Adjunctive photobiomodulation to Basic Periodontal therapy using different low-power laser application techniques: a systematic review and meta-analysis.

To review current literature and synthesize clinical outcomes related to different low-level laser techniques as a complement to basic periodontal therapy (BPT). Electronic searches were conducted in PubMed, Cochrane, and Scopus, and clinical trials published from January 2013 to August 2023 using photobiomodulation as a complement to basic periodontal therapy, with a clear description of the laser technique, were included. The risk of bias was assessed using the Joanna Briggs Institute Critical Assessment Checklist. Estimates of interest were calculated using random effects meta-analyses. A total of 947 references were retrieved, and 22 studies were included for qualitative synthesis. Ten studies used intrasulcular laser techniques, with 89% using infrared wavelength, and 12 studies used transgingival techniques, with 61.5% using red wavelength. The frequency of photobiomodulation after BPT ranged from 1 to 9 sessions, with follow-up periods ranging from 5 days to 12 months. Risk of bias was considered low in 16 studies and moderate in six studies. Meta-analysis of 13 studies showed that BPT reduced probing depth at 4-, 12- and 24-weeks post-treatment, and improved clinical level attachment at 6-, 12- and 24-weeks post-treatment. Studies suggest that photobiomodulation may be a valuable complement in the treatment of periodontitis, especially using transgingival application technique.

A Narrative Review on Oral and Periodontal Bacteria Microbiota Photobiomodulation, through Visible and Near-Infrared Light: From the Origins to Modern Therapies.

Photobiomodulation (PBM) consists of a photon energy transfer to the cell, employing non-ionizing light sources belonging to the visible and infrared spectrum. PBM acts on some intrinsic properties of molecules, energizing them through specific light wavelengths. During the evolution of life, semiconducting minerals were energized by sun radiation. The molecules that followed became photoacceptors and were expressed into the first proto-cells and prokaryote membranes. Afterward, the components of the mitochondria electron transport chain influenced the eukaryotic cell physiology. Therefore, although many organisms have not utilized light as an energy source, many of the molecules involved in their physiology have retained their primordial photoacceptive properties. Thus, in this review, we discuss how PBM can affect the oral microbiota through photo-energization and the non-thermal effect of light on photoacceptors (i.e., cytochromes, flavins, and iron-proteins). Sometimes, the interaction of photons with pigments of an endogenous nature is followed by thermal or photodynamic-like effects. However, the preliminary data do not allow determining reliable therapies but stress the need for further knowledge on light-bacteria interactions and microbiota management in the health and illness of patients through PBM.

Macrophage response and surface analysis of dental cementum after treatment with high intensity focused ultrasound.

OBJECTIVE: To investigate effects of HIFU on macrophage phenotype, surface micro-topography and nano-scale surface mechanical properties of dental cementum. MATERIALS AND METHODS: Root discs (2 mm thickness) were cut apical to CEJ and sectioned into quadrants. HIFU setup with bowl-shaped piezo ceramic transducer submerged in a water tank was used for exposure on each specimen for 15 s, 30 s or 60 s. The specimens of the control group were left without any HIFU exposure. HIFU was generated with a continuous sinusoidal wave of 120Vpp amplitude, 250 KHZ resonance-frequency and highest ultrasonic pressure of ∼10 bar at the focus. Specimens for SEM were viewed, and micro-topography characterization performed, using AFM and Ra parameter and surface area (SA) calculated by specialized SPM surface analysis software. For nano-indentation testing, experiments were carried out using AFM. Macrophage cell isolation and culturing was performed on cementum to receive the HIFU treatment at different time periods. Raman spectroscopy were scanned to create spectra perpendicular to the cementum substrate to analyze generation of standard spectra for Raman intensity ratio of hydroxyapatite normalized to the peaks ν1 960 cm-1. Data was expressed as means ± standard deviations and analyzed by one-way ANOVA in term of Ra, SA, H and Er. Different points for fluorescence intensity ratio were analyzed by Raman using Wilcoxon rank sum test. RESULTS: HIFU exposure at 60 s removed the smear layer and most of cementum appeared smoothened. AFM characterisation, showed a slight decrease in the irregularity of the surface as exposure time increased. Intact macrophages can be identified in control and all experimental HIFU groups. The level of fluorescence for the control and HIFU 15 and 30 s were low as compared to HIFU 60 s. CONCLUSION: If HIFU can be successfully implemented, it may be a possible alternative to current methods used in periodontal therapy to achieve smooth root surfaces.

Evaluation of 660 nm LED light irradiation on the strategies for treating experimental periodontal intrabony defects.

This study aims to investigate the therapeutic value of 660 nm light-emitting diode (LED) light irradiation on the strategies for treating experimental periodontal intrabony defects in vivo. Large-sized periodontal intrabony defects were created bilaterally on the mesial aspect of the maxillary second molars of 48 Sprague-Dawley rats, and the rats were equally divided into four treatment groups with primary wound intention (n = 6/treatment/time point), including open flap debridement alone (OD), barrier membrane alone (MB), xenograft alone (BG), and xenograft plus barrier membrane (MG). Each group received daily 0 or 10 J/cm(2) LED light irradiation. The animals were sacrificed after 1 or 4 weeks. The treatment outcome was evaluated by gross observation of wound dehiscence and healing, micro-CT imaging for osteogenesis, and histological assessments for inflammatory cell infiltration and periodontal reattachment. With LED light irradiation, the extent of wound dehiscence was reduced, wound closure was accelerated, epithelial downgrowth was prevented, inflammation was reduced, and periodontal reattachment was promoted in all treatment strategies. Significant reduction of inflammation with LED light irradiation was noted at 1 week in the groups BG and MG (p < 0.05). Osteogenesis was significantly promoted only in the group OD at both time points (p < 0.05). Our study showed that 660 nm LED light accelerates mucoperiosteal flap healing and periodontal reattachment. However, the enhancement of osteogenesis appeared to be limited while simultaneously treating with a barrier membrane or xenograft.

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.

Is there a place for lasers in periodontal therapy?

This article aims to provide an overview on the clinical applications of lasers in periodontics.

Laser technology to manage periodontal disease: a valid concept?

UNLABELLED: Present day dental lasers can create oral environments conducive for periodontal repair. BACKGROUND AND PURPOSE: With the bacterial etiology of periodontitis and the resulting host inflammatory reaction, clinicians continue to search for therapeutic modalities to assist in the non-surgical management of periodontal disease. Traditional chairside therapies consist of mechanical debridement with manual and/or ultrasonic instrumentation with the objective of removing calculus, biofilm, and endotoxin from tooth root surfaces. Decreasing the microbial stimuli and associated end products decreases the inflammatory reaction and allows the host an opportunity to regenerate tissue through wound healing. The purpose of this article is to examine whether dental lasers, which have been in use for the past 3 decades, may augment traditional non-surgical periodontal therapy. METHODS: Review of research publications related to lasers and non-surgical periodontics with attention focused on systematic studies. CONCLUSIONS: Studies utilizing laser technology may demonstrate positive effects on 1) selectively decreasing the biofilm environment, 2) removing calculus deposits and neutralizing endotoxin, 3) removing sulcular epithelium to assist in reattachment and decreased pocket depth, and 4) biostimulation for enhanced wound healing. Comparisons of studies to determine the difference between lasers and their respective effects on the periodontium are difficult to assess due to a wide variation of laser protocols.

Efeito da terapia ativa não cirúrgica e da manutenção periodontal em indivíduos com câncer em região de cabeça e pescoço: um estudo prospectivo, controlado e pareado / Effect of non surgical active therapy and maintenance periodontal in individuals with head and neck cancer: a prospective study, controlled and paired

Estudos que investigam a condição periodontal em pacientes submetidos à radioterapia em região de cabeça e pescoço mostram aumento da perda de inserção periodontal, que pode ser explicada por uma associação de fatores como ação direta da radiação sobre os tecidos, acúmulo de biofilme bacteriano e por alteração da resposta imunológica do hospedeiro. Entretanto, estes estudos são poucos e com tamanho amostral reduzido. A proposta deste estudo prospectivo foi avaliar a condição da doença periodontal em pacientes submetidos à radioterapia associada ou não à quimioterapia (grupo caso) comparada a pacientes não submetidos a este tratamento (grupo controle). O estudo foi aprovado pelo Comitê de Ética em Pesquisa da Universidade Federal de Minas Gerais. Uma amostra de conveniência foi selecionada por fluxo contínuo (n=56). Os grupos caso e controle (n=28) foram homogeneizados com relação a sexo, idade, tabagismo, etilismo e diagnóstico clínico periodontal no baseline. A medida basal (T0) dos parâmetros clínicos periodontais como: sangramento à sondagem (SS), profundidade à sondagem (PS), nível de inserção clínica (NIC) e recessão gengival (RG), e do índice de placa (IP), executado em todos os dentes, foi feita antes do início do tratamento oncológico. O tratamento periodontal foi realizado segundo as necessidades do paciente. Avaliações periodontais foram realizadas em até 15 dias após o término da radioterapia (T1), 180 dias (T2) e 1 ano (T3) para o grupo caso. Para o grupo controle, as avaliações periodontais foram feitas 3 meses após a primeira avaliação, seguidas de mais duas avaliações com intervalo de 6 meses entre elas. Medidas descritivas dos parâmetros periodontais foram relatadas em frequência absoluta, relativa e em valores médios e percentuais quando adequados. Para cada paciente, as médias de PS, NIC e RG foram obtidos dividindo-se a soma dos valores clínicos periodontais pelo número de sítios examinados...

[Low power laser efficacy in the therapy of inflamed gingive in diabetics with parodontopathy].

BACKGROUND/AIM: There is clear evidence on direct relationship between periodontal disease and diabetes mellitus. Many investigations point out greater prevalence and severity of periodontal disease among diabetic patients. During last decade, low level laser therapy has been used in periodontal therapy. It has biostimulative effect, accelerates wound healing, minimizes pain and swelling, and there is almost no contraindication for its usage. The aim of the paper was to investigate the efficiency of low level laser therapy as adjuvant tool in reduction of gingival inflammation in diabetic patients. METHODS: The study incuded 150 participants divided into three groups: group I (50 participants with diabetes mellitus type 1 and periodontal disease), group II (50 participants with diabetes mellitus type 2 and periodontal disease), group III (nondiabetic participants with periodontal disease). Gingival health evaluation was done using gingival index Löe-Silness. Soft and hard deposits were removed, periodontal pockets cleaned and GaA1As low level laser therapy (5 mW) applied five consecutive days. In each patient, low level laser therapy was not applied on the left side of the jaw in order to compare the effects of the applied therapy. After the first, third and fifth therapy and one month after the last visit gingival index was evaluated. Before the first and after the fifth therapy exfoliative cytology of gingiva was done and nuclei areal was analyzed morphometrically. RESULTS: After all investigated periods, gingival index and nuclei areal were significantly decreased comparing to values before the therapy, at both jaw sides (p < 0.001). After the 1st, 3rd and 5th therapy, the t-test showed a significantly decreased gingival index at the lased side of jaw comparing to non-lased side. CONCLUSION: Low level laser therapy is efficient in gingival inflammation elimination and can be proposed as an adjuvant tool in basic periodontal therapy of diabetic patients.

[Effectiveness of chronic periodontal disease treatment by infrared laser light].

Thirty-six patients with light and moderate chronic periodontal disease (CPD) were included in the study. The patients were divided in two groups according to treatment options: first group (18 patients) received conventional periodontal treatment, second (18 patients) - in addition to conventional treatment were treated by phototherapy (infrared laser light). Control group included 10 persons with no signs of periodontal disease. Treatment effectiveness was assessed by local cytokine profile (IL-1ß, IL-1ra, IL-6, IL-10, TNF-α, OPG and RANKL). Increased level of inflammatory cytokines TNF-α, IL-1ß, IL-6 confirmed pronounced inflammation in periodontal tissues in CPD patients. OPG level was lower than in control group while RANKL level increased significantly. After treatment in both CРD groups TNF-α and IL-6 decrease was observed, IL-1ß (had not changed. In the second group RANKL level also decreased dramatically - 6.7-fold compared to its values before treatment.

Análise fractal de radiografias dentais antes e após tratamento periapical

Apropriando-se dos conhecimentos da Geometria Fractal com este trabalho procuramos caracterizar o processo da doença periodontal correlacionando esta ciência com imagens radiográficas de um caso clínico com diagnóstico de...

Laser phototherapy in the treatment of periodontal disease. A review.

Many studies in the literature address the effect of low-power lasers in the management of pathologies related to periodontal tissues. Due to the lack of standardized information and the absence of a consensus, this review presents the current status of laser phototherapy (LPT) in periodontics and discusses its benefits and limits in the treatment of periodontal disease. The literature was searched for reviews and original research articles relating to LPT and periodontal disease. The articles were selected using either electronic search engines or manual tracing of the references cited in key papers. The literature search retrieved references on wound and bone healing, analgesia, hypersensitivity, inflammatory process and antimicrobial photodynamic therapy. Each topic is individually addressed in this review. The current literature suggests that LPT is effective in modulating different periodontal disease aspects in vitro, in animals, and in simple clinical models. Further development of this therapy is now dependent on new clinical trials with more complex study designs.

Non-surgical periodontal therapy assisted by potassium-titanyl-phosphate laser: a pilot study.

As the American Academy of Periodontology indicates, the treatment of chronic periodontitis should be achieved in the least invasive manner through non-surgical periodontal therapy. However, complete removal of subgingival plaque and calculus is hindered with increasing probing depth (PD) and furcation involvement using hand, sonic or ultrasonic instruments. Many authors have suggested that the use of laser as an adjunct to scaling and root planing (SRP) might improve the effectiveness of conventional periodontal treatment. The aim of this study was to evaluate potassium-titanyl-phosphate (KTP) laser in non-surgical periodontal therapy. Seven hundred and thirty sites with probing depths of 4-6 mm were involved in the study. The sites were divided into four groups: control (SRP, chlorhexidine gel 0.5%), group A (SRP, chlorhexidine gel 0.5%, three sessions of KTP laser irradiation); group B (SRP, three sessions of KTP laser irradiation) and group C (SRP, irrigation with povidone-iodine 10%, three sessions of KTP laser irradiation). KTP laser was used with the following parameters: output power 0.6 W, time on 10 ms, time off 50 ms, 30 s per irradiation, fluence 19 J/cm(2). All the sites showed improvement in all clinical parameters. Clinical attachment loss (CAL), pocket probing depths (PPDs) and bleeding on probing (BOP), especially in the lased groups, showed significant results (P < 0.001). Our experience showed KTP laser to be a significant help in SRP; nevertheless, more studies are necessary to confirm our results.

Low level lasers in dentistry.

Low level laser therapy (LLLT) uses light energy, in the form of adenosine triphosphate (ATP), to elicit biological responses in the body. The increased cellular energy and changes in the cell membrane permeability result in pain relief, wound healing, muscle relaxation, immune system modulation, and nerve regeneration. This article investigates the clinical effects of LLLT and explains how it can be applied in the dental field.

Low level laser in odontostomatology practice, a critical review / Láser de baja potencia en la práctica odontoestomatológica, una revisión bibliográfica

The application of laser as a therapeutic measure in nervous regeneration in dentistry has not been a discussed subject, even though the knowledge about the response of the peripheral nervous system is very important inpractice as well as in the recovery of the patient. It has been proposed that low-level laser (LLL) therapy has beneficial effects on tissues; LLL therapy acts as an analgesic, anti-inflammatory, anti-edematous, anti-cellulitic tool, and it stimulates cellular trofism. In the present study, we conducted a meta-analysis of available literature regarding the response of the injured nerveto low-power laser using search engines EBSCO and PUBMED. The literature refers to the stimulant effect of the low-level laser in the neoformation of vessels and to the existing bibliographic evidence to propose that this mechanism is important in nervous regeneration. There is limited bibliographic evidence on the effects of LLL therapy in dentistry.

La aplicación de láser como medio terapéutico en la regeneración nerviosa en odontología, no ha sido un tema muy discutido, aún cuando el conocimiento de la respuesta del sistema nervioso periférico es muy importante tanto en la práctica como en la recuperación del paciente. Se ha propuesto que el láser de baja potencia (LBP) tiene efectos benéficos en los tejidos, entre ellos antiálgico, antiinflamatorio, antiedematoso, anticelulítico y bioestimulante del trofismo celular. En el presente estudio se realizó un metaanálisis de la literatura disponible en relación con la respuesta del nervio lesionado ante la aplicación de láser de baja potencia utilizando los buscadores EBSCO y PUBMED. La literatura se refiere al efecto estimulante del LBP en la neoformación de vasos y existiendo evidencia bibliográfica para proponer a este mecanismo como importante en la regeneración nerviosa. Los efectos del láser de baja potencia en Odontología presentaron una escasa evidencia bibliográfica.

Toluidine blue-mediated photoinactivation of periodontal pathogens from supragingival plaques.

This study aimed to assess the effect of toluidine blue (TB)-mediated photodynamic inactivation of periodontal pathogens (PP) from periodontopathic patients. Photodynamic therapy (PDT) was carried out using TB and 635 nm laser light irradiation. The bactericidal effect was evaluated, and important PDT parameters including light intensity, energy dose, and TB concentration were determined. Our findings suggest that TB-mediated lethal photosensitization of PP in vivo is possible. However, to obtain ideal bactericidal effect, higher doses of light and photosensitizer should be required in treatment in vivo than their planktonic counterparts. The best therapeutic effect was observed in treatment by 1 mg/ml TB combined with 12 J/cm(2) at 159 mW/cm(2) light irradiation. Moreover, because of the considerable interindividual differences of bacterial populations, TB-mediated PDT might not be equally effective among periodontopathic patients, and further studies on improvement of this therapeutic modality is needed.