A preliminary randomized clinical trial comparing diode laser and scalpel periosteal incision during implant surgery: impact on postoperative morbidity and implant survival

Combined use of PRPP, diode laser and piezosurgery device improves reparative osteogenesis previously to dental implants placement

OBJECTIVE

Current study evaluated whether use of the platelet-rich powder (PRPP), piezosurgery device and diode laser after removal of jawbones cysts and benign bone formations and extraction of impacted tooth could enhance bone regeneration before dental implantation.

METHODS

A study was conducted among 200 patients with post-surgical cavities (not exceeding 1.5 cm upon cystectomy, benign bone tumor removal and impacted tooth extraction) who underwent plasma powder, autograft, allograft, xenograft or beta-tricalcium phosphate augmentation procedures.

RESULTS

PRPP implantation in combination with irradiation of bone cavity by diode laser led to the formation of 15.40 % ± 2.1 of new bone. The activity of reparative osteogenesis on the bone surface was BB = 6.71 ± 1.3, which is 3 and 3.5 times higher than the mean value in comparison group after augmentation of xenograft and beta-tricalcium phosphate. The value of bone tissue resorption for main group patients was less pronounced (Ra.Oc = 25.20 % ± 2.1). The ratio between pro- and anti-inflammatory cytokines in the main group after 1, 7 and 30 days since surgical procedure was lower than the ratio of the corresponding cytokines in the comparison groups.

CONCLUSION

The examination of computed tomograms, histological and morphometric analysis of bone tissue after trepanobiopsy, cytological analysis of swabs and enzyme immunoassay to determine local immunity indicated that the proposed method of treatment with the use of PRPP, the piezosurgery device and the diode laser has a positive effect: it helped to optimize reparative osteogenesis after filling post-surgical cavities and restore bone volume.

Efficacy of Periodontal Endodontics Combined with Diode Laser (DL) Therapy on Severe Periodontitis

Background

For a long time, the impact of severe periodontitis on the pulp has been the focus of periodontal clinical research. Whether the teeth with severe periodontitis should be treated with pulp has also become the focus of clinical research.

Aims

To explore the effect of periodontal endodontic therapy combined with DL therapy on severe periodontitis.

Materials and Methods

The clinical data of 100 patients with severe periodontitis from January 2020 to July 2022 were selected and included in the retrospective study. According to the different retrieval treatment methods, they were divided into the control group and the treatment group with 50 cases in each group. The control group received periodontal endodontic treatment, and the treatment group received DL treatment on the basis of the control group. The differences in periodontal probing depth (PD), toothache degree, bleeding index (BI), inflammatory factors, plaque index (PLI), and attachment loss (AL) between the two groups were compared and analyzed.

Results

After 3 months of treatment, the bleeding index (BI), plaque index (PLI), and periodontal probing depth (PD) of the treatment group were significantly lower than those of the control group, and the difference was statistically significant (P < 0.05). The attachment loss (AL) of the group was not significantly different from that of the control group (P > 0.05). Before treatment, there was no significant difference in the levels of inflammatory factors between the two groups (P > 0.05). After 3 months of treatment, the levels of IL-6 and CRP in the treatment group were significantly lower than those in the control group, and the difference was statistically significant (P < 0.05). Before treatment, there was no significant difference in the levels of inflammatory factors between the two groups (P > 0.05). After 3 days of treatment, the VAS score of the treatment group was significantly lower than that of the control group, and the difference was statistically significant (P < 0.05).After treatment, there were no complications during follow-up in the two groups.

Conclusion

The application of DL treatment has a significant effect, which can promote the healing of periodontal tissue, reduce the depth of periodontal pockets, and reduce the degree of toothache, thereby providing a reference for clinical treatment.

Postsurgical Pain and Implant Osseointegration Failure: A Case Control Study

Aim. The relationship between postsurgical pain and osseointegration was evaluated and analyzed in this study. Material and method. 27 patients, ranging in age from 35 to 72 years old, 12 males and 15 females, who received dental implants and failed to achieve osseointegration from Tianjin Medical University Second Hospital, were analyzed and studied in the following aspects: bone density, initial torque, one- or two-stage surgery, postsurgical pain, postsurgical swelling, and radiographic evidence of osseointegration failure. Result. 5 patients were assessed to be D4 bone density and 7 cases were assessed to be D3 bone density, 2 patients were assessed to be D2 bone density and 13 patients were assessed to be D1 bone density. All cases were documented with clinically acceptable initial torque. Among the 27 cases, 2 of them were one-stage nonsubmerged surgery and 25 cases were two-stage submerged surgery. 25 out of 27 patients reported moderate to severe pain lasting for more than 72 hours. Radiologic examinations failed to offer any indication of poor osseointegration in the 7-day postsurgical follow-up. Conclusion. Moderate to severe postsurgical pain lasting more than 72 hours displays high odd ratio of poor osseointegrate. The radiological examinations alone failed to offer any valuable evidence for the early detection of osseointegration failure in this study.

Patient-reported outcomes of laser-assisted pain control following non-surgical and surgical periodontal therapy: A systematic review and meta-analysis

Adjunctive use of laser devices as high reactive-level laser/light therapy (HLLT) or photobiomodulation therapy (PBMT) for periodontal therapy is known to be more effective on suppressing pain than conventional therapy, however, there are no systematic reviews addressed its effectiveness. This systematic review and meta-analysis aim to investigate the following clinical question (CQ): does adjunctive use of lasers with conventional therapy suppress the pain associated with periodontal treatment? A systematic and extensive literature search was performed to summarize the currently available knowledge to answer the CQ using the PubMed, Cochrane Library, and Web of Science databases for randomized controlled trials (RCTs) conducted before June 2020. Bias risk was assessed using the Cochrane tool for the risk of bias evaluation. A meta-analysis was performed on quantitative evaluation of pain control based on patient-reported outcomes. After an independent screening of 165 initial records, ten RCTs were included. Six of them focused on surgical procedures and the others on non-surgical periodontal pocket therapy. The protocols of HLLT, PBMT, and combination with HLLT and PBMT were employed in five, four and one RCTs, respectively. Following the assessment of bias risk, it is revealed that all RCTs had methodological weaknesses regarding the blinding of key personnel, although other bias risk factors were not evident. Meta-analysis showed that HLLT using erbium lasers significantly reduced the patient-reported pain immediately after treatment (two RCTs, p < 0.0001), while PBMT using diode lasers significantly reduced pain 2-7 days after treatment (two RCTs, p < 0.0001 to p = 0.03). The presented systematic review and meta-analysis suggest that the alternative use of HLLT using erbium lasers to conventional instrumentation can significantly suppress postoperative pain and that intraoperative or postoperative PBMT using diode lasers combined with periodontal surgery can significantly reduce postoperative pain. However, the evidence is still insufficient and more well-designed RCTs are required.

Clinical evidence of photobiomodulation therapy (PBMT) on implant stability and success: a systematic review and meta-analysis

Background

Photobiomodulation therapy (PBMT), a type of light therapy that uses the concept of photobiomodulation, is developed to promote bone healing. Clinical studies have been conducted to assess the influence of PBMT on dental implant stability and success rate. This is the first systematic review and meta-analysis to assess the effect of PBMT and methodological quality of these studies on implants in human clinical trials.

Methods

An electronic search was performed in Pubmed, Embase, and the Cochrane Controlled Register of Trials (CENTRAL).

Results

Initially, 675 articles were identified, among which only 8 met the inclusion criteria. Four of the 8 studies presented a low risk of bias, whereas the other 4 were of moderate risk. Our review focused on implant success rates and implant stability measured at days 0 and 10, and at 3, 4, 6, and 12 weeks. No significant differences were observed between the PBMT group and the control group regarding implant stability or success rate.

Conclusions

The existing clinical studies did not provide sufficient evidence to observe positive effects of PBMT on implants in patients. An increased number of high-quality clinical randomized controlled trials (RCTs) are required to verify the data and to draw convincing conclusions.