August 2015 LITERATURE REVIEW

Compiled by Dr Igor Cernavin, Prosthodontist, Honorary Senior Fellow University of Melbourne School of Medicine, Dentistry and Health Sciences, Director and Cofounder of the Asia Pacific Institute of Dental Education and Research (AIDER), Australian representative of World Federation of Laser Dentistry (WFLD).

Canto et al1conducted a systematic review to evaluate the validity of intra-arch dimensional measurements made from laser-scanned digital dental models in comparison with measurements directly obtained from the original plaster casts (gold standard). Their conclusion was that the selected studies consistently agreed that the validity of measurements obtained after using a laser scanner from plaster models is similar to direct measurements. Any stated differences would unlikely be clinically relevant.

Doeuk and coworkers2 conducted a literature review of the effect of low level laser treatment on a variety of oral and maxillofacial conditions. Their abstract is reproduced in full.

“Low level laser treatment (LLLT) is currently being used for various disorders, but with no convincing scientific evidence. Most recently we have noticed an increase in published randomised controlled trials (RCTs) that have focused on its applications in wound healing, scarring, disorders of the temporomandibular joint (TMJ), oral mucositis, and dental pain. Our aim therefore was to assess the scientific evidence about its current efficacy in maxillofacial surgery. We reviewed PubMed from January 2003 to January 2013 using the key phrase “low level laser treatment”. Our inclusion criterion was intervention studies in humans of more than 10 patients. We excluded animal studies and papers in languages other than English, French, and German. We found 45 papers that we screened independently. The resulting full texts were scrutinised by two authors who awarded a maximum of 5 points using the Jadad scale for assessing the quality of RCT, and extracted the data according to sample size, variables of LLLT, the authors’ conclusions, and the significance of the result. LLLT seems to be effective for the treatment of oral mucositis after treatment for head and neck cancer. However, it cannot yet be considered a valid treatment for disorders of the TMJ. It seems to improve gingival healing, and myofacial and dental pain.”

Desidera et al3 investigated whether low-level laser therapy altered the expression and activity of MMP-2 and MMP-9 in the trigeminal ganglion during different stages of temporomandibular joint inflammation in rats. It also evaluated whether LLLT modifies mechanical allodynia and orofacial hyperalgesia. They found that Low-level laser therapy could constitute an adjuvant therapy to treat temporomandibular disorders and prevent inflammation-induced alterations in the levels of MMP-2 and MMP-9 and in the gelatinolytic activity in TMG’s.

Belcheva and coworkers4 published a good general review article on Paediatric dentistry and the Er:YAG laser.

Engelbach et al5 investigated the efficiency of caries removal employing an ultrashort pulsed laser and found that caries removal seemed to be much more efficient.

Aldelaimi et al6. examined the surgical use of diode lasers using the Chirolas 20 W diode laser emitting at 980 nm. Their preliminary clinical findings included sufficient hemostasis, coagulation properties, precise incision margin, lack of swelling, bleeding, pain, scar tissue formation and overall satisfaction in the clinical application. It proved to be of beneficial effect for daily practice and considered practical, effective, easy to use, offered a safe, acceptable, and impressive alternative for conventional surgical techniques.

Bhat and coworkers7 evaluated the soft tissue marginal stability achieved after excision with a conventional technique when compared with laser excision. The concluded that the soft tissue margins are more stable and stayed at the point they were excised with lasers when compared with scalpel.

Smiley et al8 present an evidence-based clinical practice guideline on nonsurgical treatment of patients with chronic periodontitis by means of scaling and root planning with or without adjuncts. The abstract is reproduced in full.

BACKGROUND: A panel of experts convened by the American Dental Association Council on Scientific Affairs presents an evidence-based clinical practice guideline on nonsurgical treatment of patients with chronic periodontitis by means of scaling and root planing (SRP) with or without adjuncts. METHODS: The authors developed this clinical practice guideline according to the American Dental Association’s evidence-based guideline development methodology. This guideline is founded on a systematic review of the evidence that included 72 research articles providing clinical attachment level data on trials of at least 6 months’ duration and published in English through July 2014. The strength of each recommendation (strong, in favor, weak, expert opinion for, expert opinion against, and against) is based on an assessment of the level of certainty in the evidence for the treatment’s benefit in combination with an assessment of the balance between the magnitude of the benefit and the potential for adverse effects. PRACTICAL IMPLICATIONS AND CONCLUSIONS: For patients with chronic periodontitis, SRP showed a moderate benefit, and the benefits were judged to outweigh potential adverse effects. The authors voted in favor of SRP as the initial nonsurgical treatment for chronic periodontitis. Although systemic subantimicrobial-dose doxycycline and systemic antimicrobials showed similar magnitudes of benefits as adjunctive therapies to SRP, they were recommended at different strengths (in favor for systemic subantimicrobial-dose doxycycline and weak for systemic antimicrobials) because of the higher potential for adverse effects with higher doses of antimicrobials. The strengths of 2 other recommendations are weak: chlorhexidine chips and photodynamic therapy with a diode laser. Recommendations for the nonsurgical use of other lasers as SRP adjuncts were limited to expert opinion against, because there was uncertainty regarding their clinical benefits and benefit-to-adverse effects balance. Note that expert opinion for does not imply endorsement but instead signifies that evidence is lacking and the level of certainty in the evidence is low.

Spivakovsky9 looked at conference proceedings and the literature to conclude that prophylactic LLLT reduced severe mucositis and pain in patients with cancer.

Medeiroset et al10 assessed the effects of low-level laser irradiation vs ultrasound irradiation on bone healing after distraction osteogenesis. They found that bone healing is accelerated with the application of laser irradiation and that the greatest effects were observed with combined ultrasound and laser treatment.

Abd-Elaal and coworkers11 evaluated the effect of low-level laser therapy on new bone formation obtained by distraction osteogenesis in the early consolidation period. They concluded that the use of LLLT on distracted bone increased the quality and quantity of bone and shortened the consolidation period, allowing early removal of the distractor and resulting in decreased morbidity and relapse.

Dos Reis et al12 evaluated by microbiological and histological analysis, the effects of Photodynamic Antimicrobial Chemotherapy on tibial surgical bone defects in rats infected by Staphylococcus aureus. They found that Photodynamic Antimicrobial Chemotherapy using toluidine blue was effective in reducing the number of S. aureus enabling a better quality bone repair.

Poli and coworkers13 evaluated those techniques and optimal parameters of Erbium Chromium Yttrium Scandium Gallium Garnet (Er,Cr:YSGG) laser use in delivering predictable painless (or with very limited discomfort) restorative cavity preparation without the aid of injected local anesthesia. They found that using these parameters the treatment was effective in a high number of cases (80%), leading to reduction in the anxiety frequently associated with dental care.

Paglia et al14 present a case of mucocele in a three-month-old infant in the right labial commissure excised by diode laser of different wavelengths (635-980 nm), with an average power of 1.8 W, in continuous wave mode, using 300 to 320 micron optical fibers. The healing occurred in 10 days. There were no adverse effects and the patient was carefully followed-up until complete healing. They conclude that the diode laser is not only a valuable tool for mucocele eradication but it also reduces relapses, thanks to the characteristics of the laser light.

Al Habashneh15 and coworkers provide a review of Photodynamic therapy in periodontal and peri-implant diseases and conclude that periodontal diseases and peri-implantitis are among the specific targets where PDT can be applied.

References
1. Canto, G De Luca; Pacheco-Pereira, C; Lagravere, M O; Flores-Mir, C; Major, P W. Intra-arch dimensional measurement validity of laser-scanned digital dental models compared with the original plaster models: a systematic review. Orthodontics & craniofacial research, 18 (2):65-76; 10.1111/ocr.12068 2015-May.
2. Doeuk, C; Hersant, B; Bosc, R; Lange, F; SidAhmed-Mezi, M; Bouhassira, J; Meningaud, J P. Current indications for low level laser treatment in maxillofacial surgery: a review. The British journal of oral & maxillofacial surgery, 53 (4):309-15;0.1016/j.bjoms.2015.02.005 2015-Apr.
3. Desidera, A C; Nascimento, G C; Gerlach, R F; Leite-Panissi, Cra. Laser therapy reduces gelatinolytic activity in the rat trigeminal ganglion during temporomandibular joint inflammation. Oral diseases, 21 (5):652-8; 10.1111/odi.12330 2015-Jul.

4. Belcheva A, Shindova M, Tomov G. Preventive approach in paediatric dentistry using Er:YAG laser. Laser international magazine of Laser Dentistry, Vol 7, pp 6-15 Issue 2/2015.
5. Engelbach, Christoph; Dehn, Claudia; Bourauel, Christoph; Meister, Jorg; Frentzen, Matthias. Ablation of carious dental tissue using an ultrashort pulsed laser (USPL) system. Lasers in medical science, 30 (5):1427-34; 10.1007/s10103-014-1594-4 2015-Jul.
6. Aldelaimi, Tahrir N; Khalil, Afrah A. Clinical Application of Diode Laser (980 nm) in Maxillofacial Surgical Procedures. The Journal of craniofacial surgery, 26 (4):1220-3; 10.1097/SCS.0000000000001727 2015-Jun.
7. Bhat, Pragathi; Thakur, Srinath L; Kulkarni, Sudhindra S. Evaluation of soft tissue marginal stability achieved after excision with a conventional technique in comparison with laser excision: A pilot study. Indian journal of dental research : official publication of Indian Society for Dental Research, 26 (2):186-8; 10.4103/0970-9290.159159 2015 Mar-Apr.
8. Smiley, Christopher J; Tracy, Sharon L; Abt, Elliot; Michalowicz, Bryan S; John, Mike T; Gunsolley, John; Cobb, Charles M; Rossmann, Jeffrey; Harrel, Stephen K; Forrest, Jane L; Hujoel, Philippe P; Noraian, Kirk W; Greenwell, Henry; Frantsve-Hawley, Julie; Estrich, Cameron; Hanson, Nicholas. Evidence-based clinical practice guideline on the nonsurgical treatment of chronic periodontitis by means of scaling and root planing with or without adjuncts. Journal of the American Dental Association (1939), 146 (7):525-35; 10.1016/j.adaj.2015.01.026 2015-Jul.
9. Spivakovsky S. Low level laser therapy may reduce risk of oral mucositis. Evidence-based dentistry, 16 (2):49; 10.1038/sj.ebd.6401095 2015-Jun.
10. Medeiros, Myrla Alves Barros; do Nascimento, Leonard Euler Andrade Gomes; Lau, Thiago Chon Leon; Mineiro, Ana Lys Bezerra Barradas; Pithon, Matheus Melo; Sant’Anna, Eduardo Franzotti. Effects of laser vs ultrasound on bone healing after distraction osteogenesis: A histomorphometric analysis. The Angle orthodontist, 85 (4):555-61; 10.2319/061414-431.1 2015-Jul.
11. Abd-Elaal, A Z; El-Mekawii, H A; Saafan, A M; El Gawad, L A; El-Hawary, Y M; Abdelrazik, M A. Evaluation of the effect of low-level diode laser therapy applied during the bone consolidation period following mandibular distraction osteogenesis in the human. International journal of oral and maxillofacial surgery, 44 (8):989-97; 10.1016/j.ijom.2015.04.010 2015-Aug.
12. Dos Reis, Joao Alves Jr; Dos Santos, Jean Nunes; Barreto, Brunna Santos; de Assis, Patricia Nascimento; Almeida, Paulo Fernando; Pinheiro, Antonio Luiz Barbosa. Photodynamic Antimicrobial Chemotherapy (PACT) in osteomyelitis induced by Staphylococcus aureus: Microbiological and histological study. Journal of photochemistry and photobiology. B, Biology, 149 235-42; 10.1016/j.jphotobiol.2015.06.005 2015-Aug.
13. Poli, Riccardo; Parker, Steven. Achieving Dental Analgesia with the Erbium Chromium Yttrium Scandium Gallium Garnet Laser (2780nm): A Protocol for Painless Conservative Treatment. Photomedicine and laser surgery, 33 (7):364-71; 10.1089/pho.2015.3928 2015-Jul.
14. Paglia, M; Crippa, R; Ferrante, F; Angiero, F. Mucocele of the minor salivary glands in an infant: treatment with diode laser. European journal of paediatric dentistry : official journal of European Academy of Paediatric Dentistry, 16 (2):139-42; 2015-Jun.
15. Al Habashneh, Rola; Asa’ad, Farah A; Khader, Yousef. Photodynamic therapy in periodontal and peri-implant diseases. Quintessence international (Berlin, Germany : 1985), 46 (8):677-90; 10.3290/j.qi.a34078 2015.

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