Photobiomodulation, photomedicine, and laser surgery最新文献

Aim: To investigate the impact of different post space sterilants, namely methylene blue (MB) photosensitizer (PS)-loaded chitosan nanoparticles (CHNPs), sepiolite nanoparticles (SepNPs), and Er, Cr: YSGG laser (ECL), on the smear layer (SL) removal and push-out bond strength (PBS) of glass fiber posts (GFPs) to canal dentin.

Methods: A total of 52 single-rooted premolars were carefully selected, crowns were decoronated, and endodontic therapy was performed; subsequently, the samples were prepared for post space utilizing Gates-Glidden instruments. The specimens were categorized into four cohorts based on the disinfection regime (n = 13): Group 1: 2.5% NaOCl + ethylenediamine tetraacetic acid (EDTA), Group 2: MB-CHNPs-PDT + EDTA, Group 3: MB-SepNPs-PDT + EDTA, and Group 4: ECL + EDTA. SL removal analysis and PS-loaded nanoparticle characterization were executed using scanning electron microscopy. Self-cure resin cement was used for bonding GFP, followed by thermocycling. The evaluation of bond strength and the analysis of the fracture mode were conducted utilizing a universal testing machine and stereomicroscope, respectively. Data analysis was conducted using Analysis of Variance (ANOVA) and a post hoc test (p < 0.05).

Result: The cervical section of Group 2 (MB-CHNPs-PDT + EDTA) test specimens displayed the maximum cleaning of SL (1.22 ± 0.23) and the highest PBS (11.23 ± 0.12 MPa). However, the apical third of Group 1 (MB-SepNPs-PDT + EDTA) reported minimum SL removal (4.53 ± 0.17) and the lowest bond strength (6.65 ± 0.13 MP). Group 1 (2.5% NaOCl + EDTA) and Group 4 (ECL + EDTA) presented no significant variation in SL elimination and PBS of GFP.

Conclusion: Using EDTA co-application, the MB-loaded CHNP protocol was associated with lower smear layer scores and higher PBS compared with the other tested groups.

Background: Laser-assisted irrigation may enhance chemomechanical debridement and improve the sealing of root canals during endodontic treatment.

Objective: This study aimed to address the scientific deficit in understanding the laser-assisted sequential versus continuous chelation in root canal irrigation.

Methods: One hundred and twenty single-rooted teeth were prepared using Reciproc R40 instruments and randomly divided into six groups (n = 20) based on the irrigation protocol. In the sequential chelation groups, canals were irrigated with NaOCl during instrumentation, followed by 17% ethylenediaminetetraacetic acid using a needle, ultrasound, or erbium-doped yttrium aluminum garnet laser activation. In the continuous chelation groups, canals were irrigated with a mixture of 2% sodium hypochlorite and 9% hydroxyethylidene diphosphonic acid during and after instrumentation, followed by final activation using the same three techniques. Ten samples per group were used to evaluate sealer penetration with Fluo-3 dye, while the remaining samples underwent push-out bond strength testing. Statistical analyses were conducted using the Kruskal-Wallis and Friedman tests (p < 0.05).

Results: No significant differences in sealer penetration were found between sequential and continuous protocols in the apical third when needle or ultrasonic activation was used. However, laser activation combined with continuous chelation resulted in significantly higher sealer penetration and bond strength (p < 0.001). Sealer penetration followed the trend: coronal > middle > apical (p < 0.05) with all irrigation techniques.

Conclusions: Continuous chelation protocols, especially when combined with laser activation, were as effective or superior to conventional methods in improving sealer penetration and bond strength. Continuous chelation with laser-assisted irrigation may improve clinical efficiency and shorten treatment time in root canal procedures.

Background and aim: Hypertrophic scars (HTs) pose challenges in aesthetic management and patient satisfaction. Conventional treatments such as corticosteroid injections and silicone gels often show limited efficacy on the vascular component. Rhodamine-based intense pulsed light (IPL) targets vascular tissues selectively, offering a potential noninvasive solution. The study aims to evaluate the efficacy and safety of rhodamine-based IPL in treating HTs with a prominent vascular component, using clinical photography, dynamic optical coherence tomography (D-OCT), and patient-reported outcomes.

Methods: A retrospective analysis was conducted on 12 patients with persistent HTs characterized by a prominent vascular component. Each patient received two IPL treatments at 20-day intervals using a rhodamine-based IPL device. Outcomes were assessed through digital photography and D-OCT imaging to quantify changes in vascular and structural characteristics. The Vancouver Scar Scale was used for clinical assessment. Patient satisfaction was evaluated using the Aesthetic Numeric Analogue (ANA) scale, and adverse effects were documented at each visit.

Results: Most patients demonstrated clinical and instrumental improvements. Digital photography and D-OCT data indicated significant reductions in erythema, vessel diameter, and vessel density. Clinical observers reported good to excellent improvements in 10 out of 12 patients. ANA scores showed increased patient satisfaction. Mild, transient erythema was observed in some patients, with no severe adverse effects reported.

Conclusion: Rhodamine-based IPL therapy is a safe, effective treatment for HTs with prominent vascular components, reducing vascularization and improving scar texture and appearance. Despite the small sample size, these findings support further exploration of rhodamine-based IPL as a targeted noninvasive therapy in HT management.

Aim: Tumor-associated macrophages (TAMs) constitute a major component of the tumor microenvironment (TME) and are frequently skewed toward an M2-like phenotype that promotes immune suppression, angiogenesis, and tumor progression.

Objectives: Reprogramming these macrophages into an M1-like, pro-inflammatory state has emerged as a promising strategy to reinvigorate antitumor immunity and enhance the efficacy of immunotherapeutic interventions. Photobiomodulation (PBM), a non-invasive therapeutic modality utilizing low-intensity red to near-infrared light (600-1100 nm), has shown growing potential in immunomodulation through its effects on mitochondrial bioenergetics, redox signaling, and transcriptional regulation.

Materials and methods: This review presents a comprehensive analysis of the molecular mechanisms by which PBM influences macrophage polarization, including activation of cytochrome c oxidase, transient increases in reactive oxygen species (ROS) and adenosine triphosphate (ATP), and downstream activation of nuclear factor κB, signal transducer and activator of transcription 1, and hypoxia-inducible factor-1alpha pathways.

Results: Pre-clinical evidence demonstrates that PBM can effectively reprogram M2-polarized TAMs toward an M1 phenotype, characterized by increased expression of inducible nitric oxide synthase and interleukin (IL)-12 and reduced levels of CD206 and IL-10. When combined with immune checkpoint inhibitors, PBM further enhances CD8⁺ T cell infiltration and tumor clearance. Nanotechnology-based delivery platforms-such as TAM-targeted upconversion nanoparticles and ROS-sensitive polymeric carriers-have enabled precise, localized PBM activation within tumors, overcoming the limitations of light penetration and systemic exposure.

Conclusion: Collectively, PBM offers a spatiotemporally controlled, drug-free approach to modulate tumor immunity by reeducating TAMs and reshaping the TME. Its integration with existing immunotherapies and nanomedicine holds significant promise for next-generation precision oncology strategies.

Purpose: To systematically review and meta-analyze the efficacy of photobiomodulation therapy (PBMT) for temporomandibular disorders (TMDs), focusing on the influence of intensity, frequency, and duration on pain reduction and functional improvement. Methods: Through a systematic search of PubMed, Cochrane, and EMBASE, we identified randomized controlled trials (RCTs) involving adults with TMD who were treated with PBMT. Ultimately, 40 RCTs were included, and a meta-analysis was conducted using Review Manager 5.4. The primary outcomes included pain, pain-free opening (PFO), maximum-unassisted opening, and maximum-assisted opening (MAO). Results: PBMT significantly reduced pain at the third assessment (T2). The optimal parameters included wavelengths (951-1070 nm) and output power (below 100 mW). Additionally, PFO and MAO significantly improved at T2. Treatment durations exceeding 10 weeks were most effective for articular-muscular TMDs, whereas shorter durations were more beneficial for purely articular or muscular TMDs. Three to four sessions per week yielded the best outcomes. Conclusion: Effective pain reduction was achieved with high wavelengths (951-1070 nm), low power (<100 mW), and frequent, long-term treatment (3-4 times per week over 10 weeks). Avoiding high energy consumption over a short period was crucial. This approach is more effective for articular-muscular TMDs than for purely articular or muscular conditions.

Background: Patients of Asian descent with Fitzpatrick skin types III-V who experience facial acne scars are a relatively under-researched demographic in medical literature, with limited studies specifically addressing their unique skin characteristics and treatment responses. Traditional treatments have variable efficacy and risk of complications. A novel technique that has shown potential in managing scars is the Q-Switched, 1064 nm neodymium-doped yttrium aluminum garnet laser with a fractional beam profile. Picosecond lasers, with extremely short pulse durations, minimize thermal damage and induce tissue remodeling, reducing post-inflammatory hyperpigmentation risk. Aim: This prospective study was proposed to judge the efficacy of 1064 nm fractional picosecond laser for treating atrophic acne scars in the Indian skin type. Methods: Twenty-two patients completed the study; all were treated at monthly intervals for three sessions. Evaluation based on Investigator's Global assessment along with patient satisfaction scores was carried out for all patients. The safety of the laser was evaluated by noting down adverse effects. Results: Fourteen patients showed improvement of 26-50% by Investigator's Global Assessment, which was similar to the patient satisfaction scores. Post-treatment edema, pinpoint bleeding, and mild erythema were the only side effects noted. Postinflammatory hyperpigmentation was not noted in any of the patients. Conclusions: Fractional picosecond laser can be considered a viable and safe option to treat acne scars in patients with dark skin type.

Background: Cultural beauty ideals in South Asia favor both lighter skin and hair pigmentation, creating demand for various lightening procedures. The skin- and hair-lightening products currently on the market carry substantial health risks, including cutaneous adverse effects and systemic toxicity. Given these safety concerns, there's a critical need for safer alternatives. Objective: This study sought to explore the deliberate application of the Q-switched 1064-nm neodymium-doped yttrium aluminum garnet (QS 1064-nm Nd:YAG) laser for hair bleaching and to evaluate its concurrent effects on pigmentary clearance and skin rejuvenation in Indian subjects. Methods: This retrospective study analyzed 25 Indian subjects treated with a 1064 nm QS Nd:YAG laser for purposes including hair bleaching, lentigo removal, and skin toning. Participants received 1-3 monthly sessions, with efficacy assessed via clinical photography and a five-point hair lightening scale. Adverse events were documented to monitor safety. Results: The cohort was predominantly female (96%) with higher skin phototypes. "Significant" hair lightening was achieved in 68% of cases, with "maximum" lightening in 8%. Larger spot sizes correlated with greater hair lightening. Beyond hair bleaching, 84% achieved "good" or "excellent" pigmentary clearance, and all saw at least "good" skin rejuvenation. Adverse events were mild and transient, with no significant hypo- or hyperpigmentation. Retinol/tretinoin use was linked to increased post-treatment erythema. All participants reported treatment satisfaction, with 69% achieving moderate to excellent satisfaction levels and no subjects reporting dissatisfaction. Conclusion: This study demonstrates that 1064 nm QS laser treatment effectively bleaches hair with an acceptable safety profile, offering a medically supervised alternative to hazardous chemical products. Its additional benefits for pigmentary clearance and skin rejuvenation position it as a promising aesthetic therapeutic modality.

Background: Phototherapy is a well-established treatment for various chronic inflammatory dermatoses, yet data on its safety and efficacy in geriatric populations remain limited. Older adults face unique clinical challenges due to age-related physiological changes, comorbidities, and polypharmacy, which may impact treatment responses and tolerance. Objective: This study aimed to evaluate the safety, efficacy, and clinical outcomes of phototherapy in elderly patients treated over a 10-year period at a tertiary dermatology center. Materials and Methods: A retrospective analysis was conducted on patients aged ≥65 years who received ≥8 sessions of phototherapy between 2013 and 2023. Narrowband UVB (NB-UVB), systemic psoralen plus ultraviolet A (PUVA), and localized PUVA therapies were administered using standardized protocols. Diagnosis-specific clinical criteria were used to assess treatment response. Data on adverse events, recurrence, and the need for additional sessions were recorded. Results: The study included 149 patients (mean age 70.2 ± 5.0 years; 44.3% female, 55.7% male) with 19 distinct dermatologic diagnoses. The most common indications were psoriasis (24.8%), generalized pruritus (18.1%), mycosis fungoides (11.4%), and lichen planus (6.7%). NB-UVB was used in 85.2% patients, while 10.1% received local PUVA and 4.7% underwent systemic PUVA. Overall, 83.2% of patients demonstrated clinical improvement. The highest treatment durations and cumulative doses were observed in mycosis fungoides (mean 9.3 months, 88.7 J/cm²) and lichen planus (9.5 months, 59.6 J/cm²). Adverse events occurred in 12.8%, predominantly mild erythema and pruritus. Recurrence was noted at 18.1%, and 16.1% required additional sessions. Despite 40.9% of patients using photosensitizing medications, no severe phototoxic reactions were observed. Conclusions: Phototherapy is a safe, effective, and well-tolerated treatment option for elderly patients with a variety of dermatologic conditions. The high clinical response rates, even in complex and refractory cases, support its continued use in this population. With its favorable safety profile and non-systemic nature, phototherapy remains a particularly suitable modality in the context of multimorbidity and polypharmacy. Further large-scale, multicenter prospective studies are warranted to establish standardized protocols tailored for geriatric populations.

Background and Objectives: This study reports an adaptive experience of pigmented scar treatment management with different characteristics. It is complicated to define a single solution for all the patients. For this reason, we report a multi-modal approach combining CO₂ laser, Q-switched lasers (QSL), and dye laser to adapt to every different patient clinical situation. Materials and Methods: Thirty patients were enrolled to treat pigmented scars. Twenty patients presented scars with exogenous pigment (such as traumatic tattoos) and 10 with endogenous pigment (hyperpigmentation cases). A combination of CO₂ laser, QSL, and dye laser was used. The number of treatment sessions performed for each laser, or their combination was as follow: For keloid scars from tattoo: 1-4 combined treatment sessions with QS and dye lasers; 3-4 combined treatment sessions with dye and CO₂ laser;1-4 treatment sessions with QS followed by dye laser; for asphalt traumatic tattoo: 2-3 treatment sessions with QS; for surgical hypertrophic scars: 2-3 combined treatment sessions of QS and CO₂ laser; for burn scars (due to asphalt contact) and hyperpigmentation: one treatment session with QS followed by CO₂ laser. Six months after the final treatment, the patient's scar improvement was evaluated compared with baseline (T0) using a five-point Global Aesthetic Improvement Scale (GAIS). Results: Regardless of the type of lesion and treatment, the whole population of the study showed satisfactory clinical results. The GAIS mean value was 3.3 ± 0.6. Specifically, 47% of the patients reported good results while 43% had excellent ones. No serious side effects were observed. Conclusions: Our results suggest that a combination of CO₂, dye, and Nd:YAG lasers is a feasible strategy for treating scars, reducing the pigmentary, fibrotic, and vascular components.

Background: The major challenge in cosmetics is the ability of functional ingredients to penetrate the skin barrier. For this reason, "skin boosters" have been developed, indicating a change from the traditional application of hyaluronic acid (HA) fillers, which had been confined to increasing the volume of the skin, to a more diversified use designed to relieve dermal complications. Methods: Thirty subjects (aged between 31 and 83 years and Fitzpatrick skin types II-IV) with skin irregularities as mild wrinkles or pigmented lesions were enrolled. Patients were treated on the one side with laser and a medical repairing ointment, and on the other side with laser and postlaser exosomes booster solution. Different laser procedures were used (Q-switched laser, CO₂ laser, 675 nm nonablative laser). To analyze the effect on postprocedure laser management, patients were monitored before treatment, immediately after, 1 h after, 3 days after, and 30 days after with the imaging system. Results: All the patients treated did not show any significant side effects apart from the redness. The side of the face treated with laser and medical repairing ointment showed a more intense redness than the side treated with laser and postlaser booster solution, both immediately after and 1 h after the treatment. Conclusions: These data confirm that the use of the postprocedure laser booster solution helps in posttreatment management by reducing redness statistically significantly, thus allowing patients to return to everyday life in a shorter time.