Soft-tissue lasers in orthodontics: an overview

Patient safety in orthodontic care: a scoping literature review with proposal for terminology and future research agenda

BACKGROUND

Knowledge about patient safety in orthodontics is scarce. Lack of standardisation and a common terminology hinders research and limits our understanding of the discipline. This study aims to 1) summarise current knowledge about patient safety incidents (PSI) in orthodontic care by conducting a systematic literature search, 2) propose a new standardisation of PSI terminology and 3) propose a future research agenda on patient safety in the field of orthodontics.

METHODS

A systematic literature search was performed in the main online sources of PubMed, Web of Science, Scopus and OpenGrey from their inception to 1 July 2023. Inclusion criteria were based on the World Health Organization´s (WHO) research cycle on patient safety. Studies providing information about the cycle's steps related to orthodontics were included. Study selection and data extraction were performed by two of the authors.

RESULTS

A total of 3,923 articles were retrieved. After review of titles and abstracts, 41 articles were selected for full-text review and 25 articles were eligible for inclusion. Seven provided information on the WHO's research cycle step 1 ("measuring harm"), twenty-one on "understanding causes" (step 2) and twelve on "identifying solutions" (step 3). No study provided information on Steps 4 and 5 ("evaluating impact" or "translating evidence into safer care").

CONCLUSION

Current evidence on patient safety in orthodontics is scarce due to a lack of standardised reporting and probably also under-reporting of PSIs. Current literature on orthodontic patient safety deals primarily with "measuring harms" and "understanding causes of patient safety", whereas less attention has been devoted to initiatives "identifying solutions", "evaluating impact" and "translating evidence into safer care". The present project holds a proposal for a new categorisation, terminology and future research agenda that may serve as a framework to support future research and clinical initiatives to improve patient safety in orthodontic care.

REGISTRATION

PROSPERO (CRD42022371982).

Effect of laser corticotomy on canine retraction rate: a split-mouth randomized clinical trial

BACKGROUND

This study assessed the effect of corticotomy with Er: YAG (erbium-doped yttrium aluminium garnet) laser on the rate of canine retraction.

METHODS

This randomized split-mouth controlled clinical trial was conducted on 12 patients undergoing orthodontic treatment with extraction of maxillary first premolars. Following initial leveling and alignment, an alginate impression was made from the maxillary arch, and Er: YAG laser corticotomy was performed in one of the maxillary quadrants of each patient. Canine retraction was started immediately after corticotomy by placement of nickel-titanium (NiTi) closed coil springs at both sides. At the end of each month, alginate records were repeated for 4 months. Study models were scanned, and the anteroposterior movement of canine was quantified bilaterally. Pain was also measured by a visual analog scale (VAS). Probing depth (PPD) of canines and two adjacent teeth was also evaluated and pulp vitality was assessed by performing the cold test. Data were analyzed by paired and independent t-test and one-way ANOVA (alpha = 0.05).

RESULTS

The rate of canine retraction was significantly greater in the laser-assisted corticotomy quadrant than the control (P < 0.05). No significant difference existed in posterior anchorage loss, canine rotation angle, PPD, pulp vitality, or pain score between two groups (P > 0.05).

CONCLUSIONS

Flapless Er: YAG laser corticotomy significantly enhanced canine retraction rate with no adverse effect on other parameters.

Gingivectomy with Diode Laser Versus the Conventional Scalpel Surgery and Nonsurgical Periodontal Therapy in Treatment of Orthodontic Treatment-Induced Gingival Enlargement: A Systematic Review

Background and objective: Some studies support the superiority of diode laser gingivectomy to scalpel surgery and nonsurgical treatments. However, a systematic review on this topic is lacking. This study aimed to compare gingivectomy with diode laser versus the conventional scalpel surgery and nonsurgical periodontal therapy (NSPT) in the treatment of orthodontic treatment-induced gingival enlargement (GE). Materials and methods: In this systematic review, an electronic search of the relevant literature was conducted in Web of Science, Medline/PubMed, Scopus, Cochrane Central Register of Controlled Trials, and ProQuest with no language restriction. Randomized clinical trials published between 1985 and 2020 on comparative treatment of orthodontic treatment-induced GE by diode laser gingivectomy and scalpel surgery or NSPT regarding intraoperative and postoperative bleeding and/or pain were included. Risk of bias was assessed by the Cochrane 1 tool. Results: Of the initially retrieved 288 articles, 40 were duplicates and excluded; 236 articles were excluded following title and abstract screening, and 5 others were excluded following full-text assessment. Finally, 7 studies underwent systematic review. In the risk-of-bias assessment, 5 studies scored 2, and 2 studies scored 3 out of 6. Intraoperative and postoperative bleeding and pain were found to be significantly lower in the laser group. Conclusions: Within the limitations of this systematic review and with respect to the quality of evidence, the present results revealed lower level of pain and bleeding in diode laser gingivectomy compared with the conventional scalpel surgery and NSPT for treatment of orthodontic treatment-induced GE.

Efficacy of three surgical methods for gingivectomy of permanent anterior teeth with delayed tooth eruption in children

OBJECTIVE

To compare the efficacy of three surgically assisted permanent anterior tooth eruption methods (laser surgery, electrosurgery and routine surgery) in children.

METHOD

Sixty-three orthodontic children with retarded permanent anterior tooth were selected and according to the random number table divided into three groups: laser surgery group (group A), electrosurgery group (group B) and routine surgery group (group C). The total operative time (min), the duration of pain after gingival excision (d), Visual Analogue Scale (VAS) pain intensity scores (0-10 cm), and gingival healing time (d) were all recorded. Six months after treatment, periodontal indexes of the three groups, including gingival indexes (GI), plaque indexes (PLI), probing depth (PD) were checked by the same periodontist and recorded.

RESULTS

Surgical records showed that compared with group C, there were statistically significant differences in operative time, pain duration, pain intensity and healing time in group A and B (P < 0.05). There was no significant difference in these four results between group A and group B. Periodontal examination indicators 6 months after surgery showed no statistical differences in GI, PLI and PD among group A, B and C. Oral clinical examination found that the three groups of patients with different treatment, dental eruption was normal.

CONCLUSION

All the three treatments can effectively solve the problem of delayed eruption of permanent anterior teeth in children. Particularly, laser surgery and high-frequency electrosurgery have good efficacy, little pain and high operability, which can be considered as a better method to aid teeth eruption.

Evaluation of upper labial frenectomy: A randomized, controlled comparative study of conventional scalpel technique and Er:YAG laser technique

Objectives

Abnormalities in the maxillary frenum may lead to esthetic or functional limitations and need to be corrected with a surgical intervention called frenectomy. The aim of the study was to compare frenectomies performed using Er:YAG laser technology with those using a conventional scalpel technique. Comparisons were of patients' experiences, treatment times, bleeding during treatment and wound healing.

Material and methods

The trial was performed as a prospective, randomized and controlled, single‐blind investigation. A total of 40 patients requiring frenectomy were randomly assigned to groups which underwent either conventional or Er:YAG laser treatment. Patients' experiences, treatment time, bleeding and wound healing were evaluated immediately after surgery and 5 days, 12 days and 3 months after surgery.

Results

Significant increase in time spent in surgery and bleeding was seen with conventional scalpel surgery. Directly after surgery the wound area was significantly larger in the laser group but at the 5‐day evaluation no difference could be observed between the groups. Finally, patients were satisfied with both methods, giving them the same assessments.

Conclusion

In the frenectomy procedure, laser surgery is faster and causes less bleeding and may be advantageous in frenectomies.

Posterior Available Space for Uprighting Horizontally Impacted Mandibular Second Molars Using Orthodontic Microimplant Anchorage

Treatment of horizontally and deeply impacted mandibular molars is challenging for both orthodontists and oral surgeons because of the limited access and anchorage control. We report on two patients who had horizontally and mesially impacted mandibular second molars (MM2s). Both patients were treated by a surgical orthodontic approach, and the crowns of the impacted teeth were brought into the arches by closed forced eruption. Mesially impacted MM2s were uprighted with orthodontic microimplants, inserted in the retromolar area, and then moved into their ideal position. The first patient was in an active growing stage, while the second patient was beyond the active growing stage. Therefore posterior available space (PAS) should be analyzed before treatment of impacted MM2s to prevent periodontal problems after uprighting of impacted teeth. If PAS is not enough for uprighting impacted MM2s, alternative treatment should be considered based on the stage of growth.

Prospective study of the 532 nm laser (KTP) versus diode laser 980 nm in the resection of hyperplastic lesions of the oral cavity

Background

The aim of this study is to evaluate the resection of hyperplastic lesions on the buccal mucosa comparing the 532nm laser (KTP), versus diode 980nm laser, considering pain, scarring, inflammation and drug consumption that occurred postoperatively with each lasers.

Material and Methods

A prospective study of consecutive series of 20 patients in two groups that presents hyperplastic lesions on the buccal mucosa. The choice of the KTP laser or diode 980nm laser for the surgery was made randomly. The power used was 1.5W in both groups in a continuous wave mode with a 320 μm optical fiber. Parameters of pain, scarring, inflammation and consumption of drugs were recorded by a Numerical Rating Scale and evaluated postoperatively. These recordings were made the day of the surgery, 24 hours after, 14 and 28 days after.

Results

Pain and inflammation was light - moderate. The consumption of paracetamol was somewhat higher in the diode 980nm laser versus the KTP laser after 24 hours, although data was not statistically significant; significant differences were found after 28 days in regards to pain (p = 0.023) and inflammation (p = 0.023), but always in the absence parameter so we find no pain in both lasers. Scarring in the two types of laser showed no differences along the visits, with not detected scar retractable.

Conclusions

Although there is a slight histological difference regarding the KTP laser in the oral soft tissues for clinical use, both wavelengths are very suitable for excision of oral fibroma.

Key words:Laser surgery, Laser therapy, oral surgery, soft tissue, 980 nm diode laser, 532 nm KTP laser.

Laser Surgery of Soft Tissue in Orthodontics: Review of the Clinical Trials

Introduction: Recently, a wide variety of procedures have been done by laser application in orthodontics. Apart from the mentioned range of various treatments, laser has become a tool for many soft tissue surgeries as an alternative to conventional scalpel-based technique during orthodontic treatments in the management of soft tissue. Due to scarce information in the latter subject, this study was designed in order to include clinical trials that included soft tissue ablation by laser in orthodontics. Methods: Literature was searched based on PubMed and Google Scholar databases in 5 years (2010-2015) with English language restriction and clinical trial design. Studies that performed soft tissue application of laser during orthodontic treatment were extracted by the authors. Results: Only eight studies met the inclusion criteria. No significant difference was found between laser ablation and conventional scalpel technique in the matter of treatment outcome. However, few issues remained to clarify the differences in the mentioned procedures. Conclusion: Laser performance can be recommended in case of preceding less bleeding and discomfort during surgical procedure. There are still quandaries among clinical application of scalpel-based surgery in aesthetic region with bracket-bonded teeth. Precaution and knowledge regarding the characteristics of laser beam such as wavelength, frequency, power and timing is extremely needed.

Laser use in direct pulp capping: A meta-analysis

BACKGROUND

The authors of this study evaluated the effects of lasers on the outcome of direct pulp capping by means of a meta-analysis.

TYPES OF STUDIES REVIEWED

The authors completed a literature search on PubMed, Cochrane Library, Embase, and China National Knowledge Infrastructure, as well as a manual search of the reference lists of all identified articles since the introduction of lasers in endodontics in 1971 through May 30, 2016. The authors systematically evaluated the studies that met the inclusion criteria and performed a meta-analysis.

RESULTS

The authors selected 5 studies about 4 laser systems (carbon dioxide; diode; erbium,chromium:yttrium-selenium-gallium-garnet; and erbium:yttrium-aluminum-garnet) from the 510 articles to be included in this meta-analysis. Using a fixed-effects model, they found no significant heterogeneity between these studies (χ² = 0.83, P = .99, I² = 0%). Their results showed that the success rate (89.9%) of the laser groups was higher than that of 67.2% of the control groups, and the difference was statistically significant (risk ratio, 1.35; 95% confidence interval, 1.23-1.49; P < .00001).

CONCLUSIONS AND PRACTICAL IMPLICATIONS

On the basis of the limited evidence, the use of lasers effectively improved the prognosis of direct pulp capping treatment for permanent teeth.

The use of lasers for direct pulp capping

Direct pulp capping helps extend the life of a diseased tooth by maintaining tooth vitality. Nowadays, lasers are more frequently used during direct pulp capping in the clinic, but their use has not been previously reviewed. This review presents the basic properties of currently available lasers, scientific evidence on the effects of laser application on direct pulp capping, and future directions for this technology. An extensive literature search was conducted in various databases for articles published up to January 2015. Original in vitro, in vivo, and clinical studies, reviews, and book chapters published in English were included. Various laser systems have been increasingly and successfully applied in direct pulp capping. Lasers offer excellent characteristics in terms of hemostasis and decontamination for field preparation during direct pulp capping treatment; however, the sealing of exposed pulp with one of the dental materials, such as calcium hydroxide, mineral trioxide aggregates, and bonded composite resins, is still required after laser treatment. Clinicians should consider the characteristics of each wavelength, the emission mode, irradiation exposure time, power, type of laser tip, and the distance between the laser tip and the surface being irradiated.

Evaluating the effect of laser irradiation on bone regeneration in midpalatal suture concurrent to rapid palatal expansion in rats

Background:

Rapid palatal expansion is one of the most important orthopedic treatments that correct the dental and palatal constriction. Stability of the changes partly depend on the rapidity of new bone formation in affected sutures after expansion. The purpose of this study was to investigate the effect of laser irradiation on the healing of midpalatal suture concurrent to the expansion of midpalatal suture in rats.

Materials and Methods:

A total of 78 male Sprague rats in seven groups were evaluated: A control group of six rats without any treatments and three experimental groups of 24 which underwent palatal expansion for different time periods (7, 14, and 30 days), and each divided into two groups of with and without laser irradiation. Laser therapy was done by gallium-aluminum-arsenide diode laser with 810 nm wavelength and 4 J/cm² irradiation in days 0, 2, 4, 6, 8, 10, 12, 14 in 4 points (1 labial and 3 palatal points). After sacrificing, the sections were evaluated by histomorphometric and quantitative analysis and results were statistically investigated by independent samples t-test.

Results:

The results in 7 days, 14 days, and 30 days show that laser therapy can increase the rate of osteogenesis in palatal suture during rapid palatal expansion but the differences in 7 days groups were not significant (P = 0.117) while in 14 days groups (P = 0.032) and 30 days groups were significant (P = 0.001). Most of effectiveness of low-power laser was seen between 14 and 30 days while the laser therapy was stopped.

Conclusion:

These findings suggest that low-level laser irradiation can increase and accelerate bone regeneration in the midpalatal suture after rapid palatal expansion, hence, reduce retention time.

Microhardness of demineralized enamel following home bleaching and laser-assisted in office bleaching

BACKGROUND

There is little data regarding the effect of tooth whitening on microhardness of white spot lesions. This study was conducted to investigate the effect of home-bleaching and laser-assisted in-office bleaching on microhardness of demineralized enamel.

MATERIAL AND METHODS

Forty bovine incisors were selected and immersed in a demineralizing solution for 12 weeks to induce white spot lesions. Enamel blocks were prepared and randomly assigned to two groups of 20 each. The first group underwent home bleaching with 15% carbamide peroxide which was applied for 8 hours a day over a period of 15 days. In the second group, in-office bleaching was performed by 40% hydrogen peroxide and powered by irradiation from an 810 nm gallium-aluminum-arsenide (GaAlAs) diode laser (CW, 2W). This process was performed for 3 sessions every seven days, in 15 days. The specimens were stored in Fusayama Meyer artificial saliva during the experiment. Surface microhardness was assessed before and after the bleaching therapies in both groups.

RESULTS

Microhardness decreased significantly following both home bleaching and laser-assisted in-office bleaching (p<0.05). There were no significant differences in hardness values among the two groups either before (p=0.131) or after (p=0.182) the bleaching procedures.

CONCLUSIONS

Tooth whitening through home bleaching or laser-assisted in-office bleaching can result in a significant reduction in microhardness of white spot lesions. Therefore, it is suggested to take protective measures on bleached demineralized enamel. Key words:White spot lesion, bleaching, laser, microhardness, demineralized enamel, home bleaching, in-office bleaching.

Types of Lasers and Their Applications in Pediatric Dentistry

Laser technology has been recently introduced into the dental field with the idea to replace drilling. Having a less painful first dental experience by the use of modern instruments like laser can be an efficient preventive and therapeutic strategy in pediatric dentistry. Pedodontists need to learn the new less invasive technologies and adopt them in their routine practice. This study aimed to review the available types of lasers and their applications in pediatric dentistry. An electronic search was carried out in IranMedex, InterScience, Scopus, Science Direct, PubMed, ProQuest, Medline and Google Scholar databases to find relevant articles published from 2000 to 2014. Relevant textbooks were reviewed as well. Laser can be used as a suitable alternative to many conventional diagnostic and therapeutic dental procedures. It is especially efficient for caries detection and removal, pulp therapy, lowering the risk of infection, inflammation and swelling and reducing bleeding. On the other hand, due to minimal invasion, laser treatment is well tolerated by children. Improved patient cooperation leads to higher satisfaction of the parents, dentists and the children themselves.

Effects of laser-assisted cosmetic smile lift gingivectomy on postoperative bleeding and pain in fixed orthodontic patients: a controlled clinical trial

Background and objective

Diode lasers are becoming popular in gingival treatment following orthodontic treatments. Despite their merit and clinical implications, postoperative pain and bleeding after surgery with diode lasers are not assessed except in few controversial studies.

Method

This controlled clinical trial was conducted on 30 healthy orthodontic patients aged 17–29 years, needing esthetic-only gingivectomy in the anterior maxilla. The patients were randomly divided into two groups of 15 each: experimental (laser-assisted surgery) and control (traditional surgery using scalpels). The bleeding rate following the surgery was assessed using the bleeding criteria established by the World Health Organization. The postsurgical pain level was recorded using visual analog scales immediately after the surgery and in patients who consumed analgesics, also 2 h after the analgesic consumption. The data were analyzed using the independent-samples t, Mann-Whitney U, and chi-square tests (α = 0.05).

Results

The average bleeding rates were 1.15 and 0.36 in the conventional and laser groups, respectively (Mann-Whitney U P < 0.05). Experimental patients had no postsurgical pain (VAS1 and VAS2 = 0). In the control group, the average VAS1 pain was 5.2 out of 10. The difference between VAS1 values in the control/experimental groups was significant (Mann-Whitney U P < 0.001).

Conclusion

940-nm diode laser seems promising in reducing postoperative bleeding and pain of patients needing cosmetic smile lift surgeries.

Effects of laser vs ultrasound on bone healing after distraction osteogenesis: A histomorphometric analysis

Objective: 

To assess the effects of low-level laser irradiation vs ultrasound irradiation on bone healing after distraction osteogenesis.

Materials and Methods: 

Distraction osteogenesis was performed with rapid maxillary expansion devices (Hyrax-Morelli, Sorocaba, São Paulo Brazil) in 24 rabbits (Oryctolagus cuniculus). After a 2-day latency period, the distraction devices were activated for 10 days at a rate of 1 mm/d. Four groups of six animals were treated as follows: (1) control, (2) laser irradiation on the right side, (3) ultrasound irradiation on the right side, and (4) laser irradiation on the right side and ultrasound on the left side. Histomorphometric analysis was used to assess the bone healing area. Analysis of variance was used to perform the statistical analyses.

Results: 

The influence of low-intensity laser associated with ultrasound irradiation on bone healing was statistically significant. The analyses showed the greatest amount of bone healing in the jaws of animals in group 4, which received treatment with both ultrasound and laser.

Conclusion: 

This study concluded that bone healing is accelerated with the application of laser irradiation. The greatest effects were observed with combined ultrasound and laser treatment.

Periodontal effects with self ligating appliances and laser biostimulation

Background:

Recently, various biostimulation's effects of low energy laser irradiation have been reported. The present study was designed to examine the effects of low-energy laser irradiation on alveolar bone remodelling during orthodontic tooth movement and finally on formation of new keratinized gingiva.

Materials and Methods:

22 patients and 27 teeth in vestibular mucosal without keratinized gingiva were selected. Every patient was treated with self ligating appliances. In every orthodontic session the patient was treated with Diode laser biostimulation. At the moment of debonding, 27 teeth involved in the research were evaluated in terms of quality and quantity of attached gingiva. BOP and CAL loss were investigated.

Results:

Every tooth considered at the end of orthodontic treatment showed an attached gingiva around the crown: The average of keratinized gingiva at the end of the study was 3.10 mm and the mean increasing at each month was 0,49 mm.

Conclusions:

The combination between self ligating appliances and laser's biostimulation could improve the differentiation of periodontal ligaments stem cells in fibroblasts, able to promote attached gingiva around the crown of the teeth erupted in oral vestibular mucosa.

Effect of 980-nm diode laser-aided circumferential supracrestal fiberotomy on fluorosed root surfaces

OBJECTIVE

To evaluate and compare the root surface morphological changes after 980-nm diode laser-aided circumferential supracrestal fiberotomy (CSF) on fluorosed and non-fluorosed teeth.

MATERIALS AND METHODS

The sample comprised 27 orthodontic patients (14 males and 13 females; mean age  =  17.3 years) with and without fluorosis, from whom 40 fluorosed and 40 non-fluorosed premolar teeth were extracted for orthodontic reasons. Conventional (control group) and laser-aided (experimental group) CSF was performed on fluorosed and non-fluorosed teeth indicated for orthodontic extraction, using a scalpel and a 980-nm diode laser at 2.5 W power, respectively. Subsequently, teeth were extracted, sectioned, and examined by scanning electron microscope to assess the ultrastructural changes.

RESULTS

There were differences in surface morphology among fluorosed and non-fluorosed roots in the control group. The root specimens of both fluorosed and non-fluorosed teeth irradiated by diode laser exhibited no evidence of smear layer, laser-induced pitting or cavitation, linear cuts/markings, carbonization of surface, and heat-induced surface cracking. However, a glazed or slightly melted appearance was observed in root specimens of fluorosed teeth after diode laser irradiation.

CONCLUSIONS

These findings suggest that the diode laser-aided CSF procedure is free from thermal hazard on non-fluorosed root surfaces but may provoke some thermal changes on fluorosed root surfaces.

Use of laser in orthodontics: applications and perspectives

Laser technology got in these years a more and more important role in modern dentistry and, recently, also in orthodontics was proposed the utilization of laser devices. The aim of this work is to describe the utilization of this technology both in soft and hard oral tissues to improve orthodontic treatment. Several cases, with different wavelengths (532, 810, 980, 1064, 2940 and 10600 nm) and in different times of the treatment (before, during and after) are presented. All the cases reported showed, according to the literature, that the use of the laser related to orthodontic treatment offers several advantages when compared with conventional methods. In the soft tissues surgery it allows to reduce or eliminate the use of anesthetic injection, to avoid use of sutures and to bond bracket in dry enamel; associated with orthophosphoric acid, it gives a stronger adhesion of the brackets to the enamel and, in the case of porcelain brackets, it detaches them without damages; at low power (LLLT) it permits to control the pain of the first period after bonding and, by increasing the speed of teeth movement in the bone, reduces the time of the treatment.

Use of laser in orthodontics: applications and perspectives

Laser technology got in these years a more and more important role in modern dentistry and, recently, also in orthodontics was proposed the utilization of laser devices. The aim of this work is to describe the utilization of this technology both in soft and hard oral tissues to improve orthodontic treatment. Several cases, with different wavelengths (532, 810, 980, 1064, 2940 and 10600 nm) and in different times of the treatment (before, during and after) are presented. All the cases reported showed, according to the literature, that the use of the laser related to orthodontic treatment offers several advantages when compared with conventional methods. In the soft tissues surgery it allows to reduce or eliminate the use of anesthetic injection, to avoid use of sutures and to bond bracket in dry enamel; associated with orthophosphoric acid, it gives a stronger adhesion of the brackets to the enamel and, in the case of porcelain brackets, it detaches them without damages; at low power (LLLT) it permits to control the pain of the first period after bonding and, by increasing the speed of teeth movement in the bone, reduces the time of the treatment.

The adjunct effectiveness of diode laser gingivectomy in maintaining periodontal health during orthodontic treatment

OBJECTIVE

To evaluate the effectiveness of diode laser gingivectomy as an adjunct to nonsurgical periodontal treatment in the management of periodontal health among patients receiving fixed orthodontic appliance therapy (FOAT).

MATERIALS AND METHODS

Thirty patients undergoing FOAT with gingival enlargement were block randomized into two treatment groups. The test group received diode laser gingivectomy (940-nm diode laser, ezlase, Biolase Technology Inc) as an adjunct to nonsurgical periodontal treatment. The control group received nonsurgical periodontal treatment only. For both groups, five periodontal parameters were assessed at baseline, 1 month, 3 months, and 6 months: Plaque Index, Gingival Index, bleeding on probing, probing pocket depth, and Gingival Overgrowth Index. Intra- and intergroup variations in the periodontal parameters were determined over time.

RESULTS

Both groups showed statistically significant improvements in periodontal health over the study period (P < .05). However, significant improvements in periodontal health were evident earlier among the test group subjects (P < .05). The magnitude of improvement in periodontal health compared to baseline was greater in the test group than in the control group for Gingival Overgrowth Index at 1 month (P < .001) and 3 months (P < .05), Gingival Index at 3 months (P < .05) and 6 months (P < .05), and probing pocket depth at 1 month (P < .05).

CONCLUSIONS

Nonsurgical periodontal management with or without the adjunct use of lasers can be effective in the management of gingival health problems among patients receiving FOAT. The adjunctive use of lasers can produce an earlier and greater improvement in gingival health.

Laser Biostimulation and Self Ligating Appliances in Orthodontics: Periodontal Remodeling

24 patients are selected and 30 teeth in vestibular mucosae, without keratinized gingiva. No active periodontal disease (no BOP and gingival recessions). No BOP and CAL loss at the start of the orthodontic treatment. Every patient was treated with self ligating appliances (Time2/Time3, American Orthodontics). In every orthodontic session (each 30 days as average) the patient was treated with Nd: Yag laser biostimulation, for 90 seconds, with 320 micron fiber section, on utilizing the Biostimulating machine paremeters. No termical effects were produced by lasers applications. At the moment of debonding, 30 teeth involved in the research were evaluated in terms of quality and quantity of attached gingiva. BOP and CAL loss were also investigated. Every tooth considerated, at the end of orthodontic treatment showed a attached gingiva around the crown: the average of keratinized gingiva at the end of the study was 2,7 mm and the mean increasing at each month was 0,45 mm. The combination between self ligating appliances and laser's biostimulation could improve the differentiation of periodontal ligaments stem cells in fibroblasts, able to promote attached gingiva around the crown of the teeth erupted in oral vestibular mucosae.

Perceptions of soft tissue laser use in orthodontics

OBJECTIVES

To compare attitudes of orthodontists, periodontists, and general dentists regarding the use of soft tissue lasers by orthodontists during the course of orthodontic treatment.

MATERIALS AND METHODS

An analogous survey was developed to evaluate and compare the current opinions of a representative sample (n  =  538) of orthodontists (61.3%), periodontists (24.3%), and general dentists (14.3%) regarding orthodontists' use of soft tissue lasers.

RESULTS

The majority (84%) of orthodontists, periodontists, and general dentists regarded the use of a soft tissue laser by orthodontists as appropriate. When compared to orthodontists and general dentists, a lower percentage of periodontists indicated that soft tissue laser use by orthodontists was appropriate (P < .01). For each of the eight specific soft tissue laser procedures investigated, periodontists reported a significantly lower level of appropriateness than did orthodontists and general dentists (P < .01). Around 75% of the total sample believed that referral would not be affected by the use of soft tissue lasers by orthodontists.

CONCLUSIONS

Orthodontists, periodontists, and general dentists differed in their opinions of the perceived appropriateness of soft tissue laser use by orthodontists, with periodontists reporting a lower level of appropriateness. Clinicians need to communicate effectively to ensure that orthodontic patients in need of adjunctive soft tissue surgery are treated to the accepted standard of care.

Soft tissue laser in orthodontics

Today a lot of minor cosmetic surgery operations on the gingiva can easily be carried out directly by the orthodontist with a small quantity of topical anaesthetic and the use of a soft tissue laser. The Diode laser is the most commonly used laser in dentistry for minor surgery to the soft tissues. This kind of laser offers numerous advantages with respect to traditional or electric scalpels. In this article the authors will analyse several typical uses of the diode laser in daily orthodontic practice.

Comparison of diode laser and Er:YAG lasers in the treatment of ankyloglossia

OBJECTIVES

The purpose of this study was to compare the tolerance of lingual frenectomy with regard to a local anesthesia requirement and comparison of postsurgical discomfort experienced by patients operated on with both diode and erbium:yttrium-aluminium-garnet (Er:YAG) lasers.

BACKGROUND

Ankyloglossia, commonly known as tongue-tie, is a congenital oral anomaly characterized by a short lingual frenulum. A short lingual frenulum may contribute to feeding, speech, and mechanical tongue problems.

METHODS

Sixteen referred patients with tongue mobility complaints were included in this study. A GaAlAs laser device with a continuous wavelength of 808 nm was used in the diode group. Frenulums were incised by applying 2 W of laser power. The Er:YAG laser device with a continuous wavelength of 2940 nm was used in the Er:YAG group. Frenulums were incised by applying 1 W of laser power. The acceptability of the lingual frenectomy without local anesthesia and the degree of the postsurgical discomfort were evaluated.

RESULTS

Although the majority of patients (six) could be operated on without local anesthesia in the Er:YAG group, all patients could not be operated on without local anesthetic agent in the diode group. There were no differences between the two groups with regard to pain, chewing, and speaking on the first or seventh day after surgery, whereas patients had more pain in the Er:YAG group than in the diode group the first 3 h after surgery.

CONCLUSIONS

The results indicate that only the Er:YAG laser can be used for lingual frenectomy without local anesthesia, and there was no difference between the two groups regarding the degree of the postsurgical discomfort except in the first 3 h. In conclusion, these results indicate that the Er:YAG laser is more advantageous than the diode laser in minor soft-tissue surgery because it can be performed without local anesthesia and with only topical anesthesia.

Laser-aided circumferential supracrestal fiberotomy and low-level laser therapy effects on relapse of rotated teeth in beagles

OBJECTIVE

To investigate the effectiveness and periodontal side effects of laser circumferential supracrestal fiberotomy (CSF) and low-level laser therapy (LLLT) on orthodontically rotated teeth in beagles.

MATERIALS AND METHODS

Eighteen mandibular incisors from nine dogs were divided into three groups by treatment (n = 6/group): A, orthodontic couple force application only (control); B, laser CSF following orthodontic couple force application; and C, LLLT following orthodontic couple force application. Both mandibular lateral incisors were rotated for 4 weeks, and the relapse tendency was observed for 4 weeks more without any retainers. The amount of relapse, sulcus depth, and gingival recession were measured at weeks 4 and 8. One-way analysis of variance (ANOVA) and Scheffé's post hoc test were used for data analysis. Tissue specimens were examined at week 8 under light microscopy after hematoxylin-eosin (H&E) and Masson's trichrome staining.

RESULTS

The mean percentage of relapse was 41.29% in group A, 14.52% in group B, and 56.80% in group C (P < .001). Four weeks after laser CSF, the sulcus depth increased by 0.67 mm, but no gingival recession was observed. There was no significant difference between groups A and C in terms of sulcus depth and gingival recession.

CONCLUSIONS

Laser CSF is an effective procedure to decrease relapse after tooth rotation, causing no apparent damage to the supporting periodontal structures, whereas LLLT on orthodontically rotated teeth without retainers appears to increase the relapse tendency.