Photobiomodulation Dose Parameters in Dentistry: A Systematic Review and Meta-Analysis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Search Strategy
- Population = Patients receiving PBM therapy as adjunct to treat presenting pathology.
- Intervention = Administered PBM to assist in pain management/healing.
- Compared with = Control groups receiving alternative therapy/sham phototherapy.
- Outcome of interest = Pain; Healing; etc.
- Study type = Randomized Controlled Trials.
- Randomized controlled clinical trials;
- Laser applied as an adjunctive therapy;
- Standard orthodox treatment performed to all groups;
- Negative control group;
- Minimum of 10 participants per group.
- PBM therapy not applied;
- Duplicates or studies with the same ethical approval number;
- Alternative to control conventional treatment applied to the test group;
- Less than 10 subjects per group;
- Clinical trials, case series, pilot studies, (not randomized controlled);
- In vitro studies;
- LED rather than laser as light source.
- Optical spot sizes in the range of 0.02–0.08 cm2 (group A–16 articles)
- Optical spot sizes in the range of 0.126–0.38 cm2 (group B–9 articles)
- Optical spot sizes in the range of 0.51–4 cm2 (group C–13 articles).
2.2. Quality Assessment
- Randomization?
- Sample size calculation and required sample number included?
- Allocation ratio of 1:1?
- Baseline situation similar?
- Blinding (single/double)?
- Parameters of laser use correctly described, and calculations checked?
- Power meter used for calibration of the source?
- Numerical results available (statistics)?
- Outcome data complete?
- Correct interpretation of data?
- High risk: 0–4.
- Moderate risk: 5–7.
- Low risk: 8–10.
3. Statistical Analysis of Systematic Review Clinical Outcome Dataset
4. Results
5. Discussion
6. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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1. Risk of Bias for Small Spot Size Articles | |||||||||||
Citation [ref] | Random-Ization | Sample size Calculation and Required Number Included | Baseline Situation Similar | Blinding | Parameters of Laser Use Described and Calculations Correct | Power-Meter Used | Numerical Results Available (Stats) | No Missing Out-Come Data | All Samples/Patients Completed the Follow-Up | Correct Inter-Pretation of Data | Total Score/10 |
SMALL SPOT SIZE | |||||||||||
Sugaya [41] | Yes | Yes | Yes | Yes | Yes | No | Yes | Yes | No | Yes | 8 |
Valenzuela [42] | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | 10 |
Barbosa [43] | Yes | Yes | Yes | Yes | No | No | Yes | Yes | No | Yes | 7 |
Dias [44] | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | No | Yes | 9 |
Neves [45] | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | No | Yes | 9 |
Rezade [46] | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | 10 |
Tuk [47] | Yes | Yes | Yes | Yes | Yes | No | Yes | Yes | No | Yes | 8 |
De Carli [48] | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | No | Yes | 9 |
Machado [49] | Yes | Yes | Yes | Yes | No | No | Yes | Yes | No | Yes | 7 |
Magri [50] | Yes | Yes | Yes | Yes | Yes | No | Yes | Yes | Yes | Yes | 9 |
Ramalho [51] | Yes | Yes | Yes | Yes | Yes | No | Yes | Yes | Yes | Yes | 9 |
Oton-Leite [52] | Yes | Yes | Yes | Yes | Yes | No | Yes | Yes | No | Yes | 8 |
Ferrante [53] | Yes | Yes | Yes | Yes | No | No | Yes | Yes | Yes | Yes | 8 |
Nobrega [54] | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | 10 |
Marin Conde [55] | Yes | Yes | Yes | Yes | Yes | No | Yes | Yes | No | Yes | 8 |
Silva [56] | Yes | Yes | Yes | Yes | No | No | Yes | Yes | Yes | Yes | 8 |
2. Risk of Bias for Medium Spot Size Articles | |||||||||||
Citation [ref] | Random-Ization | Sample size Calculation and Required Number Included | Baseline Situation Similar | Blinding | Parameters of Laser Use Described and Calculations Correct | Power-Meter Used | Numerical Results Available (Stats) | No Missing Out-Come Data | All Samples/Patients Completed the Follow-Up | Correct Inter-Pretation of Data | Total Score/10 |
MEDIUM SPOT SIZE | |||||||||||
Arduino [57] | Yes | Yes | Yes | Yes | No | Yes | Yes | Yes | No | Yes | 8 |
Elbay [58] | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | No | Yes | 9 |
Ramirez [59] | Yes | No | Yes | Yes | No | No | Yes | Yes | Yes | Yes | 7 |
Landucci [60] | Yes | No | Yes | Yes | No | No | Yes | Yes | No | Yes | 6 |
Moosavi [61] | Yes | Yes | Yes | Yes | Yes | No | Yes | Yes | Yes | Yes | 9 |
Amanat [62] | Yes | Yes | Yes | Yes | Yes | No | Yes | Yes | No | Yes | 8 |
Shirani [63] | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | 10 |
Ang Khaw [64] | Yes | Yes | Yes | Yes | Yes | No | Yes | Yes | Yes | Yes | 9 |
Antunes [65] | Yes | Yes | Yes | Yes | No | No | Yes | Yes | No | Yes | 7 |
3. Risk of Bias for Large Spot Size Articles | |||||||||||
Citation [ref] | Random-Ization | Sample size Calculation and Required Number Included | Baseline Situation Similar | Blinding | Parameters of laser Use Described and Calculations Correct | Power-Meter Used | Numerical Results Available (Stats) | No Missing Out-Come Data | All Samples/Patients Completed the Follow-Up | Correct Inter-Pretation of Data | Total Score/10 |
LARGE SPOT SIZE | |||||||||||
Aras [66] | Yes | Yes | Yes | Yes | No | No | Yes | Yes | Yes | Yes | 8 |
Ustaoglu [67] | Yes | Yes | Yes | Yes | Yes | No | Yes | Yes | No | Yes | 8 |
Asutay [68] | Yes | Yes | Yes | Yes | No | No | Yes | Yes | Yes | Yes | 8 |
Ahrari [69] | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | 10 |
Liang [70] | Yes | No | Yes | Yes | No | No | Yes | Yes | No | Yes | 6 |
Amadori [71] | Yes | Yes | Yes | Yes | Yes | No | Yes | Yes | Yes | Yes | 9 |
Caccianaga [72] | Yes | Yes | Yes | Yes | Yes | No | Yes | Yes | Yes | Yes | 9 |
Gautam 2015 [73] | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | No | Yes | 9 |
Gautam 2013 [74] | Yes | Yes | Yes | Yes | No | No | Yes | Yes | Yes | Yes | 8 |
Nicotra [75] | Yes | Yes | Yes | Yes | No | No | Yes | Yes | No | Yes | 7 |
Flieger [76] | Yes | Yes | Yes | Yes | Yes | No | Yes | Yes | Yes | Yes | 8 |
Matys [77] | Yes | Yes | Yes | Yes | Yes | No | Yes | Yes | Yes | Yes | 9 |
Feslihan [78] | Yes | Yes | Yes | Yes | No | No | Yes | Yes | Yes | Yes | 8 |
Author (Ref)/Study Type | Number of Participants: Test (T) Control (C) | (i) Small Spot Size: Target Size cm2 (ii) Target: Superficial = 1 Deep = 2 | Area Exposed to Tip (cm2); Radiant Exposure (Fluence J/cm2); Total Energy Delivered (Joules) | Net Outcome (ΔOutcome Score) | Dose Commentary | Statistical Analysis: Test vs. Control Group |
---|---|---|---|---|---|---|
Sugaya [41] RCT DB BMS | T = 13 C = 10 | 2.0 1 | 1.0 0.24 N/R | 0 | Scanning technique 2 s/spot of 0.03 cm2 Dose insufficient | Test > control, although ns. VAS Remission of symptoms: test 46% control 40% N/S |
Valenzuela [42] RCT B BMS | T gp.1 = 16. T gp.2 = 16. C = 12 | 2.0 1 | 0.3 133/200 Gp. 1: 4.0/Gp 2: 60 | 1 | Small area treated High radiant exposure, low volume exposed | Tests 1 and 2 > control: 15.7% vs. 7.3% VAS VAS score 16% improvement with test outcomes. |
Barbosa [43] RCT DB BMS | T = 25 C = 19 C gp.2 (normal) = 8 | 2.0 1 | N/R 3.0/4.28 N/R | 0 | Low irradiance (30 mW), multiple points/small spot size | Test = Control VAS Equivalence of laser to ALA |
Dias [44] RCT DB WH | T = 16 C = 16 | 1.0 1 | 0.15 3.0 N/R | 3 | Low irradiance (30 mW), multiple points to cover target | Test > control. D14 T = 16.4 (SD9.6) C = 26.2 (SD 10.6) D45 T = 5.9 (SD 1.9) C = 13.6 (SD 3.8) Wound Area D represents day 14 or 45. 40% reduction vs control T1 57% reduction vs. Control T2 |
Neves [45] RCT DB WH | T gp.1 = 18. T gp.2 = 18. C = 18 | 1.0 1 | 0.06 3 /60 Gp 1: 0.9/Gp 2: 1.8 | 1 | Low irradiance (30 mW), smaller area treated than target size | Test > control T 1 =14.4 (SD 5.1) T 2 = 14.3 (SD 6.1). C = 11.4 (SD 4) Measure: colourimetry, wound area. Significant: T1 (group 1 only) |
Rezade [46] RCT B WH | T = 40 C = 42 | 6.0 2 | 0.28 100 28 | 0 | Deep target, large area to treat: low dose to each point & small area treated | Test > Control N/S. T1 = 41.18 (SD13.03) C = 34.55 (SD 3.22) T2 = 36.6 (SD 7.98) C = 34.82 (SD 11.58) Measure: mouth opening T1 = Men T2 = Women |
Tuk [47] RCT B Pain | T = 80 C = 83 | 1.0 2 | 0.08 148.5 11.88 | 0 | Small area treated: dose to target insufficient? | Test = Control T = 4.1 (SD 2.4) C = 4.2 (SD 2.7) VAS |
De Carli [48] RCT DB Pain | T (gp.1) = 11 T (gp.2) = 10 C = 11 | 6.0 2 | 0.28 100 28 | 0 | Large and deeper target: small area treated. Dose low? | Test gp.1/2 = Control N/S Equivalence test gps to control VAS |
Machado [49] RCT DB Pain | T = 42 C (gp.1) = 40 C (gp.2) = 20 | 6.0 2 | 0.2 60 12 | 1 | Large and deeper target: small area treated. Dose low? | T= 1.6 C (gp.2 =1.1) p < 0.001 VAS |
Magri [50] RCT DB Pain | T = 20 C (gp.1) = 21 C (gp.2) = 23 | 6.0 2 | 0.34 5.9/7.5 Gp 1: 0.9/Gp 2: 1.4 | 0 | Large and deeper target: small area treated. Dose low? | T = C (gp.1) T/C (gp.1) > C (gp.2) VAS C1 = Placebo C2 = No treatment |
Ramalho [51] RCT B Pain | T (gp.1) = 15 T (gp.2) = 15 C (gp.1) = 15 C (gp.2) = 15 | 1.0 2 | 0.04 4/40 Gp 1: 0.32/Gp 2: 3.2 | 0 | Dose low | T = C (gp.1) T/C(gp.1) > C (gp.2) VAS C1 = Placebo C2 = No treatment |
Oton-Leite [52] RCT DB OM | T = 15 C = 15 | 6.0 1 | 1.72 6.2 10.75 | 3 | Oral mucositis High number of points low irradiance | T > C 50–75% reduction in OM in T vs. C OM Severity Test vs. Placebo |
Ferrante [53] RCT B WH | T = 15 C = 15 | 6.0 2 | 0.08 225 18 | 1 | Deep target, low dose | Measure: mouth opening Test: <swelling/trismus |
Nobrega [54] RCT DB Pain | T = 30 C = 30 | 1.0 2 | 0.15 38/76 Gp 1: 5/Gp 2: 2.3 | 3 | Low dose but: high radiant exposure to apex 76 J/cm2 | VAS Test vs. placebo no nil intervention |
Marin Conde [55] RCT DB OM | T = 11 C = 15 | 6.0 1 | 2.6 83.3 216 | 3 | Oral mucositis High radiant exposure large number of points | T > C 50% + reduction OM OM Severity Test vs. placebo no nil intervention |
Silva [56] RCT DB OM | T =19 C =20 | 6.0 1 | 3.2 4.0 12.8 | 3 | Oral mucositis Low radiant exposure large number of points | OM severity Test vs. Nil Marked reduction severity and incidence OM |
Author (Ref)/Study Type | Number of Participants: Test (T) Control (C) | (i) Medium Spot Size: Target Size cm2 (ii) Medium Spot Size: Target Superficial = 1 Deep = 2 | Area Exposed to Tip (cm2): Radiant Exposure (Fluence J/cm2) Total Energy Delivered (J) | Net Outcome (ΔOutcome Score) | Dose Commentary | Statistical Analysis: Test vs. Control Group |
---|---|---|---|---|---|---|
Arduino [57] RCT B OM | T = 18 C = 15 | 2.0 1 | 0.28 10.7 3.0 | 1 | Incomplete data | Outset: VAS 3.35 (SD 2.18) Time (T4): 3.47. (SD 2.14) |
Elbay [58] RCT DB Pain | T = 49 C = 49 | 1.0 2 | 0.6 90 N/R | 0 | Target at depth, dose at surface too low? | Outset VAS 2.05 (SD 2.027). Post 0.11 (SD 0.727) |
Ramirez [59] RCT DB Split Mouth Pain | T = 20 C = 20 | 6.0 2 | 3.14 1.55 12.8 | 0 | Scanning technique to cover area, target at depth: dose too low? | VAS Outset 52.47 (SD 7.05) T (24 hours) 30.74 (SD 8.94) |
Landucci [60] RCT DB Split Mouth Pain | T = 22 C = 22. | 6.0 2 | 0.126 2.39 0.3 | 1 | Target at depth, large target: dose low | VAS outset 0.27. T2 = 3.86 |
Moosavi [61] RCT DB Pain | T (gp.1) = 14 T (gp.2) = 12. C = 15 | 1.0 2 | 0.25 12.0 3.0 | 3 | Best effect with 810 nm. Small target (pulp), and good transmission via (dentine) | VAS outset 21.11 (SD 18.19). Time 1: 51.94 (SD 20.8) Time 2: 17.77 (SD 13.57). |
Amanat [62] RCT DB Pain | T = 30 C = 30 | 6.0 2 | 0.283 12.73 3.6 | 0 | Large target at depth: dose too low | VAS outset: 7.5 (SD 2.3). VAS post Rx: 3 (SD 3.7) |
Shirani [63] RCT DB Pain | T = 8. C = 8 | 6.0 2 | 0.6 6.2 6.3 | 1 | Multiple points (number not specified) | VAS outset 4 (SD 1.5). VAS post Rx 2.5. (SD 1.5) |
Ang Khaw [64] RCT DB Split Mouth WH | T = 20 C = 20 | 1.0 2 | 0.26 3.6 8.0 | 0 | Too low: 7.6 J total to sub-surface target | Wound area VAS outset 0.27 T2: 3.86. T3: 1.41 |
Antunes [65] RCT DB OM | T = 47 C = 47 | 6.0 1 | 17.28 4.2 72.0 | 4 | Oral mucositis: multiple points large area | OM severity Incidence OM Grade 3 C = 40.5% grade 1/2 = 21.3% |
Author (Ref)/Study Type | Number of Participants: Test (T) Control (C) | (i) Large Spot Size: Target Size cm2 (ii) Large Spot Size: target Superficial = 1 Deep = 2 | Area Exposed to Tip (cm2): Radiant Exposure (Fluence J/cm2) Total Energy Delivered (J) | Outcome (ΔOutcome Score) | Dose Commentary | Statistics Control Group |
---|---|---|---|---|---|---|
Aras [66] RCT B WH | T = 32 C = 16 | 2.0 2 | 3.0 4.0 12 | 2 | Incomplete data 3rd molar extractions measures: inter- incisal opening | Measure: mouth opening C-D0: 45. C-D2: 21.1 (SD5.2) C-D7: 29(SD 6.2) |
Ustaoglu [67] RCT DB WH | T = 20 C = 20 | 1.0 1 | 2.8 2.86 8.0 | 1 | Gated mode peak power 3 x average Gaussian beam | Wound area C -D0: 0 C-D14: 82. C-D21: 0 (H2O2) |
Asutay [68] RCT DB WH/Pain | T = 15 C (gp.1) = 15 C (gp.2) = 15 | 2.0 2 | 3.0 4.0 12 | 1 | Large target at depth: dose low. Control gp.3 placebo | Measure: mouth opening. VAS T > C for VAS reduction |
Ahrari [69] RCT DB WH/Pain | T = 10 C = 10 | 6.0 2 | 1.76 3.4 6.0 | 1 | Large target at depth: dose low. Placebo vs. Test VAS / inter-incisal | Measure: mouth opening. VAS C -D0: 26.9 (SD 7.78) C-D56: 29.36 (SD 6.46) |
Liang [70] RCT DB Pain | T = 30. C = 30 | 1.0 2 | 1.0 3.6 3.6 | 3 | Small sub-surface target (pulp), good optical transmission (dentine) | EPT C = 1.9%. (T = 52.8%) |
Amadori [71] RCT DB OM/Pain | T = 62 C = 61 | 6.0 1 | 1.0 4.5 4.5 | 1 | Treatment target analgesia: dose low | OM severity. VAS C >T |
Caccianaga [72] RCT DB OTM | T = 18 C = 18 | 6.0 2 | 6.0 24 150 | 3 | Sub-surface target: dose optimal (flat top beam profile) | OTM Alignment D: C = 284.1. Test D: 211.8 |
Gautam 2015 [73] RCT DB Om/Pain | T = 23 C = 26 | 6.0 1 | 12 3.0 36 | 3 | Oral mucositis: large target at surface | OM severity OM C >> T VAS C > T |
Gautam 2012 [74] RCT TB OM/Pain | T =115 C = 124 | 6.0 1 | 6.0 3.5 21 | 4 | Oral mucositis: large target at surface | OM severity. VAS OM C = 77/110 ( T= 25/110) (Pain C >>T |
Nicotra [75] RCT B Pain | T = 19 C = 37 | 1.0 2 | 1.0 30 30 | 2 | Ortho pain 3 × 10 s Test/Control C1 and C2(placebo) | VAS C > T |
Flieger [76] RCT B Implants | T = 20 C = 20 | 1.0 2 | 0.5024 40 20 | 3 | Implant stability | IS C << T |
Matys [77] RCT Implants | T = 12 C =12 | 1.0 2 | 0.5024 40 8.0 | 1 | Implant stability | IS C < T |
Feslihan [78] RCT B WH/Pain | T= 30 C =30 | 2.0 2 | 3.0 6.0 18 | 0 | Third molars test vs prednisolone. No control: measure of steroid vs. Laser: equivalence | Measure: mouth opening. VAS C = T |
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Cronshaw, M.; Parker, S.; Anagnostaki, E.; Mylona, V.; Lynch, E.; Grootveld, M. Photobiomodulation Dose Parameters in Dentistry: A Systematic Review and Meta-Analysis. Dent. J. 2020, 8, 114. https://doi.org/10.3390/dj8040114
Cronshaw M, Parker S, Anagnostaki E, Mylona V, Lynch E, Grootveld M. Photobiomodulation Dose Parameters in Dentistry: A Systematic Review and Meta-Analysis. Dentistry Journal. 2020; 8(4):114. https://doi.org/10.3390/dj8040114
Chicago/Turabian StyleCronshaw, Mark, Steven Parker, Eugenia Anagnostaki, Valina Mylona, Edward Lynch, and Martin Grootveld. 2020. "Photobiomodulation Dose Parameters in Dentistry: A Systematic Review and Meta-Analysis" Dentistry Journal 8, no. 4: 114. https://doi.org/10.3390/dj8040114