Lasers and soft tissue: periodontal therapy

Diode laser as an adjunctive treatment for periodontitis: Arandomized controlled trial

OBJECTIVE

The aim of this randomized controlled trial was to assess clinical and patient reported outcomes of subgingival instrumentation (SI) with adjunctive use of diode laser (DL) versus SI alone in the treatment of periodontitis.

METHODS

Participants requiring non-surgical periodontal treatment were randomly allocated into two treatment groups: SI with DL or SI alone. Clinical parameters [full mouth bleeding and plaque scores (FMBS and FMPS), probing pocket depth and clinical attachment level] were recorded at baseline, three and 6 months post-treatment. Visual analogue scale was used to evaluate postoperative participants' perception of pain, swelling, bleeding, bruising and root sensitivity. The impact of periodontal treatment on quality of life was assessed using the General Oral Health Assessment Index (GOHAI) at 6 months.

RESULTS

A total of 22 participants with stage III/IV periodontitis completed the 6-month follow-up. SI with or without DL resulted in statistically significant reduction in FMBS, FMPS, PPDs, and percentage of PPDs of ≥5 mm at 3- and 6-month follow-up visits (p = 0.001 to <0.001). The participants in SI/DL group had a greater reduction in the percentage of deep PPDs (≥5 mm) compared to those receiving SI alone, but statistically significant differences between the two groups were not observed (16.40 ± 9.57 vs. 32.50 ± 38.76 at 3 months and 7.20 ± 6.86 vs. 19.50 ± 35.06 at 6 months). The difference in the mean total GOHAI scores was not statistically significant at 6 months with total GOHAI scores of 7.25 ± 2.45 and 5.40 ± 3.06 for SI and SI/DL groups, respectively.

CONCLUSION

Within the limitations of this study, the use of DL as an adjunct to SI in the treatment of stage III/IV periodontitis did not produce significant additional improvement in clinical parameters or patient reported outcomes in the 6-month observation period.

[Method of comprehensive physiotherapy of dental patients after COVID-19]

Functional gastrointestinal disorders, which had an impact on the dentofacial system (pain, loose teeth and falling out of them) in patients who have had COVID-19, drew the close attention of specialists of different profiles. The pathogenesis of worsening post-COVID edentulism is insufficiently studied, as many issues of adequate therapy remain unsolved, in which the role of non-drug technologies in the treatment of dental patients who have suffered from COVID-19 is extremely high.

OBJECTIVE

To describe the mechanism of action and clinical effectiveness of the developed combined physiotherapy method, including the induced technique of piracetam iontophoresis on the frontooccipital technic and acupuncture laser therapy in dental patients with complaints of edentulism progression after COVID-19 on the basis of the analysis of single studies on the post-COVID loss of teeth treatment.

MATERIAL AND METHODS

A number of patients equal 120 who complained of tooth loss after COVID-19 during the past 6 months were examined. The following initial and end points were considered: dental bleeding and inflammation scores, vascular and endothelial dysfunction markers - levels of intercellular adhesion molecules and their receptors (SlCAM-1, SVCAM-1, VEGF-A, ET-1) before and after treatment.

RESULTS

Negative correlation between VEGF-A (pg/ml) concentration in peripheral blood serum and sVCAM-1 (ng/ml) level in the examined patients (r=0.4830, p<0.05) and strong inverse correlation between slCAM-1 (ng/ml) level and sVCAM-1 (r=0.7696, p<0.01) have been established. More significant effects after application of the combined induced method on the head's structures and laser acupuncture have been noted than after acupuncture laser exposure and after inducing technique separately, namely in the form of dental inflammation score correction by 1.76 times (p<0.001), decrease of bleeding score by 2.6 (p<0.05), decrease of concentration of SVCAM-1 by 1.7 times and SlCAM-1 by 2 times (p<0.001), increase of endothelin level by 1.7 times as well as the initial low VEGF-A (pg/ml) by 1.5 times (p<0.01).

CONCLUSION

The developed physiotherapeutic complex, which includes laser acupuncture physiotherapy and induced technique of 5% piracetam iontophoresis, can potentially be considered as a physioprophylactic and therapeutic model of post-COVID edentulism.

Different application procedures of Nd:YAG laser as an adjunct to scaling and root planning in smokers with stage III grade C periodontitis: a single-blind, randomized controlled trial

BACKGROUND

The aim of the present study was to evaluate whether different Nd:YAG laser applications as an adjunct to scaling and root planning (SRP) improve the healing response to periodontal therapy in smokers with periodontitis.

METHODS

This clinical trial included eighty systemically healthy smokers with periodontitis. Patients were randomly allocated to a treatment group: SRP alone (group 1), SRP+low-level laser therapy (LLLT) with Nd:YAG laser (group 2), SRP+pocket debridement with ND:YAG laser (group 3), and SRP+combined pocket debridement and LLLT with Nd:YAG laser (group 4). Gingival index (GI), plaque index (PI), bleeding on probing (%), probing depth (PD), and clinical attachment level (CAL) were recorded, and gingival crevicular fluid (GCF) samples for metalloproteinase-8 (MMP-8) levels were collected at baseline, 1 month and 3 months after treatment.

RESULTS

There were no significant differences between the treatment groups for the GI, PI, and BOP (%) parameters and MMP-8 levels at any time points (p > 0.05). For moderately deep pockets, PD and CAL reductions were significantly greater in all test groups compared to group 1 (p ˂ 0.05). For deep pockets, these reductions were significantly greater in group 2 and group 4 compared to group 1 (p ˂ 0.05). PD and CAL reductions were generally similar between test groups (p > 0.05) except PD reduction between baseline and 3 months in deep pockets (p ˂ 0.05).

CONCLUSIONS

The findings of this clinical trial suggest that Nd:YAG laser applications may be beneficial on the healing response of smokers to non-surgical therapy compared to SRP alone.

Comparative Evaluation of Azadirachta indica (Neem) Chip and Soft Tissue Diode Lasers as a Supplement to Phase I Periodontal Therapy in Localized Chronic Moderate Periodontitis: A Randomized Controlled Clinical Trial

Introduction

The current trial aimed to assess and compare the efficacy of neem chip and diode laser as a local drug delivery (LDD) agent as a supplement to phase I periodontal therapy in treatment of localized chronic moderate periodontitis. Materials and Methodology. Fourteen systemically healthy participants with 4-6 mm deep periodontal pockets at least in three quadrants (with no alveolar bony defect amenable to respective or regenerative osseous surgery, as seen in orthopantomograph) were selected for the trial. One week after phase I therapy, 10% absorbable chip of neem (commercially prepared by staff of a pharmacy college, Sheriguda, India) was placed in the periodontal pocket on one site, and soft tissue diode laser pocket sterilization was performed on the other site of the arch. Remaining one site was considered as a control. Parameters recorded clinically were plaque index (PI), papillary bleeding index (PBI), probing pocket depth (PPD), and relative attachment level (RAL) measured at baseline, 21^st day, and one month postoperatively.

Results

Statistically significant improvements were observed in all clinical parameters at one month as compared to baseline for both treatment groups.

Conclusion

Neem chip supplemented with phase I therapy showed best improvement in clinical parameters followed by laser supplemented with phase I therapy in comparison to phase I therapy alone at one month follow-up. Clinical Significance. Neem chips are nature's products, affordable without side effects, with a potential to be used as a local drug delivery agent in treating moderate chronic periodontitis.

Experimental realization of wavelength multiplexed nonlinear upconversion in cesium atoms

Blue-violet wavelength multiplexing offers the capability to enhance the operational capacity and efficiency in optical information processing, underwater communications, biology, and medicine. Here we present a specially designed atomic scheme of cesium for simultaneously generating two blue-violet lasers at 456 and 459 nm via four-wave-mixing (FWM)-based upconversion processes. We experimentally and theoretically show that a double-diamond-type coherent system pumped with 852 and 921 nm lasers is responsible for the efficient generation of the two blue-violet lasers. In this system, the large population inversions lead to self-amplified spontaneous emissions at 15.6 and 12.1µm, which, in turn, serve as the seeds for enhanced double FWM processes with dual-wavelength upconversions.

Do Lasers Have an Adjunctive Role in Initial Non-Surgical Periodontal Therapy? A Systematic Review

(1) Background: dental lasers have numerous applications for periodontal therapy which include surgical procedures of soft tissue and osseous structures, and non-surgical treatments such as pathogen reduction, removal of surface accretions, and photobiomodulation. The aim of this review was to evaluate the scientific literature to ascertain whether lasers have a beneficial role when used adjunctively in initial non-surgical periodontal therapy. (2) Methods: A PubMed search was performed specifically for randomized clinical trials where a dental laser was used adjunctively for initial periodontal therapy on human patients published from January 2010–April 2020. The first search identified 1294 eligible studies. After additional criteria and filters were applied, 20 manuscripts were included in this review. (3) Results: The chosen manuscripts reported on investigations into initial therapy for patients diagnosed with chronic periodontitis. After periodontal charting, conventional instrumentation such as hand and ultrasonic scaling was performed on all patients in the studies, and then a test group or groups of patients were treated adjunctively with a laser. That adjunctive laser group’s periodontal findings showed various degrees of improved health compared to the group treated with only conventional methods. (4) Conclusion: This systematic review found that 70% of the included studies reported significantly better outcomes in certain clinical parameters, but no improvement in others. The remaining 30% of the manuscripts reported no significant difference in any of the measurements. With consideration to correct parametry, lasers have an adjunctive role in initial non-surgical periodontal therapy.

Influence of Photobiomodulation Therapy on Gingivitis Induced by Multi-Bracket Appliances: A Split-Mouth Randomized Controlled Trial

OBJECTIVE

The objective of this split-mouth trial was to investigate the influence of photobiomodulation therapy (PBMT) on adjuvant treatment of gingivitis induced by multi-bracket appliances, after bracket debonding and professional tooth cleaning.

MATERIALS AND METHODS

Thirteen patients (mean age 16.15 years; standard deviation ±2.12 years) who had completed active orthodontic treatment with fixed orthodontic appliances in an orthodontic clinic were included on a randomized basis. At time point T0, after bracket debonding and professional tooth cleaning, the papilla bleeding index (PBI) and bleeding on probing (BOP) were assessed in the upper jaw by the blinded investigator (M.S.), who was not aware at any time of which quadrant received PBMT. The study was based on a patient-blinded split-mouth design. In each patient, PBMT was administered by a practitioner (S.S.) in one upper quadrant (wavelength: 660 nm; Power: 100 mW; Power density: 100 mW/cm²; Energy density per application point = 2 J/cm²; Energy per application point = 2 J; Total dose = 52 J/cm²; Total energy = 52 J; Irradiation time: 26 × 20 sec), while the other upper quadrant received a simulated laser application with the laser system turned off. Randomized equal allocation of the sides was accomplished. The second PBI and BOP assessment followed 4-6 days after laser irradiation (T1) by M.S.

RESULTS

No statistical differences were observed between the sides with regard to PBI and BOP values at T0 (p > 0.05). The PBI and BOP values decreased significantly between T0 and T1 on both sides (p < 0.05). At T1, the PBI and BOP values were significantly lower in the laser side in comparison with the control side (p < 0.05).

CONCLUSIONS

On the basis of these results and study parameters, adjuvant PBMT is able to accelerate the healing process in patients with gingivitis induced by multi-bracket appliances.

Effect of various dentin disinfection protocols on the bond strength of resin modified glass ionomer restorative material

Background

Disinfection of dentin surface prior to any restorative therapy is important for the longevity of the treatment rendered. However, these dentin disinfection methods should itself not interfere with the adhesion of the restorative material. Therefore the aim of this study was to determine the effect of various dentin disinfection protocols on the shear bond strength (SBS) of resin modified glass ionomer cement (RMGIC).

Material and Methods

The occlusal surface of 40 extracted premolars were trimmed to obtain a flat dentinal surface and was randomly divided into four groups. CTRL was the control group; NaOCl was 1% sodium hypochlorite disinfection group; CHX was 2% chlorhexidine disinfection group; and PAD was the photo-activated disinfection group. Then a predetermined dimension of RMGIC was bonded to the pre-treated dentin surfaces. Following this, each sample was tested for SBS using universal testing machine at a crosshead speed of 0.5mm/min.

Results

Among the test groups, CHX showed the least reduction in SBS and NaOCl the highest reduction in SBS as compared to the control group. PAD on the other hand showed significantly lower SBS than CTRL and CHX groups, but the values were higher than the NaOCl group.

Conclusions

Thus, it could be concluded from the present study that use of chlorhexidine based dentin disinfection does interfere with the adhesion of RMGIC. However, photo-activated disinfection should be done with caution. Moreover, sodium hypochlorite based disinfectants should be avoided prior to the use of RMGIC.

Key words:Chlorhexidine, Dentin disinfection, Photo-activated disinfection, Resin modified glass ionomer cement, Shear bond strength, Sodium hypochlorite.

Commentary: Is There Clinical Benefit From Using a Diode or Neodymium:Yttrium-Aluminum-Garnet Laser in the Treatment of Periodontitis?

Despite a quarter of a century of laser research, there is a persistent debate regarding the efficacy of dental lasers in the treatment of periodontitis or periodontal maintenance therapy. There are many claims and much hyperbole surrounding the use of lasers, either as a monotherapy or adjunctive to scaling and root planing, to treat periodontitis. There is little evidence that using a diode or neodymium:yttrium-aluminum-garnet laser adds clinical value over and above conventional non-surgical or surgical periodontal treatment. There is a significant need for better designed human clinical trials. Data from such trials should be analyzed according to initial probing depth and characteristics of the treated sites, such as non-molar, molar flat surfaces, and molar furcations, and evaluated for long-term post-treatment results.

Applications of Light Amplification by Stimulated Emission of Radiation (Lasers) for Restorative Dentistry

Light amplification by stimulated emission of radiation (laser) has been used widely in a range of biomedical and dental applications in recent years. In the field of restorative dentistry, various kinds of lasers have been developed for diagnostic (e.g. caries detection) and operative applications (e.g. tooth ablation, cavity preparation, restorations, bleaching). The main benefits for laser applications are patient comfort, pain relief and better results for specific applications. Major concerns for using dental lasers frequently are high cost, need for specialized training and sensitivity of the technique, thereby compromising its usefulness particularly in developing countries. The main aim of this paper is to evaluate and summarize the applications of lasers in restorative dentistry, including a comparison of the applications of lasers for major restorative dental procedures and conventional clinical approaches. A remarkable increase in the use of lasers for dental application is expected in the near future.

Is there a place for lasers in periodontal therapy?

This article aims to provide an overview on the clinical applications of lasers in periodontics.