Laser Assisted Treatment of Extra Oral Cutaneous Sinus Tract of Endodontic Origin: A Case Report

Introduction: Sinus tracts (or fistulas) are a common manifestation of pulpal necrosis that requires conventional or rarely surgical- endodontic treatment in order to heal. They are mainly identified intraorally and in rare cases they manifest extraorally which may frequently be misdiagnosed and incorrectly treated. New technologies such as lasers have been developed as adjuncts to standard endodontic antimicrobial procedures in order to increase the success rate of endodontic therapy and complying the desire of saving a natural tooth.Case presentation: Herein, we present a clinical case of extra oral sinus tract with Periodic pus drainage that was successfully treated by combining   conventional endodontic therapy, intra canal PDT and extra oral low level laser therapy.Results and conclusion: Treatment of the odontogenic lesion among with the extra oral lesion was an ingenious and successful technique which was achieved by laser technology and winded up to patient’s consent and satisfactory results of treatment

Effect of Diode Laser (810 nm) Irradiation on Marginal Microleakage of Multi-mode Adhesive Resins in Class V Composite Restorations

Introduction: Some studies have shown that laser irradiation on unpolymerized adhesives can improve composite-dentin adhesion. The aim of the present study was to evaluate the effect of the Diode laser (810 nm) on the microleakage of multi-mode adhesive systems at enamel and dentin margins of composite restorations.Methods: Classic Class V boxes were prepared on 48 sound premolar teeth and randomly divided into six groups (n=16). In the control groups, Scotch bond U(SBC), G-Premio (GBC), and Ambar U (AMC) were used by a self-etch mode. In the test groups (SBL, GBL, ABL), the 810 nm Diode laser was irradiated (1 Watt) for 10 seconds before the polymerization of the adhesive. The Boxes were restored by the resin composite. After finishing and polishing, the samples were thermocycled (5℃ to55℃) for 1000 cycles and then immersed in 0.1% Methylene blue dye (48 hours). Dye penetration through the gingival and occlusal margins was measured by Stereomicroscope. The data were analyzed at the 5% significance level using Kruskal-Wallis and Mann-Whitney U tests.Results: Significant differences were found between the control and test groups (p<0.05). The occlusal margins of the SBL and GBL groups and the cervical margin of the SBL group exhibited the lowest microleakage (p<0.05). The AM control group showed maximum microleakage at cervical and occlusal margins.Conclusions: The irradiation of the 810 nm Diode laser on the unpolymerized universal adhesive systems in a self-etch mode caused a significant reduction in enamel and dentin marginal microleakage of composite restorations.

Effect of Er:YAG Laser Irradiation Combined With Fluoride Application on the Resistance of Primary and Permanent Dental Enamel to Erosion

Introduction: Erosion is an important cause of tooth mineral loss. The combined use of lasers and fluoride has been introduced as a novel modality for the prevention of enamel demineralization. This study aimed to assess the effect of Er:YAG laser combined with fluoride application on primary and permanent enamel resistance to erosion.Methods: Eighty enamel specimens of permanent (n=40) and primary (n=40) molars were prepared and randomly assigned to four groups:  C —control (no pretreatment), F—acidulated phosphate fluoride (APF) gel, ­­­­­FL—APF gel application followed by Er:YAG laser irradiation, and LF—Er:YAG laser irradiation followed by the application of APF gel . The specimens were then submitted to pH cycling using Coca-Cola (pH=2.4). Enamel micro-hardness was measured using the Vickers micro-hardness tester before pretreatment and after the erosive process. The collected data were analyzed using the Kolmogorov-Smirnov test, two-way ANOVA and repeated measures ANOVA.Results: The micro-hardness of both permanent and primary enamel significantly decreased after the erosive process (P<0.05). In the permanent enamel specimens, the greatest reduction in micro-hardness was noted in groups C and F, while the least reduction was noted in group FL. However, these differences were not statistically significant (P>0.05). In the primary enamel specimens, the greatest reduction in micro-hardness was noted in groups C and LF, while the least reduction was noted in group F. These differences were not statistically significant (P>0.05).Conclusion: Within the limitations of this study, Er:YAG laser irradiation combined with fluoride application could not prevent erosion in permanent and primary enamel during the erosive process. 

Management of Post Endodontic Retreatment Pain With Low Level Laser Therapy

Introduction: Pharmacotherapy with analgesics and non-steroidal anti-inflammatory drugs has been traditionally used to relief post-operative pain of endodontic treatments. However, due to the side effects reported for these drugs, some efforts have been made to decrease the post-operative pain of the endodontic treatments through laser irradiation. The present study aimed to evaluate the effects of low level laser therapy (LLLT) on the reduction of pain after root canal retreatment.Methods: In this clinical trial, 61 patients requiring endodontic retreatments in posterior teeth were selected. A single visit endodontic retreatment was performed. After biomechanical preparation, low level laser was irradiated to the buccal and lingual mucosa overlying the apices of the target tooth in the experimental group. In the control group patients received placebo laser to eliminate the probable psychological effects of laser. Laser irradiation was done with a single dose of 808 nm wavelength (Whitening Lase II- Laser DMC, Samsung, Korea) with 100 mW power, and dose of 70 J/cm2 for 80 seconds. Pain severity was recorded before, immediately after and 4, 8, 12, 24 and 48 hours after the treatment by visual analogue scale (VAS). The pain scores were statistically analyzed by chi-square test between 2 groups. The effects of different variables on the post-operative pain experience were also studied by means of Logistic regression.Results: Pain scores decreased significantly through time until 48 hours after treatment. No significant differences were observed between the 2 modalities regarding pain scores at any time. According to regression analysis, pain severity scores were lower in the laser-irradiated specimens than control groups (OR = 5.69); however, this difference was not statistically significant. Consumption of analgesics after the treatment had significant effect in decreasing post-operative pain experience (OR = 56) while factors of age, gender, laser irradiation, pre-treatment pain scores and education level did not.Conclusion: Low level laser irradiation had limited effects to decrease pain associated with the endodontic retreatments in the first and second molars; however, more studies are required to assess the effects of different parameters of low level laser in this regard

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

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

The Clinical Evaluation of the Effects of Low-Level Laser Therapy on the Donor and Recipient Sites of the Free Gingival Graft: A Case Series

Introduction: Free gingival grafting is among the most foreseeing procedures for increasing the zone of keratinized attached gingiva and enhancing soft tissue around the teeth and dental implants. Nowadays low-level laser therapy (LLLT) is a promising approach in providing patients with more pleasing results in terms of esthetics and comfort. This study aims to investigate the effects of LLLT on gingival recessions treated with free gingival graft (FGG).Methods: This case series was conducted on 12 individuals requiring a bilateral gingival graft in the mandibular region. There was a 30-day interval between the two operations. The test side was selected randomly and irradiated by a low-level laser (LLL) just before surgery. The patients did not know which side was irradiated. LLLT was applied to the donors’ as well as recipients’ site immediately after the operation and 48 hours later. The patients were instructed to record their post-operative pain in a visual analogue scale (VAS) 3 and 24 hours and 7 days after the surgical procedure. The clinical photographs were taken immediately and 30 days after surgical treatment were graded by three experienced periodontists for color matching to adjacent tissues.Results: Ten individuals could finish the study. The test group presented significantly better shade matching and wound healing at the palatal donor site on days 7, 14 and 21. There was a significant reduction in postoperative pain after 24 hours (P = 0.007). No statistically significant difference was found between both groups in terms of clinical periodontal indices.Conclusion: LLLT could reduce post-operative pain 24 hours after surgical treatment. Furthermore, the application of LLLT could improve the donors’ site healing and the recipients’ site color matching

Comparison of Er:YAG Laser and Hand Instrumentation on the Attachment of Cultured Human Gingival Fibroblasts to Periodontally Involved Root Surfaces

BackgroundThe present study compared the effects of Er:YAG laser and hand instrumentation on the attachment of human gingival fibroblast (HGF) cells to periodontally involved root surfaces.MethodsA total of 40 tooth specimens were collected and treated in four distinct groups: scaled and root planed with hand instruments, treated with Er:YAG laser, treated with combination of hand instruments and Er:YAG laser and non-treated control group. The attachment and proliferation rate of HGF were assessed using MTT assay and the Scanning Electron Microscope (SEM) Examination was used for cell morphological evaluation.ResultsThe MTT assay showed significantly decrease in HGF cell viability in both hand instruments only and combination treated teeth specimens compared to control specimens (p<0.05), 24 hours after cell seeding. However, at time 48, the cell viability of attached cells in these two treated groups was almost similar to control.  In contrast, at 24 and 48 hours after cell seeding, viability of attached cells was higher than control in Er:YAG laser treated only specimens (p<0.05). According to SEM study, the laser treated specimens showed more surface roughness.ConclusionsEr:YAG laser increased attachment and proliferation of HGF cells in comparison with hand instruments method

Evaluating the Efficacy of the Er,Cr:YSGG Fractional Laser Before Treatment With Triamcinolone NN Ointment in Oral Lichen Planus Lesions: Lichen Planus and Laser Assisted Drug Delivery System

Introduction: It has been demonstrated that laser technology can enhance topical drug absorption. This study aimed to determine the effects of Er, Cr: YSGG laser radiation before the application of topical corticosteroids in the healing of oral lichen planus.Methods: In this double-blind split-mouth clinical trial, 32 lesions were chosen from eight patients affected by oral lichen planus (OLP). The oral lesions were randomly categorized into two groups. The first group had topical treatment with triamcinolone NN ointment and the second group had laser radiation (Er,Cr:YSGG) for eight weeks before starting the ointment. For each lesion, the irritating level based on the VAS score, the lesion level based on the Thongprasom scale score, and the healing time were measured, and the collected data were analyzed by the Friedman test and the Wilcoxon’s statistical test.Results: The mean healing time based on the verbal analog scale (VAS) score was not significantly different between the two treatment groups (P>0.05). The mean healing time based on Thongprasom scale scores did not show any significant difference between the two treatment groups (P>0.05).Conclusion: The application of the Er,Cr:YSGG laser before treatment with triamcinolone NN ointment did not show any advantage for the average healing time compared to a medicine regimen with only triamcinolone NN ointment. Doi:10.34172/jlms.2022.23

Root Surface Roughness after Treatment with Manual Curette and Er:YAG and Er,Cr:YSGG Lasers

Introduction: This study compared the root surface roughness following scaling and root planning with manual curettes and different powers of Er:YAG and Er,Cr:YSGG lasers using surface profilometry and scanning electron microscopy (SEM). Materials and Methods: In this in vitro experimental study, 50 extracted teeth were buccolingually sectioned into two halves. The obtained contaminated surfaces randomly received the following treatments: SRP with manual curettes (group I), Er:YAG laser irradiation (4 W) (group II), manual curette+Er: YAG laser (1W) (group III), manual curette+ Er,Cr:YSGG laser (150 mJ) (group IV) and Er,Cr:YSGG laser (250 mJ) (group V). Surface roughness (Ra), surface changes (Rz) and maximum roughness changes (Rmax) were calculated before and after treatment while the surface morphology was examined by SEM analysis. The differences in roughness parameters were statistically analyzed using Wilcoxon signed rank test for each modality.Results: Except for the manual curette group (I) in which the roughness parameters decreased significantly (P<0.04 for all), Ra, Rz and Rmax increased in the remaining groups. The reported increases in group II (4W Er:YAG)(P<0.005, P<0.007 and P<0.03, respectively) and group V (250 mJ Er,Cr:YSGG) were statistically significant (P<0.01, P<0.05 and P<0.05). Conclusion: Within the limitations of this study, irradiation of Er:YAG and Er,Cr:YSGG lasers at both powers with and without using manual curettes increased surface roughness values compared to using manual curettes alone. Greater roughness values were obtained by increasing the power of lasers

A Comparative Histological Study of Gingival Depigmentation by 808 and 445 nm Diode Lasers: Histological evaluation after gingival diode laser depigmentation

Introduction: Using lasers in melanin depigmentation is one of the main fields of interest for dental practitioners and patients. However, it is important to know what would happen inside the tissue and how the cells would interact inside the tissue with a laser.Methods: In this study, we used both wavelengths of 445 nm and 808 nm on sheep gingiva to find out the effects and side effects of these diode lasers while using them for gingival depigmentation.Results: After microscopic evaluation, we concluded that 808 nm and 445 nm lasers with a power of 1 W are safe enough to use in the depigmentation of gingiva, and both lasers are highly effective in melanin pigments which are located in the basal membrane.Conclusion: The 445 nm blue laser produced a less thermal effect, which means it is safer to be used in gingival hyperpigmentation than a diode lase