Lead Removal Without Extraction Tools: A Single-Center Experience

Introduction

Indications for cardiac devices have been increasing as well as the need for lead extractions as a result of infections, failed leads and device recalls. Powered laser sheaths, with a global trend towards the in-creasingly technological tools, meant to improve the procedure’s outcome but have economic implications.

Objective

The aim of this study is to demonstrate the experience of a Bra-zilian center that uses simple manual traction in most lead removals per-formed annually, questioning the real need for expensive and technically challenging new devices.

Methods

This retrospective observational study included 35 patients who had a transvenous lead extraction in the period of a year between January 1998 and October 2014 at Hospital de Messejana Dr. Carlos Alberto Studart Gomes, in Fortaleza, CE, Brazil. Data were collected through a records review. They were evaluated based on age, type of device, dwelling time, indication for removal, technique used and immediate outcomes.

Results

The median dwelling time of the devices was 46.22 months. Infec-tion, lead fracture and device malfunction were the most common indica-tions. Simple traction was the method of choice, used in 88.9% of the pro-cedures. Manual traction presented high success rates, resulting in com-plete removal without complications in 90% of the cases.

Conclusion

This article suggests that lead extraction by simple manual traction can still be performed effectively in countries with economic diffi-culties as a first attempt, leaving auxiliary tools for a second attempt in case of failure or contraindications to the simple manual traction technique.

Adhesive bond integrity of dentin conditioned by photobiomodulation and bonded to bioactive restorative material

AIM

The aim of this in-vitro study is to investigate the shear bond strength (SBS) of Bioactive bulk fill restorative material (BARM) (Activa) by surface pre-treatment using Er,Cr:YSGG (ECL) on dentin in comparison to conventional dentin conditioning techniques.

MATERIAL AND METHODS

Sixty extracted non-carious, non-fractured, restoration free human molars were collected and mounted vertically in acrylic resin. The buccal surface of all molars were ground and polished with abrasive paper. The specimens were randomly allocated into four groups (n = 15) according to the type of surface treatment. Group 1 ECL + BARM, Group 2 ECL + Ketac + BARM, Group 3 Conventional Etch and Rinse + BARM, Group 4 Self-etch + BARM. The specimens from each group were positioned in a universal testing machine for SBS testing. Ten samples from each group were assessed for modes of failure. Means and standard deviations were compared using analysis of variance (ANOVA) and Tukey's post hoc test at a significance level of p < 0.05.

RESULTS

BARM bonded to dentin surface etched with conventional etch and rinse technique (group 3) exhibited SBS value of 18.45 ± 1.34. Similarly, the lowest bond strength was observed by group 4 (self-etch regime) bonded to BARM (16.09 ± 0.81). The bond strength among groups 1 (ECL + BARM), 2 (ECL + Ketac + BARM) and 3 (etch and rinse + BARM) were found to be comparable (p > 0.05).

CONCLUSION

Conditioning of dentin with photobiomodulation for the adhesive bonding of BARM showed comparable bond strength outcomes to conventional conditioning techniques.

Gold-Curcumin Nanostructure in Photo-thermal Therapy on Breast Cancer Cell Line: 650 and 808 nm Diode Lasers as Light Sources

Background:

Au nanoparticles (AuNPs) exhibit very unique physiochemical and optical properties, which now are extensively studied in a range of medical diagnostic and therapeutic applications. AuNPs can be used for cancer clinical treatment with minimal invasion. On the other hand, curcumin is a polyphenol derived from turmeric which is used for medical purposes due to its anti-cancer, anti-microbial, anti-oxidant and anti-inflammatory properties. Despite these potential properties of curcumin, its usage is limited in medicine due to low solubility in water. Conjugation of curcumin to AuNPs (Au-Cur nanostructure) can be increasing its solubility. Photo-thermal therapy (PTT) is a novel kind of cancer treatment which involves two major components: laser and photo-thermoconversion agents.

Materials and Methods:

Here, diode lasers emitting 808 nm and 650 nm were utilized as light sources, and synthesized Au-Cur nanostructure was applied as a photo-thermo conversion agent. UV-vis absorbance spectroscopy and dynamic light scattering (DLS) were applied to study the maximum absorption of particles, size stability of the samples and their zeta potential. The synthesized Au-Cur nanostructure under irradiation of laser is used for PPT on 4T1 cells. The cytotoxicity activity of Au-Cur nanostructure and laser irradiation on 4T1 cells was evaluated by MTT assay.

Results:

Synthesized Au-Cur nanostructure showed λ_max at 540 nm and a mean hydrodynamic diameter of 25.8 nm. 4T1 cells were exposed to an 808 nm diode laser (1.5 W cm², 10 min) in the presence of different concentrations of Au-Cur nanostructure. Next, 4T1 cells with Au-Vur nanostructure were exposed to diode laser beam (650 nm, 1.5 W cm²) for 10 min. The results revealed that Au-Cur nanostructure under laser irradiation of 808 nm more decreased cell viability of 4T1 cells compared to laser irradiation of 650 nm.

Conclusion:

It was concluded that combining an 808-nm laser at a power density of 1.5W/cm² with Au-Cur nanostructure has a destruction effect on 4T1 breast cancer cells in vitro experiments compared to laser irradiation of 650 nm.

Intraoral photobiomodulation diminishes pain and improves functioning in women with temporomandibular disorder: a randomized, sham-controlled, double-blind clinical trial : Intraoral photobiomodulation diminishes pain in women with temporomandibular disorder

The aim of the present study was to evaluate the effect of intraoral photobiomodulation involving super-pulsed laser (905 nm) combined with red (640 nm) and infrared (875 nm) light-emitting diodes on pain, mandibular range of motion, and functioning in women with myogenous temporomandibular disorder. A randomized, sham-controlled, double-blind clinical trial was conducted involving 30 women with myogenous temporomandibular disorder diagnosed using the Research Diagnostic Criteria for Temporomandibular Disorders. The participants were randomly allocated to two groups (active and sham photobiomodulation). The evaluations involved this use of the visual analog scale, digital calipers, and a functional scale. Photobiomodulation was administered intraorally in the region of the pterygoid muscles, bilaterally, in all participants for a total of six sessions. Evaluations were performed on five occasions: prior to the intervention, immediately after the first session, 24 h and 48 h after the first session, and after the six sessions. Significant differences between groups were found regarding pain (p ≤ 0.01) and functioning (p ≤ 0.04). However, no statistically significant difference was found regarding range of mandibular motion. The findings demonstrate that intraoral photobiomodulation involving super-pulsed laser (905 nm) combined with red (640 nm) and infrared (875 nm) light-emitting diodes diminishes pain and improves functioning but does not exert an influence on mandibular range of motion in women with temporomandibular disorder.Trial registration: NCT02839967.

Photobiomodulation therapy on the palliative care of temporomandibular disorder and orofacial/cervical skull pain: study protocol for a randomized controlled clinical trial

Background

Temporomandibular disorder (TMD) is the most common cause of orofacial and cervical skull pain and is considered to be a public health problem, affecting 5% to 12% of the world population. TMD is multifactorial and there are several types of treatment, with the conservative types being indicated more often as they are less aggressive and reversible. The main aim of these treatments is to relieve symptoms, reduce of pain, and restore orofacial and cervical skull functions. Photobiomodulation therapy (PBMT), a noninvasive therapy, is an option for the management of musculoskeletal disorders due to its analgesic, anti-inflammatory, and regenerative effects.

Methods

The aim of the proposed study is to verify whether PBMT is effective for use in palliative care of TMD and orofacial and cervical skull pain. A randomized, triple-blinded, placebo-controlled clinical trial is proposed. This study will involve 200 adult participants (over 18 years of age) who will be randomly divided into two groups (n = 100): Group 1, active treatment (PBMT); and Group 2, placebo. Participants will be subjected to three sessions of PBMT or placebo and will be evaluated using the research diagnostic criteria (RDC) for TMD. Pain level (measured by a visual analog scale (VAS)), mandibular movements (measured by ruler and caliper), quality of life (measured by the Oral Health Impact Profile (OHIP)-14), and quality of sleep (measured by the Epworth scale) will be recorded. This study is being conducted at the Special Laboratory of Lasers in Dentistry (LELO) of the School of Dentistry of the University of Sao Paulo (USP).

Discussion

This study will verify whether PBMT is effective in reducing TMD and orofacial and cervical skull pain. PBMT may be an option for the management of musculoskeletal disorders due to its analgesic, anti-inflammatory, and regenerative effects, in addition to being a noninvasive technique.

Trial registration

Registro Brasileiro de Ensaios Clínicos, RBR-9b6mnj. Registered on 27 March 2018.

Trial registry name: Laser de baixa potência no cuidado paliativo da disfunção temporomandibular e dor crânio orofacial e cervical.

Ethics committee: #1774930 approved on 14 October 2016.

Electronic supplementary material

The online version of this article (10.1186/s13063-019-3294-7) contains supplementary material, which is available to authorized users.

Efficacy of transforaminal laser annuloplasty versus intradiscal radiofrequency annuloplasty for discogenic low back pain

Background

Discogenic pain is a common cause of disability and is assumed to be a major cause of nonspecific low back pain. Various treatment methods have been used for the treatment of discogenic pain. This study was conducted to compare the therapeutic success of radiofrequency (an intradiscal procedure) and laser annuloplasty (both an intradiscal and extradiscal procedure).

Methods

This single-center study included 80 patients and followed them for 6 months. Transforaminal laser annuloplasty (TFLA, 37 patients) or intradiscal radiofrequency annuloplasty (IDRA, 43 patients) was performed. The main outcomes included pain scores, determined by the numeric rating scale (NRS), and Oswestry disability index (ODI), at pre-treatment and at post-treatment months 1 and 6.

Results

The patients were grouped according to procedure. In all procedures, NRS and ODI scores were significantly decreased over time. Mean post-treatment pain scores at months 1 and 6 were significantly lower (P < 0.01) in both groups, and between-group differences were not significant. The ODI score was also significantly decreased compared with baseline. Among patients undergoing TFLA, 70.3% (n = 26) reported pain relief (NRS scores < 50% of baseline) at post-treatment 6 months, vs. 58.1% (n = 25) of those undergoing IDRA. There were no statistically significant differences between the groups in ODI reduction of > 40%.

Conclusions

Our results indicate that annuloplasty is a reasonable treatment option for carefully selected patients with lower back and radicular pain of discogenic origin, and TFLA might be superior to IDRA in patients with discogenic low back pain.

Detection of enamel subsurface lesions by swept-source optical coherence tomography

This study aimed to non-destructively analyze the progression of subsurface enamel caries using swept-source optical coherence tomography (SS-OCT), a recently developed imaging analysis modality. Artificial enamel caries at various stages of demineralization were created in bovine tooth enamel using a modified lactic acid gel system. Untreated enamel served as a control. OCT images from cross-sections of enamel were collected. Mineral density, distribution, and histological changes were analyzed using an electron probe microanalyzer, scanning electron microscopy, and contact microradiography. The Raman spectrum and X-ray structural analysis of the enamel surfaces were determined. SS-OCT detected significant differences in mineral loss among the samples. A high-brightness image was confirmed, along with changes in the respective brightness graphs proportionate to the degree of demineralization. SS-OCT can potentially be used to evaluate the progression of incipient enamel carious lesions.

Can Low-Level Laser and Light-Emitting Diode Enhance the Stability of Dental Implants?

Purpose

Stability of dental implants is an important factor for evaluation of osseointegration. The aim of this study was to evaluate the effect of combined use of low-level laser (LLL) and light-emitting diode (LED) therapy on the stability of dental implants during the healing phase.

Materials and Methods

This was a randomized clinical trial. Patients were assigned to two groups: In group 1, patients received LLL and LED 20 min/day for 10 days after implant insertion. Patients in group 2 (controls) did not undergo LLL and LED. The implant stability quotient (ISQ) was measured at 0 (time 0), 10 (time 1), 21 (time 2), 42 (time 3) and 63 days (time 4) after implant placement. Independent t test was used to compare the ISQs between the two groups.

Results

Fifty-eight patients were studied in two groups (n = 28). The mean ISQ did not differ immediately after insertion (P > 0.05). The mean ISQ differed significantly between the two groups on days 10, 21, 42 and 63 (P < 0.05). Results demonstrated an increase in the amount of ISQ in group 1 (intervention) at times 1, 2, 3 and 4. In the control group, the amount of ISQ decreased on days 10 and 21 following implant insertion, but increased afterward on days 42 and 63.

Conclusion

The results of this study showed that simultaneous use of LLL and LED increased the stability of the implants after 9 weeks of follow-up.

Influence of grape seed extract in adhesion on dentin surfaces conditioned with Er,Cr:YSGG laser

The proanthocyanidin (PA)-rich grape seed extract (GSE) is a collagen cross-linking agent that can perform a chemical bond with the dentin's collagen. The objective of this study was to evaluate the influence on shear bond strength (SBS) of the pre-conditioning of GSE, on human dentin surfaces conditioned with Er,Cr:YSGG laser. The sample consisted of 64 non-carious human teeth, divided into eight groups, four groups conditioned with Er,Cr:YSGG laser (4.5 W, 50 Hz, 50 μs, 70% air, 90% water) and four prepared with conventional methods (control). In both groups, a GSE solution was applied before using the two adhesives tested: Clearfil^™ SE Bond (CSE) and Scotchbond^™ Universal (SU). Subsequently, a SBS test, a scanning electron microscopy, and a statistical analysis were performed. In the laser groups, the best SBS mean (20.08 ± 4.01 MPa) was achieved in the group treated with GSE and CSE. The control group with the application of CSE showed the highest SBS mean (24.27 ± 10.28 MPa), and the group treated with laser and SU showed the lowest SBS mean (12.94 ± 6.51 MPa). Between these two groups there was a statistically significant difference (p = 0.05). However, this was not observed among the laser or control groups. The type of dentin surface preparation can influence the SBS. The CSE showed better SBS in laser and control groups. The presence of GSE did not improve the adhesion on surfaces conditioned with laser, but more studies should be carried out in the future to confirm this conclusion.

Single and double pain responses to individually titrated ultra-short laser stimulation in humans

Background

This preclinical study in humans was designed to selectively induce delayed nociceptive pain responses to individually titrated laser stimulation, enabling separate bedside intensity scoring of both immediate and delayed pain.

Methods

Forty-four (fourteen female) healthy volunteers were subjected to repeated nociceptive dermal stimulation in the plantar arc, based on ultra-short carbon dioxide laser with individually titrated energy levels associated with mild pain.

Results

Data was analysed in 42 (12 female) subjects, and 29 of them (11 females) consistently reported immediate and delayed pain responses at second-long intervals to each nociceptive stimulus. All single pain responses were delayed and associated with lower levels (p = 0.003) of laser energy density (median 61; IQR 54–71 mJ/mm²), compared with double pain responses (88; 64–110 mJ/mm²). Pain intensity levels associated with either kind of response were readily assessable at bedside.

Conclusions

This study is the first one to show in humans that individually titrated ultra-short pulses of laser stimulation, enabling separate pain intensity scoring of immediate and delayed responses at bedside, can be used to selectively induce and evaluate delayed nociceptive pain, most likely reflecting C-fibre-mediated transmission. These findings might facilitate future research on perception and management of C-fibre-mediated pain in humans.

A Face-Split Study to Evaluate the Effects of Microneedle Radiofrequency with Q-Switched Nd:YAG Laser for the Treatment of Melasma

Background

Laser toning using a low-fluence 1,064 nm Q-switched Nd:YAG laser is one of the most frequently used treatment modalities for melasma. However, this therapy is time consuming because it requires a lot of treatment sessions. Recently, it has been reported that transdermal radiofrequency (RF) is effective for the treatment of melasma.

Objective

To determine whether microneedle RF conduction could be an adjunct therapy for melasma, we have studied the effect of simultaneous treatments with laser toning and RF for melasma.

Methods

Fifteen patients with melasma underwent five sessions of laser toning and microneedle RF on the right side of the face, and only laser toning on the left side. Responses to treatments were evaluated using the Mexameter® (Courage Khazaka, Germany) score, the pigmentation and severity index (PSI) score, and the patient's overall assessment. Additionally, an electron microscopic study of a skin biopsy was performed.

Results

Both laser toning and combination therapy showed significant decreases in the Mexameter® and PSI score after five treatment sessions. Combination therapy showed a more significant improvement of melasma than laser toning. No remarkable side effects were reported. Electron microscopic analysis showed a greater number of vacuolar changes and increased loosening of melanocytes and adjacent epidermal cells after combination therapy.

Conclusion

The combination treatment of laser toning and microneedle RF therapy showed a better therapeutic effect for melasma than laser toning alone. Therefore, the microneedle RF technique could be a new and safe adjunct therapy for the treatment of melasma.

Selective Removal of Necrotic Dentin in Primary Teeth Using Laser Irradiation: One-Year Clinical Evaluation of Composite Restorations

Introduction: This study aimed to evaluate the child's salivary cortisol levels, clinical performance and marginal adaptation of restorations after selective removal of necrotic dentin in primary teeth using Er: YAG laser irradiation. Methods: A double-blind clinical study was performed in children at 7-10 years. Children who had at least 2 teeth with carious lesions involving the occlusal and proximal surfaces of primary molars counterparts were selected. Removal of necrotic dentin was performed by 2 methods: Er: YAG laser irradiation and bur-preparation. Cortisol levels (n =24) was evaluated by ELISA. Clinical analysis (n =20) was performed after the restorations polish, 6 and 12 months after restorative procedure using United States Public Health Service (USPHS) method and photographs. Scanning electron microscopy (SEM) was used to analyz the marginal gap formation (n =20). The analysis of the data was performed by 95% confidence interval, Shapiro-Wilk test, Friedman and Wilcoxon post hoc tests (α =5%). Results: Cortisol levels were higher during selective removal of necrotic dentin, regardless of the method used (P>0.05). After 12 months, there was no evidence of the difference in the restorations performed on cavities prepared by both methods. SEM analysis revealed that the laser-irradiated teeth showed 10% of gaps in the full extent of restoration. For bur-prepared teeth, 20% of gaps were found at the cavosurface margin. Conclusion: The salivary cortisol levels on children that received Er: YAG laser irradiation for removal the necrotic dentin was similar to the control group. Class II restorations evaluated after 1 year period did not suffer interference by the use of Er: YAG laser irradiation.

Comparison of conventional and laser-aided fiberotomy in relapse tendency of rotated tooth: A randomized controlled clinical trial

INTRODUCTION

The aim of the present study was to compare the tendency of mandibular incisor rotation relapse after conventional circumferential supracrestal fiberotomy (CSF) with Er,Cr:YSGG laser-aided CSF.

METHODS

In this three-arm parallel study, the patients with one lower incisor rotation greater than 30 degrees before treatment were selected. The patients were randomly assigned to three groups in a 1:1:1 ratio. Rotational relapse tendency was measured on a digitized model one month after arch wire removal. Probing depth, clinical crown height and pain levels were also measured.

RESULTS

A total of 46 patients were recruited. Relapse tendency in conventional CSF and laser-aided CSF groups were 5.09±1.59° and 4.87±2.08°, respectively, and significantly lower than 11.28±2.93° in the control group (P<0.001). Relapse tendency was not different between the conventional CSF and laser CSF groups. Probing depth, clinical crown height, and experienced pain levels exhibited negligible differences.

CONCLUSIONS

Er,Cr:YSGG laser-aided CSF in one month was as effective in reducing rotational relapse tendency of mandibular incisor teeth as conventional CSF.

Pharyngeal pouch: comparison of surgical treatment with botulinum toxin injection to the cricopharyngeus

BACKGROUND

Pharyngeal pouch surgical treatments can be carried out via an endoscopic or open approach. Injection of botulinum toxin into the cricopharyngeus was first described as an alternative treatment to the more invasive surgical procedures performed for cricopharyngeal dysfunction. It has not been previously described as a treatment option for pharyngeal pouch.

OBJECTIVES

To compare operative time, average stay, complication rates and symptom control between endoscopic laser diverticulotomy, botulinum toxin injection and open procedures for pharyngeal pouch patients.

METHODS

The medical records for 66 pharyngeal pouch procedures, carried out on 47 patients treated between 2011 and 2017, were identified and reviewed.

RESULTS

The mean operative time was 21 minutes for botulinum toxin injection, 38 for endoscopic laser diverticulotomy and 104 for open surgery. The mean hospital stay was 0.6 days for botulinum toxin injection, 4.7 for endoscopic laser diverticulotomy and 4 for open surgery. The improvement in Reflux Symptom Index scores was statistically significant for both endoscopic laser diverticulotomy and botulinum toxin injection. Botulinum toxin injection had a 0 per cent complication rate.

CONCLUSION

Botulinum toxin injection is a safe and effective treatment for pharyngeal pouch.

Comparison of the Scar Prevention Effect Between a Carbon Dioxide Fractional Laser and a Continuous Ablative Carbon Dioxide Laser with a 595-nm Nd:YAG Laser

PURPOSE

A linear surgical scar, when located in the head and neck region, can be a significant cosmetic concern. Laser skin resurfacing with a fractional laser and a pulsed dye laser has been proven to be useful for treating such scars. As alternatives, we used a classic ablative CO₂ laser in continuous mode with a 1-mm spot size and a 595-nm Nd:YAG laser. We investigated the effect of the combination of the continuous CO₂ laser and 595-nm Nd:YAG laser and compared it to the effect of fractional CO₂ laser monotherapy on linear scars.

METHODS

This was a retrospective, case-controlled study designed to compare the efficacy between fractional CO₂ laser therapy and combination therapy with a conventional CO₂ laser in continuous mode and a 595-nm Nd:YAG laser. Treatment efficacy was evaluated by two different scar scales: the Stony Brook Scar Evaluation Scale (SBSES) and the modified Vancouver Scar Scale (mVSS). Laser treatments were performed every month until the 6th month after surgery.

RESULTS

The SBSES and mVSS scores improved over time in both the monotherapy and the combination therapy (P < 0.001). No significant differences were found between the therapies for all the subcategories of the SBSES. However, among all the subcategories of the mVSS, pigmentation showed a better prognosis with combination therapy (P = 0.04).

CONCLUSION

Monotherapy and combination therapy can provide similar positive effects on linear scar improvement after repeated treatment, whereas combination therapy exerts more favorable anti-pigmentation effects than monotherapy. The combination of a continuous ablative CO₂ laser with a 595-nm Nd:YAG laser can be used as a favorable alternative to a fractional CO₂ laser. The 1-mm spot size of the CO₂ laser beam may mimic the fractional laser form and offer more effective results for linear incision scars.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Treatment of urinary calculi after Yang-Monti ileal ureter reconstruction: a case report

BACKGROUND

The development of ureteral calculi after Yang-Monti ileal ureter reconstruction has not been reported. This study was performed to explore the safety and effectiveness of ureteroscopy combined with laser lithotripsy in the treatment of ipsilateral lower ureteral calculi and lower calyceal calculi after Yang-Monti ileal ureter reconstruction.

CASE PRESENTATION

A 48-year-old man was admitted to our hospital with ipsilateral distal ureteral calculi and ipsilateral lower calyceal calculi. One year prior to this admission, the patient had undergone Yang-Monti ileal ureter reconstruction due to long-segment ureteral stenosis. After conservative treatment failed, we used a rigid ureteroscope with a holmium laser to break up the distal ureteral calculi, and successfully removed the renal calculi with a digital flexible ureteroscope and basket extractor.

CONCLUSION

The successful outcome of the present case suggests that ureteroscopy combined with laser lithotripsy is a valuable option for the management of urinary calculi following Yang-Monti ileal ureter reconstruction.

The Effects of Different Agitation Techniques of Canal Irrigant on Tubular Penetration of a Bioceramic Sealer

Introduction

This study aimed to compare the effects of different agitation techniques of sodium hypochlorite (NaOCL) as the final irrigation with XP-Finisher file, passive ultrasonic irrigation (PUI), Er:YAG laser and irrigation with conventional syringes, on penetration of Sure Seal Root bioceramic sealer into dentinal tubules.

Methods and Materials

Forty freshly extracted single-rooted human teeth were included in the present in vitro study. All the teeth were prepared up to #40 (4%) with Bio Race rotary file system, using crown-down technique. After chemomechanical preparation, the teeth were randomly assigned to 4 groups based on the agitation protocol: conventional needle irrigation (CNI) with a 30-G needle in a syringe, PUI, Er:YAG laser and XP-Finisher file, Subsequent to the agitation procedure, the root canals were obturated with tapered bioceramic-covered gutta-percha point and, bioceramic sealer, using the single-cone technique. The maximum penetration of the sealer into the dentinal tubules was determined in the coronal, middle and apical thirds using the scanning electron microscope (SEM) technique. After confirmation of the normal distribution of data with Shapiro-Wilk test, Data were analyzed using the one-way ANOVA and Tukey tests.

Results

The mean penetration depth of the bioceramic sealer into the dentinal tubules in the PUI group was greater than that of other groups; however, the difference between the two PUI and Er:YAG laser groups in the apical third was not significant (P=0.078). Er:YAG laser, PUI and XP-Finisher file agitation techniques resulted in significantly greater penetration of the bioceramic sealer into the dentinal tubules compared to the CNI (P<0.001). The XP-Finisher file technique in the apical (P=0.752) and middle thirds (P=0.339) and the Er:YAG laser technique in the apical thirds (P=0.086) were not significantly different from the conventional irrigation technique.

Conclusion

The PUI technique resulted in significantly deeper penetration of the Bioceramic sealer into the dentinal tubules compared to the three other techniques.

Effect of Er:YAG laser irradiation and chitosan biomodification on the stability of resin/demineralized bovine dentin bond

OBJECTIVE

The purpose of this study was to evaluate the effect of Er:YAG laser for selective removal of carious lesion, followed by biomodification with chitosan on the microtensile bond strength (µTBS), adhesive interface, dry mass loss and hydroxyproline release (HYP).

METHODS

Artificial lesions were created in 104 bovine dentin blocks. Blocks were divided according to caries removal method: bur or Er:YAG laser. Seventy-six blocks were acid etched and subdivided according to dentin biomodification: no chitosan and 2.5% chitosan. Composite resin restorations were performed. Blocks were sectioned into beams and stored in water. After 24 h, 6 and 12 months, beams were submitted to μTBS test (n = 10) and analysis of adhesive interface by SEM (n = 3). The other 28 blocks were sectioned into beams and initial dry mass (DM) was determined (n = 7). Beams were stored and after 7 days, DM was redetermined. HYP release (n = 7) was evaluated by ELISA. Data were analyzed by ANOVA and Bonferroni's tests (α = 0.05).

RESULTS

After 24 h, the highest µTBS was found for bur (p < 0.001). After 6 months, methods were similar (p = 0.432). After 12 months, laser-irradiated dentin showed the highest µTBS values (p = 0.025). Chitosan promoted higher µTBS values after 6 (p = 0.011) and 12 months (p < 0.001) preserving adhesive interface. Dry mass loss and HYP release were not influenced (p > 0.05) by caries removal method or by dentin biomodification.

CONCLUSION

The bond strength to demineralized dentin reduced over 50% in all groups after water storage. From 6 months of water storage, Er:YAG laser irradiation and biomodification with chitosan maintained the stability of the resin-dentin bonds, but did not influence dry mass loss and HYP release.

Striae Distensae Treatment Review and Update

Striae distansae (SD) or stretch marks are very common, asymptomatic, skin condition frequently seen among females between 5 to 50 years of ages. It often causes cosmetic morbidity and psychological distress, particularly in women and in certain professions where physical appearances have significant importance. Of late, with the increasing emphasis on cosmetic management and awareness, patients approach dermatologists for stretch marks treatment. However, despite several advances, no fully effective treatment has emerged. Unfortunately, there is paucity of the strong evidence in the literature for the effective treatment of striae. A literature search using the terms 'striae distansae (SD or stretch marks' was carried out in the PubMed, Google Scholar and Medline databases. Only articles related to the treatment were considered and analysed for their data. Commonly cited treatments include topical treatments like tretinoin, glycolic acid, ascorbic acid and various lasers including (like) carbon dioxide, Er:YAG, diode, Q-switched Nd:YAG, pulse dye and excimer laser. Other devices like radiofrequency, phototherapy and therapies like platelet rich plasma, chemical peeling, microdermabrasion, needling, carboxytherapy and galvanopuncture have also been used with variable success. This article reviews all currently accepted modalities and their effectiveness in the treatment of stretch marks.

Effects of Ultrasound, Laser and Exercises on Temporomandibular Joint Pain and Trismus Following Head and Neck Cancer

OBJECTIVE

To compare the effects of low intensity ultrasound (LIUS), traditional exercise therapy (TET), low level laser therapy (LLLT) and TET on temporomandibular joint (TMJ) pain and trismus following recovery from head and neck cancer (HNC).

METHODS

Sixty participants following, who had experienced HNC, were randomly allocated to three groups of 20 people each. Each group received different therapy. Group A received LIUS and TET; group B received LLLT and TET; while group C received TET. All 60 participants were evaluated under the visual analog scale (VAS), the University of Washington Quality of Life questionnaire (UW-QOL) and the Vernier caliper scale (VCS) at the beginning of the therapies and after 4 weeks.

RESULTS

ANOVA test revealed significant improvements across all three groups with outcomes of p<0.05. The results of the UW-QOL questionnaire showed a significant difference between groups A, B and C in favor of group A (p<0.05). The VAS results showed a more improvement in group A as compared to group B (p<0.05), while there was no statistical difference between groups B and C (p>0.05). The VCS results showed more improvement for the individuals in group B as compared to those in group C (p<0.05), while there was minimal difference between groups A and B (p>0.05).

CONCLUSION

The LIUS and TET are more effective than LLLT and/or TET in reducing TMJ pain and trismus following HNC.

Histopathological Changes of the Retina After Nd: YAG Laser Thrombolysis in Branch Retinal Vein Occlusion: An Experimental Study

Introduction: The efficacy of many therapeutics techniques for treatment of branch retinal vein occlusion (BRVO) has been the subject of many investigations. The aim of the present work is to evaluate the transluminal Nd: YAG laser thrombolysis as a new therapeutic approach used for treatment of BRVO in rabbits as an experimental model. Methods: Four rabbits were considered as a control (n=8 eyes); occlusion of the branch retinal veins was performed by using a dye enhancing thrombus formation in right eyes of 10 rabbits (n=10 eyes). Thrombi in the retinal veins were induced by intravenous injection of rose bengal solution as a photosensitizer immediately before the argon laser application with a power of 1200 mW, a spot size of 100 µm, and a duration of 20 ms. One week later, transluminal Nd: YAG laser thrombolysis (30 mJ, 3 pulses/4 ns) was employed to the site of occluded veins, until the thrombi were partially or completely shattered. The rabbits were followed up after 4 days, 1 week and 2 weeks for slit lamp fundus examination and the treated retinas were isolated for histopathological examination. Results: Argon laser photothrombosis induced complete BRVO with some vitreous hemorrhage, destruction, and necrosis in the surrounding retinal layers. Moreover, one week later, Nd: YAG laser thrombolysis showed complete venous flow, minimal vitreous hemorrhage, reperfused retina, complete veins improvement. Follow up after 2 weeks revealed more improvement of all retinal layers. Conclusion: Treatment with transluminal Nd: YAG laser thrombolysis represented a novel therapeutic modality in BRVO.

Effects of subthreshold diode micropulse laser photocoagulation on treating patients with refractory diabetic macular edema

Purpose

To evaluate the effects of subthreshold diode micropulse laser photocoagulation on treating patients with refractory diabetic macular edema (DME).

Methods

This randomized clinical trial recruited patients with DME in both eyes that were resistant to treatment with intravitreal bevacizumab (IVB). The eyes were randomly divided into two groups who received laser therapy and IVB, or IVB alone. Subthreshold diode micropulse laser photocoagulation and IVB injection were administered in one eye, and an IVB injection was administered in the second eye. IVB injections were repeated in both eyes within one month and two months after the first injection. Best corrected visual acuity (BCVA) logarithm of the minimum angle of resolution (logMAR) and central macular thickness (CMT) were measured before, within a month, and three months after start of intervention.

Results

In this study, 42 eyes of 21 patients were evaluated. The mean age of patients was 60.86 ± 8.57 years. Ten patients (47.6%) were male. Within-group analysis showed a significant decreased in BCVA logMAR in the laser + IVB group reflecting improvement in visual acuity (VA) (P < 0.001); it increased in the control group during study reflecting more vision loss (P = 0.01). In the laser + IVB group, a significant decrease in mean ± standard deviation (SD) CMT at 3 months compared to baseline was observed (baseline: 513 ± 126.29 vs. three months: 408.1 ± 95.28; P < 0.001). The mean ± SD CMT was significantly lower in the laser + IVB group of eyes than in the control group three months after intervention (P = 0.02).

Conclusion

Using subthreshold diode micropulse laser photocoagulation in combination with IVB can significantly reduce CMT and improve BCVA in patients with refractory DME.

Seborrheic Keratoses - The Most Common Benign Skin Tumor of Humans. Clinical presentation and an update on pathogenesis and treatment options

Seborrheic keratoses (SK) are the most common skin tumour of humanity. The incidence of this purely benign epithelial proliferation is increasing with age and exposure to ultraviolet light. It has a remarkable variability in its clinical presentation raising some differential diagnoses. Recently, oncogenic mutations have been detected involved in the development of SK, which, however, do not bear the risk of malignant transformation. SK may also develop with the use of modern targeted drugs for the treatment of malignancies. The classical treatment options for SK are cryotherapy and curettage. Recently, topical treatment with 40% hydrogen peroxide and the nitric-zinc complex has been investigated. Ablative laser therapy is an effective treatment as well.

Treatment modalities for recurrent high-grade vaginal intraepithelial neoplasia

Objective

We have investigated outcomes of women presenting with recurrent high-grade vaginal intra-epithelial neoplasia.

Methods

Data of consecutive women diagnosed with recurrent high-grade vaginal intra-epithelial neoplasia after primary treatment(s) were retrieved. Risk of developing new recurrence over the time was assessed using Kaplan-Meier and Cox models.

Results

Data of 117 women were available for the analysis. At primary diagnosis, 41 (35%), 4 (3.4%) and 72 (61.6%) patients had had laser, pure surgical and medical treatments, respectively. Secondary treatments included: laser ablation and medical treatment in 95 (81.2%) and 22 (18.8%) cases, respectively. After a mean (standard deviation) follow-up of 72.3 (±39.5) months, 37 (31.6%) out of the entire cohort of 117 patients developed a second recurrence. Median time to recurrence was 20 (range,5-42) months. Patients with recurrent high-grade vaginal intra-epithelial neoplasia undergoing medical treatments were at higher risk of developing a second recurrence in comparison to women having laser treatment (p=0.013, log-rank test). After we corrected our results for type of treatment used for recurrent disease, we observed that the execution of primary laser treatment was independently associated with a lower risk of developing new recurrences (hazard ratio [HR]=0.46; 95% confidence interval [CI]=0.21–0.99; p=0.050). The other variable that is independently associated with a new recurrence is the persistent infection from HPV16 or 18 (HR=3.87; 95% CI=1.15–13.0; p=0.028).

Conclusion

Patients with recurrent high-grade vaginal intra-epithelial neoplasia are at high risk of developing new recurrences. Our data underline that the choice of primary treatment might have an impact of further outcomes.

Comparison of Swallowing Act Videofluoroscopy after Open and Laser Partial Supraglottic Laryngectomy

INTRODUCTION

The aim of this study was to compare the functional outcomes of swallowing act detected by videofluoroscopy of two different techniques in the treatment of laryngeal carcinoma.

MATERIALS AND METHODS

This study was conducted on 41 patients undergoing two supraglottic laryngectomy techniques. The research population was assigned into two groups of open and laser supraglottic laryngectomy, including 21 and 20 patients, respectively.

RESULTS

Food residue was present in most of the patients in the open laryngectomy group. Aspiration of the liquid and solid contrasts was observed in 16 and 4 patients, respectively. In the laser laryngectomy group undergoing a partial supraglottic laryngectomy via carbon dioxide (CO₂) laser, aspiration was recorded in only six patients. There was a statistically significant difference between these two groups regarding the presence of aspiration as a marker of a bad functional outcome.

CONCLUSION

Techniques that include the endoscopic removal of the tumor via CO₂ laser result in good oncologic and functional outcomes, along with reduced postoperative morbidity and mortality.