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6 Pratica & Clinica Ortho Tribune Italian Edition - Marzo 2018 Foto-bio-modulazione in ortodonzia Gianluigi Caccianiga, Ricercatore Confermato Università degli studi di Milano Bicocca. Insegnamento di Parodontologia, CLMOPD, Presidente Prof. Marco Baldoni. Le apparecchiature laser sono state proposte in ortodonzia soprattutto per le loro ottime caratteristiche chirurgiche. In effetti i piccoli inter- venti eseguiti con i laser richiedono meno o nessun ricorso ai punti di sutura, hanno un decorso molto più delicato e sono ben accettati dai pic- coli pazienti. Negli ultimi anni, tut- tavia, gli studi sugli effetti foto-bio- modulatori del laser in ortodonzia sono notevolmente aumentati. Mol- to probabilmente in futuro, il laser verrà utilizzato per la biostimola- zione del movimento ortodontico, per ridurre i tempi di trattamento. Al fine di confermare l’utilità del laser in ortodonzia, una recente revisione ha dimostrato che la foto- bio-modulazione (LLLT: Low Level Laser Therapy) è in grado non solo di ridurre il tempo di trattamento, ma anche il dolore post trattamento ortodontico. LLLT è semplice da usare, indolo- re, non ha effetti collaterali e non ha praticamente controindicazioni. Per ottenere risultati positivi, è necessa- rio utilizzare i parametri laser cor- retti: la quantità di energia assorbita dal dente in movimento può variare a seconda del tipo di laser utilizzato e dei parametri impiegati (lunghezza d’onda, fascio emergente dal manipo- lo per biostimolazione ad esempio). I laser di lunghezze d’onda comprese tra i 600 e i 1100 nm hanno una mi- gliore penetrazione nei tessuti umani e sono quindi i più efficaci per l’uso nella pratica clinica ortodontica. Una corretta densità di energia (Fluenza = J/cm2) è della massima importanza per ottenere effetti bio- logici. Il dosaggio di energia laser se- gue la legge di Arndt-Schulz: basse dosi stimolano, alte dosi inibiscono. Tuttavia, se si utilizza un dosaggio troppo basso, non è possibile com- pensare aumentando il tempo di esposizione. Qui è stata percepita la necessità di configurare corretta- mente i parametri del laser. Gli effetti del laser sulla biologia ortodontica sono diversi e sono stati dimostrati negli esseri umani, negli animali e nelle colture cellulari, quali la stimolazione del rimodellamento osseo, la riduzione del dolore post- seduta ortodontica, l’aumento di altezza e spessore della gengiva che- ratinizzata in denti erotti in mucosa alveolare, la diminuzione del riassor- bimento radicolare e delle recidive. Inoltre, non sono stati dimostrati ef- fetti collaterali sistemici per LLLT. Sembra che LLLT sia in grado di stimolare il rimodellamento osseo, quindi può anche accelerare il mo- vimento ortodontico senza danneg- giare i denti e i tessuti circostanti. L’esatto meccanismo di LLLT sull’osso non è ancora stato com- pletamente compreso. Studi in vi- tro dimostrano che la luce a una bassa dose di energia viene assor- bita dai cromofori intracellulari nei mitocondri, aumentando così la proliferazione cellulare attraverso alterazioni fotochimiche. Questo meccanismo include la promozione dell’angiogenesi, la produzione di collagene, la proliferazione e diffe- renziazione cellulare osteogenica, la respirazione mitocondriale e la sintesi di adenosina trifosfato (ATP). Diversi studi hanno dimostrato clinicamente come la LLLT possa ac- celerare il movimento ortodontico con dispositivi ortodontici fissi. D’al- tra parte, ci sono studi che hanno evidenziato gli effetti della LLLT sul movimento dei denti nei trattamenti ortodontici con mascherine invisibili. > pagina 7 - Camacho AD, Velásquez Cujar SA. Dental movement acceleration: Litera- ture review by an alternative scientific evidence method. 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