Low level light theraphy /prosthodontic courses

LOW LEVEL LIGHT THERAPY
INDIAN DENTALACADEMY
Leader in continuing Dental Education
www.indiandentalacademy.com

INTRODUCTION
ight
mplification
timulated
mission
adiation

 It is a device that emits light or electromagnetic rays
through a process called stimulated emission.

HISTORY
 In 1960, Theodore Maiman developed first working
laser device , which emitted a deep red coloured beam
from a ruby crystal
 In 1967, a few years after the first working laser was
invented, Endre Mester in Semmelweis University,
Budapest, Hungary wanted to test if laser radiation
might cause cancer in mice
 He shaved the dorsal hair, divided them into two
groups and gave a laser treatment with a low powered
ruby laser (694 nm) to one group

 They did not get cancer, and to his surprise the hair on
the treated group grew back more quickly than the
untreated group.
 This was the first demonstration of "laser biostimulation".
 Currently, low-level laser (or light) therapy (LLLT), also
known as "cold laser", "soft laser", "biostimulation" or
"photobiomodulation"

PROPERTIES OF LASERS
 1.monochromaticity
 2.coherence
 3,collimation
 4.behaves like all radiation

 1.monochromacity:
 Lasers are of a single wavelength and hence of a defined
frequency
 In case of visible lasers a single pure color is produced
eg : ruby lasers give a red light
 2.coherence:
 Laser radiation is not only of same wavelength but also
in phase i,e the peaks and troughs of electric and
magnetic fields all occur at the same time this is called
temporal coherence

 They are also travelling in the same direction this is
called spatial coherance
 The distance over which the wavelength stay in phase is
called the coherance length it varies from <mm to
hundreds of meters
 Collimation: lasers remain in parallel beam
 Behaves like all radiation:
 Is reflected
 Is refracted hence focussed/scatered
 Is absorbed

TYPES
 4 categories of lasers
 Crystal & Glass (solid - rod)
 Synthetic ruby & others (synthetic ensures purity)
 Gas (chamber) – 1961
 HeNe, argon, CO2, & others (HeNe under investigation)
 Semiconductor (diode - channel) - 1962
 Gallium Arsenide (GaAs under investigation)
 Liquid (Dye) - Organic dyes as lasing medium
 Chemical – extremely high powered, frequently used for military
purposes

TYPES OF LASERS
1. High power
2. Intermediate power
3. Low power

1.HIGH POWER LASERS :

 Increase tissue kinetic energy and produce heat.
 Therapeutic effects through thermal interactions.
 output power of more than 500 mW
 Uses:
 They are used to cut , coagulate and evaporate tissues .
 These laser are often called as surgical lasers because
they can replace the scalpel of the surgeon

INTERMEDIATE POWER LASERS
 Therapeutic effects without producing significant heat.
 output powers : 250-500 mW.

3.LOW LEVEL LASERS
 Also known as therapeutic,soft &cold lasers.
No thermal effect on tissues.
Output power : < 250 mW.
 Uses:
 They can be used for stimulation of cell function
 They are also called as biostimulating/lowlevel intensity
lasers
 Their biological effect is not thermal as is the case with
surgical lasers.

EQUIPMENT
 Laser beam equipment includes a probe from which the
laser beam is emitted through an opening in the tip
 This tip serves as differential resistance device to locate
the points of lowest resistance for acupuncture
application of laser

 A visual digital read out on an lighted electronic display
is available to the clinician along with an audible signal
preset to a sound at a specific microampere level
(30ma)
 This is extreamly helpful when the clinician is
searching with the LED
 For target point that are out of the range of sight.

 The ground is not necessary when treating open
wounds since there is no skin contact during the
treatment and the target site is obvious
 The audible volume is controlled by clinician

 Recently marketed units also include simultaneous
/separate electrical stimulation modes with the laser
circuit
 The tip on these units function as an electrode and the
ground cylinder functions as a secondary electrode to
complete the circuit

SEMICONDUCTOR DIODE LASERS
 Semiconductor diode lasers are compact and have a
high conversion efficiency from electrical energy to
laser energy.
 Unlike He-Ne lasers, semiconductor laser diodes do not
require a high voltage supply, and so can be used in
portable, battery-operated devices.
 It is also possible to pulse the light at various
frequencies using simple external circuitry. Laser diodes
have a typical life-expectancy of between 100,000 and
600,000 hours [65].

 Semi-conductor diode lasers are generally variants of
either Aluminium:Gallium:Arsenide(AlGaAs) which
emit in the near infrared spectrum (wavelength 700-
940 nm), or
 Indium:Gallium:Arsenide:Phosphorus (InGaAsP) devices
which emit in the red portion of the visible spectrum
range (wavelength 600-680 nm).
 Power outputs are typically in the order of 10-50 mW,
when measured at the level of the diode laser itself.
 It is important to note that the final useable output
(from the handpiece) will be less because of losses in the
internal optical path or in the delivery system.

 Increased temperature of a diode laser device during
operation reduces the output power
 It is critical that the temperature or output of the laser
diode is monitored so that control circuitry can make
the necessary adjustments to maintain a constant
output.
 This is usually accomplished using an internal photo-
transistor which is fitted within the package of the laser
device.
 With an adequate heat sink and cooling system the
potential negative effect of temperature on laser output
at the level of the treatment beam can virtually be
eliminated.

DOSAGES
 Depends on the power factor duration of radiation and
tissue responses
 Wound healing dosage 90sec/cm of open lesions this
may retire several min of hand held direction of the
beam over the surface of the wound so that each cm.
exposed for the same 90 sec

PAIN CONTROL
 Acupuncture and trigger points nerve roots .and pain
sites a dosage of 15-20sec for each point is
recommended
 Unlike in the open wound technique the probe tip is
held in contact with the skin at these points during the
procedure

MODE
TYPES OF MODE
 Continuous beam
 Pulsed beam
CONTINUOUS BEAM-
 the continuous mode is recommended for acute pain
and fresh wounds

PULSED MODE
 More effective with chronic conditions
 For chronic /long standing open lesions would be in the
range of 4-10 pulses/ sec

PARAMETER SETTING
 Current lasers units offer manual timing /automatic
timed treatment
 For longer exposures such as open wounds uses the
automatic timer is suggested
 For pain control-manual /automated timing
 Power levels are pre set by the manufacturer and the
FDA at 1mw however the power is reduced to half (0.5
mw) when pulsed mode is effective

MECHANISM
 When laser light is applied, the photons penetrate into
the mitochondria of the cell and, through oxidative
processes, stimulate the production of ATP, which in
turn provides energy to fuel cell activity
 This increased cellular energy may yield immune
system modulation , pain relief, wound healing and
nerve regeneration

MECHANISM
Photobiostimulation/photobiochemical stimulation

 It also may cause a change in the cell membrane’s
permeability to nitric oxide and calcium ions, and
stimulate the release of growth factors.
 This in turn appears to lead to a number of
secondary and tertiary clinical effects, namely
 Increased lymphatic flow which may lead to a
reduction in swelling (edema)

 Production of ß-endorphins which often results in
pain relief.
 Increased collateral circulation and microcirculation
which is important for proper wound healing.
 Increased collagen formation and fibroblast
stimulation which facilitates wound healing.
 Reduction in the depolarization of afferent C-fibres
(which carry pulpal pain) thus contributing to
reducing dental pain sensation

 Reduction in the release of histamine, bradykinins ,
Substance and acetylcholine which helps to decreases
pain and inflammation
 Stimulation of osteoblasts and odontoblasts which
stimulates the production of bone and dentin.
 Increased activity of neutrophils and macrophages
which aids in the immune response.

CLINICAL APPLICATION OF THE LOW LEVEL LIGHT
THERAPY
 Surgery and infection
 Phototherapy has been shown to: reduce post-
operative pain and swelling, and lessen the need for
analgesics
 result in better bone form and lessen the probability of
dry socket
 increase lymphatic flow and stimulate the immune
system, when applied to submandibular lymphnodes.
 s stimulate chemotaxis, bringing neutrophils to a site of
infection for faster healing.

EFFECT OF LOW-LEVEL LASER ON ELIMINATING PAIN
AFTER SURGICAL REMOVAL OF THIRD MOLARS .
 Ga Al As (wv 808nm) with 12 J of energy, applied
intraorally at the operation site 1 cm from the target
tissue for 120 sec.
 Reduction of post operative trismus and swelling after
extraction of third molar.

 Soft Tissue Lesions –
 such as herpes, apthous ulcers, denture sores and
angular cheilitis
 Phototherapy has shown success in reducing pain and
preventing lesions from developing if the light is
applied during the prodromal stage.

EFFECT OF LOW LEVEL LIGHT THERAPY ON APTHOUS
ULCER
 Pain relief is immediate and lasting.
 ulcers heal in two to four days.
 2J/cm2 applied near the affected side.
Pre-treatment Two days later Four days later

EFFECT OF LOW LEVEL LASER ON HERPIS
LABIALIS
 Vesicles is likely disappear in 2 to 3 days.
 Reduces frequency of recurrence and relapse rate

EFFECTS OF LOW LEVEL LASER THERAPY ON ORAL
LICHENPLANUS
Before treatment After treatment
LLLT act as biostimulation that inhibit pain and inflammation in OLP

EFFECT OF LLLT ON PREMALIGNANT LESIONS
VAPOURISATION:
 Vaporization of OPLs involves applying laser energy to
the surface to ablate the epithelial lesion.
 This method may be suitable for larger, superficial OPLs
and is also especially useful in difficult-to-access areas
where traditional excision may be challenging.
 It allows treatment of the lesion while staying relatively
superficial

PROCEDURE:
 The laser energy is delivered via the appropriate hand
piece with side suction port.
 Co2 laser is set on continuous at 3-5 W.
 The beam is slightly defocused to assist with hemostasis
and provide a larger spotsize.
 If using the Varilite 940-nm laser, a 0.6-mm fiber is
used.
 The Varilite laser settings are frequency, 3 Hz;
pulsewidth, 50 ms; power, 4.8 J/cm2.

 Laser energy is delivered to the lesion using
magnification (loupes or microscope) to help assess
depth.
 The area of mucosa containing the lesion is vaporized
until the submucosal layer or muscle fibers start to
become visible.
 Bleeding may occur at the deep margin and can be
controlled with electrical or chemical cautery

VENTRAL TONGUE REGION OF LEUKOPLAKIA BEING
TREATED
WITH 940NM LASER VAPORISATION

VASCULAR ABLATION
 Vascular ablation of OPLs employs angiolytic lasers,
which preferentially target the vascular supply of the
treated region.
 When used in a pulsed mode, 532-nm lasers can
deliver higher levels of peak energy to blood vessels,
without vaporizing surrounding tissue.

 By targeting the underlying vascular supply, involution
of premalignant lesions is possible without leaving a
large mucosal defect.
 this treatment leaves a superficial layer of cells,which
act as a “biological dressing,” consequently leading to
less pain and less problems with scarring, causing
functional impairment

PROCEDURE
 A 0.4-mm or 0.6-mm laser fiber can be employed to
deliver the laser energy via an appropriate hand piece.
 For the Varilite laser typical power settings are
frequency, 3 Hz; pulse width, 50 ms; power, 4.8 J/cm2.
 For the Aura XP laser typical power settings are
frequency, 3Hz; pulse width, 15 ms; power, 15 W.

 The laser is applied to the lesion in a contact or very
close noncontact mode, applying energy to 1 spot at a
time until blanching occurs.
 This should occur within 5 seconds in each spot.
 This process is repeated until the entire lesion has been
treated macroscopically.

VASCULAR ABLATION
pretreatment
Post treatment

EFFECT OF LOW-LEVEL LASER ON MUCOSITIS PAIN
 Reduce the incidence of OM and its associated pain in
patients who are receiving high-dose chemotherapy or
radiotherapy.
 Decreases the risk of secondary infection, and
accelerated return to normal nutrition.
 Reduce levels of reactive oxygen species and/or
proinflammatory cytokines .

 InGaAlP diode laser, emitting continuous light ( 660
nm, power output of 46.7 mW and)with energy density
of 4 J/cm2.

 Endodontics
 Phototherapy has been to:
 • reduce post-operative pain and swelling, and
lessen the need for analgesics.
 • assist in the diagnosis of irreversible pulpitis
 • reduce pulp hyperemia

 Dentin Hypersensitivity
 Treat with low level laser first to provide analgesia, then
follow with an application of dentin primer and bond.
 This may be due to phototherapy’s ability to reduce
conduction of C-fibres, which carry pulpal pain, as well
as stimulation of ß-endorphins

 Restorative Dentistry
 Phototherapy has been successfully Used to provide:
 analgesia for primary teeth restorations (by inhibiting
the C-fibres, laser therapy can be used in most primary
tooth restorations).
 production of secondary dentin in deep restorative
procedure.

 Facial Pain Relief
 Phototherapy provides jaw muscle relaxation, especially
after long appointments
 Implants
 In addition to helping reduction of post-surgical pain,
osseointegration is accelerated owing to stimulation of
osteoblasts

 Orthodontics
 Phototherapy may increase speed of treatment because
of stimulation of osteoblasts.a significant decrease in
pain on the laser-treated side of the mouth, along with
an increased velocity of tooth movement

EFFECT OF LOW –LEVEL LASER ON REDUCING POST
ORTHODONTIC PAIN
 LLLT reduces the pain perception after placement of
brackets.
 Irradiations were made with a Laser probe ( 670nm
&power density 140mw/cm2 )for 30 seconds per
banded tooth at a distance of 5 to 8 mm and at a right
angle to the mucosa at the level of the biomechanical
center of resistance of the tooth

 Other Applications
 TMJ & facial pain treatment return of sensation after
traumatic damage or severing of a nerve as well as
relief from symptoms of sinusitis have all been reported
 with the use of phototherapy

Effect of low-level laser on Temporomandibular
joint disorder pain
 Alternative to other conventional treatment modalities
in TMJ of myogenic and arthrogenic origin.
 Ga As laser(wavelenght 904nm,output
power 17mW)with 6-10 J of energy
applied on tender points and muscle
attachments for a duration of
180 sec.

 Reduces pain and tension in masticatory muscles (trismus).
 Improvement of mouth opening and lateral movements.
Low-intensity LASER therapy was given using
direct skin contact technique on the pre-
determined trigger points

EFFECT OF LOW-LEVEL LASER ON TRIGEMINAL
NEURALGIA
 Effective & excellent supplement to conventional
therapies used in treatment of trigeminal neuralgia.
 Mechanism of action: laser irradiation selectively
inhibits nociceptive neuronal activities.

 Ga AlAs probe(Wavelenght 832 nm ,outputpower
32mW) placed over trigger points&painful points with
an energy density corresponding to 9.2J/cm2 .
 Significant reduction in the intensity &frequency of
painful episodes.

EFFECT OF LLLT ON DIABETIC NEUROPATHY
 LLLT could be an effective therapeutic modality in the
treatment of painful diabetic neuropathy in that it is
able to modify pain, foot skin microcirculation and
some electrophysiological parameters of peripheral
nerve function.

EFFECT OF LLLT ON PERIODONTAL DISEASE
 Periodontal diseases may be treated in a more simple
and effective way.
 Lasers can be used for calculus removal, de-
epithelization, to significantly reduce bacteria in the
pocket using different laser systems, as well as
photodynamic therapy (PDT) in conjunction with non-
surgical and surgical therapy.

OPTICAL HAZARDS
 40 – 1400 nm will interact with retina.
 All individuals in the operating room wear adequate eye
protection while the laser is being used

INDICATIONS
 Open lesions
 Decubitis ulcers
 Diabetic ulcers
 Lacerations
 Incisions
 burns
 Chronic and acute pain esp those of musculoskeletal in origin
 Restricted joint rangesof motion

CONTRAINDICATIONS
 Coagulation disorders.
 Patients that have received radiotherapy during last 6
months.
 Pregnancy.
 Malignancy.

BENEFITS OF LOW LEVEL LASER THERAPY
 Treatments are covered directly by insurance for many
clinical indications.
 • The reduced use of post-operative medications is
important when treating an aging population, due to
concerns of drug interactions.
 • Offering treatment with a low level laser has proven to
be a significant practice builder.
 There are fewer postoperative complications and after-
hours emergency calls, and there are few if any adverse
side effects oflaser treatment.

 The technology allows for effective diagnosis of dental
conditions that would otherwise be difficult for both the
practitioner and patient.
 The dentist can utilize the increase in microcirculation
to both diagnose affected teeth and identify the source
of pain

CONCLUSION
 Low level laser therapy has been found to accelerate
wound healing and reduce pain, possibly by stimulating
oxidative phosphorylation in mitochondria and
modulating inflammatory responses.
 By influencing the biological function of a variety of
cell types, it is able to exert a range of several beneficial
effects upon inflammation and healing.
 LLLT exerts marked effects upon cells in all phases on
wound healing, but particularly so during the
proliferative phase.

REFERENCES
 Gerry Ross, DDS Low Level Lasers in Dentistry
 Application of Lasers in Dentistry Dental Treatment
June 2012
 Daniel Novakovic, Office-based laser treatment of oral
premalignant lesions Operative Techniques in
Otolaryngology (2011) 22, 159-164
 Low level laser therapy in oral mucositis: a pilot study
European Archives of Paediatric Dentistry 12 (Issue 2).
2011
 Laser Dentistry: Mainstream After 25 Years Scott D.
Benjamin | DDS
 The state of the science of lasers in dentistry an J Dent
hygiene 2012; 46, no.1: 17–27, 30–48

 Abeer A. Yamany Effect of low level laser therapy on
neurovascular function of diabetic peripheral neuropathy
 Ajay Prashad Gautam Low Level Helium Neon Laser therapy
for chemoradiotherapy induced oral mucositis in oral cancer
patients – A randomized controlled trial A.P. Gautam et al. /
Oral Oncology (2012)
 Giovana Cherubini Venezian, Low Level Laser Effects On
Pain to Palpation and Eiectromyographic Activity in TMD
Patients: A Double-Blind, Randomized, Placebo-Controlled
Study APRIL 2010. VOL 28. NO. 2 THE JOURNAL OF
CRANIOMANDIBULAR PRACTICE
 Lasers in dental traumatology and low level laser therapy
(LLLT) European Archives of Paediatric Dentistry 12 (Issue
2). 2011

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