Assessment of healing following low-level laser irradiation after gingivectomy operations using a novel soft tissue healing index: A randomized, double-blind, split-mouth clinical pilot study

Effect of Open Flap Debridement with and without LLLT in Patients with Periodontitis on Wound Healing, GCF ALP Levels, and Clinical Parameters

AIM

The tenet of the study is to evaluate the efficacy of low-level laser therapy (LLLT) as an adjunct to surgical periodontal therapy [open flap debridement (OFD)] on clinical parameters, gingival crevicular fluid (GCF) alkaline phosphatase (ALP) levels in GCF and wound healing.

MATERIALS AND METHODS

Thirty subjects afflicted with chronic periodontitis showing evidence of horizontal bone loss on the radiograph, pocket probing depth (PPD) between 4 and 7 mm, and ≥20 natural teeth present in the oral cavity were included in the study. In every patient, OFD+LLLT was done in one quadrant and OFD in another was performed. The clinical parameters were assessed at baseline, 3 and 6 months visits while the GCF sample was collected at baseline visit and 6 months recall. Wound healing indices were recorded 1-week post-op surgery for each group.

RESULTS

The results showed an evident improvement in all the clinical parameters [pocket probing depth, gingival index (GI), plaque index (PI), and CAL] from baseline-6 months values; however, no statistically significant difference was seen on the intergroup comparison. Wound healing was statistically significantly superior in the OFD + LLLT group in comparison to the OFD group, indicating a positive effect of lasers on healing. Gingival crevicular fluid ALP levels in the two groups decreased after 6 months and a statistically significant reduction in the laser group indicated an anti-inflammatory effect.

CONCLUSION

The results clearly indicated the efficacy of lasers in terms of acceleration of wound healing and control of inflammation.

CLINICAL SIGNIFICANCE

Lasers as an adjunct to surgical periodontal therapy evidently have an anti-inflammatory effect (decrease in GCF ALP levels) as well as accelerate the wound healing process. How to cite this article: Gupta R, Arora SA, Gupta G, et al. Effect of Open Flap Debridement with and without LLLT in Patients with Periodontitis on Wound Healing, GCF ALP Levels, and Clinical Parameters. J Contemp Dent Pract 2024;25(12):1148-1155.

Effect of Hyaluronic Acid Mucoadhesives on Palatal Wound Healing and Postoperative Discomfort in Free Gingival Graft Surgery: A Clinical Trial

Objectives: This study aimed to assess the effect of hyaluronic acid (HA) mucoadhesives with two different concentrations on palatal epithelial wound healing and postoperative discomfort following free gingival graft (FGG) surgery. Materials and Methods: In this triple-blind, randomized, controlled clinical trial, 39 patients undergoing FGG surgery were randomly allocated to three groups (N=13). Following palatal graft harvesting, the two experimental groups received mucoadhesives containing 0.8% and 0.2% HA, while the control group received mucoadhesives without HA. In all groups, the donor site was protected with periodontal dressing. Epithelization, color match, contour, and distortion were assessed at 3, 7, 14, 21, and 42 days, postoperatively using the Landry's healing index and modified Manchester Scar Proforma (mMSP) index. Pain level and response to thermal stimuli were evaluated after 3, 7, 14, and 21 days using a visual analog scale (VAS). Data were analyzed by the Chi-square, Kruskal-Wallis, Mann-Whitney, Friedman, and Wilcoxon signed-rank tests (alpha=0.05). Results: Significant differences were observed in the mMSP index scores among the groups at 3, 7, 14, and 42 days, favoring HA groups (P<0.05). The Landry's healing index score was significantly higher in 0.8% HA group on day 21 (P=0.023), compared to the control group. No significant differences were found in pain score or thermal stimulus responses among the groups (P>0.05). Conclusion: Mucoadhesives containing HA were found to enhance palatal wound healing, leading to improved outcomes in terms of epithelization, color match, contour, and distortion reduction.

The Efficacy of Low-Level Laser Therapy on the Healing of Oral Wounds: A Systematic Review

Wound healing is an intricate process involving biological alterations in cellular integrity. Low-level laser therapy (LLLT) includes special features that speed up tissue regeneration and wound healing. The objective of this review is to examine the outcomes of photobiomodulation therapy in terms of healing. A search strategy was prepared using MeSH terms and Boolean operators. The initial search was limited to randomized controlled trials in the English language from January 2014 until January 2024. An electronic search of the National Library of Medicine (NLM catalog), Google Scholar, and Scopus was conducted using Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. The studies used LLLT of various wavelengths and parameters on oral wound healing. A total of 54 records were identified through database searching. In total, 14 studies were included according to the inclusion criteria. Ten studies examined the effects of LLLT in post-surgical hard and soft tissue healing in humans. Four animal studies observed the efficacy of photobiomodulation on the healing of bone tissue. All investigations found a substantial contrast between control and laser groups concerning wound epithelialization. When used as an adjunct or a substitute, LLLT has advantages in terms of pain and inflammation by boosting acetylcholine esterase synaptic activity, beta-endorphin synthesis, and serotonin production. By promoting the growth of osteoblasts and fibroblasts, LLLT can enhance the production of new bone at an early stage. Hence, further studies and meta-analyses are required for a better understanding of the mechanism and to confirm the efficacy with different parameters.

Impact of L-PRF on pain and healing outcomes in lower third molar surgery: a randomized split-mouth trial

This study explored the effects of L-PRF on pain, soft tissue healing, periodontal condition, and post-extraction bone repair of mandibular third molars (3Ms). A randomized, prospective, triple-blind, split-mouth clinical trial was conducted with 34 volunteers. Eligible patients were randomly allocated into two treatments: G1 (without L-PRF), G2 (alveoli filled with L-PRF), in which the removal of bilateral 3Ms was performed at the same surgical time. Outcomes were assessed according to a visual analogue scale (pain), soft tissue scoring system (wound healing), periodontal probing of mandibular second molar. Bone repair was determined by volumetric analysis (ITK-SNAP software) and fractal analysis (ImageJ software). An intention-to-treat approach to Statistical analysis was used. L-PRF reduced pain in the 7-day postoperative follow-up (p = 0.019) and not only improved soft tissue healing after 1 month of follow-up (p = 0.021), but also probing depth (distal face) in 3 months postoperatively (p = 0.011). Significant alveolar reduction occurred in 3 months after surgery in both treatments (p < 0.05), however, this was more significant in G1 (p = 0.016). The fractal dimension showed no statistical differences. L-PRF improved postoperative clinical parameters of pain, soft tissue healing, and periodontal condition, suggesting that it has a beneficial effect on preserving the alveolar ridge and accelerating the initial repair process.

Minimally Invasive Extraction System Benex-Clinical Evaluation and Comparison

Tooth extraction is one of the oldest and most well-known surgical procedures in dental medicine. It is still routinely performed by general practitioners and dental undergraduates. The Benex extraction system allows for the extraction of teeth in a vertical direction, which avoids most trauma against surrounding alveolar bone and soft tissues. The study included 56 patients who were recruited from the Department of Oral Surgery, Medical University-Plovdiv. The patients were split into two groups of 28 patients-Group I (control group) and Group II (study group). For each group, the success of the extraction, buccal cortical plate preservation, pain experience and early wound healing were assessed. There was no statistical significance between the success of the extractions in both groups. The Benex extractions preserved the buccal cortical plate in 95% of the cases, whereas the forceps extractions preserved it in only 71.8%, which is statistically significant. On the seventh day, patients in Group II reported less pain, without a significant difference. There was a significantly bigger number of completely healed extraction wounds on the 10th day. Atraumatic extractions allow for more hard and soft tissues to be preserved in the extraction site. This is essential for a successful outcome and the aesthetically pleasing results of the following dental restoration.

Comparison of glued platelet-rich fibrin membrane and noneugenol pack as periodontal dressings after gingival depigmentation

Periodontal surgery often necessitates the use of a periodontal dressing to protect the surgical site and facilitate healing. Commonly used dressings, such as noneugenol packs, offer some benefits but have significant drawbacks, including plaque accumulation, a sensation of foreignness, and no significant impact on healing enhancement. On the other hand, platelet-rich fibrin (PRF) membranes are rich in growth factors, which can accelerate wound healing and tissue regeneration. However, their use is limited due to the need for suturing to stabilize the membrane. N-butyl cyanoacrylate is a tissue adhesive known for its hemostatic and bacteriostatic properties and effectiveness in moist environments, presenting a potential solution for PRF membrane stabilization without the need for suturing. This case report evaluates the use of PRF membrane in combination with N-butyl cyanoacrylate adhesive as an alternative to traditional noneugenol periodontal dressing.

Minimally invasive extractions with physics forceps - clinical evaluation and comparison

INTRODUCTION

Tooth extraction is still one of the most common dental procedures, routinely performed for a variety of reasons. Tooth extraction forceps and elevators are well-known extraction instruments which have been the standard in tooth extraction procedures for well over a hundred years. Physics forceps are one possible alternative, aiming to perform less traumatic and more predictable extractions.

Efficacy of hyaluronic acid gel and photobiomodulation therapy on wound healing after surgical gingivectomy: a randomized controlled clinical trial

BACKGROUND

Surgical gingivectomy can be considered the gold standard treatment for gingival enlargement. The healing of wound site after gingivectomy occurs slowly by secondary intention. To accelerate the wound healing process, several studies have been conducted evaluating the effect of various treatment modalities. Photobiomodulation therapy (PBMT) was proposed to provide minimally invasive and painless treatment as well as to decrease discomfort of the patient following the surgical process. Another factor that is expected to improve the healing after surgery is topical application of chemotherapeutic agents such as Hyaluronic acid (HA). This study aims to assess the effect of topically applied HA gel after PBMT on the healing of wound site after surgical gingivectomy.

METHODS

This randomized controlled clinical trial included twenty-six surgical gingivectomy wound sites, equally divided into two groups, Group-I (test group): the surgical sites after gingivectomy were irradiated with a diode laser (980 nm, 0.2 W) then covered by 2% HA gel loaded in a special custom-made soft transparent tissue guard appliance for each patient. Group II (control group): the surgical sites were irradiated with a diode laser (980 nm, 0.2 W) only. Wound healing was assessed subjectively by Landry healing index on the 3rd, 7th, 14th and 21st days after surgery, and pain perception was assessed by the patients using visual analog scale (VAS) throughout the 21 days of the follow up period. Comparisons between the two study groups were performed using Mann-Whitney U test, while comparisons between different time points were performed using Friedman test. Significance was inferred at p value < 0.05.

RESULTS

By the end of the follow-up period, surgical sites of the test group showed excellent healing compared to the control group. There were no significant differences in VAS scores between both groups (p > 0.05).

CONCLUSIONS

Application of 2% HA gel as an adjunctive to PBMT was found to have significant clinical effects and higher power of repair among test group when compared to that achieved by PBMT alone in control group.

TRIAL REGISTRATION

This study was retrospectively registered on ClinicalTrials.gov and first posted on 28th of March 2023 with an identifier number: NCT05787912.

Efficacy of Low-Level Laser Therapy in Wound Healing and Pain Reduction After Gingivectomy: A Systematic Review and Meta-analysis

Introduction: Complete healing of a gingivectomy wound usually takes between one and two months. To speed up this process, different topical medications have been reported. In addition, there are different studies assessing the efficacy of low-level laser therapy (LLLT) in terms of wound healing and pain relief subsequent to gingivectomy, yielding inconsistent outcomes. In the present study, we systematically reviewed the existing evidence in the literature to resolve the given conflicts. Methods: We searched for the studies published from inception to 1 April 2023 in Embase, PubMed, and Scopus databases without language limitation by the use of appropriate keywords. We included randomized or non-randomized clinical trial studies that appraised the efficacy of LLLT in pain reduction and wound healing in adult patients who underwent gingivectomy. We pooled the continuous data concerning the pain visual analogue scale and the healing index extracted from the individual studies to provide a standardized mean difference (SMD) with a 95% confidence interval (CI), using a random-effects model. Results: Out of 188 sources initially captured from the database search, six studies were ultimately included. Regarding wound healing, the LLLT group exhibited a significantly higher mean value of the healing index compared to the control group on days 3 (SMD, 0.93; 95% CI, 0.39 to 1.47) and 7 (SMD, 1.03; 95% CI, 0.49 to 1.57) post-surgery. Also, significant differences were noted in the postoperative pain reduction between the two groups on days 3 (SMD, -2.00; 95% CI, -2.48 to -1.51) and 7 (SMD, -2.44; 95% CI, -4.66 to -0.22) post-surgery. Conclusion: According to the present systematic review, LLLT could potentially be an efficient adjunctive treatment after gingivectomy for wound healing acceleration and patient pain alleviation.

Effect of photobiomodulation adjunct to periodontal therapy on individuals with type 2 diabetes mellitus regarding periodontal clinical parameters: a systematic review and meta-analysis

The purpose of this study is to evaluate the scientific evidence on the impact of photobiomodulation adjunct to non-surgical periodontal treatment on individuals with type 2 diabetes mellitus (T2DM). The Preferred Reporting Items for Systematic Reviews and Meta-analyses statement was followed. A protocol was registered in the International Prospective Registry of Systematic Reviews (PROSPERO #CRD42022310756). The research was carried out in seven databases, with no restrictions regarding the year of publication. Our work included studies that compared periodontal clinical parameters among individuals undergoing non-surgical periodontal therapy associated with photobiomodulation and a control group of individuals undergoing non-surgical periodontal treatment. Study selection, data extraction, and risk of bias assessment (RoB 2.0) were performed by two review authors. Meta-analysis was performed. Mean difference (MD) and a 95% confidence interval (CI) were provided. Three hundred forty-one studies were identified, of which eight studies were included. The meta-analysis demonstrated that photobiomodulation adjunctive to periodontal therapy in individuals with diabetes resulted in a greater reduction in probing depth and greater attachment gain in comparison to periodontal treatment alone (p < 0.05). The included studies exhibited a low risk of bias. Photobiomodulation adjunct to periodontal therapy contributes to the improvement of periodontal clinical parameters in individuals with T2DM.

Effect of Low-Level Laser Therapy on Early Wound Healing and Levels of Inflammatory Mediators in Gingival Crevicular Fluid Following Open Flap Debridement

Introduction Low-level laser therapy (LLLT) has a beneficial effect on pain relief and wound healing. This study aims at a clinical evaluation of early wound healing and a biochemical evaluation of inflammatory mediators in gingival crevicular fluid (GCF) following LLLT with an open flap debridement (OFD) in periodontal therapy. Material and methods This randomized controlled trial included 40 chronic periodontitis patients with bilateral attachment loss, pocket depths of 5 mm affecting at least two quadrants, and radiographic evidence of horizontal bone loss. 120 control sites were randomly selected to receive OFD, and contralateral 120 test sites received bio-stimulation with a diode laser (890 nm) after OFD. The wound healing index was recorded at the 1st and 2nd weeks, and clinical parameters such as the plaque index, gingival index, pocket probing depth, clinical attachment level, and GCF inflammatory mediators were evaluated at baseline, 3, and 6 months. Results From the start of the study to 6 months later, there was a statistically significant drop in plaque index, gingival index, probing pocket depth, and gain clinical attachment levels in both groups. However, when the two groups were compared, there were no significant differences at any time intervals. GCF inflammatory mediators tumor necrosis factor (TNF) alpha and matrix metalloproteinases (MMP-8) decrease, and osteoprotegerin (OPG) levels increase in both the test group and control group from baseline to 3 months and 6 months. In intergroup comparisons, there was a statistically significant reduction in the test group as compared to the control group at 6 months. There was a decline in gingival crevicular fluid - interleukin-6 (GCF IL-6) levels from baseline to 3 months and 6 months in both the groups but when analysed statistically, the results were not significant on intergroup and intragroup comparison at any time interval. The Landry Wound Healing Index values in the 1st and 2nd weeks were showing statistically significant improved healing in the test group as compared to the control group. There was significantly better wound healing at sites where a diode laser was used. Conclusion LLLT increases early wound healing after periodontal surgical procedures.

Comparison between Modified Bone-splitting Technique and Distraction Osteogenesis in Horizontal Alveolar Ridge Expansion: Randomized Clinical Study

AIM

This study aimed to compare modified ridge splitting (RS) and distraction osteogenesis (DO) for horizontal ridge expansion clinically (bone width, pain, and soft tissue healing) and radiographically (bone width).

MATERIAL AND METHODS

This randomized clinical trial was conducted on fourteen patients who had a partial edentulous narrow mandibular posterior alveolar ridge (not less than 4-mm width and 12-mm height). All patients were divided randomly into two equal groups: Group I was treated with a modified bone-splitting technique, and group II was treated with DO technique by the fabricated device as AlveoWider®, and without any graft material for both groups. All patients were followed up clinically to evaluate the increase of bone width at preoperative measurement (T0) and 6 months postoperative (T6), and radiographically by cone-beam computed tomography (CBCT) at T0, 3 months postoperative (T3), and T6. Descriptive and bivariate statistics were computed using the SPSS version (SPSS, IBM Inc., Chicago, IL, USA), and p ≤ 0.05 was considered an indicator of statistical significance.

RESULTS

All patients were female. Patients' ages ranged from 18 to 45 years, with a mean age of 32.07 ± 5.87 years. Radiographically, there is no significant statistical difference in comparing between two groups for the creation of a horizontal alveolar bone; however, there was a highly significant statistical difference (p < 0.001) in each group between different interval periods (T0, T3, and T6) with mean start 5.27 ± 0.53, and 5.19 ± 0.72 at T0 reaching to 7.60 ± 0.89 and 7.09 ± 0.96 at T3, and slightly decreases to 7.52 ± 0.79 and 7.02 ± 0.79 in T6 with radiographic evaluation, and it represented clinically in each group with mean 3.57 ± 0.313 and 4.0 ± 0.58 at T0 increase to 6.55 ± 0.395 and 6.52 ± 0.45 at T6 for both groups, respectively. There is a statistically significant difference in soft tissue healing with the average mean of 4.57 ± 0.24 and 3.57 ± 0.509 and pain with an average mean of 1.66 ± 0.22 and 4.74 ± 0.55 with p = 0.001 and p < 0.001 when comparing between both groups, respectively, that is, p = 0.001 is considered to be statistically significant.

CONCLUSION

Both techniques seem to be useful as augmentation techniques for dental implant placement in a narrow alveolar ridge. Techniques are sensitive and need good experience. The modified splitting technique has fewer complications, less pain, and better soft tissue healing when compared with the DO technique.

CLINICAL SIGNIFICANCE

Both techniques are alternative methods for the treatment of the atrophic alveolar ridge with uneventful healing except for minor complications that do not interfere with dental implant placement.

Effect of Different Energy Densities of 915 nm Low Power Laser on The Biological Behavior of Human Gingival Fibroblast Cells in-vitro

Photobiomodulation is recognized as an effective method for adjunct therapy in periodontal treatments. our purpose in this study was to investigate the effects of different energy densities of 915nm diode laser on the viability and viability capacity of human gingival fibroblast cells. cell samples were examined in 5 groups, including 4 irradiation groups with low-level diode laser 915nm, 1,2,3,4 J/cm² , and a control group (no Laser irradiation). Cell viability and viability were measured 1, 3 and 5 days after irradiation by MTT and DAPI assay. Statistical differences between groups at any time were analyzed by one-way ANOVA and a post hoc Turkey's test. The cell viability and viability capacity increased on the third day at an energy density of 3 J/cm² ; (P-value = 0.007) and the fifth day at energy densities of 2,3 and 4 J/cm² was recorded compared to the control group (P-value =0.000). Also, a significant decrease in the viability and viability of irradiated cells with an energy density of 1 J/cm² was found. (P-value =0.033). according to our results, Photobiomodulation with 915nm diode laser has a positive stimulating effect on the viability and viability capacity of human gingival fibroblast cells.

Effect of nano-crystalline silver membrane on early wound healing after periodontal surgery: A comparative randomized study

Background:

Periodontal dressings are used for wound protection and patient comfort. Nano-silver particles have the ability to promote wound healing through anti-inflammatory properties. Hence, the present study aims to evaluate early wound healing parameters following periodontal surgery using nano-crystalline silver membrane as periodontal dressing.

Materials and Methods:

Forty-two systemically healthy patients diagnosed with chronic periodontitis indicated for periodontal flap surgery were enrolled for the present study. Post surgery, the patients were randomly allocated to either a nano-crystalline silver dressing (Acticoat™) group (test group) or only the noneugenol dressing group (control group). Plaque index (PI) and wound healing index were recorded at the 7^th- and 14^th-day postsurgery. The microbiological analysis and vascular endothelial growth factor (VEGF) levels were evaluated at baseline and 7^th-day postsurgery.

Results:

The healing index was significantly higher in the test group as compared to the control group at days 7 and 14 (P < 0.001; P < 0.001). The colony-forming units/ml count of bacteria were significantly reduced postsurgery in the test group (P = 0.019). VEGF levels increased significantly 7^th-day postsurgery in the test group (P = 0.001). There was no statistically significant difference in the PI on the 7^th-day postsurgery between the two groups (P = 0.173).

Conclusion:

The results of the study revealed that silver can be used as a potent periodontal dressing ingredient that can decrease the microbial colonization beneath the pack and promote faster healing postsurgery due to its antimicrobial activity.

Effect of photobiomodulation on pain control after clinical crown lengthening surgery

BACKGROUND

Photobiomodulation is a novel technique to reduce pain following different surgeries and treatments. This study aimed to investigate the effect of photobiomodulation on pain control after clinical crown lengthening procedures.

METHODS

Twenty patients were included and randomly assigned to two groups in this single-blind randomized clinical trial. The patients had been referred to the Periodontics Department, Tabriz Faculty of Dentistry, for crown lengthening surgery. In the laser group, diode laser therapy with a wavelength of 860 nm and a power of 100 mW was applied immediately after the surgery on the surgery day and three and seven days after the surgery. In the control group, the laser was turned off, and passive radiation was applied to the area as the test group for 30 seconds per session in non-contact mode. The pain was assessed by a visual analog scale (VAS) questionnaire on the study timelines. Data were analyzed with SPSS 20 using ANOVA and post hoc Tukey tests.

RESULTS

Twenty patients were included in each study group, where the pain was relieved significantly over time. On the first (5.50±1.18) and seventh (1.8±0.42) days, the pain intensity was similar in the test and control groups. However, on the third day, the laser group (2.90±0.74) experienced a significantly lower pain intensity than the control group (4.0±0.67).

CONCLUSION

Photobiomodulation relieved pain after clinical crown lengthening surgeries.

Photobiomodulation Effect of Different Diode Wavelengths on the Proliferation of Human Gingival Fibroblast Cells

This study is focused on comparing the effect of various energy densities and wavelengths of diode lasers on the proliferation of human gingival fibroblast (HGF) cells in vitro. In this study, 204 sample cells were examined in 4 test groups (laser radiation) and 1 control group (non-laser radiation). The proliferation rate of radiated cells with wavelengths of 635, 660, 808 and 980 nm and the densities of 1, 1.5, 2.5 and 4 J cm^-2 was measured after 1, 3 and 5 days using the MTT assay. The proliferation rate of human gingival fibroblast (HGF) cells in test groups was increased on day 1 at wavelengths of 635, 808 and 980 nm and on day 3 at the wavelength of 980 nm compared with the control group. Our findings denoted that the photobiomodulation therapy increased the proliferation rate of HGF. The most desirable laser radiation setting, which led to the highest proliferation rate of the cells, included 980 nm wavelength with 1, 1.5 and 4 J cm^-2 energy densities and 635 nm wavelength with 4 J cm^-2 energy density.

Effect of photobiomodulation in secondary intention gingival wound healing-a systematic review and meta-analysis

Background

Photobiomodulation is widely being used to improve the wound healing process in dentistry and a vast majority of studies have proven its benefits. But there are plenty of knowledge gaps according to the optimal laser characteristics which should be used to maximize the healing effects of lasers. The goal of this systematic review and meta-analysis was to determine the effect of photobiomodulation (PBM) as an adjunctive treatment to periodontal therapies to evaluate secondary intention gingival wound healing and post-operative pain.

Methods

Five databases (PubMed, Embase, Scopus, ProQuest, and Web of Sciences) were searched up to November 30, 2020, for clinical trials that reported the result of the application of PBM on secondary gingival healing wounds and post-operative pain and discomfort after periodontal surgeries. Two independent reviewers selected the eligible studies and the outcomes of interest were extracted. The quality of eligible studies was assessed using the Cochrane Handbook for Systematic Reviews of Interventions.

Results

Ultimately, twelve studies were included in this review. The application of PBM as an adjunct to periodontal surgeries resulted in a significant improvement in wound healing indices. The Landry wound healing index at the 7th post-operative day was significantly improved (SMD = 1.044 [95% CI 0.62–1.46]; p < 0.01) in PBM + surgery groups compared to the control groups. There was also a statistically significant increase in the complete wound epithelialization (RR = 3.23 [95% CI 1.66–6.31]; p < 0.01) at the 14th post-operative day compared to the control groups. The methods used to assess the post-operative pain were heterogeneous, and therefore the results were limited which made the meta-analysis for post-operative pain assessment not possible.

Conclusion

Based on the results of this review, PBM can be effectively used as a method to improve secondary intention wound healing. High-quality randomized clinical trials, however, are needed in the future to identify the optimal PBM irradiation parameters and the effect of PBM on post-operative pain.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-021-01611-2.

Effectiveness of Photobiomodulation as an Adjunct to Nonsurgical Periodontal Therapy in the Management of Periodontitis- A Systematic Review of in vivo Human Studies

Photobiomodulation therapy (PBMT) has anti-inflammatory, analgesic and regenerative properties. This systematic review aimed to critically appraise the published data of in vivo human randomized clinical trials (RCTs), and present a comprehensive overview of the efficacy of PBMT, as an adjunct to the nonsurgical periodontal therapy (NSPT) in the management of periodontitis. The systematic review protocol is registered in the Prospective Register Of Systematic Reviews (PROSPERO) (www.crd.york.ac.uk/PROSPERO/; ref CRD 42020169108). With the help of the appropriate key words, structured electronic and manual search strategies were applied to gather the relevant published data on in vivo human RCTs based on this topic. Seventeen papers that met the eligibility criteria were included in this review and subjected to a qualitative assessment. Current evidence lacks adequate information regarding the photobiomodulation (PBM) dosimetry, which is fundamental in establishing a standardized and replicable protocol for future researches. Furthermore, substantial discrepancies in the study methodology and a high risk of bias, arising from the majority of the included papers, abet to the inferior quality of these studies. Ultimately, there is an urgent necessity to conduct further well-designed RCTs in order to determine the effectiveness of PBMT, if any, by taking into consideration the abovementioned confounding factors.

Evaluation of the effects of photobiomodulation therapy and ozone applications after gingivectomy and gingivoplasty on postoperative pain and patients' oral health-related quality of life

The aim of this study was to evaluate the effects of photobiomodulation therapy (PBM) and ozone applications on patients' quality of life after gingivectomy and gingivoplasty. In this study, 36 patients with chronic inflammatory gingival enlargement underwent gingivectomy and gingivoplasty. The groups were randomly divided into control (n = 12), PBM (n = 12) and ozone (n = 12) groups. GaAlAs diode laser 810 nm wavelength at a non-contact and continuous mode with a power of 0.3 W and a density of 4 J/cm² used for PBM for 1 min. Ozone was applied for 1 min for every 5 mm² in contact mode at power level 9 using probe number 3. PBM and ozone applications were performed immediately after the operation, on the 3rd and 7th days. Pain assessment was performed at 3rd, 7th, 14th and 28th days after gingivectomy and gingivoplasty by using visual analogue scale (VAS). Oral Health Impact Profile (OHIP-14) records were obtained from the patients before gingivectomy and gingivoplasty and postoperative 7th and 14th days. OHIP-14 questions were also evaluated individually. VAS pain levels of the control group measured on the 3rd day were higher than the PBM group and on the 7th day were found to be significantly higher than both groups (p < 0.05). The total OHIP-14 score of the control group on the 7th postoperative day was found to be higher than the PBM group (p < 0.05). The mean score obtained from the third question of OHIP-14 at 7th and 14th day of the PBM group was found to be lower than the control and ozone groups (p < 0.05). The PBM and ozone applications after gingivectomy and gingivoplasty reduce the pain levels of patients and have a positive effect on patients' quality of life.

Photobiomodulation therapy for management of inferior alveolar nerve injury post-extraction of impacted lower third molars

Purpose

Inferior alveolar nerve (IAN) injury is one of the most serious complications after extraction of impacted lower third molars. Photobiomodulation (PBM) therapy has been noted to reduce pain and inflammation while promoting tissue healing. This study examined the efficacy of PBM therapy tested in a case series of patients with postoperative IAN injury.

Material and methods

20 patients with post-extraction IAN injury were involved in this study and divided into two groups. In the study group, PBM therapy (808-nm laser, 16 mW, 3 J/cm²) was used every other day for 2 weeks solely on post-extraction sockets in 10 patients diagnosed with IAN injury. In the control group, mecobalamine was prescribed to 10 patients with IAN injury. Objective and subjective recovery of IAN paresthesia was evaluated using clinical neurosensory testing and visual analog score.

Results

All patients showed improvement in both objective and subjective examination. Notably, the visual analog score was significantly improved after PBM treatment compared to the mecobalamine treatment (p < 0.05).

Conclusion

PBM therapy with 808-nm laser appears to be an effective approach to manage paresthesia post-IAN injury following impacted third molar surgery. Given the limited sample size in this study, large-scale, placebo-controlled, multi-center randomized controlled trials are needed for further validation of this innovative treatment.