Laser Lit Review April 2019

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).


da Silva et al1 evaluated the effect of Er,Cr:YSGG laser associated with acidulated phosphate fluoride (APF) on the control of enamel erosion progression. Er,Cr:YSGG laser irradiation ( 0.50W, 20Hz, 5.7J/cm2, 1136W/cm2) with fluoride was the only treatment capable of controlling the progression of enamel erosion.

Lingamaneni and coworkers2 confirmed once again that gingival wound healing may be improved using LLLT after gingivectomy and gingivoplasty operations. They used the 810nm diode laser.

Al-Hamdan and Rana Sulaiman3 carried out a systematic review to evaluate the efficacy of phototherapy on bond strength of bleached enamel. They concluded that it increases the bond strength of bleached enamel.

Pourshahidi et al3 compared the clinical efficacy of diode laser and Er,Cr:YSGG lasers in the treatment of dentin hypersensitivity. They found that the decrease in dentin hypersensitivity after application of Er,Cr:YSGG laser was significantly higher than that after the application of diode laser at 1-month postoperative interval.

Maran and coworkers5 carried out a systematic review and a network meta-analysis of different light-activation systems associated with dental bleaching. Their conclusions were that no type of light-activated in-office bleaching was superior to light-free in-office bleaching for both high- and low-concentrate in-office bleaching gels (they are referring to lasers as well).

Pinheiro et al6 assessed the utility of dental acid etchant containing 37% phosphoric acid and methylene blue dye (DAE) as a sensitizing agent for photodynamic therapy to reduce Streptococci mutans in dentinal caries. They concluded that it does reduce the S. mutans burden in dentinal caries.

Ishijima and coworkers7 carried out a study to determine the effect of ultraviolet light treatment of titanium on biofilm formation of human oral bacteria. Their findings were that UV treatment of titanium surfaces significantly reduces attachment of human oral bacteria and subsequent biofilm formation as well as EPS (70% less exopolysaccharides) production for at least 7 days.

Spanemberg et al 8 carried out a double-blind, randomized, controlled clinical trial using Low-level laser therapy in patients with Burning Mouth Syndrome. Their findings were that LLLT may be an alternative treatment for the relief of oral burning in patients with BMS.

Diebolder and coworkers9 carried out a study to examine the transmission behavior of dental filling materials and cements for the diode lasers' and the Nd:YAG laser's wavelengths. They concluded that the transmission behavior varied between the different material classes and even within, albeit less pronounced. Composites generally showed the highest intensities of transmitted light and are thus least susceptible to surface damage by laser light (810nm, 940nm, 980nm, 1,064nm).

Ghouth et al10 published a study to assess whether laser Doppler flowmetry is more accurate than the conventional pulp sensibility tests (electric pulp test and ethyl chloride) in assessing the pulpal status of permanent anterior teeth in children and to identify the laser Doppler flowmetry's Flux cut-off threshold. The conclusions reached were that Laser Doppler flowmetry was unable to differentiate between teeth with vital and non-vital pulps and that there was a high probability for false results.

NouhzadehMalekshah and coworkers11 assessed the efficacy of laser fluorescence alone and in combination with photosensitizers for detection of demineralized smooth-surface lesions of permanent teeth. Their conclusions were that laser fluorescence with TMPyP fluorescent dye (0.2-mM tetrakis N-methylpyridyl porphyrin) has suitable efficacy for early detection of initial enamel lesions.

Balevi12 investigated the simplest and most effective way to test the pulp.

The abstract is reproduced in full.

Data sources PubMed, Scopus and Web of Science. Study selection Cohort (retrospective and prospective) and cross-sectional clinical studies investigating the diagnostic accuracy of the cold pulp test (CPT), heat pulp test (HPT), electric pulp test (EPT), laser Doppler flowmetry (LDF) and pulp oximeter (PO). Pulpal diagnosis was confirmed by histological analysis, direct clinical observations (access cavity) or evidence of root canal filling (to confirm nonvital teeth).Data extraction and synthesis The diagnostic test's sensitivity (Sn), specificity (Sp), accuracy, positive predictive value (PPV) and negative predictive value (NPV) were extracted or calculated from the raw data of each included study. The test's outcomes were binary. A true positive (TP) was considered to have occurred when the diagnostic instrument correctly tested positive for a non-vital pulp and true negative (TN) when it correctly tested negative for a vital pulp based on a standard reference test. A false

positive (FP) and false negative (FN) occurred when the test incorrectly tested positive on a vital pulp and incorrectly tested negative on a non-vital pulp, respectively. Accuracy, PPV and NPV were adjusted (Adj.Accuracy, Adj.PPV and Adj.NPV respectively) based on a standardised total disease (non-vital pulps) prevalence (Prev.) of 42.8%. Pool estimates for all five dental pulp vitality diagnostic variables (Sn, Sp, Adj.Accuracy, Adj.PPV and Adj.NPV) were generated with a meta-analysis using a random effects model. Included studies were assessed as either high, moderate or low quality based on the Quality Assessment of Diagnostic Accuracy Studies tool.Results Twenty-eight studies met the inclusion criteria. The pooled Sn, Sp, Adj.Accuracy, Adj.PPV and Adj.NPV for each test are given in the Table 1. Heterogeneity between studies was significant for CPT, HPT and EPT; it was mild to moderate for LDF and PO. All but three studies were determined to be of low quality, with only

one assessed as high quality.Conclusions The most accurate !

dental pulp tests are the LDF and PO, with the HPT least accurate. CPT has generally high diagnostic accuracy and can be considered the primary pulp testing method in clinical practice.

References:

1. da Silva, Vilmara Rocha Mendes; Viana, Itallo Emidio Lira; Lopes, Raquel Marianna; Zezell, Denise Maria; Scaramucci, Tais; Aranha, Ana Cecilia Correa. Effect of Er,Cr:YSGG laser associated with fluoride on the control of enamel erosion progression. Archives of oral biology, 99 156-160; 10.1016/j.archoralbio.2019.01.011 2019-Jan-17.

2. Lingamaneni, Shreya; Mandadi, Lohith Reddy; Pathakota, Krishnajaneya Reddy. Assessment of healing following low-level laser irradiation after gingivectomy operations using a novel soft tissue healing index: A randomized, double-blind, split-mouth clinical pilot study. Journal of Indian Society of Periodontology, 23 (1):53-57; 10.4103/jisp.jisp_226_18 2019 Jan-Feb.

3. Al-Hamdan, Rana Sulaiman. Does bond integrity of bleached enamel increases with phototherapy? A systematic review. Photodiagnosis and photodynamic therapy, 10.1016/j.pdpdt.2019.01.029 2019-Jan-28.

4. Pourshahidi, S; Ebrahimi, H; Mansourian, A; Mousavi, Y; Kharazifard, M. Comparison of Er,Cr:YSGG and diode laser effects on dentin hypersensitivity: a split-mouth randomized clinical trial. Clinical oral investigations, 10.1007/s00784-019-02841-z 2019-Feb-18.

5. Maran, Bianca Medeiros; Ziegelmann, Patricia K; Burey, Adrieli; de Paris Matos, Thalita; Loguercio, Alessandro D; Reis, Alessandra. Different light-activation systems associated with dental bleaching: a systematic review and a network meta-analysis. Clinical oral investigations, 10.1007/s00784-019-02835-x 2019-Feb-14.

6. 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, 34 (2):305-309; 10.1007/s10103-018-2590-x 2019-Mar.

7. Ishijima, Manabu; Dorigatti de Avila, Erica; Nakhaei, Kourosh; Shi, Wenyuan; Lux, Renate; Ogawa, Takahiro. Ultraviolet Light Treatment of Titanium Suppresses Human Oral Bacterial Attachment and Biofilm Formation: A Short-Term In Vitro Study. The International journal of oral & maxillofacial implants, 10.11607/jomi.7444 2019-Feb-26.

8. Spanemberg, Juliana-Cassol; Segura-Egea, Juan-Jose; Rodriguez-de Rivera-Campillo, Eugenia; Jane-Salas, Enric; Salum, Fernanda-Goncalves; Lopez-Lopez, Jose. Low-level laser therapy in patients with Burning Mouth Syndrome: A double-blind, randomized, controlled clinical trial. Journal of clinical and experimental dentistry, 11 (2):e162-e169; 10.4317/jced.55517 2019-Feb.

9. Diebolder, Rolf; Schmid, Carmen U; Luthardt, Ralph G; Rudolph, Heike; Kuhn, Katharina. Characterization of the transmission behavior of dental filling materials and cements for the diode lasers' and the Nd:YAG laser's wavelengths. Lasers in surgery and medicine, 10.1002/lsm.23081 2019-Mar-07.

10. Ghouth, Nahar; Duggal, Monty S; Kang, Jing; Nazzal, Hani. A Diagnostic Accuracy Study of Laser Doppler Flowmetry for the Assessment of Pulpal Status in Children's Permanent Incisor Teeth. Journal of endodontics, 10.1016/j.joen.2019.01.017 2019-Mar-14.

11. NouhzadehMalekshah, Sepideh; Fekrazad, Reza; Bargrizan, Majid; Kalhori, Katayoun Am. Evaluation of laser fluorescence in combination with photosensitizers for detection of demineralized lesions. Photodiagnosis and photodynamic therapy, 10.1016/j.pdpdt.2019.03.019 2019-Mar-23.

12. Balevi, Ben. Cold pulp testing is the simplest and most accurate of all dental pulp sensibility tests. Evidence-based dentistry, 20 (1):22-23; 10.1038/s41432-019-0004-y 2019-Mar.

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