Original Article

The Effects of Diode Laser (980 nm Wavelength) and Chlorhexidin Gel in the Treatment of Chronic Periodontitis

Reza Birang, Jaber Yaghini, Mahdi Adibrad, Sima Kiany, Zinab Mohammadi, Ehsan Birang

Journal of Lasers in Medical Sciences, Vol. 2 No. 4 (2011), 8 February 2012, Page 131-138

INTRODUCTION: The aim of the present study was to investigate the effects of SRP assisted by the two clinical treatment methods of diode laser or Chlorhexidine Gel applications in comparison with SRP alone.

METHODS: Eight patients with moderate to severe chronic periodontitis, each with at least three pockets 4–7 mm deep, were selected for this study. Over 66 pockets were selected and randomly treated by either scaling and root planning (SRP) alone, or by SRP + diode laser (1.5 W,980 nm,30sec, continuous wave)(laser group),or by SRP + chlorhexidine gel-xanthan based (gel group). The clinical indices (probing pocket depth [PPD], clinical attachment level [CAL], and papillary bleeding index [PBI] mean score) and microbiological index (total bacterial count [TBC]) before, 1 month and three months after treatment were measured and evaluated.

RESULTS: The results showed that SRP assisted by chlorhexidine gel and diode laser therapies exhibits better results than SRP alone in reducing PPD, improving clinical CAL, and reducing PBI mean score and TBC (p < 0.05) both at one month and three months follow ups. Comparison of clinical indices between the laser group and the gel group showed no significant differences at neither of the follow up stages, but in 3 months follow up interval, the TBC reduction in the laser group was significantly more than the gel group (P < 0.05).

CONCLUSION: Treatment with diode laser or chlorhexidine gel as an adjunct to SRP may improve periodontal and microbiological indices compared to SRP alone. Diode laser showed better bactericidal effects in long term.

Pain Reduction Using Low Level Laser Irradiation in Single-Visit Endodontic Treatment

Mohammad Asnaashari, Shadi Mohebi, Payam Paymanpour

Journal of Lasers in Medical Sciences, Vol. 2 No. 4 (2011), 8 February 2012, Page 139-143

INTRODUCTION: Post-endodontic treatment pain is a relatively common condition which needs analgesics for patient’s pain relief. Low-level laser therapy (LLLT) is suggested as a non-pharmacological and non-invasive treatment for dealing with painful conditions. The purpose of this study was to evaluate the pain relief effect of LLLT after endodontic treatment.

METHODS: Eighty patients randomly received either LLLT (n=40), or placebo laser (n=40) after the completion of endodontic treatment for their first permanent upper or lower molars. In the laser group, the patients received a single course of low level laser therapy (Whitening Lase II- Laser DMC, Samsung, Korea) for 80 second (a dose = 70 j/cm²) per tooth. Intensity of post treatment pain was recorded using a questionnaire (The McGill Pain Questionnaire) and a numeric rating scale (Visual Analogue Scale {VAS}) at 4, 8, 12, 24, and 48 hours. VAS is a 10 cm line with “no pain” at one end, and “worst pain imaginable” at the other end. This method makes it possible to quantify pain levels. T-test and Chi-square test were used for data statistical analyses.

RESULTS: Compared to the placebo group, post-endodontic pain was significantly reduced in LLLT group at 4, 8, 12, and 48 hours (P<0.05). But the difference between the two groups was not significant at 24 hours after endodontic treatment (P>0.05).

CONCLUSION: Regarding the significant pain reduction in LLLT group at 4, 8, 12, and 48 hours after endodontic treatment, LLLT seems to be an effective and nonpharmacological approach for the reduction of post-endodontic treatment pain.

Comparison between the Holmium Laser (Made in Iran) and Pneumatic Lithotripsy in Patients Suffering from Upper Ureteral Stone between 1-2cm

Mohammad Reza Razaghi, Abdollah Razi

Journal of Lasers in Medical Sciences, Vol. 2 No. 4 (2011), 8 February 2012, Page 144-147

INTRODUCTION: The aim of this study is to compare holmium laser (LL) with pneumatic lithoclast (PL) in patients with upper ureteral stones and their ability to destruct the stones and making the patient stone free. We also compare the duration of these procedures and their complications, such as urosepsis, perforation, and pushing the stone backward.

METHODS: This has been a clinical randomized trail study in 26 patients with upper ureteral stone more than 1 cm. Patients were divided into 2 randomized groups, each treated with one of the following approaches: pneumatic lithoclast(14 patients), or holmium laser(12 patients). The goal of lithotripsy was to break the stone into particles less than 3 mm. IVP (Intravenous Pyelogram) was performed 4 weeks after.

RESULTS: The immediate stone free rate was 100% in LL group and 42.9% in PL group (P=0.001). Stone pushing back was 0% in LL group and 57.1% in PL group. Complications such as a perforation, or urosepsis, or bleeding were not seen in any of these groups. Fever more than 38º C was observed in 1.8% in LL, and 3.8% in PL group (p=0.56). After 4 weeks no complication was seen in IVP.

CONCLUSION: According to our experience, for upper ureteral stones larger than 1 cm, lithotripsy with holmium laser is preferred approach with high success rate and low complication. 

Transureteral Lithotripsy of Ureteral Calculi in Children with Holmium: Yttrium Aluminium Garnet Laser

Mohsen Amjadi, Fahimeh Kazemi Rashed, Reza Sari Motlagh, Farzin Sheikh Monazzah

Journal of Lasers in Medical Sciences, Vol. 2 No. 4 (2011), 8 February 2012, Page 148-151

INTRODUCTION: Surgical management of pediatric urinary calculi evolved dramatically over the past two decades. However, with the miniaturization of equipment and with improvisation of endourologic techniques, access to the entire pediatric urinary system is possible. Ho: YAG laser provides more maneuverability during transuretereal lithotripsy (TUL) than the pneumatic system which uses a metal probe, especially when used in pediatrics urinary systems. In this study, we report our experience about treatment of pediatric ureteral stone with HO: YAG laser.

METHODS: Between 2008 -2011, 41 children ≤ 12 years of age with ureteral stones were included in our study. Using K.U.B, sonography, and intravenous urogram, diagnoses were established for all patients. 6F or 8F wolf semi rigid ureteroscope was used for ureteroscopy under general anesthesia and stone fragmentation was implemented by Ho: YAG laser. For the evaluation of stone free rate, we used the following day & week confirmatory KUB, and sonograms additional to the direct visualization of the ureter during ureteroscopy. The patients were scheduled to be followed by control sonograms 2 weeks and 2 months after the operation to rule out past operational ureteral stenosis.

RESULTS: From our 40 patients whose ages were in the range of 8 months and twelve years of old with a mean age 3.5 years, 18 patients (45%) had distal ureteral stones, ten (25%) in mid ureter, and twelve of them (30%) had the stone in their proximal ureter. The mean diameter of stones was 9.3 mm (3.5-11 mm). Three patients had encrusted double j stents (DJS). Our overall stone free rate was 89.35% at the end of 1 week. The complications were fever in 5 patients (12.5%) and ureteral stricture due to ureteral perforation in one patient, while one patient had long hospital stay due to refractory pain and nausea. The mean time of post-surgical hospital stay was 42 hours, while for only 20% of patients (8 patients) and in the rest of patients (30 patients) this period was only 24hours.

DISCUSSION: Endoscopic lithotripsy in children has gradually become a major technique for the treatment of ureteral stones. This progression has been on the basis of the development of appropriate endoscopes and effective working instruments. The stone-free rate following urteroscopic lithotripsy for ureteral stones has been reported in as high as 98.5-100%. In this study, overall stone free rate was 89.35%. The complications after ureteroscopic laser lithotripsy are uncommon and usually related to passage of the ureteroscope than from laser action. Fever was the most common complication which occurred in 5 (12.5%) of our patients despite the fact that all patients were hospitalized the day before the procedure and were under parenteral antibiotic therapy. Postoperative stenting after ureteroscopic lithotripsy remained controversial. Most children were able to tolerate the attached string and the stent could be removed 5-7 days after without the use of an additional anesthetic. We used suitable ureteral catheters for 24 hours in all patients.

CONCLUSION: Although HO: YAG laser lithotripsy is safe in children, we need more controlledtrials to show the best method of lithotripsy in pediatric ureteral stones.

Green Light Photo Selective Vaporization of the Prostate vs. Transurethral Resection of Prostate for Benign Prostatic Hyperplasia

Alireza Mahboub Ahari, Fatemeh Sadeghi Ghyassi, Mahmoud Yousefi, Mohsen Amjadi, Ali Mostafaie

Journal of Lasers in Medical Sciences, Vol. 2 No. 4 (2011), 8 February 2012, Page 152-158

INTRODUCTION: Green light photo selective vaporization of the prostate (PVP) is a minimally invasive method of treatment for clinical benign prostatic hyperplasia with fewer side effects. The aim of this study is to evaluate the safety, effectiveness and cost analysis of PVP compared with transurethral resection of prostate.

METHODS: A systematic search was done in Cochrane, TRIP database, MEDLINE, NHS EED, NIHR HTA, CRD, Health star database, Pro Quest, Psycoinfo and Google Scholar to find randomized control trials, systematic reviews and HTA reports. The searched keywords were Green light laser (PVP or KTP) and prostate. The cost analysis was done by the perspective of society and providers.

RESULTS: Complication rate in 12 included evidences ranged from 0-9.3%. The complication rate of TUR-P (Transurethral Resection of Prostate) was more than PVP. Changing in flow rate reducing residual urine, improving patients’ symptoms and QOL (Quality of life), and operative outcome length of operation varied from no significant to significant differences in favor of TURP. Unit cost in both social and provider view was significantly high in PVP in comparison with TURP. Increasing the number of patients did not change the cost analysis.

CONCLUSION: PVP is a safe method for treatment of clinical BPH, but there is a lack of evidence for the evaluation of effectiveness. Overall, the unit cost for PVP was significantly more than TURP; for this reason this method could not be conducted in very wide indications, because of high cost.

Review Article

Effects of Laser Irradiation on Caries Prevention

Yashar Rezaei, Hossein Bagheri, Maryam Esmaeilzadeh

Journal of Lasers in Medical Sciences, Vol. 2 No. 4 (2011), 8 February 2012, Page 159-164

INTRODUCTION: Although dental caries is a preventable disease, it is still common and remains a public health problem. One of the potentially effective preventive measures is the use of lasers. The purpose of this study was to review the studies about use of laser irradiation on the inhibition of carious lesions and the effectiveness of different commercial laser type (Nd:YAG, CO2, and Argon).

METHODS: A literature search included journal databases, existing systematic reviews, and studies identified by content experts. Studies meeting inclusion criteria were assessed for quality.

RESULTS: Some studies have demonstrated the potential preventive effect of laser irradiation on sound enamel; the effect of irradiation on white spot lesions is still unclear. The effects of irradiating demineralized enamel surfaces coupled with the use of topical fluoride application is also still unclear and further research needs to be conducted in this area. Laser irradiation alone can significantly enhance acid resistance of sound enamel surfaces and prevent caries progression.

CONCLUSION: Combined use of topical fluoride application and laser irradiation on sound enamel surfaces has provided the best protection against caries initiation and progression. Laser irradiation was of limited value in managing incipient carious lesions. Argon laser use may be easier clinically due to its large and visible beam diameter, which allows for irradiation of the whole surface of the tooth instead of the overlapping and time consuming pattern of the CO2 laser.

Application of Low Level Laser in Temporomandibular Disorders

Arash Rahimi, Sepideh Rabiei, Seyed Masood Mojahedi, Emad Kosarieh

Journal of Lasers in Medical Sciences, Vol. 2 No. 4 (2011), 8 February 2012, Page 165-170

INTRODUCTION: The American Academy of Orofacial pain defined temporomandibular disorders (TMDs) as”a collective term that embraces a number of clinical problems that involve the masticatory muscles, the TMJ (Temporomandibular Joint), and the associated structures”. Pain and dysfunctional symptoms or signs such as limitations in opening, asymmetric jaw movements and TMJ sounds are the most common findings. TMD is a prevalent disease that is most common among 20 to 40 year-olds; not a disease of senility. Researches show that about 75% of the population has one sign of TMD, and approximately 33% has at least one TMD symptom. They reported that 3.6% - 7% of the population has severe TMD problems that cause patients to seek treatment. Low level laser is a conservative treatment method that has been introduced in recent years.The purpose of this article is to review the related investigations and introduce the applications of low level lasers in TMD treatment.

METHODS: Electronic data bases were searched and hand search of published articles and texts was done.

RESULT and CONCLUSION: Laser application can be beneficial in different ways for TMD problems. In many cases occlusal adjustment and taking impression for splint is necessary but the pain prevents conventional treatment. Pain relief can be achieved by irradiating the joint and tender points; musculature will be relaxed, and treatment can begin. It has been revealed in recent clinical experiences and clinical studies that for myogenic conditions rather high doses are needed and that the energy density itself is an important factor. The disagreement in result of older studies may be related to this fact.

Book Review