engleski

What the dentist should know under the prism of recent soft tissue laser surgery?

Laser devices have gained in importance since the eighties and they are often claimed to be omni-use instruments. Diode lasers offer an interesting – but not unlimited – field of application in modern dentistry including periodontology, endodontics and soft tissue treatment. LLLT (Low Level Laser Therapy) is the application of red and near infra-red light over injuries or lesions to improve wound and soft tissue healing, reduce inflammation and give relief for both acute and chronic pain. LLLT is used to increase the speed, quality and tensile strength of tissue repair ; resolve inflammation and relieve pain (analgesia). When the correct intensity and treatment times are used, red and near infrared light reduces oxidative stress and increases ATP. This improves cell metabolism and reduce inflammation. Low level laser therapy effects are biochemical and not thermal and cannot cause heating and thereby damage to living tissue. These so called soft lasers offer the dentist several interesting fields of application. The antimicrobial photodynamic therapy (aPDT) is a non-thermic light-induced inactivation of cells, microorganisms or molecules. "Antimicrobial" photodynamic therapy targets pathogenic microorganisms. Using a dye, the bacteria that cause infections are stained, sensitized and destroyed following exposure with light of a suitable wavelength and energy density. A decisive role plays the „photosensitizer“, a coloring solution (e.g. Toluidin Blue, Methylene Blue etc.). The oxygen atoms in the color molecules are activated by irradiation of appropriate light. They initiate singulet conditions, which have a toxic effect on the cells. LaserHF device was used in multiple clinical indications, surgical and therapeutical, at the Department of Oral surgery, School of Dental Medicine, University of Zagreb. Wide range of clinical indications including soft tissue oral surgery, endodontic surgery, dental implants exposure in second stage surgery, therapeutic approach of periimplant diseases (conservative and surgical), therapeutic application in cases of intraoral and labial herpes, recurrent aphthous ulcers, other ulcers and other soft tissue pathological changes. No side effects or complications of surgery, LLLT or a PDT performed using HF Laser have been found in our clinical research during follow-ups. All patients reported absence of pain, minimal postoperative discomfort and maximum comfort due to absence of sutures and bleeding. In this work results of our scientific clinical studies and number of different clinical cases, based on the laser surgery and treatment, will be included. We assessed the impact of diode laser on the healing of wounds, pain symptoms and other symptoms which usually accompany the third molar surgery. There were 150 subjects divided into 3 groups and each group consisted of 50 subjects. The first group was submitted to LLLT-therapy (acupuncture mode programme), the second group to aPDT-therapy, while the third group was placebo or control group. LaserHF (Hager & Werken GmbH & Co. KG P.O.B. 100654, 47006 Duisburg, Germany) was used. Patients were evaluated on the first, third, fifth and seventh postoperative day. There were significant differences in the subjective assesment of pain, swelling, bad breath, difficulty in feeding, speech and sleep between patients treated with lasers in comparison to the placebo group. Furthermore, objective assesment of the debris in the surgery performed area, bleeding, haematoma, exposed bone, edema, pus, trismus, the type of postextraction alveoli healing and the intensity of inflammation of the perioperative area of the mucosa were significantly lower in the laser treated groups when compared to the controls. A slightly better results were obtained when using aPDT, but without significant difference. Therefore, we might conclude that diode lasers used as LLLT or aPDT have beneficiary effect when used before alveotomy of the impacted third molars. The results of our clinical study related to the soft tissue laser intraoral surgery will be presented as well. There were 25 patients enrolled in the laser group and 25 patients included in the scalpel group. In both groups all soft tissue intraoral lesions were maximum 1 cm in diameter. There were significant differences in patients scores regarding oedema, haematoma, pain and satisfaction between laser and scalpel groups. Patients treated with laser were significantly more satisfied and had significantly less oedema, haematoma and pain when compared to the ones treated with scalpel. Therefore, we might conclude that diode laser surgery is recommended when treating small oral soft lesions in comparison to the scalpel surgery.

oral surgery ; dentistry ; laser ; aPDT ; LLLT

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