Associate Professor Dragana Gabrić

USAGE OF DIODE LASERS IN ORAL SURGERY AND DENTAL IMPLANTOLOGY

Laser devices have gained in importance since the eighties and they are often claimed to be omni-use instruments. Though many applications turned out to be impracticable, an unwaning interest in this technique has remained to date. The broad spectrum of applications for the diode laser means that it is now the most widely used device in laser dentistry. Diode lasers offer an interesting – but not unlimited – field of application in modern dentistry including periodontology, endodontics and soft tissue treatment.

LLLT (Low Level Laser Therapy) is the application of red and near infra-red light over injuries or lesions to improve wound and soft tissue healing, reduce inflammation and give relief for both acute and chronic pain. LLLT is used to increase the speed, quality and tensile strength of tissue repair; resolve inflammation and relieve pain (analgesia). The effects of LLLT are photochemical (like photosynthesis in plants). When the correct intensity and treatment times are used, red and near infrared light reduces oxidative stress and increases ATP. This improves cell metabolism and reduce inflammation. Low level laser therapy effects are biochemical and not thermal and cannot cause heating and thereby damage to living tissue. Four distinct effects are known to occur when using low level laser therapy:

A) Growth factor response within cells and tissue as a result of increased ATP and protein synthesis; improved cell proliferation; change in cell membrane permeability to calcium up-take.

B) Pain relief as a result of increased endorphin release; increased serotonin; suppression of nociceptor action.

C) Strengthening the immune system response via increasing levels of lymphocyte activity and through a newly researched mechanism termed photomodulation of blood.

D) Acupuncture point stimulation.

The antimicrobial photodynamic therapy (aPDT) is a non-thermic light-induced inactivation of cells, microorganisms or molecules. "Antimicrobial" photodynamic therapy targets pathogenic microorganisms. Using a dye, the bacteria that cause infections are stained, sensitized and destroyed following exposure with light of a suitable wavelength and energy density. A decisive role plays the „photosensitizer“, a coloring solution (e.g. Toluidin Blue, Methylene Blue etc.). The oxygen atoms in the color molecules are activated by irradiation of appropriate light. They initiate singulet conditions, which have a toxic effect on the cells.

The accent is on LaserHF device, the new instrument in the field of soft tissue surgery. Amazing composition of high frequency, diode laser and therapeutic laser in the single instrument is intriguing for the clinician. High frequency technology (HF) has been consequently developed since the seventies, with significant advancements over conventional electro surgery. HF is a unspectacular technology, but well known and accepted in surgical applications by most of the dentists. HF is great supplement for laser technology in the oral soft tissue surgery.

The diode laser offers a minimally invansive technique and can make the surgery less extensive, and may reduce the need for general anesthesia or hospital care, and lowers the overall costs.

For these reasons, it will become more widely used in the future, particularly in the increasingly elderly population.

Associate Professor Dragana Gabrić, DMD, PhD, , Scientific Advisor, Specialist in Oral Surgery, Department of Oral Surgery, School of Dental Medicine, University of Zagreb; Head of clinical Department of Oral Surgery, University Dental Clinic, University Hospital Center Zagreb, Zagreb, Croatia

2004. Degree, Doctor of Dental Medicine, University of Zagreb, Zagreb, Croatia

2005. Dean’s Award for Best Study Success

2005. Dean’s Award for Member of Sonda’s Journal Editorial Board

2006. Junior Assistant, Department of Oral Surgery, School of Dental Medicine, University of Zagreb

2007. Oral Surgeon Trainee, Department of Oral Surgery, University Hospital Center Zagreb

2010. PhD Degree, dissertation, field of experimental laser bone surgery (“Physical and ultrastructural bone effect comparison between laser and surgical drill”)

2010. Senior Assistant, Department of Oral Surgery, School of Dental Medicine, University of Zagreb, Zagreb, Croatia

2011. Associate Research Scientist, Department of Oral Surgery, School of Dental Medicine, University of Zagreb, Croatia

2011. Specialist in Oral Surgery, Department of Oral Surgery, University Hospital Center Zagreb, Zagreb, Croatia

2013. Senior Research Scientist, Department of Oral Surgery, School of Dental Medicine, University of Zagreb, Croatia

2014. Assistant Professor and PhD Tutor, Department of Oral Surgery, School of Dental Medicine, University of Zagreb, Croatia

2018. Scientific Advisor, Department of Oral Surgery, School of Dental Medicine, University of Zagreb, Croatia

2019. Associate Professor, Department of Oral Surgery, School of Dental Medicine, University of Zagreb, Croatia

2019. Head of the Reference Center for Dental Implantology of the Ministry of Health of the Republic of Croatia

2021 Head of Department of Oral Surgery, University Dental Clinic, Clinical Hospital Center Zagreb, Zagreb, Croatia

Fields of interest: dental implantology, minimally invasive surgical procedures, laser bone and soft tissue surgery, bone augmentation techniques, bone grafts, sinus surgery, peri-implant diseases; hospital dental medicine

Author and coauthor of many cited scientific papers, number of professional papers and reviews, 24 book chapters (field of medical genetics; dental implantology and bone augmentation surgical procedures; laser soft tissue surgery, dental anesthesia, orofacial pain)

Active participant of many national and international scientific and professional courses and congresses

Editorial board, member – Journal of Lasers, Optics & Photonics; Clinical Radiology & Imaging Journal (CRIJ); Journal of Dentistry, Oral Disorders and Therapy; Journal of Cancer Research Forecast; Advances in Dentistry & Oral Health; Annals of Surgery and Perioperative Care

Reviewer for several international scientific journals (Journal of Periodontology, Journal of Dentistry, Oral Disorders & Therapy, Acta Stomatologica Croatica, Journal of Cranio-Maxillary Diseases, Microscopy and Microanalysis, Journal of Laser, Optics & Photonics, Journal of Dentistry, Oral Disorders and Therapy, Journal of Applied Oral Science; Journal of Sleep Disorders and Therapy; Clinical, Cosmetic and Investigational Dentistry; Case Reports in Dentistry; Scientific Reports; Clinical Advances in Periodontics; Materials; Molecules; Diagnostics; Applied Science; Oral Clinicial Investigation; Case Reports in Dentistry; Scientific Reports)

Invited speaker of many international scientific and professional courses, congresses and Universities (China, Hong Kong, United Arab Emirates, France, Germany, Hungary, Spain, Ukraine, Slovenia, Serbia, Bosnia and Herzegovina, Macedonia, Montenegro, Bulgaria, Georgia)

2012. World Federation for Laser Dentistry, 13th Congress, Invited speaker (keynote lecture)

Member of Croatian Chamber of Dental Medicine, Croatian Society of Oral Surgeons (Secretary, Board Member), Croatian Associatian for Dental Implantology (Board Member), Croatian Medical Association, Laser and Health Academy, Croatian Association for Minimally Invasive Dental Medicine (Secretary, Board Member) and Croatian Society for Maxillofacial, Plastic and Reconstructive Surgery of the Face and Neck (Board Member)

Holder of one registered patent