Direct Pulp Capping With ProRoot MTA Alone and in Combination With Er:YAG Laser Irradiation: A Clinical Trial

Background: Due to the complications of root canal treatment, conservative modalities to preserve pulp vitality are favorable. Direct pulp capping (DPC) refers to the coverage of the pulp tissue exposed by a biocompatible agent that can improve the prognosis of the tooth by 44% to 95%. Some recent studies have reported more predictable results (a success rate of about 90%) for DPC with laser and regenerative materials such as mineral trioxide aggregate (MTA). This study aimed to clinically compare DPC with ProRoot MTA alone and in combination with Er:YAG (erbium-doped yttrium aluminium garnet) laser irradiation (2940 nm). Methods: This clinical trial was conducted on 26 patients with a mean age of 29 years (in the range of 17 to 46 years) who required DPC following pulp exposure during deep caries removal. The teeth were divided into two groups. In the control group, the teeth underwent DPC with ProRoot MTA while in the test group, the teeth were first irradiated with a 2940 nm Er:YAG laser and then underwent DPC with ProRoot MTA. The patients were recalled at one, 3 and 6 months for the follow-up (clinical and radiographic examinations). The data were analyzed using Fisher exact test. Results: The success rate was 75% in the laser group and 93% in the control group. The groups were not significantly different (P>0.05). Conclusion: No significant difference was found in terms of the success rate of DPC with ProRoot MTA alone and in combination with Er:YAG laser irradiation.

[Treatment of nevus of Ota and Ito and epidermal nevus syndrome]

Nevus of Ota, nevus of Ito and nevus of Hori are special melanocytic nevi that have a slate-brown or blue/grey coloring. They are pigmented disorders characterized by its heterotopic melanocytic dermal location and by blue/brown unilateral and sometimes bilateral facial patch in case of nevus of Ota, and in the supraclavicular, scapular, and deltoid region in case of nevus of Ito. It is more common in patients with Asian and dark-skinned ethnic backgrounds. Histologically, elongated, dendritic melanocytes are seen scattered mainly throughout the upper third of reticular dermis. An acquired variant is called Hori's nevus with more bilateral facial distribution, similar to melasma. Dermal melanocytosis can also occur elsewhere on the body, including inside the mouth. Despite its benign nature, patients frequently seek therapy because of its facial involvement. QS lasers are used effectively to treat these lesions. The number of treatment sessions correlates with clinical improvement. Post laser hypo- and hyperpigmentation are common side effects mainly affecting patients with darker skin.

Influence of the laser pulse shape in the treatment of stones in the upper urinary tract

PURPOSE

Urinary stones can be successfully treated using a Holmium: Yttrium-Aluminum-Garnet (Ho: YAG) laser. Regarding success rates, laser pulse energy, frequency, and pulse width are well-known contributing factors. Whether the pulse shape might be a further factor influencing the laser efficiency is unclear. This study aimed to evaluate different modes of laser pulse shapes in a real-world setting.

MATERIALS AND METHODS

The Dornier Medilas® H Solvo (Weßling, Germany) was used in the treatment of ureter and kidney stones. Patients were randomized into standard pulse shape (SPS) and new pulse shape groups (NPS1; ureter) and (NPS2; kidney pelvis), depending on the stone localization. The primary endpoint was laser efficiency defined as mm³ stone destruction per overall operating time. Secondary endpoints encompassed number of stone recoveries and stone-free rate.

RESULTS

Altogether 145 patients (24 SPS vs. 32 NPS1; 51 SPS vs. 38 NPS2) were included. No differences in sex, age, body mass index, stone localization and stone composition were found, except for preoperative stone size (133±95 [SPS] vs. 197±139 [NPS1] mm³; p=0.023) and (348±298 [SPS] vs. 525±429 [NPS2] mm³; p=0.042). Regarding the primary endpoint, a significant increase in laser efficiency could be detected for the NPS1 and NPS2 groups compared to the SPS groups (39.9±44.9 vs. 28.8±30.2 and 51.7±61.3 vs. 22.4±24.2 mm³/min [mean±standard deviation]). No statistically significant differences were found for secondary endpoints and perioperative complication rates.

CONCLUSIONS

Efficiency of the Ho: YAG laser can be positively influenced by different pulse shapes. This adds the variable of individualized intraoperative decision making.

[Observation and analysis of lens turbidity lesion induced by low intensity 635 nm laser radiation]

Objective: To study the characteristics of the lens turbidity after long-term exposure to low intensity 635nm laser. Methods: Cluster sampling method was adopted to select 812 employees in a laser leveler workshop in a city of Guangdong Province from January 2014 to December 2018. They were divided into the control group, diffuse reflection (DR) group and direct vision (DV) group for retrospective observation and analysis of lens turbidity. The laser irradiation intensity of each group was investigated, the position and shape of lens opacity were analyzed, and the influencing factors were statistically analyzed with the repeated measurement data of dichotomy. Results: The laser irradiance and radiant exposure of DV group were between 0.72×10(-4) and 9.92×10(-4) mW/cm(2) and between 2.61×10(-2) and 1.53 J/cm(2), respectively. The subjects were mainly diagnosed with lens turbidity lesion, especially for the DV group. Most of lesions occurred in the pole and periphery of the anterior cortex. The lesions exhibited multipoint patterns with greyish white color. The turbidity rates in DV group (before work and work for 1, 2, 3 years) were 0%, 1.99% (8/402) , 4.98% (20/402) and 6.72% (27/402) , respectively, in the order of observation points. The statistical analysis of single factor effect showed that the turbidity rate was higher in DV group and higher in the second year in the DV group (P<0.01) . Multi-factor analysis of the laser effect on the lens showed that the main effect between groups, between the observation point were statistically significant (P<0.05) , but no statistical significance in the interaction between group×observation points (P>0.05) . Conclusion: Lens turbidity lesion can be caused by long-term exposure to low intensity 635 nm laser, so the product safety classification should be strictly strengthened. It is necessary to strengthen the protection of laser photochemical damage in the production process.

Photobiomodulation Therapy in the Proliferation and Differentiation of Human Umbilical Cord Mesenchymal Stem Cells: An In Vitro Study

Introduction: Since photobiomodulation therapy (PBMT) favors in vitro mesenchymal stem cell (MSC) preconditioning before MSC transplantation, increasing the proliferation of these cells without molecular injuries by conserving their characteristics, in the present in vitro study we analyzed the effect of PBMT on the proliferation and osteogenic differentiation of human umbilical cord mesenchymal stem cells (hUCMSCs). Methods: Irradiation with an InGaAIP Laser (660 nm, 10 mW, 2.5 J/cm² , 0.08 cm² spot size, and 10 s) was carried out. The cells were divided into four groups: CONTROL [cells grown in Dulbecco's Modified Eagle Medium (DMEM)], OSTEO (cells grown in an osteogenic medium); PBMT (cells grown in DMEM+PBMT), and OSTEO+PBMT (cells grown in an osteogenic medium plus PBMT). The cell proliferation curve was obtained over periods of 24, 48 and 72 hours using the 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) assay. Osteogenic differentiation was analyzed by the formation of calcium nodules over periods of 7, 14 and 21 days. Morphometric analysis was performed to quantify the total area of nodular calcification. Results: The highest cell proliferation and cell differentiation occurred in the OSTEO+PBMT group, followed by the PBMT, OSTEO and CONTROL groups respectively, at the observed times (P <0.05). Conclusion: PBMT enhanced the osteogenic proliferation and the differentiation of hUCMSCs during the periods tested, without causing damage to the cells and preserving their specific characteristics, a fact that may represent an innovative pretreatment in the application of stem cells.

Efficacy of Er,Cr Laser incision Corticotomy in Rapid Maxillary Canine Retraction: A Split-Mouth Randomized Clinical Trial

Introduction: This study sought to evaluate the efficacy of lasercision corticotomy for the acceleration of canine movement. Our secondary objectives were assessing the canine rotation, the rate of anchorage control, the level of pain, and the gingival index (GI). Methods: Twelve orthodontic patients (9 females and 3 males) referring to the School of Dentistry and one dental clinic from May 2019 to September 2019 participated in this split-mouth randomized clinical trial. The allocation of the test and control sides was performed by flipping a coin. The mean age of patients was 18.91±3.87 years (range 15-30 years). The treatment plan included maxillary first premolar extraction. Following the initial leveling and alignment phase, an initial impression was made. Corticotomy was carried out with the erbium, chromium-doped yttrium scandium gallium garnet (Er, Cr: YSGG) laser (3.5 W, 30 Hz, 40% air, 80% water) in one maxillary quadrant (the laser side). Canine retraction was immediately initiated following surgery using nickel-titanium closed-coil springs with 150 g force. The impression was repeated 1 month after the onset of retraction. The casts were scanned, and the distance between the canine cusp tip and the rugae line was measured to quantify the amount of anteroposterior canine movement. The molar anchorage control was also evaluated by measuring the distance between the mesial contact of the permanent first molar and the rugae line. Gingival health was evaluated using the GI. The modified McGill pain questionnaire was used to assess the level of patients' pain. Results: Lasercision corticotomy accelerated canine retraction with no adverse effect on gingival health. Anchorage loss in the posterior teeth and pain scores were not significantly different between the control and laser sides. Conclusion: Laser corticotomy can effectively accelerate canine retraction with no complications or discomfort for the patients.

[Effectiveness and safety of holmium laser therapy via flexible bronchoscopy in 40 children with tracheobronchial tuberculosis]

Objective: To explore the effectiveness and safety of holmium laser treatment via flexible bronchoscopy in children with tracheobronchial tuberculosis (TBTB). Methods: The clinical data of 40 children with TBTB admitted in Qilu Children's Hospital of Shandong University from February 2016 to June 2019 were retrospectively analyzed. According to the treatment approach, they were divided into conventional treatment group (20 cases) and holmium laser treatment group (20 cases). The sex, age, course of disease and lesion location before treatment, and the time till relief of atelectasis and airway obstruction after treatment were compared between the two groups with t test and χ² test. Results: Among the 40 cases, 24 were males and 16 females, and 35 had lymph node fistula (87.5%) and 5 had granulation proliferation (12.5%). There was no statistically significamt difference between the conventional group and laser group in sex (male ratio: 50%（10/20） vs. 75%（15/20）, χ²=2.66, P=0.10), age （(3.2±2.2） years vs. （2.2±1.8） years, t=1.41, P=0.16), course of disease (<1 month ratio: 30%（6/20） vs. 35%（7/20）, χ²=0.11, P=0.73), lesion location (single lesion ratio： 45%（9/20） vs. 60%(12/20), χ²=0.90, P=0.34). The effectiveness was evaluated after 3 months, and the total effective rate were 100% in laser group and 40% in conventional group, the difference was significant (χ²=25.34, P<0.01). No serious adverse events occurred in the two groups during the observational period. Conclusions: Holmium laser treatment via bronchoscopy is an effective way to remove the tuberculosis foci in the trachea, which can reduce the incidence of further related complications, and could be applied in clinical approach.

Current use of thulium lasers in endourology and future perspectives

Thulium lasers operate at wavelengths between1940-2013 nm either in a continuous wave or in a pulsed mode, which enables smooth incisions with fast vaporization or effective laser lithotripsy for urolithiasis. Thulium laser enucleation is a minimally invasive and size-independent treatment for benign prostatic hyperplasia (BPH) with excellent long-term results. Since its introduction, several modifications in the technology and surgical techniques have been proposed such as vaporesection, vaporization and enucleation with regard to BPH treatment. Recent developments in the thulium laser technology include the introduction of a super pulsed thulium fiberlaser.  This technique delivers the laser energy through anactive fiber with an absorption maximum in water at awavelength of 1940 μm. Preclinical studies showed asignificantly higher stone fragmentation rate in differentex vivo models compared to the Ho:YAG laser. Another innovative thulium laser that works, as a hybrid laser has yet not been tested clinically, however, will soon be introduced. With the introduction of both new thulium lasers as novel devices, the armamentarium in the field of endourology for lithotripsy and enucleation increases. We here present different thulium lasers and surgical techniques that are possible to perform with each device including the reasons and advantages of each modification.

Management of peri-implantitis using a diode laser (810 nm) vs conventional treatment: a systematic review

The purpose of this study was to systematically assess clinical studies on the effect of using a diode laser in the treatment of peri-implantitis. Study question was "In patients with peri-implantitis around functional dental implants, can treatment by a diode Laser (810 nm) versus conventional treatment be effective in reducing the probing depth?". The study included only randomized controlled clinical trials that involved patients with peri-implantitis. Included articles evaluated a diode laser (810 nm) used as monotherapy or as adjuvant therapy in the non-surgical treatment while their control group received conventional methods of treatment for peri-implantitis. Studies that involved other types of laser treatment options, surgical therapy, photodynamic therapy, case series, or case reports were excluded. Three electronic databases were searched for published articles from 2010 to 2018: PubMed/Medline, Cochrane, and Web of Science. The references were manually hand searched for relevant articles. The search initially identified 44 studies, which were filtered to yield a total of 3 eligible studies. All included studies compared laser treatment by a diode laser (810 nm) to conventional therapy by mechanical debridement for a follow-up period ranging from 6 months to 1 year, and risk of bias was assessed for each of the three included studies. A qualitative analysis of the three studies was conducted. This systematic review could not support the usage of a diode laser in the treatment of peri-implantitis. To confirm this assumption, more clinical trials with long-term follow-up periods are recommended.

In vitro evaluation of shear bond strength of orthodontic metal brackets to aged composite using a self-adhesive composite: Effect of surface conditioning and different bonding agents

OBJECTIVES

Bracket bonding to composite surfaces is increasing. This study sought to assess the effect of different adhesives (acid etchant+Transbond XT™, acid etchant+Vertise Flow™, Vertise Flow™) with different surface treatments (no preparation, bur, sandblasting, Er:YAG laser) on shear bond strength (SBS) of metal brackets to aged composite.

MATERIALS AND METHODS

In this in vitro, experimental study, Filtek™ Z250 composite discs were fabricated (10×4mm). After thermocycling (10,000 cycles between 5-55°C), the samples were randomly divided into three groups (n=48) based on the type of adhesive namely acid etchant+Transbond XT™, Vertise Flow™, and acid etchant+Vertise Flow™. Samples in each group were randomly divided into four subgroups (n=12) based on the surface treatment including no-treatment, diamond bur, sandblasting and Er:YAG laser. Samples in each group were randomly divided into three subgroups (n=12) based on the type of adhesive namely acid etchant+Transbond XT™, Vertise Flow™, and acid etchant+Vertise Flow™. After bracket bonding to composite discs, the samples underwent thermocycling (5000 cycles between 5-55°C), and their SBS was measured in a universal testing machine. The samples were then inspected under a stereomicroscope at x10 magnification to determine their mode of failure and adhesive remnant index (ARI).

RESULTS

No significant difference was noted in SBS between adhesives in no-preparation and laser groups (P>0.05). In all adhesive groups, sandblast had highest SBS, but it was not significantly different in Vertise Flow™ groups, with and without etching. The SBS provided by acid etchant+Transbond XT™ was significantly higher than that of the other two adhesives (P<0.05). The SBS of sandblasted samples was significantly higher compared with other surface treatments in all adhesive subgroups (P<0.05).

CONCLUSION

Bracket bonding to aged composite using Vertise Flow™ with or without surface treatment can serve as an alternative to the conventional orthodontic adhesives.

Influence of biosafety materials of the laser output power

Biosafety materials used in the correct handling of low power laser equipment may interfere on the power delivered at the target tissue and, possibly, on the effects on biological tissues. The aim of this study was to evaluate the interference of the use of polyvinyl chloride (PVC) and polyethylene (PEAD) protection materials on the output power of low power lasers. Two low power diode laser devices with different wavelengths (red and infrared) were used. For each wavelength, two protection materials and two evaluation times (before and after protection) were considered. The output power (mW) was measured with the tip positioned in close contact with the power meter receiver. Parametric statistical test, two-way ANOVA for repeated measures (protection material and time), was performed considering the level of significance of 5%. In respect to "time", all groups had the output power reduced after placing the protective material (p < 0.05). Comparing the protection materials, the PEAD showed a greater reduction in output power than the PVC for both red and infrared wavelengths. It was concluded that, among the biosafety materials tested, PVC is the most suitable for the protection of the tip of the low power lasers.

Photodynamic therapy in the treatment of xeroderma pigmentosum: A case report

Xeroderma pigmentosum (XP) is a rare autosomal recessive dermatosis that is often complicated by multiple skin tumours at exposed locations, which are difficult to treat. We report a case of a 12-year-old girl with XP treated with oral retinoic acid and photodynamic therapy (PDT) with good clinical results. She had an 8-year history of multiple skin lesions that first appeared on her nasal dorsum, but gradually increased in size and spread to her entire face, neck, and upper limbs. Notably, the lesions became evidently aggravated after sun exposure. When she was 6 years old, sesame-seed-sized papules and plaques appeared, which were fragile and irregular in shape and would self-rupture, accompanied with slight itchiness and bloody exudate. Examination revealed multiple basal cell carcinomas. The tumours were treated with local carbon dioxide laser therapy combined with PDT. On the follow-up visit 2 months after the surgery, most of the skin lesions on her face had subsided. In cases of multiple tumours, PDT can be the treatment method of choice because it is less invasive, has less side effects, and does not damage the surrounding normal tissues.

Oncological and functional outcomes after repeat transoral laser microsurgery for the treatment of recurrent early glottic cancer

BACKGROUND

Transoral laser microsurgery for glottic squamous cell carcinoma is the standard of care at many institutions. Repeat transoral laser microsurgery for recurrence may avoid the need for radiotherapy and total laryngectomy. This study aimed to identify oncological and functional outcomes in a cohort of patients who had undergone repeat transoral laser microsurgery procedures.

METHOD

A retrospective review of prospectively collected data of patients treated with transoral laser microsurgery for carcinoma in situ or tumour stages T1 or T2 glottic cancer, from 2003 to 2018.

RESULTS

Twenty patients were identified. Additional treatment was not needed in 45 per cent of patients. The five-year overall survival rate was 90 per cent. The disease-specific survival rate was 100 per cent. The laryngeal preservation rate was 85 per cent. There was improvement in mean Voice Handicap Index-10 scores following repeat transoral laser microsurgery treatment, when comparing the pre- and post-operative periods (mean scores = 15.5 vs 11.5, p = 0.373).

CONCLUSION

Repeat transoral laser microsurgery can be an oncologically safe alternative to other salvage therapies for glottic squamous cell carcinoma recurrence, without sacrificing functional outcomes.

[In vitro study on signal transduction in mice spiral ganglion cell stimulated by multi-wavelength laser based on calcium imaging]

Objective: To research the auditory nerve transduction effects under multi-wavelength pulsed laser stimulations within a safe and acceptable signal range. Methods: The real-time detection of intracellular calcium concentration was adopted by specific fluorescent indicator staining based on calcium imager. The spiral ganglion cells of mice were cultured in vitro. After fluorescent indicating, morphologic observation under optical microscope, Fura-2 calcium ion fluorescence excitation, intact morphology cells selection, fixing the optical fiber, the spiral ganglion cells were irradiated by different wavelength laser, including visible light (450 nm) and near infrared light (808 nm,1 065 nm). The intracellular calcium concentration was monitored by calcium ion imaging. Results: When 450 nm laser stimulated spiral ganglion cells, the intracellular calcium concentration was strongly increased, however, for other wavelength laser stimulation, there was no obvious relative response. And the sensitivity expression of the nerve cells under laser was related with the location of laser fiber. Cells closer to the fiber produced more obvious changes in calcium ion concentration, while for cells farther away from the fiber, the change amplitudes were weaker although the number of changes in calcium ion concentration was consistent. Conclusion: The spiral ganglion cells of mice can induce a signal transduction response under the action of laser, and the response has laser wavelength selectivity.

Incorporating Aesthetic Devices into a Dermatologic Practice

Background: Lasers and energy-based devices allow physicians to provide quality care to patients and achieve optimal clinical results. Objective: We sought to review the benefits and drawbacks of purchasing and leasing energy-based devices and to highlight key factors that are important to consider when incorporating these devices into a practice. Methods: A PubMed search was conducted for articles on purchasing or leasing lasers and energy-based devices in dermatology. Key reports and personal commentaries on incorporating these technologies into practice are summarized in this review. Results: Energy-based devices are clinical and financial investments and can provide outstanding results for patients and result in substantial gratification for a practice. There are a variety of factors to consider when selecting specific lasers and energy-based devices. Conclusions: Capital resources, aesthetic practice values, expertise in using the device, patient demographics, location of the practice, clinic space requirements, and regulations should be considered when buying or leasing a device.

Effect of Diode Laser (810 nm) Irradiation on Marginal Microleakage of Multi-mode Adhesive Resins in Class V Composite Restorations

Introduction: Some studies have shown that laser irradiation on unpolymerized adhesives can improve composite-dentin adhesion. The aim of the present study was to evaluate the effect of the diode laser (810 nm) on the microleakage of multi-mode adhesive systems at enamel and dentin margins of composite restorations. Methods: Classic class V boxes were prepared on 48 sound premolar teeth and randomly divided into 6 groups (n=16). In the control groups, Scotchbond Universal (SBC), G-Premio (GBC), and Ambar U (AMC) were used by a self-etch mode. In the test groups (SBL, GBL, ABL), the 810 nm diode laser was irradiated (1 W) for 10 seconds before the polymerization of the adhesive. The boxes were restored by the resin composite. After finishing and polishing, the samples were thermocycled (5°C to 55°C) for 1000 cycles and then immersed in 0.1% methylene blue dye (48 hours). Dye penetration through the gingival and occlusal margins was measured by Stereomicroscope. The data were analyzed at the 5% significance level using Kruskal-Wallis and Mann-Whitney U tests. Results: Significant differences were found between the control and test groups (P < 0.05). The occlusal margins of the SBL and GBL groups and the cervical margin of the SBL group exhibited the lowest microleakage (P < 0.05). The AM control group showed maximum microleakage at cervical and occlusal margins. Conclusion: The irradiation of the 810 nm diode laser on the unpolymerized universal adhesive systems in a self-etch mode caused a significant reduction in enamel and dentin marginal microleakage of composite restorations.

The role of periodontal treatment associated with photodynamic therapy on the modulation of systemic inflammation in the experimental model of asthma and periodontitis

BACKGROUND

The association of Periodontitis (P) with several systemic diseases, among them asthma (A), has been previously studied. As periodontal treatment (TTO) associated with photodynamic therapy (PDT) is able to treat P, the aim of this study is to verify whether periodontitis exerts systemic effects on asthma, and whether TTO, associated or not with PDT, is capable of altering the systemic course of both pathologies.

METHODS

64 male Balb/c mice were divided into 8 groups (n = 8): Basal (B), P, P + TTO, P + TTO + PDT, Asthma, A + P, A + P + TTO, A + P + TTO + PDT. After 43 days, all animals were euthanized. The total and differential leukocyte count in serum, platelet count, alveolar bronchial lavage cell count, femoral lavage cell count in addition to the reactivity of the trachea, lung edema and gingiva cytokines were analyzed. The frequency of inflammatory cells was assessed via flow cytometry. One-way ANOVA test was used, followed by the Student-Newman-Keuls post-test.

RESULTS

There was an increase in the number of blood circulating eosinophils in group A when compared to group B (p < 0.01); this characterized the asthma experimental model. P (p < 0.05) presented a lower amount of cytokine TNF-α in the gingiva when compared to the Asthma group. Apart from that, there was no statistical difference found for the other analyzed parameters.

CONCLUSION

These data contributed to elucidate that P and A, associated or not with TTO and PDT, are not able to interfere with the systemic parameters of Balb/c mice.

[Safety of laser treatment for peri-implantitis: a review]

The peri-implantitis, one of the complications of dental implant surgery, has been bothered clinicians and researchers experts and scholars. Recently, laser, as an adjuvant therapy, has been applied to the treatment of peri-implantitis and achieved satisfactory results. The present review summarized the safety application of laser treatment for peri-implantitis.

Combination of laser and human adipose-derived stem cells in repair of rabbit anal sphincter injury: a new therapeutic approach

Background

Anal sphincter injury leads to fecal incontinence. Based on the regenerative capability of laser and human adipose-derived stem cells (hADSCs), this study was designed to assess the effects of co-application of these therapies on anal sphincter recovery after injury.

Design

Male rabbits were assigned to equal groups (n = 7) including control, sphincterotomy, sphincterotomy treated with laser (660 nm, 90 s, immediately after sphincterotomy, daily, 14 days), hADSCs (2 × 10⁶ hADSCs injected into injured area of the sphincter immediately after sphincterotomy), and laser + hADSCs. Ninety days after sphincterotomy, manometry and electromyography were performed, sphincter collagen content was evaluated, and Ki67, myosin heavy chain (MHC), skeletal muscle alpha-actin (ACTA1), vascular endothelial growth factor A (VEGFA), and vimentin mRNA gene expression were assessed.

Results

The laser + hADSCs group had a higher resting pressure compared with the sphincterotomy (p < 0.0001), laser (p < 0.0001), and hADSCs (p = 0.04) groups. Maximum squeeze pressure was improved in all treated animals compared with the sphincterotomized animals (p < 0.0001), without a significant difference between treatments (p > 0.05). In the laser + hADSCs group, motor unit numbers were higher than those in the laser group (p < 0.0001) but did not differ from the hADSCs group (p = 0.075). Sphincterotomy increased collagen content, but the muscle content (p = 0.36) and collagen content (p = 0.37) were not significantly different between the laser + hADSCs and control groups. Laser + hADSCs increased ACTA1 (p = 0.001) and MHC (p < 0.0001) gene expression compared with laser or hADSCs alone and was associated with increased VEGFA (p = 0.009) and Ki67 mRNA expression (p = 0.01) and decreased vimentin mRNA expression (p < 0.0001) compared with laser.

Conclusion

The combination of laser and hADSCs appears more effective than either treatment alone for promoting myogenesis, angiogenesis, and functional recovery after anal sphincterotomy.

The Effect of Titanium Tetrafluoride Treatment and the CO2 Laser on Acid Resistance of Human Enamel

Introduction: Titanium tetrafluoride (TiF4 ) is deemed more effective than the previous fluoride compounds. To enhance the effect of the fluoride compounds, researchers have suggested their association with lasers, although there are conflicting results in this area. We evaluated the acid resistance of enamel after treatment with the CO₂ laser and TiF4 . Methods: Thirteen human premolar teeth were sectioned into 5 parts and each segment was assigned to a study group: co (control): without treatment, AF: enamel treatment with APF 1.23% for 4 minutes, TF: enamel treatment with TiF4 4% for 1 minute, TF-L: enamel treatment with TiF4 4% and then the CO₂ laser (Peak power: 1 W, pulse duration: 10 ms, interval time: 500 ms, Beam spot size: 0.2 mm, distance: 2 cm), L-TF: enamel treatment with the CO₂ laser and then TiF4 4%. Each sample was kept for 7 days in acidic solution of hydroxyethyl cellulose at pH=4.5, and the amount of the calcium ion released in the solution was measured by atomic absorption spectrometry. Data were analyzed by ANOVA and Bonferroni tests. The significance level was set at 0.05. Results: The average concentration of the calcium ion released in acidic solution was 197.46, 153.30, 99.23, 61.23, 55.46 ppm in the groups respectively. There was a significant difference between the study groups (P<0.0001). Only the difference between TF-L and L-TF was not significant (P>0.05). Conclusion: The loss of calcium from the enamel samples in the groups treated with a combination of the laser and TiF4 was significantly lower than the groups treated with fluoride alone, or the control group. It did not make a significant difference whether the CO₂ laser was applied before or after TiF4 .

Successful Use of the 308-nm Excimer Laser in Early Patch Stage Mycosis Fungoides

Introduction: Mycosis fungoides (MF), a type of cutaneous T-cell lymphoma, is a rare condition with a variety of treatment options. A frequently utilized method in the treatment of early-stage MF is phototherapy. Full body phototherapy can be associated with photoaging of the skin and an increased risk of developing skin cancer. Targeted phototherapy, with a 308-nm excimer laser, may be just as effective and of a lower risk. This makes it especially useful in the treatment of patients with dysplastic nevi (DN) or other conditions which can put them at a higher risk of developing skin cancer. There are currently limited data on the treatment of early-stage MF with an excimer laser. Case Report: This study reports on a 43-year-old female patient presented to the clinic with early-stage (Ia) MF. Given her history of DN, she wished to pursue targeted phototherapy with an excimer laser. Localized light treatment was performed via a 308-nm excimer laser, 3 times weekly, for a total of 17 treatments to affected lesions. Following excimer laser treatment, she had a clinical resolution of her patches. On the follow-up clinic visits, she maintained her excellent response 12 months out. Conclusion: Targeted phototherapy with a 308-nm excimer laser may be a safer and equally effective alternative to generalized phototherapy in the treatment of early-stage MF. This case report demonstrates its efficacy and advantages over traditional generalized phototherapy.

Technological Advances in Surgical Equipment in Exotic Pet Medicine

Surgery can be challenging in exotic pets owing to their small size and blood volume, and their increased anesthetic risk compared with small animals. Various devices are available to facilitate suturing, cutting, and hemostasis in the human and veterinary fields. These surgical equipment improve the simplicity, rapidity, and effectiveness of surgery. Vessel-sealing devices, radiosurgery, lasers, and ultrasound devices are commonly used because of their ease of use and increase in surgical efficiency. Other surgical devices are available (eg, stapling devices) but are not discussed in this article.

Limited Evidence Suggests That Adjunctive Antimicrobial Photodynamic Therapy May Not Provide Additional Clinical Benefit to Conventional Instrumentation Strategy Alone in Periodontitis and Peri-implantitis Patients

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION

Antimicrobial photodynamic therapy for the treatment of periodontitis and peri-implantitis: An American Academy of Periodontology best evidence review. Chambrone L, Wang H-L, Romanos GE. J Periodontol 89(7):783-803.

SOURCE OF FUNDING

The publication was affiliated with the American Academy of Periodontology Best Evidence Consensus meeting on lasers was sponsored by J. Morita USA (Irvine, California), a manufacturer of dental laser products. Manuscript acknowledges that the funding was garnered through support from the individual authors' institutions.

TYPE OF STUDY/DESIGN

Systematic review with meta-analysis.

Four-year clinical prospective follow-up of resin composite restoration after selective caries removal using Er:YAG laser

OBJECTIVES

The aim of this study was to longitudinally evaluate, after a 4-year period, the clinical longevity of composite resin restoration compared to the baseline, after selective caries removal in permanent molars using Er:YAG laser or bur preparation with biomodification of dentin with the use of chlorhexidine.

METHODS

Selective caries removal was performed on 80 teeth of 20 individuals who each had at least four active carious lesions. These lesions, located on occlusal surfaces of permanent molar counterparts, were removed using (i) Er:YAG laser biomodified with chlorhexidine, (ii) Er:YAG laser and application of deionized water, (iii) bur preparation biomodified with chlorhexidine, and (iv) bur preparation and application of deionized water. At the end of 4 years, 64 of the 80 restorations were evaluated in 16 individuals (n = 16). The restorations were evaluated, both clinically and photographically, using scanning electron microscopy (SEM) and pulp vitality analysis. The experimental data were statistically evaluated by kappa, Fisher's, and chi-square tests, with a significance level of 5%. The Kaplan-Meier test and the Cox regression analysis were used to evaluate the survival of the restorations.

RESULTS

After 4 years of follow-up, there was a statistically significant difference in marginal discoloration criteria for all of the groups evaluated. For marginal adaptation criteria, there was a statistically significant difference for the Er:YAG laser group biomodified with chlorhexine (p = 0.050). For clinical and radiographic evaluation of pulp vitality, there were no statistically significant differences among the groups (p = 0.806).

CONCLUSION

Er:YAG laser can be used for selective caries removal, regardless of dentin biomodification with chlorhexidine or application of deionized water, once it produced promising results in composite resin restorations after 4 years of follow-up, according to the criteria evaluated. The selective caries removal using Er:YAG laser or bur and the biomodification of dentin with the use of chlorhexidine did not influence the survival of composite resin restorations after the 4-year follow-up period.

CLINICAL RELEVANCE

Composite resin restorations applied after selective caries removal using Er:YAG laser or burs, regardless of dentin biomodification with the use of chlorhexidine or application of deionized water, showed adequate clinical behavior after 4 years of follow-up.

Effects of Cyclotorsion Orientation and Magnitude in Eyes with Compound Myopic Astigmatism on the Compensation Capacity of WaveLight EX500 Photorefractive Keratectomy

Purpose

To investigate the clinical effects of different orientation and magnitude of cyclotorsion on the compensation capacity of the WaveLight EX500 photorefractive keratectomy (PRK) platform.

Methods

This retrospective study comprised 400 eyes of 200 patients who underwent bilateral simultaneous PRK due to compound myopic astigmatism. The subjects were separated according to the orientation of cyclotorsion into incyclotorsion and excyclotorsion groups, and by the magnitude of cyclotorsion into group 1 (0.50 to 2.50 degrees), group 2 (3.00 to 5.00 degrees), group 3 (5.50 to 7.50 degrees), and group 4 (8.00 to 9.50 degrees).

Results

The mean magnitude of cyclotorsion was 3.50 ± 2.4 degrees (0.50 to 9.50 degrees) in the incyclotorsion group and 3.32 ± 2.3 degrees (0.50 to 9.50 degrees) in the excyclotorsion group (p = 0.617). The postoperative refractive outcomes of the incyclotorsion and excyclotorsion groups were similar (p > 0.05 for all). The postoperative mean cylindrical refractive error was −0.32 ± 0.3 diopters (D, −1.25 to 0.00 D) in group 1, −0.47 ± 0.2 D (−2.00 to 0.00 D) in group 2, −0.62 ± 0.2 D (−1.00 to −0.25 D) in group 3, and −0.91 ± 0.2 D (−1.50 to −0.50 D) in group 4 (p < 0.001). Preoperative cylindrical refractive error was positively correlated with magnitude of cyclotorsion (r = 0.125 and p = 0.013), which was also positively correlated with postoperative cylindrical refractive error (r = 0.600 and p < 0.001).

Conclusions

Incyclotorsion and excyclotorsion can be equally compensable in the WaveLight EX500 PRK platform for compound myopic astigmatism. A value of ≤2.50 degrees cyclotorsion magnitude was observed to be more compensable than higher degrees of cyclotorsion magnitude. Preoperative high astigmatism was associated with high cyclotorsion magnitude, which was also associated with a high degree of postoperative astigmatism.