Application of Low Level Laser in Temporomandibular Disorders

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

Can Antimicrobial Photodynamic Therapy (aPDT) Enhance the Endodontic Treatment?

  In order to achieve a long-lasting effect, one of the main goals in root canal treatment is to eliminate the endodontic bacteria. Conventional chemomechanical debridement is considered as the basic treatment in root canal therapy, but adjunctive techniques such as antimicrobial photodynamic therapy (aPDT) can also be helpful. The aim of this study was to evaluate reports in the scientific literature that used different photosensitizers (PSs) for bacterial reduction. The literature search was conducted using databases including PubMed, Scopus, and Google Scholar with the keywords “photodynamic therapy,” “antimicrobial photodynamic therapy,” or “photoactivated disinfection” and “endodontic,” “Enterococcus faecalis,” or “root canal treatment,” from 2000 to 2015. By evaluating different studies, it was concluded that aPDT should be applied in combination with conventional mechanical debridement and irrigants. However, it is also important to note that the success rate is critically dependent on the type of the PS, output power of the laser used, irradiation time, pre-irradiation time, and type of tips used.  

Assessment of the Photobiomodulation Effect of a Blue Diode Laser on the Proliferation and Migration of Cultured Human Gingival Fibroblast Cells: A Preliminary In Vitro Study

Introduction: Photobiomodulation therapy (PBM) is emerging as an effective strategy for the management of wound healing. The application of red and near infra-red light sources in laser therapy has been the subject of most researches in recent literature. Considering the lack of sufficient evidence in assessing the blue light in PBM, we aimed to investigate the photobiomodulation effect of a blue diode laser on the proliferation and migration of cultured human gingival fibroblast cells as a preliminary in vitro study.Methods: Human gingival fibroblast cells were irradiated with a blue diode laser at a 445 nm wavelength. Irradiation was done using three different powers of 200 mW (irradiation times of 5, 10,15, and 20 seconds); 300 mW (irradiation times of 5, 10, and 15 seconds); and 400 mW (irradiation times of 5 and 10 seconds). The fibroblast cells without laser exposure were considered as control. After 24 hours of incubation, the MTT assay and the wound scratch test were performed on the cells to investigate the biomodulation effect of the blue laser on the proliferation and migration of the cells respectively. The results were analyzed by one-way ANOVA and a post-hoc Tukey test with a P value <0.05 as a statistical significance level.Results: PBM with blue diode laser at power densities of 400 mW/cm2 with irradiation times of 10 and 15 seconds corresponding to energy densities of 4 and 6 J/cm2 exerted the statistically significant positive effect on both proliferation and migration of gingival fibroblast cells.Conclusion: Considering the encouraging findings of this study, PBM with blue diode laser can promote proliferation and migration of human gingival fibroblasts, the key cells involved in the process of oral wound healing

Healing of large periapical lesions following delivery of dental stem cells with an injectable scaffold: New method and three case reports

Regenerative endodontics is the creation and delivery of tissues to replace diseased, missing, and traumatized pulp. A call for a paradigm shift and new protocol for the clinical management of these cases has been brought to attention. These regenerative endodontic techniques will possibly involve some combination of disinfection or debridement of infected root canal systems with apical enlargement to permit revascularization and use of stem cells, scaffolds, and growth factors. Mesenchymal stem cells (MSCs) have been isolated from the pulp tissue of permanent teeth (dental pulp stem cells (DPSCs)) and deciduous teeth (stem cells from human exfoliated deciduous teeth). Stem cells are characterized as multipotent cells for regeneration.These three case reports describe the treatment of necrotic or immature teeth with periradicular periodontitis, which was not treated with conventional apexification techniques. All cases presented here developed mature apices and bone healing after 3 to 4 months after the initial treatment without complications, and faster than traditional treatments. Our clinical observations support a shifting paradigm toward a biologic approach by providing a favorable environment for tissue regeneration. The mechanism of this continued development and formation of the root end and faster tissue healing is discussed