Photobiomodulation, Photomedicine, and Laser Surgery

Volume 37, Number 12, 2019

ª Mary Ann Liebert, Inc.
Pp. 869–886
DOI: 10.1089/photob.2019.4707

Photobiomodulation in Endodontic,
Restorative, and Prosthetic Dentistry:
A Review of the Literature

Farshid Vahdatinia, DDS,1 Leila Gholami, DDS, MS,2

Hamed Karkehabadi, DDS, MS,3 and Reza Fekrazad, DDS, PhD, FLD, FICD4,5
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Abstract

Objective: To provide a review of the literature about the photobiomodulation therapy (PBMT) dental treatment
protocols in endodontic, restorative, and prosthetic dentistry based on validated clinical studies published so far.
More specifically, this study was carried out to carefully review therapeutic protocol of PBMT in clinical
studies and their conclusions.
Background data: The importance of using low-power lasers and photobiomodulation (PBM) is increasing in
dentistry mainly due to their painless and noninvasive function. However, lack of sufficient clinical studies has led
to unclear results regarding PBMT in dentistry, and also lack of an available precise protocol for clinicians.
Moreover, scarcity of clinical studies in this area has made conduction of a precise systematic review study difficult.
Methods: In our study, published clinical studies up to April 2019 were reviewed from library sources, Google
Scholar, PubMed and Medline, Elsevier, Embase, Cochrane, Scopus, and Web of science (ISI). Inclusion
criteria included those presented in clinical trials and case report/case series, language (English), and studies
available in full text. Exclusion criterion was in vitro studies.
Results: In general, findings of clinical studies have shown that PBMT can have a significant role in reducing
postoperative dental pain, increasing depth of anesthesia, improving tooth hypersensitivity, reducing in-
flammation of the tissue, and helping wound healing.
Conclusions: A review of clinical studies showed that the use of alternative or adjunctive PBMT is of great
importance in controlling postoperative pain after endodontic treatments. In addition, evidence suggests that
different parameters of light can be efficient in the treatment of tooth hypersensitivity. Nevertheless, lack of
sufficient clinical studies and reliable results do not allow introducing a precise treatment protocol.

Keywords: photobiomodulation therapy, endodontic, restorative, prosthetic

Introduction duction.’’2 Further, with advancement of laser science, it was

found that in addition to lasers as coherent radiation, non-

I n the late 1970s, and for the first time, Dr. Endre Mester
explained the effects of Laser biostimulation following an
animal study to study the role of ‘‘Ray of Light’’ in cancer
coherent radiations such as Light-Emitting Diodes (LEDs)
also have biostimulatory properties, and hence the term
‘‘low-dose light therapies’’ was used for this group of treat-
formation. Subsequently, thousands of clinical and labora- ments.3,4 Today, the term ‘‘Photobiomodulation’’ (PBM),
tory studies have been conducted to describe physiologi- provides a more accurate interpretation of low-power treat-
cal function as well as clinical effects of Low-Level Laser ments, because it includes a wide range of electromagnetic
Therapy (LLLT).1 In accordance with the definition of the wavelengths such as broadband lights, LEDs, and lasers.3,4
North American Association of Laser, LLLT is ‘‘Nonthermal PBM can have both photostimulation and photoinhibitory
laser light application using photons (light energy) from effects on target tissues, each of which can be used in ther-
visible and infrared spectrum for tissue healing and pain re- apeutic applications. Laser therapy is performed based on
1
Dental Implants Research Center, Hamadan University of Medical Sciences, Hamandan, Iran.
2
Department of Periodontology, Hamadan University of Medical Sciences, Hamandan, Iran.
3
Department of Endodontics, Hamandan University, Hamandan, Iran.
4
Radiation Sciences Research Center, Laser Research Center in Medical Sciences, AJA University of Medical Sciences, Tehran, Iran.
5
International Network for Photo Medicine and Photo Dynamic Therapy (INPMPDT), Universal Scientific Education and Research
Network (USERN), Tehran, Iran.

869
 870
inducing a biological response through energy transfer.
Biomodulation Law proposed by Arndt-Schultz states that
low-dose energy stimulates biological processes, and high-
dose energy inhibits biological responses.5
In the PBM technique (including low-level light/laser
therapy and low-level laser irradiation), electromagnetic
radiations with visible wavelengths (380–700 nm) or near-
infrared region (700–1070 nm) are used, which have low ab-
sorption in water with 3–15 mm depth of penetration in soft and
hard tissue. Also, radiation power range of this group of treat-
ments is between 250 and 500 mW, or less than 250 mW.6–9
In this field, the most commonly used lasers include
Ruby (694 nm), Argon (694 nm), Helium/Neon (632.8 nm),
Krypton (521, 530, 568, and 647 nm), Gallium/Aluminum/
Arsenide (805, 808, 810, and 650 nm), Aluminum/Gallium/
Indium/Phosphide (650 nm), and Gallium/Arsenide (904 nm).10,11
Karu et al.11a were among the first groups of researchers
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who described mechanism of action for photobiomodulation
therapy (PBMT). The basis of the PBM technique involves
direct application of light energy with the ability of biolog-
ical stimulation to cells of the body. Cellular photoreceptors,
such as Cyto-chromophores and pigments, can absorb this
group of radiation and, by transferring it to the mitochondria
and affecting activity of cytochrome oxidase and the Krebs
cycle, can also increase the production of adenosine tri-
phosphate (ATP).
Stimulation of ATP production leads to increased cellu-
lar activity. These changes affect macrophages, fibroblasts,
endothelial cells, proliferation of mast cells, secretion rate of
bradykinin, and neurotransmission.2,8,10,12–14
Findings of previous studies have illustrated that reduc-
ing dentin sensitivity to tactile and thermal stimulations,
improving dentin formation in dental pulp, reducing in-
flammation of oral mucosa, accelerating bone formation,
reducing pain after all types of dental treatments, and im-
proving wound healing process are only some benefits of
using PBMT in dentistry.1
Despite extensive laboratory and clinical studies on the
role of PBMT in various dental treatments, inadequate under-
standing regarding mechanism of action for the PBMT, com-
plexity of radiation parameters, as well as contradictory results
of studies have made it difficult to have access to a precise
protocol of PBMT. Accordingly, the main goal of this study is
providing a review of the literature about the PBM dental
treatment protocols in Endodontic, Restorative, and Prosthetic
dentistry based on validated clinical studies published so far.
Evidence Search Strategy
In this study, clinical trials and case report/case series
published by April 2019 were selected to be reviewed. The
following keywords were employed using the Boolean
operator of ‘‘AND’’ and ‘‘OR’’ to search about the topic:
Low-Level Laser Therapy, Low-Power Laser Therapy,
Low-Intensity Laser Therapy, Cold Laser Therapy, Photo-
biomodulation Therapy, and Photobiostimulation Therapy.
Databases including Google Scholar, PubMed and Medline,
Elsevier, Embase, Cochrane, Scopus, and Web of science (ISI)
were used as the source for selection of the studies related to
PBMT in Endodontic, Restorative, and Prosthetic dentistry.
Inclusion criteria included those introduced in clinical
trials and case report/case series, language (English), and
VAHDATINIA ET AL.
studies available in full text. Exclusion criterion was in vitro
studies. Search for the articles related to the present study
was finished on April 19, 2019.
A summary of categorization of the articles on Endo-
dontic, Restorative, and Prosthetic dentistry reviewed in the
present study is shown in Figs. 1–3.
Direct Pulp Capping
PBMT has been proposed as an adjuvant in the Direct
Pulp Capping (DPC) technique, due to its significant effects
in reducing inflammation and pain, accelerating process of
wound healing, and stimulating formation of hard dentin
tissue.15 However, most of previous research in this field are
animal studies and in vitro, and findings of these studies
have shown that, proper technique and the type of materi-
als in DPC are prioritized over laser radiation, and so far,
findings of laboratory studies have not been generalized to
clinical studies.15–17 Therefore, more in vitro and in vivo
studies are needed to obtain more accurate results.
Postoperative Pain after Endodontic Treatment
Pain is always among common phenomena occurring
after endodontic treatment, which can have a significant
effect on the quality of life of individuals. Generally, this
pain can result from mechanical, chemical, or microbial
damage to the pulp tissue or areas around the root apex, and
its emergence is significantly higher after root canal re-
treatment as reported in previous studies.21,25,26 Based on
available invaluable studies, Low-Power Laser is one of the
methods in which pain is heavily considered. This thera-
peutic technique has advantages such as being noninvasive,
low cost, and minimal side effects.27 Table 1 presents the
most important clinical studies, the protocol of PBMT, and
the final conclusions.
The study by Yildiz et al. is one of the most important
studies that investigated the effect of PBM on postoperative
pain in patients with symptomatic apical periodontitis. They
used a 970 – 15 nm laser with 200 lm optical fiber and
bleaching tip placed 10 mm from the tissue surrounding the
apex and activated at 0.5 W and 10 Hz. The tissues around
the apex of mesial and distal roots were treated with laser
for 30 sec. They concluded that PBM can be useful in re-
ducing pain after endodontic treatment.19 In another study,
Asnaashari et al. used an 808-nm low-power laser with
100 mW power, 600-lm fiber diameter at a dose of 70 J/cm2
for 80 sec. Pain severity was recorded before treatment,
immediately after treatment, and 4, 8, 12, 24, and 48 h after
treatment using visual analogue scale (VAS). There was no
difference in pain between the laser and control groups at
any time, and the pain reduced for up to 48 h in both groups.
They concluded that PBMT has limited effects on reducing
the pain associated with root canal retreatment in the first
and second molars.21
Studies showed that PBMT causes a delay in the onset of
pain and reduces its severity and duration. Its mechanism of
action is through increasing synthesis of anti-inflammatory
prostaglandins, immunoglobulins, beta-endorphins, and
lymphokines. It also inhibits synthesis of inflammatory
factors and pain-related neurotransmitters.28–30 Therefore;
it has been proposed that PBMT can be effective in re-
lieving pain after root canal retreatment. However, due
 PBM IN ENDODONTIC, RESTORATIVE, AND PROSTHETIC DENTISTRY
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FIG. 1. A summary of categorization of the clinical studies on PBMT and endodontic dentistry. PBMT, photo-
biomodulation therapy.
to a limited number of clinical studies, it is not possible to
formulate an exact protocol and further studies should be
considered.
Endodontic Surgery
The importance of using PBMT in Endodontic sur-
gery has been discussed in three clinical studies with re-
spect to reducing pain, swelling, and soft and hard tissue
healing. Radiation characteristics of lasers include: diode
680 or 810 nm, 50–75 or 129 mW power output, 3–7.5 J/cm2
energy density, 3 · 60 to 600 sec irradiation time (300 sec
in each buccal and palatal surface), scanning movement
(noncontact), 9–10 cm2 irradiation area, intraoperatively and
1–7 days after surgery.
Findings of these studies revealed, desirable effect of
laser irradiation on soft and hard tissue healing and the re-
duction of pain; however, more clinical studies are needed
FIG. 2. A summary of categorization of the clinical
studies on PBMT and restorative dentistry.
871
to achieve more conclusive results.31,32 Table 2 presents the
most important clinical studies, the protocol of PBMT, and
the final conclusion.
It should be noted that, findings of two reviewed clinical
trials cannot be used as the basis for introduction of a
therapeutic protocol, and more clinical trials are needed.
Tooth Hypersensitivity
Tooth or Dentinal Hypersensitivity (DH) is one of the
most common chronic pain conditions with quite a low rate
of predictability of treatment in dentistry. Chemical or os-
motic and thermal or tactile stimulation in areas of exposed
dentin can activate the A-d nerve fibers in the dentinal tu-
bules and cause a kind of annoying sharp and short pain in
teeth not leading to other dental defects or pathologies.34
Various methods of treatment have been explored for DH
treatment.35 Laser technology is considered as an important
FIG. 3. A summary of categorization of the clinical
studies on PBMT and prosthetic dentistry.
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Table 1. Clinical Studies on PBMT for Postoperative Pain After Endodontic Treatment
Optical
Power Energy Pulsed/ fiber or
Type Alternative Laser/ Wavelength (density/ (density/ continuous Time and spot size Contact or
Study of study or adjuvant LED (nm) total) total) mode reputation diameter noncontact Conclusion
2 2
Lopes RCT Alternative Diode 808 0.10 W/point 90 J/cm Continuous 25 sec/point 0.0283 cm Contact The PBM therapy after
et al.22 per point endodontic treatment
caused a significant
decrease in prevalence of
postoperative pain.
Yıldız RCT Alternative Diode 970 0.5 W — 10 Hz 30 sec 200 lm Noncontact LLLT can be beneficial in
et al.23 (10 mm) reducing postoperative
pain in endodontics.
Arslan RCT Alternative Diode 970 0.5 W — 10 Hz 30 sec 200 lm Noncontact LLLT may reduce
et al.24 (10 mm) postoperative pain after
Root Canal Retreatment
of mandibular molars.
Asnaashari RCT Alternative Diode 808 100 mW 70 J/cm2 Continuous 80 sec 600 lm Buccal and Low-level laser irradiation
et al.18 lingual had limited effects in
mucosa decreasing the pain
overlying associated with the
the apices endodontic retreatments
in the first and second

872
molars.
Ramalho RCT Alternative Diode 780 40 mW 4 and Continuous 4 sec/point 0.04 cm2 — Laser Phototherapy (LPT)
et al.25 40 J/cm2 should be avoided in teeth
with pain due to
irreversible pulpitis.
Yoo RCT Alternative Nd:YAG 1440 — 200 mJ/cm2 1 Hz 10 sec 300 mm — Administration of the 1440-
et al.26 nm Nd:YAG laser
irradiation through fiber
optic tip to the teeth with
persistent apical
periodontitis provided
promising consequences
for pain and inflammation
modulation.
Pawar CT Alternative Diode 800 — — Pulsed 80 sec for — — LLLT has been shown to be
et al.27 each tooth effective, noninvasive,
and a
nonpharmacological
approach for reduction of
postendodontic treatment
pain, periodontal
infection, periapical and
wound healing.
LEDs, light-emitting diodes; LLLT, low-level laser therapy; PBMT, photobiomodulation therapy; RCT, randomized clinical trial.
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Table 2. Clinical Studies on PBMT for Endodontic Surgery

Power Energy
(density/ (density/ Pulsed/ Optical fiber
Type of Alternative Laser/ Wavelength total) total) continuous Time and or spot size Contact or
Study study or adjuvant LED (nm) (mW) ( J/cm2) mode reputation diameter (lm) noncontact Conclusion
Metin CT Alternative Diode 810 129 3.87 — 600 sec (300 sec 400 Noncontact LLLT improved soft and
et al.31 in buccal and hard tissue healing after
palatal side) endodontic surgery and
for 3–7 days also showed favorable
effects on pain and life
quality of patients
especially in the early
phase of healing period.
Payer CT Adjuvant Diode 680 75 3–4 — 1 min, 1, 3, and — — In routine endodontic
et al.32 7 days after surgery cases, LLLT did

873
surgery not yield a significant
clinical benefit. Further,
the results indicated a
prominent placebo
effect of soft laser
therapy.
Kreisler RCT Alternative Diode 809 50 7.5 Continuous 150 sec 600 Noncontact Low-level laser therapy
et al.33 (10 mm) can be beneficial for
reduction of
postoperative pain. It
has clinical efficiency
and applicability with
regard to endodontic
surgery.
CT, clinical trial; PBMT, photobiomodulation therapy.
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Table 3. Clinical Studies on PBMT for Tooth Hypersensitivity

Power Pulsed/ Optical fiber
Type of Alternative Laser/ Wavelength (density/ Energy continuous Time and or spot size Contact or
Study study or adjuvant LED (nm) total) (density/total) mode reputation diameter noncontact Conclusion
Tabatabaei CT Alternative Diode 810 — — — 30 sec — — Efficacy of Nd:YAG
et al.39 Nd:YAG 1064 40 sec laser in reduction of
3 sessions with dentin
7-day intervals hypersensitivity was
significantly
superior to that of
other modalities at 3
and 6 months of
follow-up.
De Paula RCT Adjunctive 808 — 1.7 J Continuous 16 sec 0.028 cm2 — The effect of PBM-
et al.40 60 J/cm2 2 points on LLLT combined
buccal with KNO3 on
surface postbleaching tooth
sensitivity was
similar to their
individual use.
Anhesini Case Alternative Diode 808 100 mW 1.1 J/point — 10 sec — After 6 months of
et al.41 report 3 sessions in one clinical evaluation,
side both sets of teeth
1 session+restoation showed scores of 0.0

874
in other side (no pain). Thus, it
can be concluded
that both treatments
provided satisfactory
outcomes.
De Araujo Case Adjunctive Diode 830 15 mW 3.8 J/cm2 — 10 sec/point, 3 3.6 mm2 Contact Both Desensibilize
et al.42 report sessions, with Nano P
72-h intervals desensitizing agent
and LLL presented
similar results, and
reduced DH after 3
sessions (99%
efficiency).
Lopes et al.43 RCT Alternative and Diode 810 -30 mW -10 J/cm2 —— 9 sec per point — Contact All treatments were
adjunctive Nd:YAG 1064 -100 mW -40 J/cm2 10 Hz 3 sessions with 72-h shown to be
-1.0 W -100 mJ intervals effective in reducing
85 J/cm2 -11 sec per point 3 dentinal
sessions with hypersensitivity, no
72-h intervals statistical
— differences were
observed in the
sensitivity levels for
all treatments.

(continued)
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Table 3. (Continued)
Power Pulsed/ Optical fiber
Type of Alternative Laser/ Wavelength (density/ Energy continuous Time and or spot size Contact or
Study study or adjuvant LED (nm) total) (density/total) mode reputation diameter noncontact Conclusion
2 2
Garcı́a- RCT Alternative Diode 660 200 mW 12 J, 10.4 J/cm Continuous 60 sec 1.15 cm Noncontact Level of discomfort
Delaney 173 mW/cm2 5 mm decreased
et al.44 distance immediately
following diode
laser therapy, and
continued to
demonstrate a
decrease during the
time of study.
Calheiros RCT Alternative Diode 780 40 mW 10 J/cm2, — 10 sec per point — Contact The laser parameters of
et al.45 0.4 J per in 2 points photobiomodulation
point tested in the present
study were not
efficient in
preventing tooth
sensitivity after in-
office bleaching.
Dantas RCT Alternative Diode 808 — 4 J/cm2 — 4 sessions at 72– — — Fluorniz was found to
et al.46 (Clean Line, 96-h intervals be more effective
Taubaté, than low-level laser
SP, Brazil) radiation in reducing
cervical dentin

875
hypersensitivity.
Bal et al.47 RCT Alternative and Diode 685 25 mW 2 J/cm2 9 Hz 100 sec 1 cm2 Noncontact LLL or desensitizing
adjunctive paste containing 8%
arginine-calcium
carbonate appeared
to be effective in
decreasing DH.
However, their
combined use did
not improve efficacy
beyond what is
attainable with each
of treatment alone.
Yaghini RCT Alternative Diode 650 5 mW — — Overall, the — — Both nonlaser
et al.48 toothbrush sensodyne tooth
works for 5 min brushes and laser
tooth brushes
improved dentin
hypersensitivity,
although the laser
toothbrush led to
better results in short
time.

(continued)
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Table 3. (Continued)
Power Pulsed/ Optical fiber
Type of Alternative Laser/ Wavelength (density/ Energy continuous Time and or spot size Contact or
Study study or adjuvant LED (nm) total) (density/total) mode reputation diameter noncontact Conclusion
Lopes et al.49 RCT Alternative Diode 810 30 mW Low dose: — 9 sec per point — Contact For low-level lasers,
100 mW 10 J/cm2 11 sec per point distinct effects were
0.20 J per point (3 sessions with observed for
High dose: 72-h intervals) different doses;
90 J/cm2 however, both were
2.5 J per point efficient in reducing
pain up to 6 months
of clinical follow-
up.
Talesara CT Alternative Nd: YAG 1064 1W — 10 Hz 60 sec 300 lm Noncontact Nd:YAG lasers is
et al.50 (irradiated twice) 2 mm better in long-term
treatment (up to 9
months).
Hashim CT Alternative Diode 810 1W — Continuous Two groups — Noncontact Laser was effective for
et al.51 30 sec reduction of dentine
60 sec hypersensitivity.
2 sessions, a weekly
interval
Doshi et al.52 RCT Alternative Diode 660 25 mW 4.5 J Continuous 3 min for 3 1 cm diameter Noncontact Postoperative DH and
11.36 mW/cm2 consecutive days 3 cm pain following
periodontal surgery
can be reduced using

876
low-level laser
therapy.
Raichur RCT Alternative Diode 940 — — — — — — 940-nm diode laser
et al.53 was not only
efficacious, but also
brought about
improved immediate
relief compared with
stannous fluoride
and potassium
nitrate gels in terms
of reduction of DH.
Lund et al.54 CT Alternative Diode 780 20 mW 5 J/cm2 — 10 sec, 4 points — — No significant
3 sessions, at 72-h differences were
intervals observed between
application of low-
level laser, 2%
topical fluoride, and
carbomer 940 gel.
The treatments were
able to reduce
painful symptoms
caused by dentin
hypersensitivity.

(continued)
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Table 3. (Continued)
Power Pulsed/ Optical fiber
Type of Alternative Laser/ Wavelength (density/ Energy continuous Time and or spot size Contact or
Study study or adjuvant LED (nm) total) (density/total) mode reputation diameter noncontact Conclusion
2 2
Flecha RCT Alternative Diode 795 120 mW 2.88 J/cm — 8 sec at 3 points 0.031 cm — Cyanoacrylate is as
et al.55 3 sessions, at 48-h effective as low-
intervals intensity laser in
reducing DH.
Yilmaz RCT Alternative Diode 810 500 mW 8.5 J/cm2 Continuous 60 sec 3.5 cm2 Noncontact Laser irradiation was
et al.56 2 mm effective in the
treatment of DH,
and it is a more
comfortable and
faster procedure than
traditional DH
treatment.
Orhan RCT Alternative Diode 655 25 mW 4 J/cm2 Continuous 160 sec in each — Contact Application of LLLT
et al.57 session per tooth and desensitizer
6 consecutive displayed similar
sessions effectiveness in
reducing moderate
dentin
hypersensitivity.
Pesevska CT Alternative Diode 630 and 670 15 mW — — 20 sec (2 points) — Contact Low-energy
et al.58 100 mW/cm2 biostimulative laser
treatment can be

877
successfully used for
the treatment of
dental
hypersensitivity
following scaling
and root planning.
Dilsiz et al.59 RCT Alternative Diode 808 100 mW 2.5 J Continuous 25 sec, 3 sessions 300 lm Noncontact Immediate and late
2 J/cm2 14-day interval 2 mm therapeutic effects of
the diode laser were
more evident
compared with those
of desensitizer
toothpaste.
Vieira RCT Alternative Diode 660 30 mW 4 J/cm2 Continuous 120 sec, 4 points 3 mm — Statistically significant
et al.60 reductions were
observed in dentinal
hypersensitivity
immediately after
and 3 months after
treatments.

(continued)
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Table 3. (Continued)
Power Pulsed/ Optical fiber
Type of Alternative Laser/ Wavelength (density/ Energy continuous Time and or spot size Contact or
Study study or adjuvant LED (nm) total) (density/total) mode reputation diameter noncontact Conclusion
Sicilia RCT Alternative Diode 810 1.5–2.5 mW — — 1 min — — Diode laser and 10%
et al.61 potassium nitrate
bioadhesive gel were
proven effective in
the treatment of
dentine
hypersensitivity.
A significantly
greater immediate
response was
observed with Diode
laser.
Ladalardo CT Alternative Diode 660 35.22 mW 4 J/cm2 per Continuous 114 sec Contact 1 mm2 The 660-nm laser was
et al.62 830 35.30 mW tooth more effective than
the 830-nm, and a
higher level of
desensitization was
observed at 15 and
30 min
postirradiation
examinations.
Gentile and CT Alternative Diode 670 15 mW 0–15 J/cm2 — 2 min, 6 sessions, Punctual 4 mm2 Therapy with low

878
Greghi63 48–72 h intervals application intensity AsGaAl
at 3 points induced a
(distal, statistically
central, and significant reduction
mesial) in the painful
condition after each
application and
between the
beginning and end of
treatment, although
there was no
statistically
significant,
difference between
the treated group
(laser) and the
control group
(placebo) at the end
of treatment.

(continued)
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Table 3. (Continued)
Power Pulsed/ Optical fiber
Type of Alternative Laser/ Wavelength (density/ Energy continuous Time and or spot size Contact or
Study study or adjuvant LED (nm) total) (density/total) mode reputation diameter noncontact Conclusion
Corona CT Alternative Diode 660 15 mW 4 J/cm2 Continuous 30 sec/tooth (on 3 — 3.6 mm2 Both treatments may
et al.64 points) be effective in
5 sessions, 72-h decreasing cervical
interval dentinal
hypersensitivity
(laser/sodium
fluoride varnish)
laser showed
improved results for
treating teeth with
higher degree of

879
sensitivity.
Ciaramicoli CT Alternative Nd:YAG 1064 1W 40 mJ/pulse 25 Hz, 100 30 sec G1 noncontact, 300 lm Laser irradiation was
et al.65 (microsecond 5 mm effective in the
pulse G2 Contact treatment of cervical
duration) dentin
hypersensitivity
after 6 months.
Gerschman RCT Alternative Diode 830 30 + 0.1 mW 1.8 J — 60 sec, 1-, 2-, and — — GaAlAs laser is an
et al.66 8-week intervals effective method for
treatment of both
thermal and tactile
dentinal
hypersensitivity.
DH, dentinal hypersensitivity; G, group; LLL, low level laser; PBM, photobiomodulation; PBMT, photobiomodulation therapy.
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Table 4. Clinical Studies on PBMT for Tooth Bleaching

Power Energy Pulsed/ Optical fiber
Type of Alternative Laser/ Wavelength (density/ (density/ continuous Time and or spot size Contact or
Study study or adjuvant LED (nm) total) (mW) total) mode reputation diameter noncontact Conclusion
Mayer-Santos Case Alternative Diode 780 70 1 J/point — 10 sec/point — Contact (middle Infrared low-power
et al.71 report region of the laser substantially
buccal surfaces reduced dental pain
of each generated by
compromised bleaching.
tooth)
Calheiros RCT Alternative Diode 780 40 10 J/cm2 — 10 sec/point 0.04 cm2 Contact (middle Considering limitation
et al.45 (2 points), of the tooth of the present study,
2 sessions, crown and the laser parameters of
1-week second in photobiomodulation

880
interval periapical tested in the present
region) study were not
efficient in
preventing tooth
sensitivity after in-
office bleaching.
Moosavi CT Alternative Diode 660 200 12 J/cm2 Continuous 15 sec — Contact LLLT with an infrared
et al.72 810 200 12 J/cm2 Continuous 15 sec Contact diode laser could be
recommended as a
suitable strategy to
reduce intensity of
tooth sensitivity after
in-office bleaching.
PBMT, photobiomodulation therapy.
 PBM IN ENDODONTIC, RESTORATIVE, AND PROSTHETIC DENTISTRY 881

nondrug therapy and was first used by Matsumoto et al. to

resin composite could

sensitivity in class V
reduce postoperative
suitable approach to
before placement of
treat dentin hypersensitivity in mid-1980.36

Application of LLLT

be suggested as a
To date, many different lasers have been examined and

Conclusion
studied for DH treatment. These lasers can act through two

restorations.
methods of dentin tubal obliteration using high-power laser
therapy or change in the pain threshold of pulp neural system
or stimulation of reactive dentine formation as a result of the
photobiostimulatory effect of low-power laser therapy.37,38
Results of clinical studies showed that, the use of GaAlAs
(795 or 830 nm) or InGaAlP (660 nm) with special radiation
protocol: power of 15–120 mW, energy density of 1.8–

noncontact
Contact or

Contact
10 J/cm2, 24–160 sec, 3–6 sessions, continuous mode, and
scanning motion can have a significant effect on reducing
dentin sensitivity. Table 3 presents the most important clin-
ical studies, the protocol of PBMT, and the final conclusion.

Table 5. Clinical Study on PBMT for Postoperative Sensitivity Restorations

Although many studies reported about efficacy and suc-

surface area
Optical fiber
or spot size
cess of this kind of treatment, there are still many contro-

diameter
Downloaded by Imperial College School Of Med from www.liebertpub.com at 12/30/19. For personal use only.

versies as a result of subjective nature of DH. Despite

2
various PBMT protocols and different comparative methods

1.7 cm
in clinical studies, still it seems that more similar laser
therapy settings are needed to be evaluated in well-designed
studies to reach evidence-based treatment protocols and

reputation
Time and
conclusions.

(sec)
60
Tooth Bleaching
Generally, increased tooth sensitivity during and after
treatment is the most important disadvantage of tooth bleach-

Continuous
continuous
Pulsed/
ing, especially in-office technique.67–69 On average, *55–

mode
100% of patients experience some degree of mild to severe
tooth sensitivity after bleaching.70 PBM is one of nondrug
and noninvasive methods used to reduce postoperative
sensitivity.
(density/

( J/cm2)
Energy

total)

Most of the studies in this field are laboratory studies and

they have focused on investigating the effect of PBMT on
1

odontoblastic cell response or neutralizing of gel bleaching

byproducts. However, results of clinical studies revealed
(density/
Power

that, application of PBMT with the following radiation

(mW)
total)

properties of Diode laser: (780, 810 nm), 70–200 mW, 10–

28

15 sec, 12 J/cm2 can be effective in reducing dental sensi-

tivity after in-office bleaching. Table 4 presents the most
Wavelength

important clinical studies, the protocol of PBMT, and the

(nm)

final conclusion.
630

Despite positive effects of PBMT on reduction of clini-

cal sensitivity and neutralization of cytotoxicity caused by
bleaching gel byproducts, findings of existing in vivo and
in vitro studies cannot specifically explain performance of
Laser/

Diode
LED

PBM, and therefore further clinical studies are required.

Postoperative Sensitivity in Restorations

PBMT, photobiomodulation therapy.
or adjuvant
Alternative

Alternative

Dental sensitivity after composite restorative treatment is

among common issues mainly caused by polymerization
shrinkage. Although different treatments have been pro-
posed to prevent these types of dental sensitivities, the ideal
approach is still under study. The use of low-power lasers
Type of
study

for deep restorations has been proposed in recently pub-

RCT

lished articles aimed at evaluating its effect on postopera-

tive sensitivity reduction.73 Moosavi et al. stated that their
proposed protocol of 630 nm, 28 mW, continuous wave,
et al.73
Moosavi

60 sec, and 1.68 J significantly reduces postoperative sensi-

Study

tivity in class V composite restorations, and hence they re-

commended the use of PBMT in deep cavities.73 Table 5
 Downloaded by Imperial College School Of Med from www.liebertpub.com at 12/30/19. For personal use only.

Table 6. Clinical Studies on PBMT for Efficiency of Anesthesia by Photobiomodulation Therapy

During Conventional and Laser-Assisted Cavity Preparation
Power Energy Pulsed/ Time and Optical fiber
Type of Alternative Laser/ Wavelength (density/ (density/ continuous reputation or spot size Contact or
Study study or adjuvant LED (nm) total) total) mode (sec) diameter noncontact Conclusion
Efthymiou RCT Alternative Diode 810 250 mW 106.2 J/cm2 Continuous 120 600 lm Noncontact PBM induced pulpal
et al.75 (20 mm from anesthesia for cavity
the tooth preparation of decayed
surface) permanent teeth.
Tanboga CT Adjuvant Er:YAG 2940 0.5 W 60 J 20 Hz 120 — Noncontact The use of LLLT before
et al.74 (2 mm from the cavity preparation by
tooth surface) the laser decreased pain
in pediatric dental
patients.
PBMT, photobiomodulation therapy.

882
Table 7. Clinical Studies on PBMT for Denture-Related Traumatic Ulceration
Power Energy Optical
(density/ (density/ Pulsed/ fiber or
Type of Alternative Laser/ Wavelength total) total) continuous Time and spot size Contact or
Study study or adjuvant LED (nm) (mW) ( J/cm2) mode reputation diameter noncontact Conclusion
Maver-Biscanin Case Alternative Diode 685 30 3.0 Continuous 10 min — Noncontact LLLT is effective
et al.80 reports 830 60 3.0 5 min (0.5 cm in the treatment
5 days from of denture
consecutively irradiated stomatitis.
area)
Maver-Biscanin CT Alternative Diode 685 30 3.0 Continuous 10 min — Noncontact Light emitted from
et al.81 830 60 3.0 5 min (0.5 cm LLLT may be
5 days from valuable in the
consecutively irradiated treatment of
area) Denture
Stomatitis.
PBMT, photobiomodulation therapy.
 PBM IN ENDODONTIC, RESTORATIVE, AND PROSTHETIC DENTISTRY
presents the most important clinical study, the protocol of
PBMT, and the final conclusion.
It is not feasible to propose a treatment protocol on the
basis of existing clinical information, and more reliable
clinical outcomes are needed in this regard.
Efficiency of Anesthesia by Photobiomodulation
Therapy During Conventional and Laser-Assisted
Cavity Preparation
Considering the importance of creating high-quality an-
esthesia during most dental treatments, it is very impor-
tant to use nondrug and noninvasive methods. Based on the
findings of past research, the ability of PBM to produce
anesthesia is estimated to be 60% to 95%, which is very
significant.74 In this regard, PBMT protocol of 810 nm diode
laser, power of 250 mW, 53.3 J/cm2 per side, 120 sec total
Downloaded by Imperial College School Of Med from www.liebertpub.com at 12/30/19. For personal use only.
(60 sec on the buccal side, and additionally 60 sec on the
lingual side), and continuous mode was recommended to
achieve a good-quality anesthesia during tooth excavation
in the usual way by Efthymiou et al.75 Also, another study
used the PBMT technique based on Er:YAG laser 2940 nm,
60 mJ energy, and 20 Hz frequency, 2 mm from the tooth
surface to achieve an appropriate level of anesthesia before
cavity preparation of primary teeth with Er:YAG laser.74
Table 6 presents the most important clinical studies, the
protocol of PBMT, and the final conclusion.
Since clinical information in this field is inadequate and
further clinical studies are required, thus it does not seem
feasible to propose a treatment protocol based on findings of
the current studies.
Denture-Related Traumatic Ulceration
or Denture Stomatitis
Today, following the increase in life expectancy, demand
for using prosthetic therapies (especially for removable
dentures) has grown with the aim of oral function restora-
tion. However, formation of oral ulcers is one of the most
common side effects regarding using removable prostheses.
Thinning of oral mucosa and its increased vulnerability
(especially in the elderly) as well as candidiasis infection are
the most common causes for the development of these ul-
cers. Also, the use of old and Ill-fitting dentures is another
cause of denture-related traumatic ulceration. Correction of
margins and occlusal defects is the most vital treatment
in the first stage. In denture stomatitis, the use of antifungal
agents such as nystatin, amphotericin B, or clotrimazole is
considered a priority for the treatment of oral ulcers caused
by Candida infection. However, in case of painful ulcers,
topical agents such as topical anesthetics or Triester glycerol
oxide gel need to be used. PBMT is another treatment that
can be useful in healing local ulcers.76–79
Results of clinical researches have indicated that us-
ing photobiomodulation therapy in the treatment of denture
stomatitis can significantly reduce growth of Candida albi-
cans, as main cause of denture stomatitis, as well as re-
ducing tissue inflammation without side effects. The family
of diode lasers with 685–830 nm wavelength and output
power of 60 mW, energy density of 3.0 J/cm2, 5–10 min
exposure time, noncontact have been applied in previous
studies.80,81 Table 7 presents the most important clinical
studies, the protocol of PBMT, and the final conclusion.
883
Due to insufficient clinical evidence in this field, it is
not possible to provide a precise conclusion about the role
of PBMT in the treatment of denture-related traumatic
ulceration.
Conclusions
Findings of clinical studies have shown that PBMT can
have an effective role in reducing postoperative dental
pain, increasing depth of anesthesia during cavity prepara-
tion, improving tooth hypersensitivity, reducing inflamma-
tion of the tissue, and healing of denture-related traumatic
ulceration.
A review of clinical studies showed that the use of
alternative or adjunctive PBMT is of great importance in
controlling postoperative pain after endodontic treatments.
In addition, evidence suggests that different parameters
of light can be efficient in the treatment of tooth hyper-
sensitivity.
However, lack of sufficient studies and reliable results do
not allow introducing a precise treatment protocol. There-
fore, there is a need for conduction of further clinical trials.
Author Disclosure Statement
No competing financial interests exist.
Funding Information
There was no funding provided for this article.
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Address correspondence to:
Reza Fekrazad, DDS, PhD, FLD, FICD
Radiation Sciences Research Center
Laser Research Center in Medical Sciences
AJA University of Medical Sciences
Flat No 12, Mooj Building
First Behestan, Pasdaran Street
Tehran 1946883893
Iran
E-mail: rezafekrazad@gmail.com
Received: June 4, 2019
Accepted after revision: October 3, 2019
Published online: November 29, 2019.