LASER in periodontal treatment: is it an effective treatment or science fiction?

There are several studies that evaluate the use of lasers in periodontal treatment in non-surgical or surgical therapy. However, while several studies showed clinically beneficial effects of some lasers in periodontal treatment, there are few clinical reports of additional advantages of lasers as adjunctive treatments in periodontology. The aim of this paper is to demonstrate and critically analyze the level of scientific evidence of effects of low-level lasers and high-power lasers in periodontology. A narrative review of the studies was carried out in each topic and type of laser or periodontal treatment. In nonsurgical periodontal therapy the results showed that there is an additional clinical benefit when using a diode laser (DL) associated with scaling and root planing (SRP) in patients with moderate to severe periodontitis. The Er:YAG laser seems to be the most suitable for nonsurgical periodontal therapy and promotes the same clinical effects as conventional therapy. In periodontal surgery vaporization of the gingival or mucosal tissue can be carried out with DL, CO2, Nd:YAG, Er:YAG and Er,Cr:YSGG lasers. Photobiomodulation (PBM), mediated by low-level lasers associated with non-surgical periodontal therapy, promotes additional benefits in the short term and accelerates the bone and gingival tissue repair process and also reduces postoperative symptoms of periodontal surgery. The effect of antimicrobial Photodynamic Therapy is relevant in the initial reevaluation periods. Studies have shown controversial results of the use of lasers in periodontics, and this fact may be due to the lack of standard parameters of irradiation in each clinical application

Influence of antimicrobial photodynamic therapy as an adjunctive to scaling and root planing on alveolar bone loss: A systematic review and meta-analysis of animal studies.

BACKGROUND: The study aimed to evaluate the effect of antimicrobial photodynamic therapy (aPDT) as adjunctive therapy to scaling and root planing in experimental periodontitis in rats, with or without systemic involvement, by means of histometric analysis of the furcation region. METHODS: Systematic search was done using PubMed/MEDLINE, SCOPUS, EMBASE and ProQuest databases. Quantitative analysis of alveolar bone loss, with subcategories for the experimental periods studied, was performed. The analysis was performed through the mean difference (MD), with 95% confidence intervals (CIs) and according to SYRCLE guidelines. RESULTS: Nine studies were considered eligible. A statistically favorable difference was observed for the use of aPDT in all periods studied in systemically healthy animals at 7 (P < 0.00001; MD: -0.71; 95% CI: [-0.85, -0.58]; I2: 90%), 15 (P < 0.00001; MD: -0.49; 95% CI: [-0.62, -0.37]; I2: 88%), and 30 (P < 0.00001; MD: -0.53; 95% CI: [-0.65, -0.41]; I2: 80%) days postoperatively. The difference was also observed for modified animals at 7 (P < 0.00001; MD: -1.03; 95% CI: [-1.43, -0.62]; I2: 97%), 15 (P < 0.00001; MD: -1.04; 95% CI: [-1.62, -0.46]; I2: 99%), and 30 (P < 0.00001; MD: -0.88; 95% CI: [-1.37, -0.39]; I2: 97%) days postoperatively. CONCLUSION: The adjunctive use of aPDT favored the reduction of alveolar bone loss in experimental periodontitis in rats, and this result was more evident in systemically compromised rats

Effects of butyl toluidine blue photosensitizer on antimicrobial photodynamic therapy for experimental periodontitis treatment in rats.

AIM: This study evaluated three concentrations of butyl toluidine blue (BuTB) for antimicrobial photodynamic therapy (aPDT) in experimental periodontitis (EP) in rats. MATERIAL AND METHODS: EP was ligature-induced at the first mandibular molar in 105 rats. Ligature was removed after 7 days and animals were distributed into the following treatments: SRP, scaling and root planing (SRP) plus saline solution; BuTB-0.1, SRP plus BuTB at 0.1 mg/mL; aPDT-0.1, SRP plus BuTB at 0.1 mg/mL and InGaAlP diode laser (DL) irradiation; BuTB-0.5, SRP plus BuTB at 0.5 mg/mL; aPDT-0.5, SRP plus BuTB at 0.5 mg/mL and DL irradiation; BuTB-2.0, SRP plus BuTB at 2 mg/mL; aPDT-2.0, SRP plus BuTB at 2 mg/mL and DL irradiation. Five animals from each group were submitted to euthanasia at 7, 15 and 30 days post-treatment. The furcation area was submitted to histological, histometric and immunohistochemical (TGF-ß1, OCN and TRAP) analyses. RESULTS: aPDT-0.5 group presented a better tissue remodeling in all periods, resolution of the inflammatory response and bone neoformation areas at 30 days. aPDT-0.5 also resulted in higher immunolabeling patterns of TGF-ß1 at all periods (p < 0.05) and of OCN at 30 days (p < 0.05). CONCLUSION: aPDT-0.5 showed the best benefits for inflammatory response and periodontal repair process

Antimicrobial photodynamic therapy compared to systemic antibiotic therapy in non-surgical treatment of periodontitis: Systematic review and meta-analysis.

BACKGROUND: Periodontitis is one of the most prevalent inflammatory diseases in humans. It is associated with the presence of bacteria and is mediated by the host's immune response This study represents a systematic review and meta-analysis trying to answer the following question: "What is the effect of antimicrobial photodynamic therapy (aPDT) as an adjunct to scaling and root planing (SRP) compared to systemic antibiotic therapy with amoxicillin plus metronidazole (AMX+MTZ) on the non-surgical treatment of periodontitis?". METHODS: Clinical studies comparing aPDT with systemic use of AMX+MTZ were searched until January of 2020 using the databases: PubMed, MEDLINE, SCOPUS, EMBASE, Cochrane Central, Web of Science and Scielo, as well manual searches in related journals. Periodontal clinical parameters such as probing depth (PD), clinical attachment level (CAL) and bleeding on probing (BOP) were statistically analyzed. RESULTS: Five randomized clinical studies (RCTs) were included within the eligibility criteria, and served as a basis for qualitative and quantitative analyzes. All the studies reported an improvement in the clinical parameters with both therapies, although in a direct comparison, our analyzes did not find statistical differences that indicate the superiority of one supporting treatment in relation to the other. CONCLUSION: Although the limited number of RCTs and the great heterogeneity between them, it can conclude that aPDT presents similar clinical results compared to antibiotic therapy with AMX+MTZ as adjuvants in the non-surgical treatment of periodontitis

Blood cell attachment to root surfaces treated with EDTA gel Adesão de células sangüíneas a superfícies radiculares tratadas com gel de EDTA

Root debridement generates a smear layer which contains microorganisms and toxins that could interfere in periodontal healing. For this reason, different substances have been used to remove it and to expose collagen fibers at the tooth surface. Blood element adhesion to demineralized roots and clot stabilization by collagen fibers are extremely important for the success of periodontal surgery. The aim of this study was to evaluate the different patterns of blood element adsorption and adhesion to root surfaces only irrigated with distilled water and after application of a manipulated or an industrialized EDTA gel. Thirty samples were planed, equally divided into three groups and treated with distilled water (control), a manipulated EDTA gel or an industrialized one. Immediately after, samples were exposed to fresh blood and prepared for scanning electron microscopy. Untreated planed dentin presented the best results with blood cells entrapped in a thick web of fibrin. In the manipulated EDTA group, the web of fibrin was thick with sparse blood elements. The worst result was seen with the industrialized EDTA group, in which no blood elements could be seen. Statistical difference was obtained between control and industrialized EDTA groups. Surfaces only irrigated presented the most organized fibrin network and cell entrapment.<br>A raspagem gera "smear layer", a qual contém microrganismos e toxinas que podem interferir no reparo periodontal. Por esse motivo, diferentes substâncias têm sido empregadas para remover esta camada e expor fibras colágenas da superfície dental. A adesão de elementos sangüíneos a superfícies radiculares desmineralizadas e a estabilização do colágeno pelas fibras colágenas são de extrema importância no sucesso da cirurgia periodontal. O objetivo deste estudo foi avaliar os diferentes padrões de adsorção e adesão de elementos sangüíneos a superfícies radiculares apenas irrigadas com água destilada e após aplicação de um gel de EDTA manipulado ou um industrializado. Trinta amostras foram raspadas, eqüitativamente divididas em 3 grupos e tratadas com água destilada (controle), um gel de EDTA manipulado ou um industrializado. Imediatamente foram expostas a sangue fresco e preparadas para microscopia eletrônica de varredura. As superfícies dentinárias apenas raspadas apresentaram os melhores resultados, com moderada quantidade de células sangüíneas entremeadas em uma fina rede de fibrina. No grupo de EDTA manipulado, a rede de fibrina foi pouco visível com escassas células. Os piores resultados foram observados com o EDTA industrializado, caracterizados pela ausência de elementos sangüíneos. Estatisticamente houve diferença apenas entre os grupos controle e EDTA industrializado. As superfícies apenas irrigadas apresentaram rede de fibrina mais bem organizada com células entremeadas

Effectiveness of antimicrobial photodynamic therapy mediated by butyl toluidine blue in preventing medication-related osteonecrosis of the jaws in rats.

Background: Medication-related osteonecrosis of the jaws (MRONJ) is difficult to treat, therefore, prevention would be the ideal clinical approach. This study evaluated the effectiveness of antimicrobial photodynamic therapy (aPDT), mediated by butyl toluidine blue (BuTB) in the prevention of MRONJ-like lesions after tooth extraction in rats. Methods: Twenty-eight senescent female rats were distributed in groups: VEH and VEH-aPDT, treated with vehicle, ZOL and ZOL-aPDT, treated with 100 µg/Kg of zoledronate, both treatments every three days over seven weeks. After three weeks from the commencement of treatment, the mandibular first molar was extracted. For the VEH and ZOL groups, no local treatment was performed, while with the VEH-aPDT and ZOL-aPDT groups, photodynamic treatment was carried out at 0, 2, and 4 days after extraction. For aPDT, 500μl of BuTB solution was deposited on the dental extraction site (0.5 mg/ml; 60 s), followed by irradiation with low-level laser (InGaAIP; 660 nm; 35 mW; 74.2 J/cm²; 60 s). After 28 postoperative days, euthanasia was performed. The hemimandibles were processed to: (1) histological analysis of tissue repair; (2) histometric analysis of the percentage of newly formed bone tissue (PNFBT) and percentage of non-vital bone tissue (PNVBT); (3) immunohistochemical analysis for tartrate-resistant acid phosphatase (TRAP). Results: The ZOL and ZOL-aPDT groups showed less TRAP-positive cells when compared with VEH and VEH-aPDT. The ZOL group demonstrated great compromise in the tissue repair process, consistent with MRONJ-like lesions. VEH, VEH-aPDT and ZOL-aPDT presented a favorable tissue repair process. PNFBT in the ZOL group was lower than in the VEH, VEH-aPDT and ZOL-aPDT groups, whereas PNVBT in the ZOL group was higher than in the VEH, VEH-aPDT and ZOL-aPDT groups. Conclusion: aPDT mediated by BuTB prevented the occurrence of MRONJ-like lesions after tooth extraction in rats