In vitro comparative study between adhesion forces obtained on zirconia ceramic micromechanically treated with femtosecond laser (1027 nm), carbon dioxide laser (10,600 nm), and aluminum-oxide particles.

Conventional surface roughening treatments used for silica-based ceramics in order to improve subsequent adhesion become unreliable for zirconia ceramics. Laser conditioning can be a good alternative. The purpose of this in vitro study was to compare conventional (macro) shear bond strength (SBS) values obtained between resin composite and zirconium oxide ceramic samples grouped according to different micromechanical treatments received, and examine differences in surface roughness. One-hundred and fifty disks of sintered zirconia were randomly divided into 5 groups and roughened as follows: (1) Group NOT, no surface treatment; (2) Group APA, abraded with 50-µm aluminum-oxide (Al2O3) particles; (3) Group TBS, abraded with 30-µm aluminum-oxide particles covered with silica; (4) Group CO2, irradiated with a CO2 laser which emitted in continuous wave mode at 3 W of power; and (5) Group FEM, irradiated with a pulsed femtosecond laser, with an incident energy of 10 µJ, a frequency of 1000 Hz, and a fluence of 1.3 kJ/cm2. All surfaces were treated with a MDP-containing adhesive/silane coupling agent mixture upon which were prepared and light polymerized composite resin cylinders. Shear bond strength was measured and samples were observed by scanning electron microscopy (SEM). Statistically significant differences (p < 0.05) were found among all groups, except between CO2 and FEM, which showed the highest adhesion values (15.12 ± 2.35 MPa and 16.03 ± 2.73 MPa). SEM revealed differences in surface patterns. CO2 laser irradiation can be an alternative to sandblasting, although it could also weaken the ceramic. Suitable surface patterns on zirconia ceramics can be obtained with ultrashort pulsed radiation emitted by a pulsed femtosecond laser.

Evaluation of student-to-student local anaesthesia administration at the University of Barcelona: A cross-sectional study.

INTRODUCTION: To determine changes in anxiety perceived in students during their first experience injecting local anaesthetic and assess the variability in the perception in the teaching/learning experience as surgeons and patients in relation to gender. MATERIAL AND METHODS: This cross-sectional study was carried out on students enrolled in the Anaesthesia and Resuscitation course at the University of Barcelona. A descriptive and bivariate analysis was carried out using McNemar and Fisher tests. The level of significance was set at a P-value of <.05. RESULTS: Out of 85 students, a total of 71 responses were obtained. Overall, significant anxiety changes associated with the inferior alveolar nerve block were observed, specifically, before and during (P = .003), before and after (P < .001), and during and after (P < .001) the injection. The calm/relaxed category showed significant differences between before and after (P < .001) and during and after (P < .001) the procedure. Opinions and responses from male and female students differed statistically in relation to the injection on each other as preparation for real work situations (P < .023), recognition of landmarks (P < .001), determination of the insertion points (P = .032) and the need for supervision (P = .043). CONCLUSIONS: This study showed that the overall, students felt more anxious before being injecting with the anaesthetic and the students learning to give the local anaesthetic to each other is an appropriate learning method. No gender-related differences were observed in the participants.

Low level laser therapy/photobiomodulation in the management of side effects of chemoradiation therapy in head and neck cancer: part 1: mechanisms of action, dosimetric, and safety considerations.

PURPOSE: There is a large body of evidence supporting the efficacy of low level laser therapy (LLLT), more recently termed photobiomodulation (PBM), for the management of oral mucositis (OM) in patients undergoing radiotherapy for head and neck cancer (HNC). Recent advances in PBM technology, together with a better understanding of mechanisms involved, may expand the applications for PBM in the management of other complications associated with HNC treatment. This article (part 1) describes PBM mechanisms of action, dosimetry, and safety aspects and, in doing so, provides a basis for a companion paper (part 2) which describes the potential breadth of potential applications of PBM in the management of side-effects of (chemo)radiation therapy in patients being treated for HNC and proposes PBM parameters. METHODS: This study is a narrative non-systematic review. RESULTS: We review PBM mechanisms of action and dosimetric considerations. Virtually, all conditions modulated by PBM (e.g., ulceration, inflammation, lymphedema, pain, fibrosis, neurological and muscular injury) are thought to be involved in the pathogenesis of (chemo)radiation therapy-induced complications in patients treated for HNC. The impact of PBM on tumor behavior and tumor response to treatment has been insufficiently studied. In vitro studies assessing the effect of PBM on tumor cells report conflicting results, perhaps attributable to inconsistencies of PBM power and dose. Nonetheless, the biological bases for the broad clinical activities ascribed to PBM have also been noted to be similar to those activities and pathways associated with negative tumor behaviors and impeded response to treatment. While there are no anecdotal descriptions of poor tumor outcomes in patients treated with PBM, confirming its neutrality with respect to cancer responsiveness is a critical priority. CONCLUSION: Based on its therapeutic effects, PBM may have utility in a broad range of oral, oropharyngeal, facial, and neck complications of HNC treatment. Although evidence suggests that PBM using LLLT is safe in HNC patients, more research is imperative and vigilance remains warranted to detect any potential adverse effects of PBM on cancer treatment outcomes and survival.

Low-level laser therapy/photobiomodulation in the management of side effects of chemoradiation therapy in head and neck cancer: part 2: proposed applications and treatment protocols.

PURPOSE: There is a large body of evidence supporting the efficacy of low-level laser therapy (LLLT), more recently termed photobiomodulation (PBM) for the management of oral mucositis (OM) in patients undergoing radiotherapy for head and neck cancer (HNC). Recent advances in PBM technology, together with a better understanding of mechanisms involved and dosimetric parameters may lead to the management of a broader range of complications associated with HNC treatment. This could enhance patient adherence to cancer therapy, and improve quality of life and treatment outcomes. The mechanisms of action, dosimetric, and safety considerations for PBM have been reviewed in part 1. Part 2 discusses the head and neck treatment side effects for which PBM may prove to be effective. In addition, PBM parameters for each of these complications are suggested and future research directions are discussed. METHODS: Narrative review and presentation of PBM parameters are based on current evidence and expert opinion. RESULTS: PBM may have potential applications in the management of a broad range of side effects of (chemo)radiation therapy (CRT) in patients being treated for HNC. For OM management, optimal PBM parameters identified were as follows: wavelength, typically between 633 and 685 nm or 780-830 nm; energy density, laser or light-emitting diode (LED) output between 10 and 150 mW; dose, 2-3 J (J/cm(2)), and no more than 6 J/cm(2) on the tissue surface treated; treatment schedule, two to three times a week up to daily; emission type, pulsed (<100 Hz); and route of delivery, intraorally and/or transcutaneously. To facilitate further studies, we propose potentially effective PBM parameters for prophylactic and therapeutic use in supportive care for dermatitis, dysphagia, dry mouth, dysgeusia, trismus, necrosis, lymphedema, and voice/speech alterations. CONCLUSION: PBM may have a role in supportive care for a broad range of complications associated with the treatment of HNC with CRT. The suggested PBM irradiation and dosimetric parameters, which are potentially effective for these complications, are intended to provide guidance for well-designed future studies. It is imperative that such studies include elucidating the effects of PBM on oncology treatment outcomes.

Atomic force microscopy visualization of injuries in Enterococcus faecalis surface caused by Er,Cr:YSGG and diode lasers.

AIM: To visualize by atomic force microscopy the alterations induced on Enterococcus. faecalis surface after treatment with 2 types of laser: Erbium chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser and Diode laser. MATERIAL AND METHODS: Bacterial suspensions from overnight cultures of E. faecalis were irradiated during 30 seconds with the laser-lights at 1 W and 2 W of power, leaving one untreated sample as control. Surface alterations on treated E. faecalis were visualized by atomic force microscopy (AFM) and its surface roughness determined. RESULTS: AFM imaging showed that at high potency of laser both cell morphology and surface roughness resulted altered, and that several cell lysis signs were easily visualized. Surface roughness clearly increase after the treatment with Er,Cr:YSGG at 2W of power, while the other treatments gave similar values of surface roughness. The effect of lasers on bacterial surfaces visualized by AFM revealed drastic alterations. CONCLUSIONS: AFM is a good tool to evaluate surface injuries after laser treatment; and could constitute a measure of antimicrobial effect that can complete data obtained by determination of microbial viability.

Efficacy and complications associated with a modified inferior alveolar nerve block technique. A randomized, triple-blind clinical trial.

OBJECTIVE: To compare the efficacy and complication rates of two different techniques for inferior alveolar nerve blocks (IANB). STUDY DESIGN: A randomized, triple-blind clinical trial comprising 109 patients who required lower third molar removal was performed. In the control group, all patients received an IANB using the conventional Halsted technique, whereas in the experimental group, a modified technique using a more inferior injection point was performed. RESULTS: A total of 100 patients were randomized. The modified technique group showed a significantly higher onset time in the lower lip and chin area, and was frequently associated to a lingual electric discharge sensation. Three failures were recorded, 2 of them in the experimental group. No relevant local or systemic complications were registered. CONCLUSIONS: Both IANB techniques used in this trial are suitable for lower third molar removal. However, performing an inferior alveolar nerve block in a more inferior position (modified technique) extends the onset time, does not seem to reduce the risk of intravascular injections and might increase the risk of lingual nerve injuries.

The use of low level laser therapy in the treatment of temporomandibular joint disorders. Review of the literature.

INTRODUCTION: The temporomandibular disorders (TMDs) have been identified as the most important cause of pain in the facial region. The low level laser therapy (LLLT) has demonstrated to have an analgesic, anti-inflammatory and biostimulating effects. The LLLT is a noninvasive, quick and safe, non-pharmaceutical intervention that may be beneficial for patients with TMDs. However the clinical efficiency of LLLT in the treatment of this kind of disorders is controversial. OBJECTIVES: Literature review in reference to the use of LLLT in the treatment of TMDs, considering the scientific evidence level of the published studies. MATERIAL AND METHODS: A MEDLINE and COCHRANE database search was made for articles. The keywords used were "temporomandibular disorders" and "low level laser therapy" or "phototherapy" and by means of the Boolean operator "AND". The search provided a bank of 35 articles, and 16 relevant articles were selected to this review. These articles were critically analyzed and classified according to their level of scientific evidence. This analysis produced 3 literature review articles and 13 are clinical trials. The SORT criteria (Strength of Recommendation Taxonomy) was used to classify the articles. RESULTS: Only one article presented an evidence level 1, twelve presented an evidence level 2, and three presented an evidence level 3. According to the principle of evidence-based dentistry, currently there is a scientific evidence level B in favor of using LLLT for treatment of TMDs. DISCUSSION AND CONCLUSIONS: Publications on the use of LLLT for treatment of TMDs are limited making difficult to compare the different studies due to the great variability of the studied variables and the selected laser parameters. The great majority of the studies concluded that the results should be taken with caution due to the methodological limitations.

Laser treatment of 13 benign oral vascular lesions by three different surgical techniques.

OBJECTIVES: Benign Oral Vascular Lesions (BOVLs) are a group of vascular diseases characterized by congenital, inflammatory or neoplastic vascular dilations clinically evidenced as more or less wide masses of commonly dark bluish color. If traumatized BOVLs are characterized by a great risk of hemorrhage and their treatment usually requires great caution to prevent massive bleeding. In the last decades lasers have dramatically changed the way of treatment of BOVLs permitting the application of even peculiar techniques that gave interesting advantages in their management reducing hemorrhage risks. The aim of this study was to evaluate the capabilities and disadvantages of three laser assisted techniques in the management of BOVLs. STUDY DESIGN: In this study 13 BOVLs were treated by three different laser techniques: the traditional excisional biopsy (EB), and two less invasive techniques, the transmucosal thermocoagulation (TMT) and the intralesional photocoagulation (ILP). Two different laser devices were adopted in the study: a KTP laser (DEKA, Florence, Italy, 532 nm) and a GaAlAs laser (Laser Innovation, Castelgandolfo, Italy, 808 nm) selected since their great effectiveness on hemoglobin. RESULTS: In each case, lasers permitted safe treatments of BOVLs without hemorrhages, both during the intervention and in the post-operative period. The minimally invasive techniques (TMT and ILP) permitted even the safe resolution of big lesions without tissue loss. CONCLUSIONS: Laser devices confirm to be the gold standard in BOVLs treatment, permitting even the introduction of minimal invasive surgery principles and reducing the risks of hemorrhage typical of these neoplasms. As usual in laser surgery, it is necessary a clear knowledge of the devices and of the laser-tissue interaction to optimize the results reducing risks and disadvantages.

Post-endodontic pain evaluation after different intracanal laser assisted disinfection techniques. A Systematic Review.

Background: Post-endodontic pain (PEP) management is an important factor to be considered in endodontic treatment. Several risk factors have been described that can attribute to its appearance. Laser-assisted disinfection has been described by many authors for its antimicrobial effect. Few studies described the relation between laser disinfection and its effect on PEP. The objective of this review is to describe the relation between different intracanal laser disinfection techniques and their effects on PEP. Material and Methods: An electronic search strategy was performed in Pubmed, Embase, and Web of Science (WOS) databases without restrictions as to the date of publication. Eligibility criteria were randomized controlled clinical trials (RCT) that used one of the different intracanal laser disinfection techniques in their experimental groups evaluating PEP outcome were included. Risk of bias analysis was performed by the Cochrane risk of bias tool. Results: The initial research identified 245 articles from which 221 were excluded and 21 studies were sought for retrieval and 12 articles met our inclusion criteria for the final qualitative analysis. The laser systems used were Nd:YAG, Er:YAG and, diode lasers including photodynamic therapy. Conclusions: The diode lasers showed the most promising results in terms of PEP reduction while Er:YAG showed more short-term efficacy (6 hours postoperative interval). The variables could not be analyzed homogenously due to the differences in the study designs. More RCT are needed comparing different laser disinfection techniques with the same baseline endodontic pathology to establish a specific protocol for the best outcome. Key words:Root canal treatment, Post-endodontic pain, Intracanal laser disinfection, laser dentistry.

Comparative Study of Transmission of 2940 nm Wavelength in Six Different Aesthetic Orthodontic Brackets.

BACKGROUND: Previous studies have confirmed the superiority of using erbium lasers (2940, 2780 nm) over other lasers in the debonding of ceramic brackets due to their safety and effectiveness. The most important factor in the debonding of aesthetic brackets is the transmission of the erbium laser through the aesthetic bracket to the adhesive resin. OBJECTIVE: To identify the transmission of the 2940 nm wavelength through different types of aesthetic brackets. MATERIALS AND METHODS: A total of 60 aesthetic brackets were divided into six equal groups (10 monocrystalline sapphire brackets-Radiance, AO; 10 monocrystalline sapphire brackets-Absolute, Star Dentech; 10 polycrystalline brackets-20/40, AO; 10 polycrystalline brackets-3M Unitek Gemini Clear Ceramic; 10 silicon brackets-Silkon Plus, AO; 10 composite brackets-Orthoflex, OrthoTech). The aesthetic brackets were mounted in a Fourier transform infrared spectrophotometer (FTIR IRPrestige-21, SHIMADZU) following the typical spectroscopy lab procedure for such samples. The transmission ratio for the 2940 nm wavelength was obtained using IRsolution software. The mean transmission values of the tested groups were compared using a one-way analysis of variance (ANOVA) test followed by a Bonferroni test (post-hoc test). RESULTS: The highest transmission ratio was observed for the Radiance sapphire brackets (64.75%) and the lowest was observed for the 3M polycrystalline brackets (40.48%). The differences among the Aesthetic brackets were significant (p < 0.05). CONCLUSIONS: The thick polycrystalline and composite brackets have the lowest transmissibility, whereas the monocrystalline sapphire brackets have the highest transmissibility for the 2940 nm wavelength, meaning that there is a higher possibility of debonding them with a hard tissue laser through thermal ablation.

Efficacy of low-level laser therapy in the management of pain, facial swelling, and postoperative trismus after a lower third molar extraction. A preliminary study.

Pain, swelling, and trismus are the most common complications after surgical removal of impacted lower third molars. The aim of this study was to evaluate the analgesic and anti-inflammatory effects of a low-level laser therapy (Laser Smile™, Biolase®, San Clemente, USA) applied to the wound appeared after the surgical removal of impacted lower third molars. A prospective, randomized, and double-blind study was undertaken in 20 healthy patients with two symmetrically impacted lower third molars. The application of a low-level laser was made randomly on one of the two sides after surgery. The experimental side received 5 J/cm(2) of energy density, a wavelength of 810 nm, and an output power of 0.5 W. On the control side, a handpiece was applied intraorally, but the laser was not activated. Evaluations of postoperative pain, trismus, and swelling were made. The sample consisted of 11 women and nine men, and mean age was 23.35 years (18-37). The pain level in the first hours after surgery was lower in the experimental side than in the placebo side, although without statistically significant differences (p = 0.258). Swelling and trismus at the 2nd and 7th postoperative days were slightly higher in the control side, although not statistically significant differences were detected (p > 0.05). The application of a low-level laser with the parameters used in this study did not show beneficial affects in reducing pain, swelling, and trismus after removal of impacted lower third molars.

Parameters Used With Diode Lasers (808-980 nm) in Dentin Hypersensitivity Management: A Systematic Review.

Introduction: The present study aimed to describe parameters used with 808- to 980-nm wavelength diode lasers for managing dentin hypersensitivity and analyze their results. Methods: The inclusion criteria were based on randomized controlled clinical trials using diode lasers at an 808-980 nm wavelength range in patients with dentine hypersensitivity with a minimum of 1-month follow-up. An electronic search for articles on Medline, PubMed and Cochrane databases was performed. The risk of bias was assessed with the Cochrane collaboration tool. Results: Our electronic search resulted in 130 papers, of which 11 articles met the inclusion criteria. A majority of the studies assessed dentine hypersensitivity using the Visual Analogue Scale, which ranged between 2.3 and 8.8 before treatment and significantly reduced to a mean value of 0.45-3.7 after diode laser application. The power settings ranged between 1.5 mW and 3 W with an emission mode of continuous wave, except for 2 authors who used chopped mode. The energy density varied from 2.5 to 128 J/cm2, and the exposure time was between 10 and 120 seconds. The authors applied a minimum of 1 to 4 treatment sessions with a 2-day to 1-week interval between them. Most of the studies mentioned the tooth surface as the treatment site but without describing the specific irradiation points. Conclusion: Despite the heterogeneity of the analyzed variables, a statistically significant improvement in all laser groups was described. However, they cannot be compared homogenously.

Photobiomodulation therapy and endodontic treatment of teeth with apical periodontitis using 940-nm diode laser. Report of two cases.

Background: Diode laser (DL) can be used in endodontics both for its bactericidal effect inside the root canal system (RCS) and for photobiomodulation therapy (PBMT) to accelerate the repair of periradicular bone tissue. Clinical Cases: This work presents two cases of pulp necrosis/asymptomatic apical periodontitis (AAP) that were treated with 940-nm DL, administered both to disinfect the root canal and to apply PBMT to the periradicular tissues. The cases were analysed by Cone-Beam Computed Tomography (CBCT). Discussion: DL has become widely accepted due to its high antimicrobial effectiveness and its ability to accelerate the repair of large apical lesions by biostimulation. Nevertheless, differences of opinion persist within the scientific community due to the lack of standardized endodontic protocols. Conclusions: The application of 940-nm DL, both for disinfection of the RCS and for PBMT, is an effective treatment in non-vital teeth with large periapical lesions. In both cases reported, bone neoformation were found at the 6-month check-up. Key words:Low-level laser therapy, photobiomodulation therapy, diode laser, endodontics.

Laser-Assisted Esthetic Crown Lengthening: Open-Flap Versus Flapless.

This study compares the clinical outcomes of Er,Cr:YSGG (2,780 nm) laser-assisted open-flap (OF) and flapless (FL) esthetic crown lengthening (ECL) for the treatment of altered passive eruption. Thirty-six healthy patients requiring ECL were randomly divided into two groups: OF and FL. Gingivectomy and ostectomy were performed with an Er,Cr:YSGG laser in both groups. The periodontal condition and gingival margin level (GML) were assessed at baseline, immediately postsurgery, and at 1, 3, and 9 months postsurgery. The effect of periodontal phenotype and tooth location on GML and supracrestal gingival tissue dimension were evaluated. A significant difference was detected in the mean of GML at all time points, except between 3 and 9 months. The main tissue rebound after 9 months was 0.25 ± 0.3 mm in the OF group and 0.26 ± 0.3 mm in the FL group (no significant difference) and was significantly higher in thick periodontal phenotypes. Er,Cr:YSGG laser-assisted ECL is a predictable technique that achieved similar outcomes using flap and flapless approaches, providing esthetic and restorative opportunities for clinicians.

Photodynamic Therapy in Endodontics: A Helpful Tool to Combat Antibiotic Resistance? A Literature Review.

BACKGROUND: Antibiotic resistance has become a growing global problem where overprescription is a contributing factor for its development. In the endodontics field, complementary treatments, such as antimicrobial photodynamic therapy (aPDT), have been described to eliminate residual bacteria from the root canal space and reduce complications. The aim of this review is to describe the literature evidence up to now regarding the advantages, efficiency, and clinical outcomes of this therapy in endodontics as a possible tool to combat antibiotic resistance. METHODS: A review of the literature from 2010 to 2021 was carried out using the PubMed and Web of Science databases. Two steps were taken: First, articles were compiled through the terms and MeSH terms "Photochesdmotherapy" and "endodontics." Then, a second search was conducted using "photodynamic therapy" and "antibiotic resistance" or "drug resistance, microbial." RESULTS: A total of 51 articles were included for evaluation: 27 laboratory studies, 14 reviews, and 10 clinical studies. Laboratory studies show that aPDT achieves significant bacterial elimination, even against antibiotic-resistant species, and is also effective in biofilm disruption. Clinical studies suggest that aPDT can be considered a promising technique to reduce bacterial complications, and reviews about the issue confirm its advantages. CONCLUSION: The benefits of aPDT in reducing complications due to its antibacterial effects means a possible decrease in systemic antibiotic prescription in endodontics. In addition, it could be an alternative to local intracanal antibiotic therapy, avoiding the appearance of possible antibiotic resistance, as no bacterial resistance with aPDT has been described to date.

Aerosols generation using Er,Cr:YSGG laser compared to rotary instruments in conservative dentistry: A preliminary study.

BACKGROUND: In restorative dentistry, the use of high-speed air turbine, which generates aerosols, can be associated with the transmission of airborne diseases. New laser technologies could be useful in reducing the amount of aerosols, but there is a lack of scientific research on this topic. MATERIAL AND METHODS: This is a descriptive study to analyze the amount of aerosols produced after class I cavity preparation using high-speed air turbine (group 1) and Er,Cr:YSGG laser with two different parameters (groups 2 and 3). Fluorescein dye was incorporated into the coolant reservoir in order to visualize the production of aerosols during each procedure. Tooth preparation was performed in a typodont with human lower molar tooth under rubber dam isolation. The procedure was carried out in a transparent plastic box to avoid aerosols dispersion. Sixteen grade I cellulose filter discs were distributed along the surfaces of the box. The area contaminated with aerosols in the filters was measured using ultraviolet illumination. RESULTS: In group 1, the contaminated surface area covered with fluorescein dye reached 77.3% (1349 cm2) of the total; in group 2 (laser with 80% water) we observed 7.3% (128 cm2) and in group 3 (laser with 40% water) it was 3.8% (68 cm2). The reduction in water parameter from 80% to 40% coincided with 48% reduction of the contaminated area on the filter discs. Focusing on the surfaces of the box, we noted that the mean contamination on the left side was more than on the right side in all three experimental groups. In group 1 using air turbine, we measured a mean of 102.6[±7.5 SD]cm2 on the left side, compared to 70.6[±32.3 SD]cm2 on the right side. In laser groups 2 and 3, a mean of 12.8[±14.9 SD]cm2 and 6.8 [±5.7SD]cm2, respectively, was described on the left surface versus 0 cm2 of surface contamination on the right surface. CONCLUSIONS: The contaminated area during the procedure of class I cavity preparation, is reduced by 70% using Er,Cr:YSGG laser compared to high-speed turbine. A slightly higher contamination was observed between laser groups with 80% versus 40% water. The use of Er,Cr:YSGG laser in restorative dentistry can be a valid treatment alternative to reduce aerosols production compared to conventional high-speed rotary instruments. Key words:Er,Cr:YSGG laser, Aerosols, SARS-CoV-2, Rotary instruments, conservative dentistry.

Effect of Photobiomodulation (Diode 810 nm) on Long-Standing Neurosensory Alterations of the Inferior Alveolar Nerve: A Case Series Study.

Objective: To evaluate and describe the results of photobiomodulation (PBM) therapy on the treatment of long-standing neurosensory inferior alveolar nerve (IAN) alterations after third molar extraction. Background: The use of PBM is an acceptable alternative method to improve the therapeutic outcomes of neural lesions. Materials and methods: Longitudinal case study research. Patients with >6 months of inferior alveolar neurosensory disturbance after third molar extraction were included. Fifteen laser sessions were done, irradiating intra- and extraoral points along the distribution of this nerve area. A semiconductor Ga,Al,As diode laser (Thor laser®) was used. Before and after the treatment, variables such as Zuniga-Essick score, British Medical Research Council (BRC) scale, visual analog scale (VAS), and mapping of the affected area were described. Gender, age, and duration of the lesion were analyzed. Descriptive statistical study was carried out with SPSS 19.0. Results: Eleven patients with a mean age of 38.5 years [standard deviation (SD) ±15.22]. Average duration of the lesion was 13.2 (SD ±4) months. The results obtained with the Zuniga-Essick scale before treatment showed mild alteration in 36.3% (4), moderate in 18.2% (2), and severe in 45.4% (5). After treatment, the percentage score improved, obtaining normality in 54.5% (6) of the patients and mild degree in 27.2% (3). In the BRC score, before the treatment, 45.4% (5) of grade S2+ and 27% (3) of S3 and S3+ were obtained. The final percentage after treatment reached an improvement of S4 in a total of 36% (4) of cases and a recovery of S3+ in 54.5% (6). Reduction of the mapped altered area and an upturn of VAS were noted. Conclusions: The laser parameters and application protocol used result in subjective and objective improvement in mechanical sensory perception in long-standing neurosensory deficit in the IAN.

Laser dentistry in daily practice during the COVID-19 pandemic: Benefits, risks and recommendations for safe treatments.

The COVID-19 pandemic forced dental professionals to cope with an unexpected challenge and caused an abrupt cessation of conventional care practices. The high degree of contagiousness as well as the diffusion of the virus through the air and droplets via respiratory transmission placed dental professionals at top-level risk of contracting and spreading the disease. General recommendations were announced in different countries, including patient distancing, air ventilation, surface and instrument sanitization, and the wearing of suitable masks and shields. However, many dental treatments are performed using lasers, and some specific precautions must be added to conventional procedures to ensure the advantages of this technology to patients because of the particular tissue­matter interaction effects of laser wavelengths. Based on the literature, the authors evaluated all of using laser wavelengths to analyze the risk and the benefits of using lasers in daily dental practice, and to provide safety recommendations during pandemic. An unrestricted search of indexed databases was performed. Laser use effects were categorized into: 1) explosive processes that produce tissue ablation and aerosol formation; 2) thermal actions that create vaporization and smoke plume; 3) photobiomodulation of the cells; and 4) enhanced chemical activity. Knowledge of the device functions and choice of adequate parameters will reduce aerosol and plume formation, and the application of suction systems with high flow volume and good filtration close to the surgical site will avoid virus dissemination during laser use. In the categories that involve low energy, the beneficial effects of lasers are available and sometimes preferable during this pandemic because only conventional precautions are required. Lasers maintain the potential to add benefits to dental practice even in the COVID-19 era, but it is necessary to know how lasers work to utilize these advantages. The great potential of laser light, with undiscovered limits, may provide a different path to face the severe health challenges of this pandemic.

Success Rate of Benign Oral Squamous Papilloma Treatments After Different Surgical Protocols (Conventional, Nd:YAG, CO2 and Diode 980 nm Lasers): A 34-Year Retrospective Study.

Objective: The aim of our retrospective study is to compare the long-term recurrence rate of the benign oral squamous papilloma (OSP) with different laser-assisted treatments and conventional procedures (use of scalpels) aiming to suggest the most suitable surgical protocol showing the lowest recurrence rate. Background: A retrospective multicenter DATA collection between 1985 and 2019 covering 781 OSP cases concerning different surgical protocols used for the treatment of OSP was done and included the use of different laser wavelengths [neodymium-doped yttrium-aluminum-garnet (Nd:YAG), carbon dioxide (CO2), and Diode 980 nm] and the conventional surgeries using the scalpel. The age, sex, and the oral location of the OSP were noted. Methods: Three different surgical protocols were selected in our study: protocol 1 regrouped surgical procedures performing the excision of OSP with an in-depth safety margin of 1 mm and just at the base of the tumor with reduced excision of the grossly normal marginal mucosa around the tumor (0-1 mm). Protocol 2 and 3 were similar to protocol 1, but with an additional excision of 1-2 mm and ≥3 mm of the grossly normal marginal mucosa, respectively, for group 2 and 3. All laser-treated OSP wounds were left without sutures. In the conventionally treated OSP, sutures were regularly performed. Follow-up was done after 15 days and at 1, 6, and 18 months. The three included wavelengths were Nd:YAG (1064 nm), CO2 laser (10,600 nm), and diode laser (980 nm). Results: After 18 months of follow-up, the highest success rate was obtained with protocol 3 (100% with Nd:YAG, 99% with CO2, 98.4% with diode, and 99% with the scalpel), which was significantly higher than the values of protocol 2 (96.6% with Nd:YAG, 91% with CO2, 96% with diode, and 95% with the scalpel) and the protocol 1 (38% with Nd:YAG, 29% with CO2, 33% with diode, and 30% with the scalpel). The oral locations of OSP were 30% on palates, 30% on the tongue, 16% on cheek, 14% on lips, and 10% on other locations. Conclusions: The lowest recurrence rate was observed when a minimum of three millimeters (≥3 mm) of grossly normal aspect mucosa around the OSP was included in the excisions. The laser wavelengths and the use of scalpel did not show any significant difference in terms of recurrence.

Advantages and esthetic results of erbium, chromium:yttrium-scandium-gallium-garnet laser application in second-stage implant surgery in patients with insufficient gingival attachment: a report of three cases.

Traditional implant placement involves two surgical stages. Although the second stage is comparatively less aggressive for the patient, postoperative pain and swelling can be further reduced by the use of laser instead of a scalpel. Correct handling of peri-implant soft tissue is of major importance in obtaining adequate gingival tissue attachment around implants. The presence of this keratinized gingiva ensures adequate esthetic results and maintains implant health. We report on three patients with implants in the anterior area who were operated on under the above conditions. Traditionally, the tissue overlying the implants is removed and eliminated. In seeking a way to preserve the attached gingiva, we raised a trapezoidal flap, uncovering each implant and allowing apical repositioning and transpositioning of keratinized gingiva to the buccal side. The results obtained were compared with those from other patients operated on by conventional scalpel. The erbium, chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser minimized postoperative pain, and the time to prosthetic rehabilitation was also shortened. The esthetic results were far superior, and no complications were recorded.