Oral mucositis (OM) is a debilitating complication of chemotherapy, and head and neck radiotherapy. In an effort to offer the best possible advice within the limitations of published research, a systematic review with an extended discussion and commentary on dosimetry and dose delivery is presented. Using keywords as listed, Pubmed, Google Scholar and Cochrane databases were searched during a period extending from 1995 to 2019. A total of 782 abstracts were identified. A total of 50 papers were analysed, and of these, 29 satisfied criteria required for systematic review in accordance with an optimized PRISMA statement. Clinical outcome as reported was subject to analysis with respect to time of intervention, incidence and severity of oral mucositis, and pain amelioration, and a comprehensive combined univariate and multivariate statistical analysis of the methods employed was performed. Recommendations are made with respect to the timing of the intervention. Moreover, there is an extended discussion available on the treatment care rationale of photobiomodulation (PBM), and its adjunctive association with OM. In conclusion, early prophylactic application offers clear advantages in clinical management. The many studies and associated variables and covariables assessed here revealed a choice of delivery techniques, associated wavelengths and many further indices to consider with regard to the accomplishment of optical parameters. It is therefore our recommendation that clinicians use PBM as a therapy with a full and proper understanding and training in order to optimise the clinical effects achievable.

Objective: This systematic review of published research evaluates the parameters and reported outcomes in photobiomodulation therapies (PBMTs) used in management of pain and accelerated tooth movement during orthodontic treatment. Background: Consequent to positive in vitro and animal studies, there has been considerable interest in the potential applications of PBMT to ameliorate pain and to accelerate orthodontic tooth movement. Due to the lack of consistency of wavelengths and parameters applied, there is as yet no consensus in respect of guidance for clinical use. Within the limitations of the reported literature, a digest of key outcomes and parameters is presented here to assist researchers and interested clinicians. Materials and methods: Search engines, PubMed, Google Scholar, and Cochrane, were applied to identify clinical investigations into the potential benefits of PBMTs in orthodontic management. Keywords used were ''low-level laser therapy,'' ''low-level light therapy,'' ''photobiomodulation,'' ''orthodontics,'' ''pain,'' ''tooth movement,'' and ''randomized clinical trial ‡5 years.'' A total of 35 articles were identified, covering the 5-year period January 2013 to December 2018. Only human clinical trials were considered. Seventeen articles were included in this investigation and the reported parameters and outcomes were assessed and presented for comparison. Results: Seven of nine studies supported the effectiveness of PBMT to reduce or prevent pain. There was no consensus on choice of wavelength and a range of parameters were found beneficial. Of the seven tooth movement studies included, four of the seven were positive, of which two used a home-use light-emitting diode (LED) device, as opposed to a clinician-applied laser. A variety of wavelengths and parameters were found to be effective in accelerating tooth movement in the range of 20-40% compared with control. Conclusions: Due to a lack of consistency in approach, further studies are required to achieve a high level of acceptance. The clinical logistics associated with frequent applications supports the concept of patient home delivery use of LED devices, although there are insufficient studies at present to make an evidence-based determination of this type of appliance. To gain more general professional acceptance of the use of PBMT in orthodontics, a continued effort to extend the number of quality human clinical trials is required. Based on the current evidence base, further positive onward progression can be regarded as inevitable.

(1) Background: Adjunctive instruments, such as lasers have been investigated to address the risk of failure of endodontic therapy due to the complexity of the root canal system. Lasers have been used therapeutically, in direct irradiation of the root canals or adjunct to irrigants placed into the canals, in combination with a photosensitizer (antimicrobial photodynamic therapy) and in pain management (photobiomodulation). The purpose of this systematic review was to evaluate the evidence in clinical use within these three areas of therapy. (2) Methods: PubMed, Cochrane and Scopus search engines were used to identify human clinical trials regarding the use of lasers in endodontic therapy. (3) Results: After applying the keywords and additional filters, inclusion and exclusion criteria, the initial number of 1486 articles was reduced to 17. It was revealed that almost all studies (14/17) presented a statistically significant improved outcome in laser-assisted endodontic therapy, with the remaining three not showing any adverse effects. (4) Conclusions: The use of laser photonic energy of appropriate delivered parameters can be proposed as useful adjunctive when considering optimal treatment modalities in orthograde endodontics. Additionally, a tendency of research towards pain modulation in this field is developing.

No abstract

Objective: This systematic review and meta-analysis of published randomized controlled trials examines a possible relationship between optical spot size at surface tissue, irradiance, radiant exposure, total energy delivered, operator technique and reported clinical outcomes. Background: Clinical photobiomodulation (PBM) therapy has achieved a high level of evidence-based acceptance in the mitigation of oral mucositis associated with cancer radiotherapy and chemotherapy, and supportive clinical research in relation to orthodontic tooth movement, oral medical conditions, including burning mouth syndrome, xerostomia and lichen planus. Inconsistent outcomes have been reported not withstanding a substantial body of primary supportive research from clinical, in vitro and animal studies. Materials and Methods: PubMed, Cochrane Database of Reviews and Google Scholar search engines were applied to identify human clinical trials of PBM therapy in clinical dentistry. A total of 766 articles between February 2009 and June 2020 were identified and following a full text evaluation, 38 papers with sufficient data to permit analyses are included in this investigation. Results: Following a detailed assessment of potential factors that may have an influence in clinical outcome, a clear trend is apparent associating optical spot size to a positive or negative effect. Furthermore, there is a clear difference in the reported results in relation to total energy applied, delivery techniques and optical parameters, which merits further investigation. Factorial statistical analyses identified an association between smaller optical surface applications and an overall lower level of reported clinical success in treating superficial and deeper targets, and correspondingly sub-surface larger target tissues were found to be more responsive to therapy by use of a larger optical surface spot size. Moreover, use of multiple small diameter probe applications was found to provide inconsistent results. Conclusions: Many factors can confound clinical success including variations in anatomy, site location, clinical condition and subject individuality. To achieve higher levels of predictable outcome, a mature appreciation of these factors, plus an expanded understanding of laser parametry, tissue volume and target depth to deliver an adequate dose within current recommended guidelines, is essential.

Background: The aim of this systematic review is to compare the effectiveness of lasers in the treatment of implant mucositis and peri-implantitis compared to conventional treatment (non-surgical or surgical: resective or regenerative). Methods: Sources of PubMed, Cochrane and Google Scholar search engines were used on articles published from 1997 to 2020 in English, with selected keyword criteria applied. Nine randomized controlled trials (RCTs) were selected. Results: All included studies were considered of “high quality” according to the quality assessment scale. The comparative assessment of the RCTs was done twice for each RCT based on the type of treatment and according to wavelength. There is strong scientific evidence that, regarding non-surgical treatment, adjunct laser application can provide better results only in the short term (three months). Regarding the surgical approach, the method of decontamination plays a subordinate role. All wavelengths/applications presented similar results. Conclusion: Within the limitations of this study, the adjunctive use of lasers in the treatment of peri-implant inflammation is effective for up to three months; there is no strong evidence regarding the long term benefit compared to conventional treatment.

Background: Antimicrobial photodynamic therapy (aPDT) has been proposed as an effective alternative method for the adjunctive treatment of all classes of oral infections. The multifactorial nature of its mechanism of action correlates with various influencing factors, involving parameters concerning both the photosensitizer and the light delivery system. This study aims to critically evaluate the recorded parameters of aPDT applications that use lasers as the light source in randomized clinical trials in dentistry. Methods: PubMed and Cochrane search engines were used to identify human clinical trials of aPDT therapy in dentistry. After applying specific keywords, additional filters, inclusion and exclusion criteria, the initial number of 7744 articles was reduced to 38. Results: Almost one-half of the articles presented incomplete parameters, whilst the others had different protocols, even with the same photosensitizer and for the same field of application. Conclusions: No safe recommendation for aPDT protocols can be extrapolated for clinical use. Further research investigations should be performed with clear protocols, so that standardization for their potential dental applications can be achieved.

Fundamental to the adjunctive use of laser photonic energy for delivering therapy and tissue management, is the ability of the incident energy to be absorbed by target tissues. The aim of this review is to examine the differential performance of the separate components of oral hard and soft tissues when exposed to laser photonic irradiance of variable wavelengths and power values. Through an examination of peer-reviewed published data and materials, the interaction of laser photonic energy and target tissues are explored in detail. Varying laser wavelength emissions relative to anatomical structures explores the ability to optimise laser–tissue interactions, and also identifies possible risk scenarios as they apply to adjacent non-target structures. The concepts and practical aspects of laser photonic energy interactions with target oral tissues are clearly demonstrated. Emphasis was placed on optimising the minimum level of laser power delivery in order to achieve a desired tissue effect, whilst minimising the risk or outcome of collateral tissue damage.