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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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Raman spectroscopic study of the effect of the use of laser/LED phototherapy on the repair of complete tibial fracture treated with internal rigid fixation. Photodiagnosis Photodyn Ther 2020; 30:101773. [PMID: 32315779 DOI: 10.1016/j.pdpdt.2020.101773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 03/17/2020] [Accepted: 04/02/2020] [Indexed: 11/23/2022]
Abstract
This study aimed to assess the repair of complete surgical tibial fractures fixed with internal rigid fixation (IRF) associated or not to the use of mineral trioxide aggregate (MTA) cement and treated or not with laser (λ = 780 nm, infrared) or LED (λ = 850 ± 10 nm, infrared) lights, 142.8 J/cm2 per treatment, by means of Raman spectroscopy. Open surgical tibial fractures were created on 18 rabbits (6 groups of 3 animals per group, ∼8 months old) and fractures were fixed with IRF. Three groups were grafted with MTA. The groups of IRF and IRF + MTA that received laser or LED were irradiated every other day during 15 days. Animals were sacrificed after 30 days, being the tibia surgically removed. Raman spectra were collected via the probe at the defect site in five points, resulting in 15 spectra per group (90 spectra in the dataset). Spectra were collected at the same day to avoid changes in laser power and experimental setup. The ANOVA general linear model showed that the laser irradiation of tibial bone fractures fixed with IRF and grafted with MTA had significant influence in the content of phosphate (peak ∼960 cm-1) and carbonated (peak ∼1,070 cm-1) hydroxyapatites as well as collagen (peak 1,452 cm-1). Also, peaks of calcium carbonate (1,088 cm-1) were found in the groups grafted with MTA. Based on the Raman spectroscopic data collected in this study, MTA has been shown to improve the repair of complete tibial fractures treated with IRF, with an evident increase of collagen matrix synthesis, and development of a scaffold of hydroxyapatite-like calcium carbonate with subsequent deposition of phosphate hydroxyapatite.
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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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Osteogenic Potential of Bovine Bone Graft in Combination with Laser Photobiomodulation: An Ex Vivo Demonstrative Study in Wistar Rats by Cross-Linked Studies Based on Synchrotron Microtomography and Histology. Int J Mol Sci 2020; 21:ijms21030778. [PMID: 31991756 PMCID: PMC7037661 DOI: 10.3390/ijms21030778] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 01/21/2020] [Accepted: 01/23/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Alveolar bone defects are usually the main concern when planning implant treatments for the appropriate oral rehabilitation of patients. To improve local conditions and achieve implant treatments, there are several methods used for increasing bone volume, among which one of the most successful, versatile, and effective is considered to be guided bone regeneration. The aim of this demonstrative study was to propose an innovative analysis protocol for the evaluation of the effect of photobiomodulation on the bone regeneration process, using rat calvarial defects of 5 mm in diameter, filled with xenograft, covered with collagen membrane, and then exposed to laser radiation. METHODS The animals were sacrificed at different points in time (i.e., after 14, 21, and 30 days). Samples of identical dimensions were harvested in order to compare the results obtained after different periods of healing. The analysis was performed by cross-linking the information obtained using histology and high-resolution synchrotron-based tomography on the same samples. A comparison was made with both the negative control (NC) group (with a bone defect which was left for spontaneous healing), and the positive control (PC) group (in which the bone defects were filled with xenografts and collagen membrane without receiving laser treatment). RESULTS We demonstrated that using photobiomodulation provides a better healing effect than when receiving only the support of the biomaterial. This effect has been evident for short times treatments, i.e., during the first 14 days after surgery. CONCLUSION The proposed analysis protocol was effective in detecting the presence of higher quantities of bone volumes under remodeling after photobiomodulation with respect to the exclusive bone regeneration guided by the xenograft.
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Escudero JSB, Perez MGB, de Oliveira Rosso MP, Buchaim DV, Pomini KT, Campos LMG, Audi M, Buchaim RL. Photobiomodulation therapy (PBMT) in bone repair: A systematic review. Injury 2019; 50:1853-1867. [PMID: 31585673 DOI: 10.1016/j.injury.2019.09.031] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 01/16/2019] [Accepted: 09/20/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Photobiomodulation therapy (PBMT) using low-level laser influences the release of several growth factors involved in the formation of epithelial cells, fibroblasts, collagen and vascular proliferation, besides accelerating the synthesis of bone matrix due to the increased vascularization and lower inflammatory response, with significant increase of osteocytes in the irradiated bone. Considering its properties, beneficial effects and clinical relevance, the aim of this review was to analyze the scientific literature regarding the use of PBMT in the process of bone defect repair. METHODS Electronic search was carried out in PubMed/MEDLINEⓇ and Web of Science databases with combination of the descriptors low-level laser therapy AND bone repair, considering the period of publication until the year 2018. RESULTS The literature search identified 254 references in PubMed/MEDLINE and 204 in Web of Science, of which 33 and 4 were selected, respectively, in accordance with the eligibility requirements. The analysis of researches showed articles using PBMT in several places of experimentation in the subjects, different types of associated biomaterials, stimulatory effects on cell proliferation, besides variations in the parameters of use of laser therapy, mainly in relation to the wavelength and density of energy. Only four articles reported that the laser did not improve the osteogenic properties of a biomaterial. CONCLUSIONS Many studies have shown that PBMT has positive photobiostimulatory effects on bone regeneration, accelerating its process regardless of parameters and the use of biomaterials. However, standardization of its use is still imperfect and should be better studied to allow correct application concerning the utilization protocols.
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Affiliation(s)
- Jose Stalin Bayas Escudero
- Department of Biological Sciences (Anatomy), Bauru School of Dentistry, University of São Paulo (USP), Bauru, SP, Brazil
| | - Maria Gabriela Benitez Perez
- Department of Biological Sciences (Anatomy), Bauru School of Dentistry, University of São Paulo (USP), Bauru, SP, Brazil
| | | | - Daniela Vieira Buchaim
- Department of Biological Sciences (Anatomy), Bauru School of Dentistry, University of São Paulo (USP), Bauru, SP, Brazil; Medical School, Discipline of Human Morphophysiology, University of Marilia (UNIMAR), Marília, SP, Brazil; Medical School, Discipline of Neuroanatomy, University Center of Adamantina (UNIFAI), Adamantina, SP, Brazil
| | - Karina Torres Pomini
- Department of Biological Sciences (Anatomy), Bauru School of Dentistry, University of São Paulo (USP), Bauru, SP, Brazil
| | | | - Mauro Audi
- Physiotherapy School, University of Marilia (UNIMAR), Marília-SP, Brazil
| | - Rogério Leone Buchaim
- Department of Biological Sciences (Anatomy), Bauru School of Dentistry, University of São Paulo (USP), Bauru, SP, Brazil; Medical School, Discipline of Human Morphophysiology, University of Marilia (UNIMAR), Marília, SP, Brazil.
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Abstract
Photobiomodulation (PBM) is a treatment method based on research findings showing that irradiation with certain wavelengths of red or near-infrared light has been shown to produce a range of physiological effects in cells, tissues, animals and humans. Scientific research into PBM was initially started in the late 1960s by utilizing the newly invented (1960) lasers, and the therapy rapidly became known as "low-level laser therapy". It was mainly used for wound healing and reduction of pain and inflammation. Despite other light sources being available during the first 40 years of PBM research, lasers remained by far the most commonly employed device, and in fact, some authors insisted that lasers were essential to the therapeutic benefit. Collimated, coherent, highly monochromatic beams with the possibility of high power densities were considered preferable. However in recent years, non-coherent light sources such as light-emitting diodes (LEDs) and broad-band lamps have become common. Advantages of LEDs include no laser safety considerations, ease of home use, ability to irradiate a large area of tissue at once, possibility of wearable devices, and much lower cost per mW. LED photobiomodulation is here to stay.
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Affiliation(s)
| | - Michael R Hamblin
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA 02114, USA and Department of Dermatology, Harvard Medical School, Boston, MA 02115, USA and Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA 02139, USA.
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Heiskanen V, Hamblin MR. Photobiomodulation: lasers vs. light emitting diodes? Photochem Photobiol Sci 2018; 17:1003-1017. [PMID: 30044464 PMCID: PMC6091542 DOI: 10.1039/c8pp90049c] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Photobiomodulation (PBM) is a treatment method based on research findings showing that irradiation with certain wavelengths of red or near-infrared light has been shown to produce a range of physiological effects in cells, tissues, animals and humans. Scientific research into PBM was initially started in the late 1960s by utilizing the newly invented (1960) lasers, and the therapy rapidly became known as "low-level laser therapy". It was mainly used for wound healing and reduction of pain and inflammation. Despite other light sources being available during the first 40 years of PBM research, lasers remained by far the most commonly employed device, and in fact, some authors insisted that lasers were essential to the therapeutic benefit. Collimated, coherent, highly monochromatic beams with the possibility of high power densities were considered preferable. However in recent years, non-coherent light sources such as light-emitting diodes (LEDs) and broad-band lamps have become common. Advantages of LEDs include no laser safety considerations, ease of home use, ability to irradiate a large area of tissue at once, possibility of wearable devices, and much lower cost per mW. LED photobiomodulation is here to stay.
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Affiliation(s)
| | - Michael R Hamblin
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA 02114, USA and Department of Dermatology, Harvard Medical School, Boston, MA 02115, USA and Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA 02139, USA.
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Burdurlu C, Deniz E, Olgac V. Histopathologic evaluation of the effects of local simvastatin application and photobiomodulation by light-emitting diode on bone healing of rat calvarial defects. BIOTECHNOL BIOTEC EQ 2017. [DOI: 10.1080/13102818.2017.1416673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Cagri Burdurlu
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Yeditepe University, Istanbul, Turkey
| | - Ediz Deniz
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Yeditepe University, Istanbul, Turkey
| | - Vakur Olgac
- Department of Pathology, Faculty of Medicine, Oncology Institute, Istanbul University, Istanbul, Turkey
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Exercise enhance the ectopic bone formation of calcium phosphate biomaterials in muscles of mice. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2017; 77:136-141. [DOI: 10.1016/j.msec.2017.03.270] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 12/18/2016] [Accepted: 03/28/2017] [Indexed: 01/26/2023]
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Deniz E, Arslan A, Diker N, Olgac V, Kilic E. Evaluation of light-emitting diode photobiomodulation on bone healing of rat calvarial defects. BIOTECHNOL BIOTEC EQ 2015. [DOI: 10.1080/13102818.2015.1036774] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Adjunctive techniques for enhancing mandibular growth in Class II malocclusion. Med Hypotheses 2015; 84:301-4. [PMID: 25648662 DOI: 10.1016/j.mehy.2015.01.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 01/11/2015] [Indexed: 01/26/2023]
Abstract
Class II malocclusions are generally characterized by mandible retrusion. For this reason, forward bite jumping appliances, also known as functional appliances were originally designed to enhance mandibular forward projection. However, there is still insufficient evidence to support the effectiveness, predictability and stability of functional appliances in modifying mandibular growth. This article was aimed at presenting evidences and hypotheses that mandibular growth may be enhanced through the use of adjunctive methods in conjunction with functional appliances. In formulating our hypothesis, we considered relevant data, mostly derived from animal studies, concerning alternative methods, such as low-intensity ultrasound and light-emitting diode, as well as their related cellular and molecular mechanisms. According to the evidences covered in this article, we suggest that both methods are potentially effective, and theoretically able to act in synergistic way to enhance functional appliances treatment on mandibular and condylar additional growth. The rationale for the use of these methods as adjunctive therapies for mandibular underdevelopment is attributed to their abilities on stimulating angiogenesis, cell differentiation, proliferation, and hypertrophy, as well as enhancing matrix production and endochondoral bone formation, especially on the condyle of growing animals. This article also proposed a study design which would be able to either prove or refute our hypothesis. If ratified, it would represent a significant scientific accomplishment which provides support for further investigations to be carried out on well-designed clinical trials.
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