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Pereira DA, Bonatto MS, Santos SDS, Mendes PGJ, Sales E Pessoa R, de Oliveira GJPL. Comparison of different dual-wavelength photobiomodulation protocols application in third molar extractions. A split-mouth randomized controlled trial. Photodiagnosis Photodyn Ther 2024; 46:104054. [PMID: 38503387 DOI: 10.1016/j.pdpdt.2024.104054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 02/27/2024] [Accepted: 03/15/2024] [Indexed: 03/21/2024]
Abstract
OBJECTIVE To compare the use of PBMT in the soft tissue and bone healing after third molar extraction using the dual-wavelength laser directly into the post-extraction alveoli (PBMT-I), or PBMT with a red laser directly into the alveoli and with an infrared laser externally on the patient's face (PBMT-IE). METHODS Twenty patients underwent extraction of four third molars were involved in this split-mouth double-blind randomized controlled trial. The Post-extraction alveoli were treated with the following protocols: PBMT-IE: Application of a red laser directly into the alveolus, and infrared laser irradiation transcutaneously and PBMT-I: Application of dual-wavelength laser intraorally. Patients were clinically evaluated 3, 7, 14, 30, and 90 days after the surgical procedure. The analyses in this study were divided into qualitative (centered on the patient's report and on the evaluators' analysis), and quantitative analyses (measurement of the vertical and horizontal dimensions of the face with the objective of measuring post-surgical edema and radiographic analyses for evaluation of the density and structure of the newly formed bone). RESULTS A progressive improvement was observed in all parameters evaluated in this study, however, this improvement was time dependent, with no distinct effect observed between the PBMT treatments applied. CONCLUSION The different dual-wavelength PBMT protocols induced a similar postoperative clinical course in third molar extraction surgeries, with a reduced occurrence of complications and a good healing pattern of hard and soft tissues.
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Affiliation(s)
- Davisson Alves Pereira
- Universidade Federal de Uberlândia - UFU, School of Dentistry, Department of Periodontology, Uberlândia, MG, Brazil
| | - Mariana Silva Bonatto
- Universidade Federal de Uberlândia - UFU, School of Dentistry, Department of Periodontology, Uberlândia, MG, Brazil
| | - Samara de Souza Santos
- Universidade Federal de Uberlândia - UFU, School of Dentistry, Department of Periodontology, Uberlândia, MG, Brazil
| | - Pedro Gomes Junqueira Mendes
- Universidade Federal de Uberlândia - UFU, School of Dentistry, Department of Periodontology, Uberlândia, MG, Brazil.
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2
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Alam M, Karami S, Mohammadikhah M, Badkoobeh A, Golkar M, Abbasi K, Soufdoost RS, Hakim LK, Talebi S, Namanloo RA, Hussain A, Heboyan A, Tebyaniyan H. The effect of photobiomodulation therapy in common maxillofacial injuries: Current status. Cell Biochem Funct 2024; 42:e3951. [PMID: 38349051 DOI: 10.1002/cbf.3951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/04/2024] [Accepted: 01/28/2024] [Indexed: 02/15/2024]
Abstract
The use of photobiomodulation therapy (PBMT) may be used for treating trauma to the maxillofacial region. The effects of PBMT on maxillofacial injuries were discussed in this review article. The electronic databases Pubmed, Scopus, and Web of Science were thoroughly searched. This review included in vitro, in vivo, and clinical studies describing how PBMT can be used in maxillofacial tissue engineering and regenerative medicine. Some studies suggest that PBMT may offer a promising therapy for traumatic maxillofacial injuries because it can stimulate the differentiation and proliferation of various cells, including dental pulp cells and mesenchymal stem cells, enhancing bone regeneration and osseointegration. PBMT reduces pain and swelling after oral surgery and tooth extraction in human and animal models of maxillofacial injuries. Patients with temporomandibular disorders also benefit from PBMT in terms of reduced inflammation and symptoms. PBMT still has some limitations, such as the need for standardizing parameters. PBMT must also be evaluated further in randomized controlled trials in various maxillofacial injuries. As a result, PBMT offers a safe and noninvasive treatment option for patients suffering from traumatic maxillofacial injuries. PBMT still requires further research to establish its efficacy in clinical practice and determine the optimal parameters.
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Affiliation(s)
- Mostafa Alam
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Meysam Mohammadikhah
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Alborz University of Medical Sciences, Karaj, Iran
| | - Ashkan Badkoobeh
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Qom University of Medical Sciences, Qom, Iran
| | - Mohsen Golkar
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kamyar Abbasi
- Department of Prosthodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | | | - Sahar Talebi
- Research Committee, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Ahmed Hussain
- School of Dentistry, Edmonton Clinic Health Academy, University of Alberta, Edmonton, Canada
| | - Artak Heboyan
- Department of Prosthodontics, Faculty of Stomatology, Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia
- Department of Research Analytics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India
| | - Hamid Tebyaniyan
- Department of Science and Research, Islimic Azade University, Tehran, Iran
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3
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Gonçalves FC, Mascaro BA, Oliveira GJPLD, Spolidório LC, Marcantonio RAC. Effects of red and infrared laser on post extraction socket repair in rats subjected to alendronate therapy. Braz Oral Res 2023; 37:e048. [PMID: 37255068 DOI: 10.1590/1807-3107bor-2023.vol37.0048] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 12/14/2021] [Indexed: 06/01/2023] Open
Abstract
This study evaluated the effect of photobiomodulation therapy (PBMT) with a red or infrared laser on the repair of post extraction sockets in rats administered alendronate (ALN). Forty male rats were randomly allocated into four groups: Control Group (CTR): subcutaneous administration of saline solution throughout the experimental period; Alendronate Group (ALN): subcutaneous administration of alendronate during the entire experimental period; Alendronate/Red Laser Group (ALN/RL): administration of ALN and irradiation with a GaAlAs laser (λ 660 nm); and Alendronate/Infrared Laser Group (ALN/IRL): administration of ALN and irradiation with a GaAlAs laser (λ 830 nm). The first lower molars were extracted 60 days after the beginning of the administration of the drugs. The PBMT was applied after tooth extraction (7 sessions with intervals of 48 hours between sessions). Thirty days after tooth extraction, the animals were euthanized. Micro-CT and histometric analysis were performed to assess the bone healing and soft tissue repair of the tooth socket. The ALN group presented with more bone than the CTR; however, most of this bone was necrotic. ALN does not affect the bone microarchitecture. On the other hand, PBMT with IRL enhances the bone density due to the increase in the number and reduction in the spacing of the trabeculae. The amount of vital bone and connective tissue matrix was higher in the ALN/RL and ALN/IRL groups than in the ALN and CTR groups. PBMT enhanced the healing of the post extraction sockets in rats subjected to ALN administration. Furthermore, IRL improved the new bone microarchitecture.
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Affiliation(s)
- Fernanda Castanheira Gonçalves
- Universidade Estadual Paulista - Unesp, School of Dentistry, Department of Diagnosis and Surgery, Araraquara, SP, Brazil
| | - Bruno Arruda Mascaro
- Universidade Estadual Paulista - Unesp, School of Dentistry, Department of Diagnosis and Surgery, Araraquara, SP, Brazil
| | | | - Luis Carlos Spolidório
- Universidade Estadual Paulista - Unesp, School of Dentistry, Department of Physiology and Pathology, Araraquara, SP, Brazil
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Freitas NRD, Guerrini LB, Esper LA, Sbrana MC, Santos CCVD, Almeida ALPFD. Photobiomodulation and Inorganic Bovine Bone in Guided Bone Regeneration: Histomorphometric Analysis in Rats. J Funct Biomater 2023; 14:jfb14050281. [PMID: 37233392 DOI: 10.3390/jfb14050281] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 05/10/2023] [Accepted: 05/14/2023] [Indexed: 05/27/2023] Open
Abstract
The objective of this study was to evaluate the efficacy of photobiomodulation in the bone regeneration of critical-sized defects (CSD) filled with inorganic bovine bone associated or not with collagen membranes. The study has been conducted on 40 critical defects in the calvaria of male rats, divided into four experimental groups (n = 10): (1) DBBM (deproteinized bovine bone mineral); (2) GBR (DBBM+collagen membrane); (3) DBBM+P (DBBM+photobiomodulation); and (4) GBR+P (GBR+photobiomodulation). At 30 days postoperative, the animals were euthanized, and after the tissue had been processed, histological, histometric, and statistical analyses were performed. The analyses have taken into account newly formed bone area (NBA), linear bone extension (LBE), and residual particle area (RPA) as variables. The Kruskal-Wallis test has been performed, followed by the Dwass-Steel-Critchlow-Fligner test for comparison between groups (p < 0.05). When the DBBM+P group was compared to the DBBM group, it was possible to observe significant statistical differences in all the variables analyzed (p < 0.05). The application of photobiomodulation in guided bone regeneration (GBR+P) has shown a decrease in the median value for the RPA variable (26.8) when compared to the GBR group (32.4), with a significant statistical difference; however, for NBA and LBE, the therapy has not provided significant results.
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Affiliation(s)
- Nicole Rosa de Freitas
- Postgraduate Program, Bauru School of Dentistry, University of São Paulo, Bauru 17012-901, Brazil
| | - Luísa Belluco Guerrini
- Postgraduate Program, Bauru School of Dentistry, University of São Paulo, Bauru 17012-901, Brazil
| | - Luis Augusto Esper
- Periodontics Sector, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru 17012-900, Brazil
| | - Michyele Cristhiane Sbrana
- Periodontics Sector, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru 17012-900, Brazil
| | | | - Ana Lúcia Pompéia Fraga de Almeida
- Periodontics Sector, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru 17012-900, Brazil
- Department of Prosthodontics and Periodontics, Bauru School of Dentistry, University of São Paulo, Bauru 17012-901, Brazil
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Chen Z, Miao D, Zhang L, Zhong L, Liu N, Chen Y. Efficacy of concentrated growth factor with low-level laser for the regeneration of interdental papilla defects. Odontology 2022; 110:795-804. [PMID: 35290532 DOI: 10.1007/s10266-022-00702-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 03/03/2022] [Indexed: 11/26/2022]
Abstract
Gingival "black triangle" is common in clinical which due to interdental papilla recession. The cause of the loss of papilla is multi-factorial and it may be caused by the absorption of interdental alveolar bone or abnormal tooth position. Besides, it is a common complication after orthodontics and implant surgery. Recession of gingival papilla influences interdental plaque control, increasing food impaction and alveolar bone absorption, causing aesthetic and pronunciation problems. Thus, the way of reducing or eliminating the gingival "black triangle" has become one of the most essential problems for dentists. Concentrated growth factor (CGF) and low-level-laser therapy have been widely used, respectively, and CGF was considered as the only self-substance which has soft tissue regeneration function. This study aims to evaluate the efficacy of regenerating interdental papilla by Liquid phase concentrated growth factor (LPCGF) injection with low-level-laser therapy (LLLT).
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Affiliation(s)
- Ziling Chen
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
- Department of Periodontology, College of Stomatology, Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Di Miao
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
- Department of Periodontology, College of Stomatology, Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Le Zhang
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
- Department of Periodontology, College of Stomatology, Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Liangqiuyue Zhong
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
- Department of Periodontology, College of Stomatology, Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Na Liu
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
- Department of Periodontology, College of Stomatology, Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Yue Chen
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, China.
- Department of Periodontology, College of Stomatology, Xi'an Jiaotong University, Xi'an, People's Republic of China.
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Santos MAFM, Silva DN, Rovaris K, Sousa FB, Dantas ELA, Loureiro LA, Pereira TMC, Meyrelles SS, Bertollo RM, Vasquez EC. Optimal Parameters of Laser Therapy to Improve Critical Calvarial Defects. Front Physiol 2022; 13:841146. [PMID: 35283760 PMCID: PMC8914104 DOI: 10.3389/fphys.2022.841146] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/21/2022] [Indexed: 02/04/2023] Open
Abstract
Body bones play diverse pivotal roles, including the protection of vital organs. For instance, the integrative functions of the brain controlling diverse peripheral actions can be affected by a traumatic injury on the calvaria and the reparative process of a large defect is a challenge in the integrative physiology. Therefore, the development of biomaterials and approaches to improve such defects still requires substantial advances. In this regard, the most attractive approaches have been covering the cavity with inorganic bovine bone (IBB) and, more recently, also using low-level laser therapy (LT), but this issue has opened many questions. Here, it was determined the number of LT sessions required to speed up and to intensify the recovery process of two 5-mm-diameter defects promoted in the calvaria of each subgroup of six adult Wistar rats. The quantitative data showed that 30 days post-surgery, the recovery process by using blood clot-filling was not significantly influenced by the number of LT sessions. However, in the IBB-filled defects, the number of LT sessions markedly contributed to the improvement of the reparative process. Compared to the Control group (non-irradiated), the percentage of mineralization (formation of new bone into the cavities) gradually increased 25, 49, and 52% with, respectively, 4, 7, and 11 sessions of LT. In summary, combining the use of IBB with seven sessions of LT seems to be an optimal approach to greatly improve the recovery of calvarial defects. This translational research opens new avenues targeting better conditions of life for those suffering from large bone traumas and in the present field could contribute to preserve the integrative functions of the brain.
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Affiliation(s)
- Matheus AFM Santos
- Dentistry Graduate Program, Federal University of Espirito Santo, UFES, Vitoria, Brazil
| | - Daniela N. Silva
- Dentistry Graduate Program, Federal University of Espirito Santo, UFES, Vitoria, Brazil
| | - Karla Rovaris
- Department of Pathology & Clinical Dentistry, Federal University of Piaui, Teresina, Brazil
| | - Frederico B. Sousa
- Department of Morphology, Federal University of Paraiba, UFPB, Joao Pessoa, Brazil
| | | | - Lucas A. Loureiro
- Pharmaceutical Sciences Graduate Program, Vila Velha University, Vila Velha, Brazil
| | - Thiago M. C. Pereira
- Pharmaceutical Sciences Graduate Program, Vila Velha University, Vila Velha, Brazil
| | - Silvana S. Meyrelles
- Dentistry Graduate Program, Federal University of Espirito Santo, UFES, Vitoria, Brazil
| | - Rossiene M. Bertollo
- Dentistry Graduate Program, Federal University of Espirito Santo, UFES, Vitoria, Brazil
| | - Elisardo C. Vasquez
- Pharmaceutical Sciences Graduate Program, Vila Velha University, Vila Velha, Brazil
- *Correspondence: Elisardo C. Vasquez,
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Inchingolo F, Hazballa D, Inchingolo AD, Malcangi G, Marinelli G, Mancini A, Maggiore ME, Bordea IR, Scarano A, Farronato M, Tartaglia GM, Lorusso F, Inchingolo AM, Dipalma G. Innovative Concepts and Recent Breakthrough for Engineered Graft and Constructs for Bone Regeneration: A Literature Systematic Review. MATERIALS 2022; 15:ma15031120. [PMID: 35161065 PMCID: PMC8839672 DOI: 10.3390/ma15031120] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/26/2022] [Accepted: 01/27/2022] [Indexed: 02/06/2023]
Abstract
Background: For decades, regenerative medicine and dentistry have been improved with new therapies and innovative clinical protocols. The aim of the present investigation was to evaluate through a critical review the recent innovations in the field of bone regeneration with a focus on the healing potentials and clinical protocols of bone substitutes combined with engineered constructs, growth factors and photobiomodulation applications. Methods: A Boolean systematic search was conducted by PubMed/Medline, PubMed/Central, Web of Science and Google scholar databases according to the PRISMA guidelines. Results: After the initial screening, a total of 304 papers were considered eligible for the qualitative synthesis. The articles included were categorized according to the main topics: alloplastic bone substitutes, autologous teeth derived substitutes, xenografts, platelet-derived concentrates, laser therapy, microbiota and bone metabolism and mesenchymal cells construct. Conclusions: The effectiveness of the present investigation showed that the use of biocompatible and bio-resorbable bone substitutes are related to the high-predictability of the bone regeneration protocols, while the oral microbiota and systemic health of the patient produce a clinical advantage for the long-term success of the regeneration procedures and implant-supported restorations. The use of growth factors is able to reduce the co-morbidity of the regenerative procedure ameliorating the post-operative healing phase. The LLLT is an adjuvant protocol to improve the soft and hard tissues response for bone regeneration treatment protocols.
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Affiliation(s)
- Francesco Inchingolo
- Department of Interdisciplinary Medicine, University of Medicine Aldo Moro, 70124 Bari, Italy; (D.H.); (A.D.I.); (G.M.); (G.M.); (A.M.); (M.E.M.); (A.M.I.)
- Correspondence: (F.I.); (F.L.); (G.D.); Tel.: +39-3312111104 (F.I.); +39-3282132586 (F.L.); +39-3396989939 (G.D.)
| | - Denisa Hazballa
- Department of Interdisciplinary Medicine, University of Medicine Aldo Moro, 70124 Bari, Italy; (D.H.); (A.D.I.); (G.M.); (G.M.); (A.M.); (M.E.M.); (A.M.I.)
- Kongresi Elbasanit, Rruga: Aqif Pasha, 3001 Elbasan, Albania
| | - Alessio Danilo Inchingolo
- Department of Interdisciplinary Medicine, University of Medicine Aldo Moro, 70124 Bari, Italy; (D.H.); (A.D.I.); (G.M.); (G.M.); (A.M.); (M.E.M.); (A.M.I.)
| | - Giuseppina Malcangi
- Department of Interdisciplinary Medicine, University of Medicine Aldo Moro, 70124 Bari, Italy; (D.H.); (A.D.I.); (G.M.); (G.M.); (A.M.); (M.E.M.); (A.M.I.)
| | - Grazia Marinelli
- Department of Interdisciplinary Medicine, University of Medicine Aldo Moro, 70124 Bari, Italy; (D.H.); (A.D.I.); (G.M.); (G.M.); (A.M.); (M.E.M.); (A.M.I.)
| | - Antonio Mancini
- Department of Interdisciplinary Medicine, University of Medicine Aldo Moro, 70124 Bari, Italy; (D.H.); (A.D.I.); (G.M.); (G.M.); (A.M.); (M.E.M.); (A.M.I.)
| | - Maria Elena Maggiore
- Department of Interdisciplinary Medicine, University of Medicine Aldo Moro, 70124 Bari, Italy; (D.H.); (A.D.I.); (G.M.); (G.M.); (A.M.); (M.E.M.); (A.M.I.)
| | - Ioana Roxana Bordea
- Department of Oral Rehabilitation, Faculty of Dentistry, Iuliu Hațieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
| | - Antonio Scarano
- Department of Innovative Technologies in Medicine and Dentistry, University of Chieti-Pescara, 66100 Chieti, Italy;
| | - Marco Farronato
- UOC Maxillo-Facial Surgery and Dentistry, Department of Biomedical, Surgical and Dental Sciences, School of Dentistry, Fondazione IRCCS Ca Granda, Ospedale Maggiore Policlinico, University of Milan, 20100 Milan, Italy; (M.F.); (G.M.T.)
| | - Gianluca Martino Tartaglia
- UOC Maxillo-Facial Surgery and Dentistry, Department of Biomedical, Surgical and Dental Sciences, School of Dentistry, Fondazione IRCCS Ca Granda, Ospedale Maggiore Policlinico, University of Milan, 20100 Milan, Italy; (M.F.); (G.M.T.)
| | - Felice Lorusso
- Department of Innovative Technologies in Medicine and Dentistry, University of Chieti-Pescara, 66100 Chieti, Italy;
- Correspondence: (F.I.); (F.L.); (G.D.); Tel.: +39-3312111104 (F.I.); +39-3282132586 (F.L.); +39-3396989939 (G.D.)
| | - Angelo Michele Inchingolo
- Department of Interdisciplinary Medicine, University of Medicine Aldo Moro, 70124 Bari, Italy; (D.H.); (A.D.I.); (G.M.); (G.M.); (A.M.); (M.E.M.); (A.M.I.)
| | - Gianna Dipalma
- Department of Interdisciplinary Medicine, University of Medicine Aldo Moro, 70124 Bari, Italy; (D.H.); (A.D.I.); (G.M.); (G.M.); (A.M.); (M.E.M.); (A.M.I.)
- Correspondence: (F.I.); (F.L.); (G.D.); Tel.: +39-3312111104 (F.I.); +39-3282132586 (F.L.); +39-3396989939 (G.D.)
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Pereira DA, Mendes PGJ, de Souza Santos S, de Rezende Barbosa GL, Pessoa RSE, de Oliveira GJPL. Effect of the association of infra-red and red wavelength photobiomodulation therapy on the healing of post-extraction sockets of third lower molars: a split-mouth randomized clinical trial. Lasers Med Sci 2022; 37:2479-2487. [DOI: 10.1007/s10103-022-03511-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 01/17/2022] [Indexed: 11/25/2022]
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Oliveira GJPLD, Pinotti FE, Aroni MAT, Marcantonio E, Marcantonio RAC. Effect of different low-level intensity laser therapy (LLLT) irradiation protocols on the osseointegration of implants placed in grafted areas. J Appl Oral Sci 2021; 29:e20200647. [PMID: 33886940 PMCID: PMC8054649 DOI: 10.1590/1678-7757-2020-0647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 01/15/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To evaluate the effect of different protocols of low-level intensity laser therapy (LLLT) irradiation on the osseointegration of implants placed in grafted areas. METHODOLOGY 84 rats were randomly allocated into six groups: DBB: defect filled with deproteinized bovine bone; HA/TCP: defect filled with biphasic ceramic of hydroxyapatite/β-tricalcium phosphate ; DBB-LI: defect filled with DBB and treated with LLLT after implant placement; HA/TCP-LI: defect filled with HA/TCP and treated with LLLT after implant placement; DBB-LIB: defect filled with DBB and treated with LLLT after graft procedure and implant placement; and HA/TCP-LIB: defect filled HA/TCP and treated with LLLT after graft procedure and implant placement. The bone defects were made in the tibia and they were grafted. After 60 days, the implants were placed. The rats were subsequently subjected to euthanasia 15 and 45 days after implant placement. The pattern of osseointegration and bone repair in the grafted area was evaluated by biomechanical, microtomographic, and histometric analyses. Furthermore, the expression of bone biomarker proteins was assessed. RESULTS The LLLT groups presented higher removal torque, mineralized tissue volume, and a greater degree of osseointegration, especially when LLLT was performed only after implant placement, and these findings were associated with higher expression of BMP2 and alkaline phosphatase. CONCLUSION LLLT performed on implants placed in grafted areas enhances the osseointegration process.
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Affiliation(s)
| | - Felipe Eduardo Pinotti
- Universidade Estadual Paulista (UNESP), Faculdade de Odontologia de Araraquara, Departmento de Diagnóstico e Cirurgia, Araraquara, SP, Brasil
| | | | - Elcio Marcantonio
- Universidade Estadual Paulista (UNESP), Faculdade de Odontologia de Araraquara, Departmento de Diagnóstico e Cirurgia, Araraquara, SP, Brasil
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10
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Magri AMP, Parisi JR, de Andrade ALM, Rennó ACM. Bone substitutes and photobiomodulation in bone regeneration: A systematic review in animal experimental studies. J Biomed Mater Res A 2021; 109:1765-1775. [PMID: 33733598 DOI: 10.1002/jbm.a.37170] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/02/2021] [Accepted: 03/08/2021] [Indexed: 11/08/2022]
Abstract
In general, bone fractures are able of healing by itself. However, in critical situations such as large bone defects, poor blood supply or even infections, the biological capacity of repair can be impaired, resulting in a delay of the consolidation process or even in non-union fractures. Thus, technologies able of improving the process of bone regeneration are of high demand. In this context, ceramic biomaterials-based bone substitutes and photobiomodulation (PBM) have been emerging as promising alternatives. Thus, the present study performed a systematic review targeting to analyze studies in the literature which investigated the effects of the association of ceramic based bone substitutes and PBM in the process of bone healing using animal models of bone defects. The search was conducted from March and April of 2019 in PubMed, Web of Science and Scopus databases. After the eligibility analyses, 16 studies were included in this review. The results showed that the most common material used was hydroxyapatite (HA) followed by Biosilicate associated with infrared PBM. Furthermore, 75% of the studies demonstrated positive effects to stimulate bone regeneration from association of ceramic biomaterials and PBM. All studies used low-level laser therapy (LLLT) device and the most studies used LLLT infrared. The evidence synthesis was moderate for all experimental studies for the variable histological analysis demonstrating the efficacy of techniques on the process of bone repair stimulation. In conclusion, this review demonstrates that the association of ceramic biomaterials and PBM presented positive effects for bone repair in experimental models of bone defects.
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Affiliation(s)
- Angela Maria Paiva Magri
- Department of Biosciences, Federal University of São Paulo (UNIFESP), Santos, São Paulo, Brazil.,University Center of the Guaxupé Education Foundation (UNIFEG), Guaxupé, Minas Gerais, Brazil
| | - Júlia Risso Parisi
- Department of Biosciences, Federal University of São Paulo (UNIFESP), Santos, São Paulo, Brazil.,Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Carlos, São Paulo, Brazil
| | | | - Ana Claudia Muniz Rennó
- Department of Biosciences, Federal University of São Paulo (UNIFESP), Santos, São Paulo, Brazil.,Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Carlos, São Paulo, Brazil
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11
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Torquato LC, Suárez EAC, Bernardo DV, Pinto ILR, Mantovani LO, Silva TIL, Jardini MAN, Santamaria MP, De Marco AC. Bone repair assessment of critical size defects in rats treated with mineralized bovine bone (Bio-Oss®) and photobiomodulation therapy: a histomorphometric and immunohistochemical study. Lasers Med Sci 2021; 36:1515-1525. [PMID: 33400010 DOI: 10.1007/s10103-020-03234-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 12/22/2020] [Indexed: 10/22/2022]
Abstract
This study aimed to investigate the effects of administering photobiomodulation therapy (PBM) with bovine bone matrix on critical size defects in rats. Seventy-two adult male rats (albinus, Wistar), 90 days old, were used. Defect of 5 mm in diameter was made in their calvaria. The animals were divided into 4 groups: C-blood clot, B-Bio-Oss®, L-PBM, B+L-Bio-Oss®+PBM. Each group has been subdivided into 07, 30, and 60 days of observation. For PBM, a low GaAlAs energy of 660 nm was irradiated, total energy density of 45 J/cm2 . PBM was conducted in a trans-surgical form once only. For immunohistochemistry, a semi-quantitative analysis was made of expression of osteoprotegerin (OPG), nuclear kappa B-factor ligand receptor activator (RANKL), and tartrate-resistant acid phosphatase (TRAP). All histomorphometric data were statistically analyzed by ANOVA and Tukey test, significance level of 5%. The groups that showed the highest proportion of neoformation were L (0.39% ± 0.13) and C (0.37% ± 0.97), but groups B and B+L had larger defect size (C-1.75 mm2 ± 0.40, B-3.02 mm2 ± 0.63, L-2.45 mm2 ± 0.53, B+L-3.23 mm2 ± 1.01). In immunohistochemistry, groups B and B+L had higher immunostaining scores for OPG and RANKL at 60 days, and TRAP immunostaining increased in all groups at 30 days, but group L was the only one to present specimens with score 0. Although, at 60 days, groups L and C presented the highest proportion of bone neoformation, at 30 days group B+L had more than twice as much bone neoformation as group B, the choice of treatment application should depend on the aim of the treatment.
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Affiliation(s)
- Letícia Cavassini Torquato
- Department of Diagnosis and Surgery, São Paulo State University (UNESP), Institute of Science and Technology, Av. Eng. Francisco José Longo, n° 777 - Jardim São Dimas, São José dos Campos, SP, 12245-000, Brazil.
| | - Eduardo Antonio Chelin Suárez
- Department of Diagnosis and Surgery, São Paulo State University (UNESP), Institute of Science and Technology, Av. Eng. Francisco José Longo, n° 777 - Jardim São Dimas, São José dos Campos, SP, 12245-000, Brazil
| | - Daniella Viscensotto Bernardo
- Department of Diagnosis and Surgery, São Paulo State University (UNESP), Institute of Science and Technology, Av. Eng. Francisco José Longo, n° 777 - Jardim São Dimas, São José dos Campos, SP, 12245-000, Brazil
| | | | | | - Thiago Igor Lemes Silva
- São Paulo State University (UNESP), Institute of Science and Technology, São José dos Campos, SP, Brazil
| | - Maria Aparecida Neves Jardini
- Department of Diagnosis and Surgery - Division of Periodontology, São Paulo State University (UNESP), Institute of Science and Tecnology, São José dos Campos, SP, Brazil
| | - Mauro Pedrine Santamaria
- Department of Diagnosis and Surgery - Division of Periodontology, São Paulo State University (UNESP), Institute of Science and Tecnology, São José dos Campos, SP, Brazil
| | - Andrea Carvalho De Marco
- Department of Diagnosis and Surgery - Division of Periodontology, São Paulo State University (UNESP), Institute of Science and Tecnology, São José dos Campos, SP, Brazil
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12
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Hanna R, Dalvi S, Amaroli A, De Angelis N, Benedicenti S. Effects of photobiomodulation on bone defects grafted with bone substitutes: A systematic review of in vivo animal studies. JOURNAL OF BIOPHOTONICS 2021; 14:e202000267. [PMID: 32857463 DOI: 10.1002/jbio.202000267] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/23/2020] [Accepted: 08/25/2020] [Indexed: 06/11/2023]
Abstract
A present, photobiomodulation therapy (PBMT) effectiveness in enhancing bone regeneration in bone defects grafted with or without biomaterials is unclear. This systematic review (PROSPERO, ref. CRD 42019148959) aimed to critically appraise animal in vivo published data and present the efficacy of PBMT and its potential synergistic effects on grafted bone defects. MEDLINE, CCCT, Scopus, Science Direct, Google Scholar, EMBASE, EBSCO were searched, utilizing the following keywords: bone repair; low-level laser therapy; LLLT; light emitting diode; LEDs; photobiomodulation therapy; in vivo animal studies, bone substitutes, to identify studies between 1994 and 2019. After applying the eligibility criteria, 38 papers included where the results reported according to "PRISMA." The results revealed insufficient and incomplete PBM parameters, however, the outcomes with or without biomaterials have positive effects on bone healing. In conclusion, in vivo animal studies with a standardized protocol to elucidate the effects of PBMT on biomaterials are required initially prior to clinical studies.
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Affiliation(s)
- Reem Hanna
- Department of Surgical Sciences and Integrated Diagnostics, Laser Therapy Centre, University of Genoa, Genoa, Italy
- Department of Oral Surgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Snehal Dalvi
- Department of Surgical Sciences and Integrated Diagnostics, Laser Therapy Centre, University of Genoa, Genoa, Italy
- Department of Periodontology, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur, India
| | - Andrea Amaroli
- Department of Orthopaedic Dentistry, First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Nicola De Angelis
- Department of Surgical Sciences and Integrated Diagnostics, Laser Therapy Centre, University of Genoa, Genoa, Italy
- Faculty of Dentistry, University of Technology MARA Sungai Buloh, Shah Alam, Malaysia
| | - Stefano Benedicenti
- Department of Surgical Sciences and Integrated Diagnostics, Laser Therapy Centre, University of Genoa, Genoa, Italy
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13
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Rosso MPDO, Oyadomari AT, Pomini KT, Della Coletta BB, Shindo JVTC, Ferreira Júnior RS, Barraviera B, Cassaro CV, Buchaim DV, Teixeira DDB, Barbalho SM, Alcalde MP, Duarte MAH, Andreo JC, Buchaim RL. Photobiomodulation Therapy Associated with Heterologous Fibrin Biopolymer and Bovine Bone Matrix Helps to Reconstruct Long Bones. Biomolecules 2020; 10:biom10030383. [PMID: 32121647 PMCID: PMC7175234 DOI: 10.3390/biom10030383] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 02/18/2020] [Accepted: 02/25/2020] [Indexed: 12/16/2022] Open
Abstract
Bone defects cause aesthetic and functional changes that affect the social, economic and especially the emotional life of human beings. This complication stimulates the scientific community to investigate strategies aimed at improving bone reconstruction processes using complementary therapies. Photobiomodulation therapy (PBMT) and the use of new biomaterials, including heterologous fibrin biopolymer (HFB), are included in this challenge. The objective of the present study was to evaluate the influence of photobiomodulation therapy on bone tibial reconstruction of rats with biomaterial consisting of lyophilized bovine bone matrix (BM) associated or not with heterologous fibrin biopolymer. Thirty male rats were randomly separated into three groups of 10 animals. In all animals, after the anesthetic procedure, a noncritical tibial defect of 2 mm was performed. The groups received the following treatments: Group 1: BM + PBMT, Group 2: BM + HFB and Group 3: BM + HFB + PBMT. The animals from Groups 1 and 3 were submitted to PBMT in the immediate postoperative period and every 48 h until the day of euthanasia that occurred at 14 and 42 days. Analyses by computed microtomography (µCT) and histomorphometry showed statistical difference in the percentage of bone formation between Groups 3 (BM + HB + PBMT) and 2 (BM + HFB) (26.4% ± 1.03% and 20.0% ± 1.87%, respectively) at 14 days and at 42 days (38.2% ± 1.59% and 31.6% ± 1.33%, respectively), and at 42 days there was presence of bone with mature characteristics and organized connective tissue. The µCT demonstrated BM particles filling the defect and the deposition of new bone in the superficial region, especially in the ruptured cortical. It was concluded that the association of PBMT with HFB and BM has the potential to assist in the process of reconstructing bone defects in the tibia of rats.
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Affiliation(s)
- Marcelie Priscila de Oliveira Rosso
- Department of Biological Sciences (Anatomy), Bauru School of Dentistry, University of São Paulo (USP), Alameda Dr. Octávio Pinheiro Brisolla, 9-75-Vila Universitaria, Bauru 17012-901, São Paulo, Brazil; (M.P.d.O.R.); (A.T.O.); (K.T.P.); (B.B.D.C.); (J.V.T.C.S.); (J.C.A.)
| | - Aline Tiemi Oyadomari
- Department of Biological Sciences (Anatomy), Bauru School of Dentistry, University of São Paulo (USP), Alameda Dr. Octávio Pinheiro Brisolla, 9-75-Vila Universitaria, Bauru 17012-901, São Paulo, Brazil; (M.P.d.O.R.); (A.T.O.); (K.T.P.); (B.B.D.C.); (J.V.T.C.S.); (J.C.A.)
| | - Karina Torres Pomini
- Department of Biological Sciences (Anatomy), Bauru School of Dentistry, University of São Paulo (USP), Alameda Dr. Octávio Pinheiro Brisolla, 9-75-Vila Universitaria, Bauru 17012-901, São Paulo, Brazil; (M.P.d.O.R.); (A.T.O.); (K.T.P.); (B.B.D.C.); (J.V.T.C.S.); (J.C.A.)
| | - Bruna Botteon Della Coletta
- Department of Biological Sciences (Anatomy), Bauru School of Dentistry, University of São Paulo (USP), Alameda Dr. Octávio Pinheiro Brisolla, 9-75-Vila Universitaria, Bauru 17012-901, São Paulo, Brazil; (M.P.d.O.R.); (A.T.O.); (K.T.P.); (B.B.D.C.); (J.V.T.C.S.); (J.C.A.)
| | - João Vitor Tadashi Cosin Shindo
- Department of Biological Sciences (Anatomy), Bauru School of Dentistry, University of São Paulo (USP), Alameda Dr. Octávio Pinheiro Brisolla, 9-75-Vila Universitaria, Bauru 17012-901, São Paulo, Brazil; (M.P.d.O.R.); (A.T.O.); (K.T.P.); (B.B.D.C.); (J.V.T.C.S.); (J.C.A.)
| | - Rui Seabra Ferreira Júnior
- Center for the Study of Venoms and Venomous Animals (CEVAP), São Paulo State University (Univ. Estadual Paulista, UNESP), Botucatu 18610-307, São Paulo, Brazil or (R.S.F.J.); (B.B.); (C.V.C.)
| | - Benedito Barraviera
- Center for the Study of Venoms and Venomous Animals (CEVAP), São Paulo State University (Univ. Estadual Paulista, UNESP), Botucatu 18610-307, São Paulo, Brazil or (R.S.F.J.); (B.B.); (C.V.C.)
| | - Claudia Vilalva Cassaro
- Center for the Study of Venoms and Venomous Animals (CEVAP), São Paulo State University (Univ. Estadual Paulista, UNESP), Botucatu 18610-307, São Paulo, Brazil or (R.S.F.J.); (B.B.); (C.V.C.)
| | - Daniela Vieira Buchaim
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marilia (UNIMAR), Avenue Hygino Muzzy Filho, 1001, Marília 17525-902, São Paulo, Brazil; (D.V.B.); (D.d.B.T.); (S.M.B.)
- Medical School, University Center of Adamantina (UniFAI), Nove de Julho Street, 730-Centro, Adamantina 17800-000, São Paulo, Brazil
| | - Daniel de Bortoli Teixeira
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marilia (UNIMAR), Avenue Hygino Muzzy Filho, 1001, Marília 17525-902, São Paulo, Brazil; (D.V.B.); (D.d.B.T.); (S.M.B.)
| | - Sandra Maria Barbalho
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marilia (UNIMAR), Avenue Hygino Muzzy Filho, 1001, Marília 17525-902, São Paulo, Brazil; (D.V.B.); (D.d.B.T.); (S.M.B.)
| | - Murilo Priori Alcalde
- Department of Health Science, University of the Sacred Heart (USC), Bauru 17011-160, São Paulo, Brazil;
- Department of Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of São Paulo (USP), Bauru 17012-901, São Paulo, Brazil;
| | - Marco Antonio Hungaro Duarte
- Department of Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of São Paulo (USP), Bauru 17012-901, São Paulo, Brazil;
| | - Jesus Carlos Andreo
- Department of Biological Sciences (Anatomy), Bauru School of Dentistry, University of São Paulo (USP), Alameda Dr. Octávio Pinheiro Brisolla, 9-75-Vila Universitaria, Bauru 17012-901, São Paulo, Brazil; (M.P.d.O.R.); (A.T.O.); (K.T.P.); (B.B.D.C.); (J.V.T.C.S.); (J.C.A.)
| | - Rogério Leone Buchaim
- Department of Biological Sciences (Anatomy), Bauru School of Dentistry, University of São Paulo (USP), Alameda Dr. Octávio Pinheiro Brisolla, 9-75-Vila Universitaria, Bauru 17012-901, São Paulo, Brazil; (M.P.d.O.R.); (A.T.O.); (K.T.P.); (B.B.D.C.); (J.V.T.C.S.); (J.C.A.)
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of Marilia (UNIMAR), Avenue Hygino Muzzy Filho, 1001, Marília 17525-902, São Paulo, Brazil; (D.V.B.); (D.d.B.T.); (S.M.B.)
- Correspondence: ; Tel.: +55-14-3235-8226
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14
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Macedo AAP, Santos TD, Cunha JLS, Matos FDS, Albuquerque Júnior RLCD, Ribeiro MAG. Effect of laser photobiomodulation associated with a bioceramic cement on the repair of bone tissue in the femur of rats. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY. B, BIOLOGY 2020; 205:111813. [PMID: 32070823 DOI: 10.1016/j.jphotobiol.2020.111813] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 02/02/2020] [Accepted: 02/04/2020] [Indexed: 12/01/2022]
Abstract
This study aimed to evaluate in vivo the effect of laser photobiomodulation associated with a repair cement (MTA Repair HP™) on the process of bone repair in the femur of rats, through histological and histomorphometric assays. Forty Wistar albino rats were randomly divided into four groups, with two periods of euthanasia - 15 and 21 days (n = 5 per period). Under general anesthesia, a bone defect was made in the left femur of each animal. In the LS (Laser) group, the defect was irradiated following the parameters: λ = 808 nm, P = 100 mW, ED = 80 J/cm2 per point, 22 s per point, E = 2.2 J per point. In the LM (MTA Repair HP™ + Laser) group, the defect was filled with MTA Repair HP™ and irradiated with laser in the same protocol of the LS group. In the MH (MTA Repair HP™) group, the defect was filled with MTA Repair HP™ without irradiation. In the CTR (Control) group, the bone defect received no treatment. At 15 days, the mean index of bone neoformation in the defect area was significantly lower in the CTR group as compared to the MH, LS, and LM groups. At 21 days, the LM group presented significantly greater bone neoformation than the MH group, without significant difference between LS and LM. Laser photobiomodulation therapy is promising as an adjuvant in the bone repair process, especially when associated with the use of biomaterials.
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Low-level laser therapy (LLLT) in sites grafted with osteoconductive bone substitutes improves osseointegration. Lasers Med Sci 2020; 35:1519-1529. [DOI: 10.1007/s10103-019-02943-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 12/22/2019] [Indexed: 10/25/2022]
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Photobiomodulation Therapy (PBMT) Applied in Bone Reconstructive Surgery Using Bovine Bone Grafts: A Systematic Review. MATERIALS 2019; 12:ma12244051. [PMID: 31817369 PMCID: PMC6947623 DOI: 10.3390/ma12244051] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 11/22/2019] [Accepted: 11/29/2019] [Indexed: 02/07/2023]
Abstract
The use of low-level laser therapy (LLLT) with biomodulatory effects on biological tissues, currently called photobiomodulation therapy (PBMT), assists in healing and reduces inflammation. The application of biomaterials has emerged in bone reconstructive surgery, especially the use of bovine bone due to its biocompatibility. Due to the many benefits related to the use of PBMT and bovine bones, the aim of this research was to review the literature to verify the relationship between PBMT and the application of bovine bone in bone reconstruction surgeries. We chose the PubMed/MEDLINE, Web of Science, and Scopus databases for the search by matching the keywords: “Bovine bone AND low-level laser therapy”, “Bovine bone AND photobiomodulation therapy”, “Xenograft AND low-level laser therapy”, and “Xenograft AND photobiomodulation therapy”. The initial search of the three databases retrieved 240 articles, 18 of which met all inclusion criteria. In the studies concerning animals (17 in total), there was evidence of PBMT assisting in biomaterial-related conduction, formation of new bone, bone healing, immunomarker expression, increasing collagen fibers, and local inflammation reduction. However, the results disagreed with regard to the resorption of biomaterial particles. The only human study showed that PBMT with bovine bone was effective for periodontal regeneration. It was concluded that PBMT assists the process in bone reconstruction when associated with bovine bone, despite divergences between applied protocols.
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