Case Report: Recalcitrant oral lichen planus involving bilaterally buccal mucosae treated with a combination of photodynamic and photobiomodulation therapies.

Background: Managing recalcitrant oral lichen planus (OLP) can be challenging. Laser therapy has been suggested as an alternative to corticosteroids for treatment. Photodynamic therapy (PDT) is a non-invasive technique that enables the removal of lesions without surgery. Photobiomodulation therapy (PBMT) can promote healing and recovery of the lesions. Case presentation: The objective was to treat unresponsive bilateral OLP of the whole buccal mucosae with a combination of PDT and PBMT. Results: A 43-year-old Thai male presented with the severe painful reticular type of OLP of bilateral buccal mucosae involving upper and lower vestibular areas. The lesions were not remitted with either prednisolone systemic steroids or fluocinolone topical corticosteroids. After undergoing ten sessions of PDT with 10% 5-Aminolevulinic acid (5-ALA) in the form of thermoplastic gel and a 635 nm diode laser at 100 to 400 mW with an energy density of 20 to 30 J/cm 2 in continuous wave mode, combined with five interim-sessions of PBMT using a 635 nm diode laser at 200 to 300 mW with an energy density of 6 to 10 J/cm 2 in continuous wave, the patient reported relief of burning sensation beside remission of lesions without any complications. Conclusion: The wide-spreading recalcitrant OLP with burning sensation can be managed by combining PDT and PBMT.

An In Vitro Study of the Effect of CO2 Laser Power Output on Ablative Properties in Porcine Tongue.

CO2 lasers have been generally used in oral soft-tissue surgery. Although an increase in power enhances the depth of ablation, the specific correlation between units of power and ablative depth has not been stated. This study aimed to explore ablative depth and width affected by a power unit of 10,600-nm CO2 laser continuous wave at 3 to 10 W in tissue blocks of the swine tongue. The 112 samples were randomly allocated into eight groups according to the power settings. The depth and width of the incision were measured by using the ImageJ program. The 3 W group showed the minimal depth of ablation [0.527 mm (0.474 and 0.817)] and width of ablation [0.147 mm (0.110 to 0.184)]. The maximal depth [3.750 mm (3.362 and 4.118)] and width [0.700 mm (0.541 to 0.860)] were in the 9 W group. The correlation between the ablative depth and power unit was 0.81 (p < 0.001). Based on the regression equation (p < 0.001), the ablative depth (mm) = (the power unit of laser in W × 0.491) − 0.731. In conclusion, the ablative depth of the CO2 laser on soft tissue was strongly correlated to power units enabling the prediction equation.

Case Report: Interstitial-intralesional laser therapy and laser-assisted new attachment procedure for the treatment of alveolar bone loss provoked by an aggressive pyogenic granuloma.

Background: A pyogenic granuloma (PG) is a common benign vascular lesion found in the oral cavity. The gold standard treatment of this lesion, comprising surgical excision and the elimination of etiological factors, cannot avoid tooth loss in the case of an aggressive pyogenic granuloma. Because of the prominent properties of 980 nm and 635 nm diode lasers in photocoagulation and photobiomodulation, we applied these wavelengths in the treatment of a large pyogenic granuloma with alveolar bone loss. Case presentation: Our objective was to use a combination of interstitial-intralesional laser therapy, photocoagulation and laser-assisted new attachment procedure (LANAP) to preserve the teeth and periodontal tissue in a case of an aggressive pyogenic granuloma. Results: The patient was a 13-year-old Thai male with a pyogenic granuloma involving the interdental papilla and lingual gingiva of the lower left first and second molars. The teeth were also displaced by the lesion. After treatment with three sessions of photocoagulation, three sessions of interstitial-intralesional laser therapy and two sessions of LANAP, the lesion was completely resolved. The periodontal status of the teeth was improved at the six-month follow-up. Conclusion: The combination of interstitial-intralesional laser therapy, photocoagulation and LANAP was able to treat an aggressive pyogenic granuloma with tooth preservation.

An Efficacy of Photobiomodulation of 850 nm on Pain Reduction in a Human Oral Capsaicin Pain Model.

Objective: The aim of this clinical trial was to evaluate the efficacy of photobiomodulation (PBM) to reduce oral pain initiated by capsaicin. Background: PBM has been used for pain reduction in oral regions; however, its clinical efficacy to alleviate burning sensations is still unknown. Methods: This clinical study was divided into two phases. There were 10 subjects in each phase. In Phase I, the burning sensation was stimulated using 0.05% in 95% ethanol capsaicin (prepared by the Faculty of Pharmaceutical Sciences, Khon Kaen University, Thailand) on filter paper and recorded with a 10-cm horizontal visual analog scale (VAS) every 1 min until the subject experienced no more pain. The area under the curve (AUC) of the graph between VAS and time was calculated. The washout period was 24 h. In Phase II, a crossover clinical trial was conducted in subjects who received the pain model as stated. Four interventions were included: (1) PBM before & after pain stimulation, (2) PBM before pain stimulation, (3) PBM after pain stimulation, and (4) Placebo. For PBM intervention, a single exposure of 850 nm Laser (AsGaAl; TOP 250 Soft Laser, Berkmed Medikal, distributed by Medical Innovation-MI, Istanbul, Turkey) with 0.10 cm2 spot size laser probe continuous wave at 1 W/cm2 and 30 J/cm2 for 30 sec was used. Results: In Phase I, there was no statistically significant difference (p = 0.09) between the average AUC of day 1 [55.63 (23.38)] and day 2 [48.99 (27.20)]. In phase II, there was no statistical difference (p = 0.20) of the average AUC among the interventions and the placebo; group 1 [56.24 (30.11)], group 2 [45.46 (45.46)], group 3 [64.15 (32.89)], and group 4 [58.59 (30.16)]. Conclusions: The human capsaicin model was suitable for a crossover design clinical trial. The PBM used in this study did not reduce oral burning sensations from capsaicin.

Efficacy of erythrosine and cyanidin-3-glucoside mediated photodynamic therapy on Porphyromonas gingivalis biofilms using green light laser.

BACKGROUND: The purpose of this in vitro study was to evaluate the efficacy of erythrosine and cyanidin-3-glucoside as photosensitizers in PDT for the elimination of Porphyromonas gingivalis (P. gingivalis) biofilms. METHODS: P. gingivalis biofilms were prepared from a chronic periodontitis subject. Erythrosine and cyanidin-3-glucoside were prepared and randomly allocated as follows: 110, 220, 330, and 440µM erythrosine; 101, 202, 303, and 404µM anthocyanin; and 440µM erythrosine+404µM cyanidin-3-glucoside. There were 18 PDT experimental groups (non-irradiated/irradiated with a 532-nm green light diode laser at 1.29J/cm2 for 60s). The 3 controls were grouped as follows: biofilms exposed to the photosensitizers alone, biofilms exposed to the laser alone, and biofilms exposed to 0.12% chlorhexidine. All sample groups were cultured at 1, 3 and 6h after PDT and incubated in an anaerobic chamber at 37°C for 4days. The surviving fraction was calculated from the log10 CFU/ml. The 330 and 440µM erythrosine and the 440µM erythrosine+404µM cyanidin-3-glucoside were mixed with spin traps (TEMPO, DMPO), and the electron spin resonance spectra were evaluated. RESULTS: The log10 CFU/ml measurements showed that the PDT groups with 330µM or 440µM erythrosine and 440µM erythrosine+404µM cyanidin-3-glucoside had statistically significant differences from the other groups (one-way ANOVA and Bonferroni's multiple comparison test, p- value≤0.05). CONCLUSIONS: PDT using 330µM erythrosine, 440µM erythrosine or 440µM erythrosine+404µM cyanidin-3-glucoside irradiated with the laser more effectively inhibited P. gingivalis in biofilms.

Soft tissue molding technique in cleft lip and palate patient using laser surgery in combination with orthodontic appliance: A case report.

BACKGROUND: Although surgical treatment protocols for cleft lip and palate patients have been established, many patients still have some soft tissue defects after complete healing from surgical interventions. These are excess soft tissue, high attached fraena and firmed tethering scares. These soft tissue defects resulted shallowing of vestibule, restricted tooth movement, compromised periodontal health and trended to limit the maxillary growth. The aim of this case report was to present a method of correcting soft tissue defects after conventional surgery in cleft lip and palate patient by using combined laser surgery and orthodontic appliance. CASE REPORT: A bilateral cleft lip and palate patient with a clinical problem of shallow upper anterior vestibule after alveolar bone graft received a vestibular extension by using CO2 laser with ablation and vaporization techniques at 4 W and continuous wave. A customized orthodontic appliance, called a buccal shield, was placed immediately after surgery and retained for 1 month to 3 months until complete soft tissue healing. The procedures were performed 2 episodes. Both interventions used the same CO2 laser procedure. The first treatment resulted in partial re-attachment of soft tissue at surgical area. The second laser operation with the proper design of buccal shield providing passive contact with more extended flange resulting in a favorable outcome from 1 year follow up. Then the corrective orthodontic treatment could be continued effectively. CONCLUSION: The CO2 laser surgery was a proper treatment for correcting soft tissue defects and the design of buccal shield was a key for success in molding surgical soft tissue.

Low intensity laser for reducing pain from anesthetic palatal injection.

OBJECTIVE: The aim of this study was to evaluate the effectiveness of pain reduction techniques for palatal injection, namely, low intensity laser therapy (LILT), topical anesthesia, pressure, and light touch. BACKGROUND DATA: Previous evidence indicates that LILT may prevent pain from palatal injection. However, no clinical trials evaluating this clinical question have been performed. METHODS: A double-blind clinical trial was conducted using 80 healthy volunteers, 18-25 years of age. The subjects were randomly allocated into four groups with 10 females and 10 males each group. Pain reduction techniques were administered at an injection point that was 10 mm from the margin of the palatal gingiva of the upper left first molar according to the following groups: (1) a 790 nm 30 mW continuous wave with a 0.13 cm2 focal spot at an applied energy of 3.6 J and fluence of 27.69 J/cm2, (2) 20% benzocaine, (3) pressure, and (4) light touch as the control. Then, 2% lidocaine with 1:100,000 epinephrine was injected using a 27-gauge needle with a pressure and volume control intraligamentary syringe. All subjects recorded pain on a 10 cm visual analog scale (VAS). RESULTS: The pain score in the LILT group was <50 mm. The median of pain scores of the LILT, 20% benzocaine, pressure, and light touch groups were 11, 23, 27, and 31 mm, respectively. There was no statistically significant difference in VAS among the groups, using Kruskal-Wallis test (p=0.385). CONCLUSIONS: No statistically significant differences in pain scores were noted among low intensity laser, 20% benzocaine, pressure, and light touch.

CO2 laser oral soft tissue welding: an in vitro study.

BACKGROUND AND AIM: Although there are some studies reporting the benefits of using laser to improve wound closure, there were a few studies in a model of oral mucosa. The aim of this in vitro study was to compare immediate tensile strength of the wound closure between suture alone and suture combined with CO2 laser welding. MATERIALS AND METHODS: The study was conducted in 40 samples of the tissue blocks from ventral sides of pig tongues. A 20 mm-length and 5 mm-depth incision was made in each sample. The samples were randomly allocated into 2 groups namely: the control group and the experimental group. The samples of the control group were sutured with 3- stitch of 4-0 black silk. The samples of the experimental group were irradiated with CO2 laser (ultrapulse mode, 800 Watt peak power, 10 Hz, 0.2 ms pulse duration and 2,262.62 J/cm(2) energy density) before sutured. The immediate tensile strength of the wound was measured by using customized tensiometer under stereomicroscope. RESULTS: The median of tensile strength of the control group and the experimental group were 30.40 g/cm(2) and 40.50 g/cm(2), respectively. There was no statistically significant difference between the groups (P value = 0.58). The proportions of the samples without wound dehiscence at the maximum limit of the tensiometer (120 g/cm(2)) were 0.15 (3/20) in the control group and 0.35 (7/20) in the experimental group. CONCLUSION: The CO2 laser welding used in this study failed to show a greater immediate tensile strength but had a higher proportion of the wound without dehiscence at the 120 g/cm(2) tensile strength by comparison with the suture alone.

A clinical efficacy of using CO2 laser irradiating to transparent gel on aphthous stomatitis patients.

BACKGROUND AND AIMS: Regarding the laser energy delivery with non-tissue alteration when irradiating CO2 laser to the transparent gel, it was worth exploring the clinical efficacy of pain relief on oral ulceration using aphthous stomatitis as a model for painful oral ulcer. The aims of this study were to compare pain scores, daily activity-disturbance scores and sizes of the ulcers between the laser group and the placebo group. SUBJECTS AND METHODS: The double blind- randomized- placebo- controlled trial was conducted in 14 patients with aphthous ulcers. The subjects were allocated into 2 groups; namely, the laser group and the placebo group. The two baselines were measured on the day before and the treatment day. Then the lesions were covered with the transparent gel and irradiated by either 2 W defocused CO2 laser for 5 seconds or the sham laser. The outcomes were collected immediately, on day 1, 3, 5 and 7 after treatment. RESULTS: The means of pain and daily activity-disturbance scores of the laser group were lesser than the placebo group in every episode. A statistically significant difference between the groups was found only the pain score on day 3 after treatment (P-value<0.001, 95% CI of the difference = 8.8 to 19.20 mm). There were no statistically significant differences in the daily activity-disturbance scores and the sizes of the ulcers between the groups (P value > 0.05). CONCLUSION: The CO2 laser therapy used in this clinical study was able to relieve pain from aphthous stomatitis compared with the placebo on the day 3 after treatment.

The Ablation Properties of CO(2) Laser Irradiating to Absorption Media: An In Vitro Study.

This study aimed to compare histological affected zone of tissue samples irradiated by defocused CO(2) laser at 1, 2, and 3W continuous wave with and without absorption media. The in vitro experiment was conducted in 70 tissue blocks. The samples were randomly allocated into 7 groups: 10 samples each group, namely, the groups irradiated with 1, 2, and 3W, defocused CO(2) laser for 5 seconds, the groups irradiated with 1, 2, and 3W, defocused CO(2) laser to the absorption media, and the media alone group as a control. Then the samples were stained with Masson's trichrome and measured the affected borders under light microscope at 10 × 10 magnification. There was no histological alteration in the groups irradiated with the defocused CO(2) laser to the absorption media while the groups without using the absorption media showed the tissue alteration by photoablation.