Clinical evaluation of low-power laser and a desensitizing agent on dentin hypersensitivity

EFFECT OF LOW-LEVEL DIODE LASER ON DENTIN TOPOGRAPHY AND SYMPTOMATIC NONCARIOUS CERVICAL LESIONS PRIOR TO COMPOSITE RESTORATIONS: A SPLIT-MOUTH RANDOMIZED CONTROLLED TRIAL

OBJECTIVES

This study assessed alterations in sensitivity among symptomatic noncarious cervical lesions (NCCLs) following the application of 3 low-level diode laser wavelengths before composite restoration. It analyzed the changes in dentin topography using a scanning electron microscope (SEM).

MATERIALS AND METHODS

Nine patients with 36 NCCLs were randomly assigned intra-individually to 4 groups based on the laser wavelength: laser simulation, 445 nm, 660 nm, and 970 nm. Cavity preparation, irradiation, and composite restoration were performed for each lesion. Sensitivity to cold stimuli was recorded using a visual analog scale (VAS) before the intervention (baseline) and at 1 day, 14 days, 1-, 3-, and 6-month. Pulp sensibility was recorded using an electrical pulp tester (EPT) at baseline, before treatment, and at 3- and 6-month. Additionally, an in vitro examination was performed on 12 extracted human molars to yield 12 dentin discs. Each disc was randomly divided into 4 quadrants to receive the same laser wavelengths to determine the diameters of the tubules using SEM. Results were analyzed statistically for clinical studies by the Friedman test, while ANOVA (RM-ANOVA) was conducted in-vitro, followed by the Bonferroni test in the case of significance (P < .05).

RESULTS

VAS readings decreased across all groups, with a significant decrease observed for 660 nm and 970 nm from 14 days to 6-month, while at 445 nm there was a significant decrease at 6-month compared to the control (P < .05). EPT showed a significant decrease in pain threshold levels at 660 nm and 970 nm at 3- and 6-month, while 445 nm showed a significant decrease at 6-month compared to the control (P < .05). The mean tubular diameter at 445 nm decreased, with no significant difference from the control, whereas a significant decrease was found at 660 nm and 970 nm compared to the control (P < .05).

CONCLUSIONS

Prior to composite restoration in symptomatic NCCLs, diode lasers with a wavelength of 660 nm showed the highest reduction in sensitivity, followed by 970 nm, whereas 445 nm diode lasers showed the least reduction. Additionally, diode lasers with wavelengths of 660 and 970 nm reduced the width of the dentinal tubules (DT) without inducing melting, as viewed under SEM.

Comparison of Lasers and Desensitizing Agents in Dentinal Hypersensitivity Therapy

The main objective of this review is to verify the validity of laser therapy in the treatment of dentin hypersensitivity, an extremely common problem in patients, with Nd: YAG lasers or high- and/or low-power diode lasers to obtain a definitive protocol for the treatment of hypersensitivity, given the multiplicity of laser treatments proposed by the numerous authors evaluated. The authors performed an electronic search on PubMed, favouring it as a search engine. Lasers represent a means of treating dentin hypersensitivity, used alone and/or in conjunction with specific products for the treatment of such a pathology. The selected articles that examined diode lasers were divided according to the wattage (w) used: low-level laser therapy protocols, i.e., those using a wattage of less than 1 W, and high-level laser therapy protocols, i.e., those using a wattage of 1 W or more. Regarding the Nd: YAG laser, it was not necessary to subdivide the studies in this way, as they used a wattage of 1 W or more. A total of 21 articles were included in the final selection. Laser therapy was found to be effective in the treatment of dentin hypersensitivity. However, the level of effectiveness depends on the laser used. The results obtained from this review show that both the Nd: YAG laser and the diode laser (high and low power) are effective in the treatment of dentin hypersensitivity. However, the high-power laser appears to be more effective in combination with fluoride varnish and the Nd: YAG laser achieved greater long-term benefits than the diode laser.

Influence of diode laser treatment and casein phosphopeptide-amorphous calcium phosphate paste on eroded root dentin

Introduction

It is still unclear whether the pretreatment for dentin hypersensitivity can interfere with the adhesive-dentin bonding strength. This study aimed to evaluate in vitro the effect of pretreatment with a casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) paste and diode laser on the shear bond strength of the etch-and-rinse adhesive system in the adhesive-dentin interface.

Materials and Methods

Seventy-five bovine root specimens were randomly divided into five experimental groups (n = 15). Samples were eroded by six cycles of immersion in hydrochloric acid solution (0.01M; pH = 1.2) for 20 s each, at 45 min intervals, and treated with: G2 - no treatment, G3 - CPP-ACP, G4 - diode laser (970 nm), and G5 - CPP-ACP + Diode laser. After treatments, the morphology of the specimens was analyzed.

Results

The fracture mode of each group was evaluated after restoration with composite resins in the treated area. Data were analyzed by the one-way ANOVA and Tukey's test (P < 0.05). G3 showed the highest values for shear bond strength; there was no significant difference among G1, G3, and G5 (P > 0.05). The adhesive fracture was predominant for all groups.

Conclusion

The use of desensitizers containing CPP-ACP, associated or not with a diode laser, increased the bond strength of the etch-and-rinse adhesive system on eroded root dentin.

Efficacy of GLUMA for the Treatment of Dentin Hypersensitivity Compared to Lasers: A Systematic Review

OBJECTIVE

Dentin hypersensitivity (DH) is characterized by a short, sharp pain in response to a thermal or tactile stimulus. The application of desensitizing agents such as GLUMA and laser is a non-invasive and safe approach to decrease sensitivity. The evidence for the efficacy of GLUMA desensitizer compared to laser desensitization in patients with DH was evaluated for 6 months.

DESIGN

In March 2022, an electronic search of PubMed, Scopus, and Web of Science databases was conducted. Articles published in English that compared GLUMA and laser in the treatment of DH with a follow-up of 6 months or more were included. Randomized, non-randomized controlled trials, and clinical trials were included. Risk of bias assessment tools developed by the Cochrane collaboration ROB 2 and ROBINS-I were used to assess the quality of studies. The GRADE assessment method was used to assess the certainty of evidence.

RESULTS

About 36 studies were identified in the search results. After applying the predefined eligibility criteria, eight studies with 205 participants and 894 sites were included in this review. Of the eight studies, four were judged to be at high risk of bias, three had some concerns, and one had a serious risk of bias. The certainty of the evidence was graded as low.

CONCLUSION

Based on limited evidence, GLUMA and laser appear to be equally effective in providing relief from DH. GLUMA showed an immediate effect and provided pain relief. Over the course of a week, laser showed long-term stable results. GLUMA is effective in providing immediate relief.

Photobiomodulation therapy and 3% potassium nitrate gel as treatment of cervical dentin hypersensitivity: a randomized clinical trial

Objectives

This randomized controlled trial aimed to evaluate different protocols for dentin hypersensitivity treatment with low-power lasers and desensitizing agents, and the association between low-power lasers and desensitizing agents.

Materials and methods

Fifty-four patients (303 teeth) were randomly allocated to three groups: G1, 3% nitrate potassium gel, UltraEZ (n = 17); G2, photobiomodulation therapy (PBM) with a low-level infrared laser (n = 17), 100 mW, spot size of 0.028 cm², and dose of 1 J per point; and G3, nitrate potassium + PBM (n = 20). Treatments were applied to the buccal cervical region at intervals of 72 h, and all protocols were performed in three sessions. The patients’ response to evaporative stimuli was rated using the visual analog scale (VAS). Re-evaluations were performed immediately after each application and 1 week, 1 month, and 3 months after treatment. A two-way repeated measures test and Tukey’s post hoc test were used for multiple comparisons (α = 5%).

Results

There was a reduction in pain levels at the end of treatment in all groups. There were no significant differences in VAS score changes between the groups immediately after treatment and after the third month, compared to the baseline (p > 0.05).

Conclusion

Under the limitations of this in vivo study, the proposed three-session protocol was effective in reducing dentin hypersensitivity after 3 months, regardless of the desensitization mechanism used. Conservative and long-term protocols are interesting for the control of pain caused by dentin hypersensitivity.

Clinical relevance

The increase in cervical dentin hypersensitivity prevalence warrants easy-to-apply and long-lasting desensitizing protocols for pain control.

Evaluation of the Effectiveness on Dentin Hypersensitivity of Sodium Fluoride and a New Desensitizing Agent, Used Alone or in Combination with a Diode Laser: A Clinical Study

(1) Background: Dentine Hypersensitivity (DH) is a frequent clinical problem that causes long-term painful discomfort to patients and is a diagnostic and therapeutic challenge for dentists. The aim of this research was to verify the efficacy of a Sodium Fluoride (NaF) gel and the VivaSens® varnish used alone or in combination with a Creation Soft Diode Laser (DL) to treat DH pain. (2) Methods: The study included 121 Non-Carious Cervical Lesions (NCCLs) in 48 patients who complained of DH pain of variable intensity, between 4 and 7 points in VAS, after application of a cold stimulus. Four study groups of 12 patients each were created and subjected to four different types of treatment. Group 1 comprised 27 NCCLs with a total VAS score of 142, who received a topical treatment of NaF. Group 2 comprised 34 NCCLs with a total VAS score of 179, who were treated with NaF in association with DL. Group 3 comprised 31 NCCLs with a total VAS score 172, who received the VivaSens varnish. Group 4 comprised 29 NCCLS with a total VAS score of 155, who were treated with VivaSens in association with DL, using a power of 0.2 Watt in continuous emission and a fiber of 400 µm diameter. (3) Results: The results for each NCCL were evaluated by the cold stimulus response and recorded according to the VAS at the end of each treatment (t1) as well as after one week (t2), 1 month (t3), and 6 months (t4). All treatments resulted in pain relief at all study times, but the best results were obtained for Group 4 at t1, with a total VAS score of 26, and for Group 2 at t2, t3, and t4, with total VAS scores of 41, 51, and 65, respectively. (4) Conclusions: The treatment with VivaSens allowed pain relief immediately after its application, but the greatest long-term benefits (t2, t3, and t4) were obtained with the topical application of NaF associated with a DL.

Evaluation of Dentin Tubule Plugging Efficiencies and Effects on Dentin Surface Roughness of Dentin Desensitizing Agents, the Er,Cr:YSGG Laser, and Their Combination After Erosion-Abrasion Cycles: An In Vitro Study

OBJECTIVES

The purposes of this in vitro study were to evaluate the tubule plugging efficiencies and effects on the surface roughness of dentin of different dentin desensitizing agents (DDAs; Teethmate Desensitizer, Kuraray; Gluma Desensitizer, Kulzer; Clinpro White Varnish, 3M ESPE; Enamelast, Ultradent) and the Er,Cr:YSGG laser (Biolase, Waterlase), both alone and in combination with DDAs, after application and after an erosion-abrasion cycle.

METHODS AND MATERIALS

For surface roughness examinations, superficial buccal dentin specimens were divided into 10 groups: the control, Teethmate Desensitizer, Gluma Desensitizer, Enamelast, Clipro White Varnish, Er,Cr:YSGG Laser, Teethmate Desensitizer-Laser, Gluma Desensitizer-Laser, and Enamelast-Laser, and Clinpro White Varnish-Laser groups. Profilometric analyses and scanning electron microscopy (SEM) examinations were performed after applications and after a 5-day erosive-abrasive cycle. For the statistical analysis of surface roughness measurements, 2-way analysis of variance (ANOVA), 1-way ANOVA, and Tukey post hoc test were used.

RESULTS

Among the treatments, only DDAs alone did not cause increase in surface roughness after application. All of the laser applications increased the surface roughness of dentin, and after the erosion-abrasion cycle, all of the test groups had increased surface roughness. However, SEM images showed that morphological changes were less frequently observed in all of the experimental groups than in the control group. In addition, all of the laser-DDA combinations had stronger tubule occlusion effects than did DDAs alone, even after erosion-abrasion.

CONCLUSIONS

All of the test treatments showed protective effects on dentin surfaces against the negative effects of erosion-abrasion. The addition of the laser to DDA applications increased tubular plugging efficiencies of DDAs, and the tubule plugs of the combination treatments were resistant to the erosion-abrasion cycle.

Effects of low-level light therapy on dentin hypersensitivity: a systematic review and meta-analysis

OBJECTIVE

To investigate the treatment efficacy of low-level light therapy on dentin hypersensitivity.

MATERIALS AND METHODS

Following the PRISMA guideline, six electronic databases supplemented with bibliographies were searched till December 2020. Two reviewers performed the screenings independently with a reliability assessment. Studies fulfilling the pre-registered eligibility criteria were included for risk-of-bias assessment and data synthesis.

RESULTS

Thirty-five articles ultimately informed this systematic review based on the eligibility criteria and underwent risk-of-bias assessment (ĸ = 0.86). Quantitative results were deduced by meta-analysis of 20 randomised controlled trials: LLLT showed favourable outcomes compared to placebos for immediate (SMD: 1.09, 95% CI: 0.47 to 1.70), interim (SMD: 1.32, 95% CI: 0.41 to 2.23), and persistent efficacies (SMD: 2.86, 95% CI: 1.98 to 3.74). However, substantial heterogeneity existed among included studies (I2: 64-95%). Regarding comparisons with other desensitising strategies, LLLT showed no significant benefits in DH alleviation over others except fluorides for interim efficacy (SMD: 0.31, 95% CI: 0.10 to 0.52) and persistent efficacy (SMD: 0.45, 95% CI: 0.03 to 0.86).

CONCLUSIONS

This systematic review shows that LLLT has positive immediate, interim, and persistent DH-treatment efficacies compared with placebo. No superior treatment effects of LLLT were observed except fluoride agent use. Further studies are warranted-RCTs with low risk of bias, consistent technical settings, comprehensive assessments, and long follow-up periods.

CLINICAL RELEVANCE

This systematic review bridges a critical research gap by analysing clinical evidence in the DH-alleviating efficacy of LLLT in comparison with placebo and other in-office desensitising strategies.

Combination of two desensitizing protocols to control dentin hypersensitivity in non-carious lesions: a randomized, double-blind clinical trial

OBJECTIVES

This study evaluated the effect of photobiomodulation (PBM) combined with 8% strontium acetate (SA8%) in the treatment of dentin hypersensitivity (DH) in non-carious lesions and analyzed the risk factors with the patient's quality of life.

METHODS

Eighty teeth with DH were randomly allocated into four treatment groups (n = 20): G1, PBM imitation + toothpaste with no active ingredient; G2, PBM imitation + toothpaste with SA8%; G3, PBM + toothpaste without the active ingredient; and G4, PBM + toothpaste with SA8%. Participants were provided with a questionnaire on the experience of dentin hypersensitivity (QEDH) to assess the impact of desensitizing treatment on health-related quality of life (HRQL). Friedman and Kruskal-Wallis tests were used for intra- and intergroup comparisons, and Wilcoxon and Mann-Whitney tests were used to analyze HRQL. All analyses used significance levels of 5%.

RESULTS

Intergroup comparisons revealed a significant difference (p < 0.05); G4 had the best response in terms of HD reduction in G4 compared to the other groups on the 7th day of assessment (T3). Only G4 showed a statistically significant difference (p < 0.05) in the reduction of EDH for intragroup analysis.

CONCLUSION

The combination of therapies was more effective in reducing DH than the isolated use of these strategies.

CLINICAL RELEVANCE

The combination of therapies is effective in the treatment of DH.

Laser therapy for dentinal hypersensitivity

BACKGROUND

Dentinal hypersensitivity is characterized by short, sharp pain from exposed dentine that occurs in response to external stimuli such as cold, heat, osmotic, tactile or chemicals, and cannot be explained by any other form of dental defect or pathology. Laser therapy has become a commonly used intervention and might be effective for dentinal hypersensitivity.

OBJECTIVES

To assess the effects of in-office employed lasers versus placebo laser, placebo agents or no treatment for relieving pain of dentinal hypersensitivity.

SEARCH METHODS

Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 20 October 2020), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library 2020, Issue 9), MEDLINE Ovid (1946 to 20 October 2020), Embase Ovid (1980 to 20 October 2020), CINAHL EBSCO (Cumulative Index to Nursing and Allied Health Literature; 1937 to 20 October 2020), and LILACS BIREME Virtual Health Library (Latin American and Caribbean Health Science Information database; from 1982 to 20 October 2020). Conference proceedings were searched via the ISI Web of Science and ZETOC, and OpenGrey was searched for grey literature. The US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases.

SELECTION CRITERIA

Randomized controlled trials (RCTs) in which in-office lasers were compared to placebo or no treatment on patients aged above 12 years with tooth hypersensitivity.

DATA COLLECTION AND ANALYSIS

Two review authors independently and in duplicate screened the search results, extracted data, and assessed the risk of bias of the included studies. Disagreement was resolved by discussion. For continuous outcomes, we used mean differences (MD) and 95% confidence intervals (CI). We conducted meta-analyses only with studies of similar comparisons reporting the same outcome measures. We assessed the overall certainty of the evidence using GRADE.

MAIN RESULTS

We included a total of 23 studies with 936 participants and 2296 teeth. We assessed five studies at overall low risk of bias, 13 at unclear, and five at high risk of bias. 17 studies contributed data to the meta-analyses. We divided the studies into six subgroups based on the type of laser and the primary outcome measure. We assessed the change in intensity of pain using quantitative pain scale (visual analogue scale (VAS) of 0 to 10 (no pain to worst possible pain)) when tested through air blast and tactile stimuli in three categories of short (0 to 24 hours), medium (more than 24 hours to 2 months), and long term (more than 2 months). Results demonstrated that compared to placebo or no treatment the application of all types of lasers combined may reduce pain intensity when tested through air blast stimuli at short term (MD -2.24, 95% CI -3.55 to -0.93; P = 0.0008; 13 studies, 978 teeth; low-certainty evidence), medium term (MD -2.46, 95% CI -3.57 to -1.35; P < 0.0001; 11 studies, 1007 teeth; very low-certainty evidence), and long term (MD -2.60, 95% CI -4.47 to -0.73; P = 0.006; 5 studies, 564 teeth; very low-certainty evidence). Similarly, compared to placebo or no treatment the application of all types of lasers combined may reduce pain intensity when tested through tactile stimuli at short term (MD -0.67, 95% CI -1.31 to -0.03; P = 0.04; 8 studies, 506 teeth; low-certainty evidence) and medium term (MD -1.73, 95% CI -3.17 to -0.30; P = 0.02; 9 studies, 591 teeth; very low-certainty evidence). However, there was insufficient evidence of a difference in pain intensity for all types of lasers when tested through tactile stimuli in the long term (MD -3.52, 95% CI -10.37 to 3.33; P = 0.31; 2 studies, 184 teeth; very low-certainty evidence). Most included studies assessed adverse events and reported that no obvious adverse events were observed during the trials. No studies investigated the impact of laser treatment on participants' quality of life.

AUTHORS' CONCLUSIONS

Limited and uncertain evidence from meta-analyses suggests that the application of laser overall may improve pain intensity when tested through air blast or tactile stimuli at short, medium, or long term when compared to placebo/no treatment. Overall, laser therapy appears to be safe. Future studies including well-designed double-blinded RCTs are necessary to further investigate the clinical efficacy of lasers as well as their cost-effectiveness.

Efficacy of Desensitizers in Reducing Post-preparation Sensitivity Prior to a Fixed Dental Prosthesis: A Randomized Controlled Clinical Trial

Aims:

The aim of this article is to evaluate and compare the effectiveness of Gluma, Shield Force Plus, and Telio CS desensitizers, in reducing pre- and post-cementation sensitivity for complete coverage restorations.

Materials and Methods:

The study was a double-blind, randomized, controlled clinical trial in which 56 patients requiring posterior three-unit fixed partial dentures were randomly assigned to four groups, each group with 14 patients (n = 14): Group C (Control group), Group GL (Gluma group), Group SF (Shield Force Plus group), and Group TC (Telio CS group). In the desensitizer groups, desensitizer application was performed following the manufacturer’s directions immediately after tooth preparation (first visit), before metal restoration try-in (second visit, 2 weeks after the first visit), and before final cementation (third visit, 2 weeks after the second visit). Sensitivity levels were scored and evaluated using a visual analog scale (VAS), using cold test and electric pulp test (EPT) during the three visits before the cementation, and then over the phone 2 weeks after the final cementation. The data were statistically analyzed using one-way analysis of variance (ANOVA) followed by post-hoc Bonferroni and unpaired t-tests.

Results:

One-way ANOVA revealed significant differences between the four groups. The post-hoc Bonferroni tests showed a significant decrease in the mean cold test scores from the first to third visit, with a p-value <0.001 for the GL, SF, and TS groups. The mean EPT scores also decreased significantly from the first to third visit (p< 0.001) for the GL and SF groups, whereas p = 0.023 for the TS group. Most of the subjects did not complain of any sensitivity post-cementation, except for one patient in Group TS.

Conclusion:

All three desensitizers were found to be effective in reducing pre- and post-cementation dentin sensitivity, as indicated by the consistent reduction in VAS scores throughout the visits.

Use of high- and low-intensity lasers in the treatment of dentin hypersensitivity: A literature review

Background

Dentin hypersensitivity (DH) is defined as an exaggerated sensitivity of vital dentin exposed to thermal, chemical and tactile stimuli. This study aimed to evaluate, through a literature review, the applicability of high- and low-intensity lasers in the treatment of DH for the past 10 years, as well as its therapeutic potential.

Material and Methods

The electronic databases MEDLINE/PubMed and LILACS were searched using the descriptors (“Dentin Sensitivity” OR “Dentin Hypersensitivity”) AND (“Low-Level Therapy” OR Laser), for articles published between 2010 and 2020. Only randomized clinical trials with full-text and full case resolution were included.

Results

We found 187 articles in total, among which 61 were pre-selected and 10 included in this literature review.

Conclusions

Considering the found results and their possible limitations, high- and low-intensity lasers, associated or not with other therapies, have demonstrated beneficial effects in the treatment of DH, being considered a promising, safe, easy, and effective field of research, reducing pain sensitivity and preserving pulp vitality.

Key words:Dentin sensitivity, dentistry, laser.

Using Laser-Doppler Flowmetry to Evaluate the Therapeutic Response in Dentin Hypersensitivity

Dentin hypersensitivity (DH) is a common medical condition with underreported prevalence and it is difficult to quantify. This study aimed to investigate whether assessing dental pulp vascular micro-dynamics by laser-Doppler flowmetry (LDF) would be functional for therapeutic evaluation, in contrast to a verbal rating scale (VRS). A split-mouth single-blind randomized study was conducted on seven patients and a total of 36 teeth. Two DH therapeutic methods were employed: (i) fluoride gel; (ii) Nd:YAG radiation combined with fluoride gel. For each tooth, five consecutive LDF determinations of pulp blood flow were made (before and immediately after desensitizing treatment, then after 24 h, 7 days, and 1 month), and the VRS was applied each time. Spearman’s correlation was applied for concurrent validation. Two-way (treatment and patient) repeated measures ANOVA full factorial was applied, followed by Tukey’s post-hoc comparisons and Pillai’s trace multivariate statistic. While VRS scores had moderate reliability, LDF could objectively estimate treatment effects. Based on partial eta-squared values, treatment and patient characteristics were estimated to explain about 84% and 50% of the variability, respectively. In conclusion, LDF is an objective technique that can quantitatively assess DH evolution, and it is effective in reliably monitoring oral health therapeutic interventions.

Efficacy of low-level laser therapy associated with fluoride therapy for the desensitisation of molar-incisor hypomineralisation: Randomised clinical trial

BACKGROUND

Molar-incisor hypomineralisation (MIH) is a qualitative enamel defect.

AIM

To investigate the low-level laser therapy (LLLT) associated with fluoride varnish for the desensitisation of teeth with MIH.

DESIGN

A randomised clinical trial was conducted with 66 children, randomly allocated to the treatments: laser (L); fluoride varnish (FV); and laser + fluoride varnish (L + FV). The participants in the L group underwent two sessions of LLLT (48-hour interval). The FV group received four applications of varnish at one-week intervals. The L + FV underwent two sessions of LLLT and four applications of varnish. Prior to each session and one month after the onset of treatment, tooth sensitivity and its magnitude were evaluated. Intra- and inter-group comparisons were performed (α = 5%).

RESULTS

A significant reduction in the mean sensitivity score was found over time in all groups. After the final treatment, a significant difference was found between the L and L + FV groups (P = .011), with a lower score in the L + FV group (0.09), whereas no difference was found between the FV and L + FV groups (P = .095).

CONCLUSIONS

Fluoride varnish and the combination of treatments (L + FV) had greater desensitising action on teeth with MIH. Laser therapy demonstrated an immediate desensitising effect, whereas fluoride varnish had a late-onset effect.

Evaluation of the Effects of 660-nm and 810-nm Low-Level Diode Lasers on the Treatment of Dentin Hypersensitivity

Introduction: Dentin hypersensitivity is a common oral problem that occurs as a short and sharp pain. There are many techniques to treat this condition, the latest of which is laser treatment. The aim of this study was to evaluate the effect of two types of low-power diode lasers (660 nm and 810 nm) on dentin hypersensitivity in order to achieve an acceptable clinical application by adjusting the effective parameters. Methods: In this randomized, double-blind clinical trial, sensitive teeth of 7 patients were divided into three groups with a randomized matching method: group I, treated with 660-nm diode laser irradiation, group II, treated with diode laser 810-nm, and group III, the control group. Irradiation parameters for 660-nm and 810-nm diode lasers were the power of 30 mW and 100 mW respectively, in contact and continuous modes, perpendicular to the tooth surface with a sweeping motion. Treatments were carried out in four sessions at weekly intervals. The data obtained were analyzed with SPSS 22, using one-way repeated measures ANOVA and the LSD (least significant difference) test. The significance level was considered as P≤0.05. Results: There were no significant differences in visual analogue scale (VAS) score changes between the two laser groups after the intervention in the first, second and third weeks compared to the baseline (P>0.05). These changes in the fourth week were significantly higher in the 810-nm laser group compared to the 660-nm laser group (P=0.04), and in the 660-nm laser group, they were more than the control group (P=0.02). The mean VAS scores at 1-week, 1-month and 2-month postoperative intervals were significantly lower in the 810-nm laser group than in the 660-nm laser group, and in the 660-nm laser group, they were less than the control group (P<0.001). Conclusion: The use of 660-nm and 810-nm diode lasers with the power of 30 and 100 mW respectively for 120 seconds was effective in reducing pain in patients with dentin hypersensitivity. However, the effect of the 810-nm laser on reducing the dentin hypersensitivity was more long-lasting than that of the 660-nm laser.

Photobiomodulation in Endodontic, Restorative, and Prosthetic Dentistry: A Review of the Literature

Objective: To provide a review of the literature about the photobiomodulation therapy (PBMT) dental treatment protocols in endodontic, restorative, and prosthetic dentistry based on validated clinical studies published so far. More specifically, this study was carried out to carefully review therapeutic protocol of PBMT in clinical studies and their conclusions. Background data: The importance of using low-power lasers and photobiomodulation (PBM) is increasing in dentistry mainly due to their painless and noninvasive function. However, lack of sufficient clinical studies has led to unclear results regarding PBMT in dentistry, and also lack of an available precise protocol for clinicians. Moreover, scarcity of clinical studies in this area has made conduction of a precise systematic review study difficult. Methods: In our study, published clinical studies up to April 2019 were reviewed from library sources, Google Scholar, PubMed and Medline, Elsevier, Embase, Cochrane, Scopus, and Web of science (ISI). Inclusion criteria included those presented in clinical trials and case report/case series, language (English), and studies available in full text. Exclusion criterion was in vitro studies. Results: In general, findings of clinical studies have shown that PBMT can have a significant role in reducing postoperative dental pain, increasing depth of anesthesia, improving tooth hypersensitivity, reducing inflammation of the tissue, and helping wound healing. Conclusions: A review of clinical studies showed that the use of alternative or adjunctive PBMT is of great importance in controlling postoperative pain after endodontic treatments. In addition, evidence suggests that different parameters of light can be efficient in the treatment of tooth hypersensitivity. Nevertheless, lack of sufficient clinical studies and reliable results do not allow introducing a precise treatment protocol.

Systematic Review of Delivery Parameters Used in Dental Photobiomodulation Therapy

Objective: This systematic review of published data critically appraises the consistency in the reported delivery parameters used in photobiomodulation (PBM) therapies research within clinical dentistry and makes reporting recommendations for future clinical protocols. Background: Key to the standardization of randomized clinical trials and associated peer-reviewed articles is the disclosure of all laser and light-emitting diode operating parameters. The current status shows a lack of full parameters and significantly impacts on the ability to integrate published data with current and future investigation into clinical PBM therapy. Materials and methods: Search engines, PubMed, Google Scholar, and Cochrane, were scanned for investigation into the effects of PBM therapy research within clinical dentistry. Key words "Low-Level-Laser," "PBM," "Photobiomodulation," "Oral" and "Therapy" were used and a total of 754 articles identified, spanning a period of 9 years and 1 month between February 2009 and March 2018. Only human clinical trials were considered. Fifty-two articles were included in this investigation and the reported basic delivery parameters used in PBM therapies research were considered for each clinical trial. Results: The overall reported basic delivery parameters used in PBM therapies research were too inadequate to be able to be replicated in further studies. These included parameters related to the power meter, beam cross-sectional dynamics, fluence, and wider aspects of dosimetry. Conclusions: The delivery parameters used in PBM therapy research within clinical dentistry, investigated in this study, presented a wide variation in their recording or nonrecording of all significant elements needed to have scientific validity. A constant inconsistency in delivering valid, reliable, PBM therapy doses, to target tissues was also identified. The lack of consensus in delivering a sound protocol for PBM therapy, is partly due to the lack of adequate reported materials and methods, which are essential for replication of individual studies. One way to resolve this problem is for Journals to insist on all comprehensive parameter records, used in PBM therapies, to be part of author guidelines in submitting articles of studies on PBM therapy in clinical dentistry.

Laser Effects on the Prevention and Treatment of Dentinal Hypersensitivity: A Systematic Review

Introduction: Dentinal hypersensitivity (DH) is an acute intensive tooth pain which can lead to dental annoyances during eating and drinking. Stimulating exposed dentinal tubules by either kind of thermal, tactile, chemical and/or osmotic stimuli is believed to be the cause of this pain. It is hypothesized that dentinal tubules' orifice occlusion (DOO) can help relieve such dental irritations. Thus, this systematic review was conducted to evaluate the effectiveness of laser application as a prevention and treatment modality on DH reduction. Methods: Electronic databases (MEDLINE, SCOPUS) were searched among randomized clinical trials from January 2007 to December 2016. The extraction of data and quality assessments were carried out by different independent observers. Results: A total of 499 items were found of which3 9 relevant articles were extracted. The profound findings proved lasers' effectiveness as a treatment of DH. Although some of the researches reported no significant difference between laser and other desensitizing agents, most of the studies suggested that better results (both rapid and long-lasting) were obtained in combined modalities. Furthermore, the preventive role of this new technology has been emphasized as well. Nd-YAG (neodymium-doped yttrium aluminum garnet) and diode lasers reduce DH after bleaching. Lasers can also protect cervical restorations from DH due to tubular occlusion. Moreover, it is suggested to apply lasers in relief of DH following scaling and root planning. Nevertheless, a few researchers dispute its beneficence as a result of placebo effect. Conclusion: The results obtained from several studies in the present review revealed that the application of lasers is effective not only in terms of treatment of DH, but also in the prevention of this intensive tooth pain. Among various types of lasers, the application of Nd:YAG laser has shown the best results in DH treatment.

Comparative Evaluation of Efficacy of Iontophoresis with 0.33% Sodium Fluoride Gel and Diode Laser Alone on Occlusion of Dentinal Tubules

INTRODUCTION

Dentinal Hypersensitivity (DH) is one of the most commonly encountered clinical problems. Literature reveals no specific therapy to satisfactorily eliminate dentinal hypersensitivity.

AIM

The aim of this study was to assess and compare the efficacy of iontophoresis with 0.33% Sodium Fluoride (NaF) gel and diode laser alone in dentinal tubule occlusion.

MATERIALS AND METHODS

This in vitro study included 20 teeth with intact root surfaces unaltered by extraction procedure for specimen preparation. Each tooth was cleaned, air dried and cut into three sections. Total 60 sections were prepared (30 longitudinal and 30 transverse sections), which were acid etched. In control group, no treatment was carried. In iontophoresis treatment group, samples were inserted into a foam tray containing 0.33 % NaF Gel and subjected to 1.5 mA output current for three minutes. In laser treatment group, specimens were lased with 980 nm diode laser at 0.5 W/PW (62.2J /cm²) in a noncontact mode for 30 seconds. Specimens were evaluated under Scanning Electron Microscope (SEM) at 10KV to 20KV under x 2000, x5000 magnification for surface characteristics and patency of dentinal tubules. Total number of tubules visible, open, completely and partially occluded were recorded in each microphotograph and compared.

RESULTS

On comparison, laser group showed the least number of open tubules i.e., 130 (31.1%) followed by iontophoresis group, 155 (51.32%) and control group 417 (100%).

CONCLUSION

Diode laser application provided better results as compared to iontophoresis on occlusion of dentinal tubules. Hence, it can be used to treat the patients with DH.

A randomized clinical trial on the efficacy of a new oxalate-containing sensitivity relief strip following professional vs self-application

OBJECTIVES

The purpose of this study was to determine the efficacy of 3.14% dipotassium oxalate monohydrate-containing strip on the relief of dentinal hypersensitivity (DH). A second objective was to determine whether there was a difference in DH levels when the strip was self-applied vs applied by a dental professional.

METHODS

Sixty subjects were randomized into self-applied, professionally applied or placebo-strip groups. Dentinal hypersensitivity was evaluated by a blinded examiner, using the Schiff Air Scale (SAS). A verbal rating scale (VRS) was also used to measure the subjects' perception of pain. Measures were taken at baseline, 30 minutes, 4 and 8 weeks post-treatment.

RESULTS

There was a significant reduction in DH in all three groups (P ≤ .05) at 30 minutes and 8 weeks post-treatment. At the 4-week follow-up, only the self- and professionally applied (active ingredient) groups had a significant reduction in DH compared to baseline. When comparing the reduction in DH levels between groups, the only significant difference occurred between the professionally applied treatment group and the placebo group at the 4-week follow-up. There were no significant differences in DH reduction levels achieved between the self- and professionally applied groups (P > .05).

CONCLUSIONS

This study confirmed the short-term (4 weeks) effectiveness of a single application of 3.14% dipotassium oxalate monohydrate-containing strip. Self- and professional application were not shown to be different.

Evaluation of the effectiveness of the photobiomodulation in the treatment of dentin hypersensitivity after basic therapy. A randomized clinical trial

BACKGROUND

Dentin hypersensitivity (DH) in one of the most common causes of patient discomfort in the general population and its prevalence is higher in patients who have received basic or surgical periodontal treatment. Efficiency of the diode laser with different wavelengths has been studied by several authors, showing an improvement rate of the DH between 60-98%. The aim of the present study was to evaluate the effect of photobiomodulation (PBM) treatment on the reduction of DH after non surgical periodontal treatment.

MATERIAL AND METHODS

A randomized split mouth clinical trial was performed involving 30 patients (120 teeth) diagnosed with DH after scaling and root planning. Two teeth of the experimental side were treated with the laser and 2 teeth of the control side were treated without activating the laser. The laser treatment parameters for each tooth were 660nm, 200mW, CW, illuminated area 1.15cm2, 173mW/cm2, 60 seconds, 12 J, 10.4J/cm2. Age, gender, smoking, plaque index, gingival recession, probing and VAS (for tactile and thermal stimulation) were registered before the laser treatment, immediate post treatment (after 2 minutes), 2 weeks, 1 month and 2 months after treatment.

RESULTS

There was significant difference (p<0.01) in discomfort to thermal and mechanical stimulation between the control and diode laser treatment sites at all evaluation periods. The level of discomfort decreased immediately following diode laser therapy, and continued to demonstrate a decrease for the duration of the study. All teeth remained vital after laser treatment, without adverse reactions or complications.

CONCLUSIONS

The PBM can be used to reduce DH without detrimental pulpal effects. Key words:Dental hypersensitivity, laser, diode laser, photobiomodulation.

Application of Diode Laser in the Treatment of Dentine Hypersensitivity

INTRODUCTION

Dentine hypersensitivity is characterized by acute, sharp pain arising from the exposed dentine, most commonly in response to thermal, tactile, or chemical stimuli, and which cannot be linked to any other pathological changes in the tooth or the environment. Therapy uses various impregnating agents in the form of solutions or gels and, in more recent times, laser.

AIM

The aim of this research was to examine the effects of treatment of hypersensitive dental cervix with diode laser.

MATERIALS AND METHODS

The study included 18 patients with 82 sensitive teeth. The degree of dentine hypersensitivity was evaluated by visual analogue scale (VAS), and the treatment was carried out by application of low-power diode laser over the span of three visits, which depended on the initial sensitivity.

RESULTS

There is a significant difference in VAS values measured at the onset of treatment (baseline) and immediately after the first laser treatment (t=9.275; p=0.000), after 7 days, after the second laser treatment (14 days) (t=7.085, p=0.000), as well as after 14 days and the third laser treatment (t=5.517, p=0.000), which confirms the effectiveness of this therapeutic procedure. The results showed a reduction of hypersensitivity in response to tactile stimulus with a probe after the third treatment, even with teeth whose value on the VAS was very high at the beginning of treatment (baseline).

CONCLUSION

Within the scope of the conducted study, laser therapy has provided extremely safe and effective results in the treatment of cervical dentine hypersensitivity.

Comparison of low level laser and arginine-calcium carbonate alone or combination in the treatment of dentin hypersensitivity: a randomized split-mouth clinical study

OBJECTIVE

This study aimed to compare the efficacy of low-level laser (LLL) and desensitizing paste (DP) containing 8% arginine-calcium carbonate, in the treatment of dentin hypersensitivity (DH) and also to determine whether their combined application would improve the efficacy of the treatment.

BACKGROUND DATA

There are various options for the treatment of DH; however, superiority of one method over others alone has not been currently demonstrated.

MATERIALS AND METHODS

Twenty-one patients with 156 teeth affected by DH were included in the study. Selected teeth were randomly divided into five groups: LLL, DP, laser followed by DP (LLL+DP), DP followed by laser (DP+LLL) applied to one of the quadrants, and a control group, consisting of a randomly selected additional tooth in one of the quadrants. Teeth were irradiated by the 685 nm diode laser treatment with 25 mW at 9 Hz for 100sec at 1 cm(2) area (2J/cm(2)) in interrupted mode. Pain response to evaporative stimulus was quantified on a visual analogue scale (VAS) over a 90-day period.

RESULTS

All four treatment groups experienced significant and persistent decrease in the mean VAS score immediately post-treatment until the end of the study, whereas the placebo group had high VAS scores throughout the study. On day 90, percent reduction in VAS scores was 72% for LLL, 65.4% for DP, 54.6% for LLL+DP, and 69.6% for DP+LLL, whereas the placebo group showed an increase of 7.8%.

CONCLUSIONS

The application of either LLL or DP containing 8% arginine-calcium carbonate appears to be effective in decreasing DH. However, their combined use does not improve the efficacy beyond what is attainable with either treatment alone.