Effects of Laser and Ozone Therapies on Bone Healing in the Calvarial Defects

Does ozone gel enhance the bone width and buccal plate of bone thickness surrounding the implant following osseodensification? A randomized controlled clinical trial

PURPOSE

The present study was conducted to evaluate the effect of using ozone gel with transcrestal sinus elevation using osteotomes, on the bone width and the buccal plate of bone thickness around the implants placed simultaneously.

MATERIALS AND METHODS

A total of 30 sinuses with an average residual alveolar bone height ranging from 4-7 mm participated in this randomized controlled clinical trial. Following a closed sinus lift procedure, patients were randomized into two groups: one for the ozone gel recipient group and the other for control group. Cone beam computed tomography was carried out both immediately and four months postoperatively. Radiographic evaluations were performed to assess bone width and labial plate thickness at both crestal and midcrestal levels.

RESULTS

Radiographic analysis revealed that the mean bone width of the control group after four months postoperative was (8.54 ± 1.46 mm) compared to (8.96 ± 1.66 mm) in the study group, which was statistically insignificant (P ≤ .0.05). The mean labial plate of bone thickness value of the control group after four months postoperative was (1.86 ± 0.63 mm) compared to (1.89 ± 0.51 mm) in the study group. Although the bone dimensions in the study group was higher than the control group, it was statistically insignificant (P ≤ .0.05).

CONCLUSION

When compared to the graftless group, the ozone gel recipient group showed non-significant difference in the results in terms of bone width and thickness. Both methods, nevertheless, produced outcomes that were acceptable.

TRIAL REGISTRATION

This study protocol was retrospectively registered on the trial registry "Clinical trials.gov PRS".

CLINICALTRIALS

gov ID is: NCT06604819 and the registration date is 20/9/2024.

Calcium Hydroxyapatite Combined with Photobiomodulation for Bone Tissue Repair: A Systematic Review

Repairing hard tissues, such as bones, remains a significant challenge, especially in adverse clinical conditions. Calcium hydroxyapatite (CaHA), a calcium phosphate (CaP), has structural and chemical characteristics similar to the mineral structure of human bones and teeth, offering bioactivity and biocompatibility properties. Photobiomodulation (PBM) uses light to reduce inflammation and accelerate tissue healing. This systematic review analyzes the combination of CaHA and PBM from 25 studies extracted from the PubMed, Web of Science, and ScienceDirect databases, using the keywords "hydroxyapatite AND photobiomodulation", "calcium hydroxyapatite AND photobiomodulation", and "low-level laser therapy AND calcium phosphate." All studies focused on bone regeneration, with no mention of soft tissue applications. The most commonly used calcium-based material was biphasic calcium phosphate (76%), a combination of CaHA and β-tricalcium phosphate, while 16% of the studies did not specify the brand or product used. With regard to PBM, the most commonly used wavelengths (48% of cases, with a tie of 24% for each) were infrared lasers at 808 nm and 780 nm, with 20% of studies not mentioning the brand or manufacturer. The results underscore the predominant focus on bone regeneration, highlighting the need for further investigations into soft tissue applications and the establishment of standardized protocols. The combination of CaHA and PBM shows promise in regenerative medicine and dentistry, although more research is needed to expand its experimental and clinical use.

The histopathologic evaluation of local effects of ozone therapy on the healing of experimental calvarial defects of rats

BACKGROUND

This study evaluates the effects of ozone on hard and soft tissue healing when a free tissue flap is used to close wound areas lacking primary closure over autogenous grafted sites.

METHODS

In our study, 24 male Wistar rats were divided into four groups: two control groups and two ozone-treated groups. All rats underwent the same surgical procedure. After surgery, the control groups received no additional treatment, while the ozone groups received topical ozone application. Ozone was applied for 2 min, three times per week, with one-day intervals, for a duration of 2 weeks post-surgery. Sacrifice was performed on the 14th day for one control and one ozone group, and on the 28th day for the remaining groups. All soft and hard tissue samples were then examined histopathologically.

CLINICAL TRIAL NUMBER

not applicable.

RESULTS

Histopathological evaluations and statistical analyses on the 14th day indicated that bone healing was significantly better in the ozone group compared to the control group (p = 0.049). For soft tissue healing, although there was no statistically significant difference between the ozone and control groups, proportional values showed better recovery in the ozone-treated groups compared to the controls.

CONCLUSIONS

The present study concludes that ozone has a positive effect on new bone formation in the early stages; however, it showed no statistically significant effect on soft tissue healing. We believe that further comprehensive studies would be beneficial to confirm these findings.

Systemic ozone therapy as an adjunctive treatment in guided bone regeneration: a histomorphometrical and immunohistochemical study in rats

OBJECTIVES

To assess the effectiveness of ozone therapy in guided bone regeneration (GBR) for critical size calvarial defects in rats.

MATERIALS AND METHODS

96 male Wistar rats were divided into four groups (n = 6 each). An 8 mm critical defect was created in the calvaria of each rat. The groups were: BIO (porcine collagen membrane, BioGide®), BIO + OZ (membrane with systemic ozone therapy every 2 days), COA + OZ (blood clot with ozone therapy), and COA (blood clot only). Evaluations at 7, 15, 30, and 60 days included histological, histomorphometric, inflammatory profile, Micro-CT, and immunohistochemical analyses. Statistical analysis involved two-factor ANOVA with Tukey's post-hoc test for general data, and one-factor ANOVA with Holm-Sidak post-hoc test for Micro-CT data.

RESULTS

The BIO + OZ group demonstrated superior bone regeneration with well-organized, mature bone tissue and significant bone formation at 30 and 60 days. The COA + OZ group showed early angiogenesis and reduced inflammation, resulting in complete defect closure by 30 days. The BIO group had good regeneration, but less mature tissue compared to BIO + OZ. The COA group exhibited limited bone formation and higher porosity.

CONCLUSION

Ozone therapy positively influences bone regeneration by enhancing cell proliferation and the healing response.

CLINICAL RELEVANCE

Improving regenerative processes with auxiliary therapies like ozone therapy can be significant for advancing dental reconstructions.

Ozone therapy in musculoskeletal medicine: a comprehensive review

Musculoskeletal disorders encompass a wide range of conditions that impact the bones, joints, muscles, and connective tissues within the body. Despite the ongoing debate on toxicity and administration, ozone demonstrated promise in managing several musculoskeletal disorders, modulating pain and inflammation. A literature search was conducted. The research design, methods, findings, and conclusions of the studies were then examined to evaluate the physiological effects, clinical application, controversies, and safety of the application of ozone in musculoskeletal medicine. Ozone application demonstrates considerable therapeutic applications in the management of musculoskeletal disorders, including fractures, osteoarthritis, and chronic pain syndromes. Despite these advantages, studies have raised concerns regarding its potential toxicity and emphasized the importance of adhering to stringent administration protocols to ensure safety. Additionally, heterogeneities in patient reactions and hazards from oxidizing agents were observed. Given its anti-inflammatory and analgesic qualities, ozone therapy holds potential in the management of several musculoskeletal disorders. Additional high-quality research with long follow-up is required to refine indications, efficacy and safety profile. Finally, for wider clinical acceptability and utilization, the development of international recommendations is essential.

Comparing the effects of low-level laser therapy and gaseous ozone as a preventive measure on medication-related osteonecrosis of the jaws following tooth extraction: a rat model

OBJECTIVES

Use of numerous medications such as tyrosine kinase inhibitors (sunitinib), monoclonal antibodies (bevacizumab), fusion proteins (aflibercept), mTOR inhibitors (everolimus), radiopharmaceuticals (radium 223), selective estrogen receptor modulators (raloxifene), and immunosuppressants (methotrexate and corticosteroids) has been reported to be a risk factor for development of medication-related osteonecrosis of the jaws till date. This study aimed to evaluate the preventive effect of low-level laser therapy (LLLT) and gaseous ozone on the onset of MRONJ following tooth extraction.

MATERIALS AND METHODS

A total of 40 male Wistar rats were randomly allocated into 4 groups of 10 rats each. The groups laser (L), ozone (O), and control (C) received weekly intraperitoneal injections of zoledronic acid (0.06 mg/kg), while group sham (S) received saline solution for 4 weeks. After the 4th injection, all subjects underwent mandibular first molar extraction and adjunctive laser or ozone was applied according to the groups. All the rats were sacrificed at 4 postoperative weeks for comparative histomorphometric evaluation of bone healing in extraction sites.

RESULTS

Laser and ozone groups demonstrated significantly higher bone formation compared to control group (p < 0.05), while no significant difference was found between laser and ozone groups (p = 1.00). Furthermore, the greatest bone formation was observed with the sham group (p < 0.05).

CONCLUSIONS

Findings of the current study support that adjunctive LLLT and ozone therapy following tooth extraction may help prevent MRONJ and improve bone healing in subjects under zoledronic acid therapy.

CLINICAL RELEVANCE

Since the introduction in 2003, great effort has been devoted to developing a certain management protocol for MRONJ. Several publications have appeared in recent years documenting promising results of adjunctive LLLT and ozone application in treatment of MRONJ. However, experimental data are limited on this regard and the present study, for the first time, aimed to evaluate and compare the effects of LLLT and ozone in prevention of MRONJ.

Effects of systemic ozone administration on the fresh extraction sockets healing: a histomorphometric and immunohistochemical study in rats

OBJECTIVE

Studies have highlighted numerous benefits of ozone therapy in the field of medicine and dentistry, including its antimicrobial efficacy against various pathogenic microorganisms, its ability to modulate the immune system effectively, reduce inflammation, prevent hypoxia, and support tissue regeneration. However, its effects on dental extraction healing remain to be elucidated. .Therefore, this study aimed to evaluate the effects of systemically administered ozone (O3) at different doses in the healing of dental extraction sockets in rats.

METHODOLOGY

To this end, 72 Wistar rats were randomly divided into four groups after extraction of the right upper central incisor: Group C - control, no systemic treatment; Group OZ0.3 - animals received a single dose of 0.3 mg/kg O3; Group OZ0.7 - a single dose of 0.7 mg/kg O3; and Group OZ1.0 - a single dose of 1.0 mg/kg O3, intraperitoneally. In total, six animals from each group were euthanized at 7, 14, and 21 days after the commencement of treatment. Bone samples were harvested and further analyzed by descriptive histology, histomorphometry, and immunohistochemistry for osteocalcin (OCN) and tartrate-resistant acid phosphatase (TRAP) protein expression.

RESULTS

All applied doses of O3 were shown to increase the percentage of bone tissue (PBT) after 21 days compared to group C. After 14 days, the OZ0.7 and OZ1.0 groups showed significantly higher PBT when compared to group C. The OZ1.0 group presented the most beneficial results regarding PBT among groups, which denotes a dose-dependent response. OCN immunostaining was higher in all groups at 21 days. However, after seven and 14 days, the OZ1.0 group showed a significant increase in OCN immunostaining compared to C group. No differences in TRAP+ osteoclasts were found between groups and time points.

CONCLUSION

Therefore, O3 therapy at higher doses might be beneficial for bone repair of the alveolar socket following tooth extraction.

The effect of photobiomodulation therapy in common maxillofacial injuries: Current status

The use of photobiomodulation therapy (PBMT) may be used for treating trauma to the maxillofacial region. The effects of PBMT on maxillofacial injuries were discussed in this review article. The electronic databases Pubmed, Scopus, and Web of Science were thoroughly searched. This review included in vitro, in vivo, and clinical studies describing how PBMT can be used in maxillofacial tissue engineering and regenerative medicine. Some studies suggest that PBMT may offer a promising therapy for traumatic maxillofacial injuries because it can stimulate the differentiation and proliferation of various cells, including dental pulp cells and mesenchymal stem cells, enhancing bone regeneration and osseointegration. PBMT reduces pain and swelling after oral surgery and tooth extraction in human and animal models of maxillofacial injuries. Patients with temporomandibular disorders also benefit from PBMT in terms of reduced inflammation and symptoms. PBMT still has some limitations, such as the need for standardizing parameters. PBMT must also be evaluated further in randomized controlled trials in various maxillofacial injuries. As a result, PBMT offers a safe and noninvasive treatment option for patients suffering from traumatic maxillofacial injuries. PBMT still requires further research to establish its efficacy in clinical practice and determine the optimal parameters.

Long-term air pollution and adverse meteorological factors might elevate the osteoporosis risk among adult Chinese

Objective

This study aims to investigate the relationship between exposure to air pollution and adverse meteorological factors, and the risk of osteoporosis.

Methods

We diagnosed osteoporosis by assessing bone mineral density through Dual-Energy X-ray absorptiometry in 2,361 participants from Jiangsu, China. Additionally, we conducted physical examinations, blood tests, and questionnaires. We evaluated pollution exposure levels using grid data, considering various lag periods (ranging from one to five years) based on participants' addresses. We utilized logistic regression analysis, adjusted for temperature, humidity, and individual factors, to examine the connections between osteoporosis and seven air pollutants: PM₁, PM₂.₅, PM₁₀, SO₂, NO₂, CO, and O₃. We assessed the robustness of our study through two-pollutant models and distributed lag non-linear models (DLNM) and explored susceptibility using stratified analyses.

Results

In Jiangsu, China, the prevalence of osteoporosis among individuals aged 40 and above was found to be 15.1%. A consistent association was observed between osteoporosis and the five-year average exposure to most pollutants, including PM₂.₅, PM₁₀, CO, and O₃. The effects of PM₁₀ and CO remained stable even after adjusting for the presence of a second pollutant. However, the levels of PM₁ and PM₂.₅ were significantly influenced by O₃ levels. Individuals aged 60 and above, those with a BMI of 25 or higher, and males were found to be more susceptible to the effects of air pollution. Interestingly, males showed a significantly higher susceptibility to PM₁ and PM₂.₅ compared to females. This study provides valuable insights into the long-term effects of air pollution on osteoporosis risk among the adult population in China.

Conclusion

This study indicates a potential association between air pollutants and osteoporosis, particularly with long-term exposure. The risk of osteoporosis induced by air pollution is found to be higher in individuals aged 60 and above, those with a BMI greater than 25, and males. These findings underscore the need for further research and public health interventions to mitigate the impact of air pollution on bone health.

Effects of NGF and Photobiomodulation Therapy on Crush Nerve Injury and Fracture Healing: A Stereological and Histopathological Study in an Animal Model

Study Design

A stereological and histopathological study in an animal model.

Objective

This study explores the effects of the nerve growth factor and photobiomodulation therapy on the damaged nerve tissue and fracture healing.

Methods

A total of 24 rabbits were divided into 4 groups: control group (n = 5), nerve growth factor (NGF) group (n = 7), photobiomodulation (PBMT) group (n = 6), and nerve growth factor and photobiomodulation therapy (NGF+PBMT) group (n = 6). The vertical fracture was performed between the mental foramen and the first premolar, and the mental nerve was crushed for 30 seconds with a standard serrated clamp with a force of approximately 50 N in all groups. The control group received an isotonic solution (.02 mL, .09% NaCl) to the operation site locally. The NGF group received 1 μg human NGF-β/.9% .2 mL NaCl solution for 7 days locally. The PBMT group received PBMT treatment (GaAlAs laser, 810 nm, .3 W, 18 J/cm2) every 48 hours for 14 sessions following the surgery. The NGF+PBMT group received both NGF and PBMT treatment as described above. After 28 days, the bone tissues and mental nerves from all groups were harvested and histologically and stereologically analyzed.

Results

According to the stereological results, the volume of the new vessel and the volume of the new bone were significantly higher in the PBMT group than in other groups (P < .001). According to the histopathological examinations, higher myelinated axons were observed in experimental groups than in the control group.

Conclusions

As a result, PBMT has beneficial effects on bone regeneration. Based on the light microscopic evaluation, more regenerated axon populations were observed in the NGF group than in the PBMT and PBMT + NGF groups in terms of myelinated axon content.

Effectiveness of Topical Ozone Gel Application in the Management of Postextraction Wound Healing: An In Vivo Study

AIM

The purpose of the current study was to determine the effectiveness of topical ozone gel application in the management of postextraction wound healing.

MATERIALS AND METHODS

The current study involved a total of 40 participants. The patients were randomly placed into two groups with sample size estimated as n = 20 in each group. Group A: Control: patients received only saline irrigation and group B: patients receiving topical ozone gel. The surgical procedure was standardized for all groups, and local anesthesia was used during the procedure. After the removal of the mandibular third molar, the control group irrigated the socket with saline, whereas in the study group, the socket was filled with ozone gel. On the first, third, fifth, and seventh postoperative days, a single examiner evaluated each participant for postoperative mouth opening, discomfort, and patient satisfaction. The t-test was used to analyze quantitative data, whereas the Fisher exact test was employed to analyze qualitative data. Statistical significance was defined as a p value less than 0.05.

RESULTS

On comparison of patient satisfaction, in the ozone gel group, 13 patients were very satisfied but in the control group, 8 patients were very satisfied. On comparison of pain intensity, on the 5th day, the complete absence of pain patients was more in the ozone gel group (12 patients) compared with the control group (4 patients). There was a statistically significant difference found between these two groups (p < 0.001). On comparison of mouth opening, on the 3rd and 5th day, mouth opening was better in the ozone gel group (29.22 ± 1.28 and 34.06 ± 0.09) compared with the control group (27.38 ± 1.03 and 31.14 ± 0.82), respectively. And there was a statistically significant difference found between these two groups (p < 0.001) on both the days.

CONCLUSION

The current study came to the conclusion that using ozone gel significantly improves postoperative pain, mouth opening range, and promotes faster wound healing.

CLINICAL SIGNIFICANCE

The primary goals of postoperative care for exodontia patients have always been pain management and infection control. The most frequent postoperative consequences are pain and edema. Hence, ozone therapy can be used as an effective topical agent to manage postextraction pain and swelling in healthy patients without the need for excess medications. How to cite this article: Varghese LJ, Lahiri B, Penumatsa NV, et al. Effectiveness of Topical Ozone Gel Application in the Management of Postextraction Wound Healing: An In Vivo Study. J Contemp Dent Pract 2023;24(11):887-890.

Ambient ozone exposure and bone turnover markers in children: Results from the GINIplus and LISA birth cohorts

BACKGROUND

Multiple environmental factors can regulate bone metabolism, and it is hypothesized that air pollution may be deleteriously involved in this regulation. However, only a few studies considered bone turnover markers (BTMs) - sensitive and specific markers of bone metabolism - as outcomes, and no study investigated the exposure to ambient ozone. Here, we intended to explore the associations between long-term exposure to ambient ozone and concentrations of two BTMs, osteocalcin and β-isomer of C-terminal telopeptide of type I collagen (CTx), amongst 10-year-old children.

METHODS

Based on the GINIplus and LISA birth cohorts, our cross-sectional analysis included 1848 children aged 10 years from Munich and Wesel. Serum osteocalcin and CTx concentrations were measured. We estimated ozone exposures by optimal interpolation, assessed nitrogen dioxide and particulate matter with an aerodynamic diameter <10 μm concentrations by land use regression models, and assigned the exposures to home addresses. Linear regression models were built and adjusted for covariates as well as co-pollutants.

RESULTS

The mean concentrations were 93.09 ng/mL and 663.66 ng/L for osteocalcin and CTx, respectively. In general, higher levels of ozone were associated with decreased concentrations of both BTMs. This held true for the two areas and different exposure metrics. The number of days per year with a maximum 8-h average concentration exceeding 120 μg/m³ showed consistent results across different models. Specifically, models adjusted for co-pollutants illustrated that the beta estimates and 95% confidence intervals on osteocalcin and CTx were -2.51 (-3.78, -1.14) and -44.53 (-57.12, -31.93), respectively, for an increase of 10 days.

CONCLUSIONS

We found that long-term exposure to ambient ozone was associated with decreased concentrations of BTMs in German children. This association might potentially affect bone metabolism. Nevertheless, unless other prospective studies confirm our results, the detrimental effects of ambient ozone on bone development in children should be interpreted cautiously.

Use of Photobiomodulation Combined with Fibrin Sealant and Bone Substitute Improving the Bone Repair of Critical Defects

In this preclinical protocol, an adjunct method is used in an attempt to overcome the limitations of conventional therapeutic approaches applied to bone repair of large bone defects filled with scaffolds. Thus, we evaluate the effects of photobiomodulation therapy (PBMT) on the bone repair process on defects filled with demineralized bovine bone (B) and fibrin sealant (T). The groups were BC (blood clot), BT (B + T), BCP (BC + PBMT), and BTP (B + T + PBMT). Microtomographically, BC and BCP presented a hypodense cavity with hyperdense regions adjacent to the border of the wound, with a slight increase at 42 days. BT and BTP presented discrete hyperdensing areas at the border and around the B particles. Quantitatively, BCP and BTP (16.96 ± 4.38; 17.37 ± 4.38) showed higher mean bone density volume in relation to BC and BT (14.42 ± 3.66; 13.44 ± 3.88). Histologically, BC and BCP presented deposition of immature bone at the periphery and at 42 days new bone tissue became lamellar with organized total collagen fibers. BT and BTP showed inflammatory infiltrate along the particles, but at 42 days, it was resolved, mainly in BTP. In the birefringence analysis, BT and BTP, the percentage of red birefringence increased (9.14% to 20.98% and 7.21% to 27.57%, respectively), but green birefringence was similar in relation to 14 days (3.3% to 3.5% and 3.5% to 4.2%, respectively). The number of osteocytes in the neoformed bone matrix proportionally reduced in all evaluated groups. Immunostaining of bone morphogenetic protein (BMP—2/4), osteocalcin (OCN), and vascular endothelial growth factor (VEGF) were higher in BCP and BTP when compared to the BC and BT groups (p < 0.05). An increased number of TRAP positive cells (tartrate resistant acid phosphatase) was observed in BT and BTP. We conclude that PBMT positively influenced the repair of bone defects filled with B and T.

The Effects of Photobiomodulation on Bone Defect Repairing in a Diabetic Rat Model

The purpose of this study is to examine the prospective therapeutic effects of photobiomodulation on the healing of bone defects in diabetic mellitus (DM) using rat models to provide basic knowledge of photobiomodulation therapy (PBMT) during bone defect repair. For in vitro study, an Alizzarin red stain assay was used to evaluate the effect of PBMT on osteogenic differentiation. For in vivo study, micro-computed tomography (microCT) scan, H&E and IHC stain analysis were used to investigate the effect of PBMT on the healing of the experimental calvarial defect (3 mm in diameter) of a diabetic rat model. For in vitro study, the high glucose groups showed lower osteogenic differentiation in both irradiated and non-irradiated with PBMT when compared to the control groups. With the PBMT, all groups (control, osmotic control and high glucose) showed higher osteogenic differentiation when compared to the non-irradiated groups. For in vivo study, the hyperglycemic group showed significantly lower bone regeneration when compared to the control group. With the PBMT, the volume of bone regeneration was increasing and back to the similar level of the control group. The treatment of PBMT in 660 nm could improve the bone defect healing on a diabetic rat calvarial defect model.

Effect of S53P4 bioactive glass and low-level laser therapy on calvarial bone repair in rats submitted to zoledronic acid therapy

PURPOSE

To evaluate the influence of bioactive glass and photobiomodulation therapy (PBMT) in calvarial bone repair process in rats submitted to zoledronic acid therapy.

METHODS

Twenty-four rats were selected and treated with the dose of 0.035 mg/kg of zoledronic acid every two weeks, totalizing eight weeks, to induce osteonecrosis. After the drug therapy, surgical procedure was performed to create 5-mm diameter parietal bone defects in the calvarial region. The rats were then randomly assigned to groups according to the following treatments: AZC: control group, treated with blood clot; AZBIO: bone defect filled with bioactive glass; AZL: treated with blood clot and submitted to PBMT; and AZBIOL: treated with bioactive glass S53P4 and submitted to PBMT. Tissue samples were collected and submitted to histomorphometric analysis after 14 and 28 days.

RESULTS

At 14 days, bone neoformation in the AZBIO (52.15 ± 9.77) and AZBIOL (49.77 ± 13.58) groups presented higher values (p ≤ 0.001) compared to the AZC (23.35 ± 10.15) and AZL groups (23.32 ± 8.75). At 28 days, AZBIO (80.24 ± 5.41)still presented significant higher bone recovery values when compared to AZC (59.59 ± 16.92)and AZL (45.25 ± 5.41) groups (p = 0.048). In the 28-day period, the AZBIOL group didn't show statistically significant difference with the other groups (71.79 ± 29.38).

CONCLUSIONS

The bioactive glass is an effective protocol to stimulate bone neoformation in critical defects surgically created in rats with drug induced osteonecrosis, in the studied periods of 14 and 28 days.

Bone substitutes and photobiomodulation in bone regeneration: A systematic review in animal experimental studies

In general, bone fractures are able of healing by itself. However, in critical situations such as large bone defects, poor blood supply or even infections, the biological capacity of repair can be impaired, resulting in a delay of the consolidation process or even in non-union fractures. Thus, technologies able of improving the process of bone regeneration are of high demand. In this context, ceramic biomaterials-based bone substitutes and photobiomodulation (PBM) have been emerging as promising alternatives. Thus, the present study performed a systematic review targeting to analyze studies in the literature which investigated the effects of the association of ceramic based bone substitutes and PBM in the process of bone healing using animal models of bone defects. The search was conducted from March and April of 2019 in PubMed, Web of Science and Scopus databases. After the eligibility analyses, 16 studies were included in this review. The results showed that the most common material used was hydroxyapatite (HA) followed by Biosilicate associated with infrared PBM. Furthermore, 75% of the studies demonstrated positive effects to stimulate bone regeneration from association of ceramic biomaterials and PBM. All studies used low-level laser therapy (LLLT) device and the most studies used LLLT infrared. The evidence synthesis was moderate for all experimental studies for the variable histological analysis demonstrating the efficacy of techniques on the process of bone repair stimulation. In conclusion, this review demonstrates that the association of ceramic biomaterials and PBM presented positive effects for bone repair in experimental models of bone defects.

Air Pollutants Interaction and Gender Difference on Bone Mineral Density T-Score in Taiwanese Adults

Osteoporosis is defined as a systemic skeletal disease characterized by a reduction in bone mass and microarchitectural deterioration of bone tissue. Previous studies have reported associations between air pollution and lower bone mineral density; however, few studies have investigated the association between air pollution and osteoporosis. In this study, we combined two databases, the first including 5000 individuals registered in the Taiwan Biobank, and the second containing detailed daily data on air pollution. After multivariable adjustments, ozone (O3) (unstandardized coefficient β, 0.015; p = 0.008) was significantly positively associated with T-score, whereas carbon monoxide (CO) (unstandardized coefficient β, -0.809; p < 0.001), sulfur dioxide (SO2) (unstandardized coefficient β, -0.050; p = 0.005), nitric oxide (NO) (unstandardized coefficient β, -0.040; p < 0.001), nitrogen dioxide (NO2) (unstandardized coefficient β, -0.023; p < 0.001), and nitrogen oxide (NOx) (unstandardized coefficient β, -0.017; p < 0.001) were significantly negatively associated with T-score. The interactions between CO and NOx (p = 0.001) and SO2 and NO2 (p = 0.004) on T-score were statistically significant. An increase in exposure to CO, NO and NOx was associated with a faster decline in T-score in the female participants compared to the male participants. In addition, an increase in O3 was associated with a faster increase in T-score in the female participants compared to the male participants. In conclusion, the air pollutants CO, SO2, NO, NO2, and NOx were associated with osteoporosis. In addition, there were interaction and synergetic effects between CO and NOx and SO2 and NO2 on T-score. We also observed differences in the associations between air pollutants and T-score between the female and male participants.

Platelet rich fibrin versus ozone gel for periodontal regeneration in induced rats' intrabony three-wall periodontal defects

BACKGROUND

The question of whether platelet rich fibrin and ozone can enhance regeneration of periodontal defect was addressed.

MATERIALS AND METHODS

three-wall periodontal defects were surgically created in 30 rats involving mesial aspect of right mandibular first molar. Rats were randomly assigned into three groups: 1) Group I (Positive control group). 2) Group II (Ozone treated group) and 3) Group III (PRF treated group). Two weeks after surgery, five rats from each group were euthanized and the remaining was euthanized 4 weeks post surgery. The degree of periodontal regeneration was evaluated using light microscope and scanning electron microscope. Histomorphometric measurements and anti-PCNA immunohistochemical counting were statistically analyzed.

RESULTS

group I showed intense inflammatory reaction with mild new bone formation. In group II, partial regeneration was seen with moderate new woven bone formation in 2 weeks period. After 4 weeks, almost complete restoration of periodontium was seen. In group III, after 2 weeks, moderate lamellar bone formation was observed. In 4 weeks period, the periodontal regeneration was almost completed. Histomorphometric analysis showed a significant difference between group I and group II. The difference between group I and group III was significant in 2 weeks and highly significant after 4 weeks. That between group II and group III was nonsignificant in 2 weeks and significant in 4 weeks. Anti-PCNA analysis was nonsignificant between groups.

CONCLUSIONS

both Platelet rich fibrin and ozone can improve histological parameters associated with healing of experimental intrabony periodontal defects in rats with the former being superior.

Study of the Effect of Topical Ozonated Oil on Healing of Calvarial Defect

BACKGROUND

Fracture healing is one of the important issues in medicine and veterinarian medicine. A new technique should be detected with fewer side effects which improves the speed of the healing. This study was conducted to evaluate the effect of topical ozonated oil on the healing of bone defects created in rat calvarium.

METHODS

Defects of 7 mm were induced with a trephine in the calvaria of 45 male Sprague-Dawley rats. The animals were divided into 3 groups, and the defects in each group were filled with ozonated oil, olive oil, or left empty as a control. The animals were euthanized at 3 different time points (14, 28, and 42 days post-operation). Histological and serological (alkaline phosphatase) assessments were carried out on 14, 28, and 42 days post-operation.

RESULTS

On 14 and 28 days post-operation, in the edges of the defect, there was a significant difference between the ozonated oil group and olive oil as well as control groups (P ≤ 0.05). However, in the center of the defect, there were no statistically significant differences between the 3 groups (P > 0.05). On day 42, in the edges and center of the defect, there was a significant difference between the ozonated oil group and olive oil as well as control groups statistically (P ≤ 0.05).

CONCLUSION

The results of this study indicate the potential efficacy of ozonated oil as a bone substitute in a rat calvarial defect model.

Efficacy of ozonized water for the treatment of erosive oral lichen planus: a randomized controlled study

BACKGROUND

Management of erosive Oral Lichen Planus (eOLP) is challenging. Currently, topical corticosteroids are widely used as first-line therapy, but they might be associated with side-effects and incomplete clinical response. Among non-pharmacological strategies, ozone at low medical concentration has proven to induce a mild activation of protective anti-oxidant pathways, thus exerting therapeutic effects in many inflammatory diseases. The aim of this randomized controlled study was to investigate the effectiveness of ozonized water in association with conventional topical corticosteroids for the treatment of eOLP.

MATERIAL AND METHODS

Fifty-one patients were included in the study and randomized into 2 groups: study group (n=26) included patients receiving ozonized water treatment; control group (n=25) included patients receiving placebo treatment (i.e. double-distilled water). Treatment protocol consisted of 1-minute oral rinses, repeated for 4 times, twice a week for 4 weeks. All patients received conventional corticosteroid topical therapy (betamethasone soluble tablets, 2 rinses/day for 4 weeks). Assessment of size of lesions, sign and pain scores was performed before treatment, after 2 weeks of treatment (T1) and at the end of 4-week treatment (T2). Efficacy Index (EI) of treatment, candidiasis and relapse rates were also recorded.

RESULTS

All patients experienced significant improvement of sign and pain scores with a higher rate of improvement in ozone-treated group (T1 improvement rates: Thongprasom 92.2% vs 28%; VAS pain 76.9% vs 32%; p<0.05). Pain and size reduction were significantly higher in ozone-treated group both at T1 and T2 (p<0.05). Ozone-treated group showed a higher EI at every time point (T0-T2: 72.77% vs 37.66%, p<0.01). Candidiasis (32% vs 11.5%) and relapse (40% vs 34.6%) rates were higher in control group, however the differences were not statistically significant.

CONCLUSIONS

Within the limitations of this study, ozonized water seems to be effective as an adjunct therapy, in combination with topical corticosteroids, for the treatment of eOLP.

Systemic Effects of Photobiomodulation on the Morphology of the Thyroid and Sublingual Glands: A Study in Rabbits

Objective: To investigate whether photobiomodulation (PBM) applied in a clinical situation with the purpose of improving the healing process of implants placed in the rabbit mandible would cause any morphological change in the thyroid and sublingual glands as a systemic effect of laser irradiation. Methods: Thirty-two New Zealand rabbits were randomly divided into four groups of eight animals each, one control group (CI, nonirradiated animals) and three experimental groups (EI, EII, and EIII) that received PBM postoperatively with an aluminum/gallium/arsenide laser diode (Theralase^®) at a wavelength of 830 nm (infrared) and 50 mW output power applied to two irradiation fields per session, for a total of seven sessions. All rabbits underwent surgical extraction of the mandibular left incisor, followed by immediate placement of an osseointegrated implant in the fresh socket. The experimental groups EI, EII, and EIII received PBM at an energy density of 5, 2.5, and 10 J/cm², respectively, per irradiation field. Results: There was no histomorphometric change in any of the groups. Conclusions: PBM, based on the irradiation protocol used in this study, does not cause morphological changes in the thyroid and sublingual glands when used to stimulate peri-implant bone healing in the rabbit mandible.

Effect of Low- Level Laser Therapy on Bone Regeneration of Critical-Size Bone Defects: A Systematic Review of In Vivo Studies and Meta-Analysis

OBJECTIVE

Low-level laser therapy is a method for osteogenesis since it stimulates cell proliferation, vascularization and osteoblastic activity. Various protocols applying low-level laser with different outcomes exist. The aim of the present study was to review the result of different methods on bone formation in critical-size defects of in vivo studies.

DESIGN

According to PRISMA statement, electronic search of PubMed, google scholar, Scopus and Web of Science and a hand search limited to in vivo English language studies until December 2019. Studies used low-level laser therapy in bone regeneration of critical-size defects met the inclusion criteria and which used high power lasers or a defect size smaller than 5 mm, were excluded.

RESULTS

Finally, 18 studies were included. Fourteen studies utilized low-level laser with a wavelength ranging from 606 to 980 nm and 53 % of studies applied low-level laser in a single session. Ten studies utilized continuous wave mode of laser. Highest and lowest values of power density were 1.5 W/cm² and 0.1 W/cm² in order. Eleven studies evaluated low-lever laser therapy on defects of 5 mm in calvaria. Meta-analysis showed the positive effect of low-level laser therapy on osteogenesis after 30 days compared to control group and no significant difference after 60 days.

CONCLUSIONS

New bone formation can be increased in early stage by applying low-level laser therapy through stimulating osteoblasts and fibroblasts' proliferation. This effect would be more remarkable by combining with bone substitutes. Hence, for each case, protocol selection should be performed according defect's properties, attentively.

Is low level laser therapy or ozone therapy more effective for bone healing? Understanding the mechanisms of HIF-1α, RANKL and OPG

Periodontitis is a common chronic infection of dental tissues. Ozone therapy (OT) and low level laser therapy (LLLT) are useful treatments for periodontitis. We investigated the effects of OT and LLLT on periodontal disease-induced bone destruction in rats with experimentally induced periodontitis (EP). We used 30 male Wistar rats divided into three groups: control, OT and LLLT. EP was induced by placing a 3.0 silk suture around the cervix of the left mandibular first molar tooth. OT was performed using an ozone generator at 80% concentration. LLLT was applied using a diode laser. Both OT and LLLT were performed for two weeks at two day intervals. Histomorphometric and immunohistochemical analyses also were performed. Alveolar bone loss was significantly less in the LLLT group compared to the control group. The number of HIF-1α positive cells was significantly less in the LLLT group compared to the control group. We found significantly fewer RANKL-positive cells in the OT group compared to the control group. The number of osteoprotegerin (OPG) positive cells was significantly greater for the LLLT group than for the control group. Although both treatments produced positive effects, LLLT appears to be more effective for increasing alveolar bone formation.

Ganoderma lucidum, a promising agent possessing antioxidant and anti-inflammatory effects for treating calvarial defects with graft application in rats

Purpose:

Ganoderma lucidum, a kind of mushroom used for its antioxidant, anti-inflammatory, and immunomodulatory activities, was investigated in the present study for its possible healing effect on calvarial defects with bone grafts.

Methods:

Wistar male rats (n = 30) were divided into 3 groups: 1) the control (defect) group (n = 10), 2) defect and graft group (n = 10), and 3) defect, graft, and G. lucidum treated group (n = 10). The G. lucidum was administered to the rats at 20 mL/kg per day via gastric lavage.

Results:

In the defect and graft group, osteonectin positive expression was observed in osteoblast and osteocyte cells at the periphery of the small bone trabeculae within the graft area. In the defect, graft, and G. lucidum treated group, osteonectin expression was positive in the osteoblast and osteocyte cells and positive osteonectin expression in new bone trabeculae. The expression of matrix metalloproteinase-9 (MMP-9) was positive in the inflammatory cells, fibroblast cells, and degenerated collagen fibril areas within the defect area.

Conclusion:

This study shows that, with its antioxidant and anti-inflammatory properties, G. Lucidum is an important factor in the treatment of calvarial bone defects.

Evaluation of the effect of topical and systemic ozone application in periodontitis: an experimental study in rats

Objective:

The goal of the present study was to determine the effect of systemic and topical ozone application on alveolar bone loss (ABL) by evaluating the effect of Hypoxia-inducible factor −1 alpha (HIF-1-α) and receptor activator of NF-kB ligand (RANKL)-positive cells on histopathological and immunohistochemical changes in a rat periodontitis model.

Methodology:

Thirty male Wistar rats were divided into three groups: 1) Group C (control group); 2) Group SO (systemic ozone group) and 3) Group TO (topical ozone group). Experimental periodontitis was induced with a 3/0 silk suture placed at the mandibular left first molars of rats, and the suture was removed 14 days later. Ozone gas was injected intraperitoneally (0.7 mg/kg) in SO group. Topical ozone application protocol was performed using an ozone generator at 80% concentration (4^th grade) 90- degree probe for the duration of 30 s. Both ozone applications were carried out for two weeks at intervals of two days. Histomorphometric and immunohistochemical analysis were performed.

Results:

ABL was significantly lower in Group SO compared to Group C (p: 0.0052). HIF-1α- positive cells were significantly lower in Group TO than in Group C (p: 0.0043). RANKL-positive cells were significantly lower in Group SO and in Group TO compared to the control group (p: 0.0033, p: 0.0075, respectively).

Conclusion:

Both ozone applications decreased RANKL-positive cell counts, TO application decreased HIF-1-α positive cells counts, and SO application was found to be more effective in reducing ABL compared to control group.

Evaluation of the Effects of Low-Level Laser Therapy on Diabetic Bone Healing

The aim of the present study was to evaluate the effects of low-level laser therapy (LLLT) and biphasic alloplastic bone graft material on diabetic bone healing. Induction of diabetes was performed in 14 male Sprague-Dawley rats by intraperitoneal injection of a 50 mg/kg dose of streptozotocin. Two bilaterally symmetrical non-critical-sized bone defects were created in the parietal bones in each rat. Right defects were filled with biphasic alloplastic bone graft. Rats were randomly divided into 2 groups, with 1 group receiving 10 sessions of LLLT (GaAlAs, 78.5 J/cm, 100mW, 0.028 cm beam). The LLLT was started immediately after surgery and once every 3 days during postoperative period. At the end of treatment period, new bone formation and osteoblast density were determined using histomorphometry. Empty (control), graft-filled, LLLT-treated and both graft-filled and LLLT-treated bone defects were compared. New bone formation was higher in the graft treatment samples compared with the control (P = 0.009) and laser samples (P = 0.029). In addition, graft-laser combination treatment samples revealed higher bone formation than control (P = 0.008) and laser (P = 0.026) samples. Osteoblast density was significantly higher in the laser treatment (P <0.001), graft treatment (P = 0.001) and graft-laser combination treatment (P <0.001) samples than control samples. In addition, significantly higher osteoblast density was observed in the graft-laser combination treatment samples compared to the graft treatment samples (P = 0.005). The LLLT was effective to stimulate osteoblastogenesis but failed to increase bone formation. Graft augmentation for treatment of bone defects seems essential for proper bone healing in diabetes, regeneration may be supported by the LLLT to enhance osteoblastogenesis.

Tratamento de ferida em Coendou prehensilis (Rodentia: Erethizontidae) com laserterapia e ozonioterapia: relato de caso

RESUMO O emprego conjunto da laserterapia e da ozonioterapia em feridas apresenta alto potencial benéfico para os pacientes, uma vez que contribui para o manejo da dor, tem ação anti-inflamatória e acelera o processo de cicatrização. Este relato de caso tem como objetivo apresentar o uso de terapias alternativas na cicatrização de ferida em exemplar de Coendou prehensilis. Um ouriço-cacheiro, fêmea, adulto, com peso de 4kg foi encaminhado para atendimento médico veterinário com histórico de ter sido atacado por um cão. Inicialmente o ouriço passou pelo procedimento de higienização e desbridamento da ferida, para a retirada das bordas necróticas. Adicionalmente, foram administrados clindamicina (10mg/kg), por via intramuscular (IM), uma vez por dia (SID), tramadol (4mg/kg, IM, SID), flunixin (0,3mg/kg, SID), por via subcutânea (SC), e ferrodextrano (25mg/kg, IM, SID). Apesar da terapia instituída, observou-se reincidência de crescimento necrótico tecidual, o que levou à eleição do tratamento da ferida com as técnicas de laserterapia e ozonioterapia. O emprego das terapias alternativas como adjuvante promoveu uma cicatrização satisfatória da ferida, com ausência de sinais de sensibilidade local e de infecção, bem como ausência de crescimento de bordas necróticas. O tratamento adjuvante foi eficaz e pode ser empregado em outras situações para cicatrização de ferida em mamíferos silvestres.

Fibrin Sealant Derived from Human Plasma as a Scaffold for Bone Grafts Associated with Photobiomodulation Therapy

Fibrin sealants derived from human blood can be used in tissue engineering to assist in the repair of bone defects. The objective of this study was to evaluate the support system formed by a xenograft fibrin sealant associated with photobiomodulation therapy of critical defects in rat calvaria. Thirty-six rats were divided into four groups: BC (n = 8), defect filled with blood clot; FSB (n = 10), filled with fibrin sealant and xenograft; BCPBMT (n = 8), blood clot and photobiomodulation; FSBPBMT (n = 10), fibrin sealant, xenograft, and photobiomodulation. The animals were killed after 14 and 42 days. In the histological and microtomographic analysis, new bone formation was observed in all groups, limited to the defect margins, and without complete wound closure. In the FSB group, bone formation increased between periods (4.3 ± 0.46 to 6.01 ± 0.32), yet with lower volume density when compared to the FSBPBMT (5.6 ± 0.45 to 10.64 ± 0.97) group. It was concluded that the support system formed by the xenograft fibrin sealant associated with the photobiomodulation therapy protocol had a positive effect on the bone repair process.

Effects of medical ozone upon healthy equine joints: Clinical and laboratorial aspects

OBJECTIVE

The aim of this study was to verify whether transient inflammatory reactions induced by intra-articular medicinal ozone administration affect joint components, by in vivo evaluation of inflammatory (prostaglandin E2, Substance P, Interleukin-6, Interleukine-1, Tumor Necrosis Factor), anti-inflammatory (Interleukin-10) and oxidative (superoxide dismutase activity and oxidative burst) biomarkers and extracellular matrix degradation products (chondroitin sulphate and hyaluronic acid) in synovial fluid.

METHODS

The effects of medicinal ozone were analyzed at two ozone concentrations (groups A and B, 20 and 40 μg/ml, respectively), using oxygen-injected joints as controls (group C); each group received ten treatments (15 ml gas per treatment). Physical evaluation, evaluation of lameness, ultrasonography, and synovial fluid analysis were performed.

RESULTS

All joints presented mild and transient effusion throughout the study. Group B exhibited the highest lameness score on day 14 (P<0.05), detected by the lameness measurement system, probably because of the higher ozone concentration. All groups exhibited increased ultrasonography scores on day 14 (P < 0.05). Groups A and B exhibited increased proteins concentrations on day 21 (P<0.05). There was no change in hyaluronic acid concentration or the percentage of high-molecular weight hyaluronic acid throughout the experiment. Chondroitin sulfate concentrations decreased in group B, and did not change in group A and C, indicating that neither treatment provoked extracellular matrix catabolism. Cytokine and eicosanoid concentrations were not significantly changed.

CONCLUSIONS

The ozonetherapy did not cause significant inflammation process or cartilage degradation, therefore, ozonetherapy is safe at both evaluated doses.

Low power laser irradiation and human adipose-derived stem cell treatments promote bone regeneration in critical-sized calvarial defects in rats

Both stem cell therapy and physical treatments have been shown to be beneficial in accelerating bone healing. However, the efficacy of combined treatment with stem cells and physical stimuli for large bone defects remains uncertain. The aim of this study was to evaluate the bone regeneration effects of low-power laser irradiation (LPLI) and human adipose-derived stem cell (ADSC) treatments during fracture repair using a comparative rat calvarial defect model. We evaluated the viability of human ADSCs, which were cultured on a porous PLGA scaffold using an MTS assay. The critical-sized calvarial bone defect rats were divided into 4 groups: control group, LPLI group, ADSC group, and ADSC+LPLI group. Bone formation was evaluated using micro-CT. New bone formation areas and osteogenic factor expression levels were then examined by histomorphological analysis and immunohistochemical staining. Our data showed that PLGA had no cytotoxic effect on human ADSCs. Micro-CT analyses revealed that both the LPLI and ADSC groups showed improved calvarial bone defect healing compared to the control group. In addition, the ADSC+LPLI group showed significantly increased bone volume at 16 weeks after surgery. The area of new bone formation ranked as follows: control group < LPLI group < ADSC group < ADSC+LPLI group. There were significant differences between the groups. In addition, both ADSC and ADSC+LPLI groups showed strong signals of vWF expression. ADSC and LPLI treatments improved fracture repair in critical-sized calvarial defects in rats. Importantly, the combined treatment of ADSCs and LPLI further enhances the bone healing process.

Comparison of effects of LLLT and LIPUS on fracture healing in animal models and patients: A systematic review

The aim of this paper is to study the in vivo potency of low-level laser therapy (LLLT) and low intensity pulsed ultrasound (LIPUS) alone, accompanied by bone grafts, or accompanied by other factors on fracture healing in animal models and patients. In this paper, we aim to systematically review the published scientific literature regarding the use of LLLT and LIPUS to accelerate fracture healing in animal models and patients. We searched the PubMed database for the terms LLLT or LIPUS and/or bone, and fracture. Our analysis also suggests that both LIPUS and LLLT may be beneficial to fracture healing in patients, and that LIPUS is more effective. These finding are of considerable importance in those treatments with a LIPUS, as a laser device may reduce healing time. The most clinically relevant impact of the LIPUS treatment could be a significant reduction in the proportion of patients who go on to develop a nonunion. If it is confirmed that the therapeutic influence is true and reliable, patients will obtain benefits from LIPUS and LLLT. Further clinical trials of high methodological quality are needed in order to determine the optimal role of LIPUS and LLLT in fracture healing in patients.

Comparison of Ozone and Photo-Biomodulation Therapies on Mental Nerve Injury in Rats

PURPOSE

This study compared photo-biomodulation (PBM) and ozone therapy (OT) for mental nerve injury by counting Schwann cells (SCs) and fasciculated nerve branches and measuring fascicular nerve areas.

MATERIALS AND METHODS

The effects of OT and PBM on mental nerve injury were evaluated. Mental nerves of 27 rats were partly sutured and allocated into 3 groups. Group 1 received no treatment, group 2 received OT, and group 3 received PBM. The number of fascicules beyond nerve branches and the number of SCs before and after nerve injury were evaluated histologically.

RESULTS

A better healing pattern was observed in the treatment groups. The number of SCs was markedly larger in the OT and PBM groups than in the control group.

CONCLUSIONS

Oral and maxillofacial surgeons should be familiar with the differential diagnosis, prevention, and management of neurosensory disturbances. This study provides insights into the management of neurosensory disturbances related to mental nerve injury using OT and PBM. This study clearly suggests that OT and PBM are promising novel methods for the treatment of mental nerve injury.

The Effects of Nigella Sativa Seed Extract on Bone Healing in an Experimental Model

The purpose of this study was to histologically evaluate the effects on bone healing of nigella sativa seed extract applied on calvarial defects in an ovariectomized rat model. The study included 32 female rats weighing 280 to 310 g with an average age of 3 months. A defect was created with a trephine burr on each rat calvarium. The rats were divided into 2 groups (control and study) of 8 animals each. All the defects were grafted with a gelatin sponge mixed with normal saline. In the study group, nigella sativa seed extract was applied systemically using an oro-gastric tube. Half of the animals in each group were sacrificed after 2 weeks, and the others after 4 weeks. In the control groups, the defects were not completely filled with regenerated bone. Osteoblast cells were observed more in the study groups. A higher rate of osteoclasts was determined in the control groups. In addition, the nigella sativa group had a statistically greater amount of bone formation than the others group at both 2 weeks and 4 weeks (P <0.05). The systemic application of nigella sativa seed extract demonstrated incredibly positive effects on enhanced bone healing in this experimental osteoporotic model.

Periodontal and peri-implant wound healing following laser therapy

Laser irradiation has numerous favorable characteristics, such as ablation or vaporization, hemostasis, biostimulation (photobiomodulation) and microbial inhibition and destruction, which induce various beneficial therapeutic effects and biological responses. Therefore, the use of lasers is considered effective and suitable for treating a variety of inflammatory and infectious oral conditions. The CO2 , neodymium-doped yttrium-aluminium-garnet (Nd:YAG) and diode lasers have mainly been used for periodontal soft-tissue management. With development of the erbium-doped yttrium-aluminium-garnet (Er:YAG) and erbium, chromium-doped yttrium-scandium-gallium-garnet (Er,Cr:YSGG) lasers, which can be applied not only on soft tissues but also on dental hard tissues, the application of lasers dramatically expanded from periodontal soft-tissue management to hard-tissue treatment. Currently, various periodontal tissues (such as gingiva, tooth roots and bone tissue), as well as titanium implant surfaces, can be treated with lasers, and a variety of dental laser systems are being employed for the management of periodontal and peri-implant diseases. In periodontics, mechanical therapy has conventionally been the mainstream of treatment; however, complete bacterial eradication and/or optimal wound healing may not be necessarily achieved with conventional mechanical therapy alone. Consequently, in addition to chemotherapy consisting of antibiotics and anti-inflammatory agents, phototherapy using lasers and light-emitting diodes has been gradually integrated with mechanical therapy to enhance subsequent wound healing by achieving thorough debridement, decontamination and tissue stimulation. With increasing evidence of benefits, therapies with low- and high-level lasers play an important role in wound healing/tissue regeneration in the treatment of periodontal and peri-implant diseases. This article discusses the outcomes of laser therapy in soft-tissue management, periodontal nonsurgical and surgical treatment, osseous surgery and peri-implant treatment, focusing on postoperative wound healing of periodontal and peri-implant tissues, based on scientific evidence from currently available basic and clinical studies, as well as on case reports.

Effect of Diode Laser on Healing of Tooth Extraction Socket: An Experimental Study in Rabbits

OBJECTIVES

To evaluate the effect of low-level laser therapy on healing of extracted tooth socket of healthy rabbits.

DESIGN

The sample of this study was 20 male rabbits of 2-2.5 kg weight with age range of 8-12 months. Right and left lower first premolar teeth were extracted. The extraction sockets of lower right first premolar were irradiated with 0.9 W gallium-aluminum-arsenide (GaAlAs) diode laser for 5 min, immediately after extraction and then every 72 h for the next 12 days. The extraction socket of left side were not exposed to laser and served as a control. The animals were sacrificed after 7, 14, 30 and 45 days and the experimental and control sockets were removed from the harvested mandibles and prepared for haematoxylin and eosin staining and Masson's stain. The prepared slides were examined under light microscope for histological and histomorphometric examination.

RESULTS

The histological examination showed that diode laser-treated sockets demonstrated early formed new bone with faster maturation of primary bone to secondary bone as compared to non-treated control sockets. Histomorphometric analysis revealed a statistically significant increase in the density and volume of trabecular bone in laser-treated sockets than control sockets.

CONCLUSION

Diode laser application to tooth extraction socket has a positive effect on bone formation.

The effect of different concentrations of topical ozone administration on bone formation in orthopedically expanded suture in rats

BACKGROUND/OBJECTIVE

The aim of this study was to investigate the effects of different concentrations of ozone (O3) therapy on bone regeneration in response to an expansion of the inter-premaxillary suture in rats.

MATERIALS AND METHODS

Forty-eight Wistar rats were randomly divided into four groups (n = 12). In groups I, II, and III, 1ml of O3 at 10, 25, and 40 µg/ml was injected at the premaxillary suture, respectively. In group IV (control group), 1ml of saline solution was injected at the same point during the expansion procedure for 5 days. Bone regeneration in the suture was evaluated histomorphometrically. The area of new bone and fibrotic area, the number of osteoblasts and osteoclasts, and the amount of vascularity were measured and compared. The density of the newly formed bone in the expansion area was measured by using cone beam computed tomography. Data were analyzed using the Kruskal-Wallis one-way analysis of variance and post hoc Student-Newman-Keuls tests.

RESULTS

New bone area, fibrotic area, osteoblast and osteoclast numbers, and the amount of vascularity were significantly higher in experimental groups compared with the control group (P < 0.001). The density of newly formed bone (P < 0.001), new bone formation (P = 0.009), number of capillaries (P < 0.001), number of osteoclasts (P = 0.016), and number of osteoblasts (P < 0.001) in the maxillary sutures were highest in the 25 μg/ml O3 group compared with the other experimental groups and control group.

CONCLUSIONS/IMPLICATIONS

The application of O3 therapy can stimulate bone regeneration in an orthopedically expanded inter-premaxillary suture during both the expansion and retention periods.

Histomorphometric and microtomographic evaluation of the effects of hyperbaric oxygen and systemic ozone, used alone and in combination, on calvarial defect healing in rats

PURPOSE

The aim of this study was to compare the efficacy of hyperbaric oxygen and systemic ozone, used separately and in combination, on the healing of bone defects.

MATERIAL AND METHODS

Sixty male Wistar rats were divided into 4 groups (n = 15) according to treatment (control, hyperbaric oxygen [HBO], ozone [O], and HBO plus O [HBO-O]) and divided further into 3 subgroups according to day of sacrifice (postsurgical days 5, 15, and 30). Surgery was performed under general anesthesia to create a critical-size bone defect (5 mm in diameter) in the cranium. After sacrifice, microtomographic images of all samples were recorded, and histomorphometric analysis was performed.

RESULTS

Histologic and radiologic measurements showed that the values of all experimental groups were higher than those of the control group. Histologic scores for all experimental groups were statistically higher than those for the control group day 30 (O, P = .045; HBO, P = .049; HBO-O, P = .042). Histologic scores also were statistically higher for the HBO group on day 5 (P = .045) and day 15 (P = .009) compared with the control group. Microtomographic scores were higher for the experimental groups than for the control group, with statistically significant differences for group O on day 5 (P = .033) and day 30 (P = .0045) and for group HBO on day 15 (P = .005). Histologic and radiologic analyses showed positive correlations.

CONCLUSION

Within the limitations of this study, the use of hyperbaric oxygen and ozone, separately and in combination, were shown to be effective in increasing bone healing. Combined usage was no more effective in stimulating bone healing than separate usage.