Relevance of Teledentistry: Brief Report and Future Perspectives.

Teledentistry is a type of telemedicine and telehealth that aims to make all major specialties of the discipline easier through a remote approach to prevention and treatment of oral and dental issues. This new method enables distant access to individuals instead of direct, face-to-face, doctor-patient contact and has been made possible thanks to developments in information technology. Teledentistry was described in 1997 as "… the practice of using video-conferencing technologies to diagnose and provide advice about treatment over a distance", and today it represents a modern way to practice dentistry by integrating digital imaging, electronics, health records, and telecommunications technology via an internet connection. This approach facilitates patients' access to care in remote settings and also enables specialists at distant locations to arrive at a correct diagnosis as well as to propose proper therapy or refer patients, where warranted. The current brief report aims to describe the present and future of this modern approach in dentistry and its advantages in patient management from prevention to diagnosis to treatment.

Use of Blue and Blue-Violet Lasers in Dentistry: A Narrative Review.

Introduction: Blue and blue-violet diode lasers (450 and 405 nm) seem to represent an interesting approach for several clinical treatments today. The aim of this narrative review is to describe and comment on the literature regarding the utilization of blue and blue-violet lasers in dentistry. Methods: A search for "blue laser AND dentistry" was conducted using the PubMed database, and all the papers referring to this topic, ranging from 1990 to April 2020, were analyzed in the review. All the original in vivo and in vitro studies using 450 nm or 405 nm lasers were included in this study. All the articles on the LED light, laser wavelengths other than 405 and 450 nm and using lasers in specialties other than dentistry, as well as case reports, guideline papers and reviews were excluded. Results: From a total of 519 results, 47 articles met the inclusion criteria and were divided into 8 groups based on their fields of application: disinfection (10), photobiomodulation (PBM) (4), bleaching (1), resin curing (20), surgery (7), periodontics (1), endodontics (1) and orthodontics (3). Conclusion: Blue and blue-violet diode lasers may represent new and effective devices to be used in a large number of applications in dentistry, even if further studies will be necessary to fully clarify the potentialities of these laser wavelengths.

"At-Home" Photobiomodulation: A New Approach for Bell's Palsy Treatment.

OBJECTIVE: This report is the first one to describe the possibility to use "self-administered" photobiomodulation (PBM) for Bell's palsy (BP) treatment. BACKGROUND: BP is a peripheral disorder of the facial nerve causing sudden paralysis of unilateral facial muscles, and PBM has been successfully suggested for its treatment without any side effect. This is the first case report where a laser device was successfully used at home by the patient herself to treat BP opening new perspectives on the therapy of this disease. METHODS: This report describes the "at-home PBM" treatment performed on a 15-year-old girl who presented BP consisting of acute pain on the right side of her face, difficulty in biting and dripping saliva from the right side of her lips. The treatment was performed twice a day by cutaneous applications, each of 15 minutes (total fluence 48 J/cm2) in an area corresponding to the parotid gland by a device emitting at 808 nm at 250 mW output power. RESULTS: Two weeks after PBM treatment, performed at home twice a day by the patient herself without any kind of pharmacological therapy, the complete disappearing of the disease was noticed with no side effects. CONCLUSION: With the limitations due to a single case report and with the need of further clinical trials to confirm it, "at-home PBM" seems to represent a good and safe approach to the treatment of BP.

Nanosecond pulsed fiber laser irradiation for enhanced zirconia crown adhesion: Morphological, chemical, thermal and mechanical analysis.

The increasing demand for aesthetics, together with advancements in technology, have contributed to the rise in popularity of all-ceramic restorations. In the last two decades, the continuous progression in ceramic materials science for dental applications has permitted the fabrication of high-strength materials. Amongst these, zirconia-based ceramics have improved in terms of fracture resistance and long-term viability in comparison with other silica-based materials. Unfortunately, while bonding of resin cement-silica ceramics can be strengthened through creation of a porous surface by applying hydrofluoric acid (5%-9.5%) and a subsequent silane coupling agent, the glass-free polycrystalline microstructure of zirconia ceramics does not allow such a reaction. The aim of the present in vitro study was to observe the effect of 1070 nm fiber nanosecond pulse laser irradiation on zirconia samples through morphological analysis (profilometry, SEM), thermal recording with Fiber Bragg Gratings (FBGs), elemental composition analysis (EDX) and bond strength testing (mechanical tests) in order to evaluate the possible advantages of this kind of treatment on zirconia surfaces, as well as to show the potential side effects and changes in chemical composition. Despite laser irradiation with a 1070 nm wavelength fiber laser and correct process parameters demonstrating suitable outcomes in terms of improved surface roughness and minimal thermal damage, comparison between irradiated and unirradiated samples did not exhibit statistically significant differences in terms of bonding strength.

Bactericidal effect of Er,Cr:YSGG laser irradiation on endodontic biofilm: An ex vivo study.

AIM: This ex vivo study aimed to evaluate the of Er,Cr:YSGG laser effectiveness in the decontamination of an endodontic biofilm. MATERIALS AND METHODS: Seventy-three single rooted human teeth, freshly were chosen. Each tooth was exposed to four associated species in an endodontic biofilm (Enterococcus faecalis, Streptococcus salivarius, Porphyromonas gingivalis, and Prevotella intermedia) and randomly allocated to one of the seven experimental groups. The group 1 (7 teeth) was used to finalize the reliable biofilm-forming technique. The groups 2 and 3 (15 teeth each group) were irradiated with two different Er;Cr:YSGG laser settings (0,75 W - 40 Hz and 4 W - 40 Hz, respectively). The groups 4 and 5 (15 teeth each group) were irrigated with two different solutions and laser irradiated with the same settings (1,5 W - 15 Hz). The group 6 (6 teeth) was the control group treated only with 4 ml 2,5% NaOCl irrigation during 60 s. RESULTS: The observations of group 2 and 3 specimens showed the ripeness of the biofilm with the presence of Enterococcus faecalis and Streptococcus salivarius in chains but in group 3 thermal edge effects produced by the optic fiber in the canal walls were present. The group 4 specimens observation showed an average cleaning of the root canal walls while on the canal walls of group 5 samples the apical third presented several debris and smear layer and in the centre cracks and melting dentin of the radicular wall were observed. CONCLUSION: In those experimental conditions, this study, demonstrated that Er,Cr:YSGG laser has a canals decontamination ability when associated to NaOCl irrigation.

Auto-Administered Photobiomodulation on Diabetic Leg Ulcers Treatment: A New Way to Manage It?

BACKGROUND: Peripheral arterial disease is a dramatic consequence of an uncontrolled diabetic condition causing an increase of morbidity and mortality and its treatment is currently medical or surgical, finally requiring, in the 7-20% of cases, major or minor amputation. Photobiomodulation therapy (PBM) is a laser treatment used in medicine, thanks to its ability to stimulate the wound healing, the acceleration of inflammatory process, and the modulation of pain. Recently, the self-administration of the treatment has been suggested for different purposes in medicine and dentistry with a great number of advantages and no side effects. METHODS: A 84-year-old woman affected by diabetes type 2 and positive for diabetes complications had diagnosis for an ulcerative lesion of 1 cm diameter on her right leg and started a treatment of the lesion applying the B-Cure Laser Pro (Erika Carmel, Haifa, Israel) on her own with a fluence per minute of 3.2 J/cm2 for 2 sessions of 15 minutes by cutaneous application. RESULTS: After a week of treatment, the ulcer dried and crusted, finally providing complete healing after 30 days of treatment. CONCLUSION: With this short case report, we think to add a further contribution by suggesting this kind of treatment for successful management of the leg ulcers in diabetic patients.

Focal Infection and Periodontitis: A Narrative Report and New Possible Approaches.

The "focal infection theory" is a historical concept based on the assumption that some infections may cause chronic and acute diseases in different districts of the body. Its great popularity spanned from 1930 to 1950 when, with the aim to remove all the foci of infection, drastic surgical interventions were performed. Periodontitis, a common oral pathology mainly of bacterial origin, is the most evident example of this phenomenon today: in fact, bacteria are able to migrate, develop and cause health problems such as cardiovascular and respiratory diseases, diabetes, and osteoporosis. The aim of this narrative report is to verify the hypothesis of the association between oral infections and systemic diseases by different ways of approach and, at the same time, to propose new kinds of treatment today made possible by technological progress. The analysis of the literature demonstrated a strong relationship between these conditions, which might be explained on the basis of the recent studies on microbiota movement inside the body. Prevention of the oral infections, as well as of the possible systemic implications, may be successfully performed with the help of new technologies, such as probiotics and laser.

Nd:YAP laser in the treatment of dentinal hypersensitivity: An ex vivo study.

PURPOSE: The aims of this ex vivo study were to evaluate the effectiveness of the Nd:YAP laser in the treatment of dentin hypersensitivity, to compare the temperature rise during laser irradiation at three different dentine thicknesses, and to analyse the composition of the dentine-lased surface. METHODS: A total of 33 teeth were used in this study. For scanning electron microscopy (SEM) observation, 24 teeth were transversely sectioned and divided into 4 groups: group A was irrigated with EDTA; group B was irradiated by Nd:YAP laser with 180 mJ energy/per pulse, 0.9 W average power, and 5 Hz frequency (power density [PD] = 229 W/cm2); group C was irradiated by Nd:YAP laser with 280 mJ energy/pulse, 1.4 W average power, and 5 Hz frequency (PD = 356 W/cm2); and group D was irradiated by Nd:YAP with 360 mJ energy/pulse, 1.8 W average power, and 5 Hz frequency (PD = 458 W/cm2). Energy-dispersive spectroscopy (EDS) analysis was performed on the same teeth evaluated for SEM observations. For temperature increase evaluation performed with thermocouples, 9 teeth were transversely sectioned at 3 different thicknesses (3 for each group) of 1, 2, and 3 mm. RESULTS: Statistical analysis showed significant changes in the diameter of the dentinal tubule orifices among all groups; EDS did not show modification of the Ca/P ratio. Temperature increase under irradiation exceeded 5.5 °C only in the group D samples. CONCLUSIONS: This ex vivo study, based on temperature recording, SEM observation, and EDS analysis, demonstrated that Nd:YAP laser at a PD of 356 W/cm2, corresponding to an average power of 1.4 W, defines the best treatment for dentine hypersensitivity in terms of compromise between efficacy of the treatment and safety of the pulp.

Photobiomodulation in Pediatric Dentistry: A Current State-of-the-Art.

Objective: Given the tremendous progress in biophotonics applications in biology and engineering, we sought to examine the evidence for the use of low-dose biophotonics treatments, termed photobiomodulation (PBM) therapy, in pediatric dentistry. Background: PBM therapy has been noted to alleviate pain and inflammation while promoting tissue healing and regeneration. These basic processes contribute to the fundamental etiopathogenesis of various oral diseases, and hence, there is now a growing list of potential clinical applications with PBM therapy in children. Materials and methods: An exhaustive literature search was conducted for PBM studies in pediatric dentistry that includes patients up to 21 years of age. An analysis of the quality of the included studies was also performed to evaluate the rigor of the evidence. Specific emphasis was placed on the treatment efficacy on the relevant specified outcomes for individual applications. Results: From a total of over 420 initial hits, 19 studies were deemed suitable for inclusion in this review. Among them, PBM therapy has been used in pediatric dentistry for prevention and treatment of oral mucositis associated with oncotherapy (chemotherapy, radiation, and transplants), for postsurgical oral pain and for pulpotomies. Overall, all studies reported therapeutic benefits, and no adverse effects were reported. Conclusions: This review noted that PBM therapy is a safe and effective treatment modality for various clinical applications in pediatric dentistry. Despite potential positive publication bias, there appears to be clear evidence of clinical benefit with this treatment, and we recommend well-designed randomized, placebo-controlled human clinical trial be pursued.

Photobiomodulation Therapy in Oral Medicine: A Guide for the Practitioner with Focus on New Possible Protocols.

Photobiomodulation (PBM) is the term to define the wide range of laser applications using low-energy densities and based on photochemical mechanisms where the energy is transferred to the intracellular mitochondrial chromophores and respiratory chain components. In literature, a great number of works are reported showing the advantages of PBM use in many oral diseases such as recurrent aphthous stomatitis, herpes infections, mucositis, and burning mouth syndrome. Different factors may explain the increasing reported use of PBM in oral medicine: the absence of side effects, the possibility of safely treating compromised patients such as oncologic patients, the possibility of a noninvasive approach not associated with pain or discomfort, and the possibility of performing short sessions. The review's aim is to describe the possible applications of PBM in oral medicine, giving practitioners simple guide for practice together with the information of a new treatment possibility "at home" performed by the patient himself under supervision.

Er:YAG laser for the aesthetic treatment of developmental enamel defects in frontal teeth: a case report.

BACKGROUND AND AIMS: Several studies highlighted how the ameloblasts, secretory cells responsible of the tooth enamel formation, are highly sensitive to changes in their environment. Due to enamel maturation, their dysfunctions during a limited period of tooth development may lead to permanent morphological consequences, namely Developmental Enamel Defects (DED). The aim of this study was to show the advantages of Er:YAG laser for DED treatment. SUBJECTS AND METHODS: The case report presented describes the treatment, by Er:YAG laser, of some DED lesions present in the upper incisors of a young patient. The settings used were: 1W power, 100mJ energy, 10 Hz frequency corresponding to a Fluence of 0.318 J/cm2 per pulse or 3, 18 J/cm2. RESULTS: The patient, even in absence of local anesthesia, did not feel any pain or discomfort during and after intervention. Follow-up at 2, 6 and 12 months did not show any problems in an aesthetic point of view as well as regarding hypersensitivity. CONCLUSIONS: The use of Er:YAG laser for the treatment of developmental enamel defects in frontal teeth is a safe, painless and minimally invasive; moreover, it is able to assure a good aesthetic result.

Effect of laser irradiation on aphthae pain management: A four different wavelengths comparison.

Recurrent Aphthous Stomatitis (RAS) is an oral condition characterized by painful ulcerations of the mucosa, healing spontaneously in 10-14 days but sometimes, due to their number, size and frequency of recurrence, lesions may be the cause of a severe disconfort with an impact on the quality of life of the patients due to the increased difficulty to eat, swallow and speak. For RAS, different protocols and treatments have been proposed as standard topical treatment to provide symptomatic relief, immunomodulating drugs as thalidomide, colchicine and steroids have been also proposed with the outcome to relief the pain, accelerating the healing process and increase the duration of ulcer-free period but without definitive results and without side effects. In this study we analysed the effect of laser treatment of aphthous lesions with four devices available on the market, two with wavelength in the infra-red region (2940 nm 808 nm) and two with a wavelength in the visible region (450 nm and 635 nm). Diode lasers 808 nm and 450 nm defined almost the same results with an improvement starting already after the application and gradually improving until 7 days after treatment without any statistically significant difference between them. Diode 635 nm was the device gaining the earliest effect reducing the pain already during the treatment and maintaining it at low level immediately after the laser application and after 3 and 7 days with levels of pain comparable with them obtained with 808 nm and 450 nm lasers. Er:YAG laser with the used parameters obtained a pain relief only during the treatment. The originality of this study was to compare different laser wavelengths, some of them never used for this purpose, and to compare also the two different ways to use lasers, the photobiomodulation (LLLT) and the high-power irradiation.

Hard dental tissues laser welding: a new help for fractured teeth? A preliminary ex vivo study.

BACKGROUND AND AIM: An important surgical goal is to provide a first intention wound healing without trauma produced by sutures and for this aim in the past several methods have been tested. The aim of this ex vivo preliminary study was to demonstrate the capacity of a 1070 nm pulsed fiber laser to treat the dental fractures by enamel and dentine melting with the apposition of hydroxyapatite nanoparticles as filler. METHODS: Out of thirty freshly-extracted human third molars, decay-free, twenty-four cylinders of 5 mm thickness were obtained to perform the test.The device used was a 1070 nm Yb-doped pulsed fiber laser: this source has a maximum average output power of 20 W and a fixed pulse duration of 100 ns, while the repetition rate ranges from 20 kHz to 100 kHz. The samples were divided in three groups (a, b, c) of eight teeth and each specimen, with the two portions strictly placed side by side, was put inside the box and irradiated three times, the first and the second at 30 kW and the last at 10 kW peak power (average powers of 60 and 20 W).The repetition rate was maintained at 20 kHz for all the tests as well as the speed of the beam at 10 mm/sec.The samples of the group a were irradiated without apposition, in the group b nanoparticles (< 200 nm) of hydroxyapatite were put in the gap between the two portions while in the group c, a powder of hydroxyapatite was employed. RESULTS: Only the specimens of the group b showed a real process of welding of the two parts, while specimens of groups a and c did not reach a complete welding process. CONCLUSION: This ex vivo preliminary study, based on the enamel and dentine welding obtained by a 1070 nm pulsed fiber laser associated to the hydroxyapatite nanoparticles, may represent a new and original approach for the treatment of the fractured teeth, even if further studies will be necessary to confirm these results.

CO2 laser dentin surface treatment most effectively increased ceramic shear bond strength.

BACKGROUND AND AIMS: The purpose of this study is to determine the effect of CO2 laser irradiation in comparison with sandblasting (Sb), hydrofluoric acid (Hf) and silane coupling agent (Si) on shear bond strength (SBS) of resin cement to CAD/CAM ceramics bonded to dentin. MATERIAL AND METHODS: Forty-eight (CAD/CAM) ceramic discs were prepared and grouped by material, i.e. lithium disilicate (Emax CAD) and zirconia ceramic (Emax ZirCAD), distributed into four different groups: group A, lithium disilicate (Li) CO2/HF/Si; group B, Li: HF/Si; group C, zirconia (Zr) CO2/Sb/Si; group D, Zr: Sb/Si. RESULTS: It was shown significant difference between irradiated and non-irradiated groups in terms of shear bond strength for zirconia ceramics (p value = 0.039). CONCLUSION: CO2 laser irradiation increases shear bond strength for both CAD/CAM ceramics bonded to dentin.

Disilicate Dental Ceramic Surface Preparation by 1070 nm Fiber Laser: Thermal and Ultrastructural Analysis.

Lithium disilicate dental ceramic bonding, realized by using different resins, is strictly dependent on micro-mechanical retention and chemical adhesion. The aim of this in vitro study was to investigate the capability of a 1070 nm fiber laser for their surface treatment. Samples were irradiated by a pulsed fiber laser at 1070 nm with different parameters (peak power of 5, 7.5 and 10 kW, repetition rate (RR) 20 kHz, speed of 10 and 50 mm/s, and total energy density from 1.3 to 27 kW/cm²) and the thermal elevation during the experiment was recorded by a fiber Bragg grating (FBG) temperature sensor. Subsequently, the surface modifications were analyzed by optical microscope, scanning electron microscope (SEM), and energy dispersive X-ray spectroscopy (EDS). With a peak power of 5 kW, RR of 20 kHz, and speed of 50 mm/s, the microscopic observation of the irradiated surface showed increased roughness with small areas of melting and carbonization. EDS analysis revealed that, with these parameters, there are no evident differences between laser-processed samples and controls. Thermal elevation during laser irradiation ranged between 5 °C and 9 °C. A 1070 nm fiber laser can be considered as a good device to increase the adhesion of lithium disilicate ceramics when optimum parameters are considered.

Erbium-Doped, Yttrium-Aluminum-Garnet Laser Debonding of Porcelain Laminate Veneers: An Ex vivo Study.

BACKGROUND: The use of ceramic laminate veneer has considerably and successfully grown to improve anterior tooth esthetics in recent years. The removal of ceramic laminate veneers with laser is reported only in a scanty number of publications and for this reason the importance and the aim of this ex vivo study consist to verify the ability of Er: YAG laser for laminate veneers debonding with the preserving of the tooth structures (scanning electron microscopy [SEM] observations). AIM: The purpose of this study consists to verify if erbium-doped, yttrium-aluminum-garnet (Er:YAG) laser, at low fluences, is able to debond porcelain veneers, successfully used to improve anterior tooth esthetics, without damaging the tooth structures. SETTINGS AND DESIGN: A total of 12 freshly extracted teeth were used, and samples were decontaminated, stored, and bonded to obtain veneers adhesion. One week after, Er:YAG laser with a non-contact sapphire tip with air-water spray was used for veneer debonding at 100 mJ of energy and 30 Hz of frequency (Fluence 19.94 J/cm2). RESULTS: Results demonstrated that veneer debonding is possible with an Er:YAG laser and the total number of pulses seems not related to its efficiency. SEM observation confirms that residual tooth structure is not altered when using these low fluences. CONCLUSIONS: Low fluences with Er:YAG laser are able to debond veneers while preserving the tooth structures and SEM observation confirmed that residual tooth structure is not altered with low fluences.

Microhardness evaluations of CAD/CAM ceramics irradiated with CO2 or Nd:YAP laser.

BACKGROUND AND AIMS: The aim of this study was to measure the microhardness values of irradiated computer-aided design/computer-aided manufacturing (CAD/CAM) ceramics surfaces before and after thermal treatment. MATERIALS AND METHODS: Sixty CAD/CAM ceramic discs were prepared and grouped by material, i.e. lithium disilicate ceramic (Emax CAD) and zirconia ceramic (Emax ZirCAD). Laser irradiation at the material surface was performed with a carbon dioxide laser at 5 Watt (W) or 10 W power in continuous mode (CW mode), or with a neodymium:yttrium aluminum perovskite (Nd:YAP) laser at 10 W on graphite and non-graphite surfaces. Vickers hardness was tested at 0.3 kgf for lithium disilicate and 1 kgf for zirconia. RESULTS: Emax CAD irradiated with CO2 at 5 W increased microhardness by 6.32 GPa whereas Emax ZirCAD irradiated with Nd:YAP decreased microhardness by 17.46 GPa. CONCLUSION: CO2 laser effectively increases the microhardness of lithium disilicate ceramics (Emax CAD).

At-home laser treatment of oral neuronal disorders: Case reports.

The neuronal disorders occurring in the oral district are mainly anaesthesia, paraesthesia, hypoesthesia and hyperaesthesia and they may occur frequently after surgical procedures. Medical treatment depends on degree of severity of the nerve injury but, in every case, it must be immediately carried out to reduce immune inflammatory reaction. The aim of this report is to investigate the effectiveness in the recovery of the peripheral nerve lesions of a new laser device recently proposed by the commerce that, due to its reduced size and to be a class I laser according the ANSI classification, may be used at home by the patient himself. Three different cases were treated with this "at-home approach": complete resolution of symptomatology was obtained after laser treatment with a good compliance for the patient and without reporting any side effect. Key words:Laser, biomodulation, low level laser therapy, oral neuronal disorders, at-home treatment, paresthesia.

Use of photo-Fenton's reaction by 400-nm LED light for endodontic disinfection: A preliminary in vitro study on Enterococcus faecalis.

One of the biggest challenges in endodontics is the complete disinfection of root canals. In addition to mechanical preparation, the technique traditionally also involves channel disinfection with other agents such as sodium hypochlorite, hydrogen peroxide, chlorhexidine, or a combination of these. Some bacterial species are particularly resistant to eradication. Using Enterococcus faecalis in this preliminary study, we tested the bactericidal effectiveness of the Fenton reaction and the photo-Fenton reaction using an LED light with a 400-nm wavelength. Discs of hydroxyapatite were incubated in brain-heart broth contaminated with Enterococcus faecalis. After 4days, they were decontaminated with different bactericidal agents, including some with proven and well-known efficacy (5% sodium hypochlorite and 3% hydrogen peroxide) and other treatments using solutions of 1.5% hydrogen peroxide and 0.15% iron gluconate (Fenton reaction) plus LED light at a Fluence of 4.0J/cm2 (photo-Fenton reaction). The photo-Fenton reaction demonstrated comparable performance to that of sodium hypochlorite in eliminating Enterococcus faecalis.