Photobiomodulation and Growth Factors in Dentistry: A Systematic Review
Abstract
:1. Introduction
1.1. Photobiomodulation
1.2. PBM Mechanisms of Action
- -
- Endodontics
- -
- Maxillofacial
- -
- Oral pathology
- -
- Oral surgery
- -
- Orthodontics
- -
- Pediatric dentistry
- -
- Periodontics
- -
- Prosthodontics
1.3. Growth Factors and Autologous Platelet Concentrates
2. Materials and Methods
2.1. Protocol and Registration
2.2. Search Processing
2.3. Inclusion Criteria
2.4. Exclusion Criteria
2.5. Data Processing
2.6. Quality Assessment
3. Results
Quality Assessment and Risk of Bias
4. Discussion
4.1. LLLT, GF, and Oral Cancer
4.2. LLLT, GF, and Surgery
4.3. LLLT, GF, and Orthodontics
4.4. LLLT, GF and Periodontology
4.5. Energy Dose and Photobiomodulation
5. Limitations
- Limited sample size: Some of the studies mentioned in the text had a small sample size, which can limit the generalizability of the findings. Small sample sizes may not accurately represent the larger population and can increase the risk of bias.
- Lack of control groups: In some studies, there was a lack of control groups or inadequate comparison groups. Without proper control groups, it becomes challenging to determine the specific effects of LLLT and growth factors independently.
- Varied study designs: The studies mentioned in the text had different designs, including clinical trials, randomized trials, and observational studies. While each study design has its merits, the lack of consistency in study designs makes it difficult to draw definitive conclusions and compare the results across studies.
- Limited understanding of mechanisms: Although the studies suggest potential interactions between LLLT, growth factors, and oral conditions, the exact underlying mechanisms of action are not well understood. Further research is needed to elucidate the precise mechanisms involved and to determine the optimal parameters for LLLT application.
- Need for more rigorous research: While the studies discussed provide preliminary evidence, additional well-designed and rigorous research is necessary to establish the efficacy, safety, and long-term effects of LLLT in conjunction with growth factors. Further investigations should include larger sample sizes, standardized protocols, and control groups to strengthen the scientific validity of the findings.
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
APCs | Autologous platelet concentrates |
ATP | Adenosine triphosphate |
bFGF | basic fibroblast growth factor |
BMP2 | Bone Morphogenetic Protein 2 |
BTA | black triangle area |
BTH | black triangle height |
CBCT | Cone-beam computed tomography |
CGF | Concentrated growth factor |
EGF | Epidermal growth factor |
FGF | Fibroblast Growth Factor |
GFs | Growth factors |
HSCT | hematopoietic stem cell transplantation |
IGF-1 | Insulin-like Growth Factor |
IL-1β | interleukin-1β |
IL-6 | interleukin-6 |
L-PRF | Leukocyte and platelet-rich fibrin |
LEDs | light emitting semiconductors |
LLLT | Low-level laser therapy |
LPCGF | Liquid Phase Concentrated Growth Factors |
MMP | Matrix Metalloproteinase |
MS | miniscrew |
NCI | National Cancer Institute |
Nd:YAG | Neodymium-doped yttrium aluminum garnet |
OHRQoL | Oral health-related quality of life |
OM | Oral Mucositis |
OSMF | Oral submucous fibrosis |
PAI-1 | plasminogen activator inhibitor 1 |
PBM | photobiomodulation |
PBMT | Photobiomodulation therapy |
PDGF | Platelet-Derived Growth Factor |
PICF | peri-implant crevicular fluid |
PMCF | peri-miniscrew crevicular fluid |
PRF | Platelet-Rich Fibrin |
PRP | Platelet-rich plasma |
RBD | Relative bone density |
SRP | scaling and root planning |
TGF | transforming growth factor |
tPA | tissue plasminogen activator |
VEGF | Vascular Endothelial Growth Factor |
WHO | Word Health Organization |
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Authors | Study Type | Number of Patients | Average Age | Material and Methods | Results |
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Oton-Leite AF et al. (2015) [51] | Double-blinded, placebo-controlled RCT | 30 | 18 years | To evaluate the effect of LLLT on the severity of oral mucositis (OM) and the release of salivary molecules during chemoradiation treatment for head and neck cancer. The study aimed to investigate the potential benefits of LLLT in reducing the severity of OM, a common side effect of chemotherapy and radiotherapy, and to understand its impact on the release of inflammatory mediators and growth factors involved in the pathogenesis of OM. | The severity of OM, as assessed by both the National Cancer Institute (NCI) and Word Health Organization (WHO) grading scales, was significantly lower in the laser group compared to the control group at the 7th, 21st, and 35th sessions of radiotherapy. Salivary concentrations of interleukin-6 (IL-6), FGF, EGF, and VEGF were lower in the laser group compared to the control group, although not all differences reached statistical significance. Matrix metalloproteinase (MMP) levels showed a slight decrease in the laser group compared to the control group, but the difference was not statistically significant. The study also mentions a reduction in IL-6 concentrations at the end of radiotherapy after 21 sessions of laser therapy. |
Silva et al. (2015) [52] | Randomized, controlled, and single-blinded clinical trial | 25 | N.D. | Patients were randomly assigned to either the laser group or the control group. Salivary and blood samples were collected at multiple time points. Laser therapy was administered using a diode laser with specific parameters. The severity of oral mucositis was assessed using the WHO mucositis scale. Saliva and plasma samples were analyzed for cytokine, growth factor, and enzyme concentrations. | The study demonstrated a significant reduction in the severity of oral mucositis in the laser group compared to the control group. The laser group had a higher proportion of patients without ulcers and a lower proportion of patients with severe mucositis. The levels of certain cytokines, growth factors, and enzymes showed differences between the laser and control groups, indicating potential modulatory effects of low-level laser therapy. |
Ali Arakeeb et al. (2019) [53] | RCCT | 40 | 40 Males (average age: 35.2 years) | The patients were randomly allocated into four groups, each consisting of 10 patients: Group A: Control Group-Implant procedure without growth factors or LLLT. Group B: LLLT Group-Implant procedure with LLLT (Diode laser 808 nm). Group C: L-PRF Group-Implant procedure with the addition of L-PRF. Group D: Combined Group-Implant procedure with both L-PRF and LLLT. | Cone-beam computed tomography (CBCT) assessed implant relative bone density (RBD) at 1, 6, and 12 weeks. Results showed the best outcomes at 12 weeks. Group A had decreased RBD at 6 weeks, while other treatment groups demonstrated increases. L-PRF exhibited the highest effect. |
Kamal et al. (2020) [54] | RCCT | 60 | 38 Males (average age: 34.5 years) 22 Females (average age: 27.1 years) | 60 patients with individual dry sockets at University Dental Hospital Sharjah were assigned to three treatment groups based on their preferences. Group I (n = 30) received conventional treatment involving gentle socket curettage and saline irrigation. Group II (n = 15) received CGF treatment, while Group III (n = 15) underwent LLLT. Patients were assessed for pain score, perisocket inflammation, perisocket tenderness, and granulation tissue formation at day 0 and followed up at 4, 7, 14, and 21 days. | CGF and LLLT speed up gum tissue formation and pain reduction. CGF outperforms LLLT by promoting faster gum tissue growth and eliminating pain within a week. |
Üretürk et al. (2017) [55] | RCT | 15 | 8 Males-7 Females | Split-mouth study: distalization of the canine after extraction of the maxillary first premolar; LLLT irradiation (gallium-aluminum-arsenide diode laser with a power of 20 mW on days 0, 3, 7, 14, 21, 30, 33, 37, 60, 63 and 67); crevicular fluid collection and cytokine measurement IL-1β and TGF-β1; 3D scan to measure the extent of displacement | Increased TGF-β1 concentration and accelerated movement by 40% in the study group |
Yassaei et al. (2023) [56] | RCT | 18 | N.D. | Split-mouth study: distalization of the canine after extraction of the maxillary first premolar and use of miniscrew (MS) (diode laser in continuous wave mode, the wavelength is 980 nm, and the output power is 100 mW at four-time points); crevicular fluid collection and cytokine measurement IL-1β and TGF-β1 | TGF-β1 lower in the laser group but the difference was not statistically significant |
Chen et al., 2022 [57] | RCT | 87 sites from 12 participants | Female participants | Liquid Phase Concentrated Growth Factors (LPCGF) was injected at time 0 and 2, 4, 8, 16, and 24 weeks after the initial injection into the connective tissue layer measuring. Then, Nd:YAG or Semiconductor laser was irradiated to the surface of the gingival papilla at the labial and lingual surface. CBCT was used to measure the BTH (black triangle height) and BTA (black triangle area) | Low-level laser treatment has been widely employed, but concentrated growth factor (CGF) was formerly thought to be the sole material capable of soft tissue regeneration. |
Pamuk et al., 2017 [58] | 60 | N.D. | On the day that SRP was applied, as well as on days 2 and 7, LLLT was also used. Clinical indicators were noted before and after day 30. On days 7, 14, and 30, samples of gingival crevicular fluid were taken before and during follow-up visits. ELISpot test was used to assess the levels of TGF-1, tissue plasminogen activator (tPA), and Plasminogen Activator Inhibitor (PAI)-1. | Particularly in smokers with chronic periodontitis, LLLT may be thought to have a role in the regulation of periodontal tissue tPA and PAI-1 gingival crevicular fluid levels. | |
Gündoğar et al., 2016 [59] | RCT | 25 adults with chronic periodontitis | 9 Males, 16 Females | Gingival index (GI), plaque index (PI), and clinical attachment level (CAL) are measured to determine the periodontal status. Gingival crevicular fluid samples are taken at baseline, 1 week, and 1 month after treatment. Strips of paper (Periopaper®) are installed inside the crack until slight resistance has occurred. Levels of cytokines, chemokines, and growth factors are determined using a MAGPIX system. | They showed no statistical significance between-group changes in these biochemical parameters at any time point |
Gokmenoglu et al., 2014 [60] | RCT | 15 patients | Unspecified | In the trial, 15 patients (8 control, 7 LED) took part. Three times each week beginning on the day of the procedure, an LED device was placed for 20 min over the surgical region for three weeks. In postoperative weeks 4 and 12, peri-implant crevicular fluid (PICF) samples were taken, and the levels of IL-1b, TGF-b, PGE2, and NO were measured. | Changes in biochemical parameters were found to be similar between groups over time. |
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Dipalma, G.; Inchingolo, A.M.; Patano, A.; Palumbo, I.; Guglielmo, M.; Trilli, I.; Netti, A.; Ferrara, I.; Viapiano, F.; Inchingolo, A.D.; et al. Photobiomodulation and Growth Factors in Dentistry: A Systematic Review. Photonics 2023, 10, 1095. https://doi.org/10.3390/photonics10101095
Dipalma G, Inchingolo AM, Patano A, Palumbo I, Guglielmo M, Trilli I, Netti A, Ferrara I, Viapiano F, Inchingolo AD, et al. Photobiomodulation and Growth Factors in Dentistry: A Systematic Review. Photonics. 2023; 10(10):1095. https://doi.org/10.3390/photonics10101095
Chicago/Turabian StyleDipalma, Gianna, Angelo Michele Inchingolo, Assunta Patano, Irene Palumbo, Mariafrancesca Guglielmo, Irma Trilli, Anna Netti, Irene Ferrara, Fabio Viapiano, Alessio Danilo Inchingolo, and et al. 2023. "Photobiomodulation and Growth Factors in Dentistry: A Systematic Review" Photonics 10, no. 10: 1095. https://doi.org/10.3390/photonics10101095
APA StyleDipalma, G., Inchingolo, A. M., Patano, A., Palumbo, I., Guglielmo, M., Trilli, I., Netti, A., Ferrara, I., Viapiano, F., Inchingolo, A. D., Favia, G., Dongiovanni, L., Palermo, A., Inchingolo, F., & Limongelli, L. (2023). Photobiomodulation and Growth Factors in Dentistry: A Systematic Review. Photonics, 10(10), 1095. https://doi.org/10.3390/photonics10101095