Effect of the Pulsed Electromagnetic Field (PEMF) on Dental Implants Stability: A Randomized Controlled Clinical Trial

Efficacy of Pulsed Electromagnetic Field Therapy for Pain Management After Impacted Mandibular Third Molar Surgery. A Randomized Clinical Trial

BACKGROUND

Postoperative pain and swelling associated with the removal of the third molar (M3) adversely affect the patient's quality of life.

PURPOSE

The study aims to measure pain reduction and analgesic use in patients treated with pulsed electromagnetic field (PEMF) therapy following M3 removal and compares it to patients who did not receive PEMF.

STUDY DESIGN, SETTING, SAMPLE

The single-center study was designed as a randomized, prospective, controlled, double-blinded trial on a sample of patients with impacted mandibular M3 ascertained by x-ray orthopantomography and computed tomography.

PREDICTOR/EXPOSURE/INDEPENDENT VARIABLES

The predictor variable is postoperative pain management. It was assigned randomly to each subject who received either PEMF or standard therapy.

MAIN OUTCOME VARIABLES

The pain was quantified using a 100 mm visual analog scale and the number of analgesics taken. Each subject kept a daily clinical diary for 7 days, recording the amount of pain using the visual analog scale and the number of analgesic tablets taken.

COVARIATES

The study covariates were age, sex, tobacco use, and Pell and Gregory's classification of M3s.

ANALYSES

Student's t test was used, placing the statistical significance for P value < .05. The primary planned analysis was a 2-group, continuity-corrected, χ2 test of equality of proportions.

RESULTS

The study sample included 90 patients, 47 men and 43 women, with an average age of 32.43 ± 8.80 years. PEMF was statistically associated with improved pain reduction (2.08 vs 5.04 with a P value = .0002) and consumption of fewer analgesics than the control group (2.6 vs 5.8 with a P value = .0062).

CONCLUSIONS AND RELEVANCE

The study's results attest to the effectiveness of PEMF therapy in pain control after M3 surgery.

Promising applications of electromagnetic field therapy in dental implantology: A systematic review

Background

Non-ionizing electromagnetic field (EMF) exposure therapies are non-invasive and safe treatment options that can potentially change available treatments. In this review, we examined the applications of such therapies in dental implant surgery by conducting a systematic review.

Methods

A comprehensive search of several international electronic databases was conducted from inception to December 14, 2022. This review included interventional studies that evaluated the advantages of adjunctive magnetic or combined EMFs on dental implants compared to conventional treatments.

Results

From a total of 1695 studies, 12 preclinical and clinical studies were selected, discussing EMF-based treatments for enhancing implant stability, osteogenesis, and osseointegration, as well as alleviating post-implant surgery manifestations. Almost all studies on maxillary and mandibular implant stability showed beneficial effects of non-ionizing EMF in humans. Most studies evaluating osteogenesis and osseointegration indicated that EMF exposure could accelerate bone repair and peri-implant bone formation and increase bone contact ratios, bone volume fraction (bone volume/total volume), trabecular number, and trabecular thickness. Only two clinical studies examined the effect of EMF on pain and swelling after dental implant surgery, with one finding that subjects exposed to EMF used analgesics fewer times and in far lower doses than the control group and the other finding no significant difference in reducing these outcomes between the groups.

Conclusion

Overall, devices that deliver non-ionizing low-level EMF can be a viable and widely recognized non-invasive adjuvant therapy for attaining success and better outcomes after dental implant surgery due to their efficacy, safety, and short exposure time.

A novel nonsurgical therapy for peri-implantitis using focused pulsed electromagnetic field: A pilot randomized double-blind controlled clinical trial

Pulsed electromagnetic field (PEMF) therapy modulates the immune response and is successfully used in orthopedics to treat osteoarthritis and improve bone regeneration. This may suggest that this treatment may consequently reduce peri-implant soft tissue inflammation and marginal bone loss. To compare clinical, radiographic, and immunological results following nonsurgical treatment for peri-implantitis with or without PEMF therapy. Patients with peri-implantitis were included: pocket probing depth (PPD) between 6 and 8 mm with bleeding on probing (BOP); crestal bone loss between 3 and 5 mm. A novel healing abutment that contained active (test) or inactive (control) PEMF was connected. PEMF was administered via the abutment at exposure ratio of 1/500-1/5000, intensity: 0.05-0.5 mT, frequency: 10-50 kHz for 30 days. Nonsurgical mechanical implant surface debridement was performed. Patients were examined at baseline, 1 and 3 months. Clinical assessment included: plaque index, BOP, PPD, recession, and bone crest level which was radiography measured. Samples of peri-implant crevicular fluid were taken to analyze interleukin-1β (IL-1β). Twenty-three patients (34 implants; 19 control, 15 test) were included. At the follow-up, mean crestal bone loss was lower in the test group at 1 and 3 months (2.48 mm vs. 3.73 mm, p < 0.05 and 2.39 vs. 3.37, p < 0.01). IL-1β levels were also lower in the test group at 2 weeks (72.86 pg/mL vs. 111.7, p < 0.05). Within all the limitation of this preliminary study, the test group improved clinical parameters after a short-term period compared to the control group.

The influence of radio frequency-based toothbrush on the accumulation of calculus and periodontal health: A randomized double-blind controlled prospective study

OBJECTIVES

The use of a toothbrush with radio frequency (RF) has shown to be of benefit regarding the reduction of plaque, calculus, and dental staining and improving teeth shade compared to conventional powered and manual toothbrushes.

AIM

To evaluate the efficacy of the RF toothbrush in the reduction of calculus accumulation and its effect on periodontal parameters as well as subject satisfaction as compared to an identical sham-tooth brush.

MATERIALS AND METHODS

Patients who are under a strict maintenance program were included. Patients were allocated to test (RF toothbrush) or control (sham) randomly and were examined at baseline, one and three months. Clinical photos were taken and a consequential calculus assessment via ImageJ software. Clinical assessment included the following: plaque index (PI), bleeding on probing (BOP), probing pocket depth (PPD), and recession (REC). Patient satisfaction was assessed via a questionnaire.

RESULTS

Fifty-eight patients (29 control, 29 test) were included. At baseline mean PPD, BOP, PI, REC, and calculus accumulation were similar between the groups. Mean buccal calculus was lower in the test group at one month 4.0% versus 6.7%, p < .05. Calculus accumulation within the groups was lower in the test group at 1 and 3 months when compared to baseline at the buccal aspect (2.8% vs. 8.9%, p < .05% and 3.8% vs. 8.9%, p < .05) and lingual aspect (6.7% vs. 16.5%, p < .05% and 8.9% vs. 16.5%, p < .05). No statistically significant results were found regarding periodontal parameters PPD, BOP, PI, and REC. No difference was found between groups regarding patient satisfaction.

CONCLUSION

RF seems to have an additive effect on preventing calculus accumulation on the buccal aspect of anterior mandibular teeth at 1 month. Nevertheless, at 3 months, no difference between the toothbrushes is seen regarding calculus formation and maintaining periodontal health (ClinicalTrials.gov, Identifier NCT04640857).

Pulsed Electromagnetic Fields (PEMF)-Physiological Response and Its Potential in Trauma Treatment

Environmental biophysical interactions are recognized to play an essential part in the human biological processes associated with trauma recovery. Many studies over several decades have furthered our understanding of the effects that Pulsed Electromagnetic Fields (PEMF) have on the human body, as well as on cellular and biophysical systems. These investigations have been driven by the observed positive clinical effects of this non-invasive treatment on patients, mainly in orthopedics. Unfortunately, the diversity of the various study setups, with regard to physical parameters, molecular and cellular response, and clinical outcomes, has made it difficult to interpret and evaluate commonalities, which could, in turn, lead to finding an underlying mechanistic understanding of this treatment modality. In this review, we give a birds-eye view of the vast landscape of studies that have been published on PEMF, presenting the reader with a scaffolded summary of relevant literature starting from categorical literature reviews down to individual studies for future research studies and clinical use. We also highlight discrepancies within the many diverse study setups to find common reporting parameters that can lead to a better universal understanding of PEMF effects.

Exposure to 10 Hz Pulsed Magnetic Field Induced Slight Apoptosis and Reactive Oxygen Species in Primary Human Gingival Fibroblasts

Extremely low frequency pulsed magnetic fields (MFs) have been increasingly used as an effective method in oral therapy, but its potential impact on health has not been clarified. In this study, we investigated the impact of 10 Hz pulsed MF exposure on primary human gingival fibroblasts (HGFs) derived from eight healthy persons (four males and four females). Cells were exposed to 10 Hz pulsed MFs at 1.0 mT for 24 h. Cell apoptosis, cell cycle progression, intracellular reactive oxygen species levels, DNA damage, and cell proliferation were determined after exposure. The results showed that 10 Hz pulsed MFs exposure have slight effects on cellular apoptosis, cell cycle progression, and DNA damage in primary HGFs from some but not all samples. In addition, no significant effect was found on cell proliferation. © 2022 Bioelectromagnetics Society.

Biophysical therapy using the pulsating electromagnetic field as adjunctive therapy for implant osseointegration - A review

Development of procedures which accelerate osseointegration of dental implants, reduce the period of healing, and lead to an early rehabilitation of the patient are required for successful oral rehabilitation. Pulsed electromagnetic field (PEMF) is a noninvasive, therapeutic form of low field magnetic stimulation that has been used for healing bone non unions and various fractures. It acts on osteoblasts and bone, affecting their metabolism, therefore, increasing the tissue integration of the implanted devices and their clinical success. A broad range of settings that includes magnetic field intensity, frequency and duration of application, etc. used for PEMFs stimulation is a hurdle to properly define treatment protocols and extensive research is needed to overcome this issue. The present review includes studies that investigated the effects of PEMFs on the response of bone cells to different classes of biomaterials and the reports that focused on in vivo and in vitro investigations of biomaterials implanted in bone. This study is expected to serve as a guide for researchers and clinicians to bring into their clinical use these strategies to improve implant osseointegration in deficient and osteoporotic bone.

Effects of Magnetic Stimulation on Dental Implant Osseointegration: A Scoping Review

This PRISMA-ScR driven scoping review aims to evaluate the influence of magnetic field stimulation on dental implant osseointegration. Seven databases were screened adopting ad-hoc strings. All clinical and preclinical studies analyzing the effects of magnetic fields on dental implant osseointegration were included. From 3124 initial items, on the basis of the eligibility criteria, 33 articles, regarding both Pulsed ElectroMagnetic Fields (PEMF) and Static magnetic Fields from permanent Magnets (SFM) were finally included and critically analyzed. In vitro studies showed a positive effect of PEMF, but contrasting effects of SFM on bone cell proliferation, whereas cell adhesion and osteogenic differentiation were induced by both types of stimulation. In vivo studies showed an increased bone-to-implant contact rate in different animal models and clinical studies revealed positive effects on implant stability, under magnetic stimulation. In conclusion, although positive effects of magnetic exposure on osteogenesis activity and osseointegration emerged, this scoping review highlighted the need for further preclinical and clinical studies. More standardized designs, accurate choice of stimulation parameters, adequate methods of evaluation of the outcomes, greater sample size and longer follow-ups are needed to clearly assess the effect of magnetic fields on dental implant osseointegration.

Effects of Physical Stimulation in the Field of Oral Health

Physical stimulation has been widely used in clinical medicine and healthcare due to its noninvasiveness. The main applications of physical stimulation in the oral cavity include laser, ultrasound, magnetic field, and vibration, which have photothermal, cavitation, magnetocaloric, and mechanical effects, respectively. In addition, the above four stimulations with their unique biological effects, which can play a role at the gene, protein, and cell levels, can provide new methods for the treatment and prevention of common oral diseases. These four physical stimulations have been used as important auxiliary treatment methods in the field of orthodontics, implants, periodontal, dental pulp, maxillofacial surgery, and oral mucosa. This paper systematically describes the application of physical stimulation as a therapeutic method in the field of stomatology to provide guidance for clinicians. In addition, some applications of physical stimulation in specific directions are still at the research stage, and the specific mechanism has not been fully elucidated. To encourage further research on the oral applications of physical stimulation, we elaborate the research results and development history of various physical stimuli in the field of oral health.

Evaluation of pulsed electromagnetic field protocols in implant osseointegration: in vivo and in vitro study

OBJECTIVES

The present study aims to evaluate two protocols of pulsed electromagnetic field (PEMF) on osseointegration and establish one that addresses ideal parameters for its use in dentistry, especially in the optimization of the implants osseointegration process.

MATERIALS AND METHODS

Sixty male rats (Wistar) were allocated into three experimental groups: control (GC), test A (GTA, 3 h exposed), and test B (GTB, 1 h exposed). All animals received titanium implants in both tibias, and PEMF application (15 Hz, ± 1 mT, 5 days/week) occurred only in the test groups. They were euthanized at 03, 07, 21, and 45 days after PEMF therapy. Removal torque, histomorphometric measurements, three-dimensional radiographic evaluation, and in vitro biological assay analyses were performed.

RESULTS

GTB showed better results compared with GTA in removal torque tests, in bone volume and bone mineral density, cell viability, total protein content, and mineralization nodules (p < 0.05). GTA showed better performance in trabecular bone thickness and cell proliferation compared with GTB (p < 0.05), especially at osseointegration early periods. In the histomorphometric analysis and number of trabeculae, there were no differences in the test groups.

CONCLUSION

PEMF as a biostimulator was effective in optimizing the events in bone tissue that lead to osseointegration, especially when applied for a shorter time and in the initial periods of bone healing.

CLINICAL RELEVANCE

The PEMF therapy is an effective alternative method for optimizing bone healing.

Antimicrobial effects of a pulsed electromagnetic field: an in vitro polymicrobial periodontal subgingival biofilm model

The objective was to test the influence of a pulsed electromagnetic field (PEMF) on bacterial biofilm colonization around implants incorporated with healing abutments. Healing abutments with (test group) and without (control group) active PEMF devices were placed in a multispecies biofilm consisting of 31 different bacterial species. The biofilm composition and total bacterial counts (x10⁵) were analyzed by checkerboard DNA-DNA hybridization. After 96 h, the mean level of 7 out of the 31 bacterial species differed significantly between groups, namely Eubacterium nodatum, Fusobacterium nucleatum ssp. nucleatum, Streptococcus intermedius, Streptococcus anginosus, Streptococcus mutans, Fusobacterium nucleatum ssp. Vicentii and Capnocytophaga ochracea were elevated in the control group (p < 0.05). The mean total bacterial counts were lower in the Test group vs the control group (p < 0.05). An electromagnetic healing cap had antimicrobial effects on the bacterial species and can be used to control bacterial colonization around dental implants. Further clinical studies should be conducted to confirm these findings.