J Clin Laser Med
Surg. 2004 Feb;22(1):15-8.
The comparison of effects between pulsed and CW lasers on
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.
MATERIALS AND 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.
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.
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
DAAA ( http://www.akupunktur-arzt.de )
OGKA (http://www.ogka.at )
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,
Bones, muscles, joints, tonification points
D: Psychic disturbances, exhaustion, pains
Commissures, alarm points
Dr. Paul Nogier
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
Frequencies according to Prof. Dr. Frank Bahr, Munich,
Prof. Dr. Bahr
1: Disruption in conversation of acquired energy,
disruption in conversation of own energy resources,
source of illness, affinity to symp. nerve system
Lower tissue layer
2: Transfer of energy, neuronal energy and distribution
function, hormonal and nerve systems, affinity to
parasympathetic nerve system and Central tissue layer
3: Boundary and tangential area between man and the
environment, biotic points, Omega-Ren channel points and
Surface tissue structures
4: Omega-Du channel points
5: Oscillation frequency, Super omega
6: Left axis, right points
7: Right axis, left points
Frequencies 6 and 7 are used in auricular-medicine for
Prof. Dr. Bahr as well the found of 8 Chakra frequencies.
A large range of new frequencies where found by Dr.
Reininger, Austria, vice president of the OGKA (Austrian
Society of Controlled Acupuncture).
Dr. K. Reininger
Reininger I, II, III
Frequencies of levels
Low-level laser therapy after
Hana Kucerováa, Tatjana Dostálováa,
Lucie Himmlováa, Jirina Bártováa, Jirí Mazánekb
Institute of Dental Research - General Medical Hospital,
Vinohradská 48, 120 60 Prague 2, Czech Republic, E-Mail:
First Medical Faculty of Charles University Prague, Czech
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
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.
dentistry, low-level laser radiation, secretory IgA,
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
- 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
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
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
- diode laser 670 nm, frequency 292
- diode laser 670 nm, frequency 9000
- diode laser 670 nm, frequency 5 Hz
- He-Ne laser Biostimul, frequency 5
- 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:
- Smékal, Mašková: continuous (CW)
beam, 5 Hz
- Mastelier: 292 Hz - "A" frequency
- 3000-9000 Hz per Navrátil
- 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
- 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.
SUBJECTIVE DETERMINATION OF TREATMENT EFFECT
We have applied local anesthesia (Supracain, Léciva,
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.
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)
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 ´s sensation from - no change to
++++ excellent results:
- no change
+ less postoperative disconfort
++ better subjective feeling
+++ best subjective feeling
++++ exellent result
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.
patient's response to treatment
The better patient ´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).
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
Frequencies recommended for wound
healing in literature often vary 1,8,9,10,.
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).
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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