The Effect of Chitosan Gel 15% in the Surgical Treatment of Stage III Periodontitis: A Case Report of Two Cases.

Periodontal diseases are widely spread, particularly in adults. Chitosan has non-toxicity and biocompatibility properties, as it has been studied in many studies in various surgical applications. This case report includes two female patients (aged 23 and 48) who were treated by the application of Chitosan gel 15% during open flap debridement in an aggregate of 26 periodontal pockets. Several clinical measurements were evaluated (probing depth, gingival recession, and bleeding on probing) for the treated periodontal pockets, between two periods, the first in baseline and then after six months. The results showed a reduction in probing depth of (3.30±0.27) after six months. The bleeding on probing also decreased from 84.61% to 0%. This case report concluded that the application of Chitosan gel 15% reduced pocket depth and bleeding on probing when applied in open flap debridement.

Comparison of pain and healing period after frenectomy using diode laser and Er:YAG laser: randomized controlled trial.

OBJECTIVES: The frenum is a mucous membrane fold that attaches the lip and the cheek to the alveolar mucosa, the gingiva, and the underlying periosteum. Frenectomy is the surgical removal of the whole frenum, including the area connected to the bones. This study's purpose was to compare the healing period and postsurgical pain experienced by patients operated with diode and erbium:yttrium-aluminium-garnet (Er:YAG) lasers. METHODS: Twenty referred patients need to excision of the abnormal upper labial frenum were included in this study. Patients were randomly assigned into two groups; Diode group (810 nm, 2W, continuous emission, initiated tip) and Er:YAG group (2940 nm, 2W, 200 mJ, 10 Hz). Both lasers were applied in contact mode. Post-operative pain was assessed with Numerical Rating Scale (NRS) at post-operative 3rd hour and every day during the first week. Epithelialization process of the wound surface was evaluated by hydrogen peroxide solution applied to the wound on days 7, 14, 30, 60 and 90 following operations. RESULTS: The result shows mean values in Pain index after 3 hours (Diode Group 2.1±2.0, Er:YAG Group 2.6±1.4), 1st day (Diode Group 1.1±1.1, Er:YAG Group 1.9±1.4), and 2nd day (Diode Group 0, Er:YAG Group 0.9±1.1) and shows no significant difference after (3-7 days); p =1.00). In Healing index the results shows a significant difference between the Diode Group and the Er:YAG Group (after 7 days; p = 0.029 and 14 days; p = 0.001) and show no significant difference after (30-60-90 days; p = 1.00). CONCLUSIONS: The Er:YAG laser has better clinical results in healing wounds, whereas the diode laser is better in decreasing pain after frenectomy during follow-up periods.

Patient-Reported Outcome Measures of Flapless Corticotomy with Low-Level Laser Therapy in En Masse Retraction of Upper Anterior Teeth: A Three-Arm Randomized Controlled Trial.

(1) Background: This study aimed to compare patient-reported outcome measures when accelerating en masse retraction between the piezocision procedure and the subsequent application of low-level laser therapy (FC+LLLT), with the piezocision alone (FC), and in a control group. (2) Methods: A three-arm randomized controlled trial (RCT) was conducted involving 60 patients (41 females and 19 males) with Class II division I malocclusion. The en masse retraction was performed using NiTi closed coil springs attached to miniscrews. The LLLT was performed using an 808 nm Ga-Al-As diode laser. Patient responses regarding pain, discomfort, swelling, and chewing difficulties were reported at ten assessment points. (3) Results: The greatest pain levels were observed 24 h after the application of force during the first and third months of retraction. The mean pain, discomfort, swelling, and chewing difficulties were significantly smaller in the control group than in the FC and FC+LLLT groups. High satisfaction levels were reported in all three groups (p < 0.05). (4) Conclusions: The accelerated en masse retraction via piezocision, followed by a small course of LLLT, was accompanied by significantly fewer pain, discomfort, and chewing difficulties than the control group. LLLT is a valuable addition to piezocision, with an improved patient experience.

Evaluation of the Patient-Reported Outcome Measures (PROMs) With Temporary Skeletal Anchorage Devices in Fixed Orthodontic Treatment: A Systematic Review.

Analysis of patient-reported outcome measures (PROMs) is essential to ensure that the skeletal and traditional anchoring methods are appropriately and effectively utilized in the context of patient acceptance and satisfaction. This review's objective was to assess the available data on the levels of discomfort, soft-tissue irritation, functional impairment, and other patient-reported outcomes related to the usage of mini-implants in the context of fixed orthodontic treatment for adult patients. A total of seven electronic bibliographic databases were searched between January 1995 and February 2022. Moreover, a manual search was done in the selected orthodontic journals. This systematic review (SR) covered cohort studies, retrospective studies, randomized clinical trials (RCTs), and controlled clinical trials (CCTs) that studied the use of mini-implants, mini-plates, or onplants as anchorage devices on patients receiving orthodontic treatment. The risk of bias was assessed using Cochrane's risk of bias tool (RoB2 tool). Three RCTs and two cohorts were included in this SR with a total of 468 patients. Three of the four included studies were at high risk of bias. The pain level was in the "mild-to-moderate" category on the first day following the insertion of mini-implants, then decreased to a mild level from the fifth day to the seventh day of insertion (mean values are 36.61, 16.36, and 11.33, respectively). The levels of functional impairments were found to be located between the "mild-to-moderate" and "moderate" categories after the placement of mini-plates and intermaxillary fixation screws, while they experienced a mild level with mini-implants. The greatest pain levels were found after the insertion of the temporary anchorage devices (TADs) and then decreased until they became mild or disappeared completely after one month. Speaking, chewing, and cleaning difficulties were more problematic when using TADs compared to conventional anchorage. To obtain good evidence in this area, more high-quality RCTs are needed.

Efficacy of 810 nm and 650 nm Diode Laser Alone and in Combination With Sodium Fluoride Gel in Treating Dentin Hypersensitivity: A Split-Mouth Randomized Clinical Study.

Introduction Dentin hypersensitivity has been defined as a short, sharp pain caused by exposing naked dentin to external stimuli such as evaporation, heat, cold, osmotic liquids, and tactile effects. None of the available treatments has been considered the gold standard in treating dentin hypersensitivity. The use of laser has recently become more popular, and it is a promising treatment method in this field. The study aimed to compare the effectiveness of both 810 nm and 650 nm diode lasers in treating dentin hypersensitivity. Materials and methods This study was conducted on six patients who were referred to the Department of Oral Medicine, Faculty of Dental Medicine, Damascus University (4 females and 2 males) with 108 teeth suffering from generalized dentin hypersensitivity and were randomly divided into two groups. Group 1 consisted of three patients with 50 teeth treated with an 810 nm diode laser; it was divided by the split-mouth design into two subgroups. The first subgroup was treated by the application of the laser alone toward the target area with 1-watt power, continuous mode, and a total application time of 90 seconds, and the second subgroup was treated by applying sodium fluoride gel for one minute, then the laser was applied with the same settings as the first subgroup. Group 2 consisted of three patients with 58 teeth treated with a 650 nm diode laser; it was divided by the split-mouth design into two subgroups. The first subgroup was treated by the application of the laser alone toward the target area with 200 m watt power, continuous mode, and a total application time of 120 seconds, and the second subgroup was treated by applying sodium fluoride gel for one minute and then applying the laser with the same settings as the first subgroup. The pain was evaluated using a numeric rating scale (NRS) of 100 degrees before and immediately after treatment, and then after three to six and nine months by applying an air stream from a dental chair syringe at a distance of 0.5 cm from the target area. Results This study showed that both types of lasers were effective in treating pain caused by dentinal hypersensitivity. The average values ​​of pain reduction on the NRS showed the superiority of the 810 nm diode laser over the 650 nm after treatment and at all time points of pain assessment. No statistically significant differences were detected between applying laser alone and applying it combined with sodium fluoride gel in pain reduction values. Conclusions The application of an 810 nm diode laser either alone or in combination with sodium fluoride gel in treating dentin hypersensitivity is effective and better than the application of a 650 nm diode laser either alone or in combination with sodium fluoride gel. In addition, applying a 650 nm diode laser either alone or in combination with sodium fluoride gel has slight effectiveness in treating dentine hypersensitivity, and it is believed that a single treatment session with a 650 nm diode laser was not enough to obtain the required pain reduction.

Low-level laser therapy has an additional effect with open flap debridement on the treatment of stage III periodontitis: a split-mouth randomized clinical trial.

OBJECTIVE: The purpose of this randomized, controlled, split-mouth trial was to clarify the clinical efficacy of using low-level laser therapy (LLLT) as an adjunct to open flap debridement in the treatment of periodontitis. METHOD AND MATERIALS: The study was conducted on 10 patients with stage III periodontitis. Clinical parameters were recorded for 70 sites of periodontal pockets at baseline and after 3 months and included Plaque Index (PI), Gingival Index (GI), bleeding on probing (BOP), probing depth (PD), relative gingival recession (RGR), and relative attachment level (RAL), and evaluated postoperative pain and dental hypersensitivity. After open flap debridement, the sites were randomly divided into test sites receiving the low-level diode laser (wavelength 808 nm) and control sites treated with laser-off. The Wilcoxon test and Mann-Whitney U-test were used for intra- and inter-group comparisons, respectively, and the Friedman test to test between different periods. RESULTS: Both treatments produced a reduction in GI, BOP, and PD, an increased RGR, and a gain in RAL between baseline and 3 months after surgery. There were significant improvements in GI, PD, and RAL after 3 months; postoperative pain after 24 hours and after 3 days; and dental hypersensitivity after 1 week and 1 month of the surgery, which significantly decreased in the test group. CONCLUSION: Both groups were clinically effective in treating stage III periodontitis, with a significant preference in reduction of GI and PD and gain of RAL, and decreased postoperative pain (after 24 hours and 3 days) and dentinal hypersensitivity (after 1 week and 1 month) for open flap debridement+LLLT. CLINICAL RELEVANCE: The use of LLLT as an adjunct to open flap debridement improved the clinical indices, postoperative pain, and dentinal hypersensitivity better than open flap debridement alone in the treatment of stage III periodontitis.

Evaluation of patient-reported outcome measures (PROMs) during surgically-assisted acceleration of orthodontic treatment: a systematic review and meta-analysis.

BACKGROUND: With the widespread of surgically-assisted orthodontic acceleration, the analysis of patient-reported outcome measures (PROMs) has become very important to assure patient acceptance and satisfaction before adopting any acceleration procedure. OBJECTIVE: This review aimed to critically appraise the available evidence regarding the levels of pain, discomfort, functional impairments, and other patient-reported outcome measures during surgically-assisted acceleration of orthodontic treatment compared with the traditional non-accelerated treatment. SEARCH METHODS: Eight electronic bibliographic databases were searched from January 1990 till May 2022. A manual search of the selected orthodontic journals was also undertaken. SELECTION CRITERIA: Randomized controlled trials (RCTs) were included in this systematic review on patients undergoing orthodontic treatment with one group subjected to an acceleration procedure. DATA COLLECTION AND ANALYSIS: Cochrane's risk of bias tool (RoB2 tool) was used to assess the risk of bias of the included RCTs. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guidelines were used to assess the overall quality of the evidence. RESULTS: Thirteen RCTs were included in this review (333 patients), and only minimally invasive surgically-assisted acceleration studies were included. Two RCTs were included in the quantitative synthesis of data. After the first day of surgical intervention, the levels of pain and discomfort ranged from mild to moderate in the surgical groups (mean values ranged from 0.8 to 6.8), while it was mild in the control groups. However, on the seventh day after the surgical intervention, the levels of pain, discomfort, swelling, and functional impairments were almost similar between groups. According to the GRADE, the quality of evidence supporting these findings ranged from low to very low. CONCLUSIONS: All surgical interventions were minimally invasive. There was very low to low evidence that acceleration caused mild to moderate pain and discomfort on the first day after the surgical intervention and disappeared completely at one week following surgery. Functional impairments were found within acceptable limits immediately and in the short-term follow-up. More high-quality randomized controlled clinical trials are needed to establish good evidence in this field. REGISTRATION: The protocol of this systematic review was registered in PROSPERO database (CRD42021274481) during the first stages of this review.

Validity and Reliability of Intraoral and Plaster Models' Photographs in the Assessment of Little's Irregularity Index, Tooth Size-Arch Length Discrepancy, and Bolton's Analysis.

Background Dental impressions have been required to obtain proper study models. This procedure is time- and labor-consuming for the orthodontist and could be exhausting to the patient, especially when braces are fitted in the context of a research project. This study aimed to assess the accuracy, reliability, and reproducibility of using intraoral photographs and plaster models' photographs in measuring Little's Irregularity Index (LII), tooth size-arch length discrepancy (TSALD), and Bolton's ratios. Methods A total of 52 dental arches of 26 patients were included in this study. Plaster models, occlusal intraoral photographs, and photographs of the collected plaster models were obtained for each patient. Then, LII, TSALD, and Bolton's ratios were measured using a manual caliper for plaster models' measurements and a software-based on-screen method for the photographs. Results The intraclass correlation coefficients (ICCs) of measurements made on intraoral photographs and photographs of plaster models were high (ranging from 0.90 to 0.99 and from 0.88 to 0.99, respectively), indicating a high level of agreement with the gold standard measurements. In addition, the differences were insignificant. The intra-/inter-examiner ICCs ranged from 0.90 to 0.99/0.92 to 0.99 and from 0.85 to 0.99/0.88 to 0.98 for plaster models and intraoral photographs of the dental arches, respectively. The analysis of reproducibility of capturing intraoral photographs of the dental arches on two different occasions showed high ICCs ranging from 0.96 to 0.99 with almost no significant differences between repeated measurements (P > 0.05). Conclusion LII, TSALD, and Bolton's overall and partial ratios can be measured from intraoral photographs of the dental arches with high accuracy, reliability, and reproducibility. Therefore, this methodology can be suggested for use in research projects when multiple records of the dental arches are required instead of depending on time- and labor-consuming procedures of ordinary dental impressions.

Assessment of a single versus double application of low-level laser therapy in pain reduction following orthodontic elastomeric separation: A randomized controlled trial.

BACKGROUND: Periodontal ligament (PDL) pain, associated with the insertion of elastomeric separators, is one of the most annoying experiences at the beginning of orthodontic treatment. Low-level laser therapy (LLLT) has recently been suggested as a method of controlling this pain. OBJECTIVES: The aim of this study was to evaluate the effectiveness of LLLT on reducing the pain associated with elastomeric separation and to compare a single dose of LLLT (1 h before the insertion of elastomeric separators) vs 2 doses of LLLT (1 h before and immediately after the insertion). MATERIAL AND METHODS: This randomized controlled trial was conducted at the Department of Orthodontics, Faculty of Dentistry of University of Damascus and at the Department of Orthodontics of Adib-Allaham Center in Damascus, Syria. The sample population was comprised of 36 patients, aged between 12 and 25 years (mean age: 17 ±3.7 years), and the patients were randomly divided into 2 groups. A split-mouth design was employed. One group received 1 dose of laser therapy 1 h before the insertion of elastomeric separators, whereas the other one received 2 doses of laser therapy - 1 h before and immediately after the insertion of elastomeric separators. A GaAlAs laser with a wavelength of 830 nm and a power of 100 mW was used. The pain levels were recorded using the Visual Analog Scale (VAS) after 1, 6, 24, 48, and 96 h. Student's t-test and the repeated measures analysis of variance (ANOVA) were employed to detect significant differences. RESULTS: Low-level laser therapy significantly reduced post-separation pain when the experimental side was compared to the placebo side in the single-irradiation group (p < 0.05). Low-level laser therapy significantly reduced separation pain with no statistical difference between single and double irradiation protocols (p > 0.05). CONCLUSIONS: Low-level laser therapy had a positive effect on reducing the pain associated with elastomeric separation, whether it was applied as a single dose before elastomeric separation or as a double dose before and after this procedure.

Evaluation of Low Level Laser Therapy on Pain Perception Following Orthodontic Elastomeric Separation: A Randomized Controlled Trial.

INTRODUCTION: Periodontal pain caused by elastomeric separators is a very common problem in the commencement of orthodontic treatment. Previous studies have shown good results in reducing this pain by Low Level Laser Therapy (LLLT) and different protocols of application have been suggested in the literature. AIM: This trial aimed to evaluate LLLT on managing orthodontic pain caused by elastomeric separators and to compare single versus double irradiation in possible pain reduction. MATERIALS AND METHODS: A clinical randomized compound (parallel-group and split-mouth design) trial was conducted on 36 patients between 12 and 26 years of age. Elastomeric separators were placed at the mesial and distal surfaces of the first molars in one jaw (upper or lower) for each patient and in only one side of the mouth (the other side served as the placebo side). The trial had two groups: the first group received single irradiation of LLLT [Gallium Aluminum Arsenide (GaAlAs): 830 nm, 4J/cm2, 100mW] immediately after separators insertion, where as the second group received double irradiation immediately after separators insertion and after 24hours. All patients were instructed to rate the level of pain at 1, 6, 24, 48, 96 hours on a Visual Analog Scale (VAS). The student 't' tests, repeated measures ANOVA and LSD post-hoc tests were employed. RESULTS: LLLT was successful in reducing post-separation pain when the experimental side was compared to the placebo side at all assessment times in each group (p<0.05). There were no statistically significant differences between single and double irradiation groups in terms of pain reduction (p>0.05). CONCLUSION: GaAlAs LLLT application reduced early orthodontic pain caused by elastomeric separators by single or double irradiation.