Photobiomodulation Delivery Parameters in Dentistry: An Evidence based Approach.

Notwithstanding around 50 years of continued research, and with an ascending level of current research submissions, there is at present no agreed methodology and process to adopted treatment protocols. Dosimetry at target tissue level is, however, largely agreed, and more recent proposals have promoted the concept of a multiphasic dose–response to clinical outcomes [1]. Higher dosimetry appears to be the most effective for analgesia, and a lower dose bracket for the growth-promoting and optimal tissue healing benefits associated with tissue regeneration and the resolution of inflammation [2–6]. There is, however, no agreement with respect to wavelengths adopted, spectral emission modes, optical beam spatial profiles, and the optical surface spot size, together with the inter-relationship of these variables to optimize therapy outcome. Further, energy delivery to subsurface targets has proven to be a significant challenge, with the requirement for the operator to deliver a meaningful photonic dose to target through overlying anisotropic multiple layers of variable tissue types [7–9]. However, despite the many difficulties that have been encountered by researchers and clinicians alike, there is considerable interest in harnessing the proven benefits of photobiomodulation (PBM) as a therapy. This has led the authors to consider broadly and as widely as possible within the prior published evidence base factors that can more consistently lead to reduced operator errors and a higher level of research and clinical endeavor outcomes. For the purpose of this study, the authors considered that a prime objective in maintaining the sustainability of evidence-based data is to mandate a full description of laser operating parameters, both those concerning control panel running parameters and computed data relating to photonic dose. In this regard, the authors conducted an audit of published randomized clinical trial (RCT)-level articles that formed the basis of five recent systematic reviews. Within a total of 141 published articles, a selection of criteria that contributed to a ‘‘risk of bias’’ determination was examined. From this, it is asserted that the high level of absence of some basic values of photonic energy delivery renders cause for concern regarding the scientific rigor of conclusions obtained in such studies.