The use of LPT in Dentistry and adjunct areas Dr Alireza Mirzaei D.D.S,MSc in Laser RWTH Aachen University Certified Trainer in WCLI(World Clinical Laser Institute) Member Of WALED(World Academy for Laser Education &research in dentistry)

 Low-level laser therapy (LLLT): form of laser medicine used in physical therapy and veterinary treatment that uses low-level (low-power) lasers or light- emitting diodes to alter cellular function Terminology

 low-power laser  soft laser  cold laser  bio stimulation laser  therapeutic laser  laser acupuncture Other names for the therapy

 1903 Finsen was awarded the Nobel Prize for developing the Carbon Arc Lamp incorporating lenses and filters for the treatment of lupus vulgaris &Tuberculosis and open wounds Laser Phototherapy-History

 Pioneer on laser Phototherapy  Carcinogenic effect of the low power Ruby and He-Ne Lasers  Prof Endre Mester, 1964 in Budapest Laser Phototherapy-History

 Faster heir regrowth  No Carcinogenic Effect  Mester E, Spiry T, Szende B, Tota JG. Effect of laser rays on wound healing. Am J Surg Oct;122(4): Faster Wound healing

Success rate: 85% 875 patients Open wounds resistant to conventional treatments Mester E, Mester AF, Mester A. The biomedical effects of laser application. Lasers Surg Med. 1985;5(1):31-9

1973 Plog investigated the HeNe laser as a viable alternative to needles for acupuncture treatment Many research projects were conducted in Eastern Europe, Soviet Union and China Clinical applications of LPT start to appear, especially at Europe, Asia, South America and Australia- less expensive and higher-powered output (30mW or less) smicondutor (GaAlAs o GaAs) devices were used. - Sun G and Tunér J- Dent Clin N Am 48(2004) Laser Phototherapy-History

 2004 FDA approval for carpal tunnel syndrome and “minor chronic neck and shoulder pain of musculoskeletal origin” has also proved to have a positive effect on the development of therapeutic laser therapy Sun G and Tunér J- Dent Clin N Am 48(2004) Laser Phototherapy-History

Terms and Definitions

More than 40 years- No reports of harm to patients Class III Safety Measures and Contraindications Non significant risk medical device

Protective eyewear is typically required where direct viewing of a class 3B laser beam may occur LPT lasers are Class 3B

No contraindications were reported so far; however there are some side effects that must be considered when treating patients with the following conditions: Malignancies Coagulations disorders Contraindications of LPT

Laser-Tissue Interactions

Laser Absorption Main Chromospheres Melanin Hemoglobin Main Chromospheres Melanin Hemoglobin

Different colors of skin

 Aging  Type of Tissue  Amount of Tissue  Superficial Lesions  Deep Lesions Constitutive properties of the target tissue

How does LPT work?

Photochemical Theory

The principle of using LPT: is to supply direct biostimulative light energy to the body’s cells. Cellular photoreceptors can absorb low- level light and pass it on to mitochondria, which promptly produce the cell’s fuel, ATP.

Cytochrome C Oxidase Calcium Channels Cell Membrane ReceptorsSuperoxide Dismutase Enzyme (SOD) Cell Chromophores

Periodontics Endodontics Restorative Dentistry: dentin, gengival retraction Soft tissues: wound healing, trismus, ulcers 5-Bone: dental implants orthodontics Nerve: paresthesias, myalgias, Myofacial Pain Dysfunction Syndrome, Facial Paralysis, nevralgia Oral Pathology: Xerostomy, Herpes labialis Clinical applications in Dentistry

 Low-level lasers do not cut or ablate but are based on photo- biological processes. Unlike the powerful surgical lasers that require >1W, these lasers function in the milliwatt range with wavelengths usually in the red and near-infrared spectrum and can be used to change intra- cellular photoreceptors, e.g. endogenous porphyrins, flavoproteins and cytochrome c-oxidase in the respiratory chain. The absorption leads to a cascade of photobiological events, which could have advantageous effects on periodontal healing  Karu, T. Low-power laser therapy. In: Biome- dical Photonics Handbook. Tuan Vo-Dinh, Ed. CRC Press. 2003, p. 48.1– 24.!  Yamamoto, Y., Kono, T., Kotani, H., Kasai, S.& Mito, M. (1996) Effect of low-power laser irradiation on procollagen synthesis in human fibroblasts. Journal of Clinical Laser Medicine and Surgery 14, 129–132 LPT and Periodontics

 post operative pain in Endodontics Patency Apical root canal sealer extravasation LPT and Endodontics

10 sessions IR 808nm 210J/cm2 59 s 100mW 5.9J Pain Control 10 sessions IR 660n 90J/cm2 63 s 40mW 2.5J Tissue Healing 10 sessions IR 660n 90J/cm2 63 s 40mW 2.5J Tissue Healing

LPT and Nerves

One of the risks of dental surgery is nerve injury and paresthesia, especially of the inferior alveolar nerve. Although most of these complications are transient, some are long standing or permanent. Using LPT when the paresthesia has occurred and prophylactically after surgery in a risk- involved zone could reduce these problems Sun & Túner. Dent Clin N Am 48 (2004): LPT and Paresthesia

Myofacial Pain Dysfunction Syndrome and LPT

 Myofacial pain dysfunction syndrome (MPDS) is the most common reason for pain and limited function of the masticatory system

To evaluate the efficacy of a particular source producing 660 nm and 890 nm wavelengths that was recommended to reduce of the pain in the masticatory muscles. Low level laser therapy and MPDS:a randomized controlled clinical trail Sixteen MPDS patients.! Laser group, two diode laser probes (660 nm, 6.2 J/cm2, 6 min, continuous wave, and 890 nm, 1 J/cm2, 10 min, 1,500 Hz) on the painful muscles.! Control group, treatment was similar, but not irradiated. Treatment was given twice a week for 3 weeks. The amount of patient pain was recorded at four time periods (before and immediately after treatment, 1 week after, and on the day of complete pain relief). ! The visual analog scale (VAS) was selected as the method of pain measurement Sixteen MPDS patients.! Laser group, two diode laser probes (660 nm, 6.2 J/cm2, 6 min, continuous wave, and 890 nm, 1 J/cm2, 10 min, 1,500 Hz) on the painful muscles.! Control group, treatment was similar, but not irradiated. Treatment was given twice a week for 3 weeks. The amount of patient pain was recorded at four time periods (before and immediately after treatment, 1 week after, and on the day of complete pain relief). ! The visual analog scale (VAS) was selected as the method of pain measurement

According to this randomized clinical trial, these particular types of LLLT (660 nm, 6.2 J/cm2, 6 min, continuous wave and 890 nm, 1 J/cm2, 10 min, and 1,500 Hz) were proven to be effective treatments for pain reduction in patients with myofacial pain dysfunction syndrome. There were no negative side effects reported under the condition of this study.

Herpes labialis

 Its average incidence is 1.6 per 1000 patients per year and its prevalence is 2.5 per 1000 patients per year. Approximately one-third of all infected patients suffer relapses  Herpes labialis is a rash of the skin and mucous membranes (in particular, the lips) and is characterized by erythema and blisters that are preceded and accompanied by burning pain.

LPT mechanisms for HSV1  From the studies of Eduardo and Donnarumma, it can be hypothesized that the main effect of the laser light is more a stimulation of the immune system than an inhibitory effect on the virus  Eduardo, F de P., Mehnert, D. U., Monezi, A. M., Zezell, D. M., Schubert, M. M., Eduardo, C de P, and Marques, M.M. (2007). In vitro effect of phototherapy with low intensity laser on HSV-1 and epithelial cells. Mechanisms for low-! light therapy II. Proc. SPIE. 6428, ! Donnarumma, G., De Gregorio, V., Fusco, A., et al. (2010). Inhibition of HSV-1 replication by laser diode-irradiation: possible mechanism of action. Int. J. Immunopathol. Phar- macol. 23, 1167–1176.!

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