|Year : 2022 | Volume
| Issue : 4 | Page : 209-212
A review of photobiomodulation and its application in dentistry
Shruti Soni, Sahil Thakar
Department of Public Health Dentistry, Himachal Dental College, Sundernagar, Himachal Pradesh, India
|Date of Submission||30-May-2022|
|Date of Acceptance||21-Jul-2022|
|Date of Web Publication||15-Nov-2022|
Himachal Dental College, Sundernagar, Himachal Pradesh
Source of Support: None, Conflict of Interest: None
Photobiomodulation (PBM), which is further termed as low-level laser therapy is a noninvasive type of therapy. It uses a certain wavelength of red and infrared light and brings about many physiological effects in cells and tissues which establish the basis of PBM. This light therapy photochemically triggers the cells and results in the production of molecules for example, adenosine triphosphate, reactive oxygen species, calcium ions, etc., This further contributes to cell proliferation, differentiation, and migration. PBM contributes in alleviating pain, promotes tissue healing and also has an anti-inflammatory effect on targeted tissues. Research on PBM began back in the 1960s and various studies conducted in the past documented that this therapy has many applications in various specialties of dentistry. Till date, further studies are being conducted to discover more beneficial properties of this therapy. This therapy can be used for the treatment of multitudinous conditions of the oral cavity such as aphthous ulcers, herpes, pemphigus, burning mouth syndrome, and many more conditions, it can mitigate the pain following the orthodontic treatment, can be used to deal with the temporomandibular disorders (TMDs), alleviate dental pains, enhances the depth of anesthesia and many more uses in dentistry.
Keywords: Low-level laser therapy, photobiomodulation, photobiomodulation therapy wavelength, use in dentistry
|How to cite this article:|
Soni S, Thakar S. A review of photobiomodulation and its application in dentistry. Indian J Dent Sci 2022;14:209-12
| Introduction|| |
Light amplification by the stimulated emission of radiation (LASER) is an initialism for the “LASER,” which was first introduced by Maiman on July 7, 1960, using helium and neon mixture at Hughes Research Laboratories in Malibu, CA. As time progressed, numerous researchers explored this subject and have thrown light on the various applications of lasers in different subject areas. The debut of lasers in dentistry was shown to be beneficial in dental practice. Hard lasers, namely CO2, Nd: YAG, Er: YAG can be used on both soft as well as hard tissues.
Despite the immense advantages of hard lasers, its downside includes thermal damage to the pulp of the tooth and its high price. Furthermore, soft lasers or cold lasers are based on semiconductor diode devices that are low-cost devices. They are vastly called low-level laser therapy (LLT) or biostimulation. Lasers can be applied in a multiple ways in the areas of dentistry and their use is increasing day by day changing the dental health care approach as well as the patient's quality of life. It is an effective way of performing many dental procedures.
| History|| |
Charles Townes along with his co-workers first introduced the Microwave amplification by stimulated emission of radiation (MASER) in physical review papers issued in 1954 and 1955 and laid the foundation of the laser era. Despite several researchers informing Townes that his device will not work, others started developing different variations of his technology and in 1960, the first light emitting MASER was invented which became famous by the name of LASER. In 1961, the Nd: YAG was first developed by 1%–3% neodymium treated crystal of yttrium-aluminum-garnet. Argon laser was developed in 1962.
In 1967, Endre Mester in Semmelweis University Budapest, Hungary did an experiment to find out whether laser can cause cancer or not. For his experiment, he used mice, shaved the hairs from their back, and split them into two batches. One batch received the low-level laser treatment while the other did not. In contrast to his expectations, he noticed that the batch treated with low-level laser was cancer free and hair growth reoccurred on the back of these mice. The growth in mice exposed to laser was fast as compared to those not exposed and this led to the discovery of “laser bio stimulation.”
| Types|| |
There are two kinds of lasers: high-intensity types and low-intensity types.
High-intensity types are also called as warm lasers which lie within the wavelength ranging from 450 to 532 nm and 800–2940 which is visible along with the infrared portion of the electromagnetic spectrum. These lasers are intended for hard or soft-tissue surgery.
The low-intensity type or the cold lasers or LLT (LLLT) also referred as Photo bio modulation therapy uses low power radiations. These are lasers having nonthermal effects on tissues and help in healing, reducing inflammation, and relieving pain. Mester reported the outcomes of LLLT for the first time in medicine.
Research findings revealed that irradiation with certain wavelengths of red or near-infrared light produces many physiological effects in cells, and tissues which form the core of Photobiomodulation therapy (PBMT). This laser therapy is a noninvasive method that helps in relieving pain, minimizes inflammation, and enhances healing and the restoring process of tissues.
| Mechanism of Action|| |
PBMT is a form of light therapy utilizing nonionizing forms of light sources (LED, LASERS, broadband light) which is visible coupled with near-infrared spectrum. During the past few years, research had been done to shed some light on the impact of photobiomodulation (PBM) on cells. The basic mechanism for PBM therapy is that it reacts photochemically with the cells and activates the mitochondria of the cell as it contains chromophores that absorb the photons out of PBM. The chromophores which primarily absorb the red light is the Cytochrome c oxidase (Cco) enzyme which affects the action of several molecules, namely Adenosine triphosphate (ATP), nitrous oxide (NO), reactive oxygen species (ROS), calcium ions.,
Reportedly the PBM can alter cellular actions in 4 different ways:
- First, after the absorption of light by Cco, there is the rise in the rate of electron transfer in the respiratory chain which further increases the rate of ATP generation
- Second, Cco enzymatically converts NO− 2 into NO and reduces O2 into H2O. NO has an antagonist effect as it inhibits respiration by binding with Cco hence reducing ATP production. PBM can dissociate NO and Cco, hence increasing free NO which increases downstream effects such as hypoxic signaling and immune signaling.
- Third, PBM has antagonistic effect on ROS formation also. This anti-oxidation effect is beneficial in stressed and damaged cells. ROS plays a critical role in the signaling of cells in addition to homeostasis
- Finally, some part of the energy is transformed into heat, which creates photo-thermal effect and is distributed along the tissues.
When cells are exposed to near-infrared light, it activates the light-sensitive ion channels that increase the level of calcium ions which interacts with the ROS and cAMP.
Wang et al. implied that blue and green light at lower wavelengths stimulates light-gated ion channels that can activate different chromophores whose example includes the one existing in the rhodopsin channel.
All these activities increase cell proliferation, differentiation, and migration.
| Use in Dentistry|| |
Technology now a day is advancing in every aspect of life. The usage of PBMT or LLLT is also advancing and increasing in the domains of dentistry. The primary action of PBMT is that it relieves pain, advances wound curing and minimizes inflammation by anti-inflammatory effect. The following are the uses of this therapy in dentistry:
Use in oral medicine
Various studies were done to find the applications of PBMT within oral medicine and studies documented that this therapy is useful in various conditions and had a beneficial influence on the treatment of recurrent herpes simplex, pemphigus vulgaris, oral lichen planus, fissured tongue, burning mouth syndrome, aphthous ulcers, facial nerve paralysis, hypo-salivation, chronic sinusitis, and various other oral diseases. PBMT in combination with other therapies or as an alternative treatment can be effective in improving symptoms and to complete the therapy of various oral diseases.
Use in oral surgery
Studies shows that PBMT is potent at alleviating swelling, pain (including trismus postextraction of the third molar), and helps in nerve recovery after the osteotomy of the mandibular ramus. For treating patients with (squamous cell carcinoma) it is hypothesized that it plays an important and beneficial role in its treatment, but evidence of its clinical efficacy and correct dosage is still needed., PBMT combined with high-intensity laser therapy after tooth extraction has been reported to help with wound healing along with the preservation of alveolar crest height.
Temporomandibular joint disease treatment
Studies proved PBMT to be an efficient noninvasive short-term therapeutic modality for the remedy of myofascial temporomandibular dysfunction pain. PBM can relieve the pain of patients with temporomandibular disorders (TMDs). Furthermore, it can also improve mandibular functionality in patients. PBM can be used as an additional therapeutic modality for TMDs and more favorable outcomes can be achieved by combining it with standard therapies for treating TMDs.
Use in orthodontics
Studies conducted to find the impact of photobiomodultion on the rate of tooth movement reported that clinically significant changes in the rate of tooth movement. Another study showed that following orthodontic elastomeric separator placement, PBMT can diminish the severity and duration of pain. Another study showed that during clear aligner treatment, daily use of PBM as an adjunctive intervention can shorten the orthodontic treatment period. LLLT can be used to stabilize micro implants which serve as an additional anchorage system as it appears to have a favorable impact on peri-implant bone healing. It also helps in reducing pain after placing orthodontic appliances in the mouth. PBM can effectively reduce the pain after the placement of the band on the molars. PBM is a profitable treatment for orthodontic pain as it has an analgesic effect and limited side effects.
Use in periodontology
Studies show positive results of LLLT on stimulation of periodontal soft and hard tissues healing along with the reduction in inflammation of tissues. LLLT stimulates the fibroblasts of human gingiva which enhances the cell viability, multiplication, migration, and synthesis of protein in the irradiated cells. PBM as an additional treatment can encourage secondary intention wound healing after periodontal soft-tissue surgeries. It has been documented that in treating recession the connective tissue graft taken from the palate can affect the patient's living condition until the wound is healed completely because of the pain and bleeding; but when PBMT is given in addition to standard treatment it can upgrade the healing as it minimizes the inflammatory phase of healing and promotes the proliferation of epithelial cells and fibroblasts and increases the deposition of collagen. The root coverage by a coronally advanced flap (CAF) along with the PBM can give better root coverage as compared to the coverage given by CAF alone.
Use in implant dentistry
It enhances wound healing after the placement of dental implant plus also helps in relieving pain after the dental implant surgery. Postoperative application of PBM has a positive impact over osseointegration and the stability of dental implants. It supports the healing process near the surgical site by boosting ATP manufacturing and the formation of blood vessels, i.e., angiogenesis. It also promotes the proliferation of osteoblast cells along with the reduction in inflammation.
Use in endodontics
It helps in controlling postoperative pain in endodontically treated tooth and intensifies the depth of anesthesia. Studies have revealed that it is efficient in treating dentinal hypersensitivity. It reduces the inflammation of the tissue and helps with wound healing. PBMT given along with conventional endodontic treatment for apical periodontitis promotes the healing of affected tissues damaged by apical periodontitis and accelerates the healing process. A study conducted to determine the effect of PBM on postoperative sensitivity after direct pulp capping (DPC), revealed that PBMT given after the DPC improves the patient's ease as it diminishes thermal sensitivity.
| Conclusion|| |
Based on the evidence provided by various studies, the application of PBM is promising in dentistry with its use increasing day by day as it have proven to be immensely beneficial in different procedures. The role of PBMT in relieving pain and promoting healing has led to increased efficiency of the therapy. It can be applied in various aspects of dentistry as it can be advantageous for the treatment of distinct oral pathologies, help in fostering tissue healing, and reduces inflammation by various physiological actions. It promotes cell migration, proliferation, and differentiation and helps in enhancing the therapy outcomes. The clinical success of PBMT counts on various parameters comprising site location, anatomic variation, the individuality of subject and the clinical status of the site. To accomplish the optimal outcomes of PBMT, one must have an extended awareness of accurate dose delivery. Researches about the suitable dosage have upgraded the results of PBMT. No side effects are not yet reported by using PBMT, thus further promoting its use in clinical dentistry.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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