J Clin Laser Med Surg. 2004 Feb;22(1):15-8.The comparison of effects between pulsed and CW lasers on wound healing.
Objective: In order to evaluate the effects of pulsed continuous wave (CW) laser and detect the role of wound healing in rats using both pulsed and CW 635-nm low-level laser therapy (LLLT), a pilot study was undertaken.
Background Data: Some acceleration effects of wound healing on animals were found after treatment using various lasers with CW. There are other reports, however, using pulsed CW laser to evaluate the effects of wound healing in rats.
Methods: An elliptic wound was created aseptically with a scalpel on the shaved back of the rats after anesthesia. The rats treated were restrained in a Plexiglas cage without anesthesia during the laser irradiation period. An Erchonia pulse laser (635 nm) was used in the experiment. The laser beam was delivered through an expander. The percentage of relative wound healing was calculated.
Results: The percentage of relative wound healing was 4.32 in 100 Hz, 3.21 in 200 Hz, 3.83 in 300 Hz, 2.22 in 400 Hz, 1.73 in 500 Hz and 4.81 in CW.
Conclusion: LLLT using pulsed, CW laser at the appropriate dosimetry and frequency can provide acceleration in wound healing in rats. The 100-Hz frequency had a better effect than other pulse frequencies used in the study. The effects of treatment using CW laser was higher than pulse frequency. The frequency of pulsed CW laser was not found to increase wound healing in rats compared with normal CW laser, as reported in our previous studies.
In alternative medicine frequencies are used since more than 25 years, especially to perform the RAC pulse test and to transmit information. The use of frequencies is scientifically not recognized.
The largest German acupuncture society DAAA and the Austrian OGKA teaches the use of the NOGIER/BAHR and REININGER frequencies in their education (level 3, 4, 5). Please refer to the literature and the medical education of the academies:
Below you will find a abridged version of the NOGIER-Frequencies, found by Dr. Nogier, Lyon, France.
A: Acute , disturbance fields
Body opening, back shu points
B: Chronic, metabolism, cell nourishment
Abdomen, sedation points
C: Circulation, energy transport, movement system, blockades
Bones, muscles, joints, tonification points
D: Psychic disturbances, exhaustion, pains
Commissures, alarm points
E: Nerve disturbances/pains, neuralgia, neuritis, shingles
Spinal cord, nerves, starting points
F: Depression, psych./emot. symptoms/causes
Face, sub cortex, end points
G: Intellectual/psychosomatic disturbance
Pre-frontal cerebral zone, forehead, source points
- Disruption in conversation of acquired energy, disruption in conversation of own energy resources, source of illness, affinity to symp, nerve system lower tissue layer
- Transfer of energy, neuronal energy and distribution function, hormonal and nerve systems, affinity to parasympathetic nerve system and Central tissue layer
- Boundary and tangential area between man and the environment, biotic points, Omega-Ren channel points and Surface tissue structures
- Omega-Du channel points
- Oscillation frequency, Super omega
- Left axis, right points
- Right axis, left points
Frequencies 6 and 7 are used in auricular-medicine for lateral balance
Prof. Dr. Bahr as well the founder of 8 Chakra frequencies.
- Reininger I, II, III
- Meridian frequencies
- Anti frequencies
- Frequencies of levels
- Frequencies Viral/Bacterial
Hana KucerovÃ¡a, Tatjana DostÃ¡lovÃ¡a, Lucie HimmlovÃ¡a, Jirina BÃ¡rtovÃ¡a, JirÃ MazÃ¡nekb
First Medical Faculty of Charles University Prague, Czech Republic
The aim of the study was to evaluate the different frequencies of low-level laser radiation (diode - 670 nm and Helium-Neon 632,8 nm) on healing process after human molar extractions. Frequencies of 5 Hz, 292 Hz and 9000 Hz were used in experiments. Monitoring of secretory IgA and albumin level in saliva and changes in bone density were used as objective markers of biostimulatory effect. Subjective evaluation of therapy was observed using scale (from - negative therapeutic effect; ++++ excellent treatment effect).
Changes of sIgA, albumin levels and bone density were compared in group of 150 patients (non-laser therapy - 30 patients). Differences in levels of the saliva markers (sIgA and albumin) were found to be significant comparing irradiated and non-irradiated groups, as well as comparing groups irradiated by various modulatory frequencies.
It was observed significant differences between increase of sIgA res. albumin and subjective treatment feelings. Bone density after extraction and six-months after surgical treatment was examined using the dental digital radiovisiography. There were detected no significant differences between bone density in irradiated and non-irradiated groups perhaps due to our used therapy diagram.
Keywords: dentistry, low-level laser radiation, secretory IgA, albumin
Extractions of teeth are a part of the dentist's everyday work in his office. It exists many reason for tooth extraction e.g. carries, periodontal diseases, retention or semi-retention tooth etc. After extraction we observe the wound and wound healing is one of the fundamental biological processes allowing the preservation of organism after tissue damage 1,2. Regeneration takes place in three overlapping phases 3.
- Inflammatory phase: lasts several hours, the damaged tissue is infiltrated with the leukocytes and makrophages infiltration and fibroblasts migration, which also occurs and lasts from 1 to 3 days
- Proliferation phase: between second and fourth day - neovascularisation, type III collagen synthesis occurs between day 2 and 16.
- Tissue reconstruction phase: in day 9 to 60 the type III collagen is replaced with type I, the amount of blood vessels is reduced and the reconstruction of fibrous tissue than continues for 6 to 12 months3.
After the extraction the open space of spongiosis is filled with blood clot. The vein re-growth is followed by cells from healing bone marrow. These cells are changed to osteoblasts. The bone is gradually strengthened by lamellar bone. This primary spongiosis structure is, depending on the local conditions, transformed into compact cortical orlamellar bone. The formation of cortical layer, secondary spongiosis and marrow spaces takes approximately 4 months. The final phase of bone differentiation then takes place, where bone is re-modeled into Haversian systems and secondary osteons appear. The re-modellation proceeds from the defect bottom and edges into the central part of the wound. In the extraction pocket the neovascularisation starts. The oxygen supply increases. The oxygen is needed for collagen synthesis and wound epithelisation 4,5 . The components needed for collagen synthesis are provided by phagocytes via damaged tissue. Consecutively, the collagen is transformed into a specific form, the further cell dividing stops, and the veins created by neovascularisation are reduced. The wound surface is epithelised, and the tissue is healed 4.
A normal consequence of using elevators during extractions is that neighouring teeth become sensitive and are difficult to chew with. From literature is known that after extraction the alveolus is irradiated along with the lingual and buccal bony wall 6. Faster coagulation, less postoperative discomfort and quicker healing could be expected 7,8, 9. In our study we decided to objectively evaluate the real effect of low-level laser radiation on healing process after human lower molars extraction 1,3,5, 7,8,9,10. The goal of study was to determine the effects of different frequencies on the healing of extraction wounds via monitoring the changes in secretory IgA and albumin levels in saliva before and after extraction and to evaluate the effects of laser therapy on the healing process of the bone wound via comparing the bone density of laser therapy-treated groups of patients and a group who did not receive any laser therapy treatment in comparison with subjective feeling of patients 1,3,8,9,10,11,12,13.
Low-level diode laser, wavelength 670 nm, power output 20 mW and HeNe , wavelength 632,8 nm, output 5 mW were used to laser therapy (Fig. 1). We used the following laser frequencies:
- Diode laser 670 nm, frequency 292 Hz
- Diode laser 670 nm, frequency 9000 Hz
- Diode laser 670 nm, frequency 5 Hz
- He-Ne laser Biostimul, frequency 5 Hz
- Control group - no laser radiation.
The use of low-level lasers is currently quite wide-spread in the dentistry offices 2,13. These lasers are usually equipped with not only the continuous beam but also with the adjustable frequency setting. Often enough, they have pre-set Nogier frequencies, Mastalier-adjusted for dentistry (A=292Hz, B=584Hz, C=1168Hz, D=2336Hz, E=4672Hz, F=9344Hz, G=146Hz). The available knowledge in the field of biostimulatory laser therapy do not give a clear-cut answer to the question what is better for the organism: to use continuous beam, to switch among several different frequencies, or to use a beam modulated into an exact frequency. Recommended frequency levels for diagnoses in dentistry that can be found in the literature either are modulated to a exact frequency or do not precise the beam type used : E.g. for the healing of extraction wounds you can find the following options:
- SmÃ©kal, MaÅ¡kovÃ¡: continuous (CW) beam, 5 Hz
- Mastelier: 292 Hz - "A" frequency per Nogier
- 3000-9000 Hz per NavrÃ¡til
- 9300 Hz per the guidebook for Oralaser Oralia Konstanz Switzerland
We focused on monitoring.150 healthy patients between 18 and 65 years old, after the extraction of their lower molars (reason for extraction: semi-retention of third bottom molars, carries of teeth 48,47,46,36,37,38). All patients, including the control group, were briefly informed about the anti-inflammatory, analgesic, regeneratory, and immunomodulatory effects of the laser before its use. In accordance with the 1964 and 1989 Helsinki Declaration they gave an informed agreement to cooperate on this project. Patients were randomly divided into five groups. The patients in every group were after extraction treated with low-level diode laser or read light (group 5 - placebo effect)
- Group 1 (30 patients) - low-level diode laser, frequency, 292Hz, (diode GaAIAs, wavelength 670nm, power output 20mW), density 1,5 J/ cm2
- Group 2 (30 patients) - low-level diode laser, frequency, 9000 Hz, (diode GaAIAs, wavelength 670nm, power output 20mW), density 1,5 J/ cm2
- Group 3 (30 patients) - low-level diode laser, 670 nm, frequency 5Hz, (diode GaAIAs, wavelength 670nm, power output 20mW), density 1,5 /J cm2
- Group 4 ( 30 patients) - He-Ne Biostimul laser, wavelength 632,8nm, output 5mW), frequency 5Hz, density 1, 5 J/ cm2
- Group 5, control (30 patients), was not laser-treated at all following the extraction.
OBJECTIVE AND SUBJECTIVE DETERMINATION OF TREATMENT EFFECT
We have applied local anesthesia (Supracain, LÃ©civa, Czech Rep., Mepivastesin, ESPE, BRD) and extracted the molar. We were used scissors and (or) elevators. Immediately after the extraction, we have irradiated the patients in the groups 1 - 4 with the respective lasers and respective frequencies and energy density 1,5 J/cm2 1,9. The alveolus was irradiated along with the lingual and buccal bony wall. We added the dose into the central part of the wound. The patients were then irradiated with laser for next 4 days.
Determining sIgA and albumin levels
An unstimulated saliva sample (approx. 1 - 1,5ml) was received from each patient prior to the treatment and on the fifth day. Quantitative determination of the secretory IgA and albumin was based on the principle of radial diffusion of saliva sIgA or albumin from the circular pit into a layer of agar gel containing monospecific antagonist. The resulting circular precipitate was evaluated after 96 hours, when a final point of immunodiffusion is achieved. The size of the ring is dependent on the concentration of the proving protein, in our case sIgA and albumin. The concentration of the sample is read directly from the reference table in the kit. Usage of the commerce kit Binding Site allows fast determination of sIgA and albumin in the saliva and guarantees reproducibility and standardization of the method. The sIgA and albumin levels after the treatment were referenced against the levels obtained from the first saliva sample and expressed in percent using the test of Student at the significance level P=0,05. The level of the first sample was considered as 100% (Fig.2).
As an additional marker for analysis of laser biostimulatory effect we evaluated the changes in bone density 6 months after extraction. To obtain the X-ray image, we have used the dental digital radiography method (Radio Visio Graph - RVG, Trophy, France). Isometric images were captured to have possibility to compare the measurements via fixed-point measurement method. We can measure up to 7 specific dimensions. The method itself is non-invasive, since it takes only 15% of the radiation exposure to obtain one conventional X-ray picture 14.
For evaluation we have used digital images taken immediately after the extraction and consecutively after 6 months. To capture the integration in the entire area of the extraction wound we have used the method of sliced RVG images, which we have taken laterally through the extraction wound 7. For that reason we have taken 3-5 slices, depending on the extraction bone area. The slices were 2 mm apart. For each slice, we have established density histogram, characterizing the density spread across the slice. Histograms were evaluated using the computer software program Sigma Scan and Sigma Scan Pro (Jandel, Germany) (Fig. 3).
Subjective patient's response to treatment
To evaluate less postoperative discomfort we prepared the special card containing relevant information on the patients: personal and health information, type of tooth and 5 degree scale of patient Â´s sensation from - no change to ++++ excellent results:
- no change
+ less postoperative disconfort
++ better subjective feeling
+++ best subjective feeling
++++ exellent result
RESULTS SIgA and albumin levels:
It was found the significant difference between patients irradiated by laser and control group (Graf 1.) The levels of sIgA and albumin increased in comparison to control. Comparison of the control group with the laser therapy treated patients groups irradiated by various frequencies (Graph 2) shows the most significant increase in the case of patients treated with laser frequency 292 Hz, 9000 Hz and for both the albumin levels and sIgA levels and for 5 Hz for sIgA level. Bone density: The results are in graph form, which compiles the density levels of individual slices for patients after extraction and after 6 months as well as the difference between these two periods (Graph 3). The treatment methods we have used (extraction wounds treated with 1,5 J/cm2 load for 4 days following the extraction) have not shown any significant differences in the bone density compared to the control group 12.
Subjective patient's response to treatment
The better patientÂ´s sensation after laser therapy was observed. The patients felt more comfort after laser therapy for all types of laser and different frequencies (Graph 4).
DISCUSSION AND CONCLUSION
The low-level laser has no influence on the process of osseintegration. This effect was observed on fracture healing in rats using He-Ne laser radiation 12. We have not found any differences in the bone density compared to the control group.
Frequencies recommended for wound healing in literature often vary 1,8,9,10
Different frequencies can have varying effect on sIgA and albumin levels 8,9,15. It is therefore important to use frequencies that increase both sIgA and albumin levels or at least don't have a negative effect. We have found significant differences in sIgA and albumin levels between patients exposed to radiation and those who were not.
The highest increase in sIgA and albumin levels were found in the group treated with the frequency of 9000Hz. Increase in the level of markers vs. the control group was found even in groups treated with other frequencies (5Hz, 292Hz).
Laser therapy objectively improves extraction wound healing and can be recommended as a method of choice16,17. We regard healing of extraction wounds with laser as contributory not only due to subjective feelings of patients who accept laser therapy largely positive due to its non-invasiveness and non-painfulness, but also due to the objectively proven changes in sIgA and albumin levels 8,15.
This research has been supported by the Grant Agency Ministry of Health of Czech Rep. No. 4091-3.
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