Radiodensitometric Assessment of the Effect of Pulsed Electromagnetic Field Stimulation Versus Low Intensity Laser Irradiation on Mandibular Fracture Repair: A Preliminary Clinical Trial

Abstract

Purpose Closed reduction of mandibular fractures usually entails a relatively long period of immobilization, with the subsequent delay of rehabilitation. Therefore, shorter immobilization period with various approaches to protect or enhance bone healing have been investigated. The aim of this study was to analyze the effects of pulsed electromagnetic field (PEMF) and low intensity laser irradiation (LILI) on the fracture healing process, through radiodensitometric assessment of the bone callus. Patients and Methods Eighteen patients with mandibular fractures at the tooth bearing area participated in this prospective study. They were treated by closed reduction using maxillo-mandibular fixation (MMF) and were consecutively assigned into 1 of 3 groups. In group A, the fracture sites were exposed to PEMF for 2 h daily for 12 days. In group B, the fracture sites were exposed to LILI on the tenth and twelfth postoperative days (2 sessions of 6 min per day 2 h apart). The fracture sites in group C acted as controls. MMF was maintained for 2 weeks in group A and 4 weeks in groups B and C. The bone fracture healing was evaluated clinically by investigating the union of the fractured segments and radiographically using computerized densitometry. The union of the fractured segments was tested by manual manipulation and the occlusion was assessed upon removal of MMF. Standardized digital panoramic radiographs were performed for each patient, immediately postoperatively as well as at 2 and 4 weeks. The digital images were manipulated using the IDRISI software. A rectangular area of 10 9 15 mm was drawn along the center of the fracture line. The obtained densitometry values were expressed in gray levels from 0 to 256. The collected data were then tabulated and statistically analyzed. Results After releasing the MMF, the bimanual mobility test of the fractured segments in all patients showed stability of the segments. The preinjury occlusion was maintained in all patients. The postoperative radiographs of all patients revealed good bony alignment of the bony segments. In all groups, comparison between the study intervals with respect to both means and changes percentages of the bone density values showed insignificant differences. At 2nd postoperative week, the mean bone density at the fracture sites decreased by 4.74, 6.6 and 27.89 % in groups A, B and C respectively. The period from the 2nd to the 4th postoperative weeks showed increase in the bone density by 1.49, 1.95 and 14.12 % in groups A, B and C respectively. Insignificant difference was found between the means of bone densities of group A and B throughout the study intervals. On the other hand, both groups showed insignificant difference with group C immediately postoperative and significant increase in bone density at the 2nd and 4th postoperative weeks. Conclusions Short period immobilization of mandibular fractures for 2 weeks supplemented with PEMF is recommended. Further studies are needed to evaluate the efficacy of LILI as a supplement to reduce the m...

Histopathologic evaluation of the effects of local simvastatin application and photobiomodulation by light-emitting diode on bone healing of rat calvarial defects

“…In the present study, we focused on the effect of PBM on the bone regeneration rate during the early period of healing. Fracture healing occurs in four consecutive histologic phases: hematoma formation phase, early inflammatory phase (2-4 weeks), repair phase (within 1-2 months) and late remodelling phase [48]. In the present study, we evaluated the effect of PBM on the early inflammatory phase, in which osteoblastic activity is just beginning with the formation of bone matrix.…”

Radiographic analysis of the management of tooth extractions in head and neck-irradiated patients: a case series

“…In healthy patients, bone formation after oral surgery can be observed on radiography even within a short period of time (from 6 to 45 days). 14 15 16 17 18 Some studies have suggested that photobiomodulation with a low-level laser may be used to accelerate the bone repair process, with a significant improvement. 14 15 16 17 18 …”

“…14 15 16 17 18 Some studies have suggested that photobiomodulation with a low-level laser may be used to accelerate the bone repair process, with a significant improvement. 14 15 16 17 18 …”

The cellular effects of Pulsed Electromagnetic Fields on osteoblasts: A review

“…EMFs, however, have been proposed to prevent bone loss in osteoporosis patients [Tabrah et al, , ; Garland et al, ] to treat non‐ or delayed unions or osteotomies [Bassett et al, , ; Barker et al, ; Sharrard, ; Scott and King, ; Simonis et al, ; Cheing et al, ; Faldini et al, ; Abdelrahim et al, ; Adie et al, ; Assiotis et al, ; Lazović et al, ; Shi et al, ; Refai et al, ; Hannemann et al, ; Streit et al, ], but their clinical application has been significantly hindered and delayed by our poor understanding of its underlying mechanisms and therefore by difficulties in defining consistent sets of parameters to be applied across a number of patients [Daish et al, ]. Although the literature is overall suggestive of clinical benefit, the fundamental heterogeneity in the published studies, coupled with the scarcity of high quality randomized controlled trials, has led to inconclusive evidence of their clinical effectiveness [Griffin et al, ; Hannemann et al, ; Handoll and Elliott, ; Spadaro, ].…”