Ozone therapy effect in medication-related osteonecrosis of the jaw as prevention or treatment: microtomographic, confocal laser microscopy and histomorphometric analysis.

OBJECTIVE: This study aimed to evaluate the efficacy of ozone therapy in the preoperative (prevention) and/or postoperative (treatment) of MRONJ. MATERIAL AND METHODS: Forty male Wistar rats were caudally treated with zoledronic acid (ZOL) and to ozone therapy before extraction (prevention, POG), after extraction (treatment, TOG), or both (prevention and treatment, TPOG), and treated with saline (SAL). The animals received intramuscular fluorochrome (calcein and alizarin), and 28 days postoperatively, they were euthanized, and the tissues were subjected to microtomographic computed tomography (microCT), LASER confocal, and histomorphometric analyses. RESULTS: Micro-CT showed a higher bone volume fraction average in all groups than that in the ZOL group (P < 0.001), the ZOL group showed high porosity (P = 0.03), and trabecular separation was greater in the TOG group than in the POG group (P < 0.05). The mineral apposition rate of the POG group was high (20.46 ± 6.31) (P < 0.001), followed by the TOG group (20.32 ± 7.4). The TOG group presented the highest mean newly formed bone area (68.322 ± 25.296) compared with the ZOL group (P < 0.05), followed by the SAL group (66.039 ± 28.379) and ZOL groups (60.856 ± 28.425). CONCLUSIONS: Ozone therapy modulated alveolar bone repair in animals treated with ZOL, mainly after surgery trauma, leading to bone formation as healing tissue. CLINICAL RELEVANCE: Osteonecrosis has been a challenge in dentistry, and owing to the lack of a consensus regarding therapy, studies presenting new therapies are important, and ozone has been one of the therapies explored empirically.

Photobiomodulation Therapy Improves Postoperative Pain and Edema in Third Molar Surgeries: A Randomized, Comparative, Double-Blind, and Prospective Clinical Trial.

PURPOSE: Laser light has biological effects that can modulate inflammatory processes. Thus, this study aimed to evaluate the effects of photobiomodulation (PBM) therapy on pain, edema, and trismus after the extraction of retained third molars. METHODS: A split-mouth, double-blind, randomized clinical trial (RCT) was conducted in 13 patients with similar bilateral third molars who received intraoral application PBM therapy at 4 points with a diode laser at 810 nm wavelength, 6 J (100 mW, 60 seconds/point) on 1 side (the PBM side); and laser irradiation simulation on the other side (SHAM side). The pain was assessed through visual analog scale (VAS) at 0, 12, 24, 48, and 72 hours, number of analgesic-relief (NAR), and mean time of first analgesic use; edema, through VAS, and linear facial measurements at 0, 24, 48, and 72 hours; and trismus, through the mouth opening measurements at 0, 24, 48, and 72 hours. The repeated-measures analysis was applied to assess the effect of the treatment, followed by Tukey's post hoc test for multiple comparisons (P < .05). RESULTS: Thirteen patients (61.77% male and 38.63% female) with age of 24.16 ± 2.06 participated in this research. VAS showed that PBM controlled pain better (7.56 ± 6.25) than SHAM (32.25 ± 22.78) at 24 hours (P < .001) and 48 hours (19.47 ± 9.27 and 39.87 ± 4.21, respectively) (P = .011). VAS also showed that PBM controlled edema better (19.7 ± 13.27) than SHAM (32.38 ± 15.28) at 24 hours (P = .037) and 48 hours (19.47 ± 13.11 and 39.87 ± 22.77, respectively) (P = .002). CONCLUSION: The PBM therapy in this study resulted in pain and edema reduction after third molar surgery and may be considered as adjuvant therapy after the surgical procedure.

Protocolo de laser de baixa potência na prevenção de dor, edema e trismo decorrente de extrações de terceiros molares inferiores retidos: estudo clínico, comparativo, randomizado e duplo cego / The effect of lowlevel laser protocol on the prevention of pain, edema and trismus due to retained lower third molar extractions: a clinical, comparative, randomized, double blind study

O objetivo desse ensaio clínico randomizado (split mouth) foi avaliar um protocolo de laser de baixa potência, no controle de dor, edema e trismo após extração de terceiros molares retidos. Foram selecionados 13 pacientes com terceiros molares inclusos bilateralmente e com posição semelhante foram utilizados para um estudo de boca dividida. Os pacientes foram distribuídos de forma randomizada, conforme o tratamento administrado, Lado Laser: dose única de laser de baixa potência no comprimento de onda 810 nm, 6 J (100 mW, 60s/ponto); e lado sham: simulação de aplicação do laser. Após a cirurgia realizada, os pacientes foram acompanhados três dias consecutivos para avaliação da 1) Dor, através da média de consumo de analgésico de resgate (NAR), Escala Visual Analógica (EVA) nos períodos de 0h, 1h, 2h, 3h, 12h, 24h, 48h, 72h e média do tempo de consumo do primeiro analgésico; 2) Edema, através da EVA, e média obtidas das medidas faciais lineares obtidas entre o ângulo mandibular até canto do olho, do tragus até comissura labial e do tragus até mento (porção central) nos períodos de 0h, 24h, 48h, 72h; 3) Trismo, através da média de abertura bucal nos períodos de 0h, 24h, 48h, 72h. Os resultados da EVA mostram que o laser controlou melhor a dor nos períodos de 3 (p = 0,010), 24 (p = 0,002), e 48 horas (p = 0,013). Não houve diferença entre Laser e Sham para NAR (p = 0,329) e para o tempo necessário para o primeiro consumo de analgésico (p = 0,462). Os resultados da EVA para edema mostram que o laser controlou melhor nos períodos de 24 (p = 0,041) e 48 horas (p = 0,013). A redução da abertura bucal foi menor no grupo Sham em todos os períodos avaliados (p < 0,05). Conclui-se que o protocolo de laser utilizado nessa pesquisa permitiu redução de dor e edema, conduto sem efeito para o trismo(AU)

The aim of this randomized clinical trial (split mouth) was to evaluate a low intensity laser protocol to control pain, edema and trismus after extraction of retained third molars. . For this, 13 patients with similarly positioned bilateral third molars were used and each patient served twice as a sample unit. Patients were randomized according to the treatment they would receive, laser side: single low power laser at 810 nm wavelength, 6 J (100 mW, 60s / dot); and sham side: laser application simulation. After surgery, patients were followed for three consecutive days to assess 1) Pain, by means of rescue analgesic consumption (NAR), Visual Analog Scale (VAS) in the periods of 0h, 1h, 2h, 3h, 12h , 24h, 48h, 72 h and mean time of first analgesic use; 2) Edema, through VAS, and mean obtained from the linear facial measurements obtained between the mandibular angle to the corner of the eye, the tragus to the labial commissure and the tragus to the chin (central por tion) in the periods of 0h, 24h, 48h, 72h; 3) Trismus, through the mouth opening average in the periods of 0h, 24h, 48h, 72h. The VAS results show that the laser better controlled pain at periods of 3 (p = 0.010), 24 (p = 0.002), and 48 hours (p = 0.013). There was no difference between Laser and Sham for NAR (p = 0.329) and for the time required for the first analgesic use (p = 0.462). VAS results for edema show that the laser controlled better at 24 (p = 0.041) and 48 hours (p = 0.013). Mouth opening redu ction was smaller in the Sham group in all periods evaluated (p <0.05). It is concluded that the laser protocol used in this research allowed pain and edema reduction, conduit without effect for trismus(AU)

Low-level laser therapy stimulates the oxidative burst in human neutrophils and increases their fungicidal capacity.

Low-level laser therapy (LLLT) is known to enhance mitochondrial electron transfer and ATP production; thus, this study asked whether LLLT could stimulate the oxidative burst in human neutrophils (PMN) and improve their ability to kill microorganisms. Blood from healthy human subjects was collected and PMN were isolated from the samples. PMN were treated in vitro with 660 nm or 780 nm CW laser light at 40 mW power and increasing energies up to 19.2 J and were subsequently incubated with Candida albicans cells. Generation of hydroxyl radicals, hypochlorite anions and superoxide anions by PMN were checked using fluorescent probes and chemiluminescence assays; a microbicidal activity assay against C. albicans was also performed. LLLT excited PMN to a higher functional profile, which was translated as superior production of reactive oxygen species (ROS) and increased fungicidal capacity. The most efficacious energy was 19.2 J and, interestingly, the 660 nm light was even more efficacious than 780 nm at increasing the respiratory burst of PMN and the fungicidal capacity. Human neutrophils (PMN) were stimulated in vitro with 660 nm or 780 nm CW laser light at 40 mW of power and a total energy of 19.2 J. Low-level laser therapy (LLLT) excited PMN to a higher functional profile, which was translated as a superior production of reactive oxygen species (ROS) such as hydroxyl radicals (HO• ) and hypochlorite anions (ClO- ) (Figure) and increased fungicidal capacity against Candida albicans cells.