Biological Characterization, Properties, and Clinical Use of a Novel Homeopathic Antiseptic Oral Recovery Kit: A Narrative Review.

Most available antiseptic solutions have strong antibacterial effects, but many also possess major cytotoxic effects on gingival fibroblasts, osteoblasts, osteoprogenitor cells, and/or epithelial cells. A novel VEGA Oral Care Recovery Kit (StellaLife) consisting of 16 active ingredients that are monographed in the Homeopathic Pharmacopeia of the United States (HPUS) has gained tremendous momentum as a replacement for more cytotoxic oral rinses such as chlorhexidine. While accumulating evidence has thus far supported its use, little of the gathered data have fully described the properties of the oral formulation. Therefore, the aim of the present review article was 3-fold. First, a biological characterization regarding the active ingredients found in StellaLife Recovery Kit including their biological properties was assessed in 4 predominant categories; 1) antimicrobial resistance, 2) accelerated wound healing, 3) pain management control, and 4) anti-cancer properties. The second aim of this review article was to assess both fundamental and clinical research to date comparing VEGA oral rinse (StellaLife) to the more commonly utilized CHX for differences regarding their effect on decreasing bacterial loads as well as cell viability, survival, proliferation, and expression of both regenerative cytokines and inflammatory markers. Lastly, clinical case examples are presented describing the use of StellaLife remedies in a variety of clinical situations. These include but are not limited to wisdom-tooth extraction, extraction site management, dental implants and ridge augmentation, soft-tissue grafting procedures, frenectomies, and also temporary relief of dry sockets, dry mouth, aphthous ulcers, mucositis, lichen planus, among others. In summary, findings from the present review article provide evidence from basic laboratory experiments that validate clinical studies supporting the use of the StellaLife oral rinse regarding its superior biocompatibility and wound healing properties when compared to common antiseptic solutions such as CHX.

Comparing the Use of Diode Lasers to Light-Emitting Diode Phototherapy in Oral Soft and Hard Tissue Procedures: A Literature Review.

Objective: In dentistry, patient and physician adoption of diode lasers and light-emitting diodes (LEDs) continues to increase as research indicates that diode lasers and LEDs may be used for surgical and nonsurgical procedures. The goal of this literature review was to critically analyze randomized controlled trials and experimental trials to provide evidence-based recommendations on the therapeutic uses of diode lasers and LEDs in oral applications based on published efficacy and safety data. Methods: A literature review was performed of published literature on patients receiving periodontal and oral surgery treatment that included the use of diode lasers and/or the use of LED phototherapy to determine if the outcomes of phototherapy were superior to conventional therapy and if one form of phototherapy was superior to the other. Results: Eighteen original clinical trials and experimental studies were suitable for review. The diode laser was presented as an effective tool in soft tissue management due to its cutting precision, incision depth, analgesic effects, and elimination of bacterial load and in periodontal applications for probing depth reduction when used as an adjunct to scaling and root planing (SRP). LEDs also served as an effective tool for pain management, wound healing, and efficacy when used as an adjunct to SRP. Other than one study, all the available studies reviewed were either evaluating the efficacy of diode lasers or LEDs, but not both. Therefore, the results for determining the more effective tool were inconclusive. Conclusions: According to existent data, diode lasers and LEDs are equally effective tools for the phototherapy in periodontology and oral surgery. Although fewer studies exist examining the use of LED for phototherapy, the studies all revealed positive results. Further clinical comparative investigations utilizing both diode lasers and LED are needed to determine superiority of this application for periodontal management and oral surgery.

Efficacy of photobiomodulation therapy on neurosensory recovery in patients with inferior alveolar nerve injury following oral surgical procedures: a systematic review.

OBJECTIVE: The present systematic review aimed to assess the efficacy of photobiomodulation (PBM) therapy on neurosensory recovery of patients with inferior alveolar nerve injury following third molar surgery or dental implant placement. METHOD AND MATERIALS: An electronic search was carried out in Scopus, Embase, Medline, PubMed, Web of Science, Cochrane Library, and Google Scholar databases. Among 1,122 identified papers, seven articles (three RCTs, one observational study, and three case series) met the inclusion criteria.
Results: Time lapse from nerve injury to the onset of PBM therapy varied widely from 2 days to 4 years. The number of patients in each study ranged between 4 and 74. In the majority of the studies, PBM was done using a diode laser at wavelengths ?in the range of 808 to 830 nm with power of 5 to 500 mW and radiation dose of 3 to 244 J/cm2. Two out of three RCTs found significant neurosensory recovery in the patients who received PBM therapy compared to the controls. The observational study and all case series reported significant improvement in the neurosensory status following PBM therapy. The degree of neurosensory recovery was found to be greater in younger patients and those who received the treatment within 6 months following the injury.
Conclusions: Due to the limited number of well-designed RCTs and small number of patients in each study, it is not possible to make a clear conclusion about the efficacy of PBM therapy on neurosensory recovery in patients with inferior alveolar nerve injury following third molar or implant procedures. Considering the possibility of spontaneous inferior alveolar nerve recovery during this period, the conclusion based on the studies with no control group should be interpreted with caution. (Quintessence Int 2021;52:140-153; doi: 10.3290/j.qi.a45430).

Assessment of routine diet (garlic consumption) as a pre- and postoperative protocol in oral and maxillofacial surgical interventions: An evidence-based literature review.

BACKGROUND: It was hypothesized that pathological bleeding (PB) during and/or after oral surgical procedures is higher in systemically healthy patients who have a history of garlic intake compared to controls (patients without a history of garlic consumption). AIM: The aim of the present review article was to identify studies in which garlic consumption was included as a patient management protocol before and after oral and maxillofacial surgery (OMFS). METHODS: A review of pertinent indexed literature was performed. The focused question that was addressed was "Has diet (garlic consumption) been considered as a patient management protocol before and after OMFS?" The inclusion criteria were: (a) studies published in indexed databases, (b) original studies, (c) studies on OMFS, and (d) studies that considered diet (garlic consumption) as a patient management protocol before and after OMFS. Literature review, commentaries, letters to the editor, and studies published in non-indexed resources were excluded. The pattern of the present review was customized to summarize the pertinent information. RESULTS: The initial search using the terms "oral," maxillofacial," "protocol," and "surgery" yielded 1478 studies. The addition of the term "diet" to this search strategy reduced the number of studies to five. Further filtration of these studies using the terms "garlic" and/or "Allium sativum" showed no studies. CONCLUSIONS: Garlic intake predisposes patients to PB. However, there are no studies in the indexed literature that have considered the inclusion of garlic consumption in patient management protocols before and after OMFS.

Photobiomodulation in Periodontology and Implant Dentistry: Part 1.

(Part 2 of this article can be located at www.liebertpub.com/doi/10.1089/photob.2019.4731.) Objective: Finding evidence-based treatment strategies for low-level light therapy (LLLT) and the correct incorporation of these treatment methods in the clinical practice of periodontics. Background: Photobiomodulation has been shown to have biostimulatory, anti-inflammatory and analgesic effects that can be beneficial in periodontal and dental implant treatment procedures. Methods: In this review we have addressed some clinical questions regarding the potential clinical application of low-level light irradiation and its photobiomodulatory effects in periodontology and implantology. The literature was searched for in vivo (animal or clinical) articles written in English in four electronic databases of PubMed, Scopus, Google Scholar, and Cochrane Library until April 2019. Only studies with low irradiation doses without any thermal effects used only for their photobiomodulatory purposes were included. Results: We were able to find relevant studies for all of our questions, and positive effects for the application of light therapy were reported in most of the studies. However, there is still great deal of heterogeneity in terms of study designs and most importantly in light irradiation devices and the parameters used. Owing to this issue it was not possible to reach specific evidence-based irradiation protocols for the questions addressed in this review. Conclusions: Based on our search results, an obvious positive effect of LLLT on stimulation of healing of periodontal soft and hard tissues and reduction of inflammation can be seen. Future well-designed randomized control studies with the same irradiation settings and systematic reviews evaluating the studies found on the questions mentioned are necessary to reach evidence-based recommendations.

Photobiomodulation in Periodontology and Implant Dentistry: Part 2.

(Part 1 of this article can be located at www.liebertpub.com/doi/10.1089/photob.2019.4710.) Objective: Finding evidence-based treatment strategies for low-level light therapy and the correct incorporation of these treatment methods in the clinical practice of periodontics. Background: Photobiomodulation has been shown to have biostimulatory, anti-inflammatory, and analgesic effects that can be beneficial in periodontal and dental implant treatment procedures. Methods: In this review, we have addressed some clinical questions regarding the potential clinical application of low-level light irradiation and its photobobiomodulatory effects in periodontology and implantology. The literature was searched for in vivo (animal or clinical) articles written in English in four electronic databases of PubMed, Scopus, Google Scholar, and Cochrane Library until April 2019. Only studies with low irradiation doses without any thermal effects used only for their photobiomodulatory purposes were included. Results: We were able to find relevant studies for all of our questions, and positive effects for the application of light therapy were reported in most of the studies. However, there is still a great deal of heterogeneity in terms of study designs and most importantly in light irradiation devices and the parameters used. Due to this issue, it was not possible to reach specific evidence-based irradiation protocols for the questions addressed in this review. Conclusions: Based on our search results, an obvious positive effect of low-level light therapy on stimulation of healing of periodontal soft and hard tissues and reduction of inflammation can be seen. Future well-designed randomized control studies with the same irradiation settings and systematic reviews evaluating the studies found on the questions mentioned are necessary to reach evidence-based recommendations.

Photothermal Effects of Defocused Initiated Versus Noninitiated Diode Implant Irradiation.

Background: Diode lasers have been used for implant decontamination. However, the use of initiated or noninitiated tips remains unevaluated to verify potential photothermal risks. Objective: To assess the photothermal effects of defocused-initiated versus noninitiated irradiation. Materials and methods: A dental implant (3.5 × 11 mm) was placed into an artificial bone, an infrabony defect was created to simulate a four-wall peri-implant defect. Irradiation was performed using pulsed diode lasers of 940, 975, and 980 nm. The laser tips were positioned parallel to the implant (maximum 2W pulsed mode). The implant was irradiated for 30 sec using noninitiated, cork-, and blue paper-initiated tips. Temperature differences were observed at the apical and coronal regions of the implant. The data were statistically evaluated and compared using one-way analysis of variance and Tukey tests. Results: The average temperature increase and the amount of time that it took to yield the critical temperature were comparable at the coronal level for the 940 and 975 nm diode lasers (p > 0.05). For the 980 nm laser, blue-initiated tip had the highest temperature increase (22.4°C), followed by cork (18.8°C) and noninitiated tip (17.3°C). The critical threshold at the coronal portion for the 980 nm laser was reached in 11.5, 8.79, and 6.46 sec for the blue paper-, cork-, and noninitiated tips, respectively. The 975 and 980 nm lasers had average temperature increases, comparable among the blue paper-, cork-, and noninitiated tips at the apical level (p > 0.05). Apically, for the 940 nm, the noninitiated tip had the highest temperature increase (5.57°C), followed by the cork- (4.96°C) and blue paper-initiated tip (4.54°C). Conclusions: The initiator does not affect the temperatures produced during implant decontamination although noninitiated diode lasers may overheat (within 30 sec) than initiated tips. There is minimal risk of overheating at the apical portion. It seems that the 940 nm diode is the safest of the evaluated laser systems.

Influence of low-level laser therapy on orthodontically-induced inflammatory root resorption. A systematic review.

OBJECTIVE: The aim was to assess the influence of low-level laser therapy (LLLT) on orthodontically-induced inflammatory root resorption (OIIRR). METHODS: A systematic search was conducted in indexed databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The eligibility criteria were as follows: (a) original clinical and animal/experimental studies; (b) prospective studies; (c) intervention: effect of LLLT on OIIRR; (d) control group (OIIRR without LLLT); (e) statistical analysis; and (f) tomographic or histologic assessment of OIIRR. Quality assessment of the experimental and clinical studies was performed following the Animal Research Reporting In-vivo Experiments (ARRIVE) and Consolidated Standards of Reporting Trials (CONSORT) guidelines, respectively. The risk of bias of the included studies was also determined. RESULTS: Nine (7 experimental and 2 clinical) of the initially identified 39 studies were included. One clinical and 2 experimental studies showed that LLLT during orthodontic tooth movement (OTM) significantly reduces OIIRR. One experimental study reported that LLLT during OTM in sockets treated with alloplastic materials significantly reduces OIIRR. One experimental study found that LLLT after OTM significantly repairs OIIRR, whereas one clinical study did not report a significant reparative affect. Three experimental studies showed that LLLT increases OIIRR during OTM, corticotomized-OTM, and OTM into grafted defects, respectively. The minimum, median and highest ARRIVE scores (out of 20) of the included experimental studies were 15, 17 and 19, respectively. The mean CONSORT score of the included clinical studies was 23 (out of 25). CONCLUSIONS: In conclusion, the influence of LLLT on OIIRR remains debatable.

Various Tip Applications and Temperature Changes of Er,Cr:YSGG-Laser Irradiated Implants In Vitro.

The impact of the laser tip on implant temperature when irradiating implants with lasers to treat peri-implantitis has received little attention. The present study was designed to assess the influence of two laser tips (sapphire chisel [MC3] and radial firing perio [RFP]) on temperature change of an implant irradiated with an Er,Cr:YSGG laser in vitro under various operational conditions. The results suggest that Er,Cr:YSGG irradiation using either tip with supplemental cooling can be a thermally safe approach to implant decontamination. However, use of the RFP tip consistently resulted in a greater temperature rise. The MC3 tip thus may be preferable to the RFP tip for open-flap implant debridement.

Clinical and microbiological efficacy of 4% Garcinia mangostana L. pericarp gel as local drug delivery in the treatment of chronic periodontitis: A randomized, controlled clinical trial.

AIM: The aim of the present study was to assess the periodontal status of individuals and the presence of red complex microorganisms (RCM), such as Treponema denticola (Td), Porphyromonas gingivalis, and Tannerella forsythia in the subgingival tissues of periodontitis patients before and after the application of 4% mangostana gel (Garcinia mangostana [MGA]) as an adjunct to scaling and root planing (SRP). METHODS: Twenty-five patients (MGA group) were treated with SRP, and the subgingival application of mangostana gel was used as local drug delivery. Twenty-five patients (placebo group) were treated with SRP and placebo gel. Clinical parameters were recorded, and the presence of RCM was assessed at baseline and at the third month. RESULTS: Clinical parameters, such as probing pocket depth, clinical attachment level, bleeding index, plaque index, and Td, were significantly reduced in the MGA group compared to the placebo group from baseline to the third month. CONCLUSION: There was a significant improvement in the periodontal status with a reduction in Td with the application of mangostana gel in periodontal pockets. In the near future, 4% mangostana gel can be used as an adjunct to SRP to provide a new dimension to periodontal therapy.

Efficacy of Vitamin D3 Supplementation on Osseointegration of Implants.

PURPOSE: The aim was to systematically review the efficacy of vitamin D3 (VD3) supplementation on the osseointegration of implants. METHODS: The addressed focused question was "does VD3 supplementation affect osseointegration around implants?" Indexed databases were searched from 1969 up to and including March 2015 using various key words including: "Bone to implant contact"; "implant"; "vitamin D"; and "osseointegration." Letters to the editor, case reports/case series, reviews, and articles published in languages other than English were excluded. The pattern of the present systematic review was customized to primarily summarize the pertinent data. RESULTS: Six experimental studies (4 in rodents and 2 in rabbits) were included. Number of titanium implants placed ranged between 28 and 100 implants. Results from 5 studies showed that VD3 supplementation enhanced new bone formation and/or bone to implant contact (BIC) around implants. One study showed no significant difference in BIC and new bone formation around VD3 coated and noncoated implants. One study reported that insulin therapy with adjunct VD3 supplementation enhances new bone formation around implants in diabetic rats than when insulin replacement therapy is used alone. CONCLUSION: Efficacy of VD3 supplementation on osseointegration of implants remains controversial and requires further investigations.

Periodontal and peri-implant wound healing following laser therapy.

Laser irradiation has numerous favorable characteristics, such as ablation or vaporization, hemostasis, biostimulation (photobiomodulation) and microbial inhibition and destruction, which induce various beneficial therapeutic effects and biological responses. Therefore, the use of lasers is considered effective and suitable for treating a variety of inflammatory and infectious oral conditions. The CO2 , neodymium-doped yttrium-aluminium-garnet (Nd:YAG) and diode lasers have mainly been used for periodontal soft-tissue management. With development of the erbium-doped yttrium-aluminium-garnet (Er:YAG) and erbium, chromium-doped yttrium-scandium-gallium-garnet (Er,Cr:YSGG) lasers, which can be applied not only on soft tissues but also on dental hard tissues, the application of lasers dramatically expanded from periodontal soft-tissue management to hard-tissue treatment. Currently, various periodontal tissues (such as gingiva, tooth roots and bone tissue), as well as titanium implant surfaces, can be treated with lasers, and a variety of dental laser systems are being employed for the management of periodontal and peri-implant diseases. In periodontics, mechanical therapy has conventionally been the mainstream of treatment; however, complete bacterial eradication and/or optimal wound healing may not be necessarily achieved with conventional mechanical therapy alone. Consequently, in addition to chemotherapy consisting of antibiotics and anti-inflammatory agents, phototherapy using lasers and light-emitting diodes has been gradually integrated with mechanical therapy to enhance subsequent wound healing by achieving thorough debridement, decontamination and tissue stimulation. With increasing evidence of benefits, therapies with low- and high-level lasers play an important role in wound healing/tissue regeneration in the treatment of periodontal and peri-implant diseases. This article discusses the outcomes of laser therapy in soft-tissue management, periodontal nonsurgical and surgical treatment, osseous surgery and peri-implant treatment, focusing on postoperative wound healing of periodontal and peri-implant tissues, based on scientific evidence from currently available basic and clinical studies, as well as on case reports.

Histological and Histomorphometric Evaluation of Zirconia Dental Implants Modified by Femtosecond Laser versus Titanium Implants: An Experimental Study in Fox Hound Dogs.

PURPOSE: This study applied femtosecond laser technology to zirconia dental implants (Bredent GmbH & Co.KG, Senden, Germany) to generate a surface texture of microgrooves over the entire intraosseous surface, analyzing its behavior in an in vivo model in comparison with titanium implants with sandblasted and acid-etched surfaces. MATERIALS AND METHODS: The study used six American Fox Hound dogs. Each received four implants per hemi-mandible, making a total of eight implants per animal. The 48 immediate loaded implants were divided into two groups of 24 titanium implants (control group) and 24 zirconia implants (study/test group), distributed randomly. Bone-to-implant contact (BIC) values and crestal resorption were determined at 1 and 3 months, also measuring calcium, phosphorous, and carbon concentrations by means of energy dispersive x-ray. RESULTS: BIC percentages after 30 days were 51.36% for titanium implants and 44.68% for zirconia implants. After 90 days, values increased to 61.73% in titanium and 47.94% in zirconia implants. After 30 days, there was more crestal bone lost in the titanium group (0.77 mm) compared with the zirconia group (0.01 mm). After 90 days, zirconia implants showed greater marginal bone resorption (1.25 mm) compared with the titanium group (0.37 mm). CONCLUSIONS: The present study shows that zirconia implants with modified surfaces can produce good osseointegration values when compared with titanium implants in terms of BIC and crestal bone resorption at 1 and 3 months.

Thermodynamic effects of laser irradiation of implants placed in bone: an in vitro study.

Lasers have been proposed for various applications involving dental implants, including uncovering implants and treating peri-implantitis. However, the effect of laser irradiation on the implant surface temperature is only partially known. The aim of this pilot study was to determine the effect of irradiation with diode, carbon dioxide, and Er:YAG lasers on the surface temperature of dental implants placed in bone, in vitro. For this study, one dental implant was placed in a bovine rib. A trephine bur was used to create a circumferential defect to simulate peri-implantitis, and thermocouples were placed at the coronal and apical aspect of the implant. The implant was irradiated for 60 s using four different lasers independently and change in temperature as well as time to reach a 10 °C increase in temperature were recorded. There was wide variability in results among the lasers and settings. Time for a 10 °C increase ranged from 0.9 to over 60 s for the coronal thermocouple and from 18 to over 60 s for the apical thermocouple. Maximum temperature ranged from 5.9 to 70.9 °C coronally and from 1.4 to 23.4 °C apically. During laser irradiation of dental implants, a surface temperature increase beyond the "critical threshold" of 10 °C can be reached after only 18 s.

Role of dentifrices with essential oil formulations in periodontal healing.

INTRODUCTION: Essential oil (EO)-formulated dentifrices have significant effectiveness in reducing periodontal inflammation. This study aimed to review the role of dentifrices with EO formulations in periodontal healing. METHODS: Databases were explored from 1968 until March 2010. The focused question was what is the impact of dentifrices with EO formulations on periodontal wound healing? Databases were searched using the following terms in various combinations: "essential oil," "periodontal healing," "mouthrinse," "mouth-wash" and "periodontitis." RESULTS: Twenty studies were included. The numbers of participants ranged from 20 to 316 individuals (aged 18-70 years) and were rinsing with the EO-formulated dentifrices at least twice daily for 1 week to 48 weeks. Fourteen clinical studies showed reduced periodontal inflammatory conditions in the test group (individuals using EO dentifrices) compared with the placebo group. Three studies showed a reduction in periodontal pathogens in the test group compared with the placebo group. In 1 study, the microbiological findings remained inconclusive between the 2 groups. CONCLUSION: EO-formulated dentifrices have beneficial effects on the clinical and microbiological parameters of periodontal inflammation.

Temperature increase during CO(2) and Er:YAG irradiation on implant surfaces.

PURPOSE: The purpose of this study was to evaluate the temperature gradient (ΔT) generated by laser irradiation of an implant surface using a carbon dioxide (CO(2)) and an Erbium:yttrium aluminium garnet (Er:YAG) laser. MATERIALS AND METHODS: A dental implant was irradiated with a CO(2) and an Er:YAG lasers, with variable power settings. Temperature increase was measured in 2 locations of the implant surface: in the cervical area (ΔT(c)) and in the apical area (ΔT(a)). RESULTS: The CO(2) laser showed the following results: after 60 seconds of irradiation with continuous mode, ΔT(c) was 13.9°C and ΔTa was 12.5°C. The Er:YAG laser showed the following results: after 60 seconds of irradiation with continuous mode, the temperature rise ΔT(c) was 50.6°C and ΔT(a) was 38.6°C. The CO(2) laser with continuous mode generated a temperature increase of 10°C after only 36 seconds. The Er:YAG laser with continuous mode produced a more rapid temperature increase and took only 10 seconds to reach the critical threshold. CONCLUSIONS: The irradiation of implant surfaces with CO(2) and Er:YAG lasers may produce a temperature increase above the critical threshold (10°C) after 10 seconds of continuous irradiation.

Photodynamic therapy in periodontal therapy: microbiological observations from a private practice.

In recent years, the combination of laser light and photosensitizer known as photodynamic therapy (PDT) has been used in periodontal therapy. However, there are not enough clinical studies to fully evaluate the effects of PDT on the periodontal tissues. This microbiological study examined the effects of PDT on the periodontal bacteria in combination with scaling and root planing (SRP) in the same group of patients by randomly selecting PDT or SRP for use in different quadrants of the mouth. For the present study, PDT was compared with a diode laser (980 nm) and an Nd:YA G laser (1,064 nm). Microbiological samples were examined and evaluated over a period of three months. Significant bacterial reduction has been observed in all cases. The diode laser with SRP presented long-term positive results, while PDT showed a significant bacteria reduction during the entire observation period.