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Effect of photobiomodulation in secondary intention gingival wound healing—a systematic review

Effect of photobiomodulation in secondary intention gingival wound healing—a systematic review and meta-analysis

Ebrahimi, P., Hadilou, M., Naserneysari, F. et al. Effect of photobiomodulation in secondary intention gingival wound healing—a systematic review and meta-analysis. BMC Oral Health21, 258 (2021). https://doi.org/10.1186/s12903-021-01611-2a systematic review and meta-analysis

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Improvement of wound healing after periodontal surgeries is a critical factor in achieving favorable clinical results [1]. Optimal wound healing and reduction in the severity and duration of post-operative pain result in a better prognosis and outcome of the periodontal treatment and patient satisfaction [2]. Post-operative discomfort or pain is a subjective experience, and the process of wound healing is multifactorial [3, 4]. This pain is sometimes associated with a delayed wound healing. It is influenced by several emotional, clinical, and iatrogenic causes including stress and psychological condition, patient's earlier experiences, type and duration of surgery, surgeon’s experience and skills, and also the type of wound closure (primary or secondary) [5,6,7,8]. Some of the common medications and methods used by clinicians to improve wound healing after periodontal surgeries include the application of chlorhexidine with or without alcohol [9, 10], nutritional supplementations [11], and antibiotics such as azithromycin [12], vitamin D [13], professional tooth cleaning [14], and the use of fibrin sealants instead of sutures [15]. Secondary intention healing wounds can be associated with considerable discomfort and delayed healing compared to primary intention healing wounds after the periodontal flap surgeries. Gingivectomies, depigmentation procedures, and harvesting free gingival graft tissues from the palatal area are common secondary intention healing wounds. This healing type occurs when the wound site is left open to heal mostly by granulation, contraction, and epithelialization. Moreover, we encounter more scar formations and contraction [8]. The application of photobiomodulation (PBM) as an adjunctive therapy to improve wound healing has attracted the attention of many researchers in recent years [16, 17]. PBM, includes the application of laser or light-emitting diode (LED) beams for stimulation of healing, relieving pain, and reducing inflammation [18]. Numerous studies have shown the positive inductive effects of photobiomodulation on the viability and proliferation of skin and gingival fibroblast cells, in vitro [16, 17, 19, 20]. Therefore, this biophysical approach has been considered as a treatment modality which can stimulate the endogenous healing process. The main mechanisms considered for the observed biological response is the absorbance of low-level light irradiation by cellular photoreceptors or ROS production and subsequent generation of highly reactive, transient biochemical intermediates, changes in cellular ionic gradients or cell polarity and ultimate increase in ATP production, recruitment of transcription factors and increase in cell activity. This results a secondary phase of responses including cell proliferation, differentiation and migration, angiogenesis, production of growth factors and matrix synthesis which contribute to promotion of wound healing [21,22,23,24]. Clinically, PBM has also been reported to result in a decreased pain sensation, enhancement of keratinization [25,26,27], and improvements in periodontal clinical characteristics such as enhancement in clinical attachment level (CAL) and probing depth (PD) [28, 29]. Several studies have emphasized the significant effect of PBM on post-operative pain reduction and wound healing improvement after periodontal surgeries, although there exist some controversies in the reported results [20, 30,31,32,33,34]. The characteristics of PBM irradiation parameters need to be considered as an important factor in order to achieve an optimal dose of irradiation, as a small amount or too high irradiation dose could have no effect or undesirable inhibitory results on wound healing outcomes [35]. Various laser wave lengths and settings have been used to promote oral wound healing and there is a large amount of information about PBM application in the field of wound healing. However, the effects on open oral soft tissue wounds and the most fitting laser characteristics to improve the healing of these types of wounds have not been specified to date. Therefore, the present review, aimed to determine the effectiveness of the application of PBM as an adjunctive treatment in periodontal surgeries to improve secondary intention wound healing and post-operative pain and find an evidence-based answer to this question: "Does the application of PBM as an adjunct, improve the secondary intention wound healing after periodontal soft tissue surgeries?"




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