Laser Lit Review Aug 2018

Updated: Oct 22, 2018

Compiled by Dr Igor Cernavin, Prosthodontist, Honorary Senior Fellow University of Melbourne School of Medicine, Dentistry and Health Sciences, Director and Cofounder of the Asia Pacific Institute of Dental Education and Research (AIDER), Australian representative of World Federation of Laser Dentistry (WFLD).


Petrov et al(1) used a femtosecond laser with a high repetition rate, which is probably the future of lasers for hard tissue removal, to achieve fast and more precise ablation in dentin and enamel. They concluded that the ultrafast femtosecond laser used in their work holds the promise of a significant drilling ability without collateral thermomechanical effects. It achieves high processing efficiency, overcomes disadvantages of other laser systems reported and can be used to develop an instrument for cavity preparation based on fast and precise ablation. Their further aim is to exceed the speed of traditional drilling instruments and thus to reduce the treatment time which in turn will bring comfort to the patient.


Levine(2) published an article on how to choose the right laser for your practice which readers may find of interest.


Hashimoto et al(3) investigated Fluoridated hydroxyapatite (FHA) for application as an implant coating for titanium bone substitute materials in dental implants. They concluded that FHA coatings are suitable for real-world implantation applications.

Giannelli and coworkers4 carried out a double-blind, randomized, single-center, split-mouth clinical trial investigating the efficacy and patient-reported outcomes at 1year of treatment of severe periodontitis with a laser and light-emitting diode (LED) procedure adjunctive to scaling and root planning. Their study confirmed the efficacy of combined phototherapy and scaling and root planning which had emerged from previous clinical trials, extending its field of application to severe periodontitis.


Belcheva et al(5) carried out a study whose aim was to evaluate the positive effects of the carbon dioxide laser (CO2, 10,600nm) with acidulated phosphate fluoride (APF) gel on enamel acid resistance. The conclusion was that this combination was more effective in protecting the enamel surface and resisting demineralization than CO2 laser irradiation or fluoride alone.


Campos and coworkers(6) published a double blind study on immediate laser-induced hemostasis in anticoagulated rats subjected to oral soft tissue surgery. The abstract is reproduced in full. Given the growing trend towards medical indications for continuous use of anticoagulants, the number of patients on these medications continues to rise. The management of patients on oral anticoagulants requiring oral surgical procedures has aroused much controversy. Changes in an anticoagulation regimen are associated with an increased risk of thromboembolism. However, it seems logical and advantageous for the patients' health if surgery could be performed without any change to the anticoagulation therapy. In dentistry, high-power lasers have been poorly explored in this field. The hemostatic properties of high-power lasers could be helpful during oral soft tissue surgeries in anticoagulated patients. The aim of this study was to compare bleeding time in anticoagulated rats after lingual frenectomy performed with a scalpel or diode laser with bleeding time in healthy animals. Twenty-four male Wistar rats were assigned to four groups (n = 6): (CS) Control-Scalpel Surgery; (AS) Anticoagulated-Scalpel Surgery; (CL) Control-Laser (diode laser 810 nm/1.5 W) Surgery; and (AL) Anticoagulated-Laser Surgery (diode laser 810 nm/1.5 W). Warfarin administration was used to induce anticoagulation. Blood was blotted every 30 seconds with filter paper until bleeding stopped to verify bleeding time. Two blinded researchers performed the surgeries and collected the bleeding time data. Diode laser surgery led to complete hemostasis in rats during and after lingual frenectomy. Zero bleeding was assessed during surgeries and after diode laser surgeries in anticoagulated rats. Laser-induced hemostasis offered an alternative solution to the controversial issue of intraoperative and postoperative bleeding control in patients on anticoagulation therapy.


Carvalho et al(7) drafted a guide directed at the team of health professionals involved in the oral care of oncological patients. The abstract is reproduced in full even though it is not directly related to lasers but will be useful for clinicians to read.


  • OBJECTIVE: Oncological treatment can cause changes in the oral cavity compromising oral functions. The aim of the study was, based on a systematic review, to draft a guide directed at the team of health professionals involved in the oral care of oncological patients.


  • METHODS: A systematic search of the literature was performed for articles published between 2000 and April 2017. Searches were made of electronic databases and hand search. The inclusion criteria were systematic reviews of randomized clinical trials (RCTs) and RCTs published in English, involving pediatric and adult oncological patients and focused on the prevention and treatment of oral complications as well as studies addressing the maintenance of oral health. Among the 1237 studies identified, 129 were pre-selected and 54 were selected to form the basis for the clinical guide.


  • RESULTS: The studies analyzed stress the need for oral assessments as well as preventive and curative actions prior to oncological treatment. To minimize the severity of oral problems, the studies emphasize daily oral care, the treatment of xerostomia with saliva substitute and hydration, and low-level laser therapy, nystatin, acyclovir, respectively, for the prevention and treatment of oral mucositis, oral candidiasis, and infection by herpes simplex virus. Thus, the guide produced addresses oral assessments and professional and home care before, during, and after oncological treatment. CONCLUSION: The guide drafted has the function of assisting health professionals involved in the oral care of patients with cancer, enabling the prevention or treatment of oral complications stemming from oncological treatment.

Tani et al(8) carried out an in vitro study which compared photobiomodulation potentiality using red (635 ± 5 nm) or near-infrared (NIR, 808 ± 10 nm) diode lasers and violet-blue (405 ± 5 nm) light-emitting diode operating in a continuous wave with a 0.4 J/cm energy density, on human osteoblast and mesenchymal stromal cell (hMSC) viability, proliferation, adhesion and osteogenic differentiation. They concluded that the 635 nm laser had a potential effective option for promoting/improving bone regeneration.


Ghouth and coworkers(9) carried out a to systematic review of the evidence on the use of laser Doppler flowmetry in the assessment of the pulpal status of permanent teeth compared with other sensibility and/or vitality tests. They concluded that despite the higher reported sensitivity and specificity of laser Doppler flowmetry in assessing pulp blood flow, these data are based on studies with a high level of bias and serious shortfalls in study designs. More research is needed to study the effect of different laser Doppler flowmetry's parameters on its diagnostic accuracy and the true cut-off ratios over which a tooth could be diagnosed as having a normal pulp.


Kaur et al(10) compared soft tissue wound healing using diode lasers (810 nm) versus the conventional scalpel approach as an uncovering technique during second-stage surgery in implants and found that it can minimize surgical trauma, reduce the amount of anesthesia, improve visibility during surgery due to the absence of bleeding, and eliminate postoperative discomfort.


ALBalkhi and coworkers(11) studied the efficiency of debonding porcelain laminate (PLVs) veneers using several laser parameters and two different application modes of the Er:YAG laser [contact CM and non-contact NCM]. Their finding was that the Er:YAG laser is an effective tool in debonding PLVs. The NCM application mode was more efficient in reducing debonding time than CM application mode but with a higher change in pulp temperature.


Kellesarian et al(12) carried out a comprehensive review to assess the effectiveness of erbium lasers in the removal of all ceramic fixed dental prostheses and found that the benefits of lasers over mechanical instrumentation for crown removal encompassed efficient restoration retrievability without restoration or tooth surface damage and was a relatively easier and more time effective procedure with no prerequisite for anesthetic agents. It is however imperative for clinicians to be well-trained and exhibit adequate knowledge regarding recommended power settings and laser-safety parameters with reference to interactions between light and different tissues and ceramics.


Mirhashemi and coworkers(13) investigated the effect of Er:YAG (smart 2940 Dplus, DEKA, Italy) and Er:CrYSGG (Waterlase iPlus, Biolase, USA) lasers on the shear bond strength between the orthodontic brackets and dental porcelain in comparison with conventional acid etching with 9% hydrofluoric acid (HF, Ultradent, USA). They concluded that with the laser groups the failures were mostly adhesive whilst with the controls they were mostly cohesive. The Er:YAG laser with the stated specifications is not a suitable alternative to HF etching. In the case of Er:CrYSGG laser, although the conditioning outcome met the bond strength requirement for orthodontic brackets (that is, 6-8MPa) the bond strength must be further improved by fine-tuning the irradiation details.


Yassaei et al(14) assessed the efficacy of erbium-doped yttrium aluminum garnet laser and pastes containing casein phosphopeptide amorphous calcium phosphate (CPP-ACP) with and without fluoride and their combination for prevention of white spot lesions in the enamel. They found that the Er: YAG laser was able to decrease demineralization and was a potential alternative to preventive dentistry and was more effective when combined with CPP-ACP products. This would be useful especially for orthodontics.


Sarmadi and coworkers(15) evaluated patient’s experiences of two excavation methods, Er:YAG laser and rotary bur and the time required by these methods, as well as objective assessments of quality and durability of restorations over a two-year period. Their conclusions were that the Er:YAG laser technique was more time-consuming than the rotary bur, but despite this, the laser technique caused less discomfort and was preferred as an excavation method by patients.


Li et al(16) carried out a meta-analysis to systematically evaluate the applications of Er:YAG lasers for the removal of caries and cavity preparation in children. They concluded that the time required for Er:YAG laser treatment was longer than that for the conventional mechanical method, but there was less pain associated with the Er:YAG laser treatment. There were no significant differences in the complete retention rate, marginal discoloration, and marginal adaptation when compared with the conventional method.


Pinheiro and coworkers(17) assessed the utility of dental acid etchant containing 37% phosphoric acid and methylene blue dye (DAE) as a sensitizing agent for photodynamic therapy (PDT) to reduce Streptococci mutans in dentinal caries. They concluded that this treatment can be used as a photosensitizing agent for PDT to reduce the S. mutans burden in dentinal caries.

REFERENCES

1. Petrov, Todor; Pecheva, Emilia; Walmsley, Anthony D; Dimov, Stefan. Femtosecond laser ablation of dentin and enamel for fast and more precise dental cavity preparation. Materials science & engineering. C, Materials for biological applications, 90 433-438; 10.1016/j.msec.2018.04.070 2018-Sep-01.

2. Levine. Dental Lasers: Choosing the Right Equipment for Your Practice. Compendium of continuing education in dentistry (Jamesburg, N.J. : 1995), 39 (6):402-404; 2018-Jun.

3. Hashimoto, Yoshiya; Ueda, Mamoru; Kohiga, Yu; Imura, Kazuki; Hontsu, Shigeki. Application of fluoridated hydroxyapatite thin film coatings using KrF pulsed laser deposition. Dental materials journal, 37 (3):408-413; 10.4012/dmj.2017-122 2018-Jun-08.

4. Giannelli, Marco; Materassi, Fabrizio; Fossi, Tiziana; Lorenzini, Luca; Bani, Daniele. Treatment of severe periodontitis with a laser and light-emitting diode (LED) procedure adjunctive to scaling and root planing: a double-blind, randomized, single-center, split-mouth clinical trial investigating its efficacy and patient-reported outcomes at 1year. Lasers in medical science, 33 (5):991-1002; 10.1007/s10103-018-2441-9 2018-Jul.

5. Belcheva, A; El Feghali, R; Nihtianova, T; Parker, S. Effect of the carbon dioxide 10,600-nm laser and topical fluoride gel application on enamel microstructure and microhardness after acid challenge: an in vitro study. Lasers in medical science, 33 (5):1009-1017; 10.1007/s10103-018-2446-4 2018-Jul.

6. Campos, Flavio Halak de Oliveira; Ferreira, Lorraine Braga; Romano, Marcelo Munhoes; Moreira, Maria Stella; Eduardo, Carlos de Paula; Ramalho, Karen Muller. Immediate laser-induced hemostasis in anticoagulated rats subjected to oral soft tissue surgery: a double-blind study. Brazilian oral research, 32 e56; 10.1590/1807-3107bor-2018.vol32.0056 2018 Jun 07.

7. Carvalho, Caroline Gomes; Medeiros-Filho, Joao Batista; Ferreira, Meire Coelho. Guide for health professionals addressing oral care for individuals in oncological treatment based on scientific evidence. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 26 (8):2651-2661; 10.1007/s00520-018-4111-7 2018-Aug.

8. Tani, Alessia; Chellini, Flaminia; Giannelli, Marco; Nosi, Daniele; Zecchi-Orlandini, Sandra; Sassoli, Chiara. Red (635 nm), Near-Infrared (808 nm) and Violet-Blue (405 nm) Photobiomodulation Potentiality on Human Osteoblasts and Mesenchymal Stromal Cells: A Morphological and Molecular In Vitro Study. International journal of molecular sciences, 19 (7):10.3390/ijms19071946 2018 Jul 03.

9. Ghouth, Nahar; Duggal, Monty S; BaniHani, Alaa; Nazzal, Hani. The diagnostic accuracy of laser Doppler flowmetry in assessing pulp blood flow in permanent teeth: A systematic review. Dental traumatology : official publication of International Association for Dental Traumatology, 10.1111/edt.12424 2018-Jun-28.

10. Kaur, Manvir; Sharma, Yash Paul Dev; Singh, Preetinder; Sharma, Shivli; Wahi, Ankur. Comparative evaluation of efficacy and soft tissue wound healing using diode laser (810 nm) versus conventional scalpel technique for second-stage implant surgery. Journal of Indian Society of Periodontology, 22 (3):228-234; 10.4103/jisp.jisp_46_17 2018 May-Jun.

11. ALBalkhi, Mohand; Swed, Eyad; Hamadah, Omar. Efficiency of Er:YAG laser in debonding of porcelain laminate veneers by contact and non-contact laser application modes (in vitro study). Journal of esthetic and restorative dentistry : official publication of the American Academy of Esthetic Dentistry ... [et al.], 30 (3):223-228; 10.1111/jerd.12361 2018-May.

12. Kellesarian, Sergio Varela; Ros Malignaggi, Vanessa; Aldosary, Khaled M; Javed, Fawad. Laser-assisted removal of all ceramic fixed dental prostheses: A comprehensive review. Journal of esthetic and restorative dentistry : official publication of the American Academy of Esthetic Dentistry ... [et al.], 30 (3):216-222; 10.1111/jerd.12360 2018-May.

13. Mirhashemi, Amirhossein; Chiniforush, Nasim; Jadidi, Hanieh; Sharifi, Nastaran. Comparative study of the effect of Er:YAG and Er:Cr;YSGG lasers on porcelain: etching for the bonding of orthodontic brackets. Lasers in medical science, 10.1007/s10103-018-2573-y 2018-Jul-06.

14. Yassaei, Sogra; Aghili, Hossein; Shahraki, Neda; Safari, Isa. Efficacy of erbium-doped yttrium aluminum garnet laser with casein phosphopeptide amorphous calcium phosphate with and without fluoride for remineralization of white spot lesions around orthodontic brackets. European journal of dentistry, 12 (2):210-216; 10.4103/ejd.ejd_265_17 2018 Apr-Jun.

15. Sarmadi, Roxana; Andersson, Elin Viktoria; Lingstrom, Peter; Gabre, Pia. A Randomized Controlled Trial Comparing Er:YAG Laser and Rotary Bur in the Excavation of Caries - Patients' Experiences and the Quality of Composite Restoration. The open dentistry journal, 12 443-454; 10.2174/1874210601812010443 2018.

16. Li, Ting; Zhang, Xiaolin; Shi, Hong; Ma, Zhe; Lv, Bingjian; Xie, Meng. Er:YAG laser application in caries removal and cavity preparation in children: a meta-analysis. Lasers in medical science, 10.1007/s10103-018-2582-x 2018-Jul-12.

Author(s):Pinheiro, Sergio Luiz; Segatti, Bruna; Pucca, Daniel Sartorelli; Dutra, Priscila Tessaro. Dental acid etchant as a sensitizing agent in photodynamic therapy to reduce S. mutans in dentinal carious lesions. Lasers in medical science, 10.1007/s10103-018-2590-x 2018-Jul-19.

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