Laser Therapy and Endodontic Treatment: Major Considerations and Systematic Review

Introduction: Laser application in endodontics has increased due to its safety and effectiveness in dental treatments, involving dentin hypersensitivity, removal of decayed tissues, dental preparations, pulp capping or pulpotomy, and root canal treatment. Postoperative pain after endodontic treatments is a common complication, affecting 3% to 58% of patients. Low-level laser therapy has been used in dentistry to promote analgesia, modulation of inflammation, and tissue healing. Objective: performed a concise systematic review to present the main clinical outcomes of endodontic treatment with low-intensity laser therapy. Methods: The research was carried out from April 2021 to July 2021 and developed based on Scopus, PubMed, Science Direct, Scielo, and Google Scholar, following the Systematic Review-PRISMA rules. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results: After the selectivity of articles and literary findings through the following descriptors, a total of 65 studies were analyzed, with only 17 medium and high-quality studies selected, according to GRADE rules, and with risks of bias that do not compromise scientific development. The authors showed that low-intensity laser therapy has the property of oral sterilization, facilitating tissue healing after surgical procedures. The effects related to anti-inflammatory and analgesic capacities with the application of low-intensity laser were also evidenced. Conclusion: Laser therapy has been shown to improve the healing of soft and hard tissues after endodontic surgery and has also shown favorable effects on pain and patients' quality of life.

Major approaches to antiseptic management for endodontic treatment in the COVID-19 pandemic: a guideline

Introduction: In the COVID-19 pandemic scenario, in addition to the pathogenesis of SARS-CoV-2, microbial coinfection increases the difficulties of diagnosis, treatment, the prognosis of COVID-19, as well as it can worsen comorbidities and affect the risk of the life of patients. COVID-19 has had a profound impact on dentistry. In addition to endodontic treatment, a management protocol was suggested. Objective: To present the importance of effectively performing endodontic asepsis in the context of the COVID-19 pandemic, to elucidate that infection by the SARS-CoV-2 virus can lead to coinfection, worsening the conditions for endodontic treatment. Methods: The research was carried out from July 2021 to August 2021 and developed based on Scopus, PubMed, Science Direct, Scielo, and Google Scholar, following the Systematic Review-PRISMA rules. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results: A total of 70 articles were found involving the endodontic treatment and COVID-19. A total of 58 articles were evaluated in full and 39 were included and evaluated in the present study. It was found that ozone has high antimicrobial action. N-acetylcysteine (NAC) has a potent effect against endodontic biofilms. Calcium hydroxide is more effective as a root canal disinfectant in primary teeth than formocresol and camphorphenol. The association of 2% chlorhexidine followed by ozone gas for 24 seconds promoted the complete elimination of Candida albicans and Enterococcus faecalis. Low-intensity laser therapy has the property of oral sterilization, facilitating tissue healing and sterilization. Combining antimicrobial photodynamic therapy with antimicrobial irrigants may provide a synergistic effect. Conclusion: There are effective treatments for the sterilization of endodontic tissues, to avoid as much as possible the coinfection with SARS-CoV-2 and the consequent worsening of the infectious condition, highlighting calcium hydroxide, ozone therapy, and laser therapy.

The Use of the Low-Intensity Laser Therapy (LLLT) Technique for Face Burning

This work describes a case report by the Hospital Dentistry team of the Beneficent Association of Campo Grande Santa Casa MS, where a patient presented with a burn caused by the explosion of the carbon dioxide gas (Co2) through the inhalation of the vapor with acute physical changes, which resulted in burns that reached approximately 10% of the anterior area of the skull with involvement of the cervical and pharyngeal region. Admitted under Orotracheal Intubation, he was treated using the LLLT technique with the use of the InGaAIP low intensity laser on the injured tissues. Through a multi professional approach, using the Low Level Laser Therapy (LLLT) technique as a therapeutic alternative for the treatment of burn injuries of the periorbital region, lips and oral cavity, with the daily monitoring of the patient and regular on-site applications of laser therapy, there was a significant improvement in the injured region, and healing with rapid evolution, in addition to analgesia with reduced bleeding and site inflammation

Controlling pain and hyperuricemia in patients with tophaceous gout after joints surgery

The primary treatment of tophaceous gout is to control the disease by pharmacological therapy. Additional surgical intervention is used to correct cosmetic deformation in joints or disabling functional disorder; however, one of its reported complications is hyperuricemia and recurrent attacks of pain. Objectives: to access the effectiveness of Low Intensity Laser therapy as addition to urate lowering treatment in patients with tophaceous gout, who underwent joints surgery in the Chengdu Rheumatism Hospital, in comparison to those patients who received only nonsurgical treatment. Subjects and methods. The effectiveness of Low Intensity Laser therapy (LILT) and urate lowering treatment in patients with tophaceous gout was investigated in 63 male patients of Chengdu Rheumatism hospital with tophaceous gout who underwent joints surgery. Control group was formed of 63 gout patients comparable in age and pre-treatment uric acid, who received non-surgical treatment.Results. Patients underwent surgery in one or two sessions, the most common lesion site being foot joints: toes (49.41%), ankle (39.68%) and knee (34.92%), with restricted mobility in the mentioned joints. Levels of CRP before the treatment were elevated in almost all patients (median 3.74 (0.2, 48.75) mg/L), regardless of the other comorbidities. Urate lowering therapy notably reduced the levels of CRP to 2.44 (0, 33.27) mg/L in study group and to 1.3 (0.13, 31.72) mg/L in controls. After surgery and following urate lowering therapy all patients noted functional improvement and reduction of pain. Decrease in serum urate levels were reported in 96.83% of patients in study group and in 93.65% of controls. There was no significant difference in serum UA between patients who underwent joint surgery and who didn’t. Patients, who in addition to surgery received Low-Level Laser Therapy therapy, had a lowest mean serum UA after treatment (280.93 ± 97.05 μmol/L), but due to wide range of variation, difference to other groups wasn’t statistically significant. Addition of laser therapy also helped to reduce the pain almost twice (0.56±0.56 compared to 1.04 ± 0.91). However, we haven’t registered notable anti-inflammatory influence of LILT. There was a weak direct link established between levels of serum UA and CRP after treatment, but in patients receiving laser therapy, CRP was elevated more often, compared to those who weren’t prescribed with LILT or controls. Conclusion. Arthroscopic shaving and other surgical approaches focused on joints often doesn’t affect system hyperuricemia in any way and can’t be viewed as a substitute to urate lowering therapy. However, our experience confirms that timely performed surgery contribute to functional improvement and reduction of pain in gout patients. Low Intensity Laser therapy doesn’t affect hyperuricemia or guarantee long-term systemic anti-inflammatory effect, but help to additionally relieve pain in joints and thus enhance treatment effect and quality of patients’ life.

Orthokeratology and Low-Intensity Laser Therapy for Slowing the Progression of Myopia in Children

Orthokeratology (OK) is widely used to slow the progression of myopia. Low-level laser therapy (LLLT) provides sufficient low energy to change the cellular function. This research is aimed at verifying the hypothesis that LLLT treatment could control myopia progression and comparing the abilities of OK lenses and LLLT to control the refractive error of myopia. Eighty-one children (81 eyes) who wore OK lenses, 74 children (74 eyes) who underwent LLLT treatment, and 74 children (74 eyes) who wore single-vision distance spectacles for 6 months were included. Changes in axial length (AL) were 0.23 ± 0.06 mm for children wearing spectacles, 0.06 ± 0.15 mm for children wearing OK lens, and − 0.06 ± 0.15 mm for children treated with LLLT for 6 months. Changes in subfoveal choroidal thickness (SFChT) observed at the 6-month examination were − 16.84 ± 7.85 μ m , 14.98 ± 22.50 μ m , and 35.30 ± 31.75 μ m for the control group, OK group, and LLLT group, respectively. Increases in AL at 1 month and 6 months were significantly associated with age at LLLT treatment. Changes in AL were significantly correlated with the baseline spherical equivalent refraction (SER) and baseline AL in the OK and LLLT groups. Increases in SFChT at 1 month and 6 months were positively associated with age at enrolment for children wearing OK lens. At 6 months, axial elongation had decelerated in OK lens-wearers and LLLT-treated children. Slightly better myopia control was observed with LLLT treatment than with overnight OK lens-wearing. Evaluations of age, SER, and AL can enhance screening for high-risk myopia, improve the myopia prognosis, and help determine suitable control methods yielding the most benefits.

Antimicrobial Photodinamic Therapy Combined with Laser Photobiomodulation in the Treatment of Skin Wounds in a Dog (Canis lupus familiaris)

Background: Laser photobiomodulation has been used in the treatment of various injuries and diseases. This promotes modulation of the inflammatory process, edema reduction and devitalized tissue regeneration. The advantages of Antimicrobial photodynamic therapy are its easy application and the absence of side effects. Other advantages are the cost of the therapy, minimal damage to animal tissue, the broad spectrum of action, and efficiency against strains resistant to antimicrobials. The aim of this study was to report the clinical and their resolution in a female dog with a traumatic, infected wound treated with laser phototherapy as an alternative therapy method.Case: A 3-year-old bitch Border Collie, weighing 18 kg, from the municipality of Ilhéus, Bahia, Brazil, waspresented for examination with a history of traumatic laceration of the left thoracic member. On the anamnesis, it was reported that the patient presented with laceration of the left thoracic member. The wound was cleaned and an antibiotic [30 mg/kg of 12/12 h] and anti-inflammatory [0.1 mg/kg every 24 h were prescribed, both for 5 days]. Twenty-four h after the surgical procedure, there was dehiscence of the sutures, with daily topical therapy based on zinc oxide for secondary intention healing. Upon physical examination, the wound was found to be contaminated with swollen and erythematous edges, an ulcerated area with devitalized tissue, serous exudate, and 8.8 cm2 of wounded area. Given the macroscopic characteristics of the lesion, phototherapy was associated with conventional therapy until complete healing of the wound, with three weekly applications at 48 h intervals. Initially, the wound was cleaned with saline solution at 0.9% and a single treatment with aPDT was scheduled due to the high degree of contamination. The dosimetry parameters of irradiation were calculated according to the wounded area with a diode laser of 0.1W of power, continuous emission, spot area of 0.028 cm2, and energy of 9 J per application point. A gauze imbibed with 1 mL of methylene blue aqueous solution (300 μM), which was the photosensitizer was applied to the lesion, with a pre-irradiation time of 5 min, after which it was irradiated with red laser (RL) (λ = 660nm) for 90 s per point, using the sweeping technique. The edge of the lesion was irradiated with infrared laser (IRL) (λ = 808 nm), total energy of 5 J, using the technique of specific points and 1 J of energy/point. After aPDT, low-intensity laser therapy (LILT) sessions were set up with RL and IRL, with energies of 0.5 J/point and 1 J/point, respectively. The wound was cleaned daily, protected with a bandage, and clinically evaluated until complete regression.Discussion: In the present case, methylene blue was used as a photosensitizer, but it is noteworthy that, apparently, each microorganism responds differently to photosensitizers. Thus, the therapy becomes specific for each application, for example: the type of photosensitizer, its concentration, pre-irradiation time, type of light used in photosensitization, wavelength, energy, power, mode delivery of light. Thus, for the best result, the specific protocol in each application should be used Low-intensity laser therapy is an easily executed technique with effective results. The use of PDT associated with photobiomodulation therapy enabled rapid healing of the cutaneous wound, in addition to an improvement in clinical signs and pain caused by the lesion. The technique proved to be an efficient alternative in the treatment of wounds, whether used in isolation or associated with conventional therapy. Keywords: methylene blue, healing, wound, photobiomodulation, low-level laser.Título: Terapia fotodinâmica antimicrobiana combinada com a fotobiomodulação a laser no tratamento de ferida cutânea em cão (Canis lupus familiaris).

INCIDENCE AND RISK FACTORS FOR ORAL MUCOSITIS AFTER BONE MARROW TRANSPLANTATION PATIENTS UNDER LOW INTENSITY LASER THERAPY: A LONGITUDINAL STUDY

Bone marrow transplantation (BMT) has been used to treat numerous malignant and non-malignant hematological diseases, genetic and immunological diseases with a high risk of oral mucositis (OM) due to the action of antineoplastic drugs. As photobiomodulation therapy (FBMT) with low-level laser is a proven non-invasive treatment for OM, the objective of this study was to evaluate the incidence of OM in patients on BMT undergoing FBM. 53 patients undergoing treatment received FBMT (red laser, 2J, 20s, 100mW) as a preventive protocol. If MO was observed, an infrared laser (4J, 40s, 100W) was administered. The following data were collected from patients' medical records: sex, age, chemotherapy protocol (QT) and type of BMT. An incidence of 34% was observed in the population studied (20% grade I, 11.3% grade II and 1.9% grade III). Prevention protocols using FBMT significantly reduced the incidence of oral mucositis (p = 0.004). Now, young patients with myeloid leukemia, the time between QT and BMT (p = 0.010) and time of QT (p = 0.018) were directly associated with the increased incidence of oral mucositis. It was concluded that low-intensity preventive laser therapy was associated with a reduction in the incidence of oral mucositis, showing the importance of this therapy in the management of patients undergoing BMT.