Review Article

Laser-Aided Ceramic Bracket Debonding: A Comprehensive Review

Rezvaneh Ghazanfari, Hanieh Nokhbatolfoghahaei, Marzieh Alikhasi

Journal of Lasers in Medical Sciences, Vol. 7 No. 1 (2016), 26 January 2016, Page 2-11

Different techniques have been introduced for the removal of ceramic brackets. Since the early 1990s, lasers have been used experimentally for debonding ceramic brackets. The goal of this study is to give a comprehensive literature review on laser-aided ceramic bracket debonding. PubMed and Google Scholar databases were used to identify dental articles with the following combination of key words: Ceramic brackets, Debonding, and Laser. Sixteen English articles from 2004 to 2015 were selected. The selected studies were categorized according to the variables investigated including the intrapulpal temperature, shear bond strength, debonding time, enamel damage and bracket failure. Most articles reported decreased shear bond strength and debonding time following laser irradiation without any critical and irritating increase in pulpal temperature. There were no reports of bracket failure or enamel damage. Laser irradiation is an efficient way to reduce shear bond strength of ceramic bracket and debonding time. This technique is a safe way for removing ceramic bracket with minimal impact on intrapulpal temperature and enamel surface and it reduces ceramic bracket failure.

Original Article

Outpatient Transurethral Cystolithotripsy of Large Bladder Stones by Holmium Laser

Hosein Karami, Moahammad Reza Razaghi, Babak Javanmard, Mohammad Yaghoobi, Amin Hasanzadeh Hadad, Maryam Amani, Amin Golmohammadi Taklimi

Journal of Lasers in Medical Sciences, Vol. 7 No. 1 (2016), 26 January 2016, Page 5-12

Introduction: To assessment of the efficacy and safety of transurethral cystolithotripsy of large bladder stones by holmium laser in the outpatient setting.

Methods: In a prospective study, 48 consecutive adult patients with large bladder stones, were enrolled for transurethral cystolithotripsy. Patients older than 18 years, with bladder stones larger than 2 cm were enrolled. Urethral stricture, active urinary infection, and any anesthetic contraindications for operation, were the exclusion criteria. Demographic characteristics of patients, outcomes and complications related to operation and post operation period, were recorded.

Results: Patients mean age was 46 ± 7.3 years. Male to female ratio was 45/3. Mean body mass index of patients was 28.5 ± 3.5. Mean stone size was 3.7 ± 1.6 cm. Mean operation time was 43.5 ± 15.5 minutes. Nearly complete stone clearance (98.5%) was achieved in all patients. Mean hospital stay was 6.5 ± 1.3 hours. No major complications were seen. Mean visual analog pain score (VAS) was 4.2 ± 2.1 and 1.4 ± 0.6, during and 1 hour after operation, respectively. During follow up of 22.4 ± 12.5 months, recurrence of bladder stone was not seen. No case of urethral stricture was detected.

Conclusion: Transurethral holmium laser lithotripsy is an effective and safe alternative in selected patients with large bladder stones. This procedure can be easily performed in the outpatient setting.

Evaluation of the Effects of Intravenous and Percutaneous Low Level Laser Therapy in the Management of Shoulder Myofascial Pain Syndrome

Sirous Momenzadeh, Vahid Akhyani, Zahra Razaghi, Asghar Ebadifar, Mohammadzaki Abbasi

Journal of Lasers in Medical Sciences, Vol. 7 No. 1 (2016), 26 January 2016, Page 16-20

Introduction: Myofascial pain syndrome (MPS) treatment is challenging with a high recurrence rate and still lacks a clear treatment frame. Therefore research on new, more efficient and long lasting effect treatment modalities is necessary. This study looked at the effects of intravenous laser therapy (IVL) and percutaneous low level laser (PLLL) in the management of shoulder MPS.

Methods: In this randomized controlled trial, 30 patients fulfilling inclusion criteria were randomly equally allocated to 3 groups, control, IVL and PLLL. Control group received 12 sessions of placebo low level laser, IVL group received 12 sessions of IVL therapy, and PLLL group received 12 sessions of PLLL therapy. All patients were trained for better body posture, body mechanics, gentle massage of trigger points, stretching exercises of affected muscle (trapezius), and received 10 mg of oral nortriptyline regimen every night for 3 months. Outcomes included pain severity, functional disability, and quality of life. Patients were assessed using Numeric Rating Scale (NRS), Pain Disability Index (PDI), and Short Form Health Survey (SF-12). Data collected were analyzed using analysis of variance (ANOVA), Mann-Whitney and t tests.

Results: The mean of PDI and maximum pain intensity during day and night significantly reduced in both PLLL and IVL groups compared to control group. Although pain severity and PDI reduction was more pronounced in IVL group compared to PLLL group, the differences were not statistically significant. Also, quality of life statistically significantly improved in both IVL and PLLL groups compared to control group was more, and although higher in IVL group, the difference was not statistically significant when compared to PLLL group. No side effects were observed in the intervention groups.

Conclusion: Intravenous laser and PLLL therapy had a positive effect on pain severity and PDI reduction, and quality of life in this study. Also no adverse event was recorded. Thus, intravenous lasers and PLLL therapy seem to be effective complementary modalities in managing patients with shoulder MPS.

An In Vitro Comparison of Antimicrobial Effects of Curcumin-Based Photodynamic Therapy and Chlorhexidine, on Aggregatibacter actinomycetemcomitans

Shamsoulmolouk Najafi, Mina Khayamzadeh, Mojgan Paknejad, Golfam Poursepanj, Mohammad Javad Kharazi Fard, Abbas Bahador

Journal of Lasers in Medical Sciences, Vol. 7 No. 1 (2016), 26 January 2016, Page 21-25

Introduction: Considering the importance of prevention in periodontal diseases and the important role of Aggregatibacter actinomycetemcomitans in induction and progression of these diseases, the aim of the present in vitro study was to compare the antimicrobial effects of chlorhexidine digluconate (CHX), curcumin and light-emitting diode (LED) laser, on this bacterium.

Methods: Antimicrobial activity of curcumin (5 mg/ml), CHX (2%), LED (120 J/cm2) and LED + curcumin (120 J/cm2 + 2.5 mg/ml) against A. actinomycetemcomitans were tested in vitro, using micro-broth dilution test. One-way analysis of variance (ANOVA) and Tukey’s HSD tests served for statistical analysis.

Results: Regarding the minimum inhibitory concentration (MIC), CHX had a significantly lower MIC than curcumin (P < 0.05). Sorted out by bacterial growth from lowest to highest, were CHX, LED + curcumin, curcumin, and LED groups. All the differences were found to be statistically significant (P < 0.05) except for the LED group.

Conclusion: We conclude that curcumin is an effective substance in preventing the growth of A. actinomycetemcomitans, whose impact is reinforced when used simultaneously with photodynamic therapy (PDT).

The Effect of One Session Low Level Laser Therapy of Extracted Follicular Units on the Outcome of Hair Transplantation

Seyed Mehdi Tabaie, Hoda Berenji Ardestani, Mir Hadi Azizjalali

Journal of Lasers in Medical Sciences, Vol. 7 No. 1 (2016), 26 January 2016, Page 26-29


Introduction: Photobiostimulation with low level laser (LLL) has been used in medicine for a long time and its effects have been shown in many diseases. Some studies have evaluated the effect of LLL on androgenic alopecia. One of the most important limitations of the use of LLL in the treatment of alopecia is the requirement for multiple sessions, which is hardly accepted by patients. This study was conducted to evaluate the effect of the irradiation of extracted follicular hair units by LLL on the outcome of hair transplantation.

Methods: We enrolled 10 patients with androgenic alopecia and after screening tests for infections and other diseases, we extracted hair follicular units. The hair units were divided in two groups. One group was irradiated by LLL 20 minutes before transplantation (660 nm, 80 Hz, 100 mW) and the other one was used as control. The containing plates were labeled as A and B and sent to the operation room. The surgeon was unaware of the therapy assigned to the plates and transplanted them randomly on the right or left side of the head. One hundred follicular units on each sides of the scalp were transplanted symmetrically. The follicles on both sides were evaluated at 3 and 6 months of transplantation for hair growth rate by another physician, blinded to the treatment assigned to each side.

Results: Ten patient with androgenic alopecia and mean (SD) age of 31.5 (6.6) years (range 25-45 years) completed the study. All patients had 100% hair growth at 3 and 6 months follow-up except one who had hair growth of 20% at three months of transplantation, which changed to 100% at sixth months. There was no significant difference between the groups regarding hair growth (P > 0.8).

Conclusion: One session of LLL irradiation has no significant effect on the outcome of transplanted hair follicles. Studies with larger sample size are needed to draw a definite conclusion.

Photodynamic Therapy – A Non-invasive Treatment Modality for Precancerous Lesions

Kotya Naik Maloth, Nagalaxmi Velpula, Srikanth Kodangal, Mithare Sangmesh, Kiran Vallamchetla, Sridevi Ugrappa, Nagajyothi Meka

Journal of Lasers in Medical Sciences, Vol. 7 No. 1 (2016), 26 January 2016, Page 30-36

Introduction: Oral premalignant lesions are conditions having high potential tendency for transformation into malignancy. The use of a conservative and effective treatment modality is one of the best strategies for cancer prevention. Photodynamic therapy (PDT) is a non-invasive method for topical and selective treatment of oral precancerous lesions. The present study was taken up to determine the efficacy of PDT in oral precancerous lesions.

Methods: The study consisted 13 patients with 24 oral leukoplakia (OL) lesions and 8 with 20 oral lichen planus (OLP) lesions, divided into control and study groups. These lesions were affecting various intraoral sites, the buccal mucosa being the most common site followed by tongue and gingiva. The treatment regimen of PDT included 98% 5–aminolevulinic acid (5-ALA) which is topical applied and irradiated with light emitting diode (LED) of 420 nm wavelengths at several sessions.

Results: In OL 16.6% of cases showed complete response, 66.6% partial response and 16.6% no response of the lesions to the treatment. In OLP 80% and 20% of the lesions showed partial and no response respectively. The differences with control groups for OL + OLP were found to be significant (P < 0.001).

Conclusion: Based on the results of the present study, we can conclude that PDT appears to be a feasible alternative to conventional therapy for oral premalignant lesions.

Surface Treatment by Different Parameters of Erbium:Yttrium–Aluminum–Garnet (Er:YAG) Laser: Scanning Electron Microscope (SEM) Evaluation

Nasim Chiniforush, Hanieh Nokhbatolfoghahaei, Abbas Monzavi, Edris pordel, Sajjad Ashnagar

Journal of Lasers in Medical Sciences, Vol. 7 No. 1 (2016), 26 January 2016, Page 37-39

Introduction: This study aimed to assess the Scanning Electron Microscope (SEM) analysis of tooth surface irradiated by erbium:yttrium–aluminum–garnet (Er:YAG) laser with various parameters.

Methods: Number of 25 extracted human third molars free of caries were used in this study. The teeth were put into 5 groups for laser irradiation as follows: group 1 (power: 0.5 W, Energy: 50 mJ); group 2 (power: 1 W, Energy: 100 mJ); group 3 (power: 1.5 W, Energy: 150 mJ); group 4 (power: 2 W, Energy: 200 mJ); group 5 (power: 2.5 W, Energy: 250 mJ). All samples were prepared by repetition rate of 10 Hz and duration of 230 μs, using a non-contact handpiece at a distance of 4 mm. Then, the samples were prepared for SEM examination.

Results: SEM evaluation of every 25 samples, treated by Er:YAG, showed that all groups had exposed dentinal tubules without any melted area or cracks.

Conclusion: In this study we used SEM to investigate ablated dentine with different parameters of Er:YAG laser energy. Our findings support these conclusions. All powers of laser below 3 W are proper for ablation, and make no cracks.

Effects of Neodymium-Doped Yttrium Aluminium Garnet (Nd:YAG) Laser Irradiation on Bone Metabolism During Tooth Movement

Yuji Tsuka, Tadashi Fujita, Maya Shirakura, Ryo Kunimatsu, Shao-Ching Su, Eri Fujii, Kotaro Tanimoto

Journal of Lasers in Medical Sciences, Vol. 7 No. 1 (2016), 26 January 2016, Page 40-44

Introduction: The aim of this study is to evaluate the effects of low-level neodymium-doped yttrium aluminium garnet (Nd:YAG) laser irradiation on orthodontic tooth movement and histological examination.

Methods: Eleven male Wistar rats (aged 10 weeks) were included. To produce experimental tooth movement in rats, 10 g force was applied to maxillary first molars with nickel titanium closed coil springs. Right molars were irradiated with Nd:YAG laser on days 0, 1, 2, 3, 7, 10, 14, 17, 21 and 24, while un-irradiated left molars were used as control. Distance between mesial side of second molar and distal side of first molar was measured on μCT image during tooth movement and the rats were sacrificed 4 weeks after the initiation of tooth movement.

Results: The amount of tooth movement was significantly greater in the irradiation group (0.20 ± 0.06) than in the control group (0.14 ± 0.03) during the first week (P < 0.05). However, no statistically significant difference was found afterwards. There was a tendency of higher tartrate-resistant acid phosphatase (TRAP)-positive nuclei count in the pressure zones of the laser irradiation group, but it was not statistically significant. In immuno-histological examination, expressions of alkaline phosphatase (ALP) and receptor activator of nuclear factor kappa-B ligand (RANKL) were higher at the pressure site of the laser irradiation group than the control group, whereas there was no difference in osteoprotegerin (OPG) expression.

Conclusion: The results suggest that low-level Nd:YAG laser may stimulate osteoclast and osteoblast activation and accelerate bone metabolism during tooth movement.

Low Level Laser Therapy Versus Pharmacotherapy in Improving Myofascial Pain Disorder Syndrome

Hamid Reza Khalighi, Hamed Mortazavi, Seyed Masoud Mojahedi, Saranaz Azari Marhabi, Faranak Moradi Abbasabadi

Journal of Lasers in Medical Sciences, Vol. 7 No. 1 (2016), 26 January 2016, Page 45-50

Introduction: Temporomandibular disorders (TMD) lead to masticatory muscle pain, jaw movement disability and limitation in mouth opening. Pain is the chief complaint in 90% of the TMD patients which leads to disability and severe socioeconomic costs. The purpose of this study was to evaluate the therapeutic effects of low level laser therapy (LLLT) compared to pharmacotherapy with NSAIDs (naproxen) in myofascial pain disorder syndrome (MPDS).

Methods: In this randomized controlled clinical trial, 40 MPDS patients were divided into two groups. One group received naproxen 500 mg bid for 3 weeks as treatment modality and also had placebo laser sessions. The other group received active laser (diode 810 nm CW) as treatment and placebo drug. Pain intensity was measured by visual analogue scale (VAS) and maximum painless mouth opening was also measured as a functional index every session and at 2 months follow up. Data was collected and analyzed with SPSS software. Independent t test was used to analyze the data. A P < 0.05 was considered significant.

Results: Low level laser caused significant reduction in pain intensity (P < 0.05) and a significant increase in mouth opening. In naproxen group neither pain intensity nor maximum mouth opening had significant improvement. Pain relief, in subjective VAS was observed in third session in LLLT group, but did not occur in naproxen group. Maximum mouth opening increased significantly in laser group compared to the naproxen group from the eighth session.

Conclusion: Treatment with LLLT caused a significant improvement in mouth opening and pain intensity in patients with MPDS. Similar improvement was not observed in naproxen group.

Influence of Different Proportions of External Irrigation During the Er,Cr:YSGG Laser Irradiation on Wear and Roughness of Root Surface

Guilherme José Pimentel Lopes de Oliveir, Felipe Eduardo Pinotti, Heglécia da Luz Carvalho, Cássio Rocha Scardueli, Rosemary Adriana Chiérici Marcantonio

Journal of Lasers in Medical Sciences, Vol. 7 No. 1 (2016), 26 January 2016, Page 51-55

Introduction: The aim of this study was to evaluate the influence of different levels of external irrigation during irradiation with an erbium, chromium: yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser on the roughness and wear of dental tissue during scaling procedures.

Methods: Twenty-Five uniradicular bovine teeth had the proximal surfaces planed and divided into 3 regions: upper, middle and lower. The upper region was treated with hand instruments, the middle region was not treated and served as a control, and the lower region was treated by the Er,Cr:YSGG laser. The teeth were randomly divided into five groups according to the different proportions of external irrigation used during the laser irradiation: G1: 10%; G2: 20%; G3: 30%; G4: 40% and G5: 50%. The samples were analyzed for roughness and wear on the root surface irradiated with the laser.

Results: There were no differences in the surface roughness and wear parameters between the groups irradiated with the laser, but the laser irradiation produced a rougher surface of the dentin than treatment with hand scaling.

Conclusion: Changes in the external irrigation level did not influence the wear and roughness of root surfaces treated with an Er,Cr:YSGG laser

Case Report

Management of a Recurrent Pyogenic Granuloma of the Hard Palate with Diode Laser: A Case Report

Güzin Neda Hasanoglu Erbasar, Burcu Senguven, Sibel Elif Gultekin, Sedat Cetiner

Journal of Lasers in Medical Sciences, Vol. 7 No. 1 (2016), 26 January 2016, Page 56-61

Introduction: Pyogenic granuloma (PG) is a prevalent inflammatory hyperplasia of skin and oral mucosa which is often caused by constant low-grade local irritation, traumatic injury or hormonal factors. In many cases, gingival irritation and inflammation due to poor oral hygiene are precipitating factors. Oral PG occurs predominantly on the gingiva, but it is also encountered on the lips, tongue, buccal mucosa and rarely on the hard palate. Although surgical excision is the first choice of treatment, many other treatment modalities could be counted such as cryosurgery, sodium tetradecyl sulfate sclerotherapy, intralesional steroids, flash lamp pulsed dye laser, neodymium-doped yttrium aluminium garnet (Nd:YAG) laser, carbon dioxide (CO2) laser, erbium-doped yttrium aluminum garnet (Er:YAG) lasers and diode laser have been suggested. After surgical excision recurrence occurs up to 16% of these lesions. It is believed that recurrence ensues as a result of incomplete excision, failure to eliminate etiologic factors or repeated trauma.

Case Report: A 50-year-old female was referred to the Department of Oral Surgery, Gazi University, School of Dentistry, complaining of a swelling and growth on the right side of the hard palate for four months. Patient reported a similar growth in the same area about two years earlier, which had turned out to be a PG by histopathology. The treatment plan included surgical excision of the lesion using diode laser.

Results: The patient reported no pain after the surgery. She was discharged with a prescription of chlorhexidine mouthwash and necessary post-operative instructions. At 7 days follow up visit, immediate recurrence of the lesion was observed, and it was excised by diode laser with 2 mm margins at its clinical periphery, to a depth up to the periosteum, by the same operator. No recurrence or scarring was observed in 14 months follow-up.

Conclusion: Although diode laser is a secure and efficient technique for the treatment of intraoral PG, in order to minimize its recurrence, the lesion should be excised with a wider margin down to the periosteum or to the causing agent. Also due to its high recurrence rate, long-term follow-up is recommended.