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Laser Therapy Research for Dental Applications

Effect of adjunctive low level laser therapy (LLLT) on nonsurgical treatment of chronic periodontitis.

Makhlouf M, Dahaba MM, Tunér J, Eissa SA, Harhash TA.

Laser Institute, Cairo, Egypt.

Photomed Laser Surg. 2012 Mar;30(3):160-6. Epub 2012 Jan 10. [PMID: 22233558]

OBJECTIVE: The aim of this split-mouth, double blinded, short-term, controlled clinical trial was to study the effect of low-level laser therapy (LLLT) as an adjunct to scaling and root planing (SRP) for treatment of chronic periodontitis.

BACKGROUND DATA: LLLT is reported to improve the outcome of traditional SRP, but the evidence is still weak.

MATERIALS & METHODS: Sixteen patients with a probing pocket depth (PPD) of 4-6 mm involving at least three teeth in each quadrant were recruited for the study. Afterwards, SRP quadrants were randomly assigned for 10 sessions of LLLT.

RESULTS: Results showed that when compared to sites treated with SRP alone, those treated with SRP+LLLT (10 sessions, 830 nm, 100 mW, 3 J per point, 3 J/cm(2)) exhibited greater reductions in PPD at 5 weeks and 3 months but not at 6 months. Further, SRP+LLLT-treated sites had a statistically significant increase in mean radiographic bone density when comparing 6- and 12-month data and overall from baseline to 12 months. There was a trend to reduce interleukin (IL)-1β but the difference between control and laser sites was not statistically significant.

CONCLUSIONS: SRP combined with LLLT improved radiographic bone density and short-term PPD reduction in patients with chronic periodontitis, but did not significantly affect either the gingival crevicular fluid of IL-1β or the gingival or plaque index.

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Adjunctive Infrared Diode Laser Therapy Accelerates Healing in Apical Granulomas: A Case Report Study

Rozana Dana Vieru and Agafita Lefter
Center for Dentistry, Periodontology and Laser, Bucharest, Romania

Abstract: The final stage of severe infection round the apex of a tooth is granuloma formation, the treatment of which can be a major problem in clinical dentistry. Although granulomas in the early stages can respond to conservative conventional therapy, such as the application of calcium hydroxide, many in the later stage require surgical intervention with the risk of postoperative sequelae and patient downtime. Low Reactive-Level Laser Therapy (LLLT) has been shown to reduce inflammation and accelerate wound healing. The present study was designed to assess the role of 830nm diode laser therapy in conjuction with conservative conventional therapy in the treatment of severe apical granulomas. Thirty-three young male patients with severe apical granulomas participated in the study, 19 of whom were treated with conventional treatments, and 14 with calcium hydroxide combined with 0.5 J/cm2 - 2 J/cm2 intra- and extraoral diode laser therapy. Significant improvements were seen in the LLLT combination group compared with the control group in the time taken for the resolution of acute postoperative pain (100 vs 500 min) and inflammation (1.6 vs 5.6 days), and long-term tooth remineralization and alveolar bone regeneration (15 vs 33 months). LLLT with the 830 nm diode laser was shown to be safe and effective in combination with conservative conventional therapy in the treatment of severe apical granulomas and was superior to the conventional approach on its own for granulomas of similar severity.

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Low-level laser therapy influences mouse odontoblast-like cell response in vitro.

Pereira LB, Chimello DT, Ferreira MR, Bachmann L, Rosa AL, Bombonato-Prado KF.

Department of Orthodontics, Nihon University School of Dentistry, Chiyoda-ku, Tokyo, Japan.

Photomed Laser Surg. 2012 Apr;30(4):206-13. Epub 2012 Feb 29. [PMID: 22375953]

OBJECTIVE: The purpose of this study was to analyze the influence of two different irradiation times with 85 mW/cm(2) 830 nm laser on the behavior of mouse odontoblast-like cells.

BACKGROUND DATA: The use of low-level laser therapy (LLLT) to stimulate pulp tissue is a reality, but few reports relate odontoblastic responses to irradiation in in vitro models.

METHODS: Odontoblast-like cells (MDPC-23) were cultivated and divided into three groups: control/nonirradiated (group 1); or irradiated with 85 mW/cm(2), 830 nm laser for 10 sec (0.8 J/cm(2)) (group 2); or for 50 sec (4.2 J/cm(2)) (group 3) with a wavelength of 830 nm. After 3, 7, and 10 days, it was analyzed: growth curve and cell viability, total protein content, alkaline phosphatase (ALP) activity, calcified nodules detection and quantification, collagen immunolocalization, vascular endothelial growth factor (VEGF) expression, and real-time polymerase chain reaction (PCR) for DMP1 gene. Data were analyzed by Kruskall-Wallis test (α=0.05).

RESULTS: Cell growth was smaller in group 2 (p<0.01), whereas viability was similar in all groups and at all periods. Total protein content and ALP activity increased on the 10th day with 0.8 J/cm(2) (p<0.01), as well as the detection and quantification of mineralization nodules (p<0.05), collagen, and VEGF expression (p<0.01). The expression of DMP1 increased in all groups (p<0.05) compared with control at 3 days, except for 0.8 J/cm(2) at 3 days and control at 10 days.

CONCLUSIONS: LLLT influenced the behavior of odontoblast-like cells; the shorter time/smallest energy density promoted the expression of odontoblastic phenotype in a more significant way.

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Effect of low-level laser therapy (GaAlAs) on bone regeneration in midpalatal anterior suture after surgically assisted rapid maxillary expansion.

Angeletti P, Pereira MD, Gomes HC, Hino CT, Ferreira LM.

Division of Plastic Surgery, Federal University of São Paulo, São Paulo, Brazil

Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010 Mar;109(3):e38-46. [PMID: 20219584]

OBJECTIVE: The aim of this study was to evaluate the effects of laser therapy on bone regeneration in the midpalatal anterior suture (MPAS) after surgically assisted rapid maxillary expansion (SARME).

METHODS: Thirteen patients aged between 18 and 33 years old with maxillary transverse deficiency (> or =7.0 mm) were evaluated. All patients underwent subtotal Le Fort I osteotomy with separation of the pterygomaxillary suture with the use of Hyrax expander, and were divided into 2 groups: control group (n = 6) and laser group (n = 7). A GaAlAs laser (P = 100 mW, lambda = 830 nm, Ø = 0.06 cm(2)) was used. The laser was applied in 8 treatment sessions with intervals of 48 hours. Each treatment session consisted of laser applications, per point (E = 8.4J, ED = 140J/cm(2)), at 3 points on the MPAS, and total dose of E = 25.2 J, ED = 420 J/cm(2). Digital radiographs were taken before the surgical procedure and at 1-, 2-, 3-, 4-, and 7-month follow-up visits. Optical density analysis of the regenerated bone was performed using Adobe Photoshop 8.0 software.

RESULTS: Bone regeneration associated with the use of laser after SARME showed a statistically significant difference. A higher mineralization rate was found in the laser group (26.3%, P < .001) than the control group.

CONCLUSIONS: Low-level laser irradiation (GaAlAs) accelerates bone regeneration in MPAS after SARME. However, the optical density measurements after 7 months of follow-up were lower in comparison with the preoperative measurements.

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Low reactive-level 830 nm GaAlAs diode laser therapy successfully accelerates regeneration of peripheral nerves in human

Ezekiel Dangwa Midamba and Hans Reidar Haanaes
Department of Oral and Maxillofacial Surgery and Oral Medicine, Odense University Hospital, Denmark
Laser Therapy 5; 125-129, 1993 © John Wiley & Sons, Ltd.

Abstract:Forty patients with short and long-term neurosensory impairment following perioral nerve injuries are presented in this study. Assessment of their sensory level was undertaken using a variety of nerve tests, one of them was a visual analog scale for registration of sensitivity level prior to and after 10 treatment sessions and additionally for 21 of the 40 patients after 20 treatment sessions. Low level laser therapy was applied using GaAlAs 830 nm, 70 mW continuous wave. Dose of 6.0 J/cm2 was standardized for all patients. Improvement of the eight patients with clinical symptoms of less than 1 year after 10 treatments, was between 40-90% and after 20 treatments between 60-80% for the three patients who continued with the treatment. In 32 of the 40 patients with clinical symptoms of more than 1 year in duration, their improvement was estimated at between 40 and 80%, 21 patients completed 20 treatment sessions and the end results were between 60-90%. This was an uncontrolled clinical study of LLLT on perioral nerve injuries and demonstrated the effectiveness of GaAlAs laser on the nerve involved when applied to the nerve trunk and terminal endings. Although controlled research into actual mechanisms and pathways is needed, the preliminary findings are very promising

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Analgesic effect of a low-level laser therapy (830 nm) in early orthodontic treatment.

Artés-Ribas M, Arnabat-Dominguez J, Puigdollers A.

Dental School, International University of Catalunya, Campus Sant Cugat, Josep Trueta s/n, 08195-St. Cugat del Vallès, Barcelona, Spain.

Lasers Med Sci. 2012 Jul 21. [Epub ahead of print] [PMID: 22814893]

Abstract: The aim of this study was to evaluate the pain sensation that orthodontic patients experience when elastic separators are placed between molars and premolars and to determine the degree of analgesic efficacy of low-level laser therapy (LLLT) compared to a placebo treatment. The study was conducted with 20 volunteers who were fitted with elastic separators between the maxillary molars and premolars. One quadrant was randomly chosen to be irradiated with an 830-nm laser, 100 mW, beam diameter of 7 mm, 250 mW/cm(2) applied for 20 s per point (5 J/cm(2)). Three points were irradiated in the buccal face and three were irradiated in the palate. The same procedure was applied in the contralateral quadrant with a placebo light. A visual analogue scale was used to assess pain 5 min, 6 h, 24 h, 48 h, and 72 h after placement of the separators. Maximum pain occurred 6-24 h after placement of the elastic separators. Pain intensity was significantly lower in the laser-treated quadrant (mean, 7.7 mm) than in the placebo-treated quadrant (mean, 14.14 mm; p = 0.0001). LLLT at these parameters can reduce pain in patients following placement of orthodontic rubber separators.

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Effects of low-level laser therapy and orthodontic tooth movement on dental pulps in rats

Abi-Ramia LB, Sasso Stuani A, Sasso Stuani A, Sasso Stuani MB, de Moraes Mendes A.

Angle Orthod. 2010 Jan;80(1):116-22. [PMID: 19852650]

Abstract Objectives: To describe the microscopic pulpal reactions resulting from orthodontically induced tooth movement associated with low-level laser therapy (LLLT) in rats.

Materials and Methods: Forty-five young male Wistar rats were randomly assigned to three groups. In group I (n = 20), the maxillary right first molars were submitted to orthodontic movement with placement of a coil spring. In group II (n = 20), the teeth were submitted to orthodontic movement plus LLLT at 4 seconds per point (buccal, palatal, and mesial) with a GaAlAs diode laser source (830 nm, 100 mW, 18 J/cm(2)). Group III (n = 5) served as a control (no orthodontic movement or LLLT). Groups I and II were divided into four subgroups according to the time elapsed between the start of tooth movement and sacrifice (12 hours, 24 hours, 3 days, and 7 days).

Results: Up until the 3-day period, the specimens in group I presented a thicker odontoblastic layer, no cell-free zone of Weil, pulp core with differentiated mesenchymal and defense cells, and a high concentration of blood vessels. In group II, at the 12- and 24-hour time points, the odontoblastic layer was disorganized and the cell-free zone of Weil was absent, presenting undifferentiated cells, intensive vascularization with congested capillaries, and scarce defense cells in the cell-rich zone. In groups I and II, pulpal responses to the stimuli were more intense in the area underneath the region of application of the force or force/laser.

Conclusions: The orthodontic-induced tooth movement and LLLT association showed reversible hyperemia as a tissue response to the stimulus. LLLT leads to a faster repair of the pulpal tissue due to orthodontic movement.

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The Short-term Effects of Low Level Lasers as Adjunct Therapy in the Treatment of Periodontal Inflammation

Qadri T, Miranda L, Tuné r J, Gustafsson A.
Department of Periodontology, Institute of Odontology, Karolinska Institutet, Huddinge, Sweden.

J Clin Periodontol. 2005 Jul;32(7):714-9. [PMID: 15966876]

OBJECTIVES: The aim of this split-mouth, double-blind controlled clinical trial was to study the effects of irradiation with low-level lasers as an adjunctive treatment of inflamed gingival tissue.

MATERIALS AND METHODS: Seventeen patients with moderate periodontitis were included. After clinical examination, all teeth were scaled and root planed (SRP). One week after SRP, we took samples of gingival crevicular fluid (GCF) and subgingival plaque. The laser therapy was started 1 week later and continued once a week for 6 weeks. One side of the upper jaw was treated with active laser and the other with a placebo. The test side was treated with two low-level lasers having wavelengths of 635 and 830 nm. The patients then underwent another clinical examination with sampling of GCF and plaque. The GCF samples were analysed for elastase activity, interleukin-1beta (IL-1beta) and metalloproteinase-8 (MMP-8). We examined the subgingival plaque for 12 bacteria using DNA probes.

RESULTS: The clinical variables i.e. probing pocket depth, plaque and gingival indices were reduced more on the laser side than on the placebo one (p<0.01). The decrease in GCF volume was also greater on the laser side, 0, 12 microl, than on the placebo side, 0.05 microl (p=0.01). The total amount of MMP-8 increased on the placebo side but was slightly lower on the laser side (p=0.052). Elastase activity, IL-1beta concentration and the microbiological analyses showed no significant differences between the laser and placebo sides.

CONCLUSION: Additional treatment with low-level lasers reduced periodontal gingival inflammation.

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Low-level laser therapy enhances the stability of orthodontic mini-implants via bone formation related to BMP-2 expression in a rat model.

Omasa S, Motoyoshi M, Arai Y, Ejima K, Shimizu N.
Department of Orthodontics, Nihon University School of Dentistry, Chiyoda-ku, Tokyo, Japan

Photomed Laser Surg. 2012 May;30(5):255-61. Epub 2012 Mar 9. [PMID: 22404559]

OBJECTIVES:: The aim of this study was to investigate the stimulatory effects of low-level laser therapy (LLLT) on the stability of mini-implants in rat tibiae.

BACKGROUND DATA: In adolescent patients, loosening is a notable complication of mini-implants used to provide anchorage in orthodontic treatments. Previously, the stimulatory effects of LLLT on bone formation were reported; here, it was examined whether LLLT enhanced the stability of mini-implants via peri-implant bone formation.

MATERIALS AND METHODS: Seventy-eight titanium mini-implants were placed into both tibiae of 6-week-old male rats. The mini-implants in the right tibia were subjected to LLLT of gallium-aluminium-arsenide laser (830 nm) once a day during 7 days, and the mini-implants in the left tibia served as nonirradiated controls. At 7 and 35 days after implantation, the stability of the mini-implants was investigated using the diagnostic tool (Periotest). New bone volume around the mini-implants was measured on days 3, 5, and 7 by in vivo microfocus CT. The gene expression of bone m2orphogenetic protein (BMP)-2 in bone around the mini-implants was also analyzed using real-time reverse-transcription polymerase chain reaction assays. The data were statistically analyzed using Student's t test.

RESULTS: Periotest values were significantly lower (0.79- to 0.65-fold) and the volume of newly formed bone was significantly higher (1.53-fold) in the LLLT group. LLLT also stimulated significant BMP-2 gene expression in peri-implant bone (1.92-fold).

CONCLUSIONS: LLLT enhanced the stability of mini-implants placed in rat tibiae and accelerated peri-implant bone formation by increasing the gene expression of BMP-2 in surrounding cells.

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Infrared laser photobiomodulation (lambda 830 nm) on bone tissue around dental implants: a Raman spectroscopy and scanning electronic microscopy study in rabbits.

Lopes CB, Pinheiro AL, Sathaiah S, Da Silva NS, Salgado MA.
Instituto de Pesquisa & Desenvolvimento [Institute for Research & Development] (IP&D), Universidade do Vale do Paraíba (UNIVAP), São José dos Campos, Brazil., Department of Dentistry, UNIVAP, São José dos Campos, Brazil.

Photomed Laser Surg. 2007 Apr;25(2):96-101. [PMID: 17508844]

OBJECTIVES: The aim of this study was to assess, through Raman spectroscopy, the incorporation of calcium hydroxyapatite (CHA; approximately 960 cm(1)), and scanning electron microscopy (SEM), the bone quality on the healing bone around dental implants after laser photobiomodulation (lambda830 nm).

BACKGROUND DATA:Laser photobiomodulation has been successfully used to improve bone quality around dental implants, allowing early wearing of prostheses.

METHODS: Fourteen rabbits received a titanium implant on the tibia; eight of them were irradiated with lambda830 nm laser (seven sessions at 48-h intervals, 21.5 J/cm(2) per point, 10 mW, phi approximately 0.0028 cm(2), 86 J per session), and six acted as control. The animals were sacrificed 15, 30, and 45 days after surgery. Specimens were routinely prepared for Raman spectroscopy and SEM. Eight readings were taken on the bone around the implant.

RESULTS: The results showed significant differences on the concentration of CHA on irradiated and control specimens at both 30 and 45 days after surgery (p < 0.001).

CONCLUSION: It is concluded that infrared laser photobiomodulation does improve bone healing, and this may be safely assessed by Raman spectroscopy or SEM.

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Effect of low-level laser therapy on Candida albicans growth in patients with denture stomatitis.

Maver-Biscanin M, Mravak-Stipetic M, Jerolimov V.
Department of Prosthodontics, Clinical Hospital Centre, Zagreb, Croatia.

Photomed Laser Surg. 2005 Jun;23(3):328-32. [PMID: 15954824]

OBJECTIVE: The purpose of our report is to present the effect of low-level laser therapy on Candida albicans growth and palatal inflammation in two patients with denture stomatitis.

BACKGROUND DATA: The most common oral mucosal disorder in denture wearers is denture stomatitis, a condition that is usually associated with the presence of the yeast Candida albicans. Different treatment methods have been suggested to treat this symptom, none of which is proven to be absolutely effective.

METHODS: Two denture-wearing patients, both with palatal inflammation diagnosed as Newton type II denture stomatitis were treated with low-power semiconductor diode laser (BTL-2000, Prague, Czech Republic) at different wavelengths (685 and 830 nm) for 5 d consecutively. In both patients, palatal mucosa and acrylic denture base were irradiated in noncontact mode (probe distance of 0.5 cm from irradiated area) with different exposure times-5 min (830 nm, 3.0 J/cm2, 60 mW) and 10 min (685 nm, 3.0 J/cm2, 30 mW). The effect of laser light on fungal growth in vivo was evaluated after the final treatment using the swab method and semiquantitative estimation of Candida albicans colonies growth on agar plates. The severity of inflammation was evaluated using clinical criteria.

RESULTS: After lowlevel laser treatment, the reduction of yeast colonies on the agar plates was observed and palatal inflammation was diminished.

CONCLUSION: LLLT is effective in the treatment of denture stomatitis. Further placebo controlled studies are in progress.

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ML830 Laser Therapy for the Treatment of TMJ & TMD

Dr. Donald G. Kimble Neuro Muscular TMJ Specialist

There are a variety of treatment modalities, which can be divided into Phase I and Phase II. The purpose of Phase I is to eliminate muscle spasms, TMJ swelling, bruxism (grinding of the teeth) and any dislocation, and generally reduce any type of pain. This treatment usually includes the use of the TMJ appliance (mouth splint), exercises, medication, different therapy, and natural muscles relaxants, and Micro-light Cold Laser Treatments (ML830) to relieve TMJ pain. The ML830 ia a non-invasive, non-thermal laser, capable of penetrating deep into tissue. It is one of the most fascinatingnew healing advances, and is FDA CLEARED to treat and manage TMJD pain, muscle and joint pain relief.
The purpose of Phase I therapy is to definitively correct any discrepancies, if necessary, between the upper and lower jaws. Phase 1 therapy may include adjustments of the TMJ joint, orthodontics, surgery or a combination of treatments. It is important to note that Phase II therapy should not be attempted without successful Phase 1 treatment.
Phase I Therapy is usually composed of three types of treatment, all aimed at reducing or eliminating muscle and joint pain.
Therapy No.1
The use of an intra-oral splint (The TMJ Appliance). The TMJ appliance is a computer designed intra oral device that fits most adult mouths without adjusting. It is specifically designed to assist in the treatments of TMJ disorders. The TMJ appliance has been designed by Australian Dentist Dr. Chris Farrell, in response to the need for a low cost intra-oral splint that could be implemented by health care providers, as well as dentists, for the many patients who present with symptoms of TMJ disorders. It is specifically designed to assist in treatments of TMJ disorder. No molding, adjusting or custom fitting is required.
Therapy No. 2
The use of different modes of treatment to reduce muscle and nerve pain. This is a special natural pain relief supplement called (SERENITOL). Proven effective in reducing the reversing the effect if Sleep Apnea, Bruxism, nightly TMJ dysfunction, insomnia, Anxiety Neurosis, Chronic Fatigue and other sleep related disorders. Use of Serenitol, used properly and conservatively is very benefical.
Therapy No.3
The use of MicroLight ML830 Cold Laser Therapy. The ML830 Laser is a non-thermal laser capable of penetrating deep into tissue. FDA CLEARED to treat and manage TMJD pain, muscle and joint pain relief, the ML830 Laser is also used to treat carpal tunnel syndrome at our office.
One of the most fascinating and used healing advances is the ML830 low level laser. We are pleased to announce that the ML830 laser has received clearance for the treatment of TMJD and Carpal Tunnel Syndrome.
Laser therapy has been successfully used around the world for over 25 years, with no reported long-term or irreversible side effect. TMJD sufferers are now free to seek relief from TMJ jaw pain through a new non-invasive form of therapy before resorting to surgery. We have had excellent results using the non-thermal laser to relieve pain and promote healing of the painful tissue.
Phase I therapy is considered reversible. In other words, if treatment of phase 1 therapy is discontinued, no detrimental changes will have occurred. If the patient sees no improvement, then they are no worse off than before they began treatment.

Dr. Donald G. Kimble Neuro Muscular TMJ Specialist

Click Here to Read the Full Article on ML830 Laser for TMJ

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Evaluation of low-level laser therapy in patients with acute and chronic temporomandibular disorders.

Salmos-Brito JA, de Menezes RF, Teixeira CE, Gonzaga RK, Rodrigues BH, Braz R, Bessa-Nogueira RV, de Martínez Gerbi ME.

Dental School, University of Pernambuco, Pernambuco, Brazil,

Lasers Med Sci. 2012 Feb 25. [Epub ahead of print] [PMID: 22367394]

Abstract: The purpose of this study was to address the following question: among patients with acute or chronic temporomandibular disorders (TMD), does low-level laser therapy (LLLT) reduce pain intensity and improve maximal mouth opening? The sample comprised myogenic TMD patients (according Research Diagnostic Criteria for TMD). Inclusion criteria were: male/female, no age limit, orofacial pain, tender points, limited jaw movements and chewing difficulties. Patients with other TMD subtypes or associated musculoskeletal/rheumatologic disease, missing incisors teeth, LLLT contra-indication, and previous TMD treatment were excluded. According to disease duration, patients were allocated into two groups, acute (<6 months) and chronic TMD (≥6 months). For each patient, 12 LLLT sessions were performed (gallium-aluminum-arsenide; λ = 830 nm, P = 40 mW, CW, ED = 8 J/cm(2)). Pain intensity was recorded using a 10-cm visual analog scale and maximal mouth opening using a digital ruler (both recorded before/after LLLT). The investigators were previously calibrated and blinded to the groups (double-blind study) and level of significance was 5% (p < 0.05). Fifty-eight patients met all criteria, 32 (acute TMD), and 26 (chronic TMD). Both groups had a significant pain intensity reduction and maximal mouth opening improvement after LLLT (Wilcoxon test, p < 0.001). Between the groups, acute TMD patient had a more significant pain intensity reduction (Mann-Whitney test, p = 0.002) and a more significant maximal mouth opening improvement (Mann-Whitney test, p = 0.011). Low-level laser therapy can be considered as an alternative physical modality or supplementary approach for management of acute and chronic myogenic temporomandibular disorder; however, patients with acute disease are likely to have a better outcome.

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Effectiveness of physiotherapy and GaAlAs laser in the management of temporomandibular joint disorders.

Dostalová T, Hlinakova P, Kasparova M, Rehacek A, Vavrickova L, Navrátil L.

Department of Paediatric Stomatology, 2nd Medical Faculty, Charles University, Prague, Czech Republic.

Photomed Laser Surg. 2012 May;30(5):275-80. [PMID: 22551049]

OBJECTIVE: Low-level laser therapy (LLLT) is a treatment method commonly used in physiotherapy for musculoskeletal disorders. The aim of this study was to monitor the function of temporomandibular joint (TMJ) and surrounding tissues and compare the objective measurements of the effect of LLLT.

BACKGROUND DATA: LLLT has been considered effective in reducing pain and muscular tension; thus improving the quality of patients' lives.

MATERIALS AND METHODS: TMJ function was evaluated by cephalometric tracing analysis, orthopantomogram, TMJ tomogram, and computer face-bow record. Interalveolar space between central incisors before and after therapy was measured. Patients evaluated pain on the Visual Analog Scale. LLLT was performed in five treatment sessions (energy density of 15.4 J/cm(2)) by semiconductive GaAlAs laser with an output of 280 mW, emitting radiation wavelength of 830 mm. The laser supplied a spot of ~0.2 cm(2).

RESULTS: Baseline comparisons between the healthy patients and patients with low-level laser application show that TMJ pain during function is based on anatomical and function changes in TMJ areas. Significant differences were seen in the posterior and anterior face height. The results comparing healthy and impaired TMJ sagittal condyle paths showed that patients with TMJ pain during function had significantly flatter nonanatomical movement during function. After therapy, the unpleasant feeling was reduced from 27.5 to 4.16 on the pain Visual Analog Scale. The pain had reduced the ability to open the mouth from 34 to 42 mm.

CONCLUSIONS: The laser therapy was effective in the improvement of the range of temporomandibular disorders (TMD) and promoted a significant reduction of pain symptoms.

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Rheumatoid arthritis-affected temporomandibular joint pain analgesia by linear polarized near infrared irradiation.

Yokoyama K, Oku T.
Department of Anesthesia, School of Dentistry, Kagoshima University Dental Hospital, Sakuragaoka, Japan.

Can J Anaesth. 1999 Jul;46(7):683-7. [PMID: 10442966]

PURPOSE: To describe a new short-term treatment for pain in rheumatoid arthritis (RA)-affected temporomandibular joint (TMJ).

CLINICAL FEATURES: We investigated four female patients (age 42.8+/-26.0 yr) with chronic rheumatoid arthritis affecting a single TMJ. Patients had received antirheumatic drugs such as sodium aurothiomalate, and as a result showed no symptoms in other body joints. Linear polarized near infrared radiation using Super Lizer was applied weekly with and/or without jaw movement to the unilateral skin areas overlying the mandibular fossa, anterior articular tubercle, masseter muscle and posterior margin of the ramus of the mandible. The duration of irradiation to each point was two seconds on and ten seconds off per cycle and the intensity at each point was approximately 138 J x cm(-2) at a wavelength of 830 nm. Interincisal distance was measured with maximal mouth opening in the absence and presence of pain before and after each treatment. Additionally, subjective TMJ pain scores assessed using a visual analog scale were performed for painful maximal mouth opening before and after each irradiation. TMJ pain disappeared after only four treatments. Moreover, painless maximal mouth opening without pain after irradiation in three patients was on average improved to 5.3+/-2.1 mm. However, one case was observed where the opening length prior to irradiation did not improve, despite the fact that the RA-affected TMJ pain had disappeared.

Conclusion: Application of linear polarized near infrared irradiation to patients with RA-affected TMJ pain is an effective and non-invasive short-term treatment.

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Measurements of Jaw Movements and TMJ Pain Intensity in Patients Treated with GaAlAs Laser

Marcelo Oliveira MAZZETTO 1; Takami Hirono HOTTA 1,2; Renata Campi de Andrade PIZZO 1
1) Ribeirão Preto Dental School, University of São Paulo, Ribeirão Preto, SP, Brazil; 2) Dental School, University of Franca, Franca, SP, Brazil

Braz Dent J (2010) 21(4): 356-360 [PMID: 20976388]

Abstract: The aim of this study was to evaluate the effectiveness of low-level laser therapy (LLLT) on the improvement of the mandibular movements and painful symptoms in individuals with temporomandibular disorders (TMD). Forty patients were randomly divided into two groups (n=20): Group 1 received the effective dose (GaAlAs laser λ 830 nm, 40 mW, 5J/cm²) and Group 2 received the placebo application (0 J/cm²), in continuous mode on the affected condyle lateral pole: superior, anterior, posterior, and posterior-inferior, twice a week during 4 weeks. Four evaluations were performed: E1 (before laser application), E2 (right after the last application), E3 (one week after the last application) and E4 (30 days after the last application). The Kruskal-Wallis test showed significant more improvements (p<0.01) in painful symptoms in the treated group than in the placebo group. A significant improvement in the range of mandibular movements was observed when the results were compared between the groups at E4. Laser application can be a supportive therapy in the treatment of TMD, since it resulted in the immediate decrease of painful symptoms and increased range of mandibular movements in the treated group. The same results were not observed in the placebo group.

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Effectiveness of low-level laser therapy in temporomandibular joint disorders: a placebo-controlled study

Fikácková H, Dostálová T, Navrátil L, Klaschka J.
Institute of Biophysics and Informatics, 1st Medical Faculty, Charles University, Prague, Czech Republic.

Photomed Laser Surg. 2007 Aug;25(4):297-303. [PMID: 17803388]

OBJECTIVE: Low-level laser therapy (LLLT) treatment for pain caused by temporomandibular joint disorders (TMD) was investigated in a controlled study comparing applied energy density, subgroups of TMD, and duration of disorders.

BACKGROUND DATA: Although LLLT is a physical therapy used in the treatment of musculoskeletal disorders, there is little evidence for its effectiveness in the treatment of TMD.

METHODS: The study group of 61 patients was treated with 10 J/cm(2) or 15 J/cm(2), and the control group of 19 patients was treated with 0.1 J/cm(2). LLLT was performed by a GaAlAs diode laser with output of 400 mW emitting radiation wavelength of 830 nm in 10 sessions. The probe with aperture 0.2 cm(2) was placed over the painful muscle spots in the patients with myofascial pain. In patients with TMD arthralgia the probe was placed behind, in front of, and above the mandibular condyle, and into the meatus acusticus externus. Changes in pain were evaluated by self-administered questionnaire.

RESULTS: Application of 10 J/cm(2) or 15 J/cm(2) was significantly more effective in reducing pain compared to placebo, but there were no significant differences between the energy densities used in the study group and between patients with myofascial pain and temporomandibular joint arthralgia. Results were marked in those with chronic pain.

CONCLUSION: The results suggest that LLLT (application of 10 J/cm(2) and 15 J/cm(2)) can be considered as a useful method for the treatment of TMD-related pain, especially long lasting pain.

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Arthralgia of the temporomandibular joint and low-level laser therapy

Fikácková H, Dostálová T, Vosická R, Peterová V, Navrátil L, Lesák J.
Institute of Biophysics and Informatics, 1st Medical Faculty, Charles University, Prague, Czech Republic.

Photomed Laser Surg. 2006 Aug;24(4):522-7. [PMID: 16942435]

OBJECTIVE: This case report describes the treatment of a patient with arthralgia of the temporomandibular joint (TMJ) caused by disc displacement.

BACKGROUND DATA: The goal of the treatment of TMJ arthralgia is to decrease pain by promotion of the musculoskeletal system’s natural healing ability.

METHODS: This report describes the complex treatment of TMJ arthralgia. Low-level laser therapy (LLLT) was chosen for its antiinflammatory and analgesic effects. Laser therapy was carried out using the GaAlAs diode laser with an output power of 400 mW, emitting radiation with a wavelength of 830 nm, and having energy density of 15 J/cm2; the laser radiation was applied by contact mode on four targeted spots in 10 sessions. Physiotherapy was recommended to this patient to prevent the injury of intraarticular tissue caused by incorrect movement during opening of the mouth. Splint stabilization and prosthetic treatment were used to reduce overloading of the TMJ, resulting from unstable occlusion and to help repositioning of the dislocated disc.

RESULTS: Five applications of LLLT led to decrease of pain in the area of the TMJ on the Visual Analog Scale, from 20 to 5 mm. The anti-inflammatory effect of the laser was confirmed by thermographic examination. Before treatment, the temperature differences between the areas of the normal TMJ and TMJ with arthralgia was higher than 0.5 degrees C. However, at the conclusion of LLLT, temperatures in the areas surrounding the TMJ were equalized.

CONCLUSION: This study showed the effectiveness of complex non-invasive treatment in patients with arthralgia of the TMJ. The analgesic and anti-inflammatory effects of LLLT were confirmed by infrared thermography.

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