Práticas integrativas e complementares na odontologia / Integrative and complementary practices in dentistry / Prácticas integradoras y complementarias en odontología

As Práticas Integrativas e Complementares (PICs) apresentam-se como métodos coadjuvantes, auxiliando na obtenção de sucesso em determinados tratamentos clínicos e/ou cirúrgicos, atuando na prevenção, auxiliando na cura e no equilíbrio psicossomático com a finalidade de reestabelecer concordância entre mente e corpo. O Conselho Federal de Odontologia (CFO) regulamentou práticas como acupuntura, hipnose, terapia floral e fitoterapia, entretanto, suas aplicabilidades dependem da emissão de uma habilitação e seu devido registro no Conselho (Resolução CFO 82/2008). Para a Odontologia, as PICs proporcionam novas ferramentas para exercer um atendimento integral do ser humano. Neste trabalho, propõe-se fazer uma revisão de literatura sobre as PICs e Odontologia. Esta revisão de literatura foi realizada por meio de busca de artigos na base de dados Scielo, PubMed e Scholar Google no período de 2000 a 2021. Foram encontrados artigos sobre as seguintes PICs atuando conjuntamente com a Odontologia: terapias florais, acupuntura, hipnodontia, ozonioterapia, laserterapia, fitoterapia, homeopatia e odontologia antroposófica. Essas práticas apresentam grande valia, pois promovem o bem-estar sem causar dano ao indivíduo, apresentando poucos ou nenhum efeito colateral possibilitando maior segurança aos pacientes, além de favorecer a relação entre paciente e cirurgião-dentista, otimizando o tempo de trabalho no consultório odontológico e reduzindo custos.

Integrative and Complementary Practices (PICs) are presented as supporting methods, helping to achieve success in certain clinical and/or surgical treatments, acting in prevention, assisting in healing and psychosomatic balance in order to reestablish agreement between mind and body. . The Federal Council of Dentistry (CFO) has regulated practices such as acupuncture, hypnosis, floral therapy and herbal medicine, however, their applicability depends on the issuance of a license and its proper registration with the Council (Resolution CFO 82/2008). For Dentistry, PICs provide new tools to provide comprehensive care to human beings. In this work, we propose to review the literature on PICs and Dentistry. This literature review was carried out by searching articles in the Scielo, PubMed and Scholar Google databases from 2000 to 2021. Articles were found on the following PICs working together with Dentistry: floral therapies, acupuncture, hypnodontics, ozone therapy , laser therapy, phytotherapy, homeopathy and anthroposophic dentistry. These practices are of great value, as they promote well-being without causing harm to the individual, presenting few or no side effects, allowing greater safety for patients, in addition to favoring the relationship between patient and dentist, optimizing working time in the dental office and reducing costs.

Las Prácticas Integrativas y Complementarias (PIC) se presentan como métodos coadyuvantes, ayudando a obtener el éxito en determinados tratamientos clínicos y/o quirúrgicos, actuando en la prevención, ayudando en la cura y en el equilibrio psicosomático con el fin de restablecer la concordancia entre mente y cuerpo. El Consejo Federal de Odontología (CFO) ha regulado prácticas como la acupuntura, la hipnosis, la terapia floral y la fitoterapia, sin embargo, su aplicabilidad depende de la emisión de un título y su correcto registro en el Consejo (Resolución CFO 82/2008). Para la odontología, los PIC aportan nuevas herramientas para la atención integral del ser humano. En este trabajo, nos proponemos hacer una revisión bibliográfica sobre los PIC y la Odontología. Esta revisión bibliográfica se realizó mediante la búsqueda de artículos en las bases de datos Scielo, PubMed y Scholar Google desde el año 2000 hasta el 2021. Se encontraron artículos sobre los siguientes CFP que actúan conjuntamente con la Odontología: terapias florales, acupuntura, hipnodoncia, ozonoterapia, terapia láser, fitoterapia, homeopatía y odontología antroposófica. Estas prácticas tienen un gran valor porque promueven el bienestar sin causar daño al individuo, presentando pocos o ningún efecto secundario, proporcionando mayor seguridad a los pacientes, y favoreciendo la relación entre el paciente y el dentista, optimizando el tiempo de trabajo en el consultorio y reduciendo los costos.

Síndrome de transfusão feto-fetal: revisão de literatura / Twin-twin transfusion syndrome: a literature review

A síndrome de transfusão feto-fetal é uma complicação das gestações gemelares monocoriônicas. Além de ocorrer comumente no segundo trimestre, apresenta elevada morbimortalidade fetal e neonatal, e taxas de incidência que variam de 10 a 15% dentre todas as gravidezes monocoriônicas. O objetivo deste estudo é realizar uma revisão de literatura a partir de levantamento bibliográfico acerca dos principais aspectos epidemiológicos, clínicos e terapêuticos da STFF. A base de dados PubMed foi consultada, uma vez que os termos de pesquisa utilizados foram "síndrome de transfusão feto-fetal", "diagnóstico" e "tratamento". Obtiveram-se sessenta e oito artigos de revisão de literatura e/ou revisão sistemática, sendo que apenas vinte e nove foram selecionados após aplicação dos critérios de elegibilidade. Em relação à fisiopatologia, a síndrome é explicada pela transferência sanguínea direta entre os fetos gemelares através de anastomoses arteriovenosas placentárias, conceitualmente determinando a existência de um feto receptor e outro doador. Embora as gestantes comumente se apresentam assintomáticas, as repercussões clínicas fetais costumam ser graves. O diagnóstico é exclusivamente ultrassonográfico e deve ser feito o mais precocemente possível, ressaltando-se a importância da detecção da corionicidade da gestação gemelar, além de acompanhamento ultrassonográfico seriado para rastreio do desenvolvimento da síndrome. Apesar de ainda não haver protocolo de tratamento bem estabelecido, a ablação dos vasos placentários a laser é tida como o padrão-ouro dentre as opções terapêuticas disponíveis. Apresenta elevada taxa de sobrevida de pelo menos um dos fetos e baixos índices de sequelas neurológicas neonatais, podendo ser realizada somente até a 26ª semana de gestação.

Twin-twin transfusion syndrome is a complication of monochorionic twin pregnancies. In addition to commonly occurring in the second trimester, it has high fetal and neonatal morbidity and mortality and incidence rates ranging from 10 to 15% among all monochorionic pregnancies. This study aims to perform a literature review based on a bibliographic survey about the main epidemiological, clinical and therapeutic aspects of TTTS. The PubMed database was consulted, as the search terms used were "twin-twin transfusion syndrome", "diagnosis", and "treatment". Sixty-eight literature review and systematic review articles were obtained, and only twenty-nine were selected after applying the eligibility criteria. About the pathophysiology, the syndrome is explained by direct blood transfer between the twin fetuses through placental arteriovenous anastomoses, determining the existence of a recipient fetus and another donor. Although pregnant women are usually asymptomatic, the clinical fetal repercussions are often severe. Diagnosis is exclusively ultrasonographic and must be made as early as possible, emphasizing the importance of detecting chorionicity in twin pregnancy, in addition to serial ultrasonographic follow-up to track the development of the syndrome. Although there is still no well-established treatment protocol, endoscopic laser ablation of vascular anastomoses is considered the gold standard among the available therapeutic options. It has a high survival rate for at least one of the fetuses and low rates of neonatal neurological sequelae and can only be performed until the 26th week of pregnancy.

Effects of low-level laser therapy on liver regeneration and laser parameters employed / Efeitos da laserterapia de baixa potência na regeneração hepática e parâmetros empregados de laser

Low-level laser therapy has several biological effects; one of them is tissue regeneration. Recent studies have been held on the application of laser therapy on the liver of rats after partial hepatectomy to promote liver regeneration. The aim of this article was to review the recent studies on the effects of low-level laser therapy on rat liver regeneration after partial hepatectomy and the laser parameters used in those studies. A review of recent relevant literature was performed in Pubmed, Scielo, Medline, and Bireme databases. Articles related to the application of low-level laser therapy on hepatic regeneration were included. Articles with hepatic regeneration in the presence of pathologies were not included. Nine studies were found matching the study criteria. In most studies, low-level laser therapy promoted liver regeneration after partial hepatectomy, without further damage to the remaining liver. Not all laser parameters required for the reproducibility of the study were described by all authors. The therapeutic use of low-level laser therapy in liver regeneration can be promising; however, since the liver is a vital organ, and the laser application is intraoperative, future studies are necessary. The parameters used must be properly described and standardized to allow the reproducibility of the study, in order to define a therapeutic window and thus, consider its clinical use. It is also essential to clarify the mechanisms by which laser promotes liver regeneration to guarantee its safety and therapeutic efficacy.

Laserterapia de baixa potência tem vários efeitos biológicos, sendo um deles a regeneração de tecido. Sua aplicação no fígado de ratos após hepatectomia parcial para promoção de regeneração hepática tem sido estudada recentemente. O objetivo deste artigo foi revisar os estudos recentes dos efeitos da laserterapia de baixa potência na regeneração de fígado de ratos após hepatectomia parcial de fígado e os parâmetros de laser empregados. Uma revisão da literatura relevante recente foi realizada nas bases de dados Pubmed, Scielo, Medline e Bireme. Artigos sobre a aplicação da laserterapia de baixa potência na regeneração de fígado foram incluídos. Artigos sobre regeneração hepática na presença de patologias foram excluídos. Nove estudos foram encontrados correspondendo aos critérios do estudo. Na maioria dos estudos, a laserterapia de baixa potência promoveu regeneração hepática após hepatectomia parcial, sem causar danos adicionais ao fígado remanescente. Não foram descritos todos os parâmetros necessários para reprodutibilidade dos estudos por todos os autores. O uso terapêutico da laserterapia de baixa potência na regeneração de fígado pode ser promissor, entretanto, como o fígado é um órgão vital e a aplicação do laser é intraoperativa, estudos futuros são necessários, assim como os parâmetros da aplicação de laser precisam ser descritos apropriadamente e padronizados, para permitir a reprodutibilidade do estudo, para que uma janela terapêutica possa ser definida e seu uso clínico possa ser considerado. Também é essencial esclarecer através de quais mecanismos o laser promove regeneração de fígado para garantir sua segurança e eficácia terapêutica.

Uso do laser de 1. 470 nm para o tratamento de insuficiência venosa superficial / Use of 1, 470 nm laser for treatment of superficial venous insufficiency

Resumo Contexto Existem diversas formas de tratamento de varizes de membros inferiores. Entre elas, destaca-se o uso do laser diodo de 1.470 nm. Essa técnica proporciona aos pacientes uma cirurgia em regime ambulatorial, com retorno precoce à atividade ocupacional, bom resultado estético e baixo índice de complicações. No entanto, ainda se discute exaustivamente variáveis como comprimento de onda do laser, potência aplicada em cada área, tipo de fibra, necessidade ou não de tumescência e densidade de energia endovenosa linear. Objetivos Analisar os resultados do tratamento da insuficiência venosa superficial com laser diodo de 1.470 nm. Métodos Estudo retrospectivo, realizado em uma clínica privada de um hospital privado em Florianópolis a partir de dados colhidos prospectivamente. As amostras eram de 287 pacientes submetidos à cirurgia para tratamento da insuficiência venosa superficial com laser diodo de 1.470 nm, de janeiro de 2016 a dezembro de 2018, totalizando 358 veias safenas magnas e 84 veias safenas parvas tratadas. Resultados A taxa de oclusão total após 12 meses de cirurgia foi de 94,4%, com densidade de energia endovenosa linear média de 45,90 J/cm nas veias safenas magnas e de 96,4% com densidade de energia endovenosa linear média de 44,07 J/cm nas veias safenas parvas. Conclusões No período acompanhado, o laser diodo de 1.470 nm mostrou-se um tratamento seguro, muito efetivo e com baixas taxas de complicações (dor, edema, equimose, trombose venosa profunda e trombose induzida pelo calor endovenoso).

Abstract Background There are several ways to treat varicose veins of the lower limbs, among which use of 1470nm diode lasers stands out. This technique can be used to treat patients in outpatient settings, with early return to work, good esthetic results, and low rates of complications. However, variables such as the laser wavelength, the power administered in each area, the type of fiber, and the linear intravenous energy density (LEED) are still extensively discussed. Objectives To analyze the results of superficial venous insufficiency treatment with a 1470nm diode laser. Methods Retrospective study conducted at a private clinic in a private hospital in Florianopolis, based on a database collected prospectively. The sample comprised 287 patients who underwent surgery to treat superficial venous insufficiency with 1470nm diode laser, from January 2016 to December 2018, totaling 358 great saphenous veins (GSVs) and 84 small saphenous veins (SSVs) treated. Results The total occlusion rates after 12 months of surgery were 94.4% in the GSVs, with an average LEED of 45.90 J/cm, and 96.4% in the SSVs, with an average LEED of 44.07 J/cm. Conclusions During the follow-up period, the 1470nm diode laser proved to be a safe treatment, with great efficacy and low rates of complications (pain, edema, bruising, deep vein thrombosis, and endothermal heat-induced thrombosis - EHIT).

Efficacy of Lasers Treatment of Exposed Pulps to Stimulate Healing: A Systematic Review and Meta-Analysis

Abstract Objective: The present systematic review and meta-analysis aimed at evaluating the efficacy of laser's treatment of exposed pulps to stimulate healing. Material and Methods: MEDLINE, PubMed, Cochrane Library, Embase, ISI, Google Scholar have been searched as the electronic databases for performing systematic literature between 2005 to 2019. Searches were performed with MESH terms. The quality of the studies included was assessed using the Critical Appraisal Skills Program checklist. For Data extraction, two reviewers blind and independently extracted data from the abstract and full text of the studies included. Moreover, the fixed-effect model's odds ratio for a 95% confidence interval (CI) was calculated. Random effects were used to deal with potential heterogeneity, and I2 showed heterogeneity. The meta-analysis and forest plots have been evaluated using the Comprehensive Meta-Analysis Stata. Results: Five studies (3 RCTs and 2 animal studies) were included in this study. The Odds Ratio was 1.90 (95% CI 1.39-2.42; p=0.00); there was a statistically significant difference between the laser and the control groups (p=0.00). Conclusion: The success rate of laser treatment for exposed pulps is higher than mineral trioxide aggregate, resin, calcium hydroxide and resin-modified glass-ionomer cement. The exact mechanism of this effect has not yet been determined; further research on lasers' impact on exposed pulps treatment is required.

Perceptions of the Use of the Diode Laser in Dental Surgery: A Qualitative Study

Abstract Objective: To discover the perceptions of pediatric patients, their parents and undergraduate Dentistry students of the use of the diode laser in frenectomy surgeries. Material and Methods: A qualitative study was conducted through semi-structured interviews, recorded and transcribed with subsequent content analysis. Twelve healthy children (5-8 years old) who needed a frenectomy were selected and invited, together with their parents, to undergo laser diode surgery. In addition, 28 undergraduate dentistry students were invited to attend the procedures. One week after performing the surgical procedures, the children (Group 1), their parents (Group 2) and the students who attended the procedures (Group 3) were individually interviewed for the thematic analysis. Results: The analysis of the conversations identified three emerging contents: positive thoughts on the use of diode laser; frustrations from the use of diode laser; and aspects related to professional training. Conclusion: The results pointed to the acceptance of surgical laser use in pediatric dentistry; however, the feelings of frustration indicate that its use requires guidance from the child and his/her parents, in addition to careful handling and specific training.

Development of Gun-type Tube-Guide Device of Laser Fiber / 中国医疗器械杂志

With the development of laryngeal microsurgery, the requirements for the flexibility and convenience of surgical instruments are increasing. The research on related instruments has important value for the clinical application of laryngeal microsurgery. We have redesigned a gun-type tube-guide device of laser fiber by comparing the shortcomings of existing laser fiber introducers. The innovation of this design lies in its rotating nut device with adjustable laser angle and pre-bent tip. The corresponding

Comparison of the effects of low-level laser and pulsed and continuous ultrasound on pain and physical disability in chronic nonspecific low back pain: a randomized controlled clinical trial

Abstract Objective: To compare the short-term effects of pulsed laser and pulsed and continuous ultrasound on pain and functional disability in women with chronic non-specific low back pain. Methods: The sample was composed of 100 volunteers randomly allocated into four groups: The Pulsed Laser Group (n = 26) was treated with 3 J/cm2; the Pulsed Ultrasound Group (n = 24; 3 MHz) was treated with 1 W/cm2; the Continuous Ultrasound Group (n = 26; 1 MHz) was treated with 1 W/cm2; and a Control Group (n = 24), where the patients were still waiting for treatment. Before and after 10 sessions of treatment, the intensity of pain was assessed using the visual analogue scale (VAS), the quality of pain was evaluated using the McGill pain questionnaire and functional disability was investigated using the Roland-Morris questionnaire. Results: The three treated groups exhibited a decrease in pain (p < 0.001); the Pulsed Laser Group showed the greater relative gain (91.2%), Meanwhile, the Control Group exhibited a worsening of - 5.8%. The three treated groups demonstrated improvement in the quality of pain (McGill) in the total, sensory and affective dimensions (p < 0.005; p < 0.002; p < 0.013, respectively). All treated groups showed a decrease in functional disability (p < 0.001), but the Pulsed Ultrasound Group showed the highest relative gain (83.3%). Conclusions: The three modalities have significant effects to decreasing low back pain and improving functional disability in women with non-specific chronic low back pain, but the pulsed low-level laser had the best results on pain while the pulsed ultrasound had the best results on improve the functional disability. Trial registration:ClinicalTrials.gov: NCT02150096.

Peribulbar block combined with general anesthesia in babies undergoing laser treatment for retinopathy of prematurity: a retrospective analysis / Bloqueio peribulbar combinado com anestesia geral em bebês submetidos a tratamento a laser para retinopatia da prematuridade: uma análise retrospectiva

Abstract Background and objectives Currently there is no agreement regarding which one is the most adequate anesthetic technique for the treatment of retinopathy of prematurity. Peribulbar block may reduce the incidence of oculocardiac reflex and postoperative apnea. The goal of this study was to report the outcomes of peribulbar block, when combined with general anesthesia, for the laser treatment for retinopathy of prematurity, in premature babies. Methods A retrospective analysis of anesthetic records of all babies who underwent laser treatment for retinopathy of prematurity from January 2008 through December 2015 in a tertiary hospital was performed. Results During that period a total of six babies was submitted to laser treatment for retinopathy of prematurity, all under peribulbar block combined with general anesthesia. A single infratemporal injection of 0.15 mL.kg−1 per eye ropivacaine 1% or 0.75% was performed. At the end of the procedure, all babies resumed spontaneous ventilation. No perioperative complications were reported. Conclusions Peribulbar block was a safe anesthetic technique in our sample considered.

Resumo Justificativa e objetivos Até o momento não há um consenso sobre a técnica anestésica mais adequada para o tratamento de retinopatia da prematuridade. O bloqueio peribulbar pode reduzir a incidência de reflexo oculocardíaco e apneia no pós-operatório. O objetivo deste estudo foi relatar os resultados do bloqueio peribulbar, quando combinado com anestesia geral, para o tratamento a laser de retinopatia da prematuridade em bebês prematuros. Métodos Uma análise retrospectiva dos registros anestésicos de todos os bebês submetidos ao tratamento a laser para retinopatia da prematuridade de janeiro de 2008 a dezembro de 2015 foi realizada em um hospital terciário. Resultados Durante esse período, seis bebês foram submetidos ao tratamento a laser para retinopatia da prematuridade, todos sob bloqueio peribulbar combinado com anestesia geral. Uma injeção infratemporal única de ropivacaína a 1% ou 0,75% (0,15 mL.kg−1) foi administrada por olho. No fim do procedimento, todos os bebês retomaram a ventilação espontânea. Não foram relatadas complicações perioperatórias. Conclusões O bloqueio peribulbar foi uma técnica anestésica segura em nossa amostra considerada.

High-intensity laser application in Orthodontics

ABSTRACT Introduction: In dental practice, low-level laser therapy (LLLT) and high-intensity laser therapy (HILT) are mainly used for dental surgery and biostimulation therapy. Within the Orthodontic specialty, while LLLT has been widely used to treat pain associated with orthodontic movement, accelerate bone regeneration after rapid maxillary expansion, and enhance orthodontic tooth movement, HILT, in turn, has been seen as an alternative for addressing soft tissue complications associated to orthodontic treatment. Objective: The aim of this study is to discuss HILT applications in orthodontic treatment. Methods: This study describes the use of HILT in surgical treatments such as gingivectomy, ulotomy, ulectomy, fiberotomy, labial and lingual frenectomies, as well as hard tissue and other dental restorative materials applications. Conclusion: Despite the many applications for lasers in Orthodontics, they are still underused by Brazilian practitioners. However, it is quite likely that this demand will increase over the next years - following the trend in the USA, where laser therapies are more widely used.

Tratamento de cicatriz de queimadura com luz intensa pulsada e laser ablativo fracionado Erbium: YAG / Treatment of burning scars with intense pulsed lip and fractionated ablative laser Erbium: YAG / Tratamiento de cicatrices por quemaduras con luz intensa pulsada y láser ablativo fraccionado Erbio: YAG

Cicatrizes decorrentes de queimadura acarretam grandes danos físicos e emocionais aos pacientes. Seu tratamento permanece um desafio na prática clínica. O uso atual de tecnologias a laser e luz, como o laser ablativo fracionado e a luz intensa pulsada (LIP), tem se mostrado eficaz na recuperação estética e funcional da pele acometida. Este trabalho tem por objetivo a demonstração do resultado do tratamento de cicatriz de queimadura extensa com LIP e laser ablativo fracionado Erbium: YAG a partir do relato de caso de uma paciente de 38 anos vítima de queimadura por chama direta aos 6 anos de idade. A paciente apresentou melhora clínica significativa no aspecto estético e funcional da lesão. O uso desses métodos combinados apresenta resultados favoráveis para o tratamento desses casos.

Scars resulting from burning causes great physical and emotional damage to patients. Its treatment remains a challenge in clinical practice. Current use of laser and light technologies, such as fractional ablative laser and intense pulsed light (ILP), have been shown to be effective in aesthetic and functional recovery of affected skin. This work aims to demonstrate the results of the treatment of extensive burn scarring with ILP and fractional ablative laser Erbium:YAG relating the case report of a 38-year-old female victim of direct flame burn at 6-years-old. The patient presented significant clinical improvement in the aesthetic and functional aspect of the lesion. The use of these combined methods presents favorable results for the treatment of these cases.

Las cicatrices resultantes de quemaduras causan grandes daños físicos y emocionales a los pacientes. El tratamiento sigue siendo un reto en la práctica clínica. El uso actual de tecnologías láser y de luz, tales como el láser ablativo fraccionado y la luz pulsada intensa (LPI) han demostrado ser herramientas eficaces para la recuperación estética y funcional de la piel afectada. Este trabajo tiene como objetivo mostrar el resultado del tratamiento de una cicatriz extensa por quemadura usando LPI y láser ablativo fraccional Erbio:YAG a partir del caso clínico de una paciente de 38 años de edad víctima de quemaduras por fuego directo (llama) a los 6 años de edad. La paciente mostró una mejoría clínica significativa en el aspecto estético y funcional de la lesión. El uso de estos métodos combinados mostró resultados favorables para el tratamiento de este tipo de casos.

EVLTraining®: aplicativo para treino do cálculo da densidade de energia endovenosa linear / EVLTraining®: mobile app for training and calculating linear endovenous energy density

CONTEXTO: O reconhecimento da termoablação endovenosa como tratamento da insuficiência de veias safenas traz a necessidade de maior conhecimento e compreensão do método. A densidade de energia endovenosa linear (linear endovenous energy density – LEED) é a variável mais aceita para padronização, cada vez mais amplamente divulgada. Não deve ser utilizada apenas para comparação de resultados científicos deve também ser usada no intraoperatório para a realização do procedimento com segurança. OBJETIVOS: Desenvolver aplicativo para mensuração da LEED e avaliar sua aplicabilidade. MÉTODOS: O aplicativo para iOS EVLTraining® foi desenvolvido para equipamentos portáteis com o intuito de padronizar a emissão energética em procedimentos de termoablação endovenosa. RESULTADOS: O aplicativo criado mostrou equivalência com as medidas aplicadas no procedimento cirúrgico. CONCLUSÕES: O software EVLTraining® permite o treino prévio de cirurgião e equipe para a velocidade de tração da fibra ótica que será aplicada.

BACKGROUND: Recognition of endovenous thermal ablation as a treatment for saphenous vein insufficiency brings a need for greater knowledge and understanding of the method. Linear endovenous energy density (LEED) is the most accepted variable for standardization and it has been covered in a growing number of publications. However, it should not exclusively be used for comparison of scientific results, it should also be used intraoperatively so that the procedure is conducted safely. OBJECTIVES: To develop a mobile app for measurement of LEED and evaluate its applicability. METHOD: The application for iOS EVLTraining® was developed for portable devices in order to standardize energy emission in endovenous thermal ablation procedures. RESULTS: The application developed demonstrated equivalence to measures applied during surgical procedures. CONCLUSION: The EVLTraining® software enables surgeons and staff to train the optical fiber pullback speed to be applied prior to surgery.

Photodynamic Therapy: A Shining Light in Periodontics.

Photodynamic therapy (PDT) uses a photoactive dye (photosensitizer [PS])that activates by exposure to light of a specific wavelength in the presence of oxygen. The energy transfer from the activated PS to available oxygen leads to the formation of reactive oxygen species, such as singlet oxygen and free radicals. These chemical species are extremely reactive and can damage proteins, lipids, nucleic acids, and other components of the bacterial cell wall. Bacterial biofilms are widely implicated in their role in the causation of gingivitis and periodontitis. Prophylactic and therapeutic regimens for dental plaque related diseases include the usage of various chemotherapeutic agents. Since it is difficult to maintain therapeutic concentrations of these agents in the oral cavity and they run the risk of being rendered ineffective by bacterial resistance mechanisms, the need for an alternative antimicrobial approach in the treatment and prevention of dental plaque related diseases was felt. Many studies have reported the killing of bacteria via lethal photosensitization including both Gram-positive and Gram-negative bacteria. Photosensitization leads to bacterial elimination, with minimal chances of microbial resistance and with no adverse effects on host tissues and resident microflora. In dentistry, PDT has found use in the treatment of oral cancers, bacterial and fungal infections, and also in the detection of malignancies. PDT is free from genotoxic and mutagenic effects; another important factor for long-term safety. The ease of accessibility of the oral cavity to illumination makes it a suitable target for PDT.

Laser Assisted Periodontal Therapy: A Case Series.

Periodontitis is a one of the commonly occurring disease. Various therapies have been used and suggested for its treatment which includes nonsurgical, antimicrobial, and surgical therapy. In the recent years, lasers have been used frequently for periodontal therapy. Lasers have been applied for debridement, reshaping as well as the reduction of bacterial load in the pocket. This case series represent the use of lasers for exposure of impacted teeth, second stage surgery for dental implant, and vestibuloplasty. The surgical procedure with a 810 nm diode laser has been described. The laser-assisted procedures provided excellent results without complications as well as high patient and clinician satisfaction.

Comparação entre capsulotomia assistida por laser de femtossegundo e capsulorrexe curvilínea contínua guiada por imagem digital / Comparison between femtosecond laser capsulotomy and manual continuous curvilinear digital image guided capsulorrhexis

Objetivo: Medir e comparar o tamanho e forma de capsulotomias realizadas com laser de femtossegundo com os de capsulorrexes curvilíneas contínuas (CCC) realizadas com auxilio guiado por imagem digital e avaliar o resultado refracional. Métodos: Durante cirurgia de catarata, 40 olhos de 40 pacientes tiveram a capsulotomia realizada com auxílio do laser de femtossegundo e seus resultados foram comparados com os de 40 olhos de 40 outros pacientes que tiveram a capsulorrexe guiada por sistema de imagem digital. Os parâmetros de circularidade, forma e overlap foram medidos usando o Adobe Photoshop (Adobe Systems Inc.) e os resultados refracionais pós-operatórios foram avaliados em ambos os grupos. Resultados: Os diâmetros, tamanho e forma de alta precisão e previsibilidade foram atingidos com laser de femtossegundo e houve diferença estatística entre os grupos. Quando comparado o equivalente esférico entre os grupos, não houve diferença estatística. Conclusão: As capsulotomias realizadas pelo laser de femtossegundo possuem circularidade programada, diâmetro pretendido e valores de desvio padrão médios, indicando resultados reprodutíveis mais elevados. No entanto, CCC realizada por um cirurgião experiente com auxílio guiado de imagem digital, com configurações apropriadas, fornece resultados semelhantes e sugere que diferentes técnicas são igualmente eficazes. .

Purpose: To measure and compare size and shape parameters of femtosecond laser capsulotomy with manually continuous curvilinear digital guided capsulorhexis (CCC) and their refractive outcomes. Methods: Laser capsulotomies in 40 eyes of 40 patients were performed using LenSx femtosecond laser device (Alcon, Forthworth, US) and its results were compared with the CCC digital guided carried out in 40 eyes of 40 patients using the Callisto Eye digital image system (Zeiss, Germany). Capsulorhexis circularity, shape and capsule overlap were measured using Adobe Photoshop (Adobe Systems Inc.) and postoperative refraction outcomes were evaluated in both groups. Results: Highly accurate and predictable capsulotomy diameter, size and shape were achieved with femtosecond laser capsulotomy compared with capsulorhexis and showed statistical difference between groups. Spherical equivalent comparison between groups showed no statistical difference. Conclusions: Femtosecond laser anterior capsulotomy with programed circularity had the intended diameter with average standard deviation values, indicating higher reproducible outcomes. Capsulorhexis performed by an experienced surgeon with auxiliary image guide and appropriate settings provides similar results our results suggest that different techniques are equally effective. .

Cirugía láser transoral para neoplasias laríngeas / Transoral laser surgery for laryngeal neoplasms

La cirugía con láser ha sido indicada para tratar todo tipo de lesiones benignas y malignas en otorrinolaringología y en cirugía de cabeza y cuello. Los cirujanos han aprendido las aplicaciones más importantes en este campo, y entre ellas aún persiste el tratamiento de las lesiones malignas de la hipofaringe, y especialmente de la laringe. En este artículo se describen detalladamente los tipos de láser, además de las indicaciones para llevar a cabo cirugía de laringe con láser. Se explican los diferentes pasos que se deben seguir, las medidas de seguridad y el tipo de lesiones que son susceptibles de ser resecadas…

Laser surgery has been indicated to treat all sorts of benign and malignant tumors in Otolaryngology. When performing head and neck surgery, surgeons have learned its true and most important applications in this field; among them remains the treatment of malignant lesions of the hypo pharynx and especially the larynx. In this article a description of the present types of laser energy, as well as the indications as to when to perform surgery in patients with larynx cancer is detailed. The different steps involved when a laser is used in the operating room, the safety measures, which lesions can be resected, etc., are described…

Effect of Nd:YAG laser combined with fluoride on the prevention of primary tooth enamel demineralization

Most studies dealing with the caries preventive action of Nd:YAG laser have been done in permanent teeth and studies on primary teeth are still lacking. The aim of this study was to evaluate in vitro the effect of Nd:YAG laser combined or not with fluoride sources on the acid resistance of primary tooth enamel after artificial caries induction by assessing longitudinal microhardness and demineralization depth. Sixty enamel blocks obtained from the buccal/lingual surface of exfoliated human primary molars were coated with nail polish/wax, leaving only a 9 mm² area exposed on the outer enamel surface, and randomly assigned to 6 groups (n=10) according to the type of treatment: C-control (no treatment); APF: 1.23% acidulated phosphate fluoride gel; FV: 5% fluoride varnish; L: Nd:YAG laser 0.5 W/10 Hz in contact mode; APFL: fluoride gel + laser; FVL: fluoride varnish + laser. After treatment, the specimens were subjected to a des-remineralization cycle for induction of artificial caries lesions. Longitudinal microhardness data (%LMC) were analyzed by the Kruskal-Wallis test and demineralization depth data were analyzed by oneway ANOVA and Fisher’s LSD test (á=0.05). APFL and APF groups presented the lowest percentage of microhardness change (p<0.05). Demineralization depth was smaller in all treated groups compared with the untreated control. In conclusion, Nd:YAG laser combined or not with fluoride gel/varnish was not more effective than fluoride alone to prevent enamel demineralization within the experimental period.

A maioria dos estudos que utilizam o laser Nd:YAG com ação preventiva são em dentes permanentes, e são escassos os estudos em dentes decíduos. Desta forma, o objetivo do presente estudo foi avaliar in vitro o efeito do laser Nd: YAG combinado ou não com flúor na resistência ácida do esmalte decíduo após a indução de cárie artificial, através da avaliação de microdureza longitudinal e profundidade da desmineralização. Para tanto, foram selecionados 60 fragmentos de esmalte obtidos a partir da superfície bucal / lingual de molares decíduos irrompidos, os quais foram isolados com esmalte de unha e cera, deixando uma área exposta de 9 mm² na superfície do esmalte. Os espécimes foram divididos aleatoriamente em 6 grupos (n = 10) de acordo com o tipo de tratamento: C- Controle: sem tratamento; APF: aplicação de gel flúor fosfato acidulado 1,23%; FV: aplicação de verniz fluoretado 5%; L: aplicação do Laser Nd:YAG 0,5 W/10 Hz no modo contato; APFL: aplicação de gel flúor fosfato acidulado + Laser Nd:YAG; FVL: aplicação de verniz fluoretado 5% + Laser Nd:YAG. Após os tratamentos, os espécimes foram submetidos a um ciclo de desremineralização para a indução de lesão de cárie artificial. Os dados de microdureza longitudinal (%LMC) foram avaliados pelo teste de Kruskal-Wallis e os dados de profundidade da desmineralização foram avaliados pelos testes ANOVA e Fisher’s LSD (α=5%). Observou-se que os grupos APFL e APF apresentaram menor percentual de perda de dureza (p<0,05). A profundidade de desmineralização foi menor em todos os grupos tratados em comparação com o controle. Em conclusão, o laser Nd: YAG associado ou não com flúor/verniz não foi mais efetivo do que o flúor sozinho para prevenir a desmineralização do esmalte durante o período experimental.

Aferição dos equipamentos de laser de baixa intensidade / Calibration of low-level laser therapy equipment

CONTEXTUALIZAÇÃO: A laserterapia de baixa intensidade (LBI) vem sendo cada vez mais utilizada, porém ainda não há consenso na literatura quanto ao tempo em que os equipamentos devem ser submetidos à aferição ou calibragem. OBJETIVO: Analisar a potência média real (PmR) dos equipamentos de LBI na região da Grande São Paulo. MÉTODOS: Para análise dos equipamentos, utilizou-se um potenciômetro (Lasercheck), próprio para aferição de equipamentos contínuos, o qual foi programado com dados referentes ao comprimento de onda do laser a ser avaliado, obtendo-se assim a PmR emitida. Os equipamentos foram analisados de duas formas: uma, com o LBI desaquecido, e outra, após 10 minutos de uso (aquecido), sendo que três análises foram feitas para cada condição. A caneta emissora foi acoplada ao potenciômetro, o qual fornecia a PmR emitida pelo LBI. Todos os dados e informações referentes à aplicação do laser foram coletados por um questionário respondido pelos responsáveis. RESULTADOS: Os 60 equipamentos avaliados mostraram déficit na PmR com os equipamentos desaquecidos e aquecidos. A análise estatística (ANOVA) mostrou diminuição significativa (P<0,05) da PmR aferida em relação à potência média do fabricante (PmF). Em média, a dose mais empregada nas clínicas foi de 4 J/cm², tendo os efeitos de cicatrização e anti-inflamatório como os mais desejados. Segundo a World Association for Laser Therapy (WALT), para atingir esse efeito, necessita-se de 1 a 4 J de energia final, sendo que apenas um dos 60 aparelhos conseguiria atingir a janela terapêutica preconizada. CONCLUSÃO: Os equipamentos de LBI apresentam um déficit acentuado na PmR, o que mostra uma desordem na utilização desse recurso. Neste estudo, observou-se a necessidade de aferição periódica dos aparelhos de LBI bem como melhor conhecimento técnico dos profissionais envolvidos.

BACKGROUND: Despite the increase in the use of low-level laser therapy (LLLT), there is still a lack of consensus in the literature regarding how often the equipment must be calibrated. OBJECTIVE: To evaluate the real average power of LLLT devices in the Greater São Paulo area. METHODS: For the evaluation, a LaserCheck power meter designed to calibrate continuous equipment was used. The power meter was programmed with data related to the laser's wavelength to gauge the real average power being emitted. The LLLT devices were evaluated in two ways: first with the device cooled down and then with the device warmed up for 10 minutes. For each condition, three tests were performed. The laser probe was aligned with the power meter, which provided the real average power being emitted by the LLLT device. All of the data and information related to the laser application were collected with the use of a questionnaire filled in by the supervising therapists. RESULTS: The 60 devices evaluated showed deficit in real average power in the cooled-down and warmed-up condition. The statistical analysis (ANOVA) showed a significant decrease (p<0.05) in the real average power measured in relation to the manufacturer's average power. On average, the most common dose in the clinics was 4 J/cm², and the most desired effects were healing and anti-inflammatory effects. According to the World Association for Laser Therapy (WALT), 1 to 4 J of final energy are necessary to achieve these effects, however only one device was able to reach the recommended therapeutic window. CONCLUSION: The LLLT devices showed a deficit in real average power that emphasized a lack of order in the application of this tool. The present study also showed the need for periodical calibration of LLLT equipment and a better technical knowledge of the therapists involved.

Efeitos do laser terapêutico no processo de cicatrização das queimaduras: uma revisão bibliográfica / Effects of the therapeutic laser on the wound healing of burns: a bibliographic review

Introdução: O tratamento de queimaduras sempre foi um desafio, tanto pela sua gravidade, como pelas múltiplas complicações que normalmente ocorrem proporcionais ao tempo necessário para a cura da lesão. O laser terapêutico é uma luz monocromática e coerente que tem sido usada para induzir a cicatrização de feridas indolentes. Objetivos: O estudo tem como objetivo descrever os efeitos, o mecanismo de ação e parâmetros de aplicação do laser terapêutico na cicatrização de queimaduras. Método: Foi realizado um levantamento bibliográfico por meio de livros e publicações de periódicos indexados (MEDLINE, LILACS, SciELO, Portal Periódicos da CAPES) que enfoquem o tema em questão. Resultados: Essa revisão evidencia que o laser terapêutico acelera a proliferação das células reparativas e aumenta a organização do colágeno, porém há carência de estudos utilizando queimaduras como modelo experimental, falta de padronização dos parâmetros de aplicação e informação da profundidade da lesão. Conclusão: O laser terapêutico pode ser um recurso valioso no tratamento de queimados pela sua capacidade de induzir cicatrização rápida e organizada.

Background: The treatment of burns has always been a challenge in terms of their seriousness, as the multiple complications that usually occur in proportion to the time needed to cure the lesion. The therapeutic laser is a monochromatic and coherent light that has been used to induce the healing of wounds indolent. Objectives: The study aims to describe the effects, the mechanism of action and application parameters of therapeutic laser on the healing of burns. Methods: A bibliographic survey was carried out through books and publications indexed journals (MEDLINE, LILACS, SciELO, CAPES) that address the issue in question. Results: This review shows that the laser therapy accelerates the proliferation of reparative cells and increases the organization of collagen, but there is a lack of studies using burns as an experimental model, lack of standardized criteria and application information on the depth of the lesion. Conclusion: Laser treatment can be a valuable resource in the treatment of burns by its ability to induce rapid healing and organized.

Comparison of tonsillectomy by standard dissection/snare technique and KTP laser method: a pilot study

A pilot study compared the post-operative morbidity following tonsillectomy by potassium-titanyl Phosphate laser [KTP/532] and standard dissection/snare methods. Twenty one consecutive patients over the age of 12 years had the tonsil on one side removed by standard dissection and that on the other side by KTP/532 laser. The intra-operative blood loss was greater in male and older patients [p=0.01] and significantly less on the KTP laser side [9.8 +/- 5.2 ml] than the dissection side [40.5 +/- 12.2 ml]; p = 0.001. During the first two days following surgery; 71.4% of patients experienced more pain on the laser side. By the first week 76.2% of patients felt both side of the throat were equally painful. At the end of second week 6 1.9% of patients had more persistent pain on the laser side compared to the dissection side. After four weeks all patients had recovered fully. This pilot study showed KTP/laser tonsillectomy had reduced intra-operative blood loss but there was more pain and increased risk of secondary hemorrhage compared to the side of standard dissection. Based on our initial results, we suggest a larger prospective randomized controlled study to compare both methods of tonsillectomy and to determine the potential to perform laser tonsillectomy as a day care procedure