Review Article

Laser Treatment of Peri-Implantitis: A Literature Review

Sajjad Ashnagar, Hessam Nowzari, Hanieh Nokhbatolfoghahaei, Behnoush Yaghoub Zadeh, Nasim Chiniforush, Nastaran Choukhachi Zadeh

Journal of Lasers in Medical Sciences, Vol. 5 No. 4 (2014), 24 September 2014, Page 153-162

Peri-implantitis is a state defined as an inflammatory reaction around osseointegrated implants, leading to progressive loss of supporting bone. Various treatment methods are suggested in the treatment of peri-implantitis and clinicians have to choose a method over a large number of treatment protocols. Lasers have shown promising therapeutic effect in treatment of peri-implantitis. However, some controversies have been found in clinical outcomes after using lasers. Therefore, we aimed to review the current literature over the past ten years for the use of lasers in treatment of peri-implantitis, via the Pubmed electronic database of the US National Library of Medicine. Fifteen human studies were reviewed. Er:YAG (Erbium-Doped Yttrium Aluminum Garnet), CO2(Carbon Dioxide Laser) and Diode lasers were used. Despite inconsistencies and disharmonies among studies in terms of study design, positive treatment outcomes were obvious among the majority of them. However, short period of follow-ups and poor control of plaque index, as a critical confounding factor, were the major problems which these studies suffered from. It seems that one session laser therapy is not adequate for achieving optimal clinical outcome. Further studies with longer periods of follow-ups, intense control of plaque index, and various sessions of laser treatments are needed to clearly illustrate the clinical privilege of laser therapy.

Effect of Low Level Laser Therapy on Proliferation and Differentiation of the Cells Contributing in Bone Regeneration: A Systematic Review

Reza Amid, Mahdi Kadkhodazadeh, Mitra Ghazizadeh Ahsaie, Arian Hakakzadeh

Journal of Lasers in Medical Sciences, Vol. 5 No. 4 (2014), 24 September 2014, Page 163-170

Introduction: Low level laser therapy (LLLT) also known as photobiomodulation, is a treatment that uses low-level lasers or light-emitting diodes (LEDs) to change cellular function and is a clinically well accepted tool in regenerative medicine and dentistry. Considering the variety of laser, exposure, cells and study types, the exact effects of low level laser therapy seems to be unclear. The aim of this study was to review the data published in the field of the effects of low level laser therapy on proliferation and differentiation of the cells contributing in bone regeneration.

Methods: To access relevant articles, an electronic search in PubMed was conducted from 2001 to April 2014. English language published papers on low level laser therapy were found using the selected keywords .The full texts of potentially suitable articles were obtained for final assessment according to the exclusion and inclusion criteria.

Results: 240 articles were found from 2001 to April 2014. Following the initial screening of titles and abstracts as well as the final screening of full texts, 22 articles completely fulfilled the inclusion criteria of this study. Wavelength used in LLLT irradiation varied between 600 to 1000 nm with an energy density of 0.04–60J/cm2. Although almost all studies agreed on getting positive effects from LLLT, some had opposing results.

Conclusion: Low level laser with low-energy density range appears to exert a biostimulatory effect on bone tissue, enhance osteoblastic proliferation and differentiation on cell lines used in in vitro studies. Despite the fact that many researches have been recently done on the effects of LLLT on different cell lines, without knowing the precise mechanism and effects, we are not able to offer a clinical treatment protocol. This paper is a beginning to help further progress and extend practical use of LLLT in future.

Original Article

Shear Bond Strength of the Repair Composite Resin to Zirconia Ceramic by Different Surface Treatments

Sakineh Arami, Masoumeh Hasani Tabatabaei, Fatemeh Namdar, Nassimeh Safavi, Nasim Chiniforush

Journal of Lasers in Medical Sciences, Vol. 5 No. 4 (2014), 24 September 2014, Page 171-175

Introduction: The purpose of this study is the evaluation of the amount of surface roughness (Ra) of Zirconia Ceramic following different surface treatments as well as the assessment of its shear bond strength to composite resin.

Methods: 40 sintered zirconia ceramic block samples were randomly divided in 4 groups of 10 and underwent the following surface treatments:

a) Control group without treatment

b) Air abrasion with Al2O3 particles (50um)

c) Er:YAG laser  with 2W power for 10s

d) Nd:YAG laser with 1.5W power for 2min

Then the mean surface roughness (Ra) was evaluated by profilometer. In the next step, Alloy primer was used on a section of 9mm2 on the samples following the manufacturer’s instructions. After that Clearfil AP-X composite resin in cylinder shape with an internal diameter and height of 3mm were cured on the sections mentioned. At the end, all samples were tested to assess the shear bond strength by the Universal Testing Machine at a speed of 0.5mm/min until fracture occurred. The mean shear bond strengths were calculated and statistically analyzed by One Way ANOVA.

Results:  ANOVA analysis showed that roughness (Ra) was significantly different between the groups (P≤0.05). Ra was higher in the Nd:YAG group compared to the other groups (P≤0.05). The lower Ra was related to the control group. Air abrasion group showed highest amounts of shear bond strength and Nd:YAG laser group demonstrated lower amounts of shear bond strength (P≤0.05).

Conclusion: Various surface treatments are differently effective on bond strength. Air abrasion is the most effective method to condition zirconia ceramic surfaces.

Monochromatic Infrared Photo Energy versus Low Level Laser Therapy in Patients with Knee Osteoarthritis

Tarek Abdel Rahman Ali Ammar

Journal of Lasers in Medical Sciences, Vol. 5 No. 4 (2014), 24 September 2014, Page 176-182

Introduction: Knee osteoarthritis (KO) is the most common joint disease for which there is no optimal treatment. Monochromatic infrared photo energy (MIPE) is a relatively new light modality used to reduce pain and increase circulation. Low Level Laser Therapy (LLLT) is another light modality used to reduce pain in KO.

Methods: The aim of this study was to compare the effects of the MIPE and LLLT in improving pain and function in KO. Sixty participants with KO completed the program and were randomly assigned into two groups. Group 1 (experimental, n=30) received MIPE and exercises. Group 2 (control, n=30) received LLLT and exercises. Both groups received two visits per week for six weeks. Outcome included pain intensity measured on a visual analogue scale and physical function measured with the lower extremity functional scale, before and after the 12 therapy sessions (6 weeks after the start of the intervention).

Results: There were statistically significant improvements in pain intensity and lower extremity functional scale scores (p<0.05) in each group. However, no significant differences were recorded between the groups (p>0.05).

Conclusion: Therefore, MIPE and LLLT reduce pain and improve function in KO; however, there are no differences between the two modalities in reducing pain and increasing physical function in KO.

Comparison of Micro-Leakage from Resin-Modified Glass Ionomer Restorations in Cavities Prepared by Er:YAG (Erbium-Doped Yttrium Aluminum Garnet) Laser and Conventional Method in Primary Teeth

Zahra Bahrololoomi, Foroughosadat Razavi, Ali Asghar Soleymani

Journal of Lasers in Medical Sciences, Vol. 5 No. 4 (2014), 24 September 2014, Page 183-187

Introduction: In recent years, significant developments have been taking place in caries removal and cavity preparation using laser in dentistry. As laser use is considered for cavity preparation, it is necessary to determine the quality of restoration margins. Glass ionomer cements have great applications for conservative restoration in the pediatric field.

The purpose of this in vitro study was to compare resin-modified glass ionomer restorations micro-leakage in cavities prepared by Er:YAG (Erbium-Doped Yttrium Aluminum Garnet) laser irradiation and conventional method in primary teeth.

Methods: This was an in vitro experimental study. Forty primary canine teeth were divided into 2 groups: group 1 represented cavities prepared by the no. 008 diamond bur, group 2 represented cavities prepared by Er:YAG laser. After cavity preparation, samples were restored by resin-modified glass ionomer. The teeth were thermocycled for 700 cycles, placed in 2% methylene blue for 24h and sectioned in the buccolingual direction. The degree of dye penetration was scored by 3 examiners. Data was analyzed using Mann-Whitney Test.

Results: There was no statistical difference in micro-leakage between the two modes of cavity preparation (P=0.862)

Conclusion: Since preparing conservative cavities is very important in pediatric dentistry, it is possible to use Er:YAG laser because of its novel and portable technology. However, further investigations of other restorative materials and other laser powers are required.

Comparison of Alexandrite and Diode Lasers for Hair Removal in Dark and Medium Skin: Which is Better?

Farhad Hamad Mustafa, Mohamad Suhimi Jaafar, Asaad Hamid Ismail, Kussay Nugamesh Mutter

Journal of Lasers in Medical Sciences, Vol. 5 No. 4 (2014), 24 September 2014, Page 188-193

Introduction: To improve laser hair removal (LHR) for dark skin, the fluence rate reaching the hair follicle in LHR is important. This paper presents the results of a comparative study examining the function of wavelength on dark skin types using 755 nm alexandrite and 810 nm diode lasers.

Methods: The structure of the skin was created using a realistic skin model by the Advanced Systems Analysis Program.

Result: In this study, the alexandrite laser (755 nm) and diode laser (810 nm) beam–skin tissue interactions were simulated. The simulation results for both lasers differed. The transmission ratio of the diode laser to the dark skin dermis was approximately 4% more than that of the alexandrite laser for the same skin type. For the diode laser at skin depth z = 0.67 mm, the average transmission ratios of both samples were 36% and 27.5%, but those for the alexandrite laser at the same skin depth were 32% and 25%.

Conclusion: Both lasers were suitable in LHR for dark skin types, but the diode laser was better than the alexandrite laser because the former could penetrate deeper into the dermis layer.

The Safety and Efficacy of the 1540nm Non-Ablative Fractional XD Probe of Star Lux 500 Device in the Treatment of Striae Alba: Before-After Study

Farhad Malekzad, Safoura Shakoei, Azin Ayatollahi, Somayeh Hejazi

Journal of Lasers in Medical Sciences, Vol. 5 No. 4 (2014), 24 September 2014, Page 194-198

Introduction: Striae distensae (SD) are a frequent skin condition for which treatment remains a challenge. The 1540-nm non-ablative fractional laser (Star Lux 500) has been shown to improve atrophic scars by increasing the amount of dermal collagen. To assess the safety and efficacy of the Star Lux 500 laser in the treatment of mature hypopigmented striae in Persian people (Striae Alba).

Methods: Ten women aged 26–50 years with SD and Fitzpatrick skin types III–V were enrolled in the study. The exclusion criteria were a history of keloids, photosensitivity and collagen, elastin disorders as well as history of other striae treatment within one year. The lesions were treated with non-ablative fractional laser 1540nm, and a total of four treatments were given at 4-week intervals. Clinical standard photographs were taken before each treatment. Also, patients were followed up at 3 months after the last treatment. Clinical improvement was assessed by comparing baseline and post-treatment photographs by two independent blinded physicians using grading scale. Treatment efficacy analysis was performed via the comparison between the images taken before and after each treatment session.

Results: There was a clinically appreciable improvement in striae ranging from 1 to 24%. A significant improvement in striae between the 16-week treatment and the 4-week treatment was identified (P<0.0001). Three months after the final treatment, patients showed noticeable improvement in the striae, compared with baseline (P<0.048). Mild post inflammatory hyperpigmentation was observed in one patient after the 8-week treatment and mild to moderate acne occurred in another patient after 4 weeks of treatment.

Conclusion: Therapy with Star lux 500 laser had clinically and statistically striae improvement with no adverse events. This may be a safe and an effective treatment modality for Striae Alba lesions.

Case Report

Pyogenic Granuloma: Surgical Treatment with Er:YAG Laser

Reza Fekrazad, Hanieh Nokhbatolfoghahaei, Farzaneh Khoei, Katayoon AM Kalhori

Journal of Lasers in Medical Sciences, Vol. 5 No. 4 (2014), 24 September 2014, Page 199-205

Introduction: Pyogenic granuloma (PG) is a common tumor-like growth of the oral cavity, considered to be of non-neoplastic nature, often caused by constant low-grade trauma as well as poor oral hygiene and maybe due to hormonal disturbances. Surgical excision, and removal of underlying cause in some cases, is the preferred method of treatment as it is only a benign lesion.

In order to remove this lesion, scalpel, cryosurgery and laser are used. Currently different lasers, with adequate parameters, are used for the surgery of PG, which include CO2 (Carbon Dioxide Laser), Nd:YAG (Neodymium-Doped Yttrium Aluminium Garnet), Diode and Er Family amongst others. In this present case, due to the proximity of the lesion with dental hard tissue, Er:YAG (Erbium-Doped Yttrium Aluminum Garnet) laser appears to be the more appropriate laser.

The application of Laser is also a newly recommended technique. The aim of this study is to assess the stages of treatment, recovery and recurrence of PG when the Er:YAG laser is used. Furthermore this study aims to also evaluate the friendliness of this method with regards to the surgeon (therapist).

Case report: A 24-year-old female was referred to the Laser Research Center of Dentistry of Tehran University of Medical Sciences with a complaint of gingival overgrowth and bleeding. This lesion was in the buccal and palatal side of the 5 and 6 maxillary teeth.

Treatment plan included an excisional biopsy of the lesion using Er:YAG laser (3W, 300mJ, 10Hz, Short pulse, with contact headpiece).

The bones were then cleaned of soft tissue before being smoothed using a curette.

The excised specimen was preserved and sent for histopathological examination.

Results: The patient reported no pain after surgery and did not use any systemic antibiotics.

The patient was satisfied after the surgery. Chlorhexidine mouthwash was given to the patient. Pathology results confirmed Pyogenic granuloma.

After 2 weeks, complete healing was observed. The 9-month follow-up was also carried out in order to check the process of healing as well as the recurrence.

Conclusion: Excisional surgery is the preferred treatment method for PG. The application of laser can be considered as an effective and safe technique for excision of this lesion with minimal invasion and many clinical advantages such as less intra-operative bleeding, hemostasis and reduced pain and times of healing.