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 Table of Contents  
ORIGINAL RESEARCH
Year : 2019  |  Volume : 11  |  Issue : 4  |  Page : 181-186

The effect of low-level laser therapy after simple tooth extraction


Department of Oral Surgery, College of Dentistry, Mustansiriyah University, Baghdad, Iraq

Date of Web Publication14-Aug-2019

Correspondence Address:
Dr. Noor Sahban Ibraheem
Department of Oral Surgery, College of Dentistry, Mustansiriyah University, Baghdad.
Iraq
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jioh.jioh_288_18

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  Abstract 

Aims and Objectives: The purpose of this study is to assess the use of low-level laser therapy (LLLT) on pain, discomfort, bleeding, and clot formation inside the socket after extraction the upper anterior teeth of healthy adult patients. Materials and Methods: Twenty patients, their age 15–60-year-old, were used in this current study. Patients were randomly separated into two groups; each group has 10 patients using the same surgical protocol for both groups. Immediately after the extraction, the laser group received low power laser therapy intraorally using a diode laser 940nm and 0.8 W power output in continuous mode with exposure time ranging 15–60s. All patients were given postoperative recommendation. Variable parameters were evaluated after teeth extraction for 7 days including pain, discomfort, and bleeding. Data analysis was achieved by using the Statistical Package for the Social Sciences statistics Version 21. Results: The pain scores in the laser group revealed significant difference (P = 0.001). There was found a significant difference only in the 5th day (P < 0.05) postoperatively when comparing the pain level between the two groups. The study results also showed a significant decreased level of discomfort in the second group (laser group), while the level of discomfort in the first group (control group) was not significant. On the 1st day up to the 5th, 6th, and 7th day (P < 0.05), postoperatively, there were significant differences when comparing the discomfort level between the two groups. Bleeding score was significant between the two groups (P = 0.001). Conclusion: Using a diode laser 940nm with 0.8 W (output power) in continuous mode, as LLLT has a significant effect in reducing pain, discomfort, and bleeding levels with the formation of a stable blood clot inside the tooth socket.

Keywords: Clot formation, discomfort, low-level laser therapy, pain, tooth extraction


How to cite this article:
Hamzah BF, Ibraheem NS. The effect of low-level laser therapy after simple tooth extraction. J Int Oral Health 2019;11:181-6

How to cite this URL:
Hamzah BF, Ibraheem NS. The effect of low-level laser therapy after simple tooth extraction. J Int Oral Health [serial online] 2019 [cited 2019 Sep 17];11:181-6. Available from: http://www.jioh.org/text.asp?2019/11/4/181/264429


  Introduction Top


In oral surgery practice, the most recurrently encountered intraoral wounds are freshly extracted sockets which consist mainly of the oral mucosa and alveolar bone.[1] Due to its anatomical location in the mouth, the wound surface of the extracted socket is frequently disturbed by the mouth activities, which may lead to postoperative complaints by the patients rather than the surgery itself.[2]

Many patients suffer from pain after tooth extraction and it is considered the most common sign of complaining; it occurs due to the release of pain mediators and trauma form surgical procedure; consequently, control the pain postoperatively is an imperative part of routine oral surgical procedures, which may affects the patient’s subjective impression about the surgical procedure.[3] Researchers have suggested many methods to prevent these complaints such as giving drugs, for example, nonsteroidal anti-inflammatory.[3],[4],[5]

The applications of low power laser therapy in dentistry have been addressed by several studies.[6],[7],[8] It is suggested that low-level laser therapy (LLLT) aids in the reduction of pain and the inflammatory process and enhances wound healing without any indication of side effects.[9],[10],[11],[12]

One of the mechanisms proposed to be concerning the cellular effect of laser therapy is the capability of laser photons to change cellular metabolism. LLLT is suggested to act on mitochondria by removing nitric oxide from the respiratory chain, thus increasing the levels of adenosine triphosphate (ATP) and reactive oxygen species. As a result of these high levels of ATP (the energy currency for a cell), the metabolism and function of the cell increases in wounded, ischemic, or poorly perfused tissues.[12],[13],[14],[15]

The therapeutic outcome of LLLT varies with different laser parameters such as power density, power, wavelength, beam profile, number and frequency of treatment, duration of treatment, energy, and energy density.[16]

The purpose of this current study is to evaluate the use of LLLT on pain, discomfort, bleeding and clot formation inside the socket after extraction the upper anterior teeth of healthy adult patients.


  Materials and Methods Top


It is a prospective randomized study design with twenty patients included, their age ranges between 15 and 60 years (9 males and 11 females), attending Oral Surgery Clinic of the Teaching Hospital at College of Dentistry/Mustansiriyah University during a period of 6 months from October 2018 to March 2018 for extraction upper anterior teeth for different reasons such as bridge construction, prosthodontic and implant purposes. The study was approved by the Scientific Committee in Oral Surgery Department/College of Dentistry/Mustansiriyah University (Ref No: MU/OS/236/18). Inclusion criteria were as follow: patients were systemically healthy, nonsmoker, and without active infection at the site of extraction. The exclusion criteria were patients with poor oral hygiene, smoking habit, local infection (teeth with periapical lesion), pregnancy, or those a history of systemic diseases or any kind of disorders that could effect on the clot stability after extraction.

After a clinical examination on the accused tooth was carried out, periapical radiographs were taken for all the patients to confirm the absence of any periapical or periodontal or general bony defects. Signed informed consent was obtained from all the participants after an extensive explanation about the benefits from the use of laser for coagulation the blood after the teeth extraction. All the extractions were performed by single surgeon and under local anesthesia. The patients were classified into two groups: a control and laser groups, each group contains 10 patients.

Surgical protocol

Tooth extraction (conventional technique) was performed under local anesthesia by infiltration injection with 1.8ml of lidocaine HCL 2% with epinephrine 1:80,000 to the area. When the onset of anesthesia, which usually appeared after 3–5min, the teeth were extracted by conventional method using dental forceps or dental elevator or both and then the socket gently squeezed to re-establish the normal contour of the bone after extraction and make sure that the socket filled with blood (to form the blood clot). A properly shaped gauze piece put over the socket to gain initial control of the hemorrhage and the patient was instructed to keep biting on the gauze for at least half hour.

Laser treatment

The laser device was used in this present study, a 940-nm wavelength diode laser (diode Epic, BioLase, USA) as shown in [Figure 1]. It was used in a continuous mode through a delivery system consisted of a hand piece with flexible fiber that had 400um diameter. Laser parameter was set as follow: output power 0.8W in continuous mode of operation during the work, and in defocusing mode, while the irradiation time (exposure time of radiation) was calculated by timer. After the teeth extraction, the laser beam through the laser fiber tip was applied to the teeth socket immediately. The tip was held vertically at an approximately 8mm away from the teeth socket without contact, while moving the hand piece in a horizontal motion over the surface of the blood-filled socket until the bleeding stopped and the clot was formed. The hemostasis of blood inside the teeth socket was done by means of a continuous laser beam as shown in [Figure 2].
Figure 1: The laser device (Diode Epic, BioLase, USA)

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,
Figure 2: Clot formation inside the tooth socket after laser treatment

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Clot formation with the use of diode laser after teeth extraction was faster than that of the conventional method; the clot needed 15–60s to be formed by laser, while with the conventional technique, 5–10min were needed.

The same postoperative instructions were given to all patients in both groups which included eating a soft food diet on the day of surgery, avoiding rinsing or spitting on the day of surgery, and rinsing the mouth with warm salt water after meals to remove any loose debris twice daily starting 24h postoperatively and continue for 7 days.

The following clinical parameters were assessed: pain, discomfort, and bleeding. Pain and discomfort were evaluated daily starting at the day of extraction and continued for 7 days. The patients were given a questionnaire case sheet to record the pain and discomfort levels using verbal Rating Scaling with descriptive words. For pain intensity, the scores were: 0 (no pain), 1 (mild), 2 (moderate), and 3 (severe), while for discomfort, the scores ranged from 1 (none), 2 (mild), 3 (moderate), and 4 (severe).[17] Bleeding was assessed intraoperatively and the grades were: 1 (None), 2 (Self-limiting), 3 (Requiring light pressure), 4 (Requiring coagulation), and 5 (Requiring ligation or Hemoclips).[18]

Statistical analysis

All data were arranged and plotted to submit them to statistical analysis. Data analysis was achieved by using the Statistical Package for the Social Sciences (SPSS, IBM Corp., USA, version 21.0). This analysis comprised descriptive statistics and association tests for comparisons between two groups. A P value of <0.05 was considered significant.


  Results Top


The percentage distribution of pain scores in days for the laser and control groups is demonstrated in [Table 1]. In the laser group, the (no pain) score percentage started to increase constantly from the 1st day to the 5th day (30%, 60%, 80%, 90%, and 100%) and continued at 100% until the 7th day, while in the control group, the score percentage (no pain) started to increase from the 1st day (40%) to reach 60% at the 2nd and 3rd day, then decrease to 40% at the 4th day, then increase to 60% then 100% at the 5th, 6th, and 7th day.
Table 1: Percentage distribution of pain scores in days for two methods

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The pain scores in the second group revealed significant difference (P = 0.001). There was a significant difference when comparing the pain level between the two groups only in the 5th day (P < 0.05) postoperatively as presented in [Table 2].
Table 2: Statistical analysis of pain scale between the tested techniques

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[Table 3] shows the percentage distribution of discomfort scores in days for both groups. In the laser group, the score percentage (none discomfort) started to increase constantly from the 1st day (30%) to 50% at the 2nd and the 3rd day, then 70% at the 4th day to reach 90% at the 5th day until the 7th day. In the control group, the score percentage (none discomfort) started to increase from the 1st day (40%) to 60% at the 2nd and the 3rd, then decrease to 40% at the 4th and the 5th day, then increase to 60% at the 6th and 7th day.
Table 3: Percentage distribution of discomfort scores in days for two methods

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The study results also showed a significantly decreased level of discomfort in the second group, while in the first group (control group), the level of discomfort was not significant. On the 1st day, up to the 5th, 6th, and 7th day (P < 0.05) postoperatively, there was significant difference when comparing the discomfort level between the two groups as shown in [Table 4].
Table 4: Statistical analysis of discomfort scale between the tested techniques

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The results revealed that there was a significant difference in bleeding score between the control and laser groups (P = 0.001) as shown in [Table 5].
Table 5: Statistical analysis of bleeding between the tested techniques

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  Discussion Top


The current study showed the effect of LLLT on pain, discomfort, and bleeding after the extraction of upper anterior teeth. The study findings exposed that the second group had lower pain scores than the first group, but there was a significant difference only in the 5th day postoperatively when comparing the pain level between the two groups.

It was established that LLLT application has several beneficial effects in dentistry including, anti-inflammatory, analgesic and biostimulant effects to enhance wound healing.[2],[19],[20],[21],[22] The mechanism of the analgesic effect of LLLT can be explained with the stimulation of the synthesis of endogenous endorphins and reduction of the activity of bradykinin and C fibers with the change in pain threshold.[2],[19],[22] On the other hand, LLLT encourage the hyperpolarized state of the primary nerve endings, thus inhibits the painful stimuli transmission to the central nervous system, it also has a profound and rapid effect in reducing the level of mediators responsible for pain and inflammation such as prostaglandin E2, interleukin 1, cyclooxygenase 2, and tumor necrosis factor.[20]

These finding partially agreed with the findings of Alan et al.[2] who observed that the pain intensity was slightly lower in the side of laser application with the pain level showing a significant differences only in the 7th day in the second group compared with the first group (control group) after removing the impacted lower third molar using 810-nm diode laser with continuous mode extraorally after the surgery and on the 2nd day postoperatively, and they contributed this reduction to the analgesic, anti-inflammatory, and biostimulant effect of laser application.

These results were in agreement with El-Soudand and El Shenawy[3] who found in laser group, a significant reduction in the pain level when compared to the control group starting from 2nd-day postoperatively and continue through the follow-up period (7 days) when using a soft laser intraorally with 870-nm wavelength and 50-mW output power at a distance 1cm for 10min after the extraction of simple third molar.

The results of this study agreed with Hamid[5] who showed a reduction in pain level after lower third molar extraction using a gallium aluminum arsenide intraorally at three points with 810-nm wavelength in continuous mode.

The study results were in line with Fabre et al.[19] who reported the pain intensity was reduced after the 3rd day postoperatively and all the patients were asymptomatic on the 7th day, supporting the possible analgesic effect of low power laser therapy when using diode laser 660nm with CW mode for four successive daily sessions starting 24h after extracting the mandibular third molars.

The results of this study were in agreement with Mozzati et al.[21] who found less pain in sites which treated by laser when compared with control sites using a gallium arsenide laser (904–910-nm wavelength and 200 mW output power) in superpulsed mode immediately after extracting the molar and at the 3rd and 5th day, with the laser probe placed in contact with the mucosa and covering the alveolar socket.

The findings of this present study were consistent with Saber et al.[23] who found that the pain level was significantly lower in laser compared to control group when using laser with 100 mW output power and 810-nm wavelength in continuous mode.

The results agreed with Landucci et al.[24] who found that the pain intensity reduced significantly at 48h and 7 days after extracting the lower third molars compared with the first group (control group) when a single dose of low power laser therapy was applied intraorally; at 4 points in adjacent to the socket and at 6 points extraorally along the masseter muscle.

These findings agreed with the findings of Eshghpour et al.[25] who showed that in laser side, the level of pain was significantly lower than in the control side at all time points during the study when using LLLT 660nm with output power (200 mW) intraorally followed by 810nm and output power (200 mW) extraorally at 3 points and then repeated on days 2 and 4 after lower third molar surgery.

The results ofthe current study differed with Ferrante et al.[4] and Raiesian et al.[20] who found in laser group a significantly lower mean score of pain compared with the control group at 24h and 1 week after extracting the lower third molar when a diode laser 980nm, CW mode was administrated intraorally on two positions (vestibular and lingual); about 1cm from surgery site and at the insertion point of the masseter muscle extraorally immediately after surgery and 24h after surgery.

These results disagree with López-Ramírez et al.[26] who concluded that the intraoral application of low power laser 810nm with 0.5 W output power after the extraction of lower third molar had no beneficial effect in pain reduction.

The current results of this study also showed a significant difference on the 1st day and the on the 5th, 6th, and 7th days postoperatively when comparing the discomfort level between the two groups. This is attributed to (according to the patients’ notes) the lack of cotton dressing that is usually used after tooth extraction and also to the lack of the taste of blood or bleeding after tooth extraction (due to complete homeostasis in laser group) that sometimes associated with conventional tooth extraction.

The study results were consistent with the studies of Ferrante et al.[4] and Landucci et al.[24] who concluded that low power laser therapy was efficient in reducing patients’ discomfort after extracting the lower third molar. They attributed this conclusion to reduce the pain intensity, degree of trismus, and swelling associated with surgical extraction of lower-third molar not to specific parameters like what was used in the current study.

The results of this current study pointed that diode laser 940nm better than the conventional technique in controlling bleeding and producing a firm blood clot inside the extraction socket, these findings supported by the findings of Mirdan[27] who revealed that the use of 980-nm diode laser in CW mode with 0.86W power output on rabbits’ tooth socket had a beneficial effect on blood coagulation and provided dressing to the wound. She suggested that clot formation was accomplished due to absorption and that laser scattering confines the laser photothermal effect for clot formation without any harmful effect on the surrounding bone but rather stimulating bone healing by residual scattered light from the incident laser.


  Conclusion and Suggestions Top


Within the limits of this study, the data suggests that LLLT using 940-nm diode laser intraorally, output power (0.8 W) in continuous mode has a significant effect in reducing pain, discomfort, and bleeding levels with the formation of a stable blood clot inside the tooth socket which aids in the reduction of postoperative complications after tooth extraction.

Further studies are needed with larger sample, also further study the effect of LLLT on medically compromised patients such as diabetic patients and patients with bleeding disorders or taking medication that affects blood coagulation.

Acknowledgment

The authors would like to thank Assistant Prof. Eman N. Najee, Department of Biology, College of Science, Mustansiriyah University, Baghdad, Iraq.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
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    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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