Tratamento de lesão periradicular, de origem endodôntica, com auxílio de laserterapia: uma revisão sistemática da literatura e apresentação se caso clínico / Treatment of periradicular injury, of endodontic origin, with the aid of laser therapy: a systematic review of the literature and presentation if clinical case

É sabido que a cavidade oral é a porta de entrada para muitos microrganismos e que possui alguns gêneros de bactérias que quando se associam ou proliferam em excesso, com a falta de higienização correta, fatores ambientais e imunológicos podem causar danos em algumas partes dos dentes como no tecido pulpar e canais radiculares. Neste sentido, a endodontia tem sido capaz de tratar pessoas com problemas dentários em fases muito precoces como as medidas profiláticas até casos infeciosos que afetam a polpa dos dentes causando as lesões perirradiculares que são infecções causadas por microrganismos, Para tanto, é necessário que a odontologia ofereça transformações positivas por meio de técnicas que sejam mais previsíveis para os tratamentos. A literatura tem indicado o uso da laserterapia como técnica auxiliar para o tratamento endodôntico pelo seu potencial mínimo invasivo, preciso e eficaz em menor tempo de cura de patologias orais como as lesões perirradiculares. Este estudo pretendeu abordar a importância da laserterapia sobre as variáveis patológicas de pacientes com lesão perirradiculares. Para realiza-lo foi necessário buscar na literatura estudos que associem este tipo de tratamento e sua eficiência no tratamento desta patologia. Para realizar esta pesquisa foi necessário buscar dados na literatura que tratam sobre o tema para investigar o tempo indicado ao tratamento com a laserterapia bem como o estágio em que as lesões podem ser tratadas com auxílio deste método. Corroborando com o estudo apresentamos um caso clínico(AU)

It is known that the oral cavity is the gateway to many microorganisms and that it has some genera of bacteria that when they associate or proliferate in excess, with the lack of correct hygiene, environmental and immunological factors can cause damage in some parts of the teeth such as in pulp tissue and root canals. In this sense, endodontics has been able to treat people with dental problems at very early stages such as prophylactic measures to infectious cases that affect the pulp of teeth causing perirradicular lesions that are infections caused by microorganisms, therefore, it is necessary that dentistry offer positive transformations through techniques that are more predictable for treatments. The literature has indicated the use of laser therapy as an auxiliary technique for endodontic treatment for its minimal invasive, precise and effective potential in shorter time of cure of oral pathologies such as perirradicular lesions. This study aimed to address the importance of laser therapy on the pathological variables of patients with perirradicular lesions. To accomplish this, it was necessary to seek studies in the literature that associate this type of treatment and its efficiency in the treatment of this pathology. To carry out this research it was necessary to seek data in the literature that deal with the subject to investigate the time indicated for treatment with laser therapy as well as the stage at which lesions can be treated with the aid of this method. Corroborating the study, we present a clinical case(AU)

Parestesia do nervo alveolar inferior decorrente de procedimentos cirúrgicos e suas formas de tratamentos / Paresthesi of the lower alveolar nerve resulting from surgical procedures and its forms of treatment

Nas cirurgias odontológicas é possível que ocorra alguns acidentes ou complicações que podem interferir no dia a dia do paciente. A lesão do nervo alveolar inferior é uma complicação decorrente de cirurgias orais que podem causar um distúrbio de sensibilidade transitória ou persistente, na região do lábio inferior e na região delimitada do forame mentoniano e hemi-arco da mucosa. O diagnóstico da parestesia pode ser feito através de testes mecanoceptivos e nocioceptivos em que o profissional escolherá para qual melhor se adapte no paciente. O objetivo do presente trabalho foi abordar por meio de uma revisão de literatura as formas de diagnóstico e tratamento da parestesia do nervo alveolar inferior decorrentes de cirurgias orais. As bases de dados utilizadas para confecção desta revisão são encontradas nas bibliotecas virtuais eletrônicas: BVS (Biblioteca Virtual em Saúde), LILACS (Literatura Latino-Americana e do Caribe em Ciências da Saúde) e Pubmed. Como critério de inclusão foram selecionados artigos publicados de 2012 a 2022 em língua inglesa, portuguesa e espanhola. Após a leitura do título e resumo dos resultados da pesquisa e aplicação dos critérios de inclusão e exclusão dentre eles foram excluídos 883, pois não se enquadravam no nosso critério de inclusão. No final, foram selecionados 13 estudos por meio de base de dados, que serviram de base para esta revisão. Concluímos que as formas de tratamento para a parestesia na literatura, são um pouco escassas e conflitantes, mas relata que o uso da laserterapia e acupuntura tem sido uma forma de tratamento com um bom índice de sucesso, e para os casos que não sejam suficientes tais tratamentos, pode-se optar por uma cirurgia(AU)

In dental surgeries it is possible to have some accidents or complications that can interfere with the patient's day. Injury to the inferior alveolar nerve is a complication resulting from oral surgeries that can cause a disturbance of sensitivity that can be transient or persistent in the region of the lower lip and in the delimited region of the mental foramen and hemiarch of the mucosa. The diagnosis of paresthesia can be made through mechanoceptive and nocioceptive tests that the professional will choose, which best suits the patient. The objective of the present work is to approach, through a literature review, the forms of diagnosis and treatment aimed at inferior alveolar nerve paresthesia resulting from oral surgeries. The databases used for this review are found in the virtual electronic libraries: VHL (Virtual Health Library), LILACS (Latin American and Caribbean Literature on Health Sciences) and Pubmed. As inclusion criteria, articles published from 2012 to 2022 in English, Portuguese and Spanish were selected. After reading the title and summary of the research results and applying the inclusion and exclusion criteria, 883 were excluded, as they did not meet our inclusion criteria. In the end, 13 studies were selected from the database, which served as the basis for this review. We conclude that the forms of treatment for paresthesia in the literature are a little scarce and conflicting, but it reports that the use of laser therapy and acupuncture has been a form of treatment with a good success rate, and for cases that are not enough, such treatments, one can opt for surgery(AU)

Evaluation of teaching low intensity laser in perspective dentist

Search knowledge dentist front surgeon to low intensity laser through a questionnaire. They were selected randomly in the city of Juiz de Fora and region 91 Dental Surgeons of Minas Gerais. These employees were sent during the months from July to October 2013, a standard form printed with questions about laser education assessment of low intensity. Of the 91 participants, 42 (46.2%) were female and 49 (53.8%) were male. Fifty-seven (62.6%) had dental public institution of higher education; 32 (35.2%) attended a private institution and 2 (2.2%) did not report this data. Eighty-nine dentists reported the time of graduation, and this varied with a minimum of 1 year and a maximum of 38 years of training, the average being 11 years and this is the standard deviation of 10.7. The age of these professionals is on average thirty-five years, ranging from twenty-two years to sixty-five years of age and the standard deviation of this is 10.8. The distribution according to academic title was: 35 dentists (38.5%) had a degree in dentistry; 13 (14.3%) were specialists; 14 (15.4%) had master's and 4 (4.4%) doctorate. 25 (27.5%) did not report the academic title. The most relevant mentioned specialties were general practitioner, endodontics and implantology. We can conclude that the Juiz de Fora dentist - MG and region makes little use of laser therapy and this is mainly due to little knowledge acquired at the undergraduate and graduate education.

Mucosite oral em pacientes com câncer de cabeça e pescoço: limitações das escalas de graduação, avaliação da terapia fotodinâmica antimicrobiana no tratamento e associação com microbioma oral / Oral mucositis in patients with head and neck cancer: limitations of grading scales, evaluation of antimicrobial photodynamic therapy in treatment and association with oral microbiome

O câncer de cabeça e pescoço (CCP) é uma das principais causas de morbidade e mortalidade em todo mundo. Cirurgia, radioterapia (RT) e quimioterapia (QT) são os principais tratamentos empregados. Contudo, pacientes submetidos a RT e QT podem apresentar complicações como mucosite oral (MO). A terapêutica mais recomendada para MO é a fotobiomodulação (FTBM). Há diversas escalas para graduação da MO, entretanto elas apresentam limitações quando aplicadas em pacientes com CCP. Por esse motivo, foi desenvolvido uma revisão da literatura para descrever as escalas mais utilizadas e apontar as limitações. Microrganismos podem agravar a cicatrização da MO. Diante disso, a terapia fotodinâmica antimicrobiana (aPDT), poderia complementar a ação da FTBM. Assim, foi realizado estudo comparativo entre o uso da FTBM isolada e FTBM + aPDT no tratamento da MO. Mudanças no microbioma oral induzidas pela RT e seu papel no agravamento das complicações, como MO, vem sendo descrito. Em razão disso, amostras da cavidade oral dos pacientes com CCP foram coletadas com swab antes da RT (T0), entre 12 e 16 Grays (Gy) (T1), entre 30 e 36 Gy (T2) e acima de 60 Gy (T3) para caracterização molecular por meio da amplificação e sequenciamento das regiões v1-v2 do gene 16S rRNA. As escalas da World Health Organization - WHO, Radiation Therapy Oncology Group - RTOG e National Cancer Institute ­ NCI foram as mais utilizadas e todas apresentaram limitações associadas principalmente com a dificuldade de diferenciar entre os sinais e sintomas da MO e os do tumor, como por exemplo a disfagia. O estudo comparativo (FTBM isolada X FTBM + aPDT) foi composto por 14 pacientes, com câncer de boca e orofaringe submetidos a RT e QT concomitantes, com 6 pacientes no grupo FTBM isolada e 8 no grupo FTBM + aPDT. A média de redução no tamanho da MO no grupo intervenção foi de 0,70 cm2 (±0,35) e 0,30 cm2 (±1,10) no grupo controle. A média de duração foi de 18,37 dias (±12,12) para o grupo intervenção e 23 dias (±14,78) para o grupo controle. O grupo intervenção teve redução média de 3,40 pontos na escala de dor (±2,44), enquanto o grupo controle teve 0,17 (±2,28). O estudo prospectivo que avaliou o microbioma oral (filo e gênero) ao longo da RT foi composto por 49 pacientes com CCP. Intrigantemente não foi observado diferença no microbioma oral dos pacientes que apresentaram MO (n=31) daqueles que não apresentaram (n=18). Interessantemente foi observado ao final da RT (T3) diminuição de Porphyromonas (p=<0.0001), Prevotella (p=0.010), Fusobacterium (p=<0.0001), gêneros associados ao câncer. Não há uma escala ideal para a avaliação da mucosite oral em pacientes com CCP. A mensuração das lesões de MO associada aos dados de dor e duração da MO pode ser uma forma mais eficaz de avaliação. A combinação de FTBM + aPDT parece ser uma abordagem promissora para descontaminar lesões de MO. Não foi observado diferença no microbioma oral de pacientes com e sem MO. Mudanças na composição do microbioma oral foram observadas durante a RT.

Head and neck cancer (HNC) is one of the main causes of morbidity and mortality worldwide. Surgery, radiotherapy (RT) and chemotherapy (CT) are the main treatments used. However, patients undergoing RT and CT may present complications such as oral mucositis (OM). The most recommended therapy for OM is photobiomodulation (PBM-T). There are several scales for grading OM, however they have limitations when applied to patients with HNC. For this reason, a literature review was developed to describe the most used scales and point out the limitations. Microorganisms can aggravate OM healing. Therefore, antimicrobial photodynamic therapy (aPDT) could complement the action of PBM-T. Thus, a comparative study was carried out between the use of PBM-T alone and PBM-T + aPDT in the treatment of OM. RT-induced changes in the oral microbiome and its role in worsening complications such as OM have been described. For this reason, samples from the oral cavity of patients with HNC were collected with a swab before RT (T0), between 12 and 16 Grays (Gy) (T1), between 30 and 36 Gy (T2) and above 60 Gy (T3) for molecular characterization through amplification and sequencing of regions v1-v2 of the 16S rRNA gene. The World Health Organization - WHO, Radiation Therapy Oncology Group - RTOG and National Cancer Institute - NCI scales were the most used and all had limitations mainly associated with the difficulty of differentiating between the signs and symptoms of OM and those of the tumor, such as example dysphagia. The comparative study (isolated PBM-T X PBM-T + aPDT) consisted of 14 patients with oral and oropharyngeal cancer who underwent concomitant RT and CT, with 6 patients in the isolated PBM-T group and 8 in the PBM-T + aPDT group. The mean reduction in OM size in the intervention group was 0.70 cm2 (±0.35) and 0.30 cm2 (±1.10) in the control group. The mean duration was 18.37 days (±12.12) for the intervention group and 23 days (±14.78) for the control group. The intervention group had an average reduction of 3.40 points on the pain scale (±2.44), while the control group had 0.17 (±2.28). The prospective study that evaluated the oral microbiome (phylum and genus) during RT consisted of 49 patients with HNC. Intriguingly, no difference was observed in the oral microbiome of patients who had OM (n=31) and those who did not (n=18). Interestingly, a decrease in Porphyromonas (p=<0.0001), Prevotella (p=0.010), Fusobacterium (p=<0.0001) was observed at the end of RT (T3), genera associated with cancer. There is no ideal scale for assessing oral mucositis in patients with HNC. Measurement of OM lesions associated with data on pain and duration of OM may be a more effective form of evaluation. The combination of PBM- T + aPDT appears to be a promising approach to decontaminate OM lesions. No difference was observed in the oral microbiome of patients with and without OM. Changes in oral microbiome composition were observed during RT.

Comparative Evaluation of Clinical Efficacy of Diode LASER and Cryosurgery for Gingival Pigmentation: A Split-Mouth Randomized Clinical Study

ABSTRACT Objective: To compare and evaluate the clinical efficacy of diode laser and cryosurgery for treating melanin pigmentation of gingiva. Material and Methods: A total of twenty-five subjects with physiological gingival pigmentation on the facial aspect of both maxillary and mandibular anterior arches (50 sites), both male and female, with an average age ranging from 18-35 years, participated in the study. The sites were randomly divided into Group I: depigmentation by Laser and Group II: depigmentation by Cryosurgery. The following parameters were assessed for the evaluation of treatment results: Melanin Oral Pigmentation Index (PI), Visual Analogue Scale (VAS) for pain evaluation and Healing index (HI). The data collected was statistically evaluated. Results: On intergroup comparison, there was no statistical difference in the score from baseline (p>0.05); however, a statistically significant difference was seen at the end of 1 year (p<0.05). Moreover, 57-60% of arches showed recurrence of pigmentation in the laser group whereas; only 12.7-17% recurrence was seen in the cryosurgery group at the end of the first year. Conclusion: Treatment of gingival hyperpigmentation with laser and cryosurgery shows a marked improvement of gingival pigmentation in both groups, but the cryosurgery depigmentation sites showed more sustainability.

Tratamento de trauma por mordedura autoinflingida com laserterapia e bandagem elástica: relato de caso / Bite trauma treatment with laser therapy and elastic bandage: case report

Introdução: trauma de mordedura ou úlcera traumática é uma lesão aguda da mucosa oral que tem como etiologia um trauma mecânico ou irritação no tecido mole afetado. Objetivo: relatar um tratamento multidisciplinar de trauma por mordedura autoinflingida em lábio inferior. Relato do caso: paciente com 17 anos de idade, sexo masculino, paraplégico, ficou acamado devido às limitações neuromotoras e, de forma involuntária e reflexa, realizava a mordedura dos lábios. Essa movimentação traumatizava a região do lábio inferior causando a úlcera traumática, que não cicatrizava. Inicialmente foi instalado um protetor bucal de etil vinil acetato, mas o paciente não se adaptou. Então, foi realizado três sessões de laserterapia (fotobiomodulação), semanalmente e de forma pontual, ao longo da úlcera traumática, nas radiações vermelha e infravermelha (660nm; 808nm; 100mW; 2J/cm2 ­ Laser DUO MMO), aliado às bandagens elásticas (o método Therapy Taping®) para evitar a invaginação para cavidade bucal, afastando o lábio inferior dos dentes a fim de evitar o trauma da mucosa oral. Conclusão: a apresentação desse relato demonstrou algumas possibilidades de tratamento de uma lesão traumática, sendo o seu manejo ainda um grande desafio clínico na Odontologia e em especial para pacientes com deficiências motoras e ou cognitivas.

Introduction: bite trauma or traumatic ulcer is an acute injury of the oral mucosa whose etiology is mechanical trauma or irritation of the affected soft tissue. Objective: to report a multidisciplinary treatment of self-inflicted lower lip trauma. Case report: 17-year-old male patient, paraplegic, was bedridden due to neuromotor limitations and, involuntary and reflexive, bit the lips. This movement traumatized the region of the lower lip causing the traumatic ulcer, which did not heal. Initially, an ethyl vinyl acetate mouthguard was installed, but the patient did not adapt. Then, three sessions of laser therapy (photobiomodulation) was performed weekly and point, along the traumatic ulcer, in red and infrared radiation (660nm; 808nm; 100mW; 2J/cm2 ­ Laser DUO MMO), combined with elastic bandages (the Therapy Taping® method) to prevent invagination into the oral cavity, to move the lower lip away from his teeth in order to avoid trauma to the oral mucosa. Conclusion: the presentation of this report demonstrated some possibilities for the treatment of a traumatic injury, and its management is still a major clinical challenge in Dentistry, especially for patients with motor and/or cognitive impairments.

High-power laser for periodontal surgery in a patient with glanzmann thrombasthenia / Laser de alta potência para cirurgia periodontal em paciente com trombastenia de glanzmann

Background: Glanzmann thrombasthenia (GT) is a rare autosomal recessive disorder characterized by platelet function impairment. Considering that the oral cavity is highly vascularized and performing some local hemostatic maneuvers may be difficult, GT patients are at high risk for hemorrhage related to invasive oral procedures. This study aimed to present an alternative method for periodontal surgery in a young GT patient. Case Report: A 15-year-old female GT patient with a recent history of excessive bleeding following dental surgeries was referred to a public dental center, presenting gingival hyperplasia. The procedure was performed using a high-power laser (HPL), and except for local anesthesia with epinephrine, no further hemostatic agent was necessary. Conclusion: According to the case, the HPL seems to be an efficient tool for preventing perioperative bleeding in GT patients submitted to minor oral surgeries(AU)

Introdução: A trombastenia de Glanzmann (TG) é uma doença autossômica recessiva rara caracterizada por comprometimento da função plaquetária. Tendo em vista que a cavidade oral é altamente vascularizada e a realização de algumas manobras hemostáticas locais pode ser difícil, pacientes com TG apresentam alto risco de hemorragia relacionada a procedimentos orais invasivos. Este artigo teve como objetivo apresentar uma técnica alternativa para cirurgia periodontal em um paciente jovem com TG. Relato de Caso: Paciente com TG, sexo feminino, 15 anos, com história recente de sangramento excessivo relacionado a cirurgias odontológicas prévias, foi encaminhada a um centro odontológico público apresentando hiperplasia gengival. O procedimento de remoção foi realizado com laser de alta potência e, com exceção da anestesia local com epinefrina, nenhum outro agente hemostático foi necessário. Conclusão: De acordo com o caso, o laser de alta potência parece ser uma ferramenta eficiente na prevenção de sangramento perioperatório em pacientes com TG submetidos a pequenas cirurgias orais(AU)

Applications of diode laser in periodontal therapy ­ clinical guidelines and tips / Aplicações do laser de diodo na terapia periodontal ­ Orientações e dicas clínicas

Os lasers de diodo tornaram-se ferramentas clínicas populares devido ao seu tamanho compacto, acessibilidade, facilidade de uso e versatilidade. O objetivo deste artigo é apresentar as diversas aplicações de um laser de diodo na prática diária e destacar os aspectos técnicos do uso do laser de diodo para o mesmo. Esta série de casos relata o manejo de seis diferentes situações clínicas com laser de diodo: anquiloglossia, bolsa periodontal, zênites gengivais desiguais, mucocele, hipersensibilidade dentinária e gengiva hiperpigmentada. Os pacientes foram tratados com laser de diodo de 940 nm com potência de 0,5 W a 2 W dependendo do caso. A cicatrização pós-operatória transcorreu sem intercorrências na maioria dos casos e foram observados resultados favoráveis. O laser de diodo ofereceu vantagens cirúrgicas como ­ campo seco, desinfecção do sítio cirúrgico e cirurgia sem sutura. Além disso, os autores observaram melhor satisfação do paciente devido à mínima dor ou edema pós-operatório e alívio imediato em caso de hipersensibilidade dentinária. Este artigo apresenta as aplicações cirúrgicas e não cirúrgicas do laser de diodo juntamente com os aspectos técnicos. Embora a literatura disponível não forneça evidências substanciais para comparação direta do laser de diodo com as técnicas convencionais, é seguro concluir que o laser de diodo é uma ferramenta eficiente para uso rotineiro em odontologia.(AU)

The diode lasers have become popular clinical tools because of their compact size, affordability, ease of use and versatility. The aim of this paper is to put forth the various applications of a diode laser in day to day practice and highlight the technical aspects of diode laser use for the same. This case series reports management of six different clinical situations with diode laser namely ­ ankyloglossia, periodontal pocket, unequal gingival zeniths, mucocele, dentinal hypersensitivity and hyper-pigmented gingiva. The patients were treated with 940 nm diode laser with power settings from 0.5 W to 2 W depending on the case. The post-operative healing was uneventful in most cases and favourable outcomes were observed. The diode laser offered surgical advantages like ­ dry field, disinfection of surgical site and suture-less surgery. In addition, the authors observed better patient satisfaction owing to minimal post-operative pain or swelling and immediate relief in case of dentinal hypersensitivity. This paper presents both surgical and non-surgical applications of diode laser along with the technical aspects. Even though the available literature does not lend substantial evidence for direct comparison of diode laser with conventional techniques, it is safe to conclude that diode laser is an efficient tool for routine use in dentistry.(AU)

Low level laser therapy versus benzydamin in prevention and treatment of oral mucositis induced by anticancer treatments (clinical and biochemical study) / Terapia a laser de baixa intensidade versus benzidamina na prevenção e tratamento da mucosite oral induzida por terapia oncológica

Objective: In this study, patients undergoing neck and head radiotherapy (RT) with or with no chemotherapy were contrasted to the low-level laser therapy (LLLT) efficacy against benzydamine hydrochloride in treating and preventing oral mucositis (OM) (CHT). Material and Methods: This study included 90 individuals with neck and head cancer who were undergoing radiotherapy (RT) individually or in mixture with chemotherapy (CHT), varying in age from 18 to 80 years. Three equal groups were randomly formulated: Group, I patients were using oral care only, Group II patients were using benzydamine hydrochloride mouth rinse, and Group III patients were medicated by using low-level laser therapy. The National Institute of Cancer-Common Toxicity Criteria (NIC-CTC) and the World Health Organization (WHO) were used to rate the severity of OM, and the pain was validated utilizing a visual analog scale (VAS). The salivary level of tumor necrotic factor-α (TNF- α) was assayed. Results: As per WHO and NIC, the grade of oral mucositis at the end of cancer treatment was less in the LLLT group than in the other two groups. The alteration in TNF- α level was not significant. The laser group is more liable to have less salivary levels of the pro-inflammatory cytokines TNF- α . Conclusion: The incidence of oral mucositis severity has seemed to be reduced due to the prophylactic use of benzydamine hydrochloride and laser therapy protocols. However, laser therapy was more efficient in controlling the shape and progression of OM (AU)

Objetivo: Neste estudo, pacientes submetidos à radioterapia (RT) da cabeça e pescoço com ou sem quimioterapia foram avaliados quanto à eficácia da terapia com laser de baixa potência (LLLT) versus o cloridrato de benzidamina no tratamento e prevenção da mucosite oral (MO) (CHT). Material e Métodos: Este estudo incluiu 90 indivíduos com câncer de cabeça e pescoço submetidos à radioterapia (RT) individualmente ou em combinação com quimioterapia (QT), com idade variando de 18 a 80 anos. Três grupos iguais foram aleatoriamente formulados: os pacientes do Grupo I usaram apenas higiene bucal, os pacientes do Grupo II usaram bochechos com cloridrato de benzidamina e os pacientes do Grupo III foram medicados com terapia a laser de baixa intensidade. Foram utilizados os critérios do National Institute of Cancer-Common Toxicity Criteria (NIC-CTC) e da Organização Mundial da Saúde (OMS) para classificar a gravidade da OM, e a dor foi validada utilizando uma escala visual analógica (VAS). O nível salivar de fator necrótico tumoral-α (TNF-α) foi ensaiado. Resultados: De acordo com a OMS e NIC, o grau de mucosite oral ao final do tratamento do câncer foi menor no grupo LLLT do que nos outros dois grupos. A alteração no nível de TNF-α não foi significativa. O grupo com tratamento a laser apresentou menores níveis de citocinas pró-inflamatórias TNF-α na saliva. Conclusão: A gravidade da mucosite oral parece ser reduzida devido ao uso profilático de cloridrato de benzidamina e protocolos de laserterapia. No entanto, a laserterapia foi mais eficiente em controlar a forma e a progressão da MO. (AU)

Laser terapia no tratamento da perimplantite, mito ou realidade / Laser therapy in the treatment of periimplantitis, myth or reality

O presente trabalho faz uma revisão de literatura abordando o uso dos diversos tipos de lasers de alta intensidade no tratamento da perimplantite como terapia única ou coadjuvante aos métodos tradicionalmente usados, como mecânico e químico. A busca por novos recursos de tratamento, que sejam menos invasivos, mais seguros e de maior alcance em regiões remotas, impulsiona as pesquisas usando terapias com os diversos tipos delasers e sua aplicação no campo da implantodontia. Evidências de baixa confiabilidade, custo elevado dos equipamentos ainda são um obstáculo a ser vencido na realidade do uso do laser como terapia única. Com futuro promissor no tratamento coadjuvante às tradicionais terapias o uso do laser segue como aliado importante no complexo horizonte da perimplantite.

This paper reviews the literature addressing the use of different types ofhigh-intensity laser in the treatment of perimplantitis as a single therapy or as an adjunct to traditionally used methods, such as mechanical and chemical. The search for new treatment resources, which are less invasive, safer and with greater reach in remote regions, boosts research using therapies with different types of lasers and its application in the field of implantology. Evidence of low reliability and high cost of equipment are still an obstacle to be overcome in the reality of using lasers as the only therapy. With a promising future in adjunctive treatment to traditional therapies, the use of laser continues to be an important ally in the complex horizon of perimplantitis.

Efficacy of Lasers Treatment of Exposed Pulps to Stimulate Healing: A Systematic Review and Meta-Analysis

Abstract Objective: The present systematic review and meta-analysis aimed at evaluating the efficacy of laser's treatment of exposed pulps to stimulate healing. Material and Methods: MEDLINE, PubMed, Cochrane Library, Embase, ISI, Google Scholar have been searched as the electronic databases for performing systematic literature between 2005 to 2019. Searches were performed with MESH terms. The quality of the studies included was assessed using the Critical Appraisal Skills Program checklist. For Data extraction, two reviewers blind and independently extracted data from the abstract and full text of the studies included. Moreover, the fixed-effect model's odds ratio for a 95% confidence interval (CI) was calculated. Random effects were used to deal with potential heterogeneity, and I2 showed heterogeneity. The meta-analysis and forest plots have been evaluated using the Comprehensive Meta-Analysis Stata. Results: Five studies (3 RCTs and 2 animal studies) were included in this study. The Odds Ratio was 1.90 (95% CI 1.39-2.42; p=0.00); there was a statistically significant difference between the laser and the control groups (p=0.00). Conclusion: The success rate of laser treatment for exposed pulps is higher than mineral trioxide aggregate, resin, calcium hydroxide and resin-modified glass-ionomer cement. The exact mechanism of this effect has not yet been determined; further research on lasers' impact on exposed pulps treatment is required.

Surgical Management of Frenula: Laser Therapy Compared with Z-Frenuloplasty Technique

Abstract Objective: To compare intra- and post-operative consequences associated with Z-frenuloplasty and laser therapy for both upper labial and lingual frenulectomies. Material and Methods: Clinical data of 120 consecutive patients with a mean age of 11 years and 2 months (age range from 9 years and 1 month to 14 years and 3 months) with hypertrophic labial and lingual frenula were assembled. Of the 70 labial frenula, 35 were removed through Z-frenuloplasty (Group 1) and 35 with laser (Group 2); of 50 lingual frenula, instead, 25 were extracted through Z-frenuloplasty (Group 1A) and 25 with laser (Group 2A). The cutting device was Laser Diode Handy 10 in continuous mode. Finally, the time of the surgery, pain and swelling were measured 24-48 hours after the removal. VAS scale was used. Results: The time of the surgery, VAS score after the removal and the swelling were lesser in Group 2 and 2A. Conclusion: Both Z-frenuloplasty and Laser therapy are valid instruments to remove frenula. Moreover, laser offers more advantages like less use of anesthesia, no bleeding in the operating phase, no need for suturing, a faster tissue healing and minor limitations in speech and nutrition.

Perceptions of the Use of the Diode Laser in Dental Surgery: A Qualitative Study

Abstract Objective: To discover the perceptions of pediatric patients, their parents and undergraduate Dentistry students of the use of the diode laser in frenectomy surgeries. Material and Methods: A qualitative study was conducted through semi-structured interviews, recorded and transcribed with subsequent content analysis. Twelve healthy children (5-8 years old) who needed a frenectomy were selected and invited, together with their parents, to undergo laser diode surgery. In addition, 28 undergraduate dentistry students were invited to attend the procedures. One week after performing the surgical procedures, the children (Group 1), their parents (Group 2) and the students who attended the procedures (Group 3) were individually interviewed for the thematic analysis. Results: The analysis of the conversations identified three emerging contents: positive thoughts on the use of diode laser; frustrations from the use of diode laser; and aspects related to professional training. Conclusion: The results pointed to the acceptance of surgical laser use in pediatric dentistry; however, the feelings of frustration indicate that its use requires guidance from the child and his/her parents, in addition to careful handling and specific training.

Influência da laserterapia de baixa intensidade no processo inflamatório e na imunomarcação da interleucina­23 e do fator indutor de hipóxia 1-alfa no tecido pulpar de dentes clareados / Influence of low-level laser therapy on the inflammatory process and immunolabeling of interleukin-23 and hypoxia-inducing factor 1-alpha in the pulp tissue of bleached teeth

Introdução: O uso do laser infravermelho (LIV) através da fotobiomodulação, tem demonstrado efeitos benéficos aos tecidos. Objetivos: Avaliar a influência do LIV sobre o processo inflamatório, por meio da imunomarcação da interleucina próinflamatória IL-23, e sobre a angiogênese, por meio da imunomarcação do fator induzível por hipóxia-1 alfa (HIF-1α), no tecido pulpar de dentes clareados. Materiais e métodos: Quarenta ratos Wistar foram distribuídos aleatoriamente em 4 grupos de 20 hemi-maxilas cada: Grupo Controle ­ recebeu o tratamento com o gel placebo; Grupo Cla - recebeu 30 minutos do gel clareador H2O2 a 35%; Grupo LIV ­ recebeu uma aplicação de LIV (808 nm, 30 segundos, 3J); Grupo Cla-LIV ­ imediatamente após a aplicação do H2O2 a 35%, recebeu uma aplicação de LIV, como descrito no grupo LIV. Após 2 e 30 dias (n = 10), os animais foram eutanasiados e as maxilas removidas e processadas para avaliação histológica (H.E.) e imunoistoquímica. Forma de análise: Os cortes teciduais seriados e com espessura de 5 µm corados em H.E. foram avaliados por escores atribuídos à inflamação, e a análise imunoistoquímica foi realizada através de escores atribuídos à imunomarcação. Os dados foram submetidos aos testes de Wilcoxon e Mann Whitney (p < 0,05). Resultados: Aos 2 dias, houve inflamação severa e necrose nos terços oclusal e médio do tecido pulpar no grupo Cla, diferente do grupo Cla-LIV com inflamação leve à moderada (p < 0,05). No terço cervical, houve inflamação moderada a severa no grupo Cla, e leve no grupo Cla-LIV (p < 0,05). Aos 30 dias, houve ausência de inflamação e os grupos clareados apresentaram deposição de dentina terciária. Em relação à IL-23, aos 2 dias foi observada imunomarcação severa no grupo Cla e moderada no grupo Cla-LIV (p < 0,05); aos 30 dias, houve redução na imunomarcação de IL-23 nos grupos clareados, onde o grupo Cla apresentou imunomarcação moderada, e o grupo Cla-LIV leve imunomarcação, sem diferença significante (p > 0,05). HIF-1α foi mais presente aos 2 dias no grupo Cla, sem diferença significativa com Cla-LIV (p > 0,05). Foi observada diferença entre os grupos clareados e seus respectivos controles, que não apresentaram imunomarcação (p < 0,05); aos 30 dias, o grupo Cla apresentou redução na imunomarcação para HIF-1α, enquanto o grupo Cla-LIV apresentou aumento da imunomarcação, mas a diferença permaneceu apenas entre os grupos clareados e seus controles (p > 0,05). Conclusão: O laser infravermelho minimizou o infiltrado inflamatório e a imunomarcação de IL-23 no tecido pulpar após a clareação dentária, mas não influenciou a imunomarcação de HIF-1α(AU)

Introduction: The use of infrared laser (IRL) through photobiomodulation has shown beneficial effects on tissues. Objectives: To evaluate the influence of LLL on the inflammatory process, by immunolabeling IL-23 pro-inflammatory interleukin, and on angiogenesis, by immunolabeling hif-1 alpha inducible factor (HIF-1α) in the pulp tissue of bleached teeth (HIF-1α). Materials and methods: Forty Wistar rats were randomly divided into 4 groups of 20 hemimaxilla each: control group - received treatment with placebo gel; Ble group - received 30 minutes of 35% H2O2 bleaching gel; IRL group - received one application of IRL (808 nm, 30 seconds, 3 J); Ble-IRL group - immediately after application of 35% H2O2, received an application of IRL, as described in the IRL group.. After 2 and 30 days (n = 10), the rats were euthanized and the jaws removed and processed for histological evaluation (H.E.) and immunohistochemistry. Form of analysis: Serial tissue sections with thickness of 5 µm stained in H.E. were evaluated by scores attributed to inflammation, and immunohistochemical analysis was performed by scores attributed to immunolabeling. The data were submitted to the Wilcoxon and Mann Whitney tests (P < 0.05). Results: At 2 days, there was a severe inflammation and the presence of necrosis in the occlusal and middle thirds of the pulp tissue in the Ble group, different compared to the Ble-IRL group with moderate to mild inflammation (P < 0.05). In the cervical third, there was moderate to severe inflammation in the Ble group, and mild in the Ble-IRL group (P < 0.05). At 30 days, there was absence of inflammation and bleached groups had an extensive deposition of tertiary dentin. Regarding IL-23, at 2 days was observed severe immunolabeling in the Ble group and moderate in the Ble-IRL group (P < 0.05); at 30 days, there was a reduction in IL-23 immunolabeling in the bleached groups, where Ble group had moderate immunolabeling, and Ble-IRL group had mild immunolabeling, without significant difference (P > 0.05). HIF-1α was more evident at 2 days in the Ble group, without significant difference with Ble-IRL (P > 0.05). The difference was observed between the bleached groups and their respective controls, which had no immunolabeling (P < 0.05); at 30 days, the Ble group had a reduction in HIF-1α immunolabeling, while the Ble-IRL group had an increase in immunolabeling from moderate to severe; however, the difference remained only between the bleached groups and their controls (P > 0.05). Conclusion: Infrared laser minimized the inflammatory infiltrate and IL-23 immunolabeling in the pulp tissue after dental bleaching, but did not influenced HIF-1α immunolabeling(AU)

Fototerapia no tratamento da mucosite oral: uma revisão de literatura / Phototherapy in the treatment of oral mucositis: a literature review

Objetivo: O presente estudo tem por objetivo relatar as características da mucosite oral e o efeito da fototerapia no tratamento desta condição. Métodos: Realizou-se uma pesquisa bibliográfica nas bases de dados eletrônicas Web of Science, Scopus, PubMed e Scielo. A estratégia de busca foi baseada na pesquisa dos descritores "LLLT", "Low-Level Laser Therapy", "Light, phototherapy", "phototherapy", "Photobiomodulation Therapy" "Photobiostimulation Laser Irradiation", "Laser", "Mucositis" e "Oral Mucositis". Resultados:Após a análise dos artigos completos, 22 artigos foram considerados adequados para serem incluídos na revisão, sendo um publicado em 2012 (4,5%), um em 2013 (4,5%), dois em 2015 (9,1%), dois em 2016 (9,1%), quatro em 2017 (18,2%), nove em 2018 (40,9%) e três em 2019 (13,7%). Conclusão: Pode-se concluir que a laserterapia é eficaz na prevenção e tratamento da mucosite oral induzida por quimioradioterapia, reduzindo a dor e promovendo a cicatrização tecidual. (AU)

Aim: This study aims to report the characteristics of oral mucositis and the effect of phototherapy in the treatment of this condition. Methods: A bibliographic search was done in the electronic databases Web of Science, Scopus, PubMed, and Scielo. The search strategy was based on the research of the following descriptors: LLLT, Low-Level Laser Therapy, Light, phototherapy, phototherapy, Photobiomodulation Therapy, Photobiostimulation Laser Irradiation, Laser, Mucositis, and Oral Mucositis. Results:After reviewing the full articles, 22 articles were considered adequate to be included in the review, with one published in 2012 (4.5%), one in 2013 (4.5%), two in 2015 (9.1%), two in 2016 (9.1%), four in 2017 (18.2%), nine in 2018 (40.9%), and three in 2019 (13.7%). Conclusion: It can be concluded that laser therapy is effective in the prevention and treatment of oral mucositis induced by chemoradiotherapy, reducing pain and promoting tissue healing. (AU)

Effects of the combination of Er: YAG laser and sandblasting on the shear bond strength between zirconia and resin cement

Aim: This study was conducted to determine the bond strength between zirconia ceramic and resin luting cement according to the type of surface treatment applied. Methods: Sixty zirconia cylinders measuring 4 x 4 mm were manufactured and distributed into five experimental groups and a control group (n = 10): G1 - sandblasting with 110 µm aluminum oxide; G2 - sandblasting with 30 µm Rocatec Soft®; G3 - Er:YAG laser irradiation at 400 mJ; G4 - Er:YAG laser combined with sandblasting with aluminum oxide; G5 - Er:YAG laser combined with sandblasting with Rocatec Soft®; G6 - no treatment (Control). The zirconia cylinders were bonded in the center of composite resin cylinders (6 mm diameter) using RelyX Ultimate® cement. Shear strength was measured after thermocycling (6000 cycles and 5-55° C). Data were analyzed using one-way ANOVA and Tukey's post-hoc with a 5% significance level. Results: Group 4 had a significantly higher shear strength than all the other groups, except Group 1. Group 3 had a significantly lower shear strength compared with Groups 1 and 4. Conclusion: Sandblasting with 110µm aluminum oxide particles after laser irradiation may be an effective zirconia surface treatment. The use of Er: YAG laser alone is not effective at increasing the bond between resin cement and zirconia

Effects of an Antioxidant on the Shear Bond Strengths of Orthodontic Brackets After Conventional and Laser-Assisted Extra-Coronal Bleaching / Efecto de un antioxidante sobre la fuerza de unión de brackets de ortodoncia posterior al blanqueamiento convencional y asistido por láser

RESUMEN El objetivo del presente estudio fue evaluar los efectos de la aplicación de un antioxidante sobre las fuerzas de unión (SBS) de brackets de ortodoncia posterior al blanqueamiento con peróxido de hidrógeno (HP). Metodología: Cincuenta premolares recién extraídos se dividieron aleatoriamente en tres grupos. El Grupo 1 se trató con 40% de HP (n=20), el grupo 2 con 40% de HP y se activó con láser de Nd: YAG (n=20) y un grupo de control (Grupo 3) no recibió tratamiento (n=10). Después del blanqueamiento, los Grupos 1 y 2 se dividieron en dos subgrupos (Grupo 1a, Grupo 1b, Grupo 2a y Grupo 2b). Las muestras en los subgrupos 1a y 2a (n=10) no recibieron ninguna aplicación del antioxidante. Se aplicó una solución de ascorbato de sodio al 10% a las muestras en los Grupos 1b y 2b (n=10). Luego, los brackets se adherieron a las superficies de esmalte de todos los grupos experimentales. Las muestras se sometieron a pruebas de SBS y los datos analizados estadisticamente. Resultados: La fuerza de unión de los grupos 1 y 2 fue significativamente más baja que el grupo de control (p <0.001); sin embargo, no se observaron diferencias estadísticamente significativas en SBS entre los grupos 1 y 2 (p>0.001). Las muestras tratadas con antioxidantes de los grupos 1b y 2b fueron significativamente mayores que las de los grupos 1a y 2a (p <0,001). Conclusion: La aplicación de 40% HP tuvo un efecto negativo en la resistencia de unión de los brackets. El uso de antioxidante durante 15 minutos mejoró significativamente la SBS.

ABSTRACT Purpose: The purpose of this study was to evaluate the effects of the application of antioxidant on the shear bond strengths (SBS) of orthodontic brackets bonded to human enamel after extra-coronal bleaching with hydrogen peroxide (HP). Materials and methods: Fifty freshly extracted premolars were randomly divided into three groups. One group (Group 1) was bleached with 40% HP (n=20), another group (Group 2) was bleached with 40% HP and activated with an Nd: YAG laser (n=20), and a control group (Group 3) received no treatment (n=10). After the bleaching procedure, Groups 1 and 2 were further divided into two subgroups (Group 1a, Group 1b, Group 2a, and Group 2b). Specimens in Groups 1a and 2a (n=10) received no antioxidant application. A 10% sodium ascorbate solution was applied to specimens in Groups 1b and 2b (n=10). The brackets were then bonded with light-cure adhesive paste to the enamel surfaces of all experimental groups. Specimens were subjected to SBS tests for debonding. Results: The SBS of brackets bonded in Groups 1 and 2 were significantly lower than those of brackets bonded to the control group (p<0.001); however, no statistically significant differences in SBS were noted in Groups 1 and 2 (p>0.001). The antioxidant-treated SBS of brackets in Groups 1b and 2b were significantly higher than those of Groups 1a and 2a (p<0.001). Conclusions: The application of 40% HP had a negative effect on the bond strength. The use of antioxidant for 15 min resulted in the reversal of failed bond strength.

A pilot study on the use of biolase in the treatment of recurrent aphthous ulcer

Recurrent Aphthous Ulcer (RAU) is a common oral pathology that produces pain which affects the lifestyle of the patient. Its aetiology and pathogenesis still remain unclear. A considerable number of treatments are available with the main goal directed towards pain relief. Previous studies on RAU treatment using low level laser therapy (LLLT) show immediate pain relief after application. Aim: This study aims to evaluate and compare treatment effectiveness in relieving pain provided by Waterlase (BIOLASE) LLLT and conventional topical corticosteroid using Triamcinolone Acetonide 0.1% dental paste. Methods: Thirty(30) volunteered patients of age between 18-27 years old weredivided into two groups. Each group consists of 15 patients with7 males and 8 females. Group 1 patients were treated by usingLLLT while group 2 patients were treated by using triamcinolone acetonide 0.1%. The patient's details, pain intensity and clinical photographs were recorded in a specially prepared case sheet.Mann-Whitney U test was used to compare significance in painreduction provided by both methods of treatment. Results:Both groups showed significant pain reduction immediately, day 3 and day 7. Higher reduction in pain intensity was observedimmediately (p=0.001) and 3 days (p=0.002) after treatment in group 1 patients (LLLT) compared to group 2 patients (triamcinolone acetonide 0.1%). Conclusion: Waterlase (BIOLASE) LLLT is clinically more effective in relieving pain compared to Triamcinolone Acetonide 0.1%

Gengivectomia convencional e gengivectomia a laser ­ uma revisão crítica / Conventional gingivectomy and laser gingivectomy ­ a critical review

Objetivo: realizar uma avaliação crítica da literatura em relação à melhor técnica cirúrgica, convencional ou a laser, bem como suas indicações. Material e métodos: para síntese deste trabalho, foi realizada uma busca bibliográfica na base PubMed e incluídos estudos relevantes relacionados ao tema. Resultados: foram selecionados, por dois revisores, dez artigos para serem incluídos nessa revisão da literatura: um ensaio clínico, um estudo experimental e oito relatos de casos. Conclusão: a gengivectomia convencional continua sendo uma técnica de grande escolha, e a gengivectomia a laser é uma opção que traz resultados satisfatórios com tempo cirúrgico menor, hemostasia, conforto para o paciente e cicatrização mais rápida. Entretanto, é necessária a realização de ensaios clínicos controlados randomizados para afi rmar se esta tecnologia poderá tornar-se padrão-ouro na prática diária.

Objective: to perform a critical literature review regarding the best surgical technique (conventional or laser) and its indications. Material and methods: an electronic search was made at the PubMed and relevant studies were included. Results: 10 articles were selected by two reviewers to be included as follows: 1 clinical trial, 1 experimental study, and 8 case reports. Conclusion: conventional gengivectomy continues to be the chosen technique, and laser gengivectomy is an option with satisfactory results with less surgical time, hemostasis, more patient comfort, and a fast healing. However, more randomized controlled clinical trials are needed to verify whether this technology will be the gold-standard in our daily practice.

Uso de ultrassom e laser na descontaminação do sistema de canais radiculares: revisão de literatura / Use of ultrasound and laser in root canal decontamination: literature review

O maior obstáculo para o sucesso do tratamento endodôntico é a eliminação da microbiota instalada. A instrumentação mecânica, bem como as substâncias químicas auxiliares, é utilizada para eliminação dessa microbiota. Além das soluções irrigantes, outras técnicas complementares, como a agitação ultrassônica passiva (PUI) e o laser, estão sendo utilizadas para otimizar a eliminação dos microrganismos. Desse modo, o presente estudo objetivou o levantamento bibliográfico de diferentes tipos de agitação dos irrigantes no tratamento endodôntico. A PUI tem sido sugerida como um meio para melhorar o desbridamento do canal. Já o laser tem sido utilizado por apresentar vantagens terapêuticas ao tratamento. Todas as técnicas citadas para melhorar a limpeza dos canais radiculares mostraram alguma melhora. A técnica mais empregada ainda é a agitação ultrassônica, por apresentar eficiência e praticidade no procedimento. Pôde-se concluir que a diminuição da microbiota é mais eficiente quando se utiliza uma maior concentração da solução irrigadora, independentemente da agitação final de escolha.