Review of oral mucositis treatment guidelines with an emphasis on laser therapy.

Healthcare professionals require effective treatment options for managing the complications that may arise during cancer treatment. The Multinational Association of Supportive Care in Cancer (MASCC) and the International Society of Oral Oncology (ISOO) work together to reduce oral complications secondary to cancer, including difficulties associated with oral mucositis (OM). The present article is intended to summarize the MASCC/ISOO guidelines, which are updated periodically based on the most recent evidence supporting the multiple treatment options for OM caused by chemotherapy and radiotherapy used to treat head and neck tumors. The Mucositis Study Group (MSG) of MASCC/ ISOO conducted systematic reviews of the current literature pertaining to several interventions, including anti-inflammatory agents; basic oral care; vitamins, minerals, and nutritional supplements; and photobiomodulation. The MSG then categorized the effectiveness of each treatment for preventing OM or reducing the severity, duration, and reported pain of patients with OM based on the type of cancer being treated, the cancer treatment modality (chemotherapy, radiotherapy, or combination therapy), and the goals of the OM treatment (preventive or therapeutic). The present article also describes a case demonstrating the positive effects of using various laser devices to heal the symptoms of OM in a patient undergoing radiotherapy and chemotherapy for a squamous cell carcinoma at the base of the tongue.

Resin cement removal from titanium dental implant surface using a novel side-firing laser fiber and Er,Cr:YSGG irradiation.

PURPOSE: evaluate the influence of an erbium, chromium: yttrium, scandium, gallium, garnet (Er,Cr:YSGG) laser using multiple tip types, on the removal of retained cement on a titanium implant surface. METHODS: Nine titanium dental implants were coated with a non-eugenol resin composite implant cement. An Er,Cr:YSGG device at a wavelength of 2,780 nm was fitted sequentially with three laser fiber tips: (1) 6 mm long, 600 µm diameter end-firing, quartz; (2) 9 mm long, Radial-Firing Perio Tip, 500 µm diameter, quartz; and (3) 18 mm long Side-Firing Tip, 800 µm x 300 µm, sapphire. Irradiation on the implant surfaces was performed in short pulse mode (140 µsec pulse duration) with output power of 1.5 W, 50% water, 40% air, and either: (1) 15 Hz, 100 mJ/pulse; (2) 30 Hz, 50 mJ/pulse; or (3) 40 Hz, 37.5 mJ/pulse. Three trials each were completed for each of three different fiber tip types for a total of 27 trials (three trials for each of the nine groups). RESULTS: All samples in Groups 1-6 demonstrated complete removal of cement from the implant surface. SEM inspection revealed a high degree of melting of the resin composite cement on the implant surface in all samples treated with 100 mJ/pulse (Groups 1, 2, 3). At 50 mJ/pulse (30 Hz), the results of the end-firing and side-firing tips improved remarkably, with clean implant surfaces and comparatively little melting. The side-firing fiber at 50 mJ/pulse and 30 Hz provided the best overall combination of cement removal and least amount of residual melted material on the implant surface. Based on the limitations of this study, the most appropriate method of removing residual cement from a TiUnite coated titanium implant surface is by using an Er,Cr:YSGG laser device fitted with a side-firing laser tip. Laser parameters of 50 mJ/pulse and 30 Hz (1.5W average power), with at least 50% water and 40% air in the aerosolized water spray are ideal. CLINICAL SIGNIFICANCE: As the presence of peri-implantitis continues to increase in numbers and severity, it is imperative to have a predictable treatment protocol to address the large number of ailing and failing implant cases. This study offers one solution to the problem of peri-implantitis, especially if caused by retained cement. Optimal laser settings are proposed for surface decontamination and treatment.

Optimizing teaching effectiveness in dental education for a new generation of learners.

PURPOSE: Today's dental students, Generation Z (Gen Z), are said to learn differently than those of previous generations. As generations of dental students vary, our teaching styles must keep up with unique and changing groups of individuals. METHODS: This article discusses learner-focused teaching methods including techniques that address the characteristics of Gen Z learners. Blended learning methods that combine online media with traditional face-to-face sessions, team-based learning, and a flipped classroom format have previously been suggested as ways to increase learning effectiveness and student satisfaction. RESULTS: In this paper, the characteristics and preferences of Gen Z students are described along with the challenges they create with conventional teaching methods. An implementation strategy using principles from organizational agility and Bolman and Deal's Four Frames Model is proposed for dental schools to transition to a more learner-centered teaching approach. CONCLUSIONS: The suggested strategy can be customized and could be useful to schools that wish to enhance their teaching methods to meet the learning needs of Gen Z dental students and beyond.

Immunomodulatory activity seen as a result of photobiomodulation therapy in stimulated primary human fibroblasts.

OBJECTIVE: Oral biofilms burden host responses by induction of inflammatory mediators, exacerbating periodontal inflammation. Photobiomodulation Therapy (PBMT) has been shown to decrease levels of pro-inflammatory cytokines and chemokines. However, optimal wavelengths and exposure doses have not been established. This study investigated the effects of PBMT on human periodontal ligament fibroblasts (hPDLFs) stimulated with inflammatory mediators (LPS, TNF-α, and IL-1ß). METHODS: Cytotoxic effects of laser wavelengths 660 nm and 810 nm were assessed by measuring their effects on cellular dehydrogenase activity. The study was expanded to include 980 nm, 660 nm + 810 nm, and 810 nm + 980 nm. P.g. LPS, TNF-α, and/or IL-1ß were added one hour before irradiation, then exposed to laser irradiation to determine the most appropriate stimulus. The levels of INF-γ, IL-6, IL-8, IL-17A/F, and MCP-1 production in stimulated hPDLFs were measured and analyzed. RESULTS: P.g. LPS was a poor stimulus for hPDLFs, while TNF-α and IL-1ß significantly elevated the analytes. The 660 nm laser treatment induced pro-inflammatory cytokines when stimulated, while 810 nm exhibited significant suppression. IL-1ß was the stimulus of choice and the 810 nm wavelength alone exhibited anti-inflammatory effects for all analytes except IL-8, while the 810 nm in combination with 660 nm and/or 980 nm exhibited effects similar to 810 nm alone. CONCLUSIONS: The downregulation of inflammatory mediators by the combination or individual treatment with 810 nm wavelength shows promise for the management of periodontal inflammation. PBMT may lead to the development of a novel approach in the management of periodontal disease.

Guidelines for the Biopsy of Oral Mucosal Lesions Using a Laser.

Dental lasers are increasingly being used to harvest soft-tissue biopsies. Lasers generally offer numerous benefits compared with conventional treatment modalities of tissue collection, including providing less trauma, uncomplicated healing, and faster recovery. Also, common problems seen with other novel methods of sample collection are avoided with the use of dental lasers. However, because of a laser's thermal effects, incisional margins may not always be as sufficiently defined as necessary for histopathologic analysis. Deficiencies associated with the use of a dental laser to collect a proper sample are related mostly to either insufficient tissue for diagnosis or other tissue artifacts, specifically thermal artifacts. This article, therefore, is aimed at assisting clinicians in enhancing biopsy technique when using a laser.

Composite removal by means of erbium, chromium:yttrium-scandium-gallium-garnet laser compared with rotary instruments.

BACKGROUND: Complete removal of existing composite restorations without unnecessary removal of tooth structure is challenging. The authors compared the amount of tooth structure removed and composite remaining in Class III preparations when using an erbium laser or a rotary instrument. METHODS: Mesiolingual and distolingual preparations were prepared in 14 extracted anterior teeth, restored with shade-matched composite, finished, and polished. One restoration was removed with an erbium, chromium:yttrium-scandium-gallium-garnet laser and the other with a rotary instrument (handpiece and carbide burs). Gypsum models made from vinyl polysiloxane impressions of the preparation and removal stages were scanned. The 2 scans were precisely aligned to calculate the amount of tooth structure removed and residual composite, which were statistically compared (t test) between the bur and laser groups. RESULTS: Rotary instruments removed significantly more tooth structure than the laser in terms of mean depth (P = .0017) but not maximum depth (P = .0762). Although mean depth of tooth loss was smaller in the laser group, the area of tooth loss was significantly larger (P = .0004) because the rotary instrumentation left significantly more composite than the laser in terms of volume (P = .0104), mean depth (P = .0375), maximum depth (P = .0318), and area (P = .0056). CONCLUSIONS AND PRACTICAL IMPLICATIONS: The erbium, chromium:yttrium-scandium-gallium-garnet laser was more selective in removing existing composite restorations than a rotary instrument because it removed less tooth structure and left behind less composite. Unintentional loss of tooth structure and unnoticeable residual composite are inevitable when removing existing composites. Erbium lasers are alternative means of composite removal that may be more selective than a rotary instrument.

Early bone response to machined, sandblasting acid etching (SLA) and novel surface-functionalization (SLAffinity) titanium implants: characterization, biomechanical analysis and histological evaluation in pigs.

The purpose of the present study was to examine early tissue response and osseointegration in the animal model. The surface morphologies of SLAffinity were characterized using scanning electron microscopy and atomic force microscopy. The microstructures were examined by X-ray diffraction, and hardness was measured by nanoindentation. Moreover, the safety and toxicity properties were evaluated using computer-aided programs and cell cytotoxicity assays. In the animal model, implants were installed in the mandibular canine-premolar area of 12 miniature pigs. Each pig received three implants: machine, sandblasted, large grit, acid-etched, and SLAffinity-treated implants. The results showed that surface treatment did affect bone-to-implant contact (BIC) significantly. At 3 weeks, the SLAffinity-treated implants were found to present significantly higher BIC values than the untreated implants. The SLAffinity treatments enhanced osseointegration significantly, especially at early stages of bone tissue healing. As described above, the results of the present study demonstrate that the SLAffinity treatment is a reliable surface modification method.

Irritation fibroma removal: a comparison of two laser wavelengths.

Laser wavelengths are available that offer dentists treatment options for both hard and soft oral tissues. This article discusses the benefits of removing hypertrophic soft tissue by using an all-tissue laser. A clinical case is presented involving the use of both an 810 nm diode laser and a 2,780 nm Er,Cr:YSGG laser to remove two irritation fibromas, both located on the left cheek of the same patient. This unique perspective was ideal for comparing the healing of each wound. The Er,Cr:YSGG appeared to have a less traumatic effect on target tissue and offered improved postoperative healing, faster recovery time, and less trauma than traditional surgical modalities.