Gingivitis – Gingiva

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.


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


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.

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.

Vojnosanit Pregl. 2008 Oct;65(10):755-7.

[Low-level laser efficiency in the therapy of chronic gingivitis in children]

[Article in Serbian]

Igi? M, Kesi? L, Apostolovi? M, Kostadinovi? L.

Medicinski fakultet, Klinika za stomatologiju, Nis, Srbija.

BACKGROUND/AIM: Gingivitis is a frequent phenomenon in children considered to be a risk factor for the occurrence and progression of paradontal tissue disease. So, it is necessary not only to identify inflammation, but also to react in due time and adequately in order to avoid further disease spread and the beginning of periodontitis. The aim of this study was to determine the efficiency of a low-level laser application in the therapy of chronic gingivitis in children. METHODS: The study a included hundred of children with permanent dentition suffering from chronic gingivitis. All the examinees were divided into two groups: group I–50 examinees with chronic gingivitis, who underwent the basic therapy; group II–50 examinees with chronic gingivitis, who underwent the basic therapy and also a therapy with a low-level laser. Evaluation of the condition of oral hygiene, the health of gingiva and periodontium were done using appropriate index before and after the therapy. RESULTS: For the plaque index (PI) following results were obtained: in the group I PI = 1.94, and in the group II PI = 1.82. After the therapy in both groups PI was 0. In the group I sulcus plaque index (SPI) was 2.02 before the therapy and 0.32 after the therapy. In the group II SPI was 1.90 before the therapy, and 0.08 after the therapy. In the group I Community Periodontal Index of Treatment Needs (CPITN) was 1.66 before the therapy, and 0.32 after the therapy, and in the group II CPITN was 1.60 before the therapy, and 0.08 after the therapy. CONCLUSION: Chronic gingivitis in children can be successfully cured by the basic treatment. The use of a low-level laser can significantly improve this effect.

Lasers Med Sci. 2008 Jul;23(3):331-5. Epub 2007 Sep 5.

Effects of low-level He-Ne laser irradiation on the gene expression of IL-1beta, TNF-alpha, IFN-gamma, TGF-beta, bFGF, and PDGF in rat’s gingiva.

Safavi SM, Kazemi B, Esmaeili M, Fallah A, Modarresi A, Mir M.

Center for Dental Research, Shaheed Beheshti University of Medical Sciences, Evin, Tehran 19834, Iran.

Biostimulatory effects of laser irradiation on cell proliferation and wound healing has been reported. However, little is known about the molecular basis of the mechanism. Interleukin 1beta (IL-1beta), tumor necrotic factor-alpha (TNF-alpha), and interferon-gamma (IFN-gamma) play an important role in inflammation, while platelet-derived growth factor (PDGF), transforming growth factor-beta (TGF-beta) and blood-derived fibroblast growth factor (bFGF) are the most important growth factors of periodontal tissues. The aim of this study was to investigate the effect of low-level He-Ne laser on the gene expression of these mediators in rats’ gingiva and mucosal tissues. Twenty male Wistar rats were randomly assigned into four groups (A(24), A(48), B(24), B(48)) in which A(24) and A(48) were cases and B(24), B(48) were controls. An incision was made on gingiva and mucosa of the labial surface of the rats’ mandibular incisors. Group A(24) was irradiated twice with 24 hours interval, while the inflamed tissues of group A(48) was irradiated three times with continuous He-Ne laser (632.8 nm) at a dose of 7.5 J/cm2 for 300 s. An energy of 5.1 J was given to the 68 mm(2) irradiation zone. Rats were killed 30 min after the last irradiation of case and control groups, then excisional biopsy was performed. Gene expression of the cytokines was measured using reverse transcriptase-polymerase chain reaction (RT-PCR) technique. Results were analyzed with Kruskal-Wallis and Mann-Whitney U tests. The gene expression of IL-1beta and IFN-gamma was significantly inhibited in the test groups (P < 0.05), while the gene expression of PDGF and TGF-beta were significantly increased (P < 0.05). The case and control groups did not have a significant difference in the gene expression of TNF-alpha and bFGF (P > 0.05). These findings suggest that low-level He-Ne laser irradiation decreases the amount of inflammation and accelerates the wound healing process by changing the expression of genes responsible for the production of inflammatory cytokines.

Lasers Med Sci. 2007 Nov;22(4):245-51. Epub 2007 Mar 3.

The importance of coherence length in laser phototherapy of gingival inflammation: a pilot study.

Qadri T, Bohdanecka P, Tunér J, Miranda L, Altamash M, Gustafsson A.

Department of Periodontology, Institute of Odontology, Karolinska Institutet, Huddinge, Sweden.

The aim of this study was to investigate if coherence length is of importance in laser phototherapy. Twenty patients with moderate periodontitis were selected. After oral hygiene instructions, scaling and root planing (SRP), one side of the upper jaw was randomly selected for HeNe (632.8 nm, 3 mW) or InGaAlP (650 nm, 3 mW) laser irradiation. One week after SRP, the following parameters were measured: pocket depth, gingival index, plaque index, gingival crevicular fluid volume, matrix metalloproteinase (MMP-8), interleukin (IL-8) and subgingival microflora. The irradiation (180 s per point, energy 0.54 J) was then performed once a week for 6 weeks. At the follow up examination, all clinical parameters had improved significantly in both groups. A more pronounced decrease of clinical inflammation was observed after HeNe treatment. MMP-8 levels were considerably reduced on the HeNe side, while there was no difference for IL-8 or microflora. Coherence length appears to be an important factor in laser phototherapy.

Photomed Laser Surg. 2007 Aug;25(4):250-6.

Effect of the diode laser on bacteremia associated with dental ultrasonic scaling: a clinical and microbiological study.

Assaf M, Yilmaz S, Kuru B, Ipci SD, Noyun U, Kadir T.

Faculty of Dentistry, Al-Quds University, Jerusalem., Faculty of Dentistry, Yeditepe University, Istanbul, Turkey.

OBJECTIVE: The purpose of this study is to evaluate the potential use of diode lasers (DLs) to reduce bacteremia associated with ultrasonic scaling (US). Furthermore, the clinical efficacy of DLs as an adjunct to US in the treatment of gingivitis was investigated. BACKGROUND DATA: Recently, lasers have found new applications in dental practice. The benefits of the use of DLs as an adjunct to US have not yet been determined. METHODS: Twenty-two gingivitis patients were treated using a split-mouth study design in which each side was randomly treated by US alone or DL followed by US (DL + US). Blood samples were drawn just before and during US in each treatment step to detect induced bacteremia. Clinical parameters including plaque index, sulcus bleeding index, probing depth, and relative attachment level were recorded at baseline and 4 weeks postoperatively. RESULTS: Bacteremia was detected in 15 patients (68%) after US alone, and in 8 patients following DL + US (36%). The reduction of the incidence of odontogenic bacteremia during US after the application of DL was statistically significant (p < 0.05). Clinical signs improved eventually, with no significant differences between the two treatment regimens (p > 0.05). CONCLUSIONS: Application of DL energy can reduce bacteria in gingival crevices which may reduce bacteremia following US. The use of DL did not show additional clinical influence on gingival healing after treatment of gingivitis with US.

Photomed Laser Surg. 2008 Aug;26(4):315-21.

Investigation of mast cells in human gingiva following low-intensity laser irradiation.

Silveira LB, Prates RA, Novelli MD, Marigo HA, Garrocho AA, Amorim JC, Sousa GR, Pinotti M, Ribeiro MS.

IPEN-CNEN/SP, Cidade Universitária, São Paulo, Brazil.

OBJECTIVE: The aims of the present study were to investigate the effect of low-intensity laser irradiation on the total number of mast cells as well as the percentage of degranulation in human gingiva. Blood vessel dilation was also evaluated. BACKGROUND DATA: It has been proposed that low-intensity laser irradiation can ameliorate pain, swelling, and inflammation. In periodontal tissue, mast cells may influence either the destructive events or the defense mechanism against periodontal disease via secretion of cytokines and through cellular migration to improve the healing process. Mast cells play an important role in the inflammatory process. METHODS: Twenty patients with gingival enlargement indicated for gingivectomy were selected. Gingival fragments were obtained from each patient and divided into three different groups before surgery. One fragment was removed without any irradiation. The two others were submitted to punctual irradiation with an energy density of 8 J/cm(2) at an output power of 50 mW at 36 Hz for 36 sec before gingivectomy. Nondegranulated and degranulated mast cells were counted in five areas of the gingival fragment connective tissue. Major and minor diameters of the blood vessels were also measured. RESULTS: Both red and infrared radiation promoted a significant increase in mast cell degranulation compared to controls; however, no statistically significant differences (p > 0.05) were observed between the irradiated groups. No significant differences among the groups were observed regarding blood vessel size. CONCLUSION: The results suggests that red and infrared wavelengths promote mast cell degranulation in human gingival tissue, although no dilation of blood vessels was observed. The effects of premature degranulation of mast cells in human tissue and the laser radiation protocol applied in this study encourage further investigations to extend these results into clinical practice.

Photomed Laser Surg. 2008 Aug;26(4):387-91.

Evaluation of the effect of the GaAlAs laser on subgingival scaling and root planing.

Ribeiro IW, Sbrana MC, Esper LA, Almeida AL.

Department of Periodontics, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil.

OBJECTIVE: To evaluate the auxiliary effect of the low-intensity laser in subgingival scaling and root planing by analysis of its clinical aspects, as well as its analgesic potential during the procedure. BACKGROUND DATA: Despite the large number of studies conducted on low-intensity laser energy, few clinical studies are available on periodontics. MATERIALS AND METHODS: Ten patients were selected and submitted to measurement of six sites per tooth, four teeth per hemiarch (960 sites in all). All patients then received subgingival scaling and root planing. Besides periodontal treatment, the test side was also submitted to laser application. The analysis comprised measurement of probing depth, clinical attachment level, and gingival index. Laser energy was applied at a wavelength of 780 nm (35 J/cm(2), 70 mW, 20 sec per site) for preoperative analgesia, and scaling and root planing were performed with application of laser energy at a wavelength of 780 nm (35 J/cm(2), 70 mW, 20 sec) for analgesia, and at a wavelength of 630 nm (8.8 J/cm(2), 35 mW, 10 sec) for healing. The patients filled out a visual analogue scale to assess the pain they felt during the procedure. After 24 and 48 h, the laser was again applied at the wavelength of 630 nm, and the patients were re-evaluated after 3 d. RESULTS: There was a reduction in gingival inflammation, yet without a statistically significant difference between the study and control sides, both in clinical aspects and evaluation of pain during the procedure. CONCLUSION: Utilization of the diode laser as an auxiliary in subgingival scaling and root planing did not provide any apparent clinical benefit for teeth with shallow to moderate pockets.

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 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 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.

J Clin Periodontol. 2005 Jul;32(7):714-9.

The short-term effects of low-level lasers as adjunct therapy in the treatment of periodontal inflammation.

Qadri T, Miranda L, Tunér J, Gustafsson A.

Department of Periodontology, Institute of Odontology, Karolinska Institutet, Huddinge, Sweden.

OBJECTIVES: The aim of this split-mouth, double-blind controlled clinical trial was to study the effects of irradiation with low-level lasers as an adjunctive treatment of inflamed gingival tissue. MATERIALS AND METHODS: Seventeen patients with moderate periodontitis were included. After clinical examination, all teeth were scaled and root planed (SRP). One week after SRP, we took samples of gingival crevicular fluid (GCF) and subgingival plaque. The laser therapy was started 1 week later and continued once a week for 6 weeks. One side of the upper jaw was treated with active laser and the other with a placebo. The test side was treated with two low-level lasers having wavelengths of 635 and 830 nm. The patients then underwent another clinical examination with sampling of GCF and plaque. The GCF samples were analysed for elastase activity, interleukin-1beta (IL-1beta) and metalloproteinase-8 (MMP-8). We examined the subgingival plaque for 12 bacteria using DNA probes. RESULTS: The clinical variables i.e. probing pocket depth, plaque and gingival indices were reduced more on the laser side than on the placebo one (p<0.01). The decrease in GCF volume was also greater on the laser side, 0, 12 microl, than on the placebo side, 0.05 microl (p=0.01). The total amount of MMP-8 increased on the placebo side but was slightly lower on the laser side (p=0.052). Elastase activity, IL-1beta concentration and the microbiological analyses showed no significant differences between the laser and placebo sides. CONCLUSION: Additional treatment with low-level lasers reduced periodontal gingival inflammation.

Photomed Laser Surg. 2004 Dec;22(6):509-12.

Diode laser (980 nm) as adjunct to scaling and root planing.

Borrajo JL, Varela LG, Castro GL, Rodríguez-Nuñez I, Torreira MG.

Department of Periodontology, School of Dentistry, Faculty of Medicine and Dentistry, University of Santiago de Compostela, Spain.

OBJECTIVE: The aim of this study was to evaluate clinical efficacy of InGaAsP diode laser as adjunct to traditional scaling and root planing. BACKGROUND DATA: The use of laser is one of the most recent methods in nonsurgical periodontal treatment. Efficacy and side effects of each type of laser treatment have yet to be determined. METHODS: Thirty patients suffering from moderate periodontal disease have been considered. They were randomly selected to undergo either scaling and root planing with curets, or scaling and root planing combined with InGaAsP laser (980 nm and 2 W). The papilla bleeding index (PBI), bleeding on probing (BOP), and clinical attachment level (CAL) were registered at the beginning and end of treatment. RESULTS: At the end of treatment, PBI average in the group treated with laser was 0.24 versus 0.43 in the group under conventional treatment (p = 0.014). In the group undergoing scaling and root planing, BOP decrease is 19.55% less (p < 0.0001) than in the group also treated with laser. Nevertheless, CAL differences cannot be considered significant between both groups (p = 0.67). CONCLUSIONS: Scaling and root planing in combination with laser produce moderate clinical improvement over traditional treatment.

Aust Orthod J. 2002 Mar;18(1):53-63.

Laser irradiation inhibition of open gingival embrasure space after orthodontic treatment.

Meguro D, Yamaguchi M, Kasai K.

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

The purpose of this study was to investigate the inhibitory effect of low-energy laser irradiation on an incidence of open gingival embrasure space after orthodontic treatment. The patient was a 20-year, 7-month-old Japanese female with an Angle Class I malocclusion and crowding in the mandible. Treatment consisted of extraction of maxillary and mandibular first premolars and use of the Edgewise technique. A Ga-Al-As diode laser was used to irradiate an area of 0.5 cm2 at the labial and lingual gingival papilla between the canines. The time of exposure was 6 minutes for 3 days, carried out between the relevelling and en masse stages of movement. The total energy corresponding to 6 minutes of exposure varied from 1.90 J/cm2. There was no further evidence of open gingival embrasure space, except at the mandibular central incisor. Further: an improvement in the gingival inflammation caused by a periodontal disease was observed, and periodontal pocket depth was maintained. These results suggest that low-energy laser irradiation may inhibit the incidence of open gingival embrasure space after orthodontic treatment.

Stomatologiia (Mosk). 2001;80(1):61-3.

[Combined therapy of chronic catarrhal gingivitis using low intensity laser light]

[Article in Russian]

Mozgovaia LA, Fokina NB.

Periodontal diseases, one of which is chronic catarrhal gingivitis (CCG), represent a medicosocial problem. Standard therapy often fails to bring about stable results. Addition of low-energy laser exposure at wavelengths of 0.63 micron and 0.85-0.89 micron to therapeutic complexes helps attain stable results, which is confirmed by clinical, functional, immunological, and x-ray data and densitometry. Laser therapy exerts a multifactorial pathogenetic effect, eliminating inflammation in periodontal tissue, normalizing microcirculation in the periodontium, improving mineral saturation of osseous tissue of the alveolar processes of the jaws, and improving local immunity of the oral cavity. All this accelerates treatment and decreases the probability of relapses.

Eur J Oral Sci. 2000 Feb;108(1):29-34.

Inhibitory effect of low-level laser irradiation on LPS-stimulated prostaglandin E2 production and cyclooxygenase-2 in human gingival fibroblasts.

Sakurai Y, Yamaguchi M, Abiko Y.

Department of Biochemistry, Nihon University School of Dentistry at Matsudo, Chiba, Japan.

It has been reported that lipopolysaccharide (LPS) from periodontal pathogens can penetrate gingival tissues and stimulate the production of prostaglandin E2 (PGE2), which is known as a potent stimulator of inflammation and bone resorption. Although biostimulatory effects of low-level laser irradiation such as anti-inflammatory results have been reported, the physiological mechanism is not yet clarified. The purpose of the present study was to determine the effect of laser irradiation on PGE2 production and cyclooxygenase (COX)-1 and COX-2 gene expression in LPS-challenged human gingival fibroblast (hGF) cells in vitro. hGF cells were prepared from healthy gingival tissues and challenged with LPS, and Ga-Al-As diode laser was irradiated to the hGF cells. The amount of PGE2 released in the culture medium was measured by radioimmunoassay, and mRNA levels were analyzed by reverse transcriptase-polymerase chain reaction (RT-PCR). Irradiation with Ga-Al-As diode low-level laser significantly inhibited PGE2 production in a dose-dependent manner, which led to a reduction of COX-2 mRNA levels. In conclusion, low-level laser irradiation inhibited PGE2 by LPS in hGF cells through a reduction of COX-2 mRNA level. The findings suggest that low-level laser irradiation may be of therapeutic benefit against the aggravation of gingivitis and periodontitis by bacterial infection.