Caccianiga Gianluigi, Rey Gerard, Baldoni Marco, Caccianiga Paolo, Porcaro Gianluca, Baldoni Alessandro, Ceraulo Saverio
School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy.
Dental Surgery Faculty, University of Paris-Diderot, Paris, France.
Photobiomodul Photomed Laser Surg. 2022 May;40(5):343-354. doi: 10.1089/photob.2021.0062. Epub 2022 Mar 7.
Tooth loss reduces crestal bone with important resorption of alveolar dimensions, reducing the possibility of placing implants after wounds healing. The goal of this pilot experience was to consider, in alveolar ridge preservation, the regenerative and decontaminating potential of oxygen high-level laser therapy (OHLLT), a high-frequency and high-power diode laser combined with hydrogen peroxide 10 volumes 3%, and to evaluate wound closure during the 14-21 days after surgery. For this study we selected 15 patients (age range from 30 to 70 years old) who underwent alveolar ridge preservation (three patients were treated in the anterior maxilla, 12 in the mandibular jaw, with molars and premolars involved). A clinical and radiographic examination was performed at baseline. In this pilot experience, after the extractions, the sockets were treated with photodynamic therapy without dye (OHLLT/SiOxyL+ protocol) to decontaminate the area that was treated, combined with allografts, Osteobiol, granulometry 25, Platelet-Rich Fibrin and collagen membranes, Biogide/Geistlich. Photobiomodulation (PBM) sessions with ATP38 were made for the first 4 months every 2 weeks. Clinical evaluations were performed at 14, 21, 90, and 240 days. Radiographic evaluations with cone beam computed tomography (CBCT) were performed at 240 days, before the second surgery. Two hundred seventy days after the first surgery, a new surgical treatment was made with the same concepts adopted in the first surgery, to place implants. All alveolar ridge preservation surgeries were successful, with minimal bone resorption after 9 months. Closure of gingival tissue healed by secondary intention was achieved after 14 days for all patients, except one, who showed wound closure after 21 days. This pilot experience showed that this technique allowed to obtain new bone and wound healing by secondary intention in treated sites and to place implants in all patients, without other bone augmentation techniques, thanks to extracellular matrix induced by photodynamic laser therapy on grafts materials and to PBM made each 2 weeks for the first 4 months postsurgery. The study was conducted according to the guidelines of the Ethics Committee of the School of Medicine and Surgery at the Milano Bicocca University (protocol n. 11/17), and derived from the approval of Italian National Institute of Health (ISS), protocol 30 July 2007-0040488.
牙齿缺失会导致牙槽嵴顶骨吸收，牙槽骨尺寸显著减小，从而降低伤口愈合后植入种植体的可能性。本初步试验的目的是探讨在牙槽嵴保存术中，高频高功率二极管激光联合3% 10体积分数过氧化氢的氧高水平激光治疗（OHLLT）的再生和去污潜力，并评估术后14 - 21天的伤口闭合情况。在本研究中，我们选取了15例患者（年龄范围为30至70岁），他们均接受了牙槽嵴保存术（3例患者在上颌前部接受治疗，12例在下颌，累及磨牙和前磨牙）。在基线时进行了临床和影像学检查。在本初步试验中，拔牙后，牙槽窝采用无染料光动力疗法（OHLLT/SiOxyL +方案）进行处理，以对治疗区域进行去污，并联合使用同种异体骨、Osteobiol、粒度为25的材料、富血小板纤维蛋白和胶原膜、Biogide/Geistlich。在术后的前4个月，每2周进行一次使用ATP38的光生物调节（PBM）治疗。在术后14天、21天、90天和240天进行临床评估。在第二次手术前240天，使用锥形束计算机断层扫描（CBCT）进行影像学评估。第一次手术后270天，采用与第一次手术相同的理念进行新的手术治疗，以植入种植体。所有牙槽嵴保存手术均成功，9个月后骨吸收极少。除1例患者在21天后伤口闭合外，所有患者在14天后均实现了二期愈合的牙龈组织闭合。本初步试验表明，由于光动力激光疗法在移植材料上诱导产生细胞外基质以及术后前4个月每2周进行一次PBM治疗，该技术能够在治疗部位获得新骨并实现二期伤口愈合，且无需其他骨增量技术，所有患者均可植入种植体。本研究按照米兰比可卡大学医学与外科学学院伦理委员会的指导方针进行（方案编号11/17），并获得了意大利国家卫生研究所（ISS）2007年7月30日 - 0040488号方案的批准。
