Bottle-feeding and gastroesophageal reflux disease improvement after restrictive tethered oral tissues release.

Aim: This study aimed to determine the impact of laser surgical tongue-tie, lip-tie, buccal-tie release on bottle-feeding and gastroesophageal reflux disease (GERD) after functional assessment of tongue and lip movement in a prospective cohort study conducted from June 2019 to June 2020 in a private general dental practice. Methods: Preoperative, one-week and one-month postoperative surveys were completed, using the Revised Infant Gastroesophageal Reflux Questionnaire (I-GERQ-R). All study participants were bottle-feeding dyads (0-12 weeks of age) with untreated ankyloglossia and/or tethered maxillary/buccal frena. Results: The study had 40 bottle feeding infants enrolled. Posterior :tongue-tie was noted in 67.5% of this cohort. Statistically significant improvement in I-GERQ-R scores was reported between preoperative (16.6, SD: 6.1; min-max: 8-28), 1 week (14.1, SD: 4.2; min-max: 6-24) and 1 month I-GERQ-R total scores (9.1, SD: 4.5; min-max:3-27) (ANOVA test - P <.001). Conclusion: This study confirms the need for functional assessment of tongue and lip movement for this significantly affected cohort when surgical release is proposed. Laser surgical release (frenotomy) of tongue-tie, lip-tie, buccal-tie resulted in significant improvement in I-GERQ-R outcomes were found for cohorts of the classically recognised anterior tongue-tie and the less obvious (without functional assessment) and less diagnosed posterior tongue tie were found.

Short lingual frenum in infants, children and adolescents. Part 2: Lingual frenum release. Functional surgical approach.

AIM: The aim of this study was to review the craniofacial growth impairment and different malfunctions associated with short lingual frenum and to assess the validity of lingual frenum surgery based on minimally invasive laser release with a myofunctional approach. MATERIALS AND METHODS: Thirty patients, children and adolescents whose ages ranged from 8 years to 18 years, diagnosed with a short lingual frenum and concomitant orthodontic problems and/or presence of associated muscular or postural problems, were treated in this study. Pre-operative tongue assessment was performed following morphological and functional criteria, consisting of measurement of the free tongue, and of visual assessment of tongue protrusion out of the mouth and elevation to the incisive palatal papilla. Postural evaluation was assessed in frontal and lateral view. Laser surgery was completed with local anaesthesia, using Erbium YAG laser (2940 nm, LightWalker, AT-Fotona, Ljubljana, Slovenia) equipped with sapphire conical tip (600 micron), with energy ranging from 120 to 160 mJ, at 15 Hz frequency, and varying the adjustable pulse duration from 300 µs to 600 µs. RESULTS: Significant improvement was noted in 29 of 30 patients comparing preoperative scores to both three-week and two-month post-op scores. Postural improvement was found in 18 of 30 patients, indicating the multifactorial involvement of different causes for correct body posture. CONCLUSION: This study confirmed the validity of Erbium:YAG laser surgery as an effective technique in children and adolescents to release a short lingual frenum. The functional approach of the procedure performed with the Erbium:YAG laser, and the concomitant myofunctional therapy demonstrated to be simple and safe in children, and adolescents. Because of the multifactorial causes involved in correct body posture, an adequate osteopathic therapy is important to successfully complete the full body rehabilitation.

Short lingual frenum in infants, children and adolescents. Part 1: Breastfeeding and gastroesophageal reflux disease improvement after tethered oral tissues release.

AIM: This study aimed to determine the impact of laser surgical tongue-tie, lip-tie, buccal tie release on breastfeeding and Gastroesophageal Reflux Disease (GERD) in a prospective cohort study conducted from June 2019 to June 2020 in a private general dental practice. MATERIALS AND METHODS: Preoperative, one-week and one-month postoperative surveys were completed, consisting of Visual Analogue Scale (VAS) for nipple pain severity, Breastfeeding Self-Efficacy Scale Short Form (BSES-SF), and the Revised Infant Gastroesophageal Reflux Questionnaire (I-GERQ-R). All study participants were breastfeeding dyads (0-12 weeks of age) with untreated ankyloglossia and/or tethered maxillary/buccal frena. The laser surgery was completed using 2 different near- infrared diode lasers with 300µm diameter fibre: a 980 nm wavelength diode laser (Lasotronix Smart Pro, Piaseczno Poland) was used at 4.0 W, gated with 100 µs t/on and 100 µs t/off, and a 1470 nm wavelength diode laser (Pioon S1, Wuhan Pioon Tech Co Ltd., Wuhan, China), used at 3.5W, gated with 50 ms t/on and 50 ms t/off. RESULTS: Statistically significant improvement was noted in VAS, I-GERQ-R and BSES-SF comparing preoperative scores to both one-week and one-month scores. The study had 132 breastfeeding dyads enrolled. Posterior tongue-tie was noted in 71% of this cohort. CONCLUSION: This study confirms the need for functional assessment of tongue and lip movement for this significantly affected cohort. Laser surgical release (frenotomy) of tongue-tie, lip-tie, buccal-tie resulted in significant improvement in breastfeeding outcomes. These improvements (VAS, I-GERQ-R and BSES-SF) in breastfeeding outcomes were found for cohorts of the classically recognised anterior tongue-tie and the less obvious (without functional assessment) submucosal tongue-tie were found.

Laser labial frenectomy: a simplified and predictable technique. Retrospective clinical study.

AIM: Anomalous maxillary median labial frenum may be associated with undesired effects such as persistence of diastema between anterior teeth or traction of marginal gingiva. The aim of this study was to propose a surgical frenum repositioning technique that is minimally invasive, safe, easy, reproducible, and predictable. Another objective of the study was to identify clinical scenarios that could have indication for labial frenectomy associated with early orthodontic therapy, so as to justify early frenum repositioning in children. A retrospective assessment of clinical outcomes of this technique is described. MATERIALS AND METHODS: A total of 20 frenectomies were performed on children aged 8 to 10 years. Frenectomies were performed with Er:YAG laser set at 150mJ 2.25-3.0W and 15-20 pulse per second, with water spray. Recall visits were done at 7, 21 and 90 days and 1, 2, 3 and 4 years. RESULTS: At post-operative visits, all patients reported no post-operative pain or minimal discomfort. None experienced post-operative bleeding at a distance of few hours. All patients reported that the procedure was well tolerated and "acceptable". No recurrences occurred 4 years after frenectomy. CONCLUSION: The Er:YAG laser used in this study allowed considerable reduction of the operating time, reducing the amount of local anaesthetic used as well as avoiding surgical sutures. The surgical design and technique also minimised post-operative discomfort and complications resulting in stable healing overtime, making the procedure fully accepted by children.

Paediatric laser dentistry. Part 2: Hard tissue laser applications.

AIM: Erbium lasers can provide effective and minimally invasive caries removal in children. The bonding phase remains a critic step as well as the choice of material. Glass ionomers exhibits lower bonding properties in laser irradiated teeth compared to the conventional method or to composite and resin modified glass ionomer. Laser can also provide effective decontamination and coagulation effects in vital and non vital pulp therapy of primary teeth, improving and simplifying the cleaning and disinfecting steps.

Paediatric laser dentistry. Part 1: General introduction.

AIM: Knowledge of the physical characteristics of different laser lights and optical and thermal properties of oral tissues is very important to understand the interaction of dental lasers with biological tissues. Choosing the correct dental laser is crucial to match specific wavelengths with target chromophores of different tissues; this affinity makes laser irradiation selective and therefore minimally invasive. Various types of lasers are used in dentistry, offering a viable alternative to low and high-speed handpieces and surgical blades, and also minimising fear and discomfort of the patient. Lasers can provide innovative and minimally invasive therapies in different branches of dentistry including preventive and restorative dentistry, traumatic injury treatments and surgical procedures. Laser has also biostimulating and anti-inflammatory effects, as well as analgesic effect.

Paediatric laser dentistry. Part 4: Soft tissue laser applications.

AIM: Lasers can provide effective soft tissues applications in children. All the wavelengths produce incision and vaporisation of oral tissues, together with a high bactericidal effect. The haemosthatic effect varys according to the wavelength used, and the choice of a visibile, near, medium or far infrared laser allows a better interaction with specific targets, gingiva, mucosa, frenum, or oral pathology.

Tooth developmental anomalies in severe combined immunodeficiency disease and juvenile myelomonocytic leukemia: common clinical features and treatment outcomes.

AIM: Human Severe Combined Immunodeficiency (SCID) is a prenatal disorder of T lymphocyte development that depends on the expression of numerous genes. Juvenile myelomonocytic leukemia (JMML), previously known as juvenile chronic myeloid leukemia (JCML), is a rare, myelodysplastic/myeloproliferative disease typically presenting in early childhood. CASE REPORTS: Two cases are described of immunodeficiency disorders, both treated with chemotherapeutic drugs (Busulfan plus cyclophosphamide) before bone marrow transplantation. After treatment, these two different cases showed several similar oral lesions: microdontia, root alterations, numerous tooth ageneses, incomplete calcification, enamel hypoplasia, premature apexification and hypodontia. Both subjects underwent dental and orthodontic treatment. The first phase comprised orthopaedic treatment using a removable appliance (Interim-G®) followed by rapid palatal expansion; in the second phase patients underwent tooth extraction and were treated using fixed appliances for 19 and 26 months, respectively (mean 2 years) to obtain final alignment and maximum intercuspation. In the third and final phase, reconstruction of malformed teeth was completed, and implant-supported protheses were applied. CONCLUSION: The difficulties of managing and treating these diseases are discussed, with particular focus on tooth anomalies and malocclusion disorders. Collaboration between dentist and paediatrician in dealing with patients with a variety of oral lesions and tooth anomalies is important in order to prevent any other possible tooth lesions and ensure correct jaw development.

Lingual frenectomy: functional evaluation and new therapeutical approach.

AIM: When ankyloglossia is relatively severe and generates mechanical limitations and functional challenges, surgical reduction of the frenum is indicated. MATERIALS AND METHODS: Laser technique is an innovative, safe and effective therapy for frenectomy in both children and adolescents. Erbium:YAG laser (2940nm) can be useful for paediatric dentist: 1.5W at 20pps is a commonly used average power to easily, safely and quickly cut the frenum. RESULTS: Usually after laser frenectomy, the postoperative symptoms and relapse are absent. CONCLUSION: Early intervention is advisable to reduce the onset of alterations correlated to the ankyloglossia. A multidisciplinary approach to the problem is advisable, in collaboration with orthodontist, physiotherapist and speech therapist, to better resolve the problem.

Effectiveness of the erbium:YAG laser and new design radial and stripped tips in removing the smear layer after root canal instrumentation.

The aim of this study was to analyze in vitro the debriding ability of an Er:YAG laser system (2,940 nm) equipped with a newly designed radial and stripped tip of 400 µm diameter by scanning electron microscopy (SEM). A total of 80 single-rooted extracted human teeth were endodontically prepared with rotary instrumentation and standardized chemical irrigation using 5.25% sodium hypochlorite. At the end of mechanical instrumentation, four different final protocols were used. Group 1 was irrigated for 2 min with saline water as a control group. Groups 2, 3 and 4 were irradiated with an Er:YAG laser at 25 mJ and 15 Hz with a pulse duration of 50 µs and laser spray off using the tip in the coronal opening of the wet root canal. Different solutions and irradiation times were used: group 2 20 s, laser irradiation in sterile distilled water, wet canal; group 3 20 s, laser irradiation in 17% EDTA, wet canal; and group 4 40 s, laser irradiation in 17% EDTA, wet canal. Debridement of and smear layer removal from the apical third of root canals were evaluated by SEM. The study showed that standardized instrumentation, followed by a final Er:YAG laser irradiation in wet canals with EDTA irrigation resulted in more cleaning of the root canal walls and a higher quantity of open tubules in comparison with the traditional irrigation method.

Laser restorative dentistry in children and adolescents.

BACKGROUND: The idea of substituting a drill with a laser light, has led to its introduction in dentistry. Besides being more accepted to patients, in paediatric dentistry the laser has demonstrated safety compared with rotating instruments. REVIEW: A review of the past 20 years of the dental literature concerning laser use in dentistry, including paediatric dentistry was completed. The findings of that review are presented. TECHNIQUES: The various types of lasers and their uses for caries detection, tooth sealing and caries removal are described. RESULTS: Laser caries detection demonstrated a good reproducibility, reliability and predictability to monitor the caries process over time. Erbium lasers have been found to be efficient for caries removal, tooth cleaning and decontamination. CONCLUSION: The laser erbium technology represents a safe device to effectively and selectively remove carious tissues from decayed teeth. For children, all the recognized advantages of this technique play a decisive role in the successful day-to-day treatment of dental caries.

Lasers in dental traumatology and low level laser therapy (LLLT).

BACKGROUND: Dental trauma in children is a frequent and often complex clinical event in which laser-assisted therapy, particularly using erbium lasers, can offer new treatment possibilities, improving the outcomes and reducing the associated complications. REVIEW: In particular, it is worth considering that the use of laser-assisted therapies is associated with a marked reduction in the use of analgesics and anti-inflammatory medications compared with conventional procedures. Laser anaesthesia is another interesting and challenging area. CONCLUSION: Given the paucity of data on laser-assisted dental trauma therapy in the international literature and the absence of well-structured guidelines, this is an area ripe for scientific research.

Lasers in dental traumatology.

AIM: Dental traumas are frequent in children. They can be complex events and sometimes real emergencies. Since very little attention is devoted to this topic in the international literature and there are no well-coded laser guidelines for these specific clinical events, our aim is to consider and present those situations in which laser-assisted therapy can offer new treatment possibilities. The authors' aim is to stimulate more extensive scientific research in this area, which might not only increase the use of these technologies, but also improve outcomes and reduce complications connected to dental trauma, particularly in children. Furthermore, laser-assisted therapies drastically reduce the need for analgesics and anti- inflammatory medications compared with conventional procedures. CONCLUSION: Using laser equipment to obtain anaesthesia is another challenge, while the use of low power setting for desensitising tissue and to obtain anaesthesia is also an open field.

Use of laser technology in orthodontics: hard and soft tissue laser treatments.

AIM: Modern technology has perfected a new instrument that has become almost indispensable in modern dentistry, in accordance with the philosophy of minimally invasive therapy: the laser. The aim of this work is to evaluate the effectiveness and efficacy of laser technology to solve mucogingival problems associated with orthodontic treatment. Some laser wavelengths work both on hard and soft tissues (2780 nm, 2940 nm), other lasers, such as the 810 nm diode, have a very good surgical and haemostatic action on soft tissues and an important analgesic and biostimulating effect that can help the healing of both TMJ painful symptoms as well as the pain following active orthodontic treatment. Several cases connected to orthodontic therapy are presented. MATERIALS AND METHODS: Different laser systems (diode laser at 810 nm; Er,Cr:YSGG laser at 2780 nm; Erbium:YAG laser at 2940 nm) were used, both for soft tissue surgery and enamel etching, and for biostimulating effect. These wavelengths were used with different parameters for each case, according to international current studies in view of minimally invasive therapy. RESULTS: The cases reported showed very quick and good healing of the laser treated tissues. These treatments, necessary for the orthodontic therapy or for its completion, become extremely simple, safe and rapid and the orthodontic specialist can perform them himself. CONCLUSION: The laser technique is very effective in many operative and surgical procedures during orthodontic therapy. Further studies are however necessary to set the treatment protocols in orthodontic biostimulation.

Evidence-based dentistry on laser paediatric dentistry: review and outlook.

AIM: The goal of paediatric dentistry is to provide preventive education to parents and patients as well as interception and therapy of dental diseases in a minimally invasive way using a stress-free approach. Different laser wavelengths are used for different applications following these minimally invasive concepts: argon, KTP, diode, Nd:YAG, and CO2 lasers are used for soft tissue applications and the erbium family is used for both soft and hard tissue procedures. This paper offers a revision and a discussion of the international literature, showing also some clinical procedures. related to these scientific studies. Soft tissues laser applications in Pediatric Dentistry include application in oral surgery as well as in periodontics and orthodontics. Laser applications on hard tissues include caries prevention and detection and application for sealing of pits and fissures. Also application for cavity preparation, carious removal and pulp therapy are discussed.

Laser in paediatric dentistry: patient acceptance of hard and soft tissue therapy.

AIM: This study aimed to evaluate the laser therapy efficacy in paediatric dentistry, considering the subjective tolerance and acceptance of therapy in children needing both dental and soft tissue treatments. METHODS: A group of 50 patients from 6 to 12 years of age, needing both hard and soft tissue therapy was selected and treated, without anesthesia, with an Er,Cr:YSGG laser 2780 nm and an Er:YAG laser 2940 nm for a total of 100 treatments performed; before and after the treatment the patients experience was tested with Wong-Baker modified facial image scale. RESULTS: The study showed a good percentage of acceptance and tolerance of both laser treatments: a success rate of 90 % for hard tissues and 63% for soft tissues was obtained; for the total 100 treatments the acceptance was of 75%. CONCLUSION: The Erbium lasers are very effective in paediatric dentistry and are good treatment options.

Removal of fibrous epulis with Er,Cr:YSGG laser: case report.

BACKGROUND: Epulis is a benign tumour located in the area of the alveolar bone, periodontal ligament and marginal gingiva. A clinical case of Epulis, treated using an Er,Cr:YSGG laser in our Paediatric Dentistry division of the PTV Hospital, University of Rome Tor Vergata, is described. CASE REPORT: A pink, sessile, broad-based lesion, elastic in consistency, was detected on the maxillary vestibular gum above the lateral right incisor. The lesion was removed with Er,Cr:YSGG laser (2780 nm) without anaesthetic infiltration, power ranged from 1,5 to 2,0 Watts at 20 Hz repetition rate under 20%-15% air-water spray. The histopathological examination confirmed the diagnosis of fibrous epulis. The immediate postoperative course was excellent, with no pain or need for anti-inflammatory or analgesic drugs. Wound healing was good after 1 week, and was completed after 1 month. The patient was followed up for 3-6 months, and checked again after 1 and 2 years to assess possible relapse. The Er,Cr:YSGG laser has several treatment advantages, fundamental in Paediatric Dentistry: it requires only topical anaesthesia, it has a high clinical safety, there is a short treatment time, no surgical sutures are required; no complications were encountered during or immediately following laser surgery, all resulting in excellent patient cooperation.

Pulp capping: advantages of using laser technology.

AIM: Pulp capping represents the boundary between conservative and endodontic therapy. The importance of this technique, which considerably improves the prognosis of the tooth, justifies the quest for new techniques and technologies: the most recent literature reports more predictable results (approximately 90%) with cappings performed using laser of different wavelengths, compared to traditional procedures, which report a success rate of approximately 60%. The purpose of this work is to assess the efficiency of laser technology combined with the use of a self-hardening calcium hydroxide base in pulp capping procedures performed on decayed permanent teeth. MATERIALS AND METHODS: This study was carried out on 34 patients, aged between 11 and 18 years (average 14,5) who needed pulp cappings for deep caries affecting permanent teeth (8 front and 26 back). They were divided into three groups based on the operative protocol employed: traditional technique, laser-assisted technique using Er,Cr:YSGG lasers (2780 nm) and laser assisted technique using Erbium:YAG lasers (2940 nm); all patients were asked to return for follow-up visits (anamnesis, vitality testing and intraoral x-ray) scheduled at 1, 3, 6, 12 months, 2 and 4 years; other 30 cases on adult patients (19 to 40 years, average 27,1), treated with the same methods, were used as control group. RESULTS: Traditional technique group showed a success of 63% (adult control group 50%); Er,Cr:YSGG laser-assisted technique showed a success rate of 80% (adult control group 80%); Erbium:YAG lasers laser-assisted technique showed a success rate of 75% (adult control group 70%). All age groups had good success rates with the pulp capping technique, regardless of the technique used. CONCLUSION: Laser technology proved effective in improving the prognosis of pulp capping procedures on teeth affected by deep caries pathology.