Journal of Lasers in Medical Sciences

Introduction: One of the major complains after surgery is pain. Recent advances in the prevention and reduction of postoperative pain have provided several modalities. One of them is the use of laser irradiation on the surgical area.
Objectives: To evaluate the effects of low level laser therapy (LLLT) on pain and side effects after surgery.
Methods: In this research, databases such as: PubMed, Science Direct, Google Scholar, Springer and Cochrane were used and the words of laser therapy, photobiomodulation, therapeutic laser, low level laser therapy, surgery and pain were searched. Articles, including systematic reviews, original articles, case series, and clinical intervention studies related to these words, were studied. The language of all articles was English and consists of papers from 2009 until 2017.
Results: A total of 370 papers were studied and 10 articles that met inclusion criteria were selected for this review. Few of these articles were followed up. Surgery included a wide range of surgeries including mastectomy, breast augment post-fracture, episiotomy, tonsillectomy and hernia. The methodological quality score on the PEDro scale was between 5 and 11. 8 trials reported positive effects and 2 trials reported negative effects. In order to study clinical effect size of laser therapy after surgery, only 4 papers met entry criteria and the mean effect sizes were 0.13 to 2.77. Accordingly, the best treatment protocol included a red laser dose of 4 J/cm2 for the post-operative pain of tonsillectomy, which was irradiated through the infra mandibular angle on the tonsils.
Conclusion: LLLT may be an appropriate modality for reducing pain after surgery, nevertheless the effect size of this modality is variable. Therefore, further research based on proper protocols for these patients and follow-up of therapeutic course should be designed and implemented.

Introduction: All-ceramic restorations are being widely used due to its various advantages. However, they have restricted durability and may have to be removed. The conventional procedure for removal is grinding the restoration with rotary instruments which are considered time-consuming and inconvenient. A newer advantageous method is the application of lasers for debonding ceramics from the tooth surface. The objective of this study is to provide a comprehensive literature review on laser-aided ceramic restorations debonding.
Methods: We searched PubMed and Google Scholar databases. Seven articles from 2011 to 2018 were identified. Studies were assessed for the efficacy of laser application and the amount of pulpal temperature rise.
Results: Studies selected were categorized according to variables including shear bond strength, debonding time and intrapulpal temperature. Oztoprak and Iseri investigated that erbium-doped yttrium, aluminum, and garnet (Er:YAG) laser application reduced shear bond strength of ceramic laminate veneers. The time of debonding took an average of 190 seconds in Rechmann’s study and 106 seconds in Morford’s study. One of the main issues while using the laser is thermal irritation of the pulp. A 5.5°C temperature increase may cause pulpal damage according to Zach and Cohen. Philips et al and Rechmann et al reported no intrapulpal harm due to temperature increase. Additionally, Phillips et al demonstrated that the laser setting affects both the debonding time and the temperature alterations and that a laser adjustment of 2.5 W/25 Hz would be the best safest group.
Conclusion: Removal of ceramic crowns and veneers from tooth surfaces can be successfully done by Er:YAG laser application in a less time-consuming procedure and without any harm to the underlying dentin. However, a temperature rise in the pulp may occur which could be overcome by adequate air water cooling.

Introduction: The abnormal maxillary labial frenum is common in children during the primary or mixed dentition stage. A conventional surgery for this abnormality usually requires infiltration anesthesia which leads to fear in children and consequent noncooperation during the surgery. The aim of present study was to evaluate the reduction in the need of infiltration anesthesia, intraoperative bleeding control and postoperative pain and wound healing in children when using the diode laser for abnormal labial frenum in the maxilla.
Methods: The present study was carried out among 30 children attending the Hanoi Medical University, Vietnam. A Diode Laser with 810 nm wavelength and power of 0.8 W was used for frenectomy.
Results: The proportion of procedures without any need of infiltration anesthesia was 70%, while 93.34% of children demonstrated positive and very positive behavior. Proportion of indolence on the first day after surgery was 83.3%. While 83.3% of children did not take any analgesics, not a single child complained of any pain 3 days after surgery.
Conclusion: Our results indicated that the use of diode laser showed several benefits in maxillary labial frenectomy in children. These included reducing the need of infiltration anesthesia, increasing the children’s cooperation as well as decreasing the postoperative pain.

 Introduction: Laser hair removal needs an accurate understanding of tissue structure and chromophores content in order to optimize the selection of laser irradiation parameters. None of the optimized laser therapy might lead to side effects in skin tissue such as severe erythema, burn, scar etc. Therefore, guidance by a noninvasive real-time diagnostic method like optical spectroscopy technique is beneficial. The purpose of this survey is to analysis the skin hemoglobin spectrum quantitatively before and after hair removal laser irradiation to minimize the side effects of the procedure.

Methods: To carry out a spectroscopy study, a halogen-tungsten light source was used in the wavelength region of 400-700 nm on an ocean optic device. The measurements were made on the facial area under identical conditions. Total 19 volunteers for laser hair removal by gentle laser Candela, ranging 14- 49 years old, were included in the study. A total of 18 spectra were taken from each person, 9 spectra before hair removal as a reference and 9 subsequent spectra. Colorimetry was done for all acquired before and after spectrums using Origin software (version 8.6). Then, the erythema index derived for each spectrum. Statistical analysis of correlation and normalization in colorimetry data were done using data analysis by SPSS (version 16).

Results: Spectra analysis, before and after optical reflectance spectrums in laser hair removal procedure, revealed the subpeak derivation, and concentration on special visible wavelength 510-610 nm. We studied the changes of skin chromophores absorption. The derived erythema index [E] and colorimetry parameters a*, b*, l* were compared and correlated statistically. There was a statistically considerable direct linear correlation between a* and E while inverse linear correlation was observed for l* and E and no correlation for b* and E.

Conclusion: Diffuse reflectance spectroscopy showed its potency as an accurate, noninvasive real-time as complementary method for laser treatment to detect erythema as a complication of the method, in order to optimize the parameters based on the tissue characteristics in various candidates.

Introduction: Many valid option modalities are available for the management of urethral stricture disease (USD), such as internal urethrotomy which has the success rates of 33%–60%. The aim of this study was to assess the outcome of holmium: YAG (Ho: YAG) laser urethrotomy (HLU).
Methods: One hundred thirty-eight patients with urethral stricture with the mean age of 48±3.03 years old treated by HLU from March 2011 to August 2017. The main purpose of this investigation was to evaluate mean operation time, stricture recurrence rate and post-operation Qmax and complications of transurethral HLU.
Results: The most common cause of USD was trauma in 82 (59.4%) patients. Mean laser operation time, mean hospital stay and mean postoperative duration of catheterization were 23.08 ± 9.1 minutes, 19.02 ± 10.7 hours and 10.3 ± 1.05 days respectively. The mean Qmax was 8.3 ± 2.07 mL/s before surgery and 16 ±3.1 mL/s afterward. At the end of 12 months follow-up, a total of 37 (26.8%) patients developed recurrence of the stricture. Patients with posterior, longer urethral strictures and previous history of interventions have more recurrence rate of the stricture.
Conclusion: HLU is minimally invasive and seems to be an effective and safe management option for primary, short, urethral strictures. The hospital stay is remarkably short and complications are negligible.

Introduction: This study aimed to evaluate the child’s salivary cortisol levels, clinical performance and marginal adaptation of restorations after selective removal of necrotic dentin in primary teeth using Er: YAG laser irradiation.
Methods: A double-blind clinical study was performed in children at 7-10 years. Children who had at least 2 teeth with carious lesions involving the occlusal and proximal surfaces of primary molars counterparts were selected. Removal of necrotic dentin was performed by 2 methods: Er: YAG laser irradiation and bur-preparation. Cortisol levels (n = 24) was evaluated by ELISA. Clinical analysis (n = 20) was performed after the restorations polish, 6 and 12 months after restorative procedure using United States Public Health Service (USPHS) method and photographs. Scanning electron microscopy (SEM) was used to analyz the marginal gap formation (n = 20). The analysis of the data was performed by 95% confidence interval, Shapiro-Wilk test, Friedman and Wilcoxon post hoc tests (α = 5%).
Results: Cortisol levels were higher during selective removal of necrotic dentin, regardless of the method used (P > 0.05). After 12 months, there was no evidence of the difference in the restorations performed on cavities prepared by both methods. SEM analysis revealed that the laser-irradiated teeth showed 10% of gaps in the full extent of restoration. For bur-prepared teeth, 20% of gaps were found at the cavosurface margin.
Conclusion: The salivary cortisol levels on children that received Er: YAG laser irradiation for removal the necrotic dentin was similar to the control group. Class II restorations evaluated after 1 year period did not suffer interference by the use of Er: YAG laser irradiation.

Introduction: In non-vital tooth bleaching, dentin is in direct contact with the bleaching agent, 1 to 3-week delay is needed to eliminate free radicals from tooth structure. The present study aimed to evaluate the effect of irradiation of Er: YAG laser on immediate microtensile bond strength of bleached dentin to composite.
Methods: Sixty sounds human teeth were collected and randomly divided into 4 groups (n = 15): no bleaching (NB), opalescence endo hydrogen peroxide (HP) gel bleaching, sodium perborate (SP) bleaching and laser bleaching with heydent gel (LB). The groups were divided into 3 subgroups (n = 5): no surface treatment, Er: YAG laser irradiation and 10% sodium ascorbate (SA). All samples were restored and underwent microtensile bond strength testing. Statistical analysis was carried out using one-way and two-way ANOVA.
Results: Bond strength in NB-SA group had a significant difference with the NB group (P < 0.05) while no significant difference was noted between NB and NB-Er groups (P = 0.55). Application of SA and Er: YAG laser after bleaching with SP did not enhance the bond strength (P = 0.07).
Conclusion: Application of SA and Er: YAG laser after HP gel bleaching significantly enhanced the bond strength. Application of Er: YAG laser after internal bleaching with HP gel could enhance the bond strength.

Introduction: Oral mucositis (OM) is an unavoidable condition of the oral cavity that accompanies chemotherapy for various malignant cases. Chemotherapy-induced oral Mucositis (COM) is a frequent complication due to mucotoxic drugs and is known to deteriorate the general health significantly, while negatively affecting the quality of life (QOL). Studies have reported that low-level laser therapy (LLLT) promotes the tissue healing. The objective of the present study was to explore the efficacy of gallium-arsenide (GaAs) laser in treating COM and its impact on inflammatory cytokine levels in patients receiving chemotherapy for various malignancies.
Methods: A total of 80 patients with COM received LLLT 6 days/week. OM was graded according to the World Health Organization (WHO) grading scale. The outcome parameters were the serum levels of tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) measured before, during and after administration of LLLT.
Results: After LLLT, a significant decrease was found in the mean values of mucositis grade from 2.35 ± 0.695 to 1.13 ± 0.333 after (P < 0.001). A significant reduction in the level of TNF-α was found after LLLT among breast cancer patients (P = 0.0045), but not in head and neck cancer and lymphoma patients. A significant reduction was also found in IL-6 level after treatment among head and neck and breast cancer patients (P = 0.0307 and 0.019, respectively).
Conclusion: The use of GaAs LLLT in treating COM in patients with various malignancies is well tolerated by patients, it results in improvement of mucositis, however; mechanism of action does not seem to be completely linked to the change of pro or anti-inflammatory cytokines.

Introduction: Gingival hyperpigmentation is excessive deposition of melanin pigments in the epithelium of gingiva which affects facial esthetics. Various surgical methods for gingival depigmentation have been used to treat the darkened color of pigmented gingiva. This study compared the use of 940 nm diode laser and liquid nitrogen cryosurgery in the treatment of gingival physiologic hyperpigmentation in terms of gingival depigmentation, postoperative pain, healing duration, pigmentation recurrence, and patients’ satisfaction.

Methods: Fifteen systemically healthy patients (11 females and 4 males; 17-35 years of age) with bilateral gingival physiologic hyperpigmentation were enrolled in this split-mouth randomized study. Maxillary anterior labial gingiva of each patient was divided into left and right halves, and each half was randomly depigmented by either laser or cryosurgery. Patients were given questionnaires to evaluate the procedures and were followed up in 3, 7, 10, 17 and 21 days postoperatively for the assessment of gingival healing and 1, 3, 6 and 12 months after the treatments to detect any sign of pigmentation recurrence.

Results: The severity of post-op pain measured by visual analogue scale (VAS) was mild to average and showed no significant difference between the 2 modalities (P > 0.05). There was no considerable swelling or hemorrhage after the treatment procedures and the healing duration was significantly shorter in laser (P < 0.05). The degree of pigmentation in all gingival sites treated by laser reached and remained at zero until the last follow up (1 year) and reached zero in 9 out of 15 cryosurgery-treated sites. All patients were completely satisfied with the laser, and 9 out of 15 were completely satisfied with cryosurgery. No pigmentation recurrence was observed during any follow-up periods.

Conclusion: Removal of gingival physiologic hyperpigmentation by laser therapy and cryotherapy was effective and safe. The efficiency of the laser was better than cryotherapy.

Introduction: To date, no novel treatment approach is available for optimum outcomes regarding refractory periodontitis. The aim of the present study was to assess the efficiency of photodynamic therapy (PDT) in treating patients diagnosed with refractory periodontitis and compare the clinical and biological outcomes of conventional periodontal treatment with or without adjunctive PDT in these patients, by assessing clinical parameters (plaque index [PI], gingival recession [GR], bleeding on probing [BOP], periodontal probing depth [PPD] and clinical attachment level [CAL]) as well as biological parameters (IL-1β) in the gingival crevicular fluid (GCF).

Methods: Sixteen patients within the age of 30 to 60 years, with a mean age of 40 years old, diagnosed with refractory periodontitis were included. In this split mouth design study, 2 quads (1 upper + 1 lower) from the same patient were randomly treated with (scaling and root planing [SRP]+PDT) together. The other 2 quadrants (1 upper + 1 lower) were treated by SRP only and selected to serve as controls. Clinical parameters including PI, GR, BOP, PPD and CAL and biological parameters (IL-1β) in the GCF were measured at baseline, then at, 2 and 6 months after therapy.

Results: A statistically significant reduction in several clinical parameters as, BOP (P < 0.001), PI (P < 0.001), PPD (P < 0.001) and CAL (P < 0.001) in quadrant treated with SRP and adjunctive PDT when compared to control group treated with SRP alone was observed and both therapies showed non-statistically significant differences in the reduction of IL-1β level.

Conclusion: The inclusion of PDT as an adjunctive measure to nonsurgical conventional periodontal treatment seems to be a useful therapeutic measure in refractory periodontitis treatment.

 Introduction: Laser hair removal (LHR) has become one of the most popular treatments in aesthetics. Side effects are an inevitable part of laser therapy, therefore managing them is crucial for every laser practitioner to ensure patients’ safety along with achieving the best results. The available references describe the effectiveness of the diode LHR for all skin types according to the Fitzpatrick scale, but the question of patient safety and minimization of side effects and postoperative complications in mixed-race patients remains unanswered. This study aims to illustrate aspects of specific side effects in patients of mixed ethnicity and the impact of those effects on the results of the treatment.

Methods: The study was conducted in Poland and the United Kingdom on 216 patients of various ethnic backgrounds. This study analyses the frequency of side effects in a mixed-race group of 32 participants, taking into account their skin type according to the Fitzpatrick scale. The patients received a course of 6 treatments using diode laser 805 nm. An objective and a subjective method were used to analyse treatment results and side effects, with adverse effects documented, if observed. Treatment settings were adjusted to skin reaction during the patch test.

Results: Objective analysis was different from the subjective analysis of the treatment’s effectiveness. No adverse effects were observed. Side effects such as hyperpigmentation, skin irritation, skin burns, and skin hypersensitivity were found.

Conclusion: 805 nm diode laser is effective and efficient at hair removal in mixed-race patients. It is a safe treatment in terms of skin reaction as only short-term side effects were observed in the treated area and no adverse effects were noted. To achieve the best results and to avoid adverse effects it is necessary to adjust treatment settings according to the individual patient’s skin reaction.

Introduction: Rhinophyma is recognized as a common and severe skin disease manifested as progressive thickening of the nasal skin due to hypertrophy of the soft tissue. The most severe complication of rhinophyma is telangiectasis. So far the pathogenetic approach for the treatment of rhinophyma should be based on the removal of the dysplastic vessels to provide the appropriate revascularization of the involved skin area.

Case Report: This study presented the experience of the treatment of rhinophyma with the copper vapor laser (CVL) designed with the computerized scanner device. A 52-year-old elderly Caucasian male patient with typical clinical signs of rhinophyma was successfully managed during three sessions of CVL treatment. CVL emits light with a wavelength of 578 nm, exposure time of 0.2 seconds. The settings used for the CVL in scanner mode were set at 1.2 W. The scanner device has a hexagonal frame with a maximum width of 12 mm with the distance of 1 mm between centers of laser spots. The CVL treatment resulted in a restoration of the natural appearance of the nose without side effect during 18 months after treatment.

Conclusion: The described clinical case demonstrates excellent results of the management of rhinophyma by means of the scanned CVL. CVL treatment was associated with the removal both of dysplastic superficial skin vessels, the solution of the inflammation, decline of the sebum production and the disappearance of the nasal hypertrophy.