The Clinical Evaluation of the Effects of Low-Level Laser Therapy on the Donor and Recipient Sites of the Free Gingival Graft: A Case Series

Effectiveness of Low-Level Laser Therapy in reducing postoperative pain after dental implant surgery: A randomized clinical trial

BACKGROUND

A clinical trial was conducted to measure the effectiveness of a combined wavelength of 660 nm and 808 nm Low-Level Laser Therapy (LLLT) in reducing postoperative pain in partially and totally edentulous patients who underwent dental implant surgery.

MATERIALS AND METHODS

The study included 20 blinded individuals divided in a randomized split-mouth fashion; the experimental group in one hemiarch and the control group in the other hemiarch. The experimental group received a total of 22.5 Joules (J) of LLLT divided into 5 points per implant immediately after surgery. The control group received a placebo treatment. At 24 h, 72 h, and 7 days, a blinded surveyor administered a pain questionnaire using a Numerical Rating Scale (NRS) combined with a Verbal Rating Scale (VRS) to assess pain onset after surgery, duration of the first pain episode, and pain evolution. Group data were analyzed with an ANOVA test for repeated measures and a paired t-test at defined time intervals.

RESULTS

The experimental group showed a significant decrease in postoperative pain at 24 h and at 72 h for fully edentulous patients. There was a non-significant difference in the duration of the first pain episode. The mean pain levels decreased over time for both the experimental and control treatments, but only statistically significantly for the experimental group in the 24-72 h and 24 h to 7 days intervals. The same was true for the control group when comparing 24 and 72 h and between 24 h and 1 week. The time range between 72 h and 1 week showed no statistically significant differences.

CONCLUSION

Within the limitations of this study, a single dose of 22.5 J LLLT per implant helps to decrease postoperative pain in dental implant surgery at 24 h for partially edentulous patients and at 24 and 72 h for fully edentulous patients.

Wound-healing agents for palatal donor area: A network meta-analysis

BACKGROUND

The aim of this systematic review and network meta-analysis (NMA) was to assess the efficacy of different wound-healing agents for palatal donor area management after soft tissue graft harvesting.

METHODS

Electronic searches in six databases were conducted for publications up to October 2023. Studies with data from patients undergoing therapeutic approaches using agents for palatal healing after gingival graft harvesting were included. Data about postoperative pain, wound-healing and postoperative complications reported for each agent were extracted. Three different tools were used for the risk of bias within studies evaluation (Murad tool for case series and case report, RoB 2.0 tool for randomized studies and ROBINS-I tool for non-randomized studies). A Bayesian random effects NMA was conducted for postoperative pain levels and wound healing.

RESULTS

Eighty-four publications were included in the systematic review (qualitative analysis), with 14 of these subjected to NMA (quantitative analysis). The summarized results from the qualitative and quantitative analysis showed that all wound-healing agents evaluated promoted better pain control and wound healing compared to spontaneous healing and hemostatic sponges alone. The NMA outcomes reveal that leucocyte- and platelet-rich fibrin (L-PRF) was the most effective agent in reducing postoperative pain in all analyzed periods. Moreover, the L-PRF seems to accelerate wound healing and reduce postoperative complications compared to other agents.

CONCLUSION

In conclusion, the L-PRF was the most effective agent in reducing postoperative pain, accelerating wound healing and reducing postoperative complications after harvesting soft tissue grafts from the palatal area.

A Comprehensive Review of Evaluating Donor Site Morbidity and Scar Outcomes in Skin Transfer Techniques

This comprehensive review delves into the intricacies of donor site morbidity and scar outcomes in skin transfer techniques central to the field of reconstructive surgery. The review synthesizes existing literature to illuminate the multifaceted factors influencing outcomes by surveying a broad spectrum of grafting methods, from traditional autografts to cutting-edge tissue engineering approaches. Key findings underscore the complex interplay of graft characteristics, surgical techniques, and patient-specific variables. The implications for clinical practice advocate for a nuanced, patient-centered approach, incorporating emerging minimally invasive procedures and adjuvant therapies. The review concludes with recommendations for future research, emphasizing the importance of longitudinal studies, comparative analyses, patient-reported outcomes, advanced imaging techniques, and exploration of tissue engineering innovations. This synthesis advances our understanding of donor site morbidity and scar outcomes. It provides a roadmap for refining clinical protocols, ultimately enhancing the delicate balance between therapeutic efficacy and patient well-being in reconstructive surgery.

Effect of botulinum toxin-A injection applied to the mentalis muscle on free gingival graft operation: A retrospective study

OBJECTIVE

The purpose of this retrospective study was to investigate the effects of Botulinum Toxin-A (BTX-A) injection into the mentalis muscle on the free gingival graft (FGG).

MATERIALS AND METHODS

Forty patients with keratinized gingiva insufficiency and Cairo's RT 2 gingival recession (formerly classified as Miller class III) in their mandibular central incisors were randomly divided into two groups: FGG and FGG + BTX. Plaque index (PI), gingival index (GI), probing pocket depth (PPD), keratinized gingiva width (KGW), attached gingiva width (AGW), clinical attachment level (CAL), gingival thickness (GT), gingival recession amount (GRA), gingival recession width (GRW), and root closure percentage (RCP%) parameters were measured at baseline and at first, third, and sixth months after the operation.

RESULTS

There was no difference in PI, GI, and PPD levels in both groups (p > 0.05). While the change in GT and RCP% levels were found to be statistically significantly higher at FGG + BTX group than FGG group, the change in GRW and CAL levels were statistically significantly lower (p < 0.05).

CONCLUSION

The findings of this study indicate that BTX-A injection applied to the mentalis muscle after FGG operation may have positive effects in terms of KGW, AGW, GT, RCP%, GRW, and CAL parameters.

CLINICAL SIGNIFICANCE

As a result of the fact that BTX-A injection into the mentalis muscle contributed to the nutrition and immobility of FGG, positive developments were obtained in terms of clinical periodontal parameters. BTX-A injection into the mentalis muscle may be an alternative method that increases the success rate of Cairo's RT 2 gingival recession.

Postoperative local interventions for the palate as a gingival graft donor area: a scoping review

OBJECTIVE

This scoping review aimed to systematically identify evidence-based interventions to stimulate healing or protect the harvested palate of patients undergoing gingival grafting.

MATERIAL AND METHODS

The study followed guidelines from the Joanna Briggs Institute and PRISMA-ScR (protocol available at osf.io/zhafn). PubMed, Embase, and seven other databases were searched on November 2022, with additional monitoring until April 2023. The inclusion criteria focused on studies evaluating outcomes related to the donor area (palate) and interventions for healing or protecting it, regardless of publication year and language. Data from the included publications was extracted and presented through narrative text, tables, and figures.

RESULTS

Eighty-one studies (including 64 clinical trials, four case series, five theses, and eight systematic reviews) and 37 clinical trial records were included. The number of studies on this topic has significantly increased, reflecting a growing interest in the field. Thirty-six interventions with published results and 12 interventions with unpublished results from clinical trial registers were identified. Some promising interventions that showed potential for improving patient-reported outcomes include cyanoacrylate adhesive, platelet-rich fibrin (PRF), and the combination of palatal stents and healing agents.

CONCLUSIONS

Thirty-six interventions with published results were identified for postoperative use on the harvested palate, showing varying levels of evidence and conflicting effectiveness for specific outcomes.

CLINICAL RELEVANCE

Postoperative discomfort and pain in the palate are commonly experienced by patients undergoing grafting procedures using this region as the donor area. Awareness of the available options and their levels of evidence is crucial for informed decision-making.

Efficacy of Low-Level Laser Therapy in Wound Healing and Pain Reduction After Gingivectomy: A Systematic Review and Meta-analysis

Introduction: Complete healing of a gingivectomy wound usually takes between one and two months. To speed up this process, different topical medications have been reported. In addition, there are different studies assessing the efficacy of low-level laser therapy (LLLT) in terms of wound healing and pain relief subsequent to gingivectomy, yielding inconsistent outcomes. In the present study, we systematically reviewed the existing evidence in the literature to resolve the given conflicts. Methods: We searched for the studies published from inception to 1 April 2023 in Embase, PubMed, and Scopus databases without language limitation by the use of appropriate keywords. We included randomized or non-randomized clinical trial studies that appraised the efficacy of LLLT in pain reduction and wound healing in adult patients who underwent gingivectomy. We pooled the continuous data concerning the pain visual analogue scale and the healing index extracted from the individual studies to provide a standardized mean difference (SMD) with a 95% confidence interval (CI), using a random-effects model. Results: Out of 188 sources initially captured from the database search, six studies were ultimately included. Regarding wound healing, the LLLT group exhibited a significantly higher mean value of the healing index compared to the control group on days 3 (SMD, 0.93; 95% CI, 0.39 to 1.47) and 7 (SMD, 1.03; 95% CI, 0.49 to 1.57) post-surgery. Also, significant differences were noted in the postoperative pain reduction between the two groups on days 3 (SMD, -2.00; 95% CI, -2.48 to -1.51) and 7 (SMD, -2.44; 95% CI, -4.66 to -0.22) post-surgery. Conclusion: According to the present systematic review, LLLT could potentially be an efficient adjunctive treatment after gingivectomy for wound healing acceleration and patient pain alleviation.

Clinical Evaluation of Bilateral Multiple Gingival Recession Treatment with Autogenous Connective Tissue Graft Associated with Low-Level Laser Therapy

BACKGROUND

Gingival recession (GR) is described as an apical displacement of the gingival margin in relation to the cementoenamel junction, exposing the root surface to the oral cavity environment. This study aimed to evaluate the clinical results of a bilateral root coverage (RC) of GR associated with an autogenous connective tissue graft (aCTG) alone or combined with low-level laser therapy (aCTG + LLLT).

METHODS

This cross-sectional, split-mouth, double-blind, clinical pilot study featured three individuals who attended a periodontics post-graduate program with the main complaint of GR and dental hypersensitivity (DHS). Of these, only one patient met the inclusion criteria and the parameters evaluated were: DHS, the keratinized tissue's thickness and width clinical attachment level (CAL), probing on depth (PD), and bilateral GR based on Cairo RT I. The patient was evaluated by a first clinical evaluator and the treatment was randomly divided into two groups, G1: aCTG only (control group, n = 3 teeth per side) and G2: aCTG + LLLT (test group, n = 3 teeth per side). LLLT used a diode laser (660 nm) with a dose of 3 J/cm² per point and 4 s per point was applied in four different periods, preoperatively; transoperatively and immediately postoperatively, the application was performed in three points (eight applications) on alternate days for 7 days and a 90-day follow-up was performed for clinical evaluations of the periodontal parameters and the collected data were analyzed by Kruskal-Wallis and Dunn tests.

RESULTS

the RC mean percentage was <95% in both groups after 90 days. Comparing treatment sides, G1 (n = 3/3, 100%) had a higher prevalence of RC than G2 had (n = 3/3, 95%). DHS significantly decreased after 90 days in both groups. Both groups showed an improvement in the other periodontal parameters evaluated during the short-term follow-up; mainly, PD had a statistically significant (p ˂ 0.05) increase after 90 days and a CAL decrease during this period; KTW and KTT also had a significant increase in both groups (p ˂ 0.05).

CONCLUSIONS

the results indicated that aCTG + LLLT might have an additional benefit to GR root coverage within the evaluated time and this section also includes the within-study limitations.

Physiological reaction of anxious patients taking sedative medications before and after periodontal surgery

Background/purpose

Clinicians use sedatives for anxiety patients at times in daily practice, but the direct influence of the medication on the wound healing of periodontal tissues is unknown. The aim of this study was to analyze the influence of the short-term administration of diazepam to patients with dental anxiety undergoing free gingival graft (FGG) procedures.

Materials and methods

A total of 51 FGG procedures in 39 patients were included. Twenty-six anxious patients medicated with 5 mg of diazepam from the night before surgery to 7 days after surgery served as the medication group, and the rest served as the control group. Direct examination, photographs and H₂O₂ were used to evaluate the healing of palatal wounds. Stress levels and sleep quality, and salivary melatonin levels were assessed.

Results

On Day 14, complete epithelization of the wounds was noted in 48.39% of the patients in the medication group and 35.29% of the patients in the control group. Regardless of whether they receive medication or not, groups with complete epithelialization by Day 14 had higher levels of preoperative melatonin than those without, with a P value of 0.02. The postoperative melatonin in the medication group tended to present higher levels than the control group.

Conclusion

Higher preoperative melatonin levels can accelerate wound healing. The short-term administration of the diazepam seemed to facilitate palatal wound healing by reducing stress and maintaining postoperative melatonin levels. This is the first time the relationships between sedatives, melatonin levels and palatal wound healing has been reported.

Low-level laser therapy is effective in controlling postoperative pain in lower third molar extractions: a systematic review and meta-analysis

This systematic review aimed to evaluate the effectiveness of low-level laser therapy in controlling postoperative pain in lower third molar extractions. A search was carried out in MEDLINE/PubMed, Web of Science and Cochrane Library (CENTRAL) databases, using the "low-level laser therapy", "photobiomodulation therapy", "impacted mandibular third molar", "mandibular third molar", "third molar extraction" descriptors and 2625 studies were found, including only randomized clinical trials published until July 2020, with no restrictions on language and country of study. Selected studies were submitted to initial screening based on the reading of titles, abstracts and full article, and duplicate studies were excluded. Overall, 2562 articles were found, of which only 15 randomized clinical trials were included in this review. A total of 648 patients (16-44 years) who received low-level laser therapy as an intervention and placebo in their control group were evaluated. The pain evaluation criterion was the Visual Analog Scale (VAS) on the second and seventh days after surgery. Photobiomodulation with low-level laser showed statistically significant reduction in postoperative pain in lower third molar extractions, both on the second (MD: - 0.59; CI: - 0.92, - 0.27) and seventh day after surgery (MD: - 0.76; CI: - 1.21, - 0.32).

Clinical Outcomes of Free Gingival Graft Following Recipient Bed Preparation with Er,Cr:YSGG Laser Versus Scalpel: A Split-Mouth Randomized Clinical Trial

Objective: Free gingival graft (FGG) procedure is accompanied with a considerable rate of graft shrinkage. This study was aimed to assess the dimensional changes of FGG after recipient site preparation with Er,Cr:YSGG laser and surgical scalpel. Materials and methods: This split-mouth randomized clinical trial evaluated 11 patients with bilateral lack of keratinized gingiva in mandibular premolars. The test side in each patient was prepared with Er,Cr:YSGG laser (3 W power, 300 mJ energy, 10 Hz frequency, long-pulsed mode), whereas the control side was prepared by surgical scalpel. All FGGs were harvested from the palate with standard dimensions of 14 × 9 mm. The graft width, length, surface area, and shrinkage and color match were measured after 1, 3, and 6 months. Postoperative complications, including pain and bleeding were also evaluated using a questionnaire. Results: In both groups, the surface area and width of graft significantly decreased at all time points compared with baseline but the difference in this respect was not significant between the two groups (p > 0.05). In both groups, maximum shrinkage occurred within the first 3 months. In control group, the surface shrinkage in 3 months was significantly greater than the first month (p = 0.025) without significant difference between groups (p = 0.79). The two groups were not significantly different regarding pain score and bleeding score either. On the day of surgery, the test group had slightly lower pain score and higher bleeding score in comparison to the control group without significant difference. The pain and bleeding scores reduced in both groups with no significant difference (p > 0.05). Conclusions: Er,Cr:YSGG laser has promising results for preparation of FGG recipient site and yields results comparable to those of surgical scalpel.