Academy of Laser Dentistry

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J O U R N A L O F L A S E R D E N T I S T R Y | 2 011 V O L . 19 , N O . 3 288 C L I N I C A L C A S E Figure 4: Two-week postoperative view of maxillary arch Figure 7: Three-month postoperative fullsmile view dependent on the patient’s smoking habits. Moreover, he has a genetic tendency to produce melanin. The gingival depigmentation procedure using the Er:YAG laser was successful, with good patient comfort, predictable healing, and satisfaction. R E F E R E N C E S 1. Brown FH, Housten GD. Smoker’s melanosis. A case report. J Periodontol 1991;62(8):524-527. 2. Coluzzi DJ, Convissar RA. Atlas of laser applications in dentistry. Chicago: Quintessence Publishing Co., Inc., 2007:1-8. 3. Nakamura Y, Hossain M, Hirayama K, Matsumoto K. A clinical study on the removal of gingival melanin pigmentation with the CO2 laser. Sun Figure 5: Two-week postoperative view of mandibular arch Figure 8: One-year postoperative fullsmile view Lasers Surg Med 1999;25(2):140-147. 4. Tal H, Oegiesser D, Tal M. Gingival depigmentation by erbium:YAG laser: Clinical observations and patient responses. J Periodontol 2003;74(11):1660-1667. 5. Rosa DSA, Aranha ACC, Eduardo Cde P, Aoki A. Esthetic treatment of gingival melanin hyperpigmentation with Er:YAG laser: Short-term clinical observations and patient follow-up. J Periodontol 2007;78(10):2018-2025. A U T H O R B I O G R A P H Y Dr. Grace Sun routinely utilizes multiple wavelengths of dental lasers. Her articles on dental lasers have been published in Dental Clinics of North America. Dr. Sun is also certified as Advanced Proficiency and was awarded Figure 6: Six-week postoperative fullsmile view Figure 9: Three-year postoperative fullsmile view Educator status by the Academy of Laser Dentistry where she was a member of the Board of Directors. She had lectured internationally on the subjects of laser and cosmetic dentistry. Dr. Sun is an accredited Fellow with the American Academy of Cosmetic Dentistry, a Fellow of the International Congress of Oral Implantologists, and is a Master of the Academy of General Dentistry. Dr. Sun may be contacted by e-mail at gracesun@sundds.com. Disclosure: Dr. Sun has no commercial relationships relative to this article. Editor’s Note: This article first appeared in J Laser Dent 2008;16(3):130-132. nn
C L I N I C A L R E V I E W A N D C A S E R E P O R T S Photobiomodulation: An Invaluable Tool for All Dental Specialties Gerald Ross, DDS, Alana Ross, BScH, Tottenham, Ontario, Canada J Laser Dent 2011;19(3):289-296 I N T R O D U C T I O N Although low-level lasers are being used successfully in many dental clinics, the wide range of applications is still largely unknown to many practitioners, especially dental specialists. In these fields, there is the potential to see the most definitive results of what laser therapy can do to improve clinical outcomes and patient satisfaction. Photobiomodulation (PBM), also commonly referred to as low-level laser therapy (LLLT) or cold laser therapy, uses light energy to elicit biological responses from the cell and normalize cell function. Numerous studies have shown that PBM affects the mitochondria of the cell, primarily cytochrome-c oxidase in the electron transfer chain and porphyrins on the cell membrane. 1-2 It has been proposed that when light photons are absorbed by these receptors, three events occur: stimulation of adenosine triphosphate (ATP) synthesis by activation of the electron transport chain; transient stimulation of reactive oxygen species, which increases the conversion of adenosine diphosphate (ADP) to ATP; and a temporary release of nitric oxide from its binding site on cytochrome-c oxidase. These factors contribute to the clinical effects seen with PBM, including tissue repair, relief of inflammation and pain, and repair of nerve damage. 3 Figure 1 depicts a flowchart showing these interactions. Studies have documented beneficial effects of PBM, such as stimulation of fibroblasts and osteoblasts, as well a reduction of the depolarization of nerve fibers. 4-6 From a clinical perspective, PBM offers dental practitioners a nonin- Figure 1: Summary of the primary mechanisms of photobiomodulation vasive and nonthermal treatment modality that can be used as an adjunct to traditional therapies or as a therapeutic tool on its own. 7 Examples of these clinical applications, which will be discussed below, include dental analgesia, treatment of dentin hypersensitivity, healing of soft tissue lesions, reduction of pain and swelling after surgical procedures, better integration of implants into bone, and faster movement of teeth during orthodontic procedures. Determining the Appropriate Dose Treatment dose is probably the most important variable in laser treatment. Dose is measured in joules per square centimeter (J/cm 2 ) and is a measure of the amount of energy that is conducted into the tissue. Clinical effects of the laser, such as wound healing, pain relief, or muscle relaxation, are all sensitive to different irradiances or doses. An example of this is the stimulation of fibroblasts; a dose of 5 J/cm 2 will stimulate the cellular activity of fibroblasts, whereas higher doses inhibit cell viability and proliferation. 8 Thus, for wound healing, the clinician should ideally use a dose lower than 5 J/cm 2 . The biostimulatory and inhibitory effects of lasers are governed by the Arndt-Schultz Law, which indicates that weak stimuli will increase physiological processes and strong stimuli will inhibit physiological activity. A therapeutic window, which includes both biostimulatory and bioinhibitory effects, is evident and is the intended target for PBM treatments. A depiction of the law, based on Baxter, 9 is shown in Figure 2. Ross and Ross J O U R N A L O F L A S E R D E N T I S T R Y | 2 011 V O L . 19 , N O . 3 289
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