Effect of Laser Therapy on the Osseointegration of Immediately Loaded Dental Implants in Patients under Vitamin C, Omega-3 and Calcium Therapy

Comparative efficacy of photobiomodulation on osseointegration in dental implants: A systematic review and meta-analysis

AIM

This study aimed to assess the effectiveness of photobiomodulation therapy (PBM) in enhancing bone integration with dental implants.

METHOD

PubMed, ScienceDirect, the Cochrane Library, Scopus, and Google Scholar were searched. Studies assessing PBM effectiveness with defined intervention/control groups were included, while those lacking specified laser types, involving severe maxillofacial defects or surgery, and not reporting outcomes related to dental implant osseointegration post-PBM therapy were excluded. The studies' risk of bias was assessed using Robvis for randomized controlled trials (RCTs) and ROBINS-I for non-RCTs. The meta-analysis was conducted utilizing a random-effects model at a significance level of 0.01.

RESULTS

The study reviewed 26 papers involving 571 patients undergoing dental implant procedures with PBM/Low-Level Laser Therapy (LLLT) or placebo/control. Implant stability quotients (ISQ) analysis showed a non-significant difference (p = 0.06, mean difference: 1.02, 95 % CI: 0.28 to 1.75, I2=28 %), while the Periotest method indicated significant improvement in stability (p < 0.01, mean difference: -0.51, 95 % CI: -0.78 to -0.24, I2=71 %). PBM resulted in a significant bone density increase (p < 0.01, mean difference: 26, 95 % CI: 6.93 to 45.06, I2=91 %), but marginal bone loss showed no significant difference (p = 0.11, mean difference: 0.00, 95 % CI: -0.06 to 0.05, I2=45 %). Implant survival rate did not significantly differ (p = 0.73, mean difference: 1.56, 95 % CI: 0.38 to 6.46, I2=0 %). Most studies raised concerns regarding randomization.

CONCLUSION

PBM could improve implant stability, as assessed with Periotest, and increase bone density, enhancing osseointegration. However, implant stability assessed with ISQ, marginal bone loss, and implant survival rate were comparable between the study groups.

Effect of photobiomodulation therapy of overprepared dental implant bed on torque removal and implant stability quotient: an experimental study in sheep

BACKGROUND

Primary stability of dental implant is an important prerequisite for achieving osseointegration. This study was conducted to evaluate the effects of photobiomodulation therapy on bone formation-around implants by measuring the implant removal torque and implant stability quotient.

METHODS

This study was conducted in six adult male sheep. Four implants were placed on each side of the lower border of the mandible. The implant beds were prepared to a size of 10 mm in length and 4.8 mm in width, to receive an implant of 8 mm in length and 4 mm in width. Laser application to the socket was performed just before implant placement, and was immediately administered to the surface of the implant and the peri-implant bone before suturing of the wound. The therapy was continued twice daily for the next seven consecutive days. The animals were sacrificed at 4, 8, and 12 weeks, with two animals per time point. The implant-removal torque was determined with an electronic wrench, and the implant stability quotient (ISQ) was assessed with an Ostell device.

RESULTS

The laser treated sides showed significantly higher removal torque and ISQ, at the three-time points (P<0.05). At 4 weeks, the ISQ was 61.44 (±10.4) in the laser group and 48.2 (±16.7) in the control group. At 8 weeks, the ISQ increased to 62.2 (±5.5) in the laser group and 56.1 (±4.3) in the control group. At 12 weeks, the ISQ was 67 (±4.5) in the laser group and 61.875 (±6.3) in the control group. The removal torque at 4 weeks was 218.6 (±62.6) in the laser group and 147.6 (±40.9) in the control group. At 8 weeks, the removal torque increased to 370.5 (±33.3) in the laser group and 250.2 (±25.0) in the control group. At 12 weeks, the removal torque increased to 912.6 (±177.2) in the laser group and 512.1 (±122.6) in the control group.

CONCLUSIONS

Photobiomodulation enhances bone formation and improves implant stability in implants with overzealously prepared oversized implant beds.

The effect of Rutin hydrate on Glucocorticoids induced osteoporosis in mandibular alveolar bone in Albino rats (Radiological, histological and histochemical study)

Background

Glucocorticoids are used in different conditions such as autoimmune disorders and organ transplantation and their administration is the most common cause of secondary osteoporosis. Rutin is a flavonoid found in many plants. Flavonoids are natural products with various therapeutic and biological effects.

Objective

Is to investigate the effect of Rutin Hydrate as a form of Rutin on glucocorticoid induced osteoporosis in mandibular alveolar bone radiologically, histologically and histochemically.

Methods

Twenty-one adult male Albino rats were randomly divided into three groups. Group I (control), group II (osteoporotic) and group III (Rutin Hydrate treated). In both group II and III rats received 21 mg/kg of methylprednisolone daily for four weeks. Then group III received 50 mg/kg of rutin hydrate in distilled water daily for another four weeks. At the end of the experiment, mandibles were dissected for radiographic assessment, then processed for histological and histochemical examination and statistical analysis.

Results

Radiologically, administration of Rutin Hydrate was able to enhance bone density than osteoporotic group. Histological examination revealed preserved cortical bone thickness that had been statistically proved. Apparently normal sized marrow cavities, some plump osteoblasts and normal osteocytes were seen in group III. Histochemical examination showed statistical increase in the area percentage of newly formed collagen in group III than group II.

Conclusions

Rutin Hydrate was able to modify the radiological and histological picture of osteoporotic alveolar bone. This was achieved by the ability of Rutin Hydrate to increase bone density, preserve cortical plates thickness and enhance new collagen formation that was proved histochemically.

Effect of Light-Emitting Diode Phototherapy on Allograft Bone After Open Sinus Lift Surgery: A Randomized Clinical Trial (Concurrent Parallel)

Introduction: Phototherapy with a light-emitting diode (LED) is used in medicine due to its potential bio-stimulatory effects on the human body. However, controversy still exists regarding the efficacy of low-level laser therapy (LLLT) and phototherapy with LED. This in vivo study aimed to quantitatively and qualitatively assess the newly formed bone following LED phototherapy of the human maxillary sinuses. Methods: This randomized clinical trial (concurrent parallel) was conducted on 44 patients in two groups (n=22) at the Implant Department of Tehran University of Medical Sciences. Randomization was done by a random sequence generator program. The inclusion criteria were absence of chronic sinusitis and chronic bone marrow conditions, no history of surgery at the site, absence of diabetes mellitus, no history of chemotherapy or radiotherapy, maxillary premolar edentulism, and signing informed consent forms. Group A underwent LED phototherapy with 620 ± 2 nm wavelength for 20 minutes daily for a total of 21 days after sinus lift surgery. Group B served as the control group and did not receive phototherapy. After 6 months, the grafted sites were re-opened for implant placement, and bone biopsy samples were obtained using a trephine bur. The samples were stained with hematoxylin and eosin and inspected under a light microscope. The results were statistically analyzed using the Mann-Whitney U test. Both the surgeon and pathologist were blinded to the group allocation of patients. Results: Forty tissue specimens were analyzed. Insignificant differences existed between the two groups in terms of the degree of inflammation, bone quality, and maturity of collagen. Histological analyses revealed no significant difference in the mineralized areas of bone between the two groups (P >0.05). Conclusion: The results indicated that LED phototherapy cannot significantly enhance osteogenesis after sinus lift surgery. No side effects were observed in the experimental group.

Radiographic analysis of the management of tooth extractions in head and neck-irradiated patients: a case series

Tooth extraction after head and neck radiotherapy exposes patients to an increased risk for osteoradionecrosis of the jaw. This study reports the results of a radiographic analysis of bone neoformation after tooth extraction in a case series of patients who underwent radiation therapy. No patients developed osteoradionecrosis within a follow-up of 1 year. Complete mucosal repair was observed 30 days after surgery, while no sign of bone formation was observed 2 months after the dental extractions. Pixel intensity and fractal dimension image analyses only showed significant bone formation 12 months after the tooth extractions. These surgical procedures must follow a strict protocol that includes antibiotic prophylaxis and therapy and complete wound closure, since bone formation at the alveolar socket occurs at a slower pace in patients who have undergone head and neck radiotherapy.

Clinical Efficacy of Photobiomodulation on Dental Implant Osseointegration: A Systematic Review

Background:

Photobiomodulation (PBM) has been shown to have a positive effect on dental implant osseointegration and stability in in vitro and animal studies; however, its usefulness in dental implant clinical practice is yet unclear.

Objective:

The objective was to assess the clinical effectiveness of PBM on dental implants’ osseointegration.

Methods:

Two reviewers independently conducted a comprehensive electronic search of articles published from inception up to January 10, 2020, in PubMed, Cochrane Library and Embase databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Randomized clinical trials (RCTs) and nonrandomized clinical studies that compared the effect of PBM on dental implant stability with control groups were included. Animals and in vitro studies studies as well as studies with confounders such as application of orthodontic were excluded. Risk of bias (using Cochrane Risk of Bias tool for RCTs and Risk of Bias in Non-Randomized Studies of Interventions tool for nonrandomized studies) was assessed by both authors. Owing to substantial heterogeneity, only a narrative synthesis of the included studies is presented.

Results:

Seven relevant clinical studies were included, and they used a variety of PBM parameters and devices. The posterior region of the jaw was found to be more frequently evaluated. For assessing the effect of PBM on implant stability, five studies used resonance frequency analysis and two used periotest; three studies additionally used biomarkers for assessment. Four studies found that PBM has a potential positive effect on the outcome of dental implant stability, whereas three studies reported that PBM has no effect on implant stability.

Conclusion:

The findings of this systematic review suggest that postoperative application of PBM may potentially have some positive effect on dental implant’s osseointegration and stability. However, additional studies are required with uniformity in methods to provide a more robust assessment of this effect.

Effect of Low-Level Laser on Some Metals Related to Redox State and Histological Alterations in the Liver and Kidney of Irradiated Rats

Low-level laser therapy (LLLT) is a type of medicine that uses laser light at low levels to activate the cellular chromophores and the initiation of cellular signaling. This study aimed to evaluate the photomodulation effect of LLL against ionizing radiation (IR)-induced metal disorders related to redox state in the liver and kidney of male rats. Rats were divided into 4 groups (control, LLLT, IR (7Gy), IR+LLLT). The results showed that LLLT 870 nm one time for 3 days post-irradiation revealed redistribution of iron (Fe), copper (Cu), zinc (Zn),calcium (Ca), magnesium (Mg), manganese (Mn), and selenium (Se) in the liver and kidney tissues. Moreover, LLLT attenuated the oxidative stress manifested by a marked reduction of hydrogen peroxide (H₂O₂), 4-hydroxynonenal (4-HNE), total oxidant state (TOS), and oxidative stress index (OSI) associated with a significant increase in total antioxidant status (TAS), glutathione (GSH) content, and glutathione peroxide (GPx), glutathione reductase (GRx), superoxide dismutase(SOD), and catalase (CAT) activities. Moreover, LLLT displayed an increase in glutathione-S-transferase (GSH-T) and ceruloplasmin activities and a decrease in the activity of gamma-glutamyl transferase (γ-GT). Besides, LLLT significantly attenuated the histological changes in the liver and kidney tissues, denoted by a reduction in the necrotic and degenerative changes of hepatocytes and an improvement in the corpuscles and tubules of the kidney. In conclusion, LLLT could be used as an adjuvant treatment post-exposure to radiation, while it is not beneficial to use it on the normal tissue.

Photobiomodulation in Periodontology and Implant Dentistry: Part 2

(Part 1 of this article can be located at www.liebertpub.com/doi/10.1089/photob.2019.4710.) Objective: Finding evidence-based treatment strategies for low-level light therapy and the correct incorporation of these treatment methods in the clinical practice of periodontics. Background: Photobiomodulation has been shown to have biostimulatory, anti-inflammatory, and analgesic effects that can be beneficial in periodontal and dental implant treatment procedures. Methods: In this review, we have addressed some clinical questions regarding the potential clinical application of low-level light irradiation and its photobobiomodulatory effects in periodontology and implantology. The literature was searched for in vivo (animal or clinical) articles written in English in four electronic databases of PubMed, Scopus, Google Scholar, and Cochrane Library until April 2019. Only studies with low irradiation doses without any thermal effects used only for their photobiomodulatory purposes were included. Results: We were able to find relevant studies for all of our questions, and positive effects for the application of light therapy were reported in most of the studies. However, there is still a great deal of heterogeneity in terms of study designs and most importantly in light irradiation devices and the parameters used. Due to this issue, it was not possible to reach specific evidence-based irradiation protocols for the questions addressed in this review. Conclusions: Based on our search results, an obvious positive effect of low-level light therapy on stimulation of healing of periodontal soft and hard tissues and reduction of inflammation can be seen. Future well-designed randomized control studies with the same irradiation settings and systematic reviews evaluating the studies found on the questions mentioned are necessary to reach evidence-based recommendations.

Effect of Combined Application of Growth Factors and Diode Laser Bio-Stimulation on the Osseo Integration of Dental Implants

BACKGROUND:

The success of implants is associated first with their osseointegration, and later on with their survival rate. In recent years, many efforts have been exerted to develop implant design, geometry, materials and techniques to enhance the osseointegration process and also to increase the success rate of implant procedures. New techniques, like leukocyte and platelet-rich fibrin (L-PRF) and low-level laser treatment (LLLT), have been developed to enhance the osseointegration around dental implants.

AIM:

This study aims at accelerating bone osseointegration process around dental implant using new techniques to increase the success rate, to allow immediate or early loading of a dental implant, and to make a comparison between the various new techniques in dental implant procedures to figure out which technique will achieve the best results.

METHODS:

The study was conducted on a random sample of 40 male patients. Dental implants were placed in the posterior areas of the lower jaw. Patients were divided randomly into 4 groups; control group, LLLT group, L-PRF group and L-PRF plus LLLT group. They were assessed using cone-beam computed tomography (CBCT).

RESULTS:

The results showed significant differences between all groups over different measured times. All the groups showed improvement in comparison with Normal group, where L-PRF group showed the best result followed by (L-PRF+LLLT) group, while the LLLT group showed the least improvement in comparison with bothL-PRF group and (L-PRF+LLLT) group.

CONCLUSION:

The study demonstrates that L-PRF gives a better performance in the osseointegration around dental implants than LLLT.

Clinical evidence of photobiomodulation therapy (PBMT) on implant stability and success: a systematic review and meta-analysis

Background

Photobiomodulation therapy (PBMT), a type of light therapy that uses the concept of photobiomodulation, is developed to promote bone healing. Clinical studies have been conducted to assess the influence of PBMT on dental implant stability and success rate. This is the first systematic review and meta-analysis to assess the effect of PBMT and methodological quality of these studies on implants in human clinical trials.

Methods

An electronic search was performed in Pubmed, Embase, and the Cochrane Controlled Register of Trials (CENTRAL).

Results

Initially, 675 articles were identified, among which only 8 met the inclusion criteria. Four of the 8 studies presented a low risk of bias, whereas the other 4 were of moderate risk. Our review focused on implant success rates and implant stability measured at days 0 and 10, and at 3, 4, 6, and 12 weeks. No significant differences were observed between the PBMT group and the control group regarding implant stability or success rate.

Conclusions

The existing clinical studies did not provide sufficient evidence to observe positive effects of PBMT on implants in patients. An increased number of high-quality clinical randomized controlled trials (RCTs) are required to verify the data and to draw convincing conclusions.