LLLT of Granuloma

Emergency Dentistry London


LLLT of granuloma


A few clinical cases


In this paper we present the clinical evidence that low level laser therapy (LLLT) substantially improved the healing effects of granuloma classical treatment.

The granuloma is the final stage of the severe tooth apical infection.

For treatment of granuloma, classical therapy was used in some cases while in others classical therapy was accompanied by LLLT.

Classical treatment is either the extraction or surgery with keeping the tooth with not many chances of healing success.

For monitoring the LLLT effect, we used calcium endodontic therapy (filling the tooth channel with calcium hydroxide which drains out the purulent infection) accompanied by laser bio stimulation. The results obtained by simple classical treatment versus classical treatment accompanied by LLLT were compared.

The common way of therapy in tooth granuloma is extraction or surgery (apical resection) with the maintaining of the tooth. These imply a mutilating procedure for tooth and patient as well as possibility of post operator accidents (inflammation hematoma, bleeding, supra-infection, pain, retaining patient from activity for 1 – 3 days), as well as use of expansive medication, possibility of in-success and recurrence, maxillary sinus complications.

In less severe infections of tooth apex, when the root did not yet enveloped granuloma, we filled the tooth channel with calcium hydroxide which drains out the purulent secretion.

When associating classical treatment with LLLT, we use the calcium hydroxide for the treatment of severe apical infection (granuloma) accompanied by repeated root irradiation until the purulent secretion dries out.

While extraction can not lead to total healing without tooth mutilation, the use of LLLT in conjugation with calcium hydroxide treatment leads to a complete and rapid healing with saving the tooth and elimination of any local inflammatory problems. That means less costs and less trauma for the patient.


LLLT effects were revealed by monitoring a group of 33 young (age 25 – 39) male patients with the same diagnosis and similar medical history. 19 of them were treated classically, while 14 underwent classical treatment associated with LLLT.

LLLT implied a/intra-tooth irradiation of the tooth root using optical laser fiber focused on the granuloma region and b/external irradiation of the tooth root applying the optical fiber on the maxillary skin and focusing the laser beam on the granuloma region.

Laser beam parameters used in LLLT


The source: infrared diode laser (from BTL 10, Czech Republic production), λ = 830 nm

Irradiation: in Nogier Pulse Mode, energy density/pulse from 0.5 J/cm2 up to 2J/ cm2

The laser parameters were automatically adjusted according to the value of the needed depth of penetration (2.5-12 mm)


Below we illustrate three of the monitored cases.

Classical treatment associated with LLLT was used in one case while classical treatment only, in other two cases.

Presentation of clinical cases


Petrishor N., age 36, treated with LLLT associated to classical treatment for parodonthosis & apical granuloma

A. X-ray image of the chistic apical granuloma from the maxillary canine tooth before treatment

B. X-ray image of the chistic apical granuloma from the maxillary canine tooth after eight weeks of LLLT associated with hydroxide calcium therapy.

After conjugated classical and laser therapy, the inspection of the X-ray image of the granuloma region shows that the bone mineralization is visibly restored, purulent secretion at the tooth apex disappeared, halisterezis (bone vacuolization) disappeared,

bone structure in the area is more compact and the tooth masticator function is restored.

Case 2

Munteanu Cristian, age 34, chistical granuloma, treated classically

A.X-ray image of the apical chistical granuloma on mandible tooth, before treatment

B.X-ray image of the apical chistical granuloma (circle) on mandible tooth after eight weeks of treatment with calcium hydroxide. No LLLT

After eight weeks of classical therapy, the inspection of the X-ray image of the granuloma region shows that the inflammatory process is still present and there is no evidence of mineralization; the tooth is in the sub-acute stage of infection

Case 3

Mihai M., 36, maxillary chistic granuloma, treated classically, with tooth extraction.

The patient refused LLLT.

A.X-ray image showing maxillary chistic granuloma complicated with endodontical origin sinusitis.

B. X-ray image showing the infected area after the extraction of the tooth with granuloma.

Examination of the patient after the treatment showed that the regional problems and the sinus infection are still present. The patient is directed to ORL treatment.

The result of the tooth extraction is a mutilation leading to morph-functional dysfunction which claims a complex prosthetic treatment.

Post-surgery accidents (inflammation, hemorrhage, infection, pain), claiming other treatment and new costs for antibiotics, vitamins as well as withdrawing for 1-3 days from social life, are very probably to happen.

The above described cases are taken out of the 33 monitored patients from which 19 underwent classical treatment and 14, the classical treatment associated with LLLT.We tried to follow the immediate effects as pain and inflammation as well as long term bone recovery.

Acute Inflammation

Time, after which inflammation is no more observed (5.7 ± 0.6 days) for control group is several times higher than for the LLLT group (1.8 ± 0.25 days).

Pain relief

Time (minutes) necessary for complete pain relief measured by the patient’s journaloupfor the control group (485 ± 32) and for the laser terapy (126 ± 15)

Bone recovery

Time (months) necessary for bone recovery, evaluated from x-ray controlfor the control group (33.2 ± 5.7) and the Laser Therapy Group (17 ± 1.7).


Biostimulation by laser therapy is an ecological procedure which requires no medication

Laser therapy associated with classical methods in therapy brings an essential improvement of healing effect comparatively to classical treatment only, leading to shortening of the treatment time and healing completely the local inflammation, avoiding expensive antibiotics and vitamin treatment claimed by local infection, avoiding tooth loss (possibly accompanied by post operator complications), avoiding social disfunction caused by tooth loss; the patient could avoid interruption of his professional and social activity.

The immediate local effects observed are: a sure and rapid biological transformation, no bleeding and other post surgical complications (hematoma, infections, pain, tooth loss). Studies on other age groups and medical history groups are necessary in order to evaluate the general impact of LLLT in granuloma treatment.


1.Steinlechner, C, Dyson, M., The effect of low level laser therapy on the proliferation of keratinocite, Laser Therapy, 1993, 5(2), 65–74.

2.Vieru Dana Rozalia, Lefter Agafiţa, Herman Sonia, The use of laser irradiation into the surgical treatment of periodontal deseases,Laser Florence 2001, SPIE, 2002, 4903.

3.Baxter, G.D., Therapeutic lasers. Theory and praxis, Churcill Livingstone,Edinburgh, London, Madrid, Melbourne, New York, Tokyo, 1994.

4.Dumitraş, D.C., Biofotonica. Bazele fizice ale aplicaţiilor laserilor în medicină şibiologie, Editura ALL, Bucureşti, 1999.

5.Kotani, H., Effects of LLLT on wound healing in rats, Laser in Med. Surg., 1995, 11(2), 25 – 47.

6.Longo, L., Tamburini, A., Monti, A. et al., Treatment with 904 and 10600 nm laser of acute lumbago – double blind control, Laser, Journ. Eur. Med. Laser Ass., 1991, 3(1), 16–19.

7.Simunowich, Z., Simunovich, K., Status after multiple teeth extraction treatment with low level laser therapy. A randomized clinical study with control group, Laser in Surgery and Medicine, 2001, suppl 13,11.

8.Avila, R. et al., Histological effects of He-Ne laser on chick embryo, Proc. X Internat. Congress Int. Soc. Laser Surg. Med., Bangkok, 1993, 164b.

9.Basford, J.R., Low intensity laser therapy: still not an established clinical tool, Lasers in Surgery and Medicine, 1995, 16, 331–342.

10.King, P., Low lever laser therapy: A Review, Lasers in Medicine Science, 1989, 4, 141–170.

11.Kolomiyets, L.A., Mechanism of treatment effect of low energy laser irradiation, Proc. SPIE, 1996, 1984, 253–264.

12.Kotani, H., Effects of LLLT on wound healing in rats, Laser in Med. Surg., 1995, 11(2), 25 – 47.

13.Baxter, G.D., Therapeutic lasers. Theory and praxis, Churcill Livingstone,Edinburgh, London, Madrid, Melbourne, New York, Tokyo, 1994.

14.Tuner, J., Hode, L., Laser Therapy. Clinical therapy and scientific backround, Prima Book, 2002, Stockholm.

15.Mester, E. et al., The biostimulatin effect of laser beam, Proc. Laser-81, Opto-Elektronik, Munchen, 1981.

16.Mostovnikov, V.A., Mostovnikova, G.R., Plavski, V.Yu., Plavskaia, L.G., Morosova, R.P., Molecular mechanism of biological and therapeutical efect of low-intensity laser irradiation, SPIE, 1995, 2391, 561–572.

17.Ohta, A., Abergel, P., Uitto, J., Laser modulation of human imunosystem: Inhibition of lymphocyte proliferation by a gallium-arsenide laser at low energy, Laser in Surgery and Medicine, 1987, 7, 199.


Emergency Dentistry London

12 Harley Street, City of London W1G 9PG

0207 9350772 07508 879201