Does laser therapy improve the wound healing process after tooth extraction? A systematic review

Prevention of retrograde peri-implantitis caused by pulpal/periapical lesions in adjacent teeth: A literature review

OBJECTIVES

To present a comprehensive review on retrograde peri-implantitis (RPI), focusing on its epidemiology, etiology, clinical manifestations, classification, treatment, and prevention strategies.

DATA

The widespread development of implantology has led to heightened concerns regarding implant failure attributed to peri-implantitis (PI). In contrast to conventional PI, retrograde peri-implantitis (RPI), defined as inflammation originating from the apical of the implant towards the crown, has gained increasing attention. Various factors can contribute to RPI, among which untreated pulpal or periapical lesions from adjacent teeth are considered as main causes.

SOURCES AND STUDY SELECTION

Using PubMed as the source for eligible literature, a total of 73 cases (from 36 articles) were identified for review. The search items are (["retrograde peri-implantitis" OR "periapical peri-implantitis" OR "peri-apical implant lesion*"] AND ["risk factor*" OR "treatment*" OR "prevent*"]).

CONCLUSIONS

Currently, clinicians often inadequately address the evaluation and management of pulpal or periapical lesions in the adjacent teeth in RPI, neglecting its causes and further the preventive measures. Overall, RPI influences the success of dental implants and therefore valid diagnosis and prevention are obligatory. Until now, there has been no relative instructions for clinicians. Moreover, new research directions (e.g. molecular biology and immunology) as well as innovative treatment (e.g. lasers and novel materials) may facilitate the precise prevention and early diagnosis of RPI.

Impact of photobiomodulation in alveolar ridge preservation and implant stability after a dental extraction: a systematic review

The bone volume preservation after dental extraction is challenging in case of implant rehabilitation for functional and aesthetics results. Photobiomodulation (or LLLT) is used in medicine for its properties of accelerating the healing process. The aim of the systematic review was to determine if the use of photobiomodulation had an impact on implant stability and on alveolar bone healing, either in quality or in quantity. A systematic review following the PRISMA guidelines was conducted on the databases PubMed, Science Direct, Scopus and Google Scholar. The review was registered on Prospero under the number CRD42023467581. 414 articles were screened, of which 12 were selected for the review. In 10 of the 12 articles, LLLT seemed to show a positive impact on bone healing and implant stability. Regarding alveolar preservation, 6 out of 8 studies found statistically significant results. Regarding implant stability, 3 out of the 4 articles found a statistically significant impact of photobiomodulation versus control group. Despite the great heterogeneity of the studies, some LLLT protocols seemed consensual: the use of a Ga-Al-As laser with an emission over 800 nm with a continuous emission consisting of 3 to 4 sessions each with a duration of 4 to 5 min, on a sole application point. The use of photobiomodulation seemed to inhance the alveolar bone healing after a dental extraction, and the implant stability in case of immediate extraction-implantation. Further randomized controlled trials with a placebo group seem mandatory to corroborate the results.

Comparative Study of Photobiomodulation Effects on Alveolar Socket Hard Tissue Healing in Rats: Application of 980 nm Versus 810 nm Lasers

Background: This study aimed to explore the differential effects of photobiomodulation (PBM) via 980 nm and 810 nm lasers on the hard tissue healing of rat alveolar sockets, with a focus on a comparative analysis of hard tissue regeneration and osteogenic gene expression. Objective: This study aimed to explore the effects of PBM using 980 nm and 810 nm lasers on hard tissue healing of rat alveolar sockets, focusing on hard tissue regeneration and osteogenic gene expression. Materials and Methods: Thirty-six male Wistar rats (5 weeks old) had both right and left maxillary first molars extracted. Post extraction, the right alveolar sockets received PBM treatment with either 980 nm (0.3 W, 18 J/cm2) or 810 nm (0.1 W, 6 J/cm2) lasers for seven days, whereas the left sockets served as controls. Rats were euthanized on days 3, 7, 14, and 28 for histopathological, immunohistochemical, micro computed tomography (micro-CT), and quantitative polymerase chain reactionanalyses. Results: On day 3, early granulation tissue, neovascularization, and inflammatory cell aggregates were observed in all groups. By day 7, active osteoclasts and osteoblasts were noted, with a significant increase in CD31-positive cells in the 980 nm group (p < 0.05). Day 14 showed new bone formation, and by day 28, increased cancellous bone and collagen content were present in all groups, with no significant differences between them (p > 0.05). Gene expression analysis revealed higher BMP-2 and Runx-2 levels in laser-treated groups on day 14 (p < 0.05), with the 980 nm group having higher BMP-2 levels than the 810 nm group (p < 0.05). Bone sialoprotein expression was higher in laser-treated groups on days 14 and 28 (p < 0.05), and osteocalcin expression was highest in the 980 nm group on both days (p < 0.05). Micro-CT analysis showed no significant differences among groups in bone mineral density, bone surface (BS)/bone volume (BV), or bone volume (BV)/TV (total volume) indices. Conclusion: PBM with 980 nm and 810 nm lasers promotes early-stage hard tissue healing in extraction sockets, with the 980 nm laser more effectively enhancing osteogenic gene expression, suggesting its potential as an adjunctive therapy in dental and oral surgery.

Successful Intentional Replantation of a Severely Compromised Tooth Using 3 Types of Phototherapy: A Case Report

Background: Intentional replantation (IR) is an emerging and cost-effective last-resort treatment for persistent apical periodontitis. Adjunctive phototherapy for IR aims to improve the management of challenging cases by enhancing disinfection, stimulating healing and promoting regeneration. Objective: We report a novel phototherapy-assisted IR protocol conducted on a compromised lateral incisor with an extensive periapical infection (Ø > 10 mm) in a 68-year-old diabetic male. Methods: The IR protocol involved pre- and postoperative photobiomodulation (660 nm, 0.2 J/cm2, 60 sec/site), antimicrobial photodynamic therapy of the root surface (660 nm, 0.6 J/cm2, 30 sec, methylene blue photosensitizer), and Er:YAG root and socket debridement (2940 nm, 21 J/cm2, 30 sec). The total time from extraction to replantation was 14 min 35 sec. Results: The tooth at 3.5-year follow-up remained clinically functional with radiographic resolution of the infection indicating a successful reimplantation. Conclusions: This case report demonstrated that an adjunctive phototherapy IR protocol can effectively treat a compromised tooth with extensive periapical infection.

Effect of low-level laser therapy in wound healing of primary molar teeth extraction

INTRODUCTION

Tooth extraction in children requires attention to wound healing and pain management, which are influenced by patient-related factors and behavioral guidance.

AIM OF THE STUDY

The study aimed to evaluate the effect of LLLT on healing sockets in pediatric patients with bilateral primary molar teeth extraction and determine its impact on pain management.

METHODS

6-10 years of age, systemically healthy, and with atraumatic extraction indications of bilateral primary molar teeth were included in the study (n = 40). In the first session, randomly selected teeth were extracted under local anesthesia. In the control group, only clot formation in the socket was observed and photographed. The other group extractions were performed 2 weeks later. The low-level laser therapy (LLLT) group was treated with a 980 nm wavelength, in a continuous emission mode, 0.5 W power, 300 J of energy, 400 µm tip, 60 s diode laser and photographed. Nonepithelialized surface measurements were performed using ImageJ. Pain assessment was performed using the Wong-Baker Pain Scale. Statistical analyses were performed using SPSS software.

RESULTS

There was a statistically significant difference between the groups in the Wong-Baker values in 3rd day (p < 0.05). In soft tissue healing on the 3rd and 7th day, the nonepithelialized surface of the laser socket was smaller than that of the control group, and the measurement results were found to be statistically significant (p < 0.05).

CONCLUSION

Although LLLT was not found to be very effective in reducing postoperative discomfort after extraction of primary molars, it provided better wound healing in extraction sockets.

Low-laser action analysis associated with Himatanthus drasticus extract in wound healing

The aim of this study was to analyze the healing action of low-intensity laser therapy associated with Himatanthus drasticus in wound healing in mice. The study was experimental, analytical, controlled, randomized, and prospective. Twenty Wistar rats were divided into four groups: control with injury, injury + laser, wound + Himatanthus drasticus, and wound + laser + Himatanthus drasticus. The animals underwent surgical skin wounds on their backs, and different treatments were applied based on the group. The healing process was evaluated histologically through the analysis of collagen fibers, neovascularization, and inflammatory reaction. The results showed that low-intensity laser therapy and Himatanthus drasticus treatment improved the healing process in terms of collagen synthesis, decreased inflammatory cell migration, fibroblast proliferation, neovascularization, wound size reduction, and edema reduction. However, the combination of laser and Himatanthus drasticus did not show significant improvement compared to individual treatments. There were no statistical differences in polymorphonuclear cells between the treatment groups. Low-intensity laser therapy and Himatanthus drasticus have demonstrated positive properties in improving the healing process. Further research is needed to better understand their individual and combined effects. The study contributes to the exploration of alternative wound healing methods and encourages further investigation in this field.

Effects of Photobiomodulation Therapy on Hard Tissue Healing in Rat Tooth Extraction Sockets

Objective: To investigate the effects of photobiomodulation therapy (PBMT) on hard tissue healing in rat maxillary first molar extraction sockets. Methods: A total of 20 male Wistar rats were used in the study. The right extraction sockets were irradiated with a Ga-Al-As laser (500 mW, 980 nm) for 51.7 J/cm2 every 24 h for 7 days, while the left sockets served as controls. Rats were sacrificed on days 3, 7, 14, and 28 after tooth extraction, and microcomputed tomography (CT) analysis, histopathological evaluation, and enzyme-linked immunosorbent assay (ELISA) were conducted at different time points. Results: Micro-CT analysis showed that the percentage of bone volume/tissue volume (TV) and bone mineral density were significantly higher in the experimental group compared to the control group on day 28 (p < 0.05). Histopathological evaluation revealed that PBMT promoted new bone formation and accelerated bone remodeling. ELISA demonstrated a significant increase in alkaline phosphatase expression in the laser sides on days 7 and 14 (p < 0.05). Conclusions: One application postextraction followed by seven consecutive daily applications of PBMT can effectively promote hard tissue healing in rat maxillary first molar extraction sockets.

Application of soft tissue laser in the management of recurrent apthous stomatitis

Apthous ulcers are relatively common pathology and are very painful, so in order to facilitate the relief in pain and healing of these ulcers application of LLT has been done in the present study.  The purpose of this study was to assess the efficacy of Low Level Laser Therapy in the treatment of recurrent aphthous ulcers. 30 patients of both sexes and all age groups with two recurrent aphthous ulcers were included in the study. One ulcer in each subject was subjected to Low Level Laser Therapy as study group and one ulcer in each subject was considered for the Sham Control group. The Student’s t-test was used for statistical evaluation of the data. The study group (LLLT) showed a statistically significant reduction in pain as compared to the sham controlled group.  Complete resolution of the ulcers in the study group was observed to be 4.7 ± 1.2 days and control group was 8.4 ± 2.6 days. On comparison with the sham group, the complete healing time for the study group (LLLT) was found to be highly significant, with a p value of <0.001.

An in-vivo study of photobiomodulation using 403 nm and 649 nm diode lasers for molar tooth extraction wound healing in wistar rats

PURPOSE

This study aims to examine the effects of red 649 nm 4 J/cm2 and blue 403 nm 8 J/cm2 diode laser treatment for post-extraction wounded healing in rats through histopathological and immunohistochemical analysis.

METHODS

Samples of 54 Wistar rats were divided into six groups: C- control group without treatment; C + wounded group without treatment; TB wound group with Povidone-iodine treatment; TD wounded group with doxycycline treatment; TLB wounded group with 403 nm diode laser treatment; and TLR wounded group with 649 nm diode laser treatment. Mandibular samples were observed for the number of lymphocytes and fibroblasts cells, new blood vessels formation, Interleukin 1β, and Collagen 1α expression level.

RESULTS

Based on the histopathological test results, red laser diode treatment significantly increased the number of lymphocyte, fibroblast cells and the formation of new blood vessels. Meanwhile, immunohistochemical tests showed an increase in the expression of the Colagen-1α protein which plays a role in the formation of collagen for new tissues formation after damage, as well as a decrease in Interleukin-1β expression level. Blue laser is also able to show a positive effect on wound healing even though its penetration level into the tissue is lower compared to red laser.

CONCLUSION

The red diode laser 649 nm has been shown to accelerate the process of proliferation in wound healing post molar extraction based on histopathological and immunohistochemical test results.

Photobiomodulation Therapy Improves Postoperative Pain and Edema in Third Molar Surgeries: A Randomized, Comparative, Double-Blind, and Prospective Clinical Trial

PURPOSE

Laser light has biological effects that can modulate inflammatory processes. Thus, this study aimed to evaluate the effects of photobiomodulation (PBM) therapy on pain, edema, and trismus after the extraction of retained third molars.

METHODS

A split-mouth, double-blind, randomized clinical trial (RCT) was conducted in 13 patients with similar bilateral third molars who received intraoral application PBM therapy at 4 points with a diode laser at 810 nm wavelength, 6 J (100 mW, 60 seconds/point) on 1 side (the PBM side); and laser irradiation simulation on the other side (SHAM side). The pain was assessed through visual analog scale (VAS) at 0, 12, 24, 48, and 72 hours, number of analgesic-relief (NAR), and mean time of first analgesic use; edema, through VAS, and linear facial measurements at 0, 24, 48, and 72 hours; and trismus, through the mouth opening measurements at 0, 24, 48, and 72 hours. The repeated-measures analysis was applied to assess the effect of the treatment, followed by Tukey's post hoc test for multiple comparisons (P < .05).

RESULTS

Thirteen patients (61.77% male and 38.63% female) with age of 24.16 ± 2.06 participated in this research. VAS showed that PBM controlled pain better (7.56 ± 6.25) than SHAM (32.25 ± 22.78) at 24 hours (P < .001) and 48 hours (19.47 ± 9.27 and 39.87 ± 4.21, respectively) (P = .011). VAS also showed that PBM controlled edema better (19.7 ± 13.27) than SHAM (32.38 ± 15.28) at 24 hours (P = .037) and 48 hours (19.47 ± 13.11 and 39.87 ± 22.77, respectively) (P = .002).

CONCLUSION

The PBM therapy in this study resulted in pain and edema reduction after third molar surgery and may be considered as adjuvant therapy after the surgical procedure.

The effect of post-extraction socket preservation laser treatment on bone density 4 months after extraction: Randomized controlled trial

Background

Post‐extraction bone resorption may affect the outcome of ensuing restorations.

Purpose

This study aimed to evaluate a comprehensive laser post‐extraction protocol by comparing resulting alveolar bone regeneration with that obtained after standard extraction procedure.

Materials and Methods

About 53 simple extractions were randomized to either laser or control group. In the laser group, erbium (Er:YAG; 2940 nm) and neodymium (Nd:YAG; 1064 nm) lasers were used for degranulation, disinfection, de‐epithelialization of the surrounding gingiva, clot stabilization, and photobiomodulation. The primary outcome measure was change in bone density in the extraction area between day 1 and 4 months after extraction. Patients were monitored for potential side effects.

Results

Increase in bone density at the follow‐up CBCT was significantly higher in laser than in control group (p < 0.001). No post‐operative pain, bleeding, or swelling was present in the laser group. In the control group, one patient had bleeding 3–5 days after extraction, two patients had swelling and three patients reported post‐operative pain rated 3–5 on a 0–10 pain scale up to 3 days after extraction.

Conclusions

The proposed laser post‐extraction procedure is a safe and effective method to improve post‐extraction bone healing.

Effects of concomitant use of hydrogen water and photobiomodulation on Parkinson disease: A pilot study

BACKGROUND

Parkinson disease (PD), the second most common neurodegenerative disease, has no cure or applicable disease-modifying approach, only symptomatic therapy. Oxidative stress and mitochondrial dysfunction play key roles in PD pathophysiology. Animal studies have demonstrated that photobiomodulation (PBM) may enhance mitochondrial function and boost adenosine triphosphate production, thus alleviating PD symptoms; however, this process can cause increased reactive oxygen species (ROS) production. Molecular hydrogen (H2) is a potent and possibly therapeutic antioxidant that can mitigate the effect of ROS. PBM targeting the brainstem may facilitate neuronal activity, and the concomitant H2 may clear additional ROS produced by PBM. Therefore, this study aimed to determine the safety and effectiveness of PBM + H2 in patients with PD.

METHODS

We included 18 patients with PD (age 30-80 years) who were at Hoehn and Yahr stages II-III. All the participants received daily PBM + H2 therapy for 2 weeks. The adverse event and the Unified Parkinson Disease Rating Scale (UPDRS) scores were recorded.

RESULTS

We noted that the UPDRS scores began significantly decreasing from the first week, and this improvement persisted until the end of therapy. Moreover, no adverse event was recorded. After 1 week of therapy cessation, UPDRS scores slightly increased but the improvement remained significant compared with the baseline.

CONCLUSION

This novel, proof-of-concept study demonstrated that PBM+H2 therapy is safe and reduces disease severity. A larger-scaled clinical trial is warranted to completely investigate the effects of PBM + H2 therapy on PD.

Dental infection associated with exuberant gingival necrosis in a patient with paroxysmal nocturnal hemoglobinuria: A case report

Paroxysmal nocturnal hemoglobinuria (PNH) is a hematological disorder that affects hematopoietic stem cells. An association with other hematological diseases, such as hemolytic anemia and neutropenia, is observed with a high occurrence of aplastic anemia. The aim of the present study is to report a case of dental infection in a patient with PNH exhibiting exuberant gingival involvement. A 45-year-old male patient sought the Federal University of Ceara reporting severe toothache associated with tooth 24. Clinical examination revealed that the tooth was associated with an apparent fistula and a yellowish lesion with smooth surface located in the palate. The patient had interrupted the medication to control PNH. Blood transfusion was requested due to deficient hematological parameters. Tooth extraction and excisional biopsy were performed under antibiotic coverage. In the postoperative period, low-level laser therapy (LLLT) was performed. Histopathological examination revealed connective tissue showing extensive necrotic areas, accumulation of basophilic material, numerous cyst-like cavities, and degenerated cells. Histopathological findings were compatible with the initial clinical diagnosis of gingival necrosis. The patient evolved with febrile neutropenia, requiring hospitalization for 1 month. Improvement in the overall health was observed after the administration of antibiotics, eculizumab, and weekly LLLT at the biopsy site.