Sourvanos, Dennis1, Fiorellini, Joseph P.2, Sarmiento, Hector2, Carroll, James3, Corby, Patricia M.4
1University of Pennsylvania School of Dental Medicine, Department of Periodontics; Center for Clinical Translational Research
2University of Pennsylvania School of Dental Medicine, Department of Periodontics
3THOR Photomedicine Ltd.
4School of Dental Medicine, Perelman Center for Advanced Medicine; University of Pennsylvania, Department of Oral Medicine, Department of Radiation Oncology
Photobiomodulation therapy (PBM) refers to the application of red and near infra-red light. This dental treatment modality has shown to significantly improve soft and hard tissue wound healing, reduce inflammation, and decrease pain discomfort when applied directly over an injury or lesion. Although human studies have trended positive results, there are no validated protocols of the use of PBM in dental extraction prior to implant placement therapies. Objective is to review human studies with PBM therapy, randomized clinical trials (RCTs), systematic reviews, classify PBM parameter’s, review the consistency of irradiation parameter reporting, and determine the spectrum of dosing per session.Methods
A systematic review was performed according to the Cochrane Collaboration and in line with PRISMA criteria. One investigator screened titles and abstracts; two investigators reviewed papers and assessed for risk of bias. Online databases searched included: PubMed, Embase, Scopus, and Web of Science. Terms were specific to photobiomodulation, PBM, low-level laser therapy, low-level light therapy, LLLT and their effects on dental extractions, alveolar ridge preservation, bone regeneration, dental implant placement, and dental implant stability.Results
A total of 28 human studies were identified. 18 were excluded for lack of randomization, incomplete parameters, using more than one wavelength on the same treatment group, and being reported in non-English language. Based on the 10 papers that met the criteria, 2 papers reported median irradiation parameters for having a positive effect on histologic/histometric analysis during dental extraction alveolar preservation therapy per point: wavelength 808nm, laser power 0.1W, beam area 0.04cm^2 & 0.028cm^2, treatment time per point 25secs & 30secs, irradiance 2.5W/cm^2 & 3.6W/cm^2, energy 2.5 & 3J, fluence dose 75J/cm^2 & 89J/cm^2.Conclusion
To date, there are no validated protocols of the use of PBM for each of these indications as an adjunct surgical protocol. The data collected from this review demonstrates the inconsistent dosing parameters reported for the treatment goals of alveolar ridge preservation in preparation for implant osseointegration. A positive effect was reported for the histologic and histometric analysis of the 808nm laser. The efficacy for this therapy was greatest when total dose was delivered for at least 30 seconds per point. The application of time as a guideline of energy per point may be used once dosing parameters, light scattering, and absorption profiles are verified.