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Laser Literature Review - October 2021

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).

Misischia et al1 compared the effectiveness of selected dental lasers for decontamination of machined titanium surfaces in vitro and concluded that the most consistent bacterial reduction of all titanium discs was with the Nd:YAG laser (100%).

Claudio and coworkers2 compared through clinical and microbiological analysis, the use of multiple applications of aPDT as an adjuvant therapy to non-surgical periodontal treatment of stage III and IV grade C periodontitis in type 2 diabetic (DM2) patients and concluded that the use of multiple aPDT sessions as adjuvant therapy in the periodontal treatment of uncompensated diabetic patients with periodontitis promotes additional clinical benefits.

Ren, Hui et al3 assessed the efficacy of low-level laser therapy (LLLT) with different wavelengths and transcutaneous electric nerve stimulation (TENS) and explored the optimal wavelength range of laser application in the treatment of pain caused by temporomandibular disorders (TMD). The results of the meta-analysis showed the LLLT had better short-term efficacy than TENS in the treatment of pain caused by TMD. Better results can be achieved with higher wavelengths. Therefore, they recommended to treat TMD using LLLT with wavelengths ranging from 910nm to 1100nm.

Mohajerani and coworkers4 evaluated the therapeutic effect of combined low-level laser (LLL) and light-emitting diode (LED) irradiation on the recovery rate of complications after extraction of mandibular third molars, including pain, swelling, and trismus and concluded that it could be an effective therapy.

Strauss,et al5 conducted a 12-month randomized, controlled clinical trial to evaluate the efficacy of a monotherapy protocol with the neodymium-doped yttrium aluminum garnet (Nd:YAG) laser for treatment of peri-implantitis. They found that laser therapy could be a valuable modality for the treatment of peri-implantitis.

Bellal, and coworkers6 explored the immediate and 1-month efficacy of near-infrared laser (NIR) therapy in treating dentinal hypersensitivity and concluded that it did have a significant immediate effect in reducing dentine hypersensitivity.

Jia, et al7 evaluated the probing depth (PD) reduction of lasers in scaling and root planing (SRP) of chronic periodontitis by network meta-analysis (NMA). The abstract is reproduced in full.

The aim was to systematically evaluate the probing depth (PD) reduction of lasers in scaling and root planing (SRP) of chronic periodontitis by network meta-analysis (NMA). Randomized controlled clinical trials (RCTs) were searched through electronic-search and hand-search up to January 2020. Standard mean different (SMD) and 95% confidence interval (CI) were counted for PD reduction. The random-effects NMA were performed using mvmeta routine in STATA software (version 13). This NMA analysed seven periodontal treatments through 37 RCTs. No inconsistency was detected. Compared with mechanical SRP, significant differences were in favour of diode laser (DL) as adjunct at 3months (SMD=0.61; 95% CI range: 0.27-0.96) and Nd:YAG as adjunct (SMD=0.29; 95% CI range: 0.03-0.55), Er,Cr:YSGG as monotherapy (SMD=0.37; 95% CI range: 0.04-0.71) and Er,Cr:YSGG as adjunct (SMD=0.53; 95% CI range: 0.23-0.84) at 6months after treatment. Compared with Er:YAG as monotherapy, significant differences were in favour of DL as adjunct at 6 months (SMD=0.51; 95% CI range: 0.07-0.95) after treatment. In terms of PD reduction at 3-month follow-up, the ranking result from best to worst was Nd:YAG as adjunct, DL as adjunct, Er:YAG as adjunct, Er,Cr:YSGG as monotherapy, Er:YAG as monotherapy and mechanical SRP. In terms of PD reduction at 6-month follow-up, the ranking result was DL as adjunct, Nd:YAG as adjunct, Er:YAG as adjunct, Er,Cr:YSGG as adjunct, Er:YAG as monotherapy, Er,Cr:YSGG as monotherapy and mechanical SRP. Laser-assisted periodontal treatment has better PD reduction.

Bytyqi, and coworkers8 assessed the antibacterial effectiveness of diode laser during root canal treatment in artificial models of infected periapical lesions. They found that disinfection with laser did not differ between microorganisms (P=0.137), and laser irradiation with a longer duration had better disinfecting action for both microorganisms Enterococcus faecalis (ATCC 29212) and Streptococcus mitis (ATCC 49456).

Shahmirzadi, et al9 compared the effect of low level laser therapy (LLLT) on postoperative pain after single-visit root canal retreatment in mandibular molars and concluded that LLLT reduced postoperative pain after single-visit root canal retreatment of mandibular molars only four hours following the procedure.

Ekici,and coworkers10 compared the effects of high-intensity laser therapy (HILT) and transcutaneous electrical nerve stimulation (TENS) therapy on the treatment of patients with TMJ disc displacement with reduction (DDWR). They found that the healing effect of pulsed Nd: YAG laser therapy was significantly higher than TENS in patients with DDWR. Therefore, HILT should be a priority option over TENS therapy in patients with disc displacement.

Rangel et al11 assessed the effectiveness of laser acupuncture and intravascular laser irradiation of blood (ILIB) for managing anxiety in pediatric dentistry. And found that this was a good alternative for managing anxiety in children.

Dortaj,and coworkers12 explored the efficacy of Nd:YAG laser-assisted periodontal therapy for management of patients with stage II-IV periodontitis and found that it results in greater Periodontal Probing Depth reduction compared to non-surgical periodontal therapy (NSPT) alone.

Belcheva, et al13 evaluated the efficacy of laser Doppler flowmetry (LDF) in determining the changes in the pulpal blood flow (PBF) during post-traumatic period of the traumatised permanent teeth. They concluded that LDF is a useful monitoring tool for revascularization of traumatised teeth and reliable objective diagnostic indicator of pulp vitality.

Bersezio, and coworkers14 compared the effectiveness and sensitivity of in-office dental bleaching with one versus two applications of 6% hydrogen peroxide (HP) gel with nitrogen titanium dioxide (TiO2) nanoparticles activated by LED/Laser lamp in a single-session. They found that it was effective.

Ou et al15 published a paper regarding aerosols and spatter which is topical at the moment. The abstract is reproduced in full.

BACKGROUND: Dental procedures often produce aerosols and spatter, which have the potential to transmit pathogens such as severe acute respiratory syndrome coronavirus 2. The existing literature is limited.

METHODS: Aerosols and spatter were generated from an ultrasonic scaling procedure on a dental manikin and characterized via 2 optical imaging methods: digital inline holography and laser sheet imaging. Capture efficiencies of various aerosol mitigation devices were evaluated and compared.

RESULTS: The ultrasonic scaling procedure generated a wide size range of aerosols (up to a few hundred mum) and occasional large spatter, which emit at low velocity (mostly < 3 m/s). Use of a saliva ejector and high-volume evacuator (HVE) resulted in overall reductions of 63% and 88%, respectively, whereas an extraoral local extractor (ELE) resulted in a reduction of 96% at the nominal design flow setting.

CONCLUSIONS: The study results showed that the use of ELE or HVE significantly reduced aerosol and spatter emission. The use of HVE generally requires an additional person to assist a dental hygienist, whereas an ELE can be operated hands free when a dental hygienist is performing ultrasonic scaling and other operations.

PRACTICAL IMPLICATIONS: An ELE aids in the reduction of aerosols and spatters during ultrasonic scaling procedures, potentially reducing transmission of oral or respiratory pathogens like severe acute respiratory syndrome coronavirus 2. Position and airflow of the device are important to effective aerosol mitigation.

Li and coworkers16 published another topical article regarding fallow time and laser light scattering. The abstract is reproduced in full.

In time, dental health care has slowly expanded beyond emergency treatment to treat oral diseases. How to reduce the cross-transmission risk in dental surgery has raised much more attention. Considering the lack of consistency of fallow time (FT) in its necessity and duration, the highly sensitive laser light scattering method has been proposed to visualize the airborne lifetime and decay rate of suspended particles in the dental surgery environment. The FT is defined as when the number of suspended particles drops to the level that the next patient can safely enter after the aerosol-generating procedures (AGPs). The ultrasonic scaling was performed in the mock-up experimental dental clinic with 6 air changes per hour (ACH), and the instantaneous moments of the droplets were recorded by a high-speed camera. Without any mitigation measures, the estimated FT in the single dental surgery environment with 6 ACH was in the range of 27-35min, significantly affecting the number of daily dental services. Despite the cooperation of high-volume evacuation (HVE [IO]) cannot eliminate the FT to zero minutes, the equipment could reduce the required FT by 3-11min for the suspended particles reducing the baseline levels. Owing to the longer airborne lifetime of suspended particles, the relevant protection equipment, especially respiratory protection, is quite essential in the dental surgery. The obtained results of this study will provide evidence to establish the revised FT in dental surgery guidelines and protect the health and wellbeing of urban dwellers.


5. Strauss, Gabriel; Goteiner, David; (...); Sullivan, Andrew. Laser-Assisted Therapy for the Treatment of Peri-implantitis. Part I. Clinical Outcomes. 2021 Jul-aug | The International journal of periodontics & restorative dentistry 41 (4) , pp.563-568.

Probing depth reduction of laser application in periodontal therapy: a network meta-analysis. Lasers in medical science. 10.1007/s10103-021-03376-0..

. Evaluation of the effectiveness in teeth whitening of a single session with 6% hydrogen peroxide Laser/LED system. Photodiagnosis and photodynamic therapy 10.1016/j.pdpdt.2021.102532 Page 102532. Published 2021-Sep-11.

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