Er:YAG Laser and Hemolasertherapy: Bone and Gingiva Gain-Case Report.

Background: Modern dentistry has increasingly valued conservative and biologically less invasive clinical practices, seeking to preserve the patients' tissues and natural dental elements. Most extractions in the dental clinic are preceded by periodontal disease that presents bone and gingival tissue loss, compromising the aesthetics as well as the support of dental elements. Objectives: The clinical approach in these cases often involves bone exertion followed by the successful installation of osseointegrated implants. Material and Methods: In this study, a case of extensive periodontal involvement and mobility of dental elements was carried out in a minimally invasive way, using the Er:YAG laser for periodontal decontamination and the hemolasertherapy technique to regenerate adjacent tissues, totaling nine weeks of treatment. Results: Clinical and radiographical improvement of tissue health and complete preservation of dental elements were observed. Conclusion: The patient underwent a follow-up appointment 2 years after the start of treatment when it was still possible to verify the stability of the clinical condition and the tissue gains obtained.

Twelve-Month Follow-Up of Different Dentinal Hypersensitivity Treatments by Photobiomodulation Therapy, Nd:YAG and Nd:YAP Lasers.

In this retrospective study, data for three different laser-assisted approaches for the management of dentinal hypersensitivity (DH) was collected (n = 920 teeth). In total, 387 teeth were treated with photobiomodulation (PBM) therapy with 660 nm red light laser (PBM group), 327 were treated with the Nd:YAG laser (1064 nm) and 206 were treated with the Nd:YAP laser (1340 nm). To assess the effectiveness of each treatment, a visual analogue scale (VAS) was used, where zero represented no pain at all and ten represented the greatest pain. VAS was used before (T0), immediately after (T1), one week after (T2), four weeks after (T3), six months after (T4) and one year after treatment (T5). Means and standard deviations of VAS at different follow-up times were calculated. Values were compared within and between groups. Statistical significance was considered to be achieved when p-value was less than 0.05. Confidence level was proposed to be 99% with a P value lower than 0.001. Within groups, a statistically significant reduction was obtained when the mean value of VAS at T0 was compared with T5. At T5, the PBM group had the highest reduction of VAS (with mean value of 0), while the Nd:YAG and Nd:YAP groups had scores of 1.065 ± 0.674 and 4.665 ± 0.674, respectively. Conclusion: this retrospective study showed that PBM therapy and irradiation with Nd:YAG and Nd:YAP lasers are effective in managing DH pain. However, PBM therapy was the only procedure that showed complete pain relief at six and twelve months after treatment.

Blinded, parallel and randomized clinical evaluation of in-office dental bleaching with violet LED (405-410nm).

This clinical study evaluated the effect of bleaching performed with violet LED light (405-410 nm), either combined with hydrogen peroxide (HP) gel, or not, on color change, dental sensitivity, participants' satisfaction and impact on their quality of life. A hundred participants were divided into one of the groups (n = 25): G1 - 35% HP (4 sessions, 1x/week); G2 - violet LED (4 sessions, 1x/week); G3 - violet LED (4 sessions, 2x/week); G4 - hybrid technique (violet LED + 35% HP; 4 sessions, 1x/week). Color evaluation was performed with colorimetric tests (objective and subjective), before, 14 days and 3 months after completion. Additionally, satisfaction with treatment, impact on quality of life (OHIP-14) and dental sensitivity were recorded. The data were submitted to statistical analysis, considering a significance level of 5%, with the exception of the data from the questionnaire on satisfaction (descriptive analysis). Two-way ANOVA and Tukey tests showed that there was no difference between color variation resulting from techniques used in G1 and G4; those used in G2 and G3 did not differ and were less effective for bleaching than those of the other groups, in both subjective and objective evaluations. Regarding tooth sensitivity, subjects in G2 and G3 experienced no sensitivity, ​​while those in G4 showed lower sensitivity values than those in G1. With respect to quality of life, only subjects in G1 and G2 showed a significant positive impact. Among the evaluated techniques, the hybrid type seemed to be a good alternative, showing effective bleaching with less tooth sensitivity.

A Randomized Comparative Clinical Study to Evaluate the Longevity of Esthetic Results of Gingival Melanin Depigmentation Treatment Using Different Laser Wavelengths (Diode, CO2, and Er:YAG).

Background: Gingival melanin hyperpigmentation is due to excessive deposition of melanin granules. The duration of pigmentation reappearance after treatment using different laser wavelengths remains controversial. Objective: The study aims to assess the longevity of gingival depigmentation (GD) and the consistency in esthetic results as three laser wavelengths (Er:YAG laser, CO2 laser, and diode laser, 980 nm) were used in two different groups (smokers and nonsmokers). This is attained by comparing the periods of time in each group before pigmentation reappearance. Methods: Seventy-two subjects were divided into daily smokers (S) and nonsmokers. Subjects underwent a randomized GD with: Erbium laser (Er), CO2 laser (CO2), and Diode laser (Diode). The subjects were divided into six groups: S and nonsmokers were treated with three different wavelengths. Irradiation was performed until there was no visible pigmentation. For qualitative measurement, Hedin Melanin Index (HMI) was used, before treatment, after 2 weeks, and until 60 months. Pigmentation reappearance of degree 1 or above of the HMI was noted. Descriptive statistics were also calculated. Results: HMI showed a 0 in all groups after 14 days of treatment. The time before pigmentation rebound was: Diode > CO2 > S-Diode > S-CO2 > Er > S-Er. The first signs of relapse shown among all groups were seen in the group S-Er group. The longest time before rebound was observed with the Diode group for the nonsmoker. Conclusions: Diode laser provides the longest-term stability in treatment. Smoking negatively affects the longevity of GD. Er laser gives the shortest time before the reappearance of gingival pigmentation.

Clinical Evaluation of In-Office Dental Bleaching Using a Violet Light-Emitted Diode.

Objective: To clinically evaluate the effect of the violet light-emitted diode (LED) light (405-410 nm) associated to in-office dental bleaching with 35% carbamide peroxide, on tooth color change and sensitivity. Participant's satisfaction after treatment was also evaluated. Materials and methods: A total of 50 participants were selected and randomized into a treatment group (n = 25): G1-two bleaching sessions of 30 min each, with 7-day interval (D0 and D7); G2-two bleaching sessions (same protocol as G1) associated with violet LED light, 30 min each session. The color evaluation was performed before and after 7 days of the second session (D0 and D14); the medium third of buccal surface of canine and central incisor teeth were evaluated under VITA Shade Guide and spectrophotometry (subjective and objective). Tooth sensitivity was evaluated immediately after the treatment and after 48 h of each bleaching session (D0, D2, D7, and D9), and a self-perception questionnaire was applied on D14. Results: Data were subjected to nonparametric Mann-Whitney test and both canine and central incisor teeth presented color change. Group G2 showed significantly more change than G1. Fisher's exact test showed no statistically significant dental sensitivity differences between groups. Both groups reported a high level of satisfaction but chi-square test showed statistically higher satisfied patients with dental bleaching in G2 than G1. Conclusions: The violet LED light (405-410 nm) could improve dental bleaching effectiveness, without sensitivity increase.

Hemolasertherapy: A Novel Procedure for Gingival Papilla Regeneration-Case Report.

BACKGROUND: Interdental papilla is of major importance to patients' orofacial aesthetics, especially regarding anterior teeth as part of the smile's harmony. Loss of gingival tissue, which constitutes interdental papilla, forms what in odontology is called black spaces. This loss, besides affecting the smile's aesthetics, also provokes phonetic and functional damage. OBJECTIVE: The objective of the authors is to present the result of three clinical cases treated with an innovative technique called hemolasertherapy, which stimulates growth of gingival papilla and thus permanently fills in the black spaces. METHODS: The photobiomodulation therapy (PBMT) used a 660 nm diode laser (Laser Duo, MMO-São Carlos, SP, Brazil), punctual, contact mode in two steps: before the bleeding (first PBMT) and immediately after bleeding (second PBMT). Parameters used were power output: 100 mW, CW; diameter tip: 5 mm; spot area: 0.19 cm2; irradiation exposure time per point: 20 sec; 14 points per daily session; total of 2 sessions, with a 1-week interval; E: 2 J per point; E: per daily session, 28 J; irradiance per point: 0.52 W/cm2; fluence per point: 10.4 J/cm2. Total in two daily sessions: total energy: 56 J; total fluence: 294.75 J/cm, 560 sec total time. An in vitro preliminary study was simultaneously carried out to demonstrate what could happen at cellular level in hemotherapy clinical cases associated with PBMT laser application. RESULTS: This initial study demonstrated that the blood clot originated from the bleeding provoked in the gingival area is rich in mesenchymal stem cells. PBMT enables preservation, viability, and further differentiation, stimulating the return of gingival stem cells, which would support their survival and differentiation in the blood clot, thus favoring interdental papilla regeneration. CONCLUSIONS: Follow-up was done for a time span of 4-5 years and considered excellent with regard to papilla preservation.

As doenças periodontais e o Diabetes Mellitus / Periodontal diseases and Diabetes Mellitus

O conhecimento das manifestações sistêmicas e das reações celulares nos pacientes diabéticos traduz e confirma sua posição de grande importância no complexo inter-relacionamento das especialidades médicas. Fica cada vez mais claro que o diabetes agrava e modifica as doenças periodontais e vice-versa. Assim, mostra-se imprescindível um estudo cientifico conjunto dessas manifestações para uma motivação consciente dos profissionais no tratamento de pacientes diabéticos.

The cognizance of the systemic manifestations and cellular reactions over the diabetic patients translates and confirms its position of great importance in the complex inter-relationship of the medical specialties. It is clearer each day that diabetes aggravates and modifies periodontal diseases and vice versa. Therefore, it shows to be necessary a combined scientific study of such diseases for a conscious motivation of the professionals in the treatment of diabetic patients.