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science & practice28 Show Preview IDS Cologne 2015 With the upcoming year, 2015, being designated as the year of light, the ac- knowledgment for the key role of light inmultitudeareasofourveryexistence andmorespecifically,inareasofhuman health are being widely promulgated.1 Many references to the beneficial ef- fects of light and specifically sunlight are replete in the literature across an- cientcivilisations. Notably,theabilityofconcentrated light radiation in the management of Lupus vulgaris by Niels Ryberg Finsen received the Nobel Prize in Medicine and Physiology in 1903.2 The all-perva- sive nature of opto-photoelectronics in our current society is readily evident such as the simplest supermarket laser scanners and optical communications toprecisionmedicallasersandmorere- cent laser weapon systems. This is also perhaps best highlighted by this year’s Nobel Prize in Physics to the inventors of the blue light emitting diodes (LEDs), a simple invention with profound im- pactonourcurrentsociety.3 Clinicallaserapplication Dentistry has historically been a leading clinical specialty in adoption of newtechnologies.Lighthasbeenacen- tralpartofclinicaldentistryfromevolu- tions of operating lights and fibre optic illuminationstolightcuredrestorations and more recently, optical imaging. Al- thoughlaserswerecommerciallyavail- able since 1960’s, the first dental laser for hard tissue applications was ap- provedbytheUSFDAin1997.Adoption for high power soft tissue applications has always been popular in many med- icalfieldssuchassurgery,oncology,der- matologyandophthalmology. Firstdiscoveries Following the invention of this ex- citing new tool, early biological con- cerns focused around the safety of this new device with natural comparisons beingdrawntoionizingformsofelectro- magnetic radiation. Among the early pioneering studies, Andre Mester re- ported a peculiar phenomenon—high doses destroyed tissue in a precise and predictable manner but very low doses produced a startling improvement in wound healing and promoted hair growth.4, 5 This was a surprising discov- eryonmanyaccounts. Whilehighenergyelectromagnetic radiation, such as Gamma, X-rays and Ultraviolet,wereabletoachievesignifi- cant linear energy transfer generating biological damage (nucleic acid strand breaks), the effects of visible (and later infra-red) lasers did not appear to fall within these routine biological re- sponses(Fig.1).Withmuchexcitement, theseinitialobservationsspurredmany investigations for the use of low pow- ered lasers and other light devices (in- cluding filter-based broad light sources and LEDs) in many clinical and lab re- searchstudies. Barriersinapplication Unfortunately,acombinationofthe complexity of the early technology and alackofunderstandingofitsbiological mechanisms has resulted in significant discrepancies in their reported thera- peutic benefits. Hence, the lack of ro- bust clinical efficacy has largely rele- gated the field to being side-lined as a pseudo-scientific and alternative medi- cinefield.Currentproblemsinthefield fromitsbasicterminologythatprevents accurate indexing of the literature, to appropriate disease or biological re- sponse-specific clinical dose recom- mendationsappeartobemajorbarriers. Nonetheless,developmentoflowpower applicationshasalsoshownsignificant progressspecificallyintheareasoftrau- maticbraininjury,post-traumaticstress disorders,reversalofmethanoltoxicity and wound healing.6–15 In more recent years,mechanisticinsightsintolight-bi- ological tissue interactions have con- tributedtoourbetterunderstandingfor the therapeutic applications of laser therapy.16–18 Definingphotobiomodulation OuroperationaldefinitionforPhoto- biomodulation (PBM) is a form of pho- totherapy that utilises non-ionizing sources(includingbroadlight,LEDsand Lasers) in the visible and infrared spec- trum that result in therapeutic benefits such as alleviation of pain or inflamma- tion, immunomodulation and promo- tion of wound healing and tissue regen- eration.PBMisanon-thermalprocessin- volving photophysical and photochemi- cal events at various length scales resulting in beneficial photobiological responses.Itsclinicalapplicationscould beappendedasPBMtherapy. Study1:ActivatingTGF-β1 Based on prior reports, we began studiesin1999toestablishtheparame- ters of the near infrared laser to effec- tively promote oral wound healing at low doses (3J/cm2 , 10mW/cm2 , 5 min- utes). We performed a, thorough litera- turesearchtoevaluatepossiblebiologi- cal pathways involved in promoting wound healing. There appeared to be distinct correlations with reported use of exogenous TGF-β1 and laser treat- mentsinwoundhealing. Based on these observations, we as- sessed the laser-treated healing re- sponse of oral tissues for TGF-β1 expres- sionandnotedincreasedexpressionim- mediately post treatment and at 14 days.19 Theincreaseat14dayscorrelated well with an increased in monocyte- macrophageinflux,well-knowncellular sources of TGF-β1. We next looked into the increased early expression of active TGF-β1 in these wounds.TGF-β1 is se- cretedasalatentgrowthfactorcomplex when associated with a Latency Associ- ated Peptide (LAP). The activation process involves dissociation of LAP from active TGF-β1 dimer that is well- documentedwithawiderangeofphysio- chemical modalities such as proteases, extremepH,heat,ionizingradiationand integrinbindingamongothers.Theearly wound has abundant latent TGF-β from degranulating platelets present in the earlywounds. We observed low power laser treatments were capable of acti- vating the latent TGF-β1 com- plex.Tofurtherpursuethis observation mechanis- One step fiber post One step fiber post Post connector system the new hollowed post Sterilized! Via Bellini 17 - 22070 Rovello Porro (CO) tel. +39 02 96754179 - fax +39 02 96754190 www.isasan.com - info@isasan.com srl Ready for you at our booth No. B018 Hall 2.1 Are you a dealer? Contact us. unique and revolutionary TECHOLE silica (white): • 6 posts in blister, GAMMA RAYS STERILIZED • Size: S - M TECHOLE carbon (black): • 6 posts in blister, GAMMA RAYS STERILIZED • Size: S - M the new hollowed post: - single step - extreme compatibility to adhesives and composites - higher adhesion - higher strength - easy retreatment - radiopaque AD Fig. 1: The use of various wavelengths at different doses can be used for various clinical applications. The following acronyms are used in this figure PBM— Photobiomodulation;enPDT—PhotodynamictherapywithendogenouschromophoresandexPDT—Photodynamictherapywithexogenouschromophores(dyes). Innovations with lasers could lead regenerative dentistry Praveen R.Arany,USA Fig.2:Therapeuticoutlineutilizinglaser-generated ROS activated TGF-β1 to direct differentiation of dental stem cells and pre-odontoblasts to induce dentin matrix and subsequent mineralization. ª tel. +390296754179 - fax +390296754190

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