Is Holmium Laser Enucleation of Prostate a Good Surgical Alternative in Benign Prostatic Hyperplasia Management? A Review Article

Amirreza Abedi, Mohammad Reza Razzaghi, Amirhossein Rahavian, Ebrahim Hazrati, Fereshte Aliakbari, Vahid Vahedisoraki, Farzad Allameh

Journal of Lasers in Medical Sciences, Vol. 11 No. 2 (2020), , Page 197-203

Several therapeutic approaches such as holmium laser enucleation of the prostate (HoLEP) have been introduced to relieve bladder outlet obstruction caused by benign prostatic hyperplasia (BPH). Compared with other techniques including the transurethral resection of the prostate (TURP) and simple open prostatectomy, HoLEP results in a shorter hospital stay and catheterization time and fewer blood loss and transfusions. HoLEP is a size-independent treatment option for BPH with average gland size from 36 g to 170 g. HoLEP is a safe procedure in patients receiving an anticoagulant and has no significant influence on the hemoglobin level. Also, HoLEP is an easy and safe technique in patients with a prior history of prostate surgery and a need for retreatment because of adenoma regrowth. The postoperative erectile dysfunction rate of patients treated with HoLEP is similar to TURP or open prostatectomy and about 77% of these patients experience loss of ejaculation. Patients with transitional zone volume less than 30 mL may suffer from persistent stress urinary incontinence following HoLEP so other surgical techniques like bipolar TURP are a good choice for these patients. In young patients, considering HoLEP with high prostate-specific antigen density and a negative standard template prostate biopsy, multiparametric MRI needs to be considered to exclude prostate cancer.

The Effect of Low-Level Laser Therapy on the Acceleration of Orthodontic Tooth Movement

Maryam Baghizadeh Fini, Pooya Olyaee, Ahmadreza Homayouni

Journal of Lasers in Medical Sciences, Vol. 11 No. 2 (2020), , Page 204-211

In clinical practice, Low-Level Laser Therapy (LLLT) is widely used. The main aim of this review is to assess the effectiveness of LLLT on accelerating tooth movement in human subjects. The PRISMA checklist was utilized as a guideline to carry out this systematic review. The electronic databases were searched from Google Scholar (2014-2018) and PubMed, and comprehensive research on this topic was also manually conducted. Therefore, 76 Randomized Clinical Trials (RCT) or Controlled Clinical Trials (CCT) articles were selected. After screening studies, consequently, ten trials met the inclusion criteria. Eight out of ten studies showed LLLT has a significant impact on the acceleration of orthodontic tooth movement, and there was no statistically significant difference in the rate of tooth movement between the laser group and the control group in the two remaining studies. Furthermore, five out of ten articles showed that LLLT has no adverse effects. Although we have some degree of understanding from a cellular point of view to low-level laser therapy effects, we still do not know whether this cellular level changes have any effect on clinical acceleration of the orthodontic tooth movement. The results are inconclusive and cannot be generalized to the public community; therefore, well-structured studies are required.

Assessment of Laser Effects on Skin Rejuvenation

Hazhir Heidari Beigvand, Mohammadreza Razzaghi, Mohammad Rostami-Nejad, Majid Rezaei-Tavirani, Saeed Safari, Mostafa Rezaei-tavirani, Vahid Mansouri, Mohammad Hossein Heidari

Journal of Lasers in Medical Sciences, Vol. 11 No. 2 (2020), , Page 212-219

Laser skin resurfacing has changed the approach of facial skin rejuvenation over the past decade. This article evaluates the laser effects on skin rejuvenation by the assessment of laser characteristics and histological and molecular changes, accompanied by the expression of proteins during and after laser-assisted rejuvenation of skin. It is important to note that different layers of skin with different cells are normally exposed to the sun’s UV radiation which is the most likely factor in aging and damaging healthy skin. To identify the expression of proteins, using validated databases and reviewing existing data could reveal altered proteins which could be analyzed and mapped to investigate their expression and their different effects on cell biological responses. In this regard, proteomics data can be used for better investigation of the changes in the proteomic profile of the treated skin. Different assessments have revealed the survival and activation of fibroblasts and new keratinocytes with an increase of collagen and elastin fibers in the dermis and the reduction of matrix metalloproteinases (MMPs) and heat shock proteins (HSPs) as a result of different low-power laser therapies of skin. There are a wide range of biological effects associated with laser application in skin rejuvenation; therefore, more safety considerations should be regarded in the application of lasers in skin rejuvenation.

The Effect of Low-Power Laser Therapy on the TGF/β Signaling Pathway in Chronic Kidney Disease: A Review

Behnaz Ahrabi, Maryam Bahrami, Reza Moghadasali, Mona Zamanian-Azodi, Maryam Sadat Khoramgah, Shahram Darabi, Fatemeh Sadat Tabatabaei Mirakabad, Hojjat-allah Abbaszadeh

Journal of Lasers in Medical Sciences, Vol. 11 No. 2 (2020), , Page 220-225

Objective: The purpose of this study is to investigate the effects of low-power lasers on kidney disease by investigating several studies.

Methods: A number of articles from 1998 to 2019 were chosen from the sources of PubMed, Scopus, and only the articles studying the effect of low-power lasers on kidney disease were investigated.

Results: After reviewing the literature, 21 articles examining only the effects of low-power lasers on kidney disease were found. The results of these studies showed that the parameter of the low-power laser would result in different outcomes. So, a low-power laser with various parameters can be effective in the treatment of kidney diseases such as acute kidney disease, diabetes, glomerulonephritis, nephrectomy, metabolic syndrome, and kidney fibrosis. Most studies have shown that low-power lasers can affect TGFβ1 signaling which is the most important signaling in the treatment of renal fibrosis.

Conclusion: Lasers can be effective in reducing or enhancing inflammatory responses, reducing fibrosis factors, and decreasing reactive oxygen species (ROS) levels in kidney disease and glomerular cell proliferation.

Assessment of Dysregulation of HERC6 and Essential Biological Processes in Response to Laser Therapy of Human Arm Skin

Saeed Safari, Mohammad Rostami-Nejad, Mostafa Rezaei-Tavirani, Vahid Mansouri, Zahra Razzaghi, Majid Rezaei-Tavirani

Journal of Lasers in Medical Sciences, Vol. 11 No. 2 (2020), , Page 115-119

Introduction: The widespread application of lasers in medicine, especially in the treatment of diseases implies more investigations to understand the precious molecular mechanism of the laser effect on the human body. In the present study, the prominent role of HERC6 in response to CO2 Laser therapy of human skin is investigated.

Methods: The numbers of 16 gene expression profiles before and after the treatment with the CO2 laser are downloaded from Gene Expression Omnibus (GEO), and differentially-expressed genes (DEGs) are analyzed to find the significant DEGs. Gene ontology analysis revealed that HERC6 and a set of its neighbors played a significant role in response to laser application.

Results: The expression changes of 52 significant DEGs were compared via heat map analysis and 27 significant DEGs were introduced as the critical genes which are involved in response to laser irradiation. “Thymidylate kinase activity” among 9 clusters of biological terms was highlighted as an important biological process related to the identified DEGs. HERC2 was proposed as a critical DEG which was related to several essential cellular processes in response to laser application.

Conclusion: The findings from the present study indicate that HERC6 and the numbers of its first neighbors are involved in the essential cellular response to laser therapy of human skin.

Evaluation of the Therapeutic Effect of Low Level Laser in Controlling Low Back Pain: A Randomized Controlled Trial

Leyla Kholoosy, Dariush Eliaspour, Mohammad Reza Akhgari, Zahra Razzaghi, Zeinab Khodamardi, Masume Bayat

Journal of Lasers in Medical Sciences, Vol. 11 No. 2 (2020), , Page 120-125

Introduction: Low back pain is a very common musculoskeletal disorder. The big burden of disease necessitates investigating a more effective modality of treatments with more persistence and also less side effects. Low power laser has been proved as a pain reducing modality, but there are lack of studies comparing it with other treatments and also among the Iranian race and society. The purpose of this study was to evaluate the effect of low level laser in patients with low back pain.

Methods: Our study was a single blind, randomized controlled trial. 40 subjects with low back pain entered the study. Patients were aged between 20-70 and their pain severity scale was 3-10 according to visual analogue scale of pain (VAS).They were randomly assigned in two groups of case (true laser) and control (sham laser). Naproxen was prescribed with a free dose (250- 1000 mg/daily) in both groups. We evaluated patients’ subjective pain, functional status (using Roland Morris disability questionnaire), spinal ROM and spinal tenderness at the basic time, one and three months post- treatment. True laser group received 12 sessions of laser (160 mw) and control group took 12 sessions of sham laser (the same laser instrument in off status). An infrared laser GaAlAs, wave length 808 nm, power 160 mw and spot size 1 cm2, power density 0.16 J/cm2, in continuous mode was used in treatment. We applied laser to articular space of vertebral column, adjacent paravertebral points, pain radiating areas and tender points and also pain-controlling acupuncture points.

Results:  From 40 subjects who included the study 6 were excluded and 34 entered the analysis. There was significant improvement in pain (p<0.001 at both groups), functional status (Case group: p<0.001, control group: p=0.004) and spinal ROM (Case group: p<0.001 and control group: p= 0.007) in both groups at the end of first month, but these gains persisted to three months only in case group (p<0.001). Regarding spinal tenderness, it was disappeared in 89.47% of patients in true laser group at the end of one month but remained unchanged in 73.33% of subjects of sham laser group.

Conclusion: We concluded that laser therapy (in combination with NSAIDs) is an effective and long-lasting therapeutic strategy in relief from LBP without any significant side.

Evaluation of the Effects of 660-nm and 810-nm Low-Level Diode Lasers on the Treatment of Dentin Hypersensitivity

Narges Naghsh, Mahdi Kachuie, Marzie Kachuie, Reza Birang

Journal of Lasers in Medical Sciences, Vol. 11 No. 2 (2020), , Page 126-131

Introduction: Dentin hypersensitivity is a common oral problem that occurs as a short and sharp pain. There are many techniques to treat this condition, the latest of which is laser treatment. The aim of this study was to evaluate the effect of two type of low-power diode lasers (660 nm and 810 nm) on dentin hypersensitivity in order to achieve an acceptable clinical application by adjusting the effective parameters.

Materials and methods: In this randomized, double-blind clinical trial, sensitive teeth of 7 patients were divided into three groups with randomized matching method: group I, treated with 660-nm diode laser irradiation; group II, treated with diode laser 810-nm and group III, the control group. Irradiation parameters for 660-nm and 810-nm diode lasers were a power of 30 mW and 100 mW, respectively, in contact and continuous mode, perpendicular to tooth surface with a sweeping motion. Treatments were carried out in four sessions, at weekly intervals. Data obtained were analyzed with SPSS 22, using one-way ANOVA, repeated measures ANOVA and LSD (least significant difference) test. Significance level was considered as a=0.05.

Results: There were no significant differences in VAS score changes between the two laser groups after the intervention in the first, second and third weeks compared to baseline (P>0.05). These changes in the fourth week were significantly higher in the 810-nm laser group compared to the 660-nm laser group (P=0.04) and in the 660-nm laser group were more than the control group (P=0.02). Mean VAS scores at 1-week, 1-month and 2-month postoperative intervals were significantly lower in 810-nm laser group than 660-nm laser group and in the 660-nm laser group they were less than the control group (P<0.001).

Conclusion: The use of 660-nm and 810-nm diode lasers with a power of 30 and 100 mW, respectively, for 120 seconds was effective in reducing pain in patients with dentin hypersensitivity. However, the effect of 810-nm laser was more long lasting in reducing the dentin hypersensitivity than that of the 660-nm laser.


Diode Laser 805 Hair Removal Side Effects in Groups of Various Ethnicities – Cohort Study Results

Magdalena Atta-Motte, Izabela Załęska

Journal of Lasers in Medical Sciences, Vol. 11 No. 2 (2020), , Page 132-137

Introduction: As hair removal has become most popular in aesthetics, the management of its side effects is crucial for every practitioner. Available studies describe the effectiveness of the diode laser hair removal for all skin types according to the Fitzpatrick scale independently, but the question of the occurrence of side effects and adverse effects remains unanswered. This study aims to illustrate aspects of side effects for patients of various ethnicities and the impact of those on the effectiveness of the treatment.

Methods: The research was carried out in Poland and the United Kingdom from March 2016 to March 2019. 217 people of various ethnic origins were qualified for the study, 206 sessions were completed and statistical analysis was performed. The procedure was performed in the pubic area with diode lasers with a wavelength of 805 nm, minimum peak power of 2100 W and pulse duration between 15 and 400 ms. ET sapphire cooling assisted handle 9 x 9 mm large and pulse energy density between 10 and 100 J/cm2 were used for all treatments. In addition, in order to illustrate the effectiveness of treatments, the subjective and objective analyses of hair loss percentages were indicated. In statistical analysis, the chi-square test for independence was used to evaluate the correlation between the type and severity of side effects and the ethnic origin of patients, the number of treatments, the Fitzpatrick scale and the level of satisfaction.

Results: The occurrence of sensitivity depended statistically significantly (P = 0.002) on ethnicity. Ethnicity had no significant effect on the occurrence of erythema. The occurrence of hyperpigmentation statistically significantly depended (P < 0.001) on ethnicity. The occurrence of burns depended statistically significantly (P = 0.001) on ethnicity. The number of treatments had a significant (P = 0.012) effect on the severity of side effects occurrence. Among participants who had 6 treatments, only half had side effects, including multiple effects occurring in 9.79% of cases. The occurrence of side effects such as sensitivity and hyperpigmentation did not depend on the number of treatments. However, the number of treatments had a significant impact on the incidence of erythema (P < 0.001) and burns (P = 0.005). More than half of the respondents (58.33%) had erythema after more than six procedures, whereas in the 6 treatments the erythema occurred only in 6.7% of cases.

Conclusion: The treatment with the use of diode lasers for all subjects with different ethnicity and thus the recognized scale according to Fitzpatrick is effective and safe. The occurring side effects are transient and do not impact the effect of the whole therapy.

Effect of Nd: YAG laser irradiation and Mechanical force on cultured human osteoblasts.

Yuji Tsuka, Ryo Kunimatsu, Hidemi Gunji, Takaharu Abe, Cynthia Concepción Medina, Kengo Nakajima, Aya Kimura, Tomoka Hiraki, Ayaka Nakatani, Kotaro Tanimoto

Journal of Lasers in Medical Sciences, Vol. 11 No. 2 (2020), , Page 138-143

Background: In recent years, laser irradiation in the NIR (Near infrared ray) area has been reported to promote bone healing. There are also reports that laser irradiation accelerates orthodontic tooth movement. In this study, we investigated the effect of NIR laser irradiation and mechanical stimulation on osteoblasts.

Methods: We seeded osteoblast-like cells and laser irradiation was performed 24 hours after cell seeding. In addition, a control group not performing anything, a group performing only neodymium · doped (Nd): YAG laser irradiation, a group performing only centrifugal loading, and a group using both Nd: YAG laser irradiation and centrifugal force loading were set, and after 24 hours and after 48 hours, cells were collected and Quantitative real-time PCR was performed.

Results: At 24 hours after laser irradiation, gene expression of Alkaline Phosphatase (ALP), Receptor activator of NF-κB ligand (RANKL) and Osteoprotegerin (OPG) was significantly higher in the 2.0 w group than in the control group. In addition, the RANKL / OPG ratio was higher in the 2.0 w group than in the control group. Also, in the group using laser irradiation and centrifugal load in combination 24 hours after laser irradiation, ALP and OPG showed significantly higher values than those with centrifugal load only group. Furthermore, the RANKL / OPG ratio also showed high values.

Conclusion: These results suggest that osteoblast-like cells activate genes related to bone metabolism by combining mechanical stimulation and laser irradiation. This helps to elucidate the influence of laser irradiation during tooth movement.

The Effect of Remineralizing Agents With/Without CO2 Laser Irradiation on Structural and Mechanical Properties of Enamel and its Shear Bond Strength to Orthodontic Brackets

Hannaneh Ghadirian, Allahyar Geramy, Waleed Shallal, Soolmaz Heidari, Nooshin Noshiri, Mohammad Ali Keshvad

Journal of Lasers in Medical Sciences, Vol. 11 No. 2 (2020), , Page 144-152

Introduction: Remineralizing agents may be used for the treatment of white spot lesions (WSLs) prior to bracket bonding. However, some concerns exist regarding their possible interference with the etching and bonding process, negatively affecting the bond strength. This study aimed to assess the effect of two remineralizing agents with/without CO2 laser irradiation on the mechanical properties and shear bond strength (SBS) of demineralized enamel to the orthodontic bracket.

Methods: This study evaluated 60 premolar teeth in 6 groups (n=10) as follows: (I) sound enamel, (II) demineralized enamel, (III) Nupro remineralizing agent (N), (IV) Nupro and CO2 laser (N/L), (V) Teethmate remineralizing agent (T), and (VI) Teethmate and CO2 laser (T/L). The remineralizing agents were applied to the enamel surfaces after their immersion in a demineralizing solution for 5 days. In groups IV and VI, the CO2 laser with a 10.6 μm wavelength, 10 ms pulse duration, a 50 Hz repetition rate, 0.3 mm beam diameter and 0.7 W power was irradiated after applying the remineralizing agents. Brackets were bonded to the enamel surfaces and SBS was measured by a universal testing machine. For the assessment of enamel microhardness, 20 sections of molar teeth were divided into 4 groups (n=5; N, N/L, T, T/L) and their microhardness was measured before demineralization, after demineralization and after remineralization. X-ray diffraction (XRD) analysis, field-emission scanning electron microscopy (FESEM) and energy-dispersive spectrometry (EDS) were carried out to assess the formation of hydroxyapatite. The atomic percentages of the C, O, P, Ca, Na, Si, F and Ca/P ratio were determined by EDS analysis.

Results: The SBS significantly decreased in group II (P < 0.001). There was no significant difference among the groups I, III, IV, V and VI (P < 0.05). This finding was similar to the microhardness results, which showed an increase in microhardness after remineralization (P < 0.05), with no difference among the remineralizing agents. The Ca/P ratio was the highest in the Nupro group and the lowest in the demineralized group.

Conclusion: Remineralizing agents can significantly improve the microhardness and structural properties of demineralized enamel to a level similar to that of sound enamel with no adverse effect on SBS to orthodontic brackets.

Effect of Surface Treatment With Er:YAG and CO2 Lasers on Shear Bond Strength of Polyether Ether Ketone to Composite Resin Veneers

Yosef Jahandideh, Mehran Falahchai, Hosein Pourkhalili

Journal of Lasers in Medical Sciences, Vol. 11 No. 2 (2020), , Page 153-159

Introduction: Polyether ether ketone (PEEK) has low surface energy and high resistance to chemical surface treatments. Therefore, different surface treatments such as laser conditioning should be investigated. There is a gap of information regarding the efficacy of laser irradiation in the surface treatment of PEEK, and the efficacy of several laser types needs to be evaluated for this purpose. This study aimed to assess the effect of surface treatment with erbium-doped yttrium aluminum garnet (Er:YAG) and carbon dioxide (CO2) lasers on shear bond strength (SBS) of PEEK to composite resin veneers.

Methods: In this experimental study, 60 rectangular-shaped PEEK samples (7 x 7 x 2 mm) were used. The samples were mounted in auto-polymerizing acrylic resin in such a way that only one surface measuring 7x7 mm remained exposed. The samples were then randomly divided into 3 groups (n = 20) of control, Er:YAG laser surface treatment (Power = 1.5 W, energy density = 119.42 J/cm2, irradiation time = 20 s) and CO2 laser surface treatment (Power = 4 W, energy density = 159.22 J/cm2, irradiation time = 50 s). The bonding agent and PEEK opaque were applied on the surface of samples and they were veneered with a composite resin using a hollow plastic cylinder with an internal diameter of 4 mm. The SBS was then measured and the data were analyzed using one-way ANOVA, Tukey HSD test and Dunnett’s test at 0.05 level of significance.

Results: The SBS of the 3 groups was significantly different (P < 0.001). The Tukey HSD test revealed that the Er:YAG laser had higher SBS than the CO2 laser group (P < 0.001). The Dunnett’s test showed that both Er:YAG and CO2 laser groups yielded higher SBS than the control group (P < 0.001).

Conclusion: The Er:YAG and CO2 laser treatments can increase the SBS of PEEK to composite resin veneers, although the Er:YAG laser seems to be more effective for this purpose.


The Effect of the Bioactive Glass and the Er:YAG Laser on the Remineralization of the Affected Dentin: A Comparative In Vitro Study

Mohammad Javad Moghaddas, Horieh Moosavi, Sara Yaghoubirad, Nasim Chiniforush

Journal of Lasers in Medical Sciences, Vol. 11 No. 2 (2020), , Page 160-166

Introduction: The purpose of this study was to compare the effect of the bioactive glass, the glass ionomer, and the Erbium YAG laser as liners on the remineralization of the affected dentin.

Methods: The present study was conducted on 64 healthy extracted human molars divided into 4 groups, 1 control group and 3 experimental groups. After artificially inducing dentinal caries lesions, each of the experimental groups was applied to the cavity floor and then restored with a composite. The samples were stored after thermocycling in an incubator for two months. Finally, the hardness of the cavity floor was measured at 3 depths of 20, 50 and 100 μm by the Vickers microhardness tester. The dentin conditions underneath the liners were also evaluated with FESEM. Statistical analysis was performed by two-way ANOVA and the post-hoc Games-Howell test (P < 0.05).

Results: Among the groups, the lowest microhardness value was in the control group (P < 0.05) except at a depth of 100 μm; therefore, there was no significant difference between the control group and the bioactive glass (P > 0.05). The laser group had the highest microhardness value, which was significantly different from the control group (P < 0.05). There was a significant difference between the laser and bioactive glass (P < 0.05), except at a depth of 20 μm. The laser and glass ionomer had only a significant difference at a depth of 100 μm (P < 0.05). The microhardness value induced by glass ionomer was higher than bioactive glass, which in no depth was significant (P > 0.05). Partial dentinal tubule occlusion was observed with FESEM in each of the experimental groups as compared to the control group.

Conclusion: The microhardness values were higher in all groups than in the control group. The laser might be more successful in remineralization than the other ones.

Immediate Implant Placement in Infected Sockets: A Consecutive Cohort Study

Ashish Kakar, Kanupriya Kakar, Minas D. Leventis, Gaurav Jain

Journal of Lasers in Medical Sciences, Vol. 11 No. 2 (2020), , Page 167-173

Introduction: Immediate placement of implants in a fresh post-extraction socket is an increasingly popular and established treatment option. However, active infection in the extraction site may adversely affect the outcome of this procedure. This study was designed to assess the clinical results of immediate placement of dental implants in infected extraction sockets using a standardized protocol, which included (a) the use of an Er,Cr:YSGG laser for the decontamination of the infected socket prior to implant insertion, and (b) the utilization of an in situ hardening alloplastic bone graft substitute to augment the gap between the implant surface and the labial plate of bone.

Patients and Methods: A retrospective record review was used to identify 68 patients who had implants placed as per the described protocol. A total of 126 implants were placed in 68 patients (65 implants in the maxilla, 61 implants in the mandible). The implants were loaded 136 ± 73 days (mean ± standard deviation; range: 37–400 days) after implant placement. Eight patients (16 implants) were subsequently lost to follow up.
Results: 105 of the 110 implants (95.45%) placed immediately in the infected sites using the described protocol survived after prosthetic loading.

Conclusion: Immediate implant placement in previously infected sites using the protocols mentioned in our study with laser decontamination of the socket, grafting with an in situ hardening alloplastic bone graft material and non-submerged healing shows a similar survival rate to the published success rates for immediate implants placed in non-infected sites.

Low-Level Laser Irradiation Modulated Viability of Normal and Tumor Human Lymphocytes In Vitro

Hesam Saghaei Bagheri, Seyed Hossein Rasta, Seyedeh Momeneh Mohammadi, Ali Akbar Rahim Rahimi, AliAkbar Movassaghpour, Hojjatollah Nozad Charoudeh

Journal of Lasers in Medical Sciences, Vol. 11 No. 2 (2020), , Page 174-180

Introduction: Laser radiation is a promising strategy against various malignancies. Recent studies have shown that the application of low-power laser therapy (LPLT) at different doses and exposure times could modulate the growth dynamic of tumor cells. Based on the type of laser, LPLT could potentially trigger cell proliferation, differentiation, and apoptosis in different cell lines.

Methods: In this study, MTT assay was used to monitor the effect of low and high laser intensities on the viability of normal and cancer lymphocytes. The protein levels of Ki-67 (a proliferation marker) and Caspase-3 (an apoptosis factor) were measured in human peripheral mononuclear cells (PBMCs) and the B-lymphoblastic cell line (Nalm-6) using flow cytometry after being-exposed to 630-nm LPLT at low (2, 4, 6, and 10 J/cm2) and high (15, 30, 60, and 120 J/cm2) energy densities in a continuous mode for 48 and 72 hours.
Results: By using higher energy densities, 60 and 120 J/cm2, a significant decrease was shown in the viability of Nalm-6 cells, which reached 6.6 and 10.1% after 48 hours compared to the control cells (P < 0.05). Notably, Cell exposure to doses 30, 60, and 120 J/cm2 yielded 7.5, 12.9, and 21.6 cell viability reduction after 72 hours. The collected data showed that the high-intensity parameters of LPLT (15 to 120 J/cm2) promoted significant apoptotic changes in the exposed cells coincided with the activation of Caspase-3 compared to the none-treated control cells (P < 0.05). The data further showed the stimulation of the Ki-67 factor both in primary PBMCs and the lymphoblastic cell line treated with LPLT at energy densities of 4 and 6 J/cm2 (P < 0.05), indicating enhanced cell proliferation. Similar to Nalm-6 cells, primary PBMCs showed apoptosis after 48 hours of being exposed to doses 60, and 120 J/cm2, indicated by increased Caspase-3 levels (P < 0.05). As expected, the Nalm-6 cells were resistant to cytotoxic effects of laser irradiation in the first 48 hours (P > 0.05) compared to normal PBMCs. The exposure of Nalm-6 cells to low-intensity laser intensities increased a proliferation rate compared to the PBMCs treated with the same doses.
Conclusion: We showed the potency of LPLT in the induction of apoptosis and proliferation in human primary PBMCs and Nalm-6 cells in a dose and time-dependent manner after 72 hours.


Microshear Bond Strength of a Self-adhesive Composite to Erbium Laser-Treated Primary Enamel

Tara Zarabian, Saba Azadi Mood, Nazanin Kiomarsi, Homa Noorollahian, Neda Hakimiha

Journal of Lasers in Medical Sciences, Vol. 11 No. 2 (2020), , Page 181-186

Introduction: Advances have been made in the composition of flowable composites in recent years and self-adhering composites, which do not require a bonding agent, have recently been introduced to the market. This study aimed to assess the microshear bond strength (μSBS) of a self-adhering flowable composite (Vertise) to primary enamel treated with a graphite disc with silicon carbide particles (SIC) and laser irradiation, the result of which was compared to that of a conventional flowable composite (Premise).

Methods: In this in vitro, experimental study, 72 samples of sound primary enamel were evaluated. A smooth enamel surface was obtained using a graphite disc. Next, the erbium chromium yttrium scandium gallium garnet (Er,Cr:YSGG) laser was used for enamel surface treatment in half of the samples (n = 36). All the samples were then randomly divided into 4 groups of (i) Premise flowable composite (PF) without laser (n = 18), (ii) Vertise flowable composite (VF) without laser (n = 18), (iii) PF with laser (n = 18), and (iv) VF with laser (n = 18). The teeth were then incubated at 37°C for 24 hours and were then subjected to thermocycling. The μSBS of samples was measured using a universal testing machine and reported in megapascal (MPa). Data were analyzed using SPSS via the two-way ANOVA and independent-samples t test at P < 0.05.

Results: The mean μSBS of VF was significantly higher to the laser-treated samples (13.60 ± 5.47) compared with the non-treated samples (5.89 ± 2.42) (P < 0.001). However, no significant difference was noted in the μSBS of PF to the laser-treated (13.18 ± 3.45) and non-treated samples (16.06 ± 3.52) (P = 0.058).

Conclusion: The μSBS of the conventional flowable composite is higher than that of the self-adhering flowable composite to the enamel of primary teeth. Enamel surface treatment with laser irradiation increases the μSBS of self-adhering flowable composites.

Photoelimination Potential of Chitosan Nanoparticles-Indocyanine Green Complex Against the Biological Activities of Acinetobacter baumannii Strains: A Preliminary In Vitro Study in Burn Wound Infections

Maryam Pourhajibagher, Nava Hosseini, Ebrahim Boluki, Nasim Chiniforush, Abbas Bahador

Journal of Lasers in Medical Sciences, Vol. 11 No. 2 (2020), , Page 187-192

Introduction: Acinetobacter baumannii strains are important agents causing serious nosocomial infections including soft-tissue and skin infections in patients with burn wounds which have become resistant to several classes of antibiotics. Antimicrobial photodynamic therapy (aPDT) as an alternative antimicrobial procedure is suggested for the treatment of these kinds of infections. The aim of the current study is to evaluate the antibacterial and anti-biofilm efficiency of aPDT by the utilization of an improved form of indocyanine green (ICG) which is encapsulated in chitosan nanoparticles (NCs@ICG).

Methods: NCs@ICG were synthesized and confirmed by the scanning electron microscope (SEM). aPDT was performed using NCs@ICG with an 810 nm wavelength of the diode laser at the fluency of 31.2 J/cm2 on 50 A. baumannii strains isolated from burn wounds. The antibacterial and anti-biofilm potential of NCs@ICG-aPDT was determined via the colony forming unit (CFU)/mL and crystal violet assays, respectively. In addition, microbial biofilm degradation was evaluated by the SEM.

Results: According to the results, NCs@ICG-aPDT showed a significant reduction of 93.2% on the CFU/mL of planktonic A. baumannii strains compared to the control group (untreated group; P < 0.05). In addition, the biofilm formation of A. baumannii strains was significantly reduced by 55.3% when the bacteria were exposed to NCs@ICG-aPDT (P < 0.05). In contrast, NCs@ICG, ICG, and the diode laser alone were not able to inhibit the CFU/mL and biofilm of A. baumannii strains (P > 0.05). Based on the results of SEM images, NCs@ICG-aPDT disrupted the biofilm structure of A. baumannii strains more than other groups.

Conclusion: NCs@ICG-aPDT demonstrates a promising treatment candidate for exploitation in wound infections against both planktonic and biofilm forms of A. baumannii strains.

The Viewpoints of Last-Year Dentistry Students of Shahid Beheshti University on the Application of Lasers as an Independent Credit in the Education of General Dentistry

Masoumeh Mehdipour, Hamed Mortazavi, Ayla Bahramian, Niloofar Haghighi Enayat, Saranaz Azari-Marhabi

Journal of Lasers in Medical Sciences, Vol. 11 No. 2 (2020), , Page 193-196

Introduction: Enhancing students’ pragmatic skills as an enabling means warrants changes in their curricula, which should be reconciled with the students’ educational needs. Thus, this study seeks to examine the viewpoints of last-year dentistry students on the need for the instruction of laser application as an independent credit in general dentistry curricula. The findings of this study can be helpful in determining the educational priorities of students while providing and compiling their curricula.

Methods: This descriptive study was done on 91 last-year dentistry students of Shahid Beheshti University in a full census manner. The data collection tool was a fieldwork questionnaire which its validity and reliability evaluation was carried out. To announce the findings, frequency distribution, frequency percentage and average tableaux were utilized.

Results: Amongst the 91 participants, regarding the average figures of value assignment from 1 to 10 to respond to questions, the highest value was assigned to learning the side effects of lasers (7.99 ± 0.01), and the lowest importance of and need for learning was assigned to learning about the history of laser and light physics (4.53 ± 0.47).

Conclusion: The findings indicate that students have a positive attitude toward the incorporation of an independent laser credit in their curricula and, thus, the necessity of incorporating this credit in their curricula can be posed.

Bladder Lymphangioma Treated by Holmium Laser: Extremely Rare Case Report

Asad Moradi, Babak Kazemzadeh Azad, Mahyar Fasihi, Fereshteh Aliakbari

Journal of Lasers in Medical Sciences, Vol. 11 No. 2 (2020), , Page 226-227

Introduction: Lymphangioma is a sporadic benign tumor of the bladder. It is a congenital disorder and based on the size of lymphatic spaces, it is divided into 3 types of capillary, cavernous, and cystic.

Case Report: In this paper, we presented a 40-year-old woman with microscopic hematuria and a normal urinary ultrasound. Urethrocystoscopy showed a flat 4 mm highlighted strawberry-like lesion on the right lateral wall of the bladder. After a cold cup biopsy, the lesion was coagulated by the holmium: YAG (Ho: YAG) laser.

Conclusion: In Bladder Lymphangioma Based on the size of the lesion, partial cystectomy or minimally invasive surgeries such as laser modality would be the principal treatment.



The Combination of Antimicrobial Photodynamic Therapy and Photobiomodulation Therapy for the Treatment of Palatal Ulcers: A Case Report

Rafael Maya, Lorena Lúcia Costa Ladeira, Juliana Elaine Maya Maya, Letícia Machado Gonçalves, Sandra Kalil Bussadori, Marco Aurelio Benini Paschoal

Journal of Lasers in Medical Sciences, Vol. 11 No. 2 (2020), , Page 228-233

Introduction: One of the unexpected side effects of the Haas type palatal expander is ulcers progressing to necrotic lesions in the palatal area due to poor hygiene. The use of antibiotic therapy is mandatory. However, long periods of healing/pain and the need for a systemic host response with the aid of metabolization, especially in children, are issues that should be taken into account in the management of this type of injury. Since phototherapy modalities (antimicrobial photodynamic therapy [aPDT] and photobiomodulation therapy [PBMT]) are able to enhance and accelerate the healing process and reduce the bacterial load, this case report aimed to describe the use of the above-mentioned therapies to treat palatal ulcers occurring during orthodontic expansion.

Case Report: The patient, a 10-year-old boy, with a chief complaint of bleeding and continuous pain in the region of his expander was verified on a follow-up visit. After a dental examination, the expander was removed and two necrotic lesions which were in contact with the acrylic part of the tooth-tissue expander were found in the palatal region. The proposal was to use one aPDT session with methylene blue followed by 4 sessions of PBMT with a red laser diode. On the 5th day, reorganized tissue was verified, with the absence of bleeding, swelling, and pain. On the 20th day of follow-up, the area showed no signs of inflammation, healthy tissue without any pathological clinical symptoms, and complete wound healing.

Conclusion: The concomitant use of PBMT and aPDT therapies may be considered feasible as an adjunct treatment to manage palatal ulcers resulting from the incorrect use of tooth-tissue types of expanders.

Lingual Lymphangioma Ablation With High Power Diode Laser: A Case Report

Amanda Vieira Aires, Camila Nazaré Alves de Oliveira Kato, Leni Verônica de Oliveira Silva, Rodrigo Soares de Andrade, Hercílio Martelli Júnior, Marcus Vinicius Lucas Ferreira, Ricardo Alves Mesquita

Journal of Lasers in Medical Sciences, Vol. 11 No. 2 (2020), , Page 234-237

Introduction: Lymphangioma is a rare vascular anomaly that affects the lymphatic vessels. Its etiology is not yet clear and it usually occurs in the head and neck region. This pathology is commonly diagnosed in childhood and there is no consensus about the most effective treatment of it.

Case Report: We report a case of lymphangioma located on the dorsum of the tongue in a 9-year-old boy, with the clinical appearance of small transparent vesicles similar to “frog-eggs”. The diagnosis was defined according to the clinical aspect and ultrasound images. The treatment performed consisted of two sessions of ablation with a high-power diode laser.

Conclusion: High-intensity diode laser ablation was a safe and effective tool for the treatment of this lesion in the tongue, which provided the patient with a faster, efficient transoperative period and a more comfortable postoperative period.