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Laser Literature Review - April 2022

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).


Owayda et al1 evaluated the analgesic effects of low-level laser therapy (LLLT) and paracetamol-caffeine in controlling orthodontic pain induced by elastomeric separators, as well as changes in oral health-related quality of life . They concluded that the pain levels were similar in the laser and drug groups


Shekarchi and coworkers2 evaluated the impact of photobiomodulation therapy (PBMT) on injection pain perception and compared it with a topical oral anesthetic gel in children.


The abstract is reproduced in full.


To evaluate the impact of photobiomodulation therapy (PBMT) on injection pain perception and compare it with a topical oral anesthetic gel. A total of 30 patients of six to nine years old seeking pulpotomy treatment of maxillary secondary primary molars of both sides were considered for this split-mouth triple-blind randomized clinical trial. On one side of the maxilla, the low-level-laser (diode laser, 808 nm, 250 mW; 16.25 J; 32.5 J/cm2 ) was irradiated upon the buccal gingiva of the tooth, while a Benzocaine 20% topical anesthetic gel was applied on the other side. A gel with the same taste (strawberry) was applied for the placebo. The Wong-Baker Faces Pain Rating Scale was used to evaluate the injection pain and post-operation pain at two timestamps, one hour and 24 hours after treatment. Patients' heart rate was also evaluated. Paired-T, Wilcoxon-signed-rank test, McNemar and Friedman tests were used for statistical analyses. Results demonstrated that PBMT could significantly decrease the injection pain perception and heart rate alternations compared to the topical anesthetic gels (P=0.000). However, no significant differences were documented between the two methods concerning the 1hour (P=0.26) and 24-hours (P=1.00) post-operation pain. PBMT can be an effective non-pharmacological technique for controlling injection pain.


Vila-Nova,et al3 conducted a systematic review and meta-analysis to evaluate whether photodynamic therapy is effective in reducing denture stomatitis. They concluded that it was effective in the treatment of denture stomatitis, but after 30 days and 15 days, the antifungals demonstrated better performance.


Poleti and coworkers4 evaluated the effects of a single session of antimicrobial photodynamic therapy (aPDT) on the alveolar repair process after tooth extraction in rats using toluidine blue laser irradiation and concluded that a single session of aPDT in the dental extraction site did not influence the alveolar repair process in rats.


Serban et al5 carried out a systematic review of emerging technologies for dentine caries detection. The abstract is reproduced in full.


This systematic review and meta-analysis aimed at assessing the diagnostic accuracy of emerging technologies, such as laser fluorescence (LF), transillumination, light-emitting diode devices, optical coherence tomography (OCT), alternating current impedance spectroscopy, fluorescence cameras (FC), photo-thermal radiometry, and modulated luminescence technology. In vivo and in vitro results of such non-ionizing, non-invasive, and non-destructive methods' effectiveness in non-cavitated dentin caries detection are sometimes ambiguous. Following the PRISMA guidelines, 34 relevant research articles published between 2011-2021 were selected. The risk of bias was assessed with a tool tailored for caries diagnostic studies, and subsequent quantitative uni- and bi-variate meta-analysis was carried out in separate sub-groups according to the investigated surface (occlusal/proximal) and study setting (in vivo/in vitro). In spite of the high heterogeneity across the review groups, in vitro studies on LF and FC proved a good diagnostic ability for the occlusal surface, with area under the curve (AUC) of 0.803 (11 studies) and 0.845 (five studies), respectively. OCT studies reported an outstanding performance with an overall AUC = 0.945 (four studies). Promising technologies, such as OCT or FC VistaProof, still need well-designed and well-powered studies to accrue experimental and clinical data for conclusive medical evidence, especially for the proximal surface. Registration: INPLASY202210097.

Dembowska and coworkers6 published a study comparing the treatment efficacy of endo-perio lesions using a standard treatment protocol and a standard diode laser-assisted treatment protocol and concluded that the conventional use of a 940 nm diode laser with an average power of 0.8 W in pulsed mode allows for the depth of periodontal pockets to be reduced. In addition, the use of a diode laser has a significant effect on tooth mobility and reduces bone loss.

McCawley et al7 published an article describing the immediate effect of the Nd:YAG laser on subgingival periodontal pathogens.

The abstract is reproduced in full.

PURPOSE: This pilot study assessed the immediate in vivo effect of high peak pulse power neodymium-doped yttrium aluminum garnet (Nd:YAG) laser monotherapy on selected red/orange complex periodontal pathogens in deep human periodontal pockets.

METHODS: Twelve adults with severe periodontitis were treated with the Laser-Assisted New Attachment Procedure (LANAP) surgical protocol, wherein a free-running, digitally pulsed, Nd:YAG dental laser was used as the initial therapeutic step before mechanical root debridement. Using a flexible optical fiber in a handpiece, Nd:YAG laser energy, at a density of 196 J/cm and a high peak pulse power of 1,333 W/pulse, was directed parallel to untreated tooth root surfaces in sequential coronal-apical passes to clinical periodontal probing depths, for a total applied energy dose of approximately 8-12 joules per millimeter of periodontal probing depth at each periodontal site. Subgingival biofilm specimens were collected from each patient before and immediately after Nd:YAG laser monotherapy from periodontal pockets exhibiting ≥6 mm probing depths and bleeding on probing. Selected red/orange complex periodontal pathogens (Porphyromonas gingivalis, Tannerella forsythia, Prevotella intermedia/nigrescens, Fusobacterium nucleatum, Parvimonas micra, and Campylobacter species) were quantified in the subgingival samples using established anaerobic culture techniques.

RESULTS: All immediate post-treatment subgingival biofilm specimens continued to yield microbial growth after Nd:YAG laser monotherapy. The mean levels of total cultivable red/orange complex periodontal pathogens per patient significantly decreased from 12.0% pre-treatment to 4.9% (a 59.2% decrease) immediately after Nd:YAG laser monotherapy, with 3 (25%) patients rendered culture-negative for all evaluated red/orange complex periodontal pathogens.

CONCLUSIONS: High peak pulse power Nd:YAG laser monotherapy, used as the initial step in the LANAP surgical protocol on mature subgingival biofilms, immediately induced significant reductions of nearly 60% in the mean total cultivable red/orange complex periodontal pathogen proportions per patient prior to mechanical root instrumentation and the rest of the LANAP surgical protocol.


Bago, Ivona and coworkers8 evaluated the efficacy of a new laser-assisted irrigation system, the shock wave enhanced emission photo-acoustic streaming (SWEEPS) technique in removing pulp tissue from single-rooted premolars. They found that SWEEPS was superior to UIA and CI in removing RPT in the apical region of round canals after single instrument root canal preparation; SWEEPS without instrumentation was inefficient in removing pulp tissue.


de Barros Silva et al9 published a review of the use of photobiomodulation (PBM) with low-level laser therapy in the prevention of tooth sensitivity induced by in-office tooth bleaching with hydrogen. The results of this systematic review and meta-analysis suggest that PBM significantly prevents pain-related symptoms after the first three weekly sessions of in-office tooth bleaching with hydrogen.


Choudhary and coworkers10 published a systematic review of the use of photodynamic therapy on oral premalignant lesions. The abstract is reproduced in full.

Background: Dentists now have access to a wide range of unique treatment methods as a result of substantial scientific and technological breakthroughs in the field of dentistry. Photodynamic therapy (PDT) is a non-invasive treatment procedure that use photosensitizers, a specific wavelength of light, and the production of singlet oxygen and reactive oxygen species (ROS) to kill undesired eukaryotic cells (such as oral tumors) and harmful microbes. In several disciplines of dentistry, it is seen as a valid therapeutic option. The purpose of this study was to examine the effectiveness and side effects of PDT in the treatment of oral premalignant lesions.

Material and Methods: Three search engines (PubMed, ISI Web of Science, and the Cochrane Library) were used to conduct a systematic review using the phrases photodynamic therapy and PDT in combination with other terms. To define our study eligibility criteria, we used the Population, Intervention and Comparison, Outcomes, and Study design technique.

Results: Initial results were 33. Definitely, 18 studies met our selection criteria.

Conclusions: Our analysis suggests ALA- PDT as a promising therapeutic modality for OEL lesions which should be treated first with the topical ALA-PDT using either the LED or laser light for successful clinical outcome for OEL lesions. Key words: Photodynamic Therapy, Photosensitizer, Aminolevulinic Acid (ALA), Methylene Blue (MB), Toludine Blue, Oral Leukoplakia, Oral Erythroplakia, Oral Verrucous hyperplasia, Oral Lichen Planus.


REFERENCES:


10. Choudhary, Ruchika; Reddy, Sujatha S; (...); Sen, Ritu. The Effect of Photodynamic Therapy on Oral-Premalignant Lesions: A Systematic Review. 2022-03-01 | Journal of clinical and experimental dentistry 14 (3) , pp.e285-e292.

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