Effect of Low Level Laser Therapy (LLLT) after tooth extraction in patients trated with bisphosphonates medication: clinical evaluation
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1
University of Turin, Department of Surgical Sciences, Italy
Aim. LLLT (Low Level Laser Therapy) works on cell metabolism and cell proliferation, increasing the expression of growth factors, macrophages and fibroblasts. This can be useful in the oral surgery, where tissue damage is part of common surgical procedures, especially when dealing with types of patients, such as those who take bisphosphonates. In case of extractions or traumas, there is the risk, in fact, of incurring the main side effect in the dental field: the BR-ONJ (Bisphosphonates-related osteonecrosis of the Jaws). Clinical data on pain and healing of post-extraction wounds of patients receiving bisphosphonate therapy were presented, using laser therapy. The aim was to emphasize or refuse a statistically significant association between the clinical use of the laser in patients taking bisphosphonates after tooth extractions compared to patients not receiving laser therapy, evaluating the quality of wound healing and post-operative algic symptomatology.
Materials and Methods. Twenty patients aged 52 to 90 (mean 70,57 ± 9,1 SD) suffering from oncological and/or osteometabolic diseases, treated with Zometa for at least 3 months and with need tooth extraction are included. They were divided into laser irradiation (5 sessions: 1 on the day of the extraction, then 1/week for 1 month) and non-irradiation (monitored with the same frequency). Then, the two groups were compared, evaluating both the healing quality of the wound by Healing Scale (HS), and the pain perceived by the patients using the VAS scale.
The laser equipment used is the diode laser Lumix 2 (Fisioline), set on a biostimulation program (Fluence 180 J/cm2, frequency 30 KHz, time: 15').
Results. According to this study, LLLT does not provide a decrease in postoperative discomfort in the immediate, but after two weeks; for each week of monitoring between patients exposed to LLLT and non-exposed patients, the VAS was found to be significant only at T3, with a p-value of 0.01. Wound healing, instead, was better in the LLLT exposed compared to unexposed subjects, especially in the third laser session; the results were significant both at T3 and at T4, with p-value values of 0.003 and 0.01 respectively.
Discussion. The presence of statistically significant differences in many parameters concerning HS compared in the exposed and in the unexposed, shows that the LLLT can be a valid support tool for the dental hygienist. The LLLT demonstrated to possess anti-inflammatory actions, helping to control pain, and biostimulant properties, going to act on bacterial control and wound healing. It has therefore proved to be effective compared to the classic clinical management of these patients, as it is easy to administer and has no side effects. It is important to underline the key role that dental hygienists can play in collaboration with the dentist in preventing the onset of osteonecrosis of the jaws, through careful evaluation of the patient, to intercept those clinical presentations that predispose him to the development of the lesion, intervening promptly through personalized prevention programs, such as laser therapy.
References
1. Tuby H, Maltz L, Oron U. Modulation of VEGF and iNOS in the rat heart by low level laser therapy are associated with cardioprotection and enhanced angiogenesis. Lasers Surg Med 2006;38:682-8
2. Latifyan et al. (2016) Bisphosphonate-related osteonecrosis of the jaw: a review of the potential efficacy of low-level laser therapy, Support Care Cancer 2016 24:3687–3693
3. Masse JF, Landry RG, Rochette C, et al. Effectiveness of soft laser treatment in periodontal surgery. Int Dent J 1993;43:121-127
Keywords:
Low level laser therapy (LLLT),
Bisphosphonates (BP),
Tooth Extraction,
MRONJ,
dental hygiene
Conference:
5th National and 1st International Symposium of Italian Society of Oral Pathology and Medicine., Ancona, Italy, 19 Oct - 20 Oct, 2018.
Presentation Type:
Poster Presentation
Topic:
Medications-related osteonecrosis of the Jaws
Citation:
Fontana
G,
Gambino
A,
Erovigni
F,
Dell'Acqua
A and
Carossa
S
(2019). Effect of Low Level Laser Therapy (LLLT) after tooth extraction in patients trated with bisphosphonates medication: clinical evaluation.
Front. Physiol.
Conference Abstract:
5th National and 1st International Symposium of Italian Society of Oral Pathology and Medicine..
doi: 10.3389/conf.fphys.2019.27.00058
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Received:
02 Nov 2018;
Published Online:
09 Dec 2019.
*
Correspondence:
Dr. Giulia Fontana, University of Turin, Department of Surgical Sciences, Turin, Piedmont, 10124, Italy, fontanagiulia06@gmail.com