting increased scar tissue following the wound repair. Additionally, many mitotic figures were present in the epithelia of the LLLT-applied rabbit, indicating epithelial cell hyperplasia. Long and irregular connective tissue protrusions projecting into the undersurface of the epithelium and mononuclear cell infiltrations were noted in the rabbits. The results suggest that LLLT used for soft tissue operations provides better and faster wound healing and that LLLT enhances epithelization.

Angle Orthod.  2012 Dec 14. [Epub ahead of print]

Effect of frequent laser irradiation on orthodontic pain.

Kim WT, Bayome M, Park JB, Park JH, Baek SH, Kook YA.

Source

a Former graduate student, Graduate School of Clinical Dental Science, The Catholic University of Korea, Seoul, Korea.

Abstract

 

Abstract Objective: To analyze the effect of low-level laser therapy (LLLT) on perception of pain after separator placement and compare it with perceptions of control and placebo groups using a frequent irradiation protocol.

Materials and Methods: Eighty-eight patients were randomly allocated to a laser group, a light-emitting diode (LED) placebo group, or a control group. Elastomeric separators were placed on the first molars. In the laser and LED groups, first molars were irradiated for 30 seconds every 12 hours for 1 week using a portable device. Pain was marked on a visual analog scale at predetermined intervals. Repeated measure analysis of variance was performed for statistical analysis.

Results: The pain scores of the laser group were significantly lower than those of the control group up to 1 day. The pain scores in the LED group were not significantly different from those of the laser group during the first 6 hours. After that point, the pain scores of the LED group were not significantly different from those of the control.

Conclusions: Frequent LLLT decreased the perception of pain to a nonsignificant level throughout the week after separator placement, compared with pain perception in the placebo and control groups. Therefore, LLLT might be an effective method of reducing orthodontic pain.

 

Lasers Med Sci.  2012 Sep 18. [Epub ahead of print]

Overview of non-invasive factors (low level laser and low intensity pulsed ultrasound) accelerating tooth movement during orthodontic treatment.

Jawad MM, Husein A, Alam MK, Hassan R, Shaari R.

Source

Orthodontic Unit, School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kota Bharu, 16150, Kelantan, Malaysia, dr.mohammedalazzawi@ymail.com.

Abstract

The need for orthodontic treatment is increasing all the time. As the treatment is time consuming ranging from a year to several years, any method of reducing the period of treatment and increasing the quality of the tissue will be beneficial to patients. The use of non-invasive techniques such as low level laser therapy and low intensity pulsed ultasound in accelerating orthodontic tooth movement are promising. Thus, this overview study will help to generate more understanding about the background information and the possible applications of them in daily orthodontics, depending on previous literature searching for reviews and original research articles.

Diabetes Technol Ther.  2012 Sep;14(9):799-803.

Low-level lasers as an adjunct in periodontal therapy in patients with diabetes mellitus.

Obradovic R, Kesic L, Mihailovi? D, Jovanovic G, Antic S, Brkic Z.

Source

1 Department of Periodontology and Oral Medicine, University of Niš , Niš, Serbia .

Abstract

Abstract Background: Diabetes mellitus (DM) increases the risk of periodontitis, and severe periodontitis often coexists with severe DM. The proposed dual pathway of tissue destruction suggests that control of chronic periodontal infection and gingival inflammation is essential for achieving long-term control of DM. The purpose this study is to evaluate the effects of low-level laser therapy (LLLT) by exfoliative cytology in patients with DM and gingival inflammation.

Subjects and Methods: Three hundred patients were divided in three equal groups: Group 1 consisted of patients with periodontitis and type 1 DM, Group 2 of patients with periodontitis and type 2 DM, and Group 3 of patients with periodontitis (control group). After oral examination, smears were taken from gingival tissue, and afterward all of the patients received oral hygiene instructions, removal of dental plaque, and full-mouth scaling and root planing. A split-mouth design was applied; on the right side of jaws GaAlAs LLLT (670?nm, 5?mW, 14?min/day) (model Mils 94; Optica Laser, Sofia, Bulgaria) was applied for five consecutive days. After the therapy was completed, smears from both sides of jaws were taken. The morphometric analysis was done using the National Institutes of Health Image software program and a model NU2 microscope (Carl Zeiss, Jena, Germany).

Results: Investigated parameters were significantly lower after therapy compared with values before therapy. After therapy on the side subjected to LLLT, there was no significantly difference between patients with DM and the control group.

Conclusions: It can be concluded that LLLT as an adjunct in periodontal therapy reduces gingival inflammation in patients with DM and periodontitis.

Int J Dent.  2012;2012:719452. Epub 2012 Jul 15.

In Vitro Wound Healing Improvement by Low-Level Laser Therapy Application in Cultured Gingival Fibroblasts.

Basso FG, Pansani TN, Turrioni AP, Bagnato VS, Hebling J, de Souza Costa CA.

Source

Faculdade de Odontologia de Piracicaba, Universidade Estadual de Campinas (UNICAMP), 13414-903 Piracicaba, SP, Brazil.

Abstract

The aim of this study was to determine adequate energy doses using specific parameters of LLLT to produce biostimulatory effects on human gingival fibroblast culture. Cells (3 × 10(4) cells/cm(2)) were seeded on 24-well acrylic plates using plain DMEM supplemented with 10% fetal bovine serum. After 48-hour incubation with 5% CO(2) at 37°C, cells were irradiated with a InGaAsP diode laser prototype (LASERTable; 780 ± 3?nm; 40?mW) with energy doses of 0.5, 1.5, 3, 5, and 7?J/cm(2). Cells were irradiated every 24?h totalizing 3 applications. Twenty-four hours after the last irradiation, cell metabolism was evaluated by the MTT assay and the two most effective doses (0.5 and 3?J/cm(2)) were selected to evaluate the cell number (trypan blue assay) and the cell migration capacity (wound healing assay; transwell migration assay). Data were analyzed by the Kruskal-Wallis and Mann-Whitney nonparametric tests with statistical significance of 5%. Irradiation of the fibroblasts with 0.5 and 3?J/cm(2) resulted in significant increase in cell metabolism compared with the nonrradiated group (P < 0.05). Both energy doses promoted significant increase in the cell number as well as in cell migration (P < 0.05). These results demonstrate that, under the tested conditions, LLLT promoted biostimulation of fibroblasts in vitro.

Lasers Med Sci. 2012 Jul 21. [Epub ahead of print]

Analgesic effect of a low-level laser therapy (830 nm) in early orthodontic treatment.

Artés-Ribas M, Arnabat-Dominguez J, Puigdollers A.

Source

Dental School, International University of Catalunya, Campus Sant Cugat, Josep Trueta s/n, 08195-St. Cugat del Vallès, Barcelona, Spain.

Abstract

The aim of this study was to evaluate the pain sensation that orthodontic patients experience when elastic separators are placed between molars and premolars and to determine the degree of analgesic efficacy of low-level laser therapy (LLLT) compared to a placebo treatment. The study was conducted with 20 volunteers who were fitted with elastic separators between the maxillary molars and premolars. One quadrant was randomly chosen to be irradiated with an 830-nm laser, 100 mW, beam diameter of 7 mm, 250 mW/cm(2) applied for 20 s per point (5 J/cm(2)). Three points were irradiated in the buccal face and three were irradiated in the palate. The same procedure was applied in the contralateral quadrant with a placebo light. A visual analogue scale was used to assess pain 5 min, 6 h, 24 h, 48 h, and 72 h after placement of the separators. Maximum pain occurred 6-24 h after placement of the elastic separators. Pain intensity was significantly lower in the laser-treated quadrant (mean, 7.7 mm) than in the placebo-treated quadrant (mean, 14.14 mm; p?=?0.0001). LLLT at these parameters can reduce pain in patients following placement of orthodontic rubber separators.

Lasers Med Sci.  2012 Jul 28. [Epub ahead of print]

Effect of low-level laser therapy after extraction of impacted lower third molars.

Ferrante M, Petrini M, Trentini P, Perfetti G, Spoto G.

Source

Dental Materials, Department of Oral Dental Diseases, University of Chieti-Italy, Via Vestini 31, 66013, Chieti, Italy, maurizio.ferrante@gmail.com.

Abstract

The aim of this study is to evaluate the effectiveness of the low-level laser therapy (LLLT) in the control of pain, swelling, and trismus associated with surgical removal of impacted lower third molars. Thirty patients were randomized into two treatment groups, each with 15 patients-group test (LLLT) and a group control (no-LLLT)-and were told to avoid any analgesics 12 h before the procedure. In group test, the 980-nm diode-laser (G-Laser 25 Galbiati, Italy) was applied, using a 600-?m handpiece, intraorally (lingual and vestibular) at 1 cm from the involved area and extraoral at the insertion point of the masseter muscle immediately after surgery and at 24 h. The group control received only routine management. Parameters used for LLLT were: continuous mode, at 300 mW (0.3 W) for a total of 180 s (60 s?×?3) (0.3 W?×?180 s?=?54 J). Group test showed improvement in the interincisal opening and remarkable reduction of trismus, swelling and intensity of pain on the first and the seventh postoperative days. Although LLLT has been reported to prevent swelling and trismus following the removal of impacted third molars, some of these studies reported a positive laser effect while others did not. All references to the use of laser therapy in the postoperative management of third molar surgery employ different methodologies and, in some, explanations as to selection of their respective radiation parameters are not given. This study has demonstrated that LLLT, with these parameters, is useful for the reduction of postoperative discomfort after third-molar surgery.

Rom J Morphol Embryol.  2012;53(1):111-6.

Healing process and laser therapy in the superficial periodontium: a histological study.

Mâru S, Amlinei C, Tatarciuc M, Rotaru M, Potârnichie O, Liliac L, Cruntu ID.

Source

Department of Periodontology, Faculty of Dental Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iassy, Romania.

Abstract

AIM:

To evaluate the efficiency of laser therapy in healing, regeneration and repair processes located in the superficial periodontium after gingivectomy procedures.

MATERIALS AND METHODS:

The study group consisted of 38 patients without any systemic diseases presenting with gingival hypertrophy developed exclusively within the clinical context of gingivitis and/or periodontitis. All patients were included in the study based on their informed consent. All patients required several surgical interventions at the level of the superficial periodontium. Subgroup 1 (17 patients) was treated only through gingivectomy procedures. For subgroup 2 (21 patients), the gingivectomy was associated with laser therapy, applied every day for seven days. Gingival mucosa fragments were taken on day 1 (curative gingivectomy) and on day 21 (clinical control and corrective gingivectomy), and routinely processed for the microscopic exam, using Hematoxylin-Eosin and special stains (trichrome Szekely and Periodic Acid-Schiff).

RESULTS AND DISCUSSION:

The comparison between the morphological pictures characterizing the healing process associated or not with laser therapy, allowed the identification of some features supporting the benefits of laser therapy. We believe that the decrease in the inflammatory infiltrate located in the lamina propria is the critical morphological trait for the control of a healing process as near to restitutio ad integrum as possible. The diminished number of lymphocytes and macrophages will implicitly determine a lower production of chemical mediators interfering with the sequences of the healing process.

CONCLUSIONS:

The morphological differences identified at the gingival epithelium level and subjacent lamina propria support the value of laser therapy, stimulating an improved healing of the damaged tissues.

Lasers Med Sci.  2011 Nov;26(6):741-7. Epub 2010 Jun 12.

Quantification of fibrosis and mast cells in the tissue response of endodontic sealer irradiated by low-level laser therapy.

Berbert FL, Sivieri-Araújo G, Ramalho LT, Pereira SA, Rodrigues DB, de Araújo MS.

Source

Department of Restorative Dentistry, Discipline of Endodontics, Dental School of Araraquara, São Paulo State University-UNESP, Rua Humaitá, 1680, PO 331, CEP 14.801-903, Araraquara, SP, Brazil.

Abstract

Low-level laser therapy (LLLT) accelerates tissue repair. Mast cells induce the proliferation of fibroblasts and the development of local fibrosis. The objective of this study was to quantify fibrosis rate and mast cells in connective tissue after endodontic sealer zinc oxide and eugenol (ZOE) was implanted and submitted to LLLT, immediately after implant and again 24 h later. Sixty mice were distributed into three groups: GI, GII, and GIII (n = 20). In GI, the tubes filled with Endofill were implanted in the animals and were not irradiated with LLLT. In GII, the tubes containing Endofill were implanted in the animals and then irradiated with red LLLT (InGaAIP) 685-nm wavelength, D?=?72 J/Cm(2), E = 2 J, T?=?58 s, P?=?35 mW, and in GIII, the tubes with Endofill were implanted and irradiated with infrared LLLT (AsGaAl) 830-nm wavelength, D?=?70 J/Cm(2), E = 2 J, T?=?40 s, P?=?50 mW. After 7 days and 30 days, the animals were killed. A series of 6-µm-thick sections were obtained and stained with Toluidine Blue and Picrosirius and analyzed under a standard light microscope using a polarized light filter for the quantification of fibrosis. The statistics were qualitative and quantitative with a significance of 5%. The irradiation with LLLT did not offer improvement in the fibrosis rate, however, it provided a significant decrease in the concentration of independent mast cells for the period studied.

Lasers Med Sci. 2011 Sep 29. [Epub ahead of print]

Cytomorphometric and clinical investigation of the gingiva before and after low-level laser therapy of gingivitis in children.

Igic M, Mihailovic D, Kesic L, Milasin J, Apostolovic M, Kostadinovic L, Janjic OT.

Source

Department of Children and Preventive Dentistry, Dental Clinic, Medical Faculty Nis, University of Nis, Bul dr Zorana Djindjica 52, 18000, Nis, Serbia, igicmarija@gmail.com

Abstract

Gingival epithelial cells are the first physical barrier against periodontal pathogenic microorganisms. Bacterial products may penetrate the epithelium and directly disturb its integrity. We investigated the clinical and cytomorphological status of the gingiva in children with gingivitis before and after low-level laser therapy. The study enrolled 130 children divided into three groups: group 1 comprised 50 children with chronic catarrhal gingivitis who received basic treatment, group 2 comprised 50 children with chronic catarrhal gingivitis who received low-level laser treatment in addition to basic treatment, and group 3 comprised 30 children with healthy gingiva as controls. Oral hygiene and the status of the gingiva were assessed using the appropriate indexes before and after treatment. Inflammation of the gingiva was monitored by cytomorphometric evaluation. Cytomorphometric analysis revealed a statistically significant difference (p?<?0.001) in the size of the nuclei of the stratified squamous epithelial cells of the gingiva before and after treatment in chronic catarrhal gingivitis. Evaluation using clinical parameters showed that treatment of gingivitis with basic treatment was successful. Cytomorphometric analysis showed that after basic treatment the nuclei of the stratified squamous epithelial cells of the gingiva were reduced in size, although not to the size found in healthy gingiva. However, after adjuvant low-level laser therapy, the size of the nuclei of the stratified squamous epithelial cells in the gingiva matched the size of the nuclei in the cells in healthy gingiva.

 

Vojnosanit Pregl.  2011 Jun;68(6):506-10.

 

Assessment of the effectiveness of low level laser in the treatment of alveolar osteitis.

 

[Article in Serbian]
Jovanovic G, Uric N, Krunic N, Tijanic M, Stojanovic S.

Source

Univerzitet u Nisu, Medicinski fakultet, Klinika za stomatologiju, Nis, Srbija.

Abstract

 

BACKGROUND/AIM:

Alveolar osteitis (AO) is the extraction wound healing disorder with a presence of severe pain. Low level laser therapy stimulates cell metabolism and microcirculation, have has pronounced analgesic, antiedematous and anti-inflammatory effect and speeds up wound healing process. The aim of this study was to present results of clinical research that examined the effectiveness of low level laser in pain relief and healing of extraction wounds with alveolar osteitis in the lower jaw which was formed on the second day after tooth extraction.

METHODS:

The study was conducted on 60 subjects divided into the study and the control group. In both groups extraction wounds were processed in similar way, except that in the study group was applied daily treatment of low level laser with a total of eight sessions of radiation, while in the control group extraction wounds were dressed with zinc oxide eugenol paste, which was changed every 48 hours up to the pain cessation. Measurement of pain intensity was done with a visual analogue scale (VAS) 10 min prior to processing of extraction wounds and daily for the next eight days. Assessment of the effectiveness of low level laser on healing of extraction wounds was performed on the day eight of the treatment.

RESULTS:

On the day five after beginning of the treatment of extraction wounds with alveolar osteitis in the patients of the study group a lower average value of pain as compared to the control group was registered. This difference was increased within the following days. Extraction wounds healing in the study group was more successful and faster than in the control group.

CONCLUSION:

This study suggested that the reduction of pain was more pronounced in the patients with alveolar osteitis whose extraction wounds were subjected to low level laser radiation in comparison to those in which extraction wounds were treated with zinc oxide eugenol paste.

J Oral Sci.  2011;53(1):51-9.

 

Transcriptional regulation of bone sialoprotein gene by CO(2) laser irradiation.

 

Sasaki Y, Wang S, Ogata Y.

Source

Department of Periodontology, Nihon University School of Dentistry, Chiba, Japan.

Abstract

 

Bone sialoprotein (BSP), an early marker of osteoblast differentiation, has been implicated in the nucleation of hydroxyapatite during de novo bone formation. Low-power laser irradiation has a stimulating effect on cells and tissues. Although the carbon dioxide (CO(2)) laser is a hard surgical laser, we have attempted to use it at low energy density to achieve biological alterations. To investigate the effects of CO(2) laser irradiation on BSP gene transcription, we used rat osteoblast-like ROS17/2.8 cells. BSP mRNA levels were increased at 12 h after irradiation with the CO(2) laser (2 W, 20 s). Transient transfection assays using various sizes of the rat BSP gene promoter linked to the luciferase reporter gene showed that CO(2) laser irradiation induced luciferase activity of a -116 to +60 BSP promoter construct (pLUC3) at 12 h in the cells. Transcriptional stimulation by CO(2) laser irradiation was abrogated in the pLUC3 construct containing a 2-bp mutation in the fibroblast growth factor 2 response element (FRE). Gel shift analyses showed that CO(2) laser irradiation increased the binding of nuclear protein to FRE. These studies demonstrate that CO(2) laser irradiation increases BSP transcription via FRE in the rat BSP gene promoter.

Vojnosanit Pregl.  2011 Jun;68(6):506-10.

 

Assessment of the effectiveness of low level laser in the treatment of alveolar osteitis.

 

[Article in Serbian]
Jovanovic G, Uric N, Krunic N, Tijanic M, Stojanovic S.

Source

Univerzitet u Nisu, Medicinski fakultet, Klinika za stomatologiju, Nis, Srbija.

Abstract

 

BACKGROUND/AIM:

Alveolar osteitis (AO) is the extraction wound healing disorder with a presence of severe pain. Low level laser therapy stimulates cell metabolism and microcirculation, have has pronounced analgesic, antiedematous and anti-inflammatory effect and speeds up wound healing process. The aim of this study was to present results of clinical research that examined the effectiveness of low level laser in pain relief and healing of extraction wounds with alveolar osteitis in the lower jaw which was formed on the second day after tooth extraction.

METHODS:

The study was conducted on 60 subjects divided into the study and the control group. In both groups extraction wounds were processed in similar way, except that in the study group was applied daily treatment of low level laser with a total of eight sessions of radiation, while in the control group extraction wounds were dressed with zinc oxide eugenol paste, which was changed every 48 hours up to the pain cessation. Measurement of pain intensity was done with a visual analogue scale (VAS) 10 min prior to processing of extraction wounds and daily for the next eight days. Assessment of the effectiveness of low level laser on healing of extraction wounds was performed on the day eight of the treatment.

RESULTS:

On the day five after beginning of the treatment of extraction wounds with alveolar osteitis in the patients of the study group a lower average value of pain as compared to the control group was registered. This difference was increased within the following days. Extraction wounds healing in the study group was more successful and faster than in the control group.

CONCLUSION:

This study suggested that the reduction of pain was more pronounced in the patients with alveolar osteitis whose extraction wounds were subjected to low level laser radiation in comparison to those in which extraction wounds were treated with zinc oxide eugenol paste.

Lasers Med Sci.  2011 May 31. [Epub ahead of print]

 

The effect of two phototherapy protocols on pain control in orthodontic procedure-a preliminary clinical study.

 

Esper MA, Nicolau RA, Arisawa EA.

Source

Centro de Laserterapia e Fotobiologia, Instituto de Pesquisa e Desenvolvimento, Universidade do Vale do Paraíba, Av. Shishima Hifumi, 2911 – Bairro Urbanova, 12244-000, São José dos Campos, SP, Brazil, angela_esper@hotmail.com

 

Abstract

Phototherapy with low-level coherent light (laser) has been reported as an analgesic and anti-inflammatory as well as having a positive effect in tissue repair in orthodontics. However, there are few clinical studies using low-level LED therapy (non-coherent light). The aim of the present study was to analyze the pain symptoms after orthodontic tooth movement associated with and not associated with coherent and non-coherent phototherapy. Fifty-five volunteers (mean age?=?24.1?±?8.1 years) were randomly divided into four groups: G1 (control), G2 (placebo), G3 (protocol 1: laser, InGaAlP, 660 nm, 4 J/cm(2), 0.03 W, 25 s), G4 (protocol 2: LED, GaAlAs, 640 nm with 40 nm full-bandwidth at half-maximum, 4 J/cm(2), 0.10 W, 70 s). Separators were used to induce orthodontic pain and the volunteers pain levels were scored with the visual analog scale (VAS) after the separator placement, after the therapy (placebo, laser, or LED), and after 2, 24, 48, 72, 96, and 120 h. The laser group did not have statistically significant results in the reduction of pain level compared to the LED group. The LED group had a significant reduction in pain levels between 2 and 120 h compared to the control and the laser groups. The LED therapy showed a significant reduction in pain sensitivity (an average of 56%), after the orthodontic tooth movement when compared to the control group.

 

Lasers Med Sci.  2011 May 27. [Epub ahead of print]

Histomorphometric analysis of inflammatory response and necrosis in re-implanted central incisor of rats treated with low-level laser therapy.

Vilela RG, Gjerde K, Frigo L, Leal Junior EC, Lopes-Martins RA, Kleine BM, Prokopowitsch I.

Source

School of Dentistry, Cruzeiro do Sul University (UNICSUL), São Paulo, Brazil.

Abstract

Low-level laser therapy is a tool employed in the management of post-operative inflammation process and in the enhancement of reparative process. The aim of the study was to perform histological evaluation of dental and periodontal ligament of rats central upper-left incisor teeth re-implanted and irradiated with low-level laser (InGaAl, 685 nm, 50 J/cm(2)) 15, 30, and 60 days after re-implantation. Seventy-two male rats had the central upper left incisor removed and kept for 15 min on dry gauze before replantation. Laser was irradiated over the root surface and empty alveolus prior replantation and over surrounding mucosa after the re-implantation. After histological procedures, all slices were analyzed regarding external resorption area and histological aspects. We observed an increase of root resorption (p?<?0.05) in the control group compared to the laser group at 15, 30, and 60 days. These results showed that the laser groups developed less root resorption areas than the control group in all experimental periods. Additionally, histological analysis revealed less inflammatory cells and necrotic areas in laser groups.

Lasers Med Sci.  2011 May 26. [Epub ahead of print]

Stimulatory effect of low-level laser therapy on root development of rat molars: a preliminary study.

Toomarian L, Fekrazad R, Tadayon N, Ramezani J, Tunér J.

Source

Department of Pediatric Dentistry, Dental School, Shahid Beheshti University of Medical Sciences, Evin, Tehran, Iran, ltoomarian@yahoo.com.

Abstract

 

Several studies suggest a biomodulatory influence of low-level laser irradiation in the inflammatory and reparative processes of dental tissues. The aim of this study was to investigate the stimulatory effect of 808-nm laser irradiation on root development of rat molars and also to evaluate the histological reaction of pulp and periapical tissues. Twenty-four 30-day-old Wistar male rats were randomly assigned to three-time and five-time laser therapy groups. After initial x-ray, using mammography equipment, laser energy was applied at a wavelength of 808 nm (2 J/cm(2), 100 mW, 20 s) to the midroot area of the lower molars of one side of mouth at repeated intervals of the 48 h. The animals were killed 1 day after the final treatment, and root length development of the experimental samples was compared to contra-lateral non-irradiated molars using mammography. The histological reaction of the pulp and periapical tissue was evaluated under light microscopy. Root development was more advanced in irradiated groups than in the non-irradiated controls (p?<?0.001). No significant differences, however, could be found between the root development changes in the three-time and five-time laser therapy groups (p?>?0.05). Histological findings showed that the occurrence of secondary cement formation was significantly higher in the irradiation groups compared to the controls (p?=?0.003). However, there were no statistically significant differences for the frequencies of pulp hyperemia, periodontal ligament fiber organization, or lamina dura remodeling between the groups (p?>?0.05). Under the conditions used in this study, 808-nm low-level laser accelerates the rat molar root development in the presence of favorable histological reactions.

Indian J Exp Biol.  2011 May;49(5):357-61.

Effect of low-level laser therapy on experimental wounds of hard palate mucosa in mice.

Fahimipour F, Nouruzian M, Anvari M, Tafti MA, Yazdi M, Khosravi M, Dehghannayeri Z, Sabounchi SS, Bayat M.

Source

Shahid Beheshti University MC, Tehran, Iran.

Abstract

 

Under general anesthesia and sterile conditions, incision wound was induced in the hard palate mucosa of adult male mice. The wounds of groups 1 and 2 were irradiated daily with He-Ne laser at 3 and 7.5 J/cm2 for 120 and 300 s, respectively, while the incision wound of group 3 not exposed served as controls. On day 3 of injury, the laser-treated wounds contained significantly lower neutrophils than the wounds in the control group. By day 7 after injury, the laser-treated wounds contained significantly more fibroblasts and at the same time contained significantly fewer macrophages. In conclusion, an acceleration of the wound healing process of experimental wounds in the hard palate mucosa of mice at low-level laser therapy with a He-Ne laser at energy densities of 3 and 7.5 J/cm2 was observed.

Eur Arch Paediatr Dent. 2011 Apr;12(2):61-7.

 

 

Laser physics and a review of laser applications in dentistry for children.

Martens LC.

Prof L.C. Martens. Dept Paediatric Dentistry, De Pintelaan 187 (P8) B – 9000 Ghent, Belgium. Email: luc.martens@ugent.be.

Abstract

AIM: The aim of this introduction to this special laser issue is to describe some basic laser physics and to delineate the potential of laser-assisted dentistry in children.

REVIEW: A brief review of the available laser literature was performed within the scope of paediatric dentistry. Attention was paid to soft tissue surgery, caries prevention and diagnosis, cavity preparation, comfort of the patient, effect on bacteria, long term pulpal vitality, endodontics in primary teeth, dental traumatology and low level laser therapy. Although there is a lack of sufficient evidence taking into account the highest standards for evidence-based dentistry, it is clear that laser application in a number of different aetiologies for soft tissue surgery in children has proven to be successful. Lasers provide a refined diagnosis of caries combined with the appropriate preventive adhesive dentistry after cavity preparation. This will further lead to a new wave of micro-dentistry based on ‘filling without drilling’.

CONCLUSION: It has become clear from a review of the literature that specific laser applications in paediatric dentistry have gained increasing importance. It can be concluded that children should be considered as amongst the first patients for receiving laser-assisted dentistry.

Eur Arch Paediatr Dent.  2011 Apr;12(2):79-84.

Lasers in dental traumatology and low level laser therapy (LLLT).

Caprioglio C, Olivi G, Genovese MD.

Paediatric Dentistry, University of Parma, Parma, Italy. Email: ac.caprioglio@tin.it.

Abstract

BACKGROUND: Dental trauma in children is a frequent and often complex clinical event in which laser-assisted therapy, particularly using erbium lasers, can offer new treatment possibilities, improving the outcomes and reducing the associated complications.

REVIEW: In particular, it is worth considering that the use of laser-assisted therapies is associated with a marked reduction in the use of analgesics and anti-inflammatory medications compared with conventional procedures. Laser anaesthesia is another interesting and challenging area.

CONCLUSION: Given the paucity of data on laser-assisted dental trauma therapy in the international literature and the absence of well-structured guidelines, this is an area ripe for scientific research.

Eur Arch Paediatr Dent.  2011 Apr;12(2):93-5.

The effect of low level laser therapy on pain during dental tooth-cavity preparation in children.

Tanboga I, Eren F, Altinok B, Peker S, Ertugral F.

Dr I. Tanboga, Marmara Üniversitesi Di? Hekimli?i Fak. Pedodonti AD, Büyükçiftlik sok. No:6 Kat:4, Ni?anta??, ?i?li/?stanbul 34365, Turkey. Email: itanboga@marmara.edu.tr

Abstract

AIM: To evaluate the effect of low level laser therapy on pain during cavity preparation with laser in paediatric dental patients.

STUDY DESIGN AND METHODS: The study was carried out on 10 children aged 6 to 9 years old for a total of 20 primary molar teeth. For laser preparation an Er: YAG laser was used. Half of the preparations were treated by low level laser therapy (LLLT) before laser preparation and the remaining half without LLLT (non-LLLT) before laser preparation. All cavities were prepared by ER:YAG laser, restored with light-cured composite resin following the application of acid etching and bonding agent. Children were instructed to rate their pain on the visual analogue scale (VAS) from 0 to 5 points. Statistical analyses were performed using Mann Whitney U test.

RESULTS: VAS Median (min-max) scores were 1(0-2) for LLLT and 3(1-4) for the non-LLT treated children. Between LLLT and non- LLLT groups results were statistically significant (p<0.01).

CONCLUSIONS: The use of LLLT before cavity preparation with laser decreased pain in paediatric dental patients.

Photomed Laser Surg.  2011 Jan 23. [Epub ahead of print]

Influence of Low-Level Laser on the Speed of Orthodontic Movement.

da Silva Sousa MV, Scanavini MA, Sannomiya EK, Velasco LG, Angelieri F.

Department of Orthodontics, Dental School, São Paulo Methodist University , São Paulo, Brazil .

Abstract

Abstract Introduction: This study evaluated the effect of low-level laser irradiation on the speed of orthodontic tooth movement of canines submitted to initial retraction.

Methods: Twenty-six canines were retracted by using NiTi spring (force of 150?g/side). Thirteen of those were irradiated with diode laser (780?nm, 20?mW, 10?sec, 5?J/cm(2)) for 3 days, and the other 13 were not irradiated and thus were considered the control group. Patients were followed up for 4 months, and nine laser applications were performed (three each month). The movement of the canines was evaluated through 3D casts, and the statistical analysis was performed with ANOVA and Tukey tests (p?<?0.05). Periapical radiographs of the studied teeth were submitted to Levander, Malmgreen, and alveolar bone ridge analyses to evaluate tissue integrity and were compared with the Wilcoxon test (p?<?0.05).

Results: A statistically significant increase in the movement speed of irradiated canines was observed in comparison with nonirradiated canines in all evaluation periods. No statistically significant difference was observed in bone and root resorption of canines, whether irradiated or not.

Conclusion: The diode laser used within the protocol guidelines increased the speed of tooth movement. This might reduce orthodontic treatment time.

Photomed Laser Surg.  2010 Dec;28(6):823-30.

Laser-induced alveolar bone changes during orthodontic movement: a histological study on rodents.

Habib FA, Gama SK, Ramalho LM, Cangussú MC, Santos Neto FP, Lacerda JA, Araújo TM, Pinheiro AL.

Centro de Ortodontia e Ortopedia Facial Prof. José Edimo Soares Martins, School of Dentistry, Federal University of Bahia (UFBA), Salvador, Brazil.

Abstract

OBJECTIVE: The aim of this study was to assess by light microscopy changes in alveolar bone during orthodontic movement in rats.

BACKGROUND: Orthodontic movement causes both removal and deposition of bone tissue. The use of laser phototherapy (LPT) is considered an enhancement factor for bone repair.

METHODS: Thirty Wistar rats were divided into two groups (n?=?15) and subdivided according to animal death (7,13, and 19 days). Half of the animals in each group were treated with LPT during orthodontic movement. After animal death, specimens were processed and underwent histological and semi-quantitative analyses (HE and Sirius red).

RESULTS: LPT-irradiated specimens showed significantly higher numbers of osteoclasts when compared with controls at both 7 (p?=?0.015) and 19 (p?=?0.007) days, as well as significant increases in the number of osteoblasts (p?=?0.015) between days 7 and 13. The amount of collagen matrix was significantly reduced between days 7 and 13 at both pressure and tension sites in controls (p?=?0.015) but not in LPT-treated animals. LPT-treated subjects showed significantly greater deposition of collagen matrix at the pressure site at both the thirteenth (p?=?0.007) and nineteenth days (p?=?0.001). At the tension site, a significant increase in the amount of collagen matrix was observed in non-irradiated specimens (p?=?0.048) between days 7 and 19.

CONCLUSIONS: LPT caused significant histological changes in the alveolar bone during induced tooth movement, including alterations in the number of both osteoclasts and osteoblasts and in collagen deposition in both pressure and tension areas.

Lasers Med Sci. 2010 Nov;25(6):781-92. Epub 2010 Jul 17.

Laser phototherapy in the treatment of periodontal disease. A review.

de Paula Eduardo C, de Freitas PM, Esteves-Oliveira M, Aranha AC, Ramalho KM, Simões A, Bello-Silva MS, Tunér J.

Special Laboratory of Lasers in Dentistry (LELO), Department of Restorative Dentistry, School of Dentistry, University of São Paulo, 227 Cidade Universitária, São Paulo, SP, Brazil. cpeduard@usp.br

Abstract

Many studies in the literature address the effect of low-power lasers in the management of pathologies related to periodontal tissues. Due to the lack of standardized information and the absence of a consensus, this review presents the current status of laser phototherapy (LPT) in periodontics and discusses its benefits and limits in the treatment of periodontal disease. The literature was searched for reviews and original research articles relating to LPT and periodontal disease. The articles were selected using either electronic search engines or manual tracing of the references cited in key papers. The literature search retrieved references on wound and bone healing, analgesia, hypersensitivity, inflammatory process and antimicrobial photodynamic therapy. Each topic is individually addressed in this review. The current literature suggests that LPT is effective in modulating different periodontal disease aspects in vitro, in animals, and in simple clinical models. Further development of this therapy is now dependent on new clinical trials with more complex study designs.

Photomed Laser Surg. 2010 Oct;28 Suppl 2:S75-8. Epub 2010 Aug 25.

Bactericidal effect of Nd:YAG and Er:YAG lasers in experimentally infected curved root canals.

Yasuda Y, Kawamorita T, Yamaguchi H, Saito T.

Division of Clinical Cariology and Endodontology, Department of Oral Rehabilitation, School of Dentistry, Health Sciences University of Hokkaido, Ishikari-Tobetsu, Hokkaido, Japan. yasuda@hoku-iryo-u.ac.jp

Abstract

OBJECTIVE: The purpose of this study was to evaluate the bactericidal efficacy of Nd:YAG and Er:YAG laser in the experimentally infected curved root canals.

BACKGROUND DATA: Previous studies revealed that laser systems have a significant bactericidal effect in both human and bovine infected straight root canals.

MATERIALS AND METHODS: Sixty extracted single-rooted teeth with single root canals were selected and then instrumented with endodontic files to a size 60 (K-type file). The degree of root curvature was determined according to modified Schneider’s method. Each of the specimens was incubated in a sterile centrifuge tube with 1 mL of the Enterococcus faecalis suspension at 37°C for 2 weeks under aerobic conditions. After laser irradiation at each of the two settings, 50 mJ, 10 pps (0.5 W) or 100 mJ, 10 pps (1.0 W), the number of E. faecalis in each root canal was examined.

RESULTS: In the straight root canals, the Er:YAG laser showed higher bactericidal effects by 6.4-10.8% than did the Nd:YAG laser. Conversely, the bactericidal effect of Er:YAG laser in the curved root canals was higher by 1.5-3.1% than was that with the Nd:YAG laser. The bactericidal effect of the Er:YAG laser in the curved root canal is significantly lower than that in the straight root canal (p < 0.05).

CONCLUSION: These results suggest that further development in the endodontic laser tip and technique is required to ensure its success in curved root canals sterilization.

Braz Dent J. 2010;21(6):491-498.

Effects of low-level laser therapy on human osteoblastic cells grown on titanium.

Petri AD, Teixeira LN, Crippa GE, Beloti MM, Oliveira PT, Rosa AL.

Cell Culture Laboratory, Ribeirão Preto Dental School, University of São Paulo, Ribeirão Preto, SP, Brazil.

Abstract

The aim of this study was to investigate the effects of low-level laser therapy (LLLT) by using gallium aluminum arsenide (GaAlAs) diode laser on human osteoblastic cells grown on titanium (Ti). Osteoblastic cells were obtained by enzymatic digestion of human alveolar bone and cultured on Ti discs for up to 17 days. Cells were exposed to LLLT at 3 J/cm2 (wavelength of 780 nm) at days 3 and 7 and non-irradiated cultures were used as control. LLLT treatment did not influence culture growth, ALP activity, and mineralized matrix formation. Analysis of cultures by epifluorescence microscopy revealed an area without cells in LLLT treated cultures, which was repopulated latter with proliferative and less differentiated cells. Gene expression of ALP, OC, BSP, and BMP-7 was higher in LLLT treated cultures, while Runx2, OPN, and OPG were lower. These results indicate that LLLT modulates cell responses in a complex way stimulating osteoblastic differentiation, which suggests possible benefits on implant osseointegration despite a transient deleterious effect immediately after laser irradiation.Este estudo teve como objetivo investigar o efeito do laser diodo de gálio-alumÃ-nio-arsênio (GaAlAs) em células osteoblásticas humanas cultivadas sobre discos de Ti. Para tanto, células osteoblásticas foram obtidas por digestão enzimática de osso alveolar humano e cultivadas sobre discos de Ti por 17 dias. As células foram submetidas à irradiação no 3º e 7º dias na dose de 3 J/cm2 e comprimento de onda de 780 nm e células não irradiadas foram usadas como controle. A irradiação não alterou a proliferação celular, atividade de ALP e formação de matriz mineralizada. Microscopia por epifluorescência indicou que após 24 h da aplicação do laser, as culturas irradiadas apresentaram áreas sem células, que mais tarde foram repovoadas por células em fase de proliferação e menos diferenciadas. O laser aumentou a expressão gênica relativa da ALP, OC, BSP e BMP-7 e reduziu a de RUNX2, OPN e OPG. Os resultados indicam que a terapia com laser modula de forma complexa as respostas celulares, estimulando a diferenciação osteoblástica. Assim, é possÃ-vel sugerir possÃ-veis benefÃ-cios do laser na osseointegração de implantes de Ti apesar do efeito deletério às células imediatamente após a irradiação.

Eur J Paediatr Dent. 2010 Jun;11(2):71-6.

Lasers in dental traumatology.

Olivi G, Caprioglio C, Genovese MD.

Visiting Professor in Restorative Dentistry, University of Genoa Private practice in Rome. olivi.g@tiscali.it

Abstract

AIM: Dental traumas are frequent in children. They can be complex events and sometimes real emergencies. Since very little attention is devoted to this topic in the international literature and there are no well-coded laser guidelines for these specific clinical events, our aim is to consider and present those situations in which laser-assisted therapy can offer new treatment possibilities. The authors’ aim is to stimulate more extensive scientific research in this area, which might not only increase the use of these technologies, but also improve outcomes and reduce complications connected to dental trauma, particularly in children. Furthermore, laser-assisted therapies drastically reduce the need for analgesics and anti- inflammatory medications compared with conventional procedures.

CONCLUSION: Using laser equipment to obtain anaesthesia is another challenge, while the use of low power setting for desensitising tissue and to obtain anaesthesia is also an open field.

J Periodontal Implant Sci. 2010 Jun;40(3):105-10. Epub 2010 Jun 25.

 

Biological effects of a semiconductor diode laser on human periodontal ligament fibroblasts.

 

Choi EJ, Yim JY, Koo KT, Seol YJ, Lee YM, Ku Y, Rhyu IC, Chung CP, Kim TI.

Department of Periodontology and Dental Research Institute, Seoul National University College of Dentistry, Seoul, Korea.

Abstract

PURPOSE: It has been reported that low-level semiconductor diode lasers could enhance the wound healing process. The periodontal ligament is crucial for maintaining the tooth and surrounding tissues in periodontal wound healing. While low-level semiconductor diode lasers have been used in low-level laser therapy, there have been few reports on their effects on periodontal ligament fibroblasts (PDLFs). We performed this study to investigate the biological effects of semiconductor diode lasers on human PDLFs.

METHODS: Human PDLFs were cultured and irradiated with a gallium-aluminum-arsenate (GaAlAs) semiconductor diode laser of which the wavelength was 810 nm. The power output was fixed at 500 mW in the continuous wave mode with various energy fluencies, which were 1.97, 3.94, and 5.91 J/cm(2). A culture of PDLFs without laser irradiation was regarded as a control. Then, cells were additionally incubated in 72 hours for MTS assay and an alkaline phosphatase (ALPase) activity test. At 48 hours post-laser irradiation, western blot analysis was performed to determine extracellular signal-regulated kinase (ERK) activity. ANOVA was used to assess the significance level of the differences among groups (P<0.05).

RESULTS: At all energy fluencies of laser irradiation, PDLFs proliferation gradually increased for 72 hours without any significant differences compared with the control over the entire period taken together. However, an increment of cell proliferation significantly greater than in the control occurred between 24 and 48 hours at laser irradiation settings of 1.97 and 3.94 J/cm(2) (P<0.05). The highest ALPase activity was found at 48 and 72 hours post-laser irradiation with 3.94 J/cm(2) energy fluency (P<0.05). The phosphorylated ERK level was more prominent at 3.94 J/cm(2) energy fluency than in the control.

CONCLUSIONS: The present study demonstrated that the GaAlAs semiconductor diode laser promoted proliferation and differentiation of human PDLFs.

Angle Orthod. 2010 Sep;80(5):925-32.

Interventions for pain during fixed orthodontic appliance therapy.  A systemic review.

 

Xiaoting L, Yin T, Yangxi C.

State Key Laboratory of Oral Disease and Department of Orthodontics, West China School of Dentistry, Sichuan University, Chengdu, China.

Abstract

OBJECTIVE: To compare the different methods of pain control intervention during fixed orthodontic appliance therapy.

MATERIALS AND METHODS: A computerized literature search was performed in MEDLINE (1966-2009), The Cochrane Library (Issue 4, 2009), EMBASE (1984-2009), and CNKI (1994-2009) to collect randomized controlled trials (RCTs) for pain reduction during orthodontic treatment. Data were independently extracted by two reviewers and a quality assessment was carried out. The Cochrane Collaboration’s RevMan5 software was used for data analysis. The Cochrane Oral Health Group’s statistical guidelines were followed.

RESULTS: Twenty-six RCTs were identified and six trials including 388 subjects were included. Meta-analysis showed that ibuprofen had a pain control effect at 6 hours and at 24 hours after archwire placement compared with the placebo group. The standard mean difference was -0.47 and -0.48, respectively. There was no difference in pain control between ibuprofen, acetaminophen, and aspirin. Other analgesics such as tenoxicam and valdecoxib had relatively lower visual analog scale (VAS) scores in pain perception. Low-level laser therapy (LLLT) was also an effective approach for pain relief with VAS scores of 3.30 in the LLLT group and 7.25 in the control group.

CONCLUSIONS: Analgesics are still the main treatment modality to reduce orthodontic pain despite their side effects. Some long-acting nonsteroidal anti-inflammatory drugs (NSAIDs) and cyclo-oxygenase enzyme (COX-2) inhibitors are recommended for their comparatively lesser side effects. Their preemptive use is promising. Other approaches such as LLLT have aroused researchers’ attention.

Angle Orthod. 2010 Sep;80(5):968-74.

Low-level laser therapy effects in traumatized permanent teeth with extrusive luxation in an orthodontic patient.

 

Görür I, Orhan K, Can-Karabulut DC, Orhan AI, Oztürk A.

Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Ankara, Ankara, Turkey.

Abstract

The aim of this case report was to present and evaluate the effect of low-level laser therapy on traumatized permanent teeth with extrusive luxation in an orthodontic patient. The treatment and follow-up evaluation of two orally luxated maxillary permanent central incisors in a 19-year-old man is described. Detailed anamnesis was taken, and extraoral, intraoral, radiographic examinations and electrical and thermal pulpal tests were performed to determine the type of the luxation and the further treatment protocol. Teeth were splinted with composite resin, and antibiotic therapy was prescribed. Low-level laser therapy was applied for 25 sessions. No root canal treatment was applied to the teeth. Continuation of the orthodontic treatment was restarted after 6 months. No sign of clinical or radiographic pathology was detected after 2 years from the end of the treatment. Teeth were identified healthy and sound without any root canal intervention. Treatments with low-level laser applications may be evaluated as noninvasive alternative treatment options in comparison with endodontic treatment for teeth with extrusive luxation more than 2 mm, especially for those who have orthodontic treatment needs.

Lasers Med Sci. 2010 Jun 30. [Epub ahead of print]

Low-level laser therapy of dentin hypersensitivity: a short-term clinical trial.

 

Orhan K, Aksoy U, Can-Karabulut DC, Kalender A.

Department of Oral Diagnosis and Radiology, Faculty of Dentistry, University of Ankara, Ankara, Turkey, call53@yahoo.com

Abstract

The aim of this study was to evaluate low-level laser therapy in cervical dentin hypersensitivity. A randomized controlled clinical trial was conducted with a total of 64 teeth. Dentin desensitizer and diode laser were applied on the cervical dentin surfaces. Distilled water and placebo laser was used as the placebo groups. The irradiance used was 4 J/cm(2) per treatment site. The baseline measurement of hypersensitivity was made by using visual analog scale (VAS). Twenty-four hours and 7 days after the application of desensitizer, diode laser and placebo groups, a new VAS analysis was conducted for the patients’ sensitivity level. The mean pain scores of placebo groups were significantly higher than the desensitizer’s and diode laser’s mean scores (ANOVA, p < 0.05). The VAS analysis revealed a significant decrease in dentin hypersensitivity in 7 days with the use of the desensitizer and low-level laser therapy and no statistically significant difference was observed between these two treatments (p > 0.05). Although low-level laser and glutaraldehyde containing desensitizer present distinct modes of action, experimental agents caused a significant reduction of dentin hypersensitivity without showing secondary effects, not irritating the pulp or causing pain, not discoloring or staining the teeth, and not irritating the soft tissues at least for a period of 1 week with no drawbacks regarding handling and/or ease of application. Low-level laser therapy and desensitizer application had displayed similar effectiveness in reducing moderate dentin hypersensitivity.

Lasers Med Sci. 2010 Jun 12. [Epub ahead of print]

Quantification of fibrosis and mast cells in the tissue response of endodontic sealer irradiated by low-level laser therapy.

 

Berbert FL, Sivieri-Araújo G, Ramalho LT, Pereira SA, Rodrigues DB, de Araújo MS.

Department of Restorative Dentistry, Discipline of Endodontics, Dental School of Araraquara, São Paulo State University-UNESP, Rua Humaitá, 1680, PO 331, CEP 14.801-903, Araraquara, SP, Brazil.

Abstract

Low-level laser therapy (LLLT) accelerates tissue repair. Mast cells induce the proliferation of fibroblasts and the development of local fibrosis. The objective of this study was to quantify fibrosis rate and mast cells in connective tissue after endodontic sealer zinc oxide and eugenol (ZOE) was implanted and submitted to LLLT, immediately after implant and again 24 h later. Sixty mice were distributed into three groups: GI, GII, and GIII (n = 20). In GI, the tubes filled with Endofill were implanted in the animals and were not irradiated with LLLT. In GII, the tubes containing Endofill were implanted in the animals and then irradiated with red LLLT (InGaAIP) 685-nm wavelength, D = 72 J/Cm(2), E = 2 J, T = 58 s, P = 35 mW, and in GIII, the tubes with Endofill were implanted and irradiated with infrared LLLT (AsGaAl) 830-nm wavelength, D = 70 J/Cm(2), E = 2 J, T = 40 s, P = 50 mW. After 7 days and 30 days, the animals were killed. A series of 6-microm-thick sections were obtained and stained with Toluidine Blue and Picrosirius and analyzed under a standard light microscope using a polarized light filter for the quantification of fibrosis. The statistics were qualitative and quantitative with a significance of 5%. The irradiation with LLLT did not offer improvement in the fibrosis rate, however, it provided a significant decrease in the concentration of independent mast cells for the period studied.

Eur J Paediatr Dent. 2010 Mar;11(1):44-8.

Use of laser technology in orthodontics: hard and soft tissue laser treatments.

 

Genovese MD, Olivi G.

Abstract

AIM: Modern technology has perfected a new instrument that has become almost indispensable in modern dentistry, in accordance with the philosophy of minimally invasive therapy: the laser. The aim of this work is to evaluate the effectiveness and efficacy of laser technology to solve mucogingival problems associated with orthodontic treatment. Some laser wavelengths work both on hard and soft tissues (2780 nm, 2940 nm), other lasers, such as the 810 nm diode, have a very good surgical and haemostatic action on soft tissues and an important analgesic and biostimulating effect that can help the healing of both TMJ painful symptoms as well as the pain following active orthodontic treatment. Several cases connected to orthodontic therapy are presented.

MATERIALS AND METHODS: Different laser systems (diode laser at 810 nm; Er,Cr:YSGG laser at 2780 nm; Erbium:YAG laser at 2940 nm) were used, both for soft tissue surgery and enamel etching, and for biostimulating effect. These wavelengths were used with different parameters for each case, according to international current studies in view of minimally invasive therapy.

RESULTS: The cases reported showed very quick and good healing of the laser treated tissues. These treatments, necessary for the orthodontic therapy or for its completion, become extremely simple, safe and rapid and the orthodontic specialist can perform them himself.

CONCLUSION: The laser technique is very effective in many operative and surgical procedures during orthodontic therapy. Further studies are however necessary to set the treatment protocols in orthodontic biostimulation.

Lasers Med Sci. 2010 Feb 11. [Epub ahead of print]

In vitro analysis of human tooth pulp chamber temperature after low-intensity laser therapy at different power outputs.

 

de Alencar Mollo M, Frigo L, Favero GM, Lopes-Martins RA, Junior AB.

Research & Development Institute, Vale do Paraíba University, Av. Shishima Hifumi, 2911, São José dos Campos, 12244-000, SP, Brazil.

In vitro studies have provided conflicting evidence of temperature changes in the tooth pulp chamber after low-level laser irradiation of the tooth surface. The present study was an in vitro evaluation of temperature increases in the human tooth pulp chamber after diode laser irradiation (GaAlAs, lambda = 808 nm) using different power densities. Twelve human teeth (three incisors, three canines, three premolars and three molars) were sectioned in the cervical third of the root and enlarged for the introduction of a thermocouple into the pulp chamber. The teeth were irradiated with 417 mW, 207 mW and 78 mW power outputs for 30 s on the vestibular surface approximately 2 mm from the cervical line of the crown. The highest average increase in temperature (5.6 degrees C) was observed in incisors irradiated with 417 mW. None of the teeth (incisors, canines, premolars or molars) irradiated with 207 mW showed temperature increases higher than 5.5 degrees C that could potentially be harmful to pulp tissue. Teeth irradiated with 78 mW showed lower temperature increases. The study showed that diode laser irradiation with a wavelength of 808 nm at 417 mW power output increased the pulp chamber temperature of certain groups of teeth, especially incisors and premolars, to critical threshold values for the dental pulp (5.5 degrees C). Thus, this study serves as a warning to clinicians that “more” is not necessarily “better”.

Orthod Craniofac Res. 2009 Nov;12(4):289-98.

Low-energy laser irradiation accelerates the velocity of tooth movement via stimulation of the alveolar bone remodeling.

 

Yoshida T, Yamaguchi M, Utsunomiya T, Kato M, Arai Y, Kaneda T, Yamamoto H, Kasai K.

Department of Orthodontics, Nihon University School of Dentistry at Matsudo, Chiba, Japan. yoshida.takamasa@nihon-u.ac.jp

INTRODUCTION: Previously, the authors have reported the acceleration of tooth movement and osteoclastogenesis on the pressure site in an experimental tooth movement model by low-energy laser irradiation (LELI), which stimulated the RANK/RANKL system and c-fms/macrophage colony-stimulating factor system. However, the effect of LELI on osteogenesis on the tension site is not known clearly. Moreover, the temporal changes in alveolar bone during tooth movement have not been investigated as yet. Therefore, the present study was designed to examine the effects of LELI on alveolar bone remodeling during experimental tooth movement, and observe the temporal bone mineral density (BMD) using micro-computed tomography (muCT).

MATERIALS AND METHODS: To induce experimental tooth movement in rats, 10 g force was applied to the upper right first molar with Nickel titanium closed-coil. Next, a gallium-aluminum-arsenide (Ga-Al-As) diode laser was used to irradiate the area around the moved tooth, and BMD and the amount of tooth movement were measured by muCT scanning for 21 days. Histopathological examination was also performed.

RESULTS: The amount of tooth movement in the LELI group was significantly greater than in the non-irradiation group by the end of the experimental period. Further, compared with the non-irradiation group, the fall of BMD was less in the LELI group.

CONCLUSION: These findings suggest that LELI accelerates the velocity of tooth movement via stimulation of the alveolar bone remodeling.

Photomed Laser Surg. 2009 Nov 22. [Epub ahead of print]

The Effects of Low Level Laser Irradiation on Gingival Inflammation.

 

Pejcic A, Kojovic D, Kesic L, Obradovic R.

Department of Periodontology and Oral Medicine, Medical Faculty, University of Nis , Nis, Serbia .

Abstract Objective: The goal of this study was to analyze the effects of low level laser irradiation treatment and conservative treatment on gingival inflammation.

Background: It is widely accepted today that the primary etiological factor for the onset of periodontitis is dental plaque, although the exact mechanism of damage remains unknown. Inflammation is a basic response of periodontal tissue to damage and serves as a fast first line of defense against damage and infections. The treatment of gingivitis and periodontitis has gone through various stages: from the simplest, classical treatment methods, through improved radical interventions, to a new era marked by laser technology. Low level laser irradiation has an anti-inflammatory effect, both general and local.

Materials and methods: The research was done on patients who had chronic periodontal disease (mild periodontitis) with expressed clinical symptoms of gingival inflammation. All patients in the study underwent conservative treatment. After conservative therapy, the patients from the experimental group were subjected to 10 low level laser treatment sessions. Both groups underwent regular follow-up visits 1, 3, and 6 months after treatment, which involved only clinical examination using plaque index (PI), gingival index (GI), and bleeding on probing index (BOP index).

Results: A considerable decrease in all three indexes after the application of both therapies was noticed. The follow-up visits revealed the difference in index values. With laser therapy, the values of indexes decreased steadily, whereas with conservative therapy they increased up to a certain point, but did not reach the pre-therapy values.

Conclusions: A general conclusion can be drawn that low level laser irradiation (semiconductor, 670 nm) can be used as a successful physical adjuvant method of treatment, which, together with traditional periodontal therapy, leads to better and longer-lasting therapeutic results.

Lasers Med Sci. 2009 May;24(3):387-95. Epub 2008 Jun 26.

Effect of soft laser and bioactive glass on bone regeneration in the treatment of infra-bony defects (a clinical study).

AboElsaad NS, Soory M, Gadalla LM, Ragab LI, Dunne S, Zalata KR, Louca C.

Department of Oral Medicine and Periodontology, Faculty of Dentistry, Mansoura University, Mansoura, Egypt.

This study aimed to investigate the influence of low-power 830 nm gallium-aluminium-arsenide (GaAlAs) laser [continuous wave (CW) 40 mW and fluence 4 J/cm(2), with total energy density of 16 J/cm(2)] on the healing of human infra-bony defects treated with bioactive glass graft material. Twenty patients with chronic periodontitis and bilateral infra-bony defects were included. Using a split mouth design, we treated 20 defects with bioactive glass plus laser irradiation during surgical procedures and on days 3, 5, 7 postoperatively; 20 contra-lateral defects were treated with bioactive glass only. Clinical probing pocket depths, clinical attachment levels and standardized periapical radiographs were recorded at baseline and at 3 months and 6 months postoperatively. At 3 months there was a statistically significant difference between the laser and non-laser sites in the parameters investigated. However, at 6 months, no difference was observed. Our results have confirmed the positive effect of soft laser in accelerating periodontal wound healing.

Gen Dent. 2008 Nov-Dec;56(7):618-27.

Lasers and pediatric dental care.

 

Kotlow L.

Academy of Laser Dentistry.

There are several types of lasers that will allow pediatric dentists to remove soft tissue (such as diode or Neodynium:Yttrium-Aluminum-Garnet (Nd:YAG) lasers) or remove both hard and soft tissue (such as the Erbium:YAG laser), in addition to photobiostimulation or therapeutic lasers that produce their healing benefits without producing heat. Lasers allow pediatric dentists to provide optimal care without many of the fear factors that result from conventional dental techniques. Lasers are extremely safe and effective when the user has a proper understanding of laser physics. Using lasers for caries removal, bone removal, and soft tissue treatment can reduce postoperative discomfort and infection and make it possible for dentists to provide safe, simple treatments.

Gen Dent. 2008 Nov-Dec;56(7):629-34.

 

Low level lasers in dentistry.

Ross G, Ross A.

Laser Light Canada.

Low level laser therapy (LLLT) uses light energy, in the form of adenosine triphosphate (ATP), to elicit biological responses in the body. The increased cellular energy and changes in the cell membrane permeability result in pain relief, wound healing, muscle relaxation, immune system modulation, and nerve regeneration. This article investigates the clinical effects of LLLT and explains how it can be applied in the dental field.

Alpha Omegan. 2008 Sep;101(3):140-51.

Lasers and soft tissue treatments for the pediatric dental patient.

Kotlow L. kiddsteeth@aol.com

Historically, oral soft tissue surgery on infants and young children was completed in the operating room under a general anesthetic agent. Many children were referred to an oral surgeon and required a physician’s physical examination and medical clearance for a hospital admission. potentially placed a child at risk during the use of a general anesthetic for an elective procedure, which may not have insurance benefits. Traditional methods of oral surgery using scalpels or electrosurgery may produce significant postoperative discomfort and require sutures and prolonged healing. Lasers provide a simple and safe in-office alternative for children while at the same time reducing the chances of infection, swelling, discomfort, and scaring.

EMLA Laser Health J 2007;2:46-67
European Medical Laser Association (EMLA)

Low level laser treatment (LLLT) during & after multiple teeth extirpations- randomised clinical study with control group

 Z. Simunovic 1, K. Simunovic 2
1. Pain Clinic – Laser Center, Switzerland
2. Private Dental Practice, Switzerland

Multiple teeth extraction is a dental surgical procedure, which is sometimes followed by complications like haemorrhage, oedema, pain and inflammation, leading to intake of related drugs, usually analgesics. The current clinical study was conducted in order to observe the efficacy of LLLT applied during and immediately after multiple teeth extractions.

Study Design – Irradiation Parameters: Total number of patients: 40, randomly allocated to two groups (20 p. – irradiated, Energy density applied: 4J/cm 2 HeNe laser & IR Laser; 20 p.- control group, no laser irradiation). The following parameters were observed: haemorrhage, oedema, redness and pain. The presence of each parameter was scored as follows: absent (0 point), mild (5 points), moderate (10 points), severe (15 points), worst (20 points).

The difference was calculated for each evaluated parameter, and demonstrated significance in favour of LLLT (p<0.05). The difference in number of patients with pain and those who took of analgesics was significant between both groups at the level of p<0.00l.

Advantages of LLLT are: no bleeding or oedema, no inflammation, significantly reduced intake of analgesic drugs – reduced presence of pain, reduced stay in hospital, fewer incidence of post­operative complications, no harmful or side effects observed.

Low level lasers in dentistry

Jan Tunér DDS, Grängesberg, Sweden

Per Hugo Christensen, DDS, Copenhagen, Denamrk

A wide range of different lasers are used in modern dentistry. The Erbium:YAG laser has a potential of replacing the drill in selected situations; the carbon dioxide laser is a valuable tool in oral surgery; the Argon laser is used in minor surgery and composite curing; the Nd:YAG is used in pocket debridement, tissue retraction and more. This is just to mention a few of the possibilities of the dental laser.

The major drawback so far has been the high cost compared to the conventional therapies and the fast development in the field. The high cost of the investment may not have paid off until the next generation of lasers is on the market. So far the majority of the dentists using lasers are mainly the entrepreneurs and the enthusiasts.

All the above listed lasers are using, or have the possibility of using high powers, ranging from fractions of a watt to 25 watts or more.  Interest from media and patients has been considerable during the last decade, party because of a general interest in “high-tech” and partly because of the eternal dream about an escape from the discomfort experienced in the dental chair.  This article will summarize the physics, science and clinic of a quite different type of dental lasers – the low level laser.

Low level lasers

While the lasers already mentioned can be labeled “High level lasers”, there is a less known type of lasers called “Low level lasers”. These lasers are generally smaller, less expensive and operate in the milliwatt range, 1-500 milliwatts. The therapy performed with such lasers is often called “Low Level Laser Therapy” (LLLT) or just “laser therapy” and the lasers are called “therapeutic lasers”. Several other names have been given to these lasers, such as “soft laser” and “low intensity level laser” whereas the therapy has been referred to as “biostimulation” and “biomodulation”. The latter term is more appropriate, since the therapy can not only stimulate, but also suppress biological processes [1}

Therapeutic lasers generally operate in the visible and the infrared spectrum, 600-900 nm wavelength. However, other wavelengths such as the Nd:YAG at 1064 nm and even the carbon dioxide laser at 10600 nm have been successfully used in laser therapy.

The energy used is indicated in Joule (J), which is the number of milliwatts x the number of seconds of irradiation. Thus, 50 mW x 60 seconds produces an energy of 3000 millijoules, equals 3 J.  Suitable therapeutic energies range from 1-10 J per point.

The dose is expressed in J/cm2. To calculate the dose, the irradiated area must be known.  1 J over an area of 1 cm2 = 1 J/cm2. 1 J over an area of 0.1 cm2 = 10 J/cm2. There is generally no heat sensation or tissue heating involved in this therapy.

The history

The first laser was demonstrated in 1960. It was a ruby laser, 694 nm wavelength.  Interest in the medical implications of laser light was high and already in 1967 [2] someof the first reports appeared on the effects of very low doses of ruby light on biological tissues. In animal studies it was observed that experimental wounds healed better if irradiated and that even the shaved fur of the experimental animals reappeared faster in the irradiated areas. There appeared to be a biological window for the dose. If too low, there was no effect, if too high there was a suppressive effect. Not much  later the Helium-Neon laser was introduced in research and the results were similar. Later on diode lasers were introduced and they provided the same results, although some wavelengths appeared to be better for certain indications. In particular, the introduction of infrared lasers improved the optical penetration of the light, reaching deeper lying tissues.

The first commercially available lasers in the early 80ies were extremely low powered, below 1 mW, in spite of the fact that the first scientific reports used 25 mW. This partly explains the initial controversy about LLLT. With the rapid development of laser diodes, the powers of therapeutic lasers have changed dramatically and diode lasers today are typically in the range of 50-500 mW. Increased power has not only shortened the treatment time but also improved the therapeutic results.

Risks and side effects

The only physical risk in laser therapy is the risk of an eye damage. While never reported to have occurred, the risk of an eye damage must be considered, especially when using an invisible and collimated (parallel) beam. Suitable protective goggles should be worn by the patient for extra oral therapy in the face.

Since the therapeutic lasers are well above the ionizing spectrum there is no risk of cancerous changes. Suspected malignancies should of course not be treated by anyone but the specialist.

Among the  side effects  (rarely) observed are:

– temporary increase of pain in chronic pain conditions. It has been suggested that this is a sign of a transfer of the chronic condition into an acute situation.

– tiredness after the treatment. This is probably a result of the pain relief where the pain previously has prevented a normal relaxation pattern

– redness and a feeling of warmness in the area which is irradiated a result of increased micro circulation

The science

There are more than 2500 scientific studies in the field of laser therapy, among them more than 100 positive double blind studies [3]. In dentistry alone, the number of studies are some 325, from 82 institutions in 37 countries [4]. The quality of these studies vary but it is interesting to note that more than 90% of the studies report on positive effects of laser therapy.

In total, 30 different dental indications have been reported in the literature. The very variety of indications has been used as an argument against the probability of laser therapy.  However, it rather shows the input on general biological systems, such as the immune system, SOD activity, ATP production, cell membrane permeability, release of transmitter substances etc.

Laser therapy science is a complicated matter where a combined knowledge about laser physics, medicine,  clinical procedures and scientific rules is essential [5]. Many studies,positive and negative, lack relevant reporting parameters and make a proper evaluation difficult. The existing literature is a sufficient foundation for successful clinical therapy but more research is still needed to find out the optimal parameters.

In two recent  US meta analyses [6], [7] there was a  high overall significance  for wound healing, tissue regeneration and pain.

Treatment

Treatment is often carried out through local irradiation of the site of injury/pain, but it can also be performed on distal points such as regional lymph nodes, ganglia and cervical nerve roots corresponding to the dermatome in question. Pain release can often be achieved in one or two sessions (especially if the reason for the pain still is in a acute stage) whereas  many conditions have to be treated during several sessions. When calculating the dosage, parameters such as pigmentation of the skin, condition of the tissue, acute/chronic stage, depth beneath skin/mucosa, transparence of overlying tissue must be considered.

New possibilities

The therapeutic lasers offer improved possibilities in the treatment of pain, wound healing, inflammation and oedema. However, they also offer the dentist a possibility to treat indications previously not within the capability of the general dentist. In the following some examples will be given, each with a selected reference

Dentinal hypersensitivity

With the advent of desensitizing agents, the prevalence of treatment-resistant dentinal hypersensitivity has diminished considerably. On the other hand, the placement of composites and inlays has brought a new reason for the very same. Gershman [8] has shown that dentinal hypersensitivity can be successfully treated with LLLT. Mild pulpitis requires higher doses than the common dentinal hypersensitivity,  and repeated treatments. Frequently a sensitive tooth neck can be treated with only one treatment.

Herpes simplex

Oral herpes (HSV1) is a common feature in the dental operatory. Instead of being a contraindication for dental treatment during the acute period, an onset of HSV1 can be a good reason for a visit to the dentist. As with any treatment of HSV1 a treatment in the early prodromal stage is most successful. The pain will be reduced immediately and the blisters will disappear within a few days. Repeated treatment, whenever a blister appears will lower the incidence of recurrence. Unlike Acyclovir tablets, there are no side effects [9]. It has been shown [10] that laser therapy can even be used in the latent period between the attacks to lower the incidence of  recurrence.

Mucositis

Patients undergoing radiotherapy [11] and/or chemoradiotherapy [12] suffer gravely from the mucositis induced by the therapy. Nutrition is troublesome and therapy regimen may have to be suboptimal for this reason. LLLT can be used not only to treat the mucositis but even to reduce it by mucosal irradiation prior to radiotherapy/chemotherapy.

Pain

The most frequent complaint among patients is of course pain. LLLT can reduce or eliminate pain of various origins ]6]. Postoperative discomfort after surgery can be substantially reduced by irradiating the operated area postoperatively before theanesthesia wears off.

Paresthesia

After oral surgery paresthesias may occur as a result of the surgery, in particular in the mandibular region. LLLT has been used to eliminate or reduce such complications [13].

Sinusitis

While many cases of sinuitis are “dental”, a great number of patients arrive in the dental office with sinuitis of a viral or bacterial background. LLLT will in most cases lead to a fast reduction of the symptoms [14], making the scheduled treatment easier.

TMD

Problems in the temporo-mandibular joint region are quite suitable for LLLT. For arthritic cases the treatment is concentrated to the joint area, in myogenic cases the muscular insertions and trigger points are treated. Laser therapy should always be used in combination with conventional treatment but will improve the outcome of the treatment  [15].

Tinnitus/vertigo

It has been shown [16] that patients suffering from Ménière’s disease (tinnitus/vertigo) have a significantly increased prevalence of problems in the masticatory, neck  and trapezius muscles plus problems in the cervical spine, particularly in the transverse processes of the atlas and the axis. Relaxation of the tension in these muscles plus occlusal stabilisation procedures (occlusal adjustment, bite splint) will reduce or eliminate the symptoms of tinnitus and vertigo in this group of patients. Laser therapy can successfully be used to promote muscular relaxation and pain relief in these cases.

Trigeminal neuralgia

Apart from being extremely debilitating, trigeminal neuralgia can sometimes make dental treatment impossible. While no miracle cure, dentists can offer a great deal of comfort to these patients, and with a non-invasive method [17].

Zoster

Zoster in the trigeminal nerve should be treated in its early phase. The zoster attack in itself is bad enough, but not too infrequently a postherpetic neuralgia will persist for years or even lifelasting. Laser therapy is a cost-effective, non-invasive method without side effects [18].

Other indications

29 different dental indications are described in the literature, some of them being aphtae, bone regeneration, dentitio dificilis and decubitus.

Acupuncture

If a dentist is trained in acupuncture, the low level laser will be a very convenient way of replacing the needles in many instances, for corporal or auricular acupuncture.  Needles are not too popular with the patients, so the laser will be appreciated. Even for a dentist not practicing acupuncture, there are some well defined acupuncture points which can be used, for instance to reduce nausea [19].

No panacea

The clinical results described above may seem impressive, even to the degree of doubts. However, laser therapy is no panacea and should only be used within the limits of its own merits. Correct diagnosis, proper treatment technique and treatment intervals plus sufficient dosage are all essential to obtain good results.

Non-biomodulating LLLT

A large number of in vitro studies have reported on the enhanced killing of bacteria using various dyes in combination with low level lasers. The most frequently used dye has been toluidine blue (TBO) and some of the microorganisms studied are streptococcus mutans (20) and staphylococcus aureus (21). The bactericidal effect of TBO is enhanced by low level laser light and the clinical implications of this combination in cariology and periodontology are indeed promising. Low level laser has also been shown to enhance the release of fluoride from  lacquers (22) and  resin cements (23).

References:

[1] Abergel P. et al: Control of connective tissue metabolism by lasers: Recent developments and future prospects. J Am Acad  Dermatol. 1984; 11: 1142

[2] Mester E. et al: Untersuchungen über die hemmende bzw. fördernde Wirkung der Laserstrahlen. Arch Klin Chir. 1968; 322: 1022.

[3] Tunér J, Hode L. 100 positive double blind studies – enough or too little? Proc. SPIE, Vol  4166, 1999: 226-232.

[4] Tunér J, Hode L. Low level laser therapy – clinical practice and scientific background. 1999. Prima Books. ISBN 91-630-7616-0.

[5] Tunér J, Hode L. It´s all in the parameters: a critical analysis of some well-known negative studies on low-level laser therapy. Journal of Clinical Laser Medicine & Surgery. 1998; 16 (5): 245-248.

[6] Parker J et al. The effects of laser therapy on tissue repair and pain control: a meta-analysis of theliterature. Proc. Third Congress World Assn for Laser Therapy, Athens, Greece, May 10-13 2000; p. 77.

[7] Bouneko J M et al. The efficacy of laser therapy in the treatment of wounds: a meta-analysis of the literature. Proc. Third Congress World Assn for Laser Therapy, Athens, Greece, May 10-13 2000; p 79.

[8] Gerschman J A et al. Low Level Laser in dentine hypersensitivity. Australian Dent J. 1994; 39: 6.

[9] Vélez-Gonzalez M et al.  Treatment of relapse in herpes simplex on labial and facial areas and of primary herpes simplex on genital areas and “area pudenda” with low power HeNe-laser or Acyclovir administred orally. SPIE Proc. 1995; Vol. 2630: 43-50

[10] Schindl A, Neuman R. Low-intensity laser therapy is an effective treatment for recurrent herpes simplex infection. Results from a randomized double-blind placebo-controlled study. J Invest Dermatol. 1999: 113 (2): 221-223.

[11] Bensadoun R J, Franqiun J C, Ciais C et al. Low energy He/Ne laser in the prevention of radiation-induced mucositis: A multicenter phase III randomized study in patients with head and neck cancer. Support Care Cancer. 1999; 7 (4): 244-252.

[12] Cowen D et al.  Low energy helium neon laser in the prevention of oral mucositis in patients undergoing bone marrow transplant: results of a double blind randomized trial. Int J Radiat Oncol Biol Phys. 1997; 38 (4): 697-703.

[13] Khullar S M et al.  Effect of low-level laser treatment on neurosensory deficits subsequent to sagittal split ramus osteotomy. Oral Surgery Oral Medicine Oral Pathology. 1996; 82 (2): 132-8.

[14] Kaiser C et al. Estudio en doble ciego randomizado sobre la eficacia del HeNe en el tratamiento de la sinuitis maxilar aguda: en pacientes con exacerbación de una infección sinusal crónica. [Double blind randomized study on the effect of HeNe in the treatment of acute maxillary sinuitis: in patients with exacerbation of a chronic maxillary sinuitis]. Boletín CDL. 1986; 9: 15. Also in Av Odontoestomatol. 1987; 3(2): 73-76.

[15] Sattayut S. PhD dissertation, St. Bartholomew’s and the Royal London School of Medicine and Dentistry. 1999.

[16] Bjorne A. Cervical signs and symptoms in patients with Ménière’s disease: a controlled study. J Cranomandib Practice. 1998; 16 (3): 194-202.

[17] Eckerdal A, Lehmann Bastian H.  Can low reactive-level laser therapy be used in the treatment of neurogenic facial pain? A double-blind, placebo controlled investigation of patients with trigeminal neuralgia. Laser Therapy. 1996; 8: 247-252.

[18] Moore K et al.  LLLT treatment of post herpetic neuralgia. Laser Therapy. 1988; 1:7

[19] Schlager A et al. Laser stimulation of acupuncture point P6 reduces postoperative vomiting in children undergoing strabismus surgery. Br J Anesth. 1998; 81 (4): 529-532.

[20] Burns T, Wilson M, Pearson G. Effect on dentine and collagen on the lethal photosensitization of streptococcus mutans. Caries Res. 1995; 29: 192-197.

[21] Wilson M, Yianni C. Killing of methicillin-resistant staphylococcus aureus by low-power laser light. J Med Microbiol. 1995; 42: 62-66.

[22] Kazmina S et al. Laser prophylaxis and treatment of primary caries. SPIE Proc. 1984; 1994: 231-233.

[23] van Rensburg S D, Wiltshire W A. The effect of soft laser irradiation on fluoride release of two fluoride-containing orthodontic bonding materials.

J Dent Assoc S Afr. 1994; 49 (3): 127-31

LOW LEVEL LASER THERAPY IN DENTISTRY

1 Kresimir Simunovic, D.M.D., 2Zlatko Simunovic, M.D., F.M.H. 1Private dental practice, Locarno-Zürich, Switzerland 2Pain Clinic-Laser Center, Locarno, Switzerland

In recent years there has been increasing number of dentists using laser technology, either low or high-energy level lasers. There is no laser yet developed that totally replaces the conventional rotary instruments, but some routine work in dental practice can now be done with use of lasers This lecture will give a brief overview of dental disorders, where LLLT proved to be an efficient therapeutic procedure, whether applied as monotherapy or complementary treatment modality LLLT is mainly used for the treatment of soft tissues inside oral cavity, in order to relieve the pain or to induce wound healing, or as a diagnostic device for dental diseases like early detection of caries. Effects of LLLT are based upon biostimulative-regenerative effect, anti-inflammatory and analgesic effect

Here are some of pathological changes, which can successfully be treated with LLLT:
– Wounds after extractions
– Recovery after dental and periodontal surgical procedures
– Open and closed wound healing after minor and major oral surgery
– Lip wounds and combustions
– Abscess
– Scar tissue
– Alveolitis sicca
– Haemathoma
– Herpes labialis
– Aphtae
– Ragadae
– Mucositis
– Dentitio difficilis
– Damages of the mucosa due to the incorrectly sitting prosthesis
– Crown preparation
– Nerve lesions
– Acute and chronic disease of periodontal tissue
– Neuralgia n. trigemini
– Temporo
-mandibular joint disorders
– Trismus
This lecture will bring you exact irradiation techniques and efficient energy densities, which are determined after many years spent in the clinical application of LLLT in dentistry.

Used by the kind permission of the Czech Society for the Use of Laser in Medicine, www.laserpartner.org

Low Level Laser Therapy in Dentistry – Preventive Performance

Dr. Rosane Lizarelli, D.D.S., Riberao Preto, SP, Brazílie

E-mail: lizarelli@neomundi.com.br

Published jointly in Laser Partner and Laser World (www.laser.nu)

Abstract

The possibility of reducing the patients’ pain and anxiety through low level laser applications has been the main objective of my research within laser therapy. This Editorial deals with the low level laser as an indispensable and irreplaceable tool for the dentist nowadays in the dental office, focusing on an innovative operator modality: its preventive performance.

***

Clinically, the use of low level laser therapy has demonstrated excellent results. In terms of tissue healing, largely discussed, it shows evidence of the acceleration process in up to three times, mainly for those patients with physiological disturbances,. This may be considered as an indispensable and preventive procedure. Furthermore, the patient’s temporary dysfunction, provoked by a wound, being surgically or not, is reduced. This fact causes a comfort that can be achieved only by low level laser.

My double-blinded study compared a group without laser and with systemic analgesic medication with two other groups with laser: one group with laser only after the surgical procedure and the other with laser therapy before and after the surgery. This study clarified that 790 nm laser therapy with a dose of 1,5 J/cm2 was as effective with regards to the analgesic and anti-inflammatory effect as conventional medication, both for the pain and oedema control.

To accomplish the present study, 45 clinical situations were selected during the Graduation Course of in Implant and Prosthesis of 3i Implants Innovations, Inc., in Ribeirão Preto, São Paulo, Brazil. The selection approach was just constituted in writing in the consent on the part of the patient taking the responsibility in coming back for the follow up care, and also in executing the rules imposed by the methodology of the research. To all the patients it was instituted a systemic medication of preventive anti-bioticotherapy was instituted and also continued after the surgical procedure for 6 days to the base of penicillin, and for the allergic ones, to the clindamicin base.

The piece of equipment of low powered laser chosen was a semiconductor diode of GaAlAs (galium, aluminum and arsenium), that emits in the infra-red close with wavelength of 790 nm and pick power of 30 mW. The emission type is continuous and the application form should be accomplished contacting the gingival tissue; the area of the active point of the crystal of quartz is of 0.13 cm2 (Compact Laser, J. Morita Co., Japan).

The patients were divided in three different groups, constituted of 15 clinical situations each one, as follows:

  • Group I: Control, the laser application was simulated, without working the “start”, just leaving a “bip” ring. All the patients from that group received that simulation during one minute scanning the operated area. Those patient were well informed with the analgesic and anti-inflammatory systemic medication to the piroxican base (Cicladol 20 mg) twice a day in the postoperative for a period of three days.
  • Group II: Lasertherapy sessions in the postoperative immediate, of 24 hs and of 48 hs. It was not instituted the analgesic and anti-inflammatory systemic medication.
  • Group III: Lasertherapy sessions in the pre-operative of -48 hs, -24 hs and minutes before the surgical intervention and also in the postoperative in the same way that in the Group II. The patients were equally well educated and have not taken the analgesic and anti-inflammatory systemic medication.

The Group III was elaborated based in NICCOLI FILHO’s studies (1995) that used the low power of density laser radiation with prevention.

All the applications were accomplished using the same energy parameters and for the same operator and the way of the application was accomplished sweeping the whole area of the tissue to be irradiated, which should be dry preferentially to allow the minimum reflection of the light for the energy not to be lost and absorbed by the tissue. The point of the equipment that contacted the tissue was involved with plastic by hygiene measure and of infection control (in the same way as it is made clinically) which promotes the loss of 10% of energy, that however is not important.

The time of each application was calculated in agreement with the formula of density power ( or intensity). The area of each clinical situation had been calculated associating the clinical exam to the radiographic, determining the same for the probable operative field that would be explored. The chosen energy was based on the studies of Kubasova that says the energy of 0.5 to 5.0 J/cm2 is enough for obtaining of the analgesia effects and of bioestimulation effects. Being like this, the chosen energy density was of 1.5 J/cm2.

The measures, with relationship to the pain and the edema, were accomplished in the immediate postoperative and in the postoperative of 72 hours, always for the same examiner. The examiner asked the patient previously to the laser application what the pain degree was in that moment considering the values of the table 1. with relationship to the edema analysis, the examiner checked the value to each case, according to the table 2.

When we irradiated the area to be operated, like suggested by Niccoli Filho (1995), we believed that we were “preparing” the cells, mainly for the chemical mediators liberation, especially for the histamine, which acts by increasing the vascular permeability.

According to Ovsiannikov, this procedure stimulates the immune system. Mikailov and Denisov compared three groups of 112 patients with stages IV of stomach cancer; 32 patients received LLLT before surgery, 38 received it after surgery, and 29 patients did not receive LLLT at all. The laser therapy before the operation was slightly more effective. LLLT increased T-active rosette cells and T-helpers, and decreased T-suppressor cells. The life span of the LLLT patients, as compared to the control group increased by a factor of 2 if surgery was performed and by a factor of 3 if surgery was not performed.

The statistical analysis was just accomplished to check the clearly observed clinical discoveries scientifically. The non-parametric Test of Wilcoxon which compares equal of samples, and with significance degree at level of 5.0% (Tab. 3) was chosen.

With relationship to the painful sensitivity, when we compared GI with GII, and GI with GIII, so much in the immediate postoperative as in the postoperative of 72 hours, we observed there were not significant statistical differences.

Even so, in the immediate postoperative, GIII shows a tendency in being significant, suggesting a superior behavior to GII.

With relationship to the edematous formation, we compared GI with GIII, so much in the immediate postoperative as in the postoperative of 72 hours, we didn’t observe significant statistical difference; differently to what we compared, in that situation, GI with GII, where a great tendency to the significance happens.

Table 3 – Statistical results with significance degree at level of 5.0%, when Tc = 138

Event Samples Pairs Immediate PO PO of 72 hours
Pain GI – GII
GI – GIII
| 45.5 |
| 107.5 |
| 67.5 |
| 22.5 |
Edema GI – GII
GI – GIII
| 133.5 |
| 42.0 |
| 135.0 |
| 90.0 |

In agreement with the applied methodology and with the obtained results, the use of low power density laser in implanted patients suggested:

1 – A similar behavior to the analgesic and anti-inflammatory systemic medication, suggesting the possibility of replacement;

2 – for pain control, lasertherapy sessions in the pre-operative were more effective than the postoperative lasertherapy sessions, as executed in GIII;

3 – for tumor formation control, lasertherapy sessions in the postoperative were enough, as executed in GII. Cells with acid pH are more susceptible to light. Furthermore, the possible mechanism at a cellular level probably is depending on the monochromatic carachter of the light, which the organisms are not adapted to evolutionwise. Thus, laser light is one of the environment factors (external agents) capable of modifying the cellular proliferation. The stimulus or inhibition caused by the light may be regarded as a sensorial answer to accommodate to the environmental conditions.

So the question is: why don’t we prepare the target tissue through low level laser irradiation as a preventive procedure prior to the trauma?

References

  1. KARU, T. I. Photobiological fundamentals of low-power laser therapy”. Journal of Quantum Eletronics, v. QE-23, 10, October, 1987.
  2. KARU, T. I. Molecular mechanism of the therapeutic effect of low-intensity laser radiation. Lasers in the Life Sciences; 2(1): 53-74, 1988.
  3. LIZARELLI, R. F. Z.; LAMANO-CARVALHO, T. L.; BRENTEGANI, L. G. Histometrical evaluation of the healing of the dental alveolus in rats after irradiation with a low-powered GaAlAs laser. In: Lasers in Dentistry V, John D. B. Featherstone, Peter Rechmann, D.D.S., Daniel Fried, Editors, Proc SPIE Vol. 3593, p. 49-56, 1999.
  4. LIZARELLI, R. F. Z.; CICONELLI, K. P. C.; BRAGA, C. A.; BERRO, R. J. Low-powered laser therapy associated to oral Implantology. in Lasers in Dentistry V, John D. B. Featherstone, Peter Rechmann, D.D.S., Daniel Fried, Editors, Proc SPIE Vol. 3593, p. 69-73, 1999.
  5. NAVRATIL, L.; DYLEVSKY, I. Mechanisms of the analgesic effect of therapeutic lasers in vivo. Laser Therapy, 9: 33-40, 1997.
  6. NICCOLI FILHO, W. D. Eficácia da radiação de dois diferentes tipos de laser de baixa energia (HeNe e GaAlAs) na prevenção de mucosites orais em pacientes submetidos a transplantes de medula óssea. Tese de Livre Docéncia. São José dos Campos: Faculdade de Odontologia de São José dos Campos UNESP, 1995. 68p.
  7. OVSIANNIKOV, V. A. Analysis of the low-energy laser treatment of some cancers and infections diseases. Journal of Clinical Laser Medicine and Surgery, 15(1):39-44, 1997.
  1. MIKHAILOV, V. A., DENISOV, I. N. Activation of the immune system by low level laser therapy (LLLT) for treating patients with stomach cancer in advanced form. Laser and Technology;7,(1): 31-44, 1997.

Lasers Med Sci. 2007 Nov;22(4):261-4. Epub 2007 Mar 3.

Effects of two types of low-level laser wave lengths (850 and 630 nm) on the orthodontic tooth movements in rabbits.

Seifi M, Shafeei HA, Daneshdoost S, Mir M.

Faculty of Dentistry, Orthodontics Department, Shaheed Beheshti University of Medical Science, Evin, Tehran, Iran. seifimassoud@gmail.com

Abstract

The effects of low-level lasers on bone cellular activity, bone structures, bone healing, fibroblasts activity and inflammation process have already been investigated. Considering orthodontic tooth movement, which is a complicated inflammatory process involving simultaneous bone apposition and resorption, the aim of this controlled study is to investigate the quantitative effects of a pulsed 850 nm laser (Optodan) and a continuous 630 nm laser (KLO3) on the orthodontic tooth movement in rabbits. This experimental study was conducted on 18 male albino rabbits divided into three equal groups of control, Optodan and KLO3. In all the groups, NiTi-closed coil springs were used on the first mandibular molars with 4-oz tension. The control group was not irradiated by laser, but the teeth in the laser groups were irradiated 9 days according to the periodontal therapeutic protocols. After 16 days, samples were sacrificed. The distance between the distal surface of the first molar and the mesial surface of the second molar was measured with 0.05-mm accuracy. The data were subjected to the statistical tests of Kolmogrov Smirnov and variance analysis. The mean orthodontic tooth movements of the first mandibular molars were 1.7 +/- 0.16 mm in control group, 0.69 +/- 0.16 mm in Optodan group and 0.86 +/- 0.13 mm in KLO3 group. There were statistically significant difference between the control and the two other laser-irradiated groups (P < 0.001). The findings of the present study imply that the amounts of orthodontic tooth movement, after low-level laser therapy, are diminished. It could not be concluded that any low-level laser will reduce the speed of teeth movement in orthodontic treatments, and further studies with less or more energies may show different results.

Arch Immunol Ther Exp (Warsz). 2005 Sep-Oct;53(5):388-98.

Inflammation in periodontal tissues in response to mechanical forces.

Yamaguchi M, Kasai K.

Department of Orthodontics, Nihon University School of Dentistry at Matsudo, Japan.

Orthodontic forces are known to produce mechanical damage and inflammatory reactions in the periodontium and dental pulp, as well as inflammatory mediators, e.g. prostaglandins, interleukin (IL)-1, IL-6, tumor necrosis factor alpha, and receptor activator of nuclear factor kappaB ligand, in the periodontal ligament (PDL) and dental pulp. We have studied the effects of aging on the production of inflammatory mediators in the PDL using in vitro and in vitro</I >methods and found that aging of PDL tissues may be an important factor in the severity of periodontal disease through a higher production of inflammatory mediators in response to mechanical forces. Further, the levels of inflammatory mediators in gingival crevicular fluid, an osmotically mediated inflammatory exudates found in the gingival sulcus, have been shown to be significantly elevated during orthodontic treatment. In order to reduce inflammation, low-level laser therapy has been recently studied in vitro</I and in vitro by many investigators as a substitute for anti-inflammatory drugs. Clinical and experimental studies have shown that low-level laser irradiation reduces orthodontic post-adjustment inflammation. We believe that orthodontic forces (mechanical forces) may play an important role in periodontal inflammation and that low-level laser therapy may be useful for its inhibition

Ann Univ Mariae Curie Sklodowska [Med]. 2004;59(1):488-94.

Comparison of the effectiveness of the conservative treatment of the periodontal pockets with or without the use of laser biostimulation.

Kiernicka M, Owczarek B, Galkowska E, Wysokinska-Miszczuk J.

Department of Periodontology, Clinic of Dental and Maxillo-Facial Surgery, Skubiszewski Medical University of Lublin.

The use of laser therapy as the agent reinforcing conventional treatment of the periodontal diseases becomes more and more common. In the physiotherapy of the periodontal diseases the biostimulating, laser is eagerly used because of its action which accelerates the healing of wounds and also because of its antioedematous, anti-inflammatory and analgesic action. The aim of work was the evaluation of the influence of laser biostimulation on the change of the periodontological pockets depth after the routine conservative periodontological treatment with additional use of laser biostimulation and without it for two groups of pockets: above and below 5 mm. In six patients having periodontitis 613 sites were submitted to the statistic analysis (290 treated conservatively only, including 251 with the depth 2-5 mm and 39 above 5 mm as well as 323 with the use of laser therapy including 297 shallow pockets and 26 deep ones). The initial values of API, SBI, PPD and their changes in the course of the treatment were registered. During each control appointment the patients subjectively estimated periodontal pain occurrence. In both studied groups statistically essential decrease of the evaluated parameters was obtained. Reinforcing the conventional treatment with laser biostimulation shortens its duration and leads to the elimination of pain faster than with the use of conservative treatment only. The changes of the PPD index among the successive examinations were statistically essentially higher in the therapy with the use of laser, especially in relation to deep pockets.

Stomatologiia (Mosk). 2003;82(3):32-7.

Treatment of inflammatory pyodestructive processes of the oral cavity, maxillofacial area, and neck by laser and magnetic-laser exposure of the carotid sinus using the Optodan laser apparatus.

[Article in Russian]

Zhizhina NA, Prokhonchukov AA, Vakhtin VI, Geniuk VIa.

This paper presents the priority original methods (patent No. 2101046, Russia) for the treatment of inflammatory pyodestructive processes in the oral cavity, maxillofacial area, and neck (odontogenic abscesses and phlegmons including those complicated by mediastinitis and sepsis), sinusitis, carbuncles and furuncles of face and neck skin, parotitis, sialadenitis, adenophlegmons, lymphadenitis, periotitis, alveolitis, arthritis, arthrosis of the temporomandibular joint, odontogenic and traumatic osteomyelitis, infected purulent traumas (including gunshot ones), fractures of the jaws, etc. making use of Optodan laser (patent No. 2014107, Russia) for laser and magnetic-laser therapy.

J Oral Rehabil. 2003 Dec;30(12):1183-9.

Clinical evaluation of low-level laser therapy and fluoride varnish for treating cervical dentinal hypersensitivity.

Corona SA, Nascimento TN, Catirse AB, Lizarelli RF, Dinelli W, Palma-Dibb RG.

Department of Restorative Dentistry, Ribeirao Preto School of Dentistry, University of Sao Paulo, Ribeirao Preto, Brazil. nelsoncorona@uol.com.br

The aim of this study was to evaluate in vivo the use of low-level galium-aluminium-arsenide (GaAlAs) (BDP 600) laser and sodium fluoride varnish (Duraphat) in the treatment of cervical dentine hypersensitivity. Twelve patients, with at least two sensitive teeth were selected. A total of 60 teeth were included in the trial. Prior to desensitizing treatment, dentine hypersensitivity was assessed by a thermal stimulus and patients’ response to the examination was considered to be a control. The GaAlAs laser (15 mW, 4 J/cm2) was irradiated on contact mode and fluoride varnish was applied at cervical region. The efficiency of the treatments was assessed at three examination periods: immediately after first application, 15 and 30 days after the first application. The degree of sensitivity was determined following predefined criteria. Data were submitted to analysis and no statistically significant difference was observed between fluoride varnish and laser. Considering the treatments separately, there was no significant difference for the fluoride varnish at the three examination periods, and for laser therapy, significant difference (P < 0.05) was found solely between the values obtained before the treatment and 30 days after the first application. It may be concluded that both treatments may be effective in decreasing cervical dentinal hypersensitivity. Moreover, the low-level GaAlAs laser showed improved results for treating teeth with higher degree of sensitivity.

Stomatologiia (Mosk). 2000;79(6):16-9.

Use of transcutaneous laser biostimulation of blood and a running alternating magnetic field in preparing periodontitis patients for surgery

[Article in Russian]

Lepilin AV, Bulkina NV, Bogomolova NV, Raigorodskii IuM.

A total of 103 patients with exacerbation of chronic generalized periodontitis of moderate and high severity were treated using running alternating magnetic field generated by ATOS device and transcutaneous laser biostimulation of the blood. These treatment modalities accelerated preoperative treatment and allowed performing the operations on the periodontal tissues in the optimal status under conditions of improved defense forces of the organism.

Stomatologiia (Mosk). 1998;77(3):12-4.

A comparative analysis of the use of Uzor and Optodan laser apparatus for the prevention and combined treatment of pulpitis and periodontitis

[Article in Russian]

Milokhova EP, Semenova LL, Balynskii IV, Nazyrov IuS.

Clinical research 242 patients for comparison purposes of efficiently of employment of semiconductor laser apparatus “Uzor” and “Optodan” as physiotherapeutic of the factor for preventive maintenance and treatment of complications, arising the ambassador endodontic of treatment is spent. Results of application of semi-conductor laser apparatus are resulted at the various forms pulpitis and periodontitis. Significant reduction of a pain directly after a procedure LSL is marked. The highest efficiency is established by use of the apparatus “Optodan”, connected with distinction configurations of a impulse.

Histometrica Evaluation of the Healing of the Dental Alveolus in Rats After Irradiation with a Low-Powered GaAlAs Laser

Rosane F. Z. Lizarelli*; Tereza L. Lamano-Carvalho**; Luis G. Brentegani***

Physics Institute of São Carlos, University of São Paulo, São Carlos, SP, Brazil. 13560-970 **College of Dentistry of Ribeirao Preto, University of São Paulo, Ribeirao Preto, SP, Brazil. 14.040-000 LIZARELLI, R. F. Z.; LAMANO-CARVALHO, T. L.; BRENTEGANI, L. G.

Histometrical evaluation of the healing of the dental alveolus in rats after irradiation with a low-powered GaAlAs laser. in Lasers in Dentistry V, John D. B. Featherstone, Peter Rechmann, D.D.S., Daniel Fried, Editors, Proceedingsof SPIE Vol. 3593, p. 49-56, 1999. ABSTRACT The aim of the present work was to evaluate histometrically the effect of the irradiation with semiconductor diode GaAlAs 790 nm low-powered laser in the chronology of alveolar repair of rats.
Lasers of low intensity possesses an eminently analgesic, anti-inflammatory and bioestimulant effect, producing an increase of the local micro-circulation and in the speed of healing. Groups of five animals had their upper right incisors extracted under anesthesia and the mucous sutured; three groups received 1.5 J/cm2 of irradiation immediately after the extraction with laser for sweeping on the operated area. After that, the animals were sacrificed in the periods of 7, 14 and 21 days after the dental extraction. The material was decalcified and processed for inclusion in paraffin. Longitudinal sections of 7 micrometers in the alveolus were made and stained with HE.

The histometric analysis was performed with the Merz grid, and 2000 points were counted in each cervical, middle and apical thirds of the alveolus, assessing the percentage of the bone tissue. The results shows that low-powered intensity laser produced acceleration in osseous formation (10%) in some periods. The influence of low-powered laser on the healing process is more significant when we can apply the laser light just after the tissue trauma. Cells with a lower than normal pH, where the redox state is shifted in the reduced direction, are considered to be more sensitive to the stimulate action of light than those with the respective parameters being optimal or near optimal. The proposed redox-regulation mechanism may be a fundamental explanation for some clinical effects of irradiation, a consequence of this was the difference between the groups of 7 days is more significant than between the other groups.

Int J Oral Maxillofac Surg. 2004 Jan;33(1):38-41.

Efficacy of low level laser therapy in reducing postoperative pain after endodontic surgery– a randomized double blind clinical study.

Kreisler MB, Haj HA, Noroozi N, Willershausen B.

Department of Oral Surgery, Johannes Gutenberg University Mainz, Mainz, Germany.

matthiaskreisler@web.de

The aim of the study was to evaluate the effect of low level laser application on postoperative pain after endodontic surgery in a double blind, randomized clinical study. Fifty-two healthy adults undergoing endodontic surgery were included into the study. Subsequently to suturing, 26 patients had the operation site treated with an 809 nm-GaAlAs-laser (oralaser voxx, Oralia GmbH, Konstanz, Germany) at a power output of 50 mW and an irradiation time of 150 s. Laser treatment was simulated in further 26 patients. Patients were instructed to evaluate their postoperative pain on 7 days after surgery by means of a visual analogue scale (VAS). The results revealed that the pain level in the laser group was lower than in the placebo group throughout the 7 day follow-up period. The differences, however, were significant only on the first postoperative day (Mann-Whitney U-test, p<0.05). Low level laser therapy can be beneficial for the reduction of postoperative pain. Its clinical efficiency and applicability with regard to endodontic surgery, however require further investigation. This is in particular true for the optimal energy dosage and the number of laser treatments needed after surgery.

Stomatologiia (Mosk). 2002;81(4):48-53.

Preparation of bone tissue of the jaw to implantation of abutment elements of dentures

[Article in Russian]

Kulakov AA, Prokhonchukov AA, Soboleva SE, Vakhtin VI.

A complex multi-staged method for stimulation of bone tissue regeneration in the jaws after removal of teeth and preparation of bone tissue for subsequent implantation, stimulation of bone tissue regeneration after implantation, and adaptation of bone tissue of the jaws to masticatory pressure is developed. The method is based on utilization of magnetic laser exposure with a universal Optodan laser device. In case of pronounced inflammation and pyodestructive processes after implantation, these processes are liquidated due to detoxifying effect of the blood, which is stimulated by irradiation of the carotid sinuses on both sides. Granulation tissue round the heads of implants is removed by laser coagulation with surgical lasers Lancet or Stokos.

Proc. SPIE Vol. 3593, 1999, p. 66-68.

Clinical results evaluation of dentinary hypersensitivity patients treated with laser therapy.

Brugnera A, Cruz FM, Zanin FA & Pecora JD.

300 human teeth were treated for hypersensitivity during the period 1995-1997. Pulpal vitality was verified using thermal tests, and only reversible processes were treated. HeNe and GaAlAs lasers were used. All teeth received 4 J/session, up to 5 sessions. 79% of the patients were treated in 3 sessions with success; 8.6% were cured in 4 sessions; and 4.3% were successfully treated in 5 sessions, obtaining 92% success in total.

Aust Dent J. 1994 Dec;39(6):353-7.

 

Low level laser therapy for dentinal tooth hypersensitivity.

Gerschman JA, Ruben J, Gebart-Eaglemont J.

Oro-Facial Pain Clinic, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne.

A comparative double blind study testing low level laser therapy (Gallium/Aluminium/Arsenide laser [GaAlAs]) against placebo was carried out in the management of dentinal tooth hypersensitivity. Subjects demonstrating dentinal hypersensitivity and complying with strict selection criteria were randomly assigned to an active and placebo group. Low level laser therapy was applied for one minute to both the apex and cervical area of the tooth; and reapplied at one week, two-week and eight-week intervals. Dentinal hypersensitivity was rated at each visit. There were 28 subjects in the placebo group and 22 and 21 subjects, respectively, in the tactile sensitivity and thermal sensitivity groups. Comparisons between the groups were conducted using independent groups t-test. In both the tactile and thermal sensitivity groups differences between the active and placebo groups were significant from the first week and increased further in the second and eighth weeks. The mean value of thermal sensitivity decreased 67 per cent (p < 0.001) compared with placebo (17 per cent) and tactile sensitivity decreased 65 per cent (p = .002) compared with placebo (21 per cent) at eight weeks. Results demonstrate that the GaAlAs laser is an effective method for the treatment of both thermal and tactile dentinal hypersensitivity. There were no reported adverse reactions or instances of oral irritation.

J Clin Laser Med Surg. 2003 Oct;21(5):291-6.

 

Effect of the clinical application of GaAlAs laser in the treatment of dentine hypersensitivity.

Marsilio AL, Rodrigues JR, Borges AB.

Restorative Dentistry, UNESP School of Dentistry, Sao Jose dos Campos, SP, Brazil.analumarsilio@bol.com.br

OBJECTIVE: The aim of this study was to evaluate the effectiveness of the clinical use of the gallium-aluminum-arsenium (GaAlAs) laser at the maximum and minimum energies recommended by the manufacturer for the treatment of dentine hypersensitivity. BACKGROUND DATA: Dentine hypersensitivity (DH) is a response to a stimulus that would not usually cause pain in a healthy tooth. It is characterized by sharp pain of short duration from the denuded dentin. Its etiology is unknown. The dentin only begins to show sensitivity when exposed to the buccal environment. This exposure can result after removal of the enamel and/or dental cement, or after root denudation. Different treatments are proposed for this disorder. MATERIALS AND METHODS: In this study, 25 patients, with a total number of 106 cases of DH, were treated with GaAlAs low-level laser therapy (LLLT). 65% of the teeth were premolars; 14% were incisors and molars; 6.6% were canines. The teeth were irradiated with 3 and 5 J/cm2 for up to six sessions, with an interval of 72 h between each application, and they were evaluated initially, after each application, and at 15 and 60 days follow-up post-treatment. RESULTS: The treatment was effective in 86.53% and 88.88% of the irradiated teeth, respectively, with the minimum and maximum energy recommended by the manufacturer. There was a statistically significant difference between DH and after a follow-up of 60 days for both groups. The difference among the energy maximum and minimum was not significant. CONCLUSION: The GaAlAs low-level laser was effective in reducing initial DH. A significant difference was found between initial values of hypersensitivity and after 60 days follow-up post-treatment. No significant difference was found between minimum (3 J/cm2) and maximum (5 J/cm2) applied energy.

J Clinical Pediatric Dentistry. 1995; 19: 232.

The effect of laser irradiation on the activation of inflammatory cells and the vital pulpotomy.  A study of the application of Ga-As semiconductor laser to endodontics.

Kurumada F.

The effects of GaAs on the activation of machrophages and fibroblasts were examined be determinating the rate of glucose utilization into the cell and the activity of lactate dehydrogenase in culture supernatant. The irradiated macrophages that had been prepared from the perioneal exudate cells, did not show any enhancement of activity, whereas the fibroblast cell line was activated by laser irradiation.
These findings suggest that GaAs irradiation was effective for the growth of fibroblasts and induced suppressive effects for macrophages. Further, the effects of laser on the vital pulpotomy were investigated. It was observed that irradiation induced enhancement of calcification in the wound surface and stimulated formation of calcified tissue. These observations indicate that laser irradiation is a useful method for the vital pulpotomy.

Human gingival fibroblast proliferation enhanced by LLLT

Almeida-Lopes L. [Analysis in vitro of the cellular proliferation of human gingival fibroblasts with low level laser.] 1999. Dissertation at Universidade do Vale do Paraíba, São Paulo, Brazil.

Human gingival fibroblast were cultured in Petri dishes with different Fetal Bovine Serum concentration, 5% or 10%. Four irradiations of 2 J/cm2 were given with 12 hours intervals. Lasers with 670, 692, 780 and 786 nm were used. Cells in 5% FBS profilerated better than in all control groups whereas the cells in the 10% FBS did not proliferate better than controls. The 670 and 692 visible lasers caused a higher improvment in cell proliferation that the infrared lasers. This study confirms the fact that cells in a less-than-optimal stage react better to LLLT than cells in an optimal nutritional stage. It also confirms that visible red is the best wavelength for superficial wound healing.

Aust Dent J. 1997 Aug;42(4):247-54.

The current status of low level laser therapy in dentistry.  Part 1. Soft tissue applications.

Walsh LJ.

Department of Dentistry, University of Queensland.

Despite more than 30 years of experience with low level laser therapy (LLLT) or ‘biostimulation’ in dentistry, concerns remain as to its effectiveness as a treatment modality. Controlled clinical studies have demonstrated that while LLLT is effective for some specific applications, it is not a panacea. This paper provides an outline of the biological basis of LLLT and summarizes the findings of controlled clinical studies of the use of LLLT for specific soft tissue applications in dentistry. Areas of controversy where there is a pressing need for further research are identified.

Aust Dent J. 1997 Oct;42(5):302-6.

 

The current status of low level laser therapy in dentistry.  Part 2. Hard tissue applications.

Walsh LJ.

Department of Dentistry, University of Queensland.

While most applications of low level laser therapy (LLLT) in dentistry are directed toward soft tissues, in recent years there has been increasing interest in tooth-related or hard tissue applications of LLLT. This report provides an overview of applications of LLLT in the treatment of dentine hypersensitivity and pain arising from the periodontal ligament, and describes the phenomenon of lethal laser photosensitization and its applications in the treatment of dental caries. Technical aspects of LLLT equipment and safety concerns are also discussed.

Am J Orthod Dentofacial Orthop. 1995 Dec;108(6):614-22.

 

A clinical investigation of the efficacy of low level laser therapy in reducing orthodontic postadjustment pain.

Lim HM, Lew KK, Tay DK.

Faculty of Dentistry, National University of Singapore.

Low level laser therapy (LLLT) has been shown to produce analgesic effects in many clinical applications. The aim of this clinical study was to test the efficacy of LLLT in controlling orthodontic postadjustment pain. Thirty-nine volunteers were selected for this study that used a double-blind design with placebo control. Elastomeric separators were placed at the proximal contacts of one premolar in each quadrant of the dentition to induce orthodontic pain. The tip of a 30 mW gallium-arsenide-aluminium (830 nm) diode laser probe was then placed at the buccal gingiva and directed at the middle third of the root. Three different treatment durations of 15, 30, and 60 seconds and one placebo treatment of 30 seconds were tested within each subject. The study was conducted over 5 days, and the visual analogue scale (VAS) was used to quantify the pain experienced by the subjects before and after laser applications for each day. Analysis of the VAS median scores showed that teeth exposed to laser treatment had lower levels of pain as compared with those with the placebo treatment. However, nonparametric statistical analysis of the data showed that the differences between treatments and placebo within each subject were not statistically significant.

Br J Oral Maxillofac Surg. 1993 Jun;31(3):170-2.

 

A randomised double blind comparative study of low level laser therapy following surgical extraction of lower third molar teeth.

 Fernando S, Hill CM, Walker R.

Department of Oral and Maxillofacial Surgery, Dental Hospital, Cardiff, South Glamorgan.

A randomised, double blind comparative study was undertaken to assess the efficacy of low level laser therapy in the reduction of postoperative pain and swelling in patients undergoing the extraction of bilaterally impacted mandibular third molar teeth. Healing of the sockets was also compared after 1 week. A group of 64 patients had one randomly-selected operation side treated with a semi-conductor laser and the other side with an apparently identical but non-operating model. Complete data were obtained from 52 of the 64 patients. The results showed that there was no evidence of a difference in pain and swelling on the third day after operation between laser and placebo sides. There was no difference between the two sides when they were assessed for healing 7 days after surgery.

Nor Tannlaegeforen Tid. 1991 Feb;101(3):78-80.

 

Laser therapy in dental practice.  What is a laser?

 [Article in Norwegian]
 

Arctander KH, Bjornland T, Haanaes HR.

Klinikk for Oral Kirurgi og Oral Medisin, Universitetet i Oslo.

This article briefly discusses laser theory and medical use of different types of laser, laserphysics and laser properties. The indications for lasertherapy as claimed from laser-producers, are numerous. However, we recommend that the effect of treatment with low level laser therapy has to be more documented before general use in a dental practice.

Effect of 830-nm laser light on the repair of bone defects grafted with inorganic bone and decalcified cortical osseous membrane.

Barbos Pinheiro AL, Limeira Junior Fde A, Marquez Gerbi ME, Pedreira Ramalho LM, Marzola C, Carneiro Ponzi EA, Oliveira Soares A, Bandeira De Carvalho LC, Vieira Lima HC, Oliveira Goncalves T.

Laser Center, School of Dentistry, Federal University of Bahia, Salvador, Brazil. albp@ufba.br

OBJECTIVE: The aim of this study was to assess histologically the effect of LLLT (lambda830 nm) on the repair of standardized bone defects on the femur of Wistar albinus rats grafted with inorganic bovine bone and associated or not to decalcified bovine cortical bone membrane. BACKGROUND DATA: Bone loss may be a result of several pathologies, trauma or a consequence of surgical procedures. This led to extensive studies on the process of bone repair and development of techniques for the correction of bone defects, including the use of several types of grafts, membranes and the association of both techniques. There is evidence in the literature of the positive effect of LLLT on the healing of soft tissue wounds. However, its effect on bone is not completely understood. MATERIALS AND METHODS: Five randomized groups were studied: Group I (Control); Group IIA (Gen-ox); Group IIB (Gen-ox + LLLT); Group IIIA (Gen-ox + Gen-derm) and Group IIIB (Gen-ox + Gen-derm + LLLT). Bone defects were created at the femur of the animals and were treated according to the group. The animals of the irradiated groups were irradiated every 48 h during 15 days; the first irradiation was performed immediately after the surgical procedure. The animals were irradiated transcutaneously in four points around the defect. At each point a dose of 4 J/cm2 was given (phi approximately 0.6 mm, 40 mW) and the total dose per session was 16 J/cm2. The animals were humanely killed 15, 21, and 30 days after surgery. The specimens were routinely processed to wax, serially cut, and stained with H&E and Picrosirius stains and analyzed under light microscopy. RESULTS: The results showed evidence of a more advanced repair on the irradiated groups when compared to non-irradiated ones. The repair of irradiated groups was characterized by both increased bone formation and amount of collagen fibers around the graft within the cavity since the 15th day after surgery, through analysis of the osteoconductive capacity of the Gen-ox and the increment of the cortical repair in specimens with Gen-derm membrane. CONCLUSION: It is concluded that LLLT had a positive effect on the repair of bone defect submitted the implantation of graft.

Stomatologiia (Mosk). 2003;82(4):20-4.

 

Magnetic laser therapy in the treatment of apical periodontitis

 [Article in Russian]
 

Giliazetdinova IuA, Vinnichenko AV, Vinnichenko IuA.

A new method for the treatment of apical periodontitis, making use of Optodan laser, differs from the known method by more rapid periapical tissue regeneration, which is paralleled by high antiinflammatory effect of magnetic laser therapy at early stages of treatment.

Lasers Surg Med. 1991;11(5):462-70.

 

Effect of low level laser therapy on wound healing after palatal surgery in beagle dogs.

In de Braekt MM, van Alphen FA, Kuijpers-Jagtman AM, Maltha JC.

Department of Orthodontics and Oral Histology, University of Nijmegen, The Netherlands.

The effect of low level laser therapy on wound healing and wound contraction after palatal surgery in Beagle dogs of 12 weeks of age was investigated. A total of 30 Beagle dogs was used and assigned to a control group (Group C; n = 6) and two experimental groups (Group L; n = 12 and group LL; n = 12). In both experimental groups, Von Langenbeck’s palatal repair was simulated. Then in the LL group the denuded bony areas were treated with low level laser therapy using a continuous Ga-As-A1 laser beam (830 nm) and energy output set at 30 mW. Per treatment a dosage of 1 J/cm2 wound surface area was used. Therapy was carried out three times a week with a total of ten treatments. Wound healing was observed clinically until wound healing was completed at 4 weeks p.o. and wound areas were measured at regular intervals on standardized intra-oral photographs. Wound contraction was measured as the increments of the distances between tattoo points on the opposite wound margins. No significant differences were found in the quality and rate of wound healing between the two experimental groups. The same held true for the increments of the distances between opposite tattoo points. It was concluded that macroscopically low level laser therapy under conditions used in this study did not have an influence on wound closure or wound contraction.

Ned Tijdschr Tandheelkd. 1994 Mar;101(3):100-3.

 

Treatment with soft laser.  The effect on complaints after the removal of

wisdom teeth in the mandible

[Article in Dutch]

Braams JW, Stegenga B, Raghoebar GM, Roodenburg JL, van der Weele LT.

Kliniek voor Mondziekten, Kaakchirurgie en Bijzondere Tandheelkunde, Academisch Ziekenhuis Groningen.

In a placebo controlled double-blind randomized study the effect of low level laser therapy on postoperative complaints after removal of lower third molars was examined. Several parameters were investigated in two groups of patients; in one group low level laser was applied during and following third molar removal, in the other no active additional laser treatment was given. The results of this study show that therapeutic low level laser treatment could not statistically reduce the postoperative pain, swelling, trismus and function impairment after extraction of lower third molars.

Low-intensity laser coupled with photosensitizer to reduce bacteria in root canals compared to chemical control.  2002. 91f.

SEGUNDO, A. S. G.

Dissertation (Professional Master’s Degree “Lasers in Dentistry”) – Nuclear and Energy Research Institute / School of Dentistry, University of São Paulo, São Paulo. Advisor: Martha Simões Ribeiro, DDS, PhD, José Luiz Lage-Marques. DDS, PhD

The photodynamic therapy is a process in which a dye is associated with an appropriate wavelength of light and this dye goes to an excited state. The excited photosensitizer reacts with oxygen to form the highly reactive compound singlet oxygen, and this compound can kill bacteria and tumor cells. The purpose of this study was to evaluate the bacterial reduction in root canal contaminated with Enterococcus Faecalis. Thirty teeth with their root canals prepared were contaminated with E. faecalis. Ten teeth have received the chemical substance sodium hypochlorite for 30 minutes; ten teeth have received the azulene dye paste for 5 minutes and have been irradiated with a diode laser, output power 10mW and ?= 685nm for 3 minutes. Ten teeth have not received treatment (control group). The bacterial reduction was significantly higher for laser group when compared to chemical and control groups. These results indicate that photodynamic therapy was an effective method to kill bacteria.

Stomatologiia (Mosk). 2002;81(5):29-35.

 

Alternative methods for prevention and treatment of dental caries using laser and magnetic laser exposure

[Article in Russian]

Prokhonchukov AA, Zhizhina NA, Kolesnik AG, Morozova NV, Vasmanova EV, Mozgovaia LA, Kunin AA, Milokhova EP, Saprykina VA, Nazyrov IuS, Kulazhenko TV, Semenova LL, Ermolov VV, Chuprakova EV.

Alternative methods for prevention and treatment of dental caries are presented, based on the use of laser and magnetic laser exposure (patent No. 2053818, in Russia) with a new generation laser device with Optodan microprocessor monitoring (patent No. 2014107, Russia). The methods are intended for wide clinical application in children and adolescents in pedodontic departments and outpatient centers and particularly for group and individual use in dental rooms at school.

Int J Oral Maxillofac Surg. 2004 Jan;33(1):38-41.

 

Efficacy of low level laser therapy in reducing postoperative pain after

Kreisler MB, Haj HA, Noroozi N, Willershausen B.

Department of Oral Surgery, Johannes Gutenberg University Mainz, Mainz, Germany. matthiaskreisler@web.de

The aim of the study was to evaluate the effect of low level laser application on postoperative pain after endodontic surgery in a double blind, randomized clinical study. Fifty-two healthy adults undergoing endodontic surgery were included into the study. Subsequently to suturing, 26 patients had the operation site treated with an 809 nm-GaAlAs-laser (oralaser voxx, Oralia GmbH, Konstanz, Germany) at a power output of 50 mW and an irradiation time of 150 s. Laser treatment was simulated in further 26 patients. Patients were instructed to evaluate their postoperative pain on 7 days after surgery by means of a visual analogue scale (VAS). The results revealed that the pain level in the laser group was lower than in the placebo group throughout the 7 day follow-up period. The differences, however, were significant only on the first postoperative day (Mann-Whitney U-test, p<0.05). Low level laser therapy can be beneficial for the reduction of postoperative pain. Its clinical efficiency and applicability with regard to endodontic surgery, however require further investigation. This is in particular true for the optimal energy dosage and the number of laser treatments needed after surgery.

J Mass Dent Soc. 1999 Spring;48(1):8-13, 40.

Rapid healing of gingival incisions by the helium-neon diode laser.

Neiburger EJ.

Fifty-eight extraction patients had one of two gingival flap incisions lased with a 1.4 mw helium-neon (670 nm) diode laser for 30 seconds (fluence = 0.34 J/cm2). Healing rates were evaluated clinically and photographically. Sixty-nine percent of the irradiated incisions healed faster than the control incisions. No significant difference in healing was noted when patients were compared by age, gender, race, and anatomic location of the incision. This study concludes that helium-neon diode lasers, at the previously mentioned energy level, increase the rate of gingival wound healing in 69 percent of patients, without any side effects. For the last 30 years, low-power lasers in dentistry have appeared to stimulate healing rates and increase the rate of repair of injured tissue. Helium-neon and similar lasers emit light in the red (600-700 nm) spectrums and produce energy densities (fluences) below 20 Joules/cm2. They have been studied in a variety of animal tissue culture and human evaluations to determine their ability to increase the rates of wound healing by biostimulation. Over the last three decades, researchers have found that ruby and gas helium-neon (low-power laser radiation) have a biostimulatory effect on living tissue. Studies show that under specific conditions, red spectrum laser light speeds the healing of wounds. Photons from the red light lasers, which include ruby lasers (694 nm), helium-neon gas lasers (632 nm), and helium-neon diode lasers (650-670 nm), appear to stimulate rapid epithelialization and fibroblast (collagen) proliferation in animal and human tissue cultures. Low-power lasers have been reported to reduce post-extraction pain and swelling and to increase rates of wound healing (including scar formation, phagocytosis) in cell culture, animal, and human clinical studies. The new, compact, and inexpensive (under $50) helium-neon diode lasers have produced similar effects. These FDA Class IIIa lasers have no hazards associated with them, although one should avoid direct exposure to the eye for a prolonged period of time. In the past, many biostimulation studies using red spectrum lasers produced confusing data and conflicting results. Some studies reported that the biostimulation effect did not occur in all cases of laser irradiation, while other research reported that it did. Results seem to depend on the delivery of appropriate energy fluence levels (between 1 and 20 J/cm2) and the type of laser (wavelength) used. Several of these studies never described the levels of laser energy used to promote the described biostimulatory results. This caused controversy when determining whether or not helium-neon lasers influence wound healing. Studies suggest that low-power laser exposure can significantly increase the healing rate during the first few days of the healing process; however, studies do not show appreciable net benefit as compared to controls toward the end of a two-week wound repair cycle. The increased healing effect appears to be centered around the early, most sensitive stages of the healing process. Several studies showed optimum tissue healing rates at helium-neon laser exposure levels between 1 J/cm2 and 20 J/cm2. Laser-enhanced biostimulation has been reported to produce metabolic changes within the cells. This results in faster cell division, rapid matrix production (increased collagen, myofibroblasts, etc.), and cell movement. There have been few controlled studies using adequate numbers of human subjects in identifying the beneficial effects of helium-neon laser biostimulation. Ethical concerns, bulky equipment, and problems with biased study designs have frustrated a practical evaluation of laser biostimulation for general dental practice. A recently published “preliminary” study involving 52 patients was designed to reduce these issues. The purpose of this study is to complement the above research and to evaluate whether helium-neon diode laser radiation at average fluences of 0.34 J/c