Botulinum Toxin Versus Dextrose Prolotherapy: Which is More Effective for Temporomandibular Joint Subluxation? A Randomized Clinical Trial.

PURPOSE: Botulinum toxin type A (BTX-A) therapy or dextrose prolotherapy (DP) has been used to treat temporomandibular joint (TMJ) disorders. However, the superiority of one method over the other has not been studied in patients with TMJ subluxation. Therefore, this study aims to answer the following clinical question: among patients with TMJ subluxation, do those undergoing BTX-A injection into lateral pterygoid muscles, compared to those undergoing intra- and periarticular DP injections, have better outcomes in terms of locking episodes and patient satisfaction? METHODS: A randomized clinical trial was implemented in adult patients with TMJ subluxation. The sample was composed of patients with TMJ subluxation with painful open-locking during wide mouth opening and/or yawning at baseline. The subjects were treated randomly with one of two treatment techniques with equal numbers as follows: one-session BTX-A injection into lateral pterygoid muscles (BTX-A group) or three sessions of dextrose injections around TMJ (prolotherapy group). The predictor variable was the treatment technique (BTX-A or prolotherapy injections). The primary outcome variable was the frequency of locking episodes. The secondary outcome variable was patient satisfaction. The primary outcome variable was recorded at baseline and 8-12 months following the injections. The secondary outcome variable was recorded only 8-12 months following the injections. Descriptive and bivariate statistics were computed. The data were analyzed with the Wilcoxon and Mann-Whitney U tests. RESULTS: The baseline sample was composed of 30 patients with TMJ subluxation. However, the follow-up sample comprised 25 subjects: 11 (9 females, 2 males; 25.64 years) in the BTX-A group and 14 (10 females, 4 males; 32.37 years) in the prolotherapy group. Locking episodes decreased significantly in the two groups with no significant difference (P < .01). Seven patients in the BTX-A group (7 of 11 patients; 63.6 percent) and eight (8 of 14 patients; 57.1 percent) in the prolotherapy group reported no complaint of locking at the end of follow-up, with no significant difference between the groups (P > .05). Patient satisfaction showed no significant difference between the groups (P > .05). CONCLUSION: These findings suggested that BTX-A injection is no more effective than DP for any outcome variables of TMJ subluxation assessed.

Bilateral ectopic third molars in maxillary sinus associated with dentigerous cyst identified with ophthalmic, nasal and maxillary complication: A rare case report.

Etopic tooth eruption is the occurrence of the tooth germ in a nonanatomical position. It can be associated with dentigerous cyst, which is the second most seen in the development of odontogenic cyst commonly presented in mandibular region and seen in single form. It is usually accompanied with mandibular third molar followed by canine. Bilateral and multiple dentigerous cysts in nonsyndromic patients are fairly rare phenomenon and barely documented in the literatüre. We report a rare case of bilateral dentigerous cysts associated with ectopic third molars in the maxillary sinuses. Computerized tomography scan confirmed the diagnosis. A 32-year-old female patient manifesting as postnasal discharge accompanied with chief complaint of nasal obstruction, pain at blinking right eye from pressure of cyst at the inferior orbital rim, and headache for the last 1 year. This report presented our management of rarely seen case of bilateral dentigerous cysts related with ectopic third molars in maxillary sinuses. Ectopic teeth eruption in maxillary sinus should be treated as early as possible once it is diagnosed, in consideration of related complication of orbital and nasal involvement. The symptoms totally recovered with the suitable management method for our patient. The prevalence of maxillary third molars ectopic eruption in the maxillary sinus (Antrum of Highmore) is extremely rare in the literature. Lack of treatment protocol for such ectopic eruptions in the maxillary sinus and its rareness deserved to be added to the literature.

The Efficacy of External Cooling and Vibration on Decreasing the Pain of Local Anesthesia Injections During Dental Treatment in Children: A Randomized Controlled Study.

PURPOSE: This study was performed to assess the efficacy of external cooling and vibration devices on the pain of injections applied to the site of local anesthesia in children during dental treatment. DESIGN: This study is a randomized controlled trial. METHODS: This study was conducted with 60 children requiring mandibular baby teeth extraction. The children in the experimental group were anesthetized after cold application, and a vibration device was administered on the application site 2 minutes before and during the anesthesia process, whereas those in the control group were only given local mandibular anesthesia without any other procedure. FINDINGS: It was found that the mean pain score was lower in the experimental group with a significant difference between the groups (P < .05). CONCLUSIONS: This study found that the application of external cooling and vibration on the site of local anesthesia had a significant effect on the injection pain experienced by children during dental treatment.

Thermographic evaluation of occlusal splint and low level laser therapy in myofascial pain syndrome.

OBJECTIVE: The purpose of this study was to compare and evaluate the effects of occlusal splint and low dose laser treatments clinically and thermographically in patients with myofascial pain syndrome. METHODS: Twenty patients aged 18-45 with myofascial pain syndrome were involved into this study. Patients were examined by clinically and Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) was used for the diagnosis of TMD. Patients divided into two groups. First group treated with stabilisation splint, while the other one with low level laser therapy (LLLT). Pre- and post-treatment pain intensity, muscle sensitivity and the superficial skin temperature differences over the masseter and anterior temporal muscle were assessed, and comparison was made within and between the groups pre- and post-operatively. RESULTS: In both groups, there was a significant decrease in temperature values, especially in the masseter region (p < 0.05) and post-treatment pain intensity and muscle sensitivity values were lower than the pre-treatment values (p < 0.05). In addition, the heat values in certain regions of the masseter were lower in the LLLT group than in the splint group and there was a statistical difference in these regions between two groups (p < 0.05). However, there was no statistical difference in the pain intensity and muscle sensitivity between both groups (p > 0.05). CONCLUSION: It was concluded that both occlusal splint therapy and low level laser therapy were effective in the treatment of MPS, and when thermographic data were taken into account, LLLT treatments could provide more advantageous results in these patients.

Evaluation of the Efficacy of Different Concentrations of Dextrose Prolotherapy in Temporomandibular Joint Hypermobility Treatment.

PURPOSE: The aim of this study was to compare and evaluate the efficacy of different concentrations of dextrose prolotherapy for the treatment of temporomandibular joint (TMJ) hypermobility. PATIENTS AND METHODS: A prospective, randomized clinical trial including patients with subluxation or dislocation was performed. The study comprised 40 patients. Patients were randomly divided into 4 groups: control group, 10% dextrose, 20% dextrose, and 30% dextrose group. Patients in all groups received injections into 4 different areas of each TMJ in 4 sessions at monthly intervals. Visual analog scale of TMJ pain intensity, maximum mouth opening (MMO), joint sounds, and frequency of luxations were recorded preoperatively and postoperatively after 1 month of last injection. The collected data were then statistically analyzed. RESULTS: Each group showed postoperatively significant improvement in TMJ pain, significant decrease in both MMO and joint sound. Besides that, TMJ locking was not observed in any patient during the follow-up period. There were no statistically significant differences throughout the study intervals between the groups. CONCLUSION: It was concluded that there was no significant difference between control group and dextrose groups and there is no superiority of any concentration of dextrose over the others in TMJ prolotherapy, and all treatment procedures were efficient in improvement of clinical symptoms related to TMJ hypermobility. If dextrose is used as a proliferant, it can be said that 10% dextrose can be sufficient in TMJ hypermobility treatment.

Comparison of Local Anesthetic Efficiency of Tramadol Hydrochloride and Lidocaine Hydrochloride.

PURPOSE: This study investigated the local anesthetic efficiency of tramadol versus lidocaine hydrochloride in maxillary infiltration anesthesia. MATERIALS AND METHODS: This study was a randomized double-blinded study involving 50 healthy volunteers. In the experimental part of this study, each volunteer received a buccal 0.5-mL injection of tramadol hydrochloride 25 mg on one side and a buccal 0.5-mL injection of vasoconstrictor-free lidocaine hydrochloride 20 mg on the other side. No other treatment was performed. After the injections, total duration of anesthesia, start and finish times of anesthesia, soft tissue (sensory) innervation, depth of anesthetic, possible side effects, and satisfaction levels were recorded from all volunteers. RESULTS: There was no relevant difference between solutions for total anesthesia duration and peak values. However, statistically, the effect of lidocaine started and ended early. The efficacy of tramadol was markedly more effective in the gingiva and skin, especially at 15 and 20 minutes, compared with lidocaine. Both anesthetic agents were well tolerated by the volunteers. CONCLUSION: Tramadol hydrochloride can be a good alternative to local anesthetic agents and beneficial to support anesthesia during long operations.

Effect of Religious Belief on Selecting of Graft Materials Used in Oral and Maxillofacial Surgery.

PURPOSE: Various graft materials, such as synthetic and biological products, are used routinely in maxillofacial surgery. These materials are usually derived from porcine, bovine, and human tissues; some religious beliefs forbid the dietary use of substances from certain animal sources. The aim of this study was to evaluate the effect of religious belief on selecting different graft types used in maxillofacial surgery. MATERIALS AND METHODS: In total, 203 participants were included in this survey. Data were collected using a questionnaire on sociodemographic characteristics and different graft types and the Revised Religious Fundamentalism Scale for religious belief levels of participants. The purpose of the study and the origins of different graft types were explained to participants, and their opinions for the acceptance or rejection of each type were recorded. Data were analyzed using SPSS 20.0 (IBM Corp, Armonk, NY). RESULTS: The most preferred grafts were autologous grafts (88.7%), followed by alloplastic grafts (65%), bovine-derived xenografts (60.1%), allografts (53.2%), and porcine-derived xenografts (7.4%). One hundred fifty-nine participants (84.6%) rejected the porcine-derived xenografts for religious reasons, and there was a statistical difference in religious belief levels between participants who accepted and those who rejected porcine-derived xenografts. CONCLUSIONS: Autogenous grafts were the most preferred grafts and porcine-derived xenografts were the least preferred grafts. Porcine-derived xenografts were refused specifically for religious reasons, and religious belief and dietary restrictions affected graft selection.

Histologic and histomorphometric assessment of sinus-floor augmentation with beta-tricalcium phosphate alone or in combination with pure-platelet-rich plasma or platelet-rich fibrin: A randomized clinical trial.

BACKGROUND: The potential effects of adding pure platelet-rich plasma (P-PRP) or platelet-rich fibrin (PRF) to beta-tricalcium phosphate (ß-TCP) graft substitute on bone formation and regeneration after maxillary sinus-floor elevation remains unclear. PURPOSE: To compare the histologic and histomorphometric outcomes of maxillary sinus-floor augmentation among ß-TCP alone, P-PRP-mixed ß-TCP, and PRF-mixed ß-TCP. MATERIAL AND METHODS: In this randomized clinical trial, elevated sinus cavities were grafted with ß-TCP (the control group), P-PRP-mixed ß-TCP (the P-PRP group), and PRF-mixed ß-TCP (PRF group). The sample was composed of 26 patients: 9 subjects in control and P-PRP groups, and 8 subjects in PRF group. After a 6-month, healing period, bone graft biopsies were harvested prior to implant placement, and the specimens were analyzed. The main outcome variables included findings of histologic and histomorphometric analyses of the bone graft biopsies. The data were analyzed by ANOVA and Tukey HSD tests. RESULTS: The mean percentages of new bone formations were 33.40 ± 10.43%, 34.83 ± 10.12%, and 32.03 ± 6.34% in control, P-PRP, and PRF groups, respectively, with no significant differences (P > .05). Mean percentages of residual graft particle area were 30.39 ± 10.29%, 28.98 ± 7.94%, and 32.66 ± 7.46% in control, P-PRP, and PRF groups, respectively, with no significant differences (P > .05). The mean percentages of soft-tissue area were 36.21 ± 10.59%, 36.19 ± 13.94%, and 35.31 ± 10.81% in control, P-PRP, and PRF groups, respectively, with no significant differences (P > .05). Mean densities of osteoblasts, osteoclasts, osteocytes, and capillary vessels showed insignificant difference between groups (P > .05), but osteoprogenitor cells were lower and inflammatory cells were higher in the PRF group than those in other groups (P < .01). Biopsies of P-PRP, PRF, and control groups showed similar composition and distribution of histologic structures. CONCLUSION: These findings suggested that adding P-PRP or PRF to ß-TCP graft substitute was not beneficial on new bone formation and regeneration, and P-PRP plus ß-TCP or PRF plus ß-TCP is not superior to ß-TCP alone.

Cone Beam Computed Tomography Assessment of Maxillary Sinus Floor Augmentation Using Beta-Tricalcium Phosphate Alone or in Combination with Platelet-Rich Plasma: A Randomized Clinical Trial.

PURPOSE: The aim of this study was to evaluate and compare the long-term clinical and radiographic outcomes between a bone graft substitute mixture (beta-tricalcium phosphate [ß-TCP] and plateletrich plasma [PRP]) and ß-TCP bone graft substitute alone used for sinus floor elevation. MATERIALS AND METHODS: This randomized clinical trial included patients with an atrophic maxilla referred for maxillary sinus floor elevation. The elevated sinus cavities of patients were randomly filled with ß-TCP plus PRP (study group) or ß-TCP alone (control group). Residual bone crest height, vertical bone height gain, and bone graft resorption were measured on cone beam computed tomography (CBCT) images at 10 days and 6 months postoperatively. Incidence of sinus membrane perforations and maxillary sinus infections were recorded. Paired t and Student t tests were used for intragroup and intergroup comparisons, respectively. RESULTS: The sample was composed of 18 subjects: nine subjects in the control group (mean age, 31.51 years) and nine subjects in the study group (mean age, 34.01 years). The mean residual bone crest height was found to be < 5 mm in both groups (4.88 mm in the control group and 2.70 mm in the study group, with no significant difference). From the 10-day to 6-month postoperative visit, mean vertical bone height gains were changed from 12.48 to 11.59 mm in the study group and from 14.77 to 13.19 mm in the control group, with no significant difference. The mean vertical bone graft resorption was -1.58 mm in the study group and -0.89 mm in the control group, with no significant difference. Sinus membrane perforation was observed in 3 of 18 patients. CONCLUSION: In this study, PRP plus ß-TCP graft substitute did not produce significantly more vertical bone height gain or significantly less vertical bone graft resorption compared with ß-TCP graft substitute alone. Within the limitations of this study, however, it can be concluded that both grafting materials produced sufficient vertical bone height gain for safe implant placement.

Is Arthrocentesis Plus Platelet-Rich Plasma Superior to Arthrocentesis Alone in the Treatment of Temporomandibular Joint Osteoarthritis? A Randomized Clinical Trial.

PURPOSE: To compare the long-term clinical and radiologic outcomes of temporomandibular joint osteoarthritis (TMJ-OA) treated with arthrocentesis plus platelet-rich plasma (PRP) versus arthrocentesis alone. MATERIALS AND METHODS: A randomized clinical trial in adult patients with TMJ-OA referred to the authors' clinic from May 2012 through July 2013 was implemented. The sample was composed of 30 consecutive patients with TMJ-OA treated randomly with arthrocentesis alone (control group) or initial arthrocentesis plus PRP injection and then 4 consecutive PRP injections (study group). The predictor variable was treatment technique. The outcome variables were visual analog scale evaluations (masticatory efficiency, joint sounds, and pain complaints), maximal interincisal opening, and cone-beam computed tomographic (CBCT) findings. Outcome variables were recorded preoperatively and 12 months postoperatively. Descriptive and bivariate statistics were computed, and significance was set at a P value less than .05. The paired t and Student t tests were used for intragroup and intergroup comparisons, respectively. RESULTS: The sample was composed of 47 joints of 30 patients with OA (control group: 15 joints of 12 patients; mean age, 35.08 ± 14.84 yr; study group: 32 joints of 18 patients; mean age, 32.22 ± 14.32 yr). Joint sounds and general pain complaints decreased statistically in the 2 groups, whereas masticatory efficiency, painless interincisal opening, and lateral motion increased statistically only in the study group. However, only masticatory efficiency showed statistically greater improvement in the study group compared with the control group. CBCT evaluations showed that reparative remodeling of the osseous abnormalities occurred at rates of 87.5 and 46.6% in the study and control groups, respectively. CONCLUSIONS: These findings suggested that arthrocentesis and PRP injections constitute a safe and promising method for the treatment of TMJ-OA that is superior to arthrocentesis alone.

The influence of low-level laser therapy with alendronate irrigation on healing of bone defects in rats.

The aim of this study was to investigate the effects of alendronate (Aln) irrigation with low-level laser therapy (LLLT) on the healing of bone defects in rats. Sixty Wistar rats weighing 250 to 300 g were randomly divided into three groups of 20 animals each: (1) control group, (2) Aln group, and (3) Aln with LLLT group. The distal epiphysis of all rats was perforated with a surgical bone drill. Twenty rats served as control. The bone defects of 40 rats received local alendronate sodium trihydrate irrigation (1 mg/ml) at the time of surgery. LLLT was applied to the bone defects of 20 rats immediately after Aln irrigation, and repeated on days 2, 4, 6, and 8 with a total dose of 10 J/cm(2) (2 J/cm(2) × 5). Continuous wave of GaAlAs laser (808 nm) was used with a power density of 0.1 W/cm(2). Laser energy was applied for 20 s (0.1 W × 20 s/1 cm(2)) per session. Control group, Aln group, and Aln with LLLT group rats were sacrificed at days 10 and 20 to compare the bone healing of each group histologically. There were significant differences between the three groups regarding union, substantia spongiosa, cortex formation, and in sum of histologic scores on days 10 and 20 (P < 0.0001). Our findings demonstrated that Aln has a more positive effect with LLLT on bone healing in rats. It was concluded that combining LLLT (808 nm laser at 10 J/cm(2)) with Aln irrigation has a beneficial effect in bone repair. It was demonstrated experimentally that Aln irrigation during the surgery had a significant effect to enhance bone formation, and LLLT significantly potentiated the osseous healing effects of Aln on bone defects. This administration method is able to minimize the dose of Aln in order to avoid both systemic and local adverse effects as well as the local injection times during the bone healing process.

The Effect of Alendronate on Various Graft Materials Used in Maxillary Sinus Augmentation: A Rabbit Study.

BACKGROUND: Increasing sinus pneumatization and the accompanying alveolar bone resorption complicate dental implant placement. This problem can be overcome today by raising the maxillary sinus floor with graft materials. Bisphosphonates are commonly used to accelerate the recovery of the graft materials and to prevent resorption. OBJECTIVES: The purpose of this study is to investigate whether systemic administration of a bisphosphonate (alendronate) would improve new bone formation and reduce fibrous tissue formation over a 6-week follow-up in rabbits treated with two different grafting materials for maxillary sinus floor augmentation. MATERIALS AND METHODS: This experimental animal study was conducted at the Experimental Medical Application and Research Center at Erzurum/ Turkey. Twelve New Zealand rabbits, each weighing between 2.7 and 3.3 kg, were used. Twenty-four maxillary sinus floor elevation operations were performed, two on each animal (n = 24). Each elevation was repaired with either deproteinized bovine bone (xenograft) or autogenous bone graft obtained from the iliac crest. Both groups were divided into 2 subgroups: saline-treated and alendronate-treated. All groups underwent the same surgical procedures and evaluation, and were sacrificed at the 6th postoperative week. Sinuses augmented with deproteinized bovine bone (xenograft) and autogenous bone graft were examined histopathologically and histomorphometrically. RESULTS: At 6 weeks, the bone area was significantly larger in the Xenograft-Alendronate group (33.0% ± 5.0%) than in the Xenograft-Saline group (20.8% ± 4.9%) and the bone area was significantly larger in the Autogenous-Alendronate group (43.3% ± 3.8%) than in the Autogenous-Saline group (37.5% ± 6.6%) (P = 0.001). The histomorphometric and histopathological results consistently showed that alendronate stimulated bone formation and reduced fibrous tissue formation in maxillary sinus augmentation grafts, especially in the deproteinized bovine bone group (xenograft). CONCLUSIONS: Alendronate may be considered a therapeutic option for improving the bone formation process and reducing resorption in different bone grafting procedures. Further detailed studies should focus on dosage and time-dependent effects of alendronate on bone remodeling.

Comparison of alvogyl, SaliCept patch, and low-level laser therapy in the management of alveolar osteitis.

PURPOSE: The aim of the present randomized prospective clinical trial was to compare the effects of alvogyl, the SaliCept patch, and low-level laser therapy in the management of alveolar osteitis. PATIENTS AND METHODS: The study population included 104 patients who had been referred to our clinic with a complaint of alveolar osteitis. The patients were randomly assigned to 1 of 4 groups: group 1, curettage and irrigation alone; group 2, curettage and irrigation followed by alvogyl applied directly to the socket; group 3, curettage and irrigation followed by a SaliCept patch applied directly to the socket; and group 4, curettage and irrigation followed by continuous-mode diode laser irradiation (808 nm, 100 mW, 60 seconds, 7.64 J/cm(2)). The treatment procedures were repeated after 3 days. The clinical signs and symptoms for each patient were recorded at diagnosis, at 3 days after the diagnosis, and at 7 days after the diagnosis. In addition, the pain intensity levels for each patient were recorded at diagnosis and daily for 7 days after the initial treatment. RESULTS: No statistically significant differences in the management of alveolar osteitis were observed between groups 2 and 3. However, the management of alveolar osteitis was significantly better in group 4 than in the other 3 groups. CONCLUSION: Within the limitations of the present study, it can be concluded that acemannan in the form of the SaliCept patch is an acceptable alternative to alvogyl as a dressing for the management of alveolar osteitis. However, low-level laser therapy treatment at 7.64 J/cm(2) (0.1 W × 60 seconds = 6 J) performed superiorly to both SaliCept and alvogyl in managing alveolar osteitis in our study population.

The use of 808-nm light therapy to treat experimental chronic osteomyelitis induced in rats by methicillin-resistant Staphylococcus aureus.

BACKGROUND DATA: In vivo and in vitro studies have reported that laser energy in differing wavelengths and irradiation regimes has a potential bactericidal effect on Staphylococcus aureus. OBJECTIVE: The purpose of this study was to investigate whether a light wavelength of 808 nm in varying doses has an effect on chronic osteomyelitis induced experimentally in the rat tibia. METHODS: Intramedullary cavities were surgically created in the left tibias of 39 adult Wistar albino rats. Five randomly selected subjects were injected with a sterile saline solution, and methicillin-resistant S. aureus (MRSA) was used to induce osteomyelitis in the remaining rats. After 3 weeks, rats with evidence of osteomyelitis were treated with debridement alone (n = 7), with debridement plus laser irradiation to induce photoeradication (n = 21), or were not treated at all [negative control, (n = 6)]. Active irradiation was performed using an 808 nm, 100 mW continuous-wave diode laser with a beam spot size of 0.7854 cm(2) (irradiance = 127.3 mW/cm(2)). Laser treatment commenced immediately after debridement surgery and was applied daily for 5 consecutive days. Irradiation lasted 60 secs (6 J at 7.64 J/cm(2): n = 7), 120 secs (12 J at 15.29 J/cm(2): n = 7), or 180 secs (18 J at 22.93 J/cm(2): n = 7). Rats in the sham and negative control groups were killed 21 days post-induction surgery, and those in the treatment groups were killed after 42 days. Following killing, tibias were removed and analyzed histopathologically, radiographically, and microbiologically. RESULTS: Histopathological analysis showed that infection levels had decreased by 37%, 67%, 81%, and 93% in the groups treated by debridement or by debridement plus 7.64, 15.29, and 22.93 J/cm(2) light therapy, respectively, compared to the negative control group. Osteomyelitis-induced rats had the highest bacteria count (5 × 10(5)). Bacterial counts fell to 1.6 × 10(4), 4.3 × 10(2), 5.5 × 10(1), and 3.3 × 10(0) in groups treated by debridement or by debridement plus 7.64, 15.29, and 22.93 J/cm(2) light therapy, respectively, compared to the negative control group. CONCLUSIONS: Within the limitations of this study, laser phototherapy with the appropriate irradiation parameters appears to be a promising adjunct and/or alternative technique to pharmacological agents in the treatment of osteomyelitis. The 808 nm 100 mW (127.3 mW/cm(2)) laser device used in this study achieved a maximum effect with an irradiation time of 180 secs, delivering 18 J at an energy density of 22.93 J/cm(2).

Does low-level laser therapy have an antianesthetic effect? A review.

Because local anesthetics are vasodilators, they tend to be absorbed into the bloodstream from the operative field as a result of the vasodilation of peripheral arterioles. To counteract this vasodilation, vasoconstrictive agents are often included in local anesthetic solutions to provide a longer duration of anesthesia. Low-level laser therapy (LLLT) has the same benefits, such as microcirculation activation and more-efficient tissue metabolism, analgesic effects, and vasodilatation. If LLLT is used to prevent pain postoperatively, improvements in local circulation and increased vasodilatation may increase the absorption of a local anesthetic agent. This may reduce the duration of the anesthesia, thereby allowing postoperative pain management to begin sooner. The maximal intensity of pain occurs during the first hours after surgery, when the local anesthetic has worn off. Theoretically, postoperative pain control can be increased with the use of a local anesthetic with a more-prolonged action. If a treatment method has both analgesic and antianesthetic effects, then the method may block its own effects. We review whether LLLT applied postoperatively to operated-on areas has an antianesthetic effect, that is, whether pain in the first hours after surgery was greater for patients who received LLLT than for control patients. Not too much evidence supports the antianesthetic effects of LLLT. However, additional experimental and clinical studies must be performed to investigate the effects of LLLT on the duration of anesthesia.

Clinical evaluation of Er:YAG, Nd:YAG, and diode laser therapy for desensitization of teeth with gingival recession.

OBJECTIVES: The aim of this study was to evaluate the effectiveness of three types of lasers, Er:YAG, Nd:YAG, and GaAlAs (Diode), as dentin desensitizers, as well as to determine both the immediate and late therapeutic effects on teeth with gingival recessions. MATERIALS AND METHODS: The study was conducted on 24 patients with 96 teeth with Miller's class I or class II gingival recessions with clinically elicitable dentin hypersensitivity (DH) divided into three test groups: (A) Er:YAG, 2,940 nm, 60 mJ/pulse, 2 Hz, 20 s; (B) Nd:YAG, 1,064 nm, 100 mJ/pulse, 15 Hz, 100 s, (C) diode; 808 nm, 100 mW, 20s; and one control group (d) control not irradiated. DH was assessed by means of air stimulus. A visual analogue scale (VAS) was used to measure DH. The selected teeth in three groups received laser therapy for three sessions. The measurements were performed before each treatment session and at 30 min after the laser application (immediate effect), and additional measurements were also performed at 15, 30, and 60 days after the conclusion of treatment (late effect) to assess the extent of desensitization obtained with the different laser devices. RESULTS: Significant reduction of DH occurred at all times measured during the three treatment sessions in groups treated with Er:YAG, Nd:YAG, and diode lasers. Comparing the means of the responses in the three treatment sessions of the four groups, Group b showed a higher degree of desensitization in teeth with gingival recession compared with the other groups (p < 0.001). The immediate and late therapeutic effects of group b were more evident compared with the other groups. CONCLUSIONS: The Er:YAG, Nd:YAG, and diode lasers can be used to reduce DH. Nd:YAG laser irradiation is more effective in the treatment of DH than are Er:YAG and diode laser. Within the limitations of the present study, the Nd:YAG laser seems to be a suitable tool for successful reduction of DH, especially because the 3-month results of this treatment modality are promising.

The effect of low-level laser therapy on healing of skin incisions made using a diode laser in diabetic rats.

BACKGROUND AND OBJECTIVE: To investigate the effect of low-level laser therapy (LLLT) on healing of skin incisions made using a diode laser in diabetic rats. MATERIAL AND METHODS: Eighteen diabetic Wistar rats were used for this study. One incision was performed on the left side of the dorsum using a diode laser, and the other two incisions were made with a scalpel and diode laser on the right side of each rat. The wound on the left side of each rat received laser stimulation (10 J/cm(2)). The rats were assigned to three experimental groups. Group 1, scalpel (n = 18); Group 2, diode (n = 18); Group 3, diode + biostimulation (n = 18). RESULTS: Reepithelialization was fastest in Group 2 than Group 1 at day 10. The difference between Groups 1 and 3 was also statistically significant in reepithelialization at day 10. There was a significant difference between Groups 1 and 2 and between Groups 2 and 3 in inflammation at day 10. There was no difference between any of the groups in inflammation and reepithelialization at day 20. CONCLUSIONS: Scalpel incisions heal more slowly than diode and diode + biostimulation incisions in diabetic rats. We can suggest that diode + biostimulation may produce the least amount of tissue injury, with the fastest resolution of inflammatory response in diabetic rats. Diode laser incision (4 W) with 10-J/cm(2) LLLT seems to have a beneficial effect on skin incisions in diabetic rats.

Simultaneous occurrence of compound odontoma and arrested root formation as developmental disturbances after maxillofacial trauma: a case report.

Traumatic injury to a primary tooth and/or a bone fracture has the potential to damage the underlying permanent tooth germ which may disturb its development. The extent of the malformation depends on the developmental stage of the permanent tooth and the intensity of the trauma. The presence of infection may be a predictive factor for these abnormalities. Open surgical procedures can also potentially cause impaction and developmental disturbances. Several developmental alterations such as discolouration, hypoplasia, crown dilaceration, root angulation or dilaceration, sequestration of permanent tooth buds and disturbance in eruption have been reported in permanent teeth after trauma. However, odontoma-like malformations and partial or complete arrest of root formation are rare complications developed after trauma. This article presents a rare case with simultaneous occurrence of an odontoma-like malformation and complete and partial arrested root formations as the results of maxillofacial trauma. Almost all pediatric fractures must be managed with closed reduction as much as possible. However, if it is necessary to perform an open reduction, careful attention must be paid during placement of the osteosynthetic plates and screws; and tooth bud development must be followed periodically.

Placebo-controlled randomized clinical trial of the effect two different low-level laser therapies (LLLT)--intraoral and extraoral--on trismus and facial swelling following surgical extraction of the lower third molar.

The purpose of this study is to compare the effects of extraoral and intraoral low-level laser therapies (LLLT) on postoperative trismus and oedema following the removal of mandibular third molars. Forty-eight patients who were to undergo surgical removal of their lower third molars were studied. Patients were randomly allocated to one of three groups: extraoral LLLT, intraoral LLLT, or placebo. In the study, a Ga-Al-As diode laser device with a continuous wavelength of 808 nm was used, and the laser therapy was applied by using a 1 x 3-cm handpiece. The flat-top laser beam profile was used in this therapy. For both of the LLLT groups, laser energy was applied at 100 mW (0.1 W) for a total of 120 s (0.1 W x 120 s = 12 J). Patients in the extraoral-LLLT group (n = 16) received 12-J (4 J/cm(2)) low-level laser irradiation, and the laser was applied at the insertion point of the masseter muscle immediately after the operation. Patients in the intraoral-LLLT group (n = 16) received 12-J (4 J/cm(2)) low-level laser irradiation intraorally at the operation site 1 cm from the target tissue. In the placebo group (n = 16), the handpiece was inserted intraorally at the operation site and then was touched extraorally to the masseter muscle for 1 min at each site (120 s total), but the laser was not activated. The size of the interincisal opening and facial swelling were evaluated on the second and seventh postoperative days. At the second postoperative day, trismus (29.0 +/- 7.6 mm [p = 0.010]) and swelling (105.3 +/- 5.0 mm [p = 0.047]) in the extraoral-LLLT group were significantly less than in the placebo group (trismus: 21.1 +/- 7.6 mm, swelling: 109.1 +/- 4.4 mm). Trismus (39.6 +/- 9.0 mm [p = 0.002]) in the extraoral-LLLT group at the seventh postoperative day was also significantly less than in the placebo group (29.0 +/- 6.2 mm). However, at the seventh postoperative day in the intraoral-LLLT group, only trismus (35.6 +/- 8.5 [p = 0.002]) was significantly less than in the placebo group (29.0 +/- 6.2 mm). This study demonstrates that extraoral LLLT is more effective than intraoral LLLT for the reduction of postoperative trismus and swelling after extraction of the lower third molar.

Er:YAG laser ablation of bone in experimental diabetics.

BACKGROUND AND OBJECTIVE: The aim of this study was to compare bone healing in experimental diabetics after ostectomies obtained by Er:YAG laser and bur drilling. STUDY DESIGN/MATERIAL AND METHODS: Twenty-eight Wistar rats weighing 250-300 g were used for this study. Diabetes was chemically induced with streptozotocin administered as a single intraperitoneal injection. Fourteen nondiabetic (normal) and 14 diabetic rats were included in the analysis. Left femur distal epiphysis of nondiabetic and diabetic rats was perforated with a surgical bone drill. Another defect with similar dimensions was created by an Er:YAG laser on the left femur of diabetic rats. An Er:YAG laser of 2940-nm wavelength with an energy density of 1.5 W was used. The rats were assigned to three experimental groups: normal bur group (control), diabetic bur group, and diabetic Er:YAG group. The rats were killed at 10 and 20 days to compare the bone healing of each group. RESULTS: At 10 days of healing, the sum of histologic scores was higher in the normal bur group than in the diabetic bur and diabetic Er:YAG groups. In the present study, union, spongiosa, and bone marrow were evaluated, respectively, and there were no significant differences among the groups regarding the union and bone marrow (p > 0.05). Spongiosa bone formation was higher in the normal bur group than in the diabetic bur and diabetic Er:YAG groups (p = 0.011). There were no significant differences among the groups as to union, spongiosa, bone marrow, and sum of histologic scores (p > 0.05) at 20 days of healing. CONCLUSIONS: Histologically, no difference was found between the Er:YAG and bur cavities in diabetic rats regarding bone healing. With these histological and experimental results, we believe that the 2940-nm Er:YAG laser (1.5 W) can be used confidently in the ablation of bones in diabetic cases.