Evaluation of the effects of photobiomodulation therapy and ozone applications after gingivectomy and gingivoplasty on postoperative pain and patients' oral health-related quality of life

The adjunctive use of antimicrobial photodynamic therapy, light-emitting-diode photobiomodulation and ozone therapy in regenerative treatment of stage III/IV grade C periodontitis: a randomized controlled clinical trial

OBJECTIVES

To assess the short-term efficacy of multiple sessions of antimicrobial photodynamic therapy (aPDT), light-emitting-diode (LED) photobiomodulation, and topical ozone therapy applications following surgical regenerative treatments on clinical parameters, patient-centered outcomes, and mRNA expression levels of VEGF, IL-6, RunX2, Nell-1, and osterix in gingival crevicular fluid samples in patients with stage III/IV, grade C periodontitis.

MATERIALS AND METHODS

Forty-eight systemically healthy patients were assigned into four groups to receive adjunctive modalities with regenerative periodontal surgical treatment. A 970 ± 15 nm diode laser plus indocyanine-green for aPDT group, a 626 nm LED for photobiomodulation group, and topical gaseous ozone were applied at 0, 1, 3, and 7 postoperative days and compared to control group. The clinical periodontal parameters, early wound healing index (EHI), and postoperative patients' morbidity were evaluated. The mRNA levels of biomarkers were assessed by real-time polymerase chain reaction.

RESULTS

No significant difference in the clinical parameters except gingival recession (GR) was identified among the groups. For group-by-time interactions, plaque index (PI) and probing pocket depths (PD) showed significant differences (p = 0.034; p = 0.022). In sites with initial PD > 7 mm, significant differences were observed between control and photobiomodulation groups in PD (p = 0.011), between control and aPDT, and control and photobiomodulation groups in CAL at 6-month follow-up (p = 0.007; p = 0.022). The relative osterix mRNA levels showed a statistically significant difference among the treatment groups (p = 0.014).

CONCLUSIONS

The additional applications of aPDT and LED after regenerative treatment of stage III/IV grade C periodontitis exhibited a more pronounced beneficial effect on clinical outcomes in deep periodontal pockets.

Ozone therapy improves early stages of osseointegration in ovariectomized rats

OBJECTIVE

the aim of this study was to analyze the influence of ozone therapy (OZN) on peri-implant bone repair in critical bones by installing osseointegrated implants in the tibia of ovariectomized rats.

METHODOLOGY

ovariectomy was performed on 30 Wistar rats, aged six months (Rattus novergicus), and, after 90 days, osseointegrated implants were installed in each tibial metaphysis. The study groups were divided into the animals that received intraperitoneal ozone at a concentration of 700 mcg/kg - OZ Group (n=15) - and a control group that received an intraperitoneal saline solution and, for this reason, was named the SAL group (n=15). The applications for both groups occurred during the immediate post-operative period on the 2nd, 4th, 6th, 8th, 10th, and 12th day post-surgery. At various stages (14, 42, and 60 days), the animals were euthanized, and tests were performed on their tibiae. These tests include histomorphometric and immunohistochemical analyses, computerized microtomography, sampling in light-cured resin for calcified sections, and confocal microscopy. The obtained data were then analyzed using One-way ANOVA and the Shapiro-Wilk, Kruskal-Wallis, and student t-tests (P<0.05).

RESULTS

our findings indicate that the OZ group (3.26±0.20 mm) showed better cellular organization and bone neoformation at 14 days (SAL group, 0.90±1.42 mm) (P=0.001). Immunohistochemistry revealed that osteocalcin labeling was moderate in the OZ group and mild in the SAL group at 14 and 42 days post-surgery. The data from the analysis of calcified tissues (microtomography, histometric, and bone dynamism analysis) at 60 days showed no statistically significant differences between the groups (P=0.32).

CONCLUSION

it was concluded that ozone therapy anticipated the initial phases of the peri-implant bone repair process.

The effects of injectable platelet-rich fibrin application on wound healing following gingivectomy and gingivoplasty operations: single-blind, randomized controlled, prospective clinical study

OBJECTIVES

The aim of this study was to evaluate the effects of wound healing using injectable platelet-rich fibrin (IPRF) after gingivectomy and gingivoplasty.

MATERIALS AND METHODS

In this clinical study, 46 systemically healthy patients with chronic inflammatory gingival enlargement were randomly treated with gingivectomy-gingivoplasty + I-PRF (n=23) or gingivectomy-gingivoplasty alone (n=23). The primary outcome was to evaluate the effect of I-PRF on wound healing over a 3-week follow-up period. Samples collected from gingival crevicular fluid (GCF) were processed using enzyme-linked immunosorbent assay (ELİSA) to measure VEGF and FGF-10 biomarkers. The surgical areas were stained with Mira-2 tone and evaluated in ImageJ. Wound healing was evaluated with Modified Manchester Scar (MMS) scale and Landry, Turnbull, and Howley (LTH) index.

RESULTS

VEGF values of the control group at baseline, week 2, and week 3 were significantly higher than the test group. In weeks 2 and 3, FGF-10 values were found to be significantly higher in the control group than the test group. The amount of staining was found to be significantly higher in the control group than in the test group on days 3, 7, and 14. LTH values of the control group were significantly lower than the test group and MMS values were significantly higher than those of the test group.

CONCLUSIONS

I-PRF applications revealed positive effects on epithelial wound healing after gingivectomy and gingivoplasty operations.

CLINICAL RELEVANCE

Platelet concentrates such as I-PRF accelerate wound healing and contribute to the patient's comfort and quality of life. I-PRF application may have positive effects on wound healing after gingivectomy and gingivoplasty operations.

The use of low level laser therapy in conjunction with diode laser-assisted and conventional vestibuloplasty: Comparison of wound healing and vestibular depth gain

BACKGROUND

The aim of this study is to compare wound healing and vestibular depth gain in individuals undergoing vestibule deepening surgery using diode laser and conventional technique and to further investigate the possible wound healing effect of low-level laser therapy (LLLT).

MATERIAL AND METHODS

52 systemically healthy individuals with insufficient vestibular depth in the region of teeth 33-43 in the lower jaw were included. Following nonsurgical periodontal treatment, patients were divided into four groups as follows: a) diode laser (L); b) diode laser + LLLT; c) conventional surgery and d) conventional surgery + LLLT. Vestibular depth and horizontal wound size measurements of the individuals were recorded using digital calipers. Reepithelization was evaluated via an image analysis program.

RESULTS

Vestibular depth measurements were found to be higher in the conventional surgery groups compared to that of diode laser groups after the operation, while the results were not statistically different between groups (p >0.05). Reepithelization area did not differ between groups in the evaluated time periods (p >0,05). On the other hand, horizontal wound shrinkage was significantly higher in the conventional surgery group than that of diode laser.

CONCLUSIONS

Within the limits of this study, both methods yielded in vestibule depth gain. On the other hand, LLLT did not have an additional positive effect on mucosal wound healing. As a clinical relevance, the results are valuable for clinicians in terms of showing that suturing of the mucosal flap formed following vestibule deepening should not be necessary in laser assisted surgery for attaining more vestibule depth.

Efficacy of hyaluronic acid gel and photobiomodulation therapy on wound healing after surgical gingivectomy: a randomized controlled clinical trial

BACKGROUND

Surgical gingivectomy can be considered the gold standard treatment for gingival enlargement. The healing of wound site after gingivectomy occurs slowly by secondary intention. To accelerate the wound healing process, several studies have been conducted evaluating the effect of various treatment modalities. Photobiomodulation therapy (PBMT) was proposed to provide minimally invasive and painless treatment as well as to decrease discomfort of the patient following the surgical process. Another factor that is expected to improve the healing after surgery is topical application of chemotherapeutic agents such as Hyaluronic acid (HA). This study aims to assess the effect of topically applied HA gel after PBMT on the healing of wound site after surgical gingivectomy.

METHODS

This randomized controlled clinical trial included twenty-six surgical gingivectomy wound sites, equally divided into two groups, Group-I (test group): the surgical sites after gingivectomy were irradiated with a diode laser (980 nm, 0.2 W) then covered by 2% HA gel loaded in a special custom-made soft transparent tissue guard appliance for each patient. Group II (control group): the surgical sites were irradiated with a diode laser (980 nm, 0.2 W) only. Wound healing was assessed subjectively by Landry healing index on the 3rd, 7th, 14th and 21st days after surgery, and pain perception was assessed by the patients using visual analog scale (VAS) throughout the 21 days of the follow up period. Comparisons between the two study groups were performed using Mann-Whitney U test, while comparisons between different time points were performed using Friedman test. Significance was inferred at p value < 0.05.

RESULTS

By the end of the follow-up period, surgical sites of the test group showed excellent healing compared to the control group. There were no significant differences in VAS scores between both groups (p > 0.05).

CONCLUSIONS

Application of 2% HA gel as an adjunctive to PBMT was found to have significant clinical effects and higher power of repair among test group when compared to that achieved by PBMT alone in control group.

TRIAL REGISTRATION

This study was retrospectively registered on ClinicalTrials.gov and first posted on 28th of March 2023 with an identifier number: NCT05787912.

Analysis of the psychopathological profile, quality of life, and cost-effectiveness of oral lichen planus patients treated with photobiomodulation

OBJECTIVES

To evaluate the effect of PBM on the psychological profile and quality of life of patients with oral lichen planus (OLP) in comparison to corticoid and to investigate the cost-effectiveness of both treatments.

MATERIALS AND METHODS

Patients were randomized into two groups: Control (clobetasol propionate 0.05%) and Photobiomodulation (660 nm, 100mW, 177 J/cm², 5 s, 0.5 J) twice a week for 30 days. The Hospital Anxiety and Depression Scale (HADS) and OHIP-14 were used in different treatment time points and at follow-up. The cost-effectiveness was calculated using the improvement in OHIP-14 after treatment.

RESULTS

OLP patients showed detected levels of anxiety, depression, and poor quality of life at baseline. No improvement in anxiety and depression was noticed after treatments. However, PBM and corticoid significantly improved the quality of life of OLP patients, considering the OHIP-14-T and the physical pain domain. The treatment with corticoid was more cost-effective than PBM.

CONCLUSIONS

Psychological distress was not improved after both treatments and PBM is as effective as corticoids in promoting a better quality of life in OLP patients, despite its higher cost.

CLINICAL RELEVANCE

This study highlights the need for additional therapeutic interventions in OLP patients, to early recognize and to manage the alterations in their psychological profile. Moreover, PBM is an effective therapy in OLP patient's quality of live and although it was a more expensive, the advantage of being a minimally invasive therapy associated with no side effects must be considered in clinical practice, especially in those patients with refractory disease.

TRIAL REGISTRATION

This study is registered at ClinicalTrials.gov; the registration number is NCT03320460, registered in 17/10/2017.