LaserWorld Guest Editorial, 4 1999.

100 positive double blind studies - enough or too little?

by Jan Tunér DDS jan.tuner@swipnet.se
Lars Hode, Dr Sci lars@hode.com

Low Level Laser Therapy still has many critics and is not readily accepted as a natural treatment modality in all countries. One main point emphasized by the critics is the lack of scientific documentation. While this was a valid point in the 80s and partly in the beginning of the 90s, is it still a solid argument? There are more than 2000 published studies and the vast majority of these report positive biological effects from Low Level Laser Therapy (LLLT).

The heart of a scientific documentation is the double blind clinical studies. There are some 140 such studies in the field of LLLT and it may come as a suprise to many critics that more than 100 of these are positive. In fact, even most advocaters of LLLT are unaware of this fact. The aim of this Editorial is to disseminate this information to the LLLT community.

Some of the negative double blind studies are well designed and should be taken seriously. Certainly all indications and all parameters cannot work. However, a number of the often quoted negative double blind studies suffer from flaws of several kinds. Some of this is outlined on http://www.laser.nu/lllt/LLLT_critic_on_critics.htm which is a chapter from our recent book "Low Level Laser Therapy - clinical practice and scientific background"

A closer analysis of 100 positive double blind studies will be presented at Laser Florence '99 (October 28-31) and will also appear in the EMLA Millennium laser book.
A weakness in the list is that many double blind studies have only been identified in the abstract form. They may have been published in full at a later stage, but not found by us. 14 studies have only been found as references in reference lists and these have not been found in spite of intensive efforts. For a complete analysis of the 100 positive double blind studies we need the assistance of the visitors of LaserWorld. In the following list abstracts are marked in red and studies not found marked in green. If you have any information about the green studies please contact us. And if you know that an abstract has been published in a journal, please do likewise. The more complete the list is, the better for the LLLT community.

The studies published in journals are listed in full in the book mentioned above.

Atsumi K et al. Biostimulation effect of low-power energy diode laser for pain relief. Lasers Surg Med. 1987; 7: 77.
Barabas K et al. Controlled clinical and experimental examinations on rheumatoid arthritis patients and synovial membranes performed with neodym phosphate glas laser irradiation. Proc. 7th Congr Internat Soc for Laser Surg and Med, Munich June 1987. Abstract no 216a.
Boerner E et al. Double-blind study on the efficacy of the lasertherapy. SPIE Proc. 1996. Vol. 2929: 75-79.
Cheng R. Combined treatments of electrotherapy plus soft laser therapy has synergistic effect in pain relief and disease healing. Surgical and Medical Lasers. 1990; 3 (3): 135
Cieslar G et al. Effect of low-power laser radiation in the treatment of the motional system overloading syndromes. SPIE Proc. Vol 3198. 1997, pp. 76-82.
Emmanoulidis O et al. CW IR low-power laser application significantly accelerates chronic pain relief rehabilitation of professional athletes. A double blind study. Lasers Surg Med. 1986; 6: 173.
Haruki E, Yamaguchi S. Double blind evaluation of low energy laser treatment for painful disease. J Phys Med. 1995; 6: 60-67. (In Japanese with English abstract)
Hopkins G O et al. Double blind cross over study of laser versus placebo in the treatment of tennis elbow. Proc Internat Congr on Lasers, "Laser Bologna". 1985: 210. Monduzzi Editore S.p.A., Bologna. Hoshino H et al. The effect of low reactive level laser therapy in the field of orthopedic surgery. Chronic Pain. 1994; 13: 101-109. (In Japanese with English abstract)
Hoteya K et al. Effects of a 1 W GaAlAs diode laser in the field of orthopedics. In: Meeting Report: The first Congress of the International Association for Laser and Sports Medicine. Tokyo, 1997. Laser Therapy 1997; 9 (4): 185.
Kamikawa K et al. Double blind experiences with mid-Lasers in Japan. 1985. Proc Int Congr on Lasers, "Laser Bologna". 1985: 165-169. Monduzzi Editore S.p.A., Bologna.
Kim J W, Lee J O. Double blind cross-over clinical study of 830 nm diode laser and 5 years clinical experience of biostimulation in plastic & aesthetic surgery in Asians. Lasers Surg Med. 1998; Suppl. 10: 59.
Kinoshita F et al. Clinical evaluation of low-energy, semi-conductor laser therapy in oral surgery - a double blind study. Josai Shika Daigaku Kiyo (Bulletin of Josai Dental University). 1986; 15 (3): 735-742. (in Japanese with English abstract)
Kosaka R et al. Double blind study of low energy diode laser irradiation for chronic pain disorders. J Phys Med. 1993; 4: 156-160.
Kouno A et al. The evaluation of pain therapy with low powerlaser- Comparative study of thermography and double blind test. Biomedical Thermology. 1993; 13: 102-107.
Lonauer G: Controlled double blind study on the efficacy of HeNe-laser beams versus HeNe- plus Infrared-laser beams in the therapy of activated osteoarthritis of finger joints. Clin Experim Rheuma. 1987; 5 (suppl 2) : 39
Lucas C et al. Low level laser therapy bij decubitus statium III. Rapport Hoegschool van Amsterdam. 1994.
Mach E S et al. Helium-Neon (Red Light) Therapy of Arthritis. Rhevmatologia, 1983; 3: 36. (In Russian)
Mester A: Biostimulative effect in wound healing by continous wave 820 nm laser diode. Double-blind randomized cross-over study. Lasers in Med Science, abstract issue July 1988, No 289.
Miyagi K. Double-blind comparative study of the effect of low-energy laser irradiation to rheumatoid arthritis. In: Current awareness of Excerpts Medica. Amsterdam. Elsevier Science Publishers BV. 1989; 25: 315.
Mokhtar B et al. A double blind placebo controlled investigation of the hypoalgesic effects of low intensity laser irradiation of the cervical roots using experimental ischaemic pain. Proc. Second Meeting of the International Laser Therapy Assn., "London Laser", Sept 1992, p 61. Mokhtar B et al. The possible significance of pulse repetition rate in lasermediated analgesia: A double blind placebo controlled investigation using experimental ischaemic pain. Proc. Second Meeting of the International Laser Therapy Assn, "London Laser" Sept 1992. p 62
Neuman I et al. Low energy phototherapy in allergic rhinitis and nasal polyposis. Laser Therapy. 1996. 1: 37.
Palmgren N et al. Low Level Laser Therapy of infected abdominal wounds after surgery. Lasers Surg Med. 1991; Suppl 3:11.
Poliakova A G., Gladkova N D, Triphonova T.D. Laserpuncture in patients with rheumatoids arthritis. Abstracts of ICMART '97 International Medical Acupuncture Symposium, Nicosia, Cyrprus, March 26-29 1997.
Rochkind S et al. Double-blind Randomized Study Using Neurotube and Laser Therapy in the Treatment of Complete Sciatic Nerve Injury of Rats. Proc. 2nd Congr World Assoc. for Laser Therapy, Kansas City, 1998.
Roumeliotis D et al. 820nm 15mW 4J/cm2, laser diode application in sports injuries. A double blind study. Proc. Fifth Annual Congress British Medical Laser Ass. 1987.
Ryo E et al. Double blind test of low energy laser radiation treatment. Evaluation of effectiveness for shoulder stiffness, arthralgia etc. Pain Clinic. 1986; 7: 185-192. (In Japanese with English abstract)
Saeki N et al. Double blind test for biostimulation effects on pain releif by diode laser. 1989. Laser Surgery; 1066: 93-100.
Sasaki K et al. A double-blind controlled study on free amino acid analysis in CO2 laser burn wounds in the mouse model following doses of low incident infrared (830 nm) diode laser energy. Proc. 2nd Meeting if the Internat Laser Therapy Assn., London, 1992, p.4.
Sato K et al. A double blind assessment of low power laser therapy in the treatment of postherpetic neuralgia. Surgical and Medical Lasers. 1990; 3 (3): 134.
Scudds R A et al. A double-blind crossover study of the effects of low-power gallium arsenide laser on the symptoms of fibrositis. Physiotherapy Canada.1989; 41: (suppl 3): 2.
Taghawinejag M et al. Laser-Therapie in der Behandlung kleiner Gelenke bei chronischer Polyarthritis. Z Phys Med Baln Med Klin. 1985; 14.
Tsurko V V et al. Laser therapy of rheumatoid arthritis. A clinical and morphological study. Ter Arkh. 1983; 55 (7) 97-102. (Russian).
Umegaki S et al. Effectiveness of low-power laser therapy on low back pain. Double blind comparative study to evaluate the analgesic effect of low power laser therapy on low-back pain. The Clinical Report. 1989; 23: 2839-2846. (In Japanese with English abstract)
Vélez-Gonzalez M et al. Treatment of relapse in herpes simplex on labial and facial areas and of primary herpes simplex on genital areas and "area pudenda" with low power HeNe-laser or Acyclovir administred orally. SPIE Proc. 1995; Vol. 2630: 43-50
Willner R et al. Low power infrared laser biostimulation of chronic osteoarthritis in hand. Lasers Surg Med. 1985; 5: 149.
Wylie L et al. The hypoalgesic effects of low intensity infrared laser therapy upon mechanical pain threshold. Lasers Surg Med. 1995; Suppl 7: 9.
Yamaguchi M et al. Clinical study on the treatment of hypersensitive dentine by GaAlAs laser diode using the double blind test. Aichi Gakuin Daigaku Shigakkai Shi - Aichi-Gakuin Journal of Dental Science. 1990; 28( 2): 703-707. (in Japanese)
Yoh K et al. A clinical trial for treatment of chronic pain in orthopedic diseases by using 150 mW diode laser system. Result of double blind test. Chronic Pain; 13: 96-100.(In Japanese with English abstract)

LaserWorld Guest Editorial, 5 1999.

Treatment of Chronic Rheumatoid Arthritis

by Low Power Laser(1) Kazuyoshi Zenba,, the president of Isehara Clinical Reserch Institute

Chronic Rheumatoid Arthritis is commonly called Rheumatism. Most of patients are middle-aged women but young women and men are not immune to this desease.
The cause of this illness is not elucidated at present. However, the most likely theory is that the immune disorder caused by outside influences starts Rheumatoid Arthritis of a patient. The stressful stimuli or the hormone imbalance is also considered to be one of causes of the illness. Rheumatoid Arthritis causes inflamation mainly at joints of body and gradually destroy them. As symtomps of this illness, the morning stiffness of joints, pains at joints and sometime small balls like beans are found at elbows and knees of patients. Joints of patients are deformed gradually.
The low power laser irradiation is very effective to the treatment of Chronic Rheumatoid Arthritis. It can restraint the progress of the illness and also mitigates inflamation, pains or stiffness. The mechanism of treatment is considered to be the anti-inflamation effect of low power laser and the improvement of immunity by low power laser. The improvement of blood circulation before and after the irradiation of low power laser is clearly confirmed by thermography. If the stage of Rheumatism of a patient is before‡U, +value of a Rheumatism test can be expected to improve to} or - after the repetition of low power laser irradiation.
The earlier treatment seems to bring about the better result.
The method of laser irradiation in our clinic is as follows.

• Low power laser:Semiconductor laser, 780nm,10mW
• Irradiation time:10-30 seconds/point
• Total irradiation time:2-3 minutes/diseased part
• Interval of treatment:2-3 times/week
• Judgment of treatment:2-3 months

Accordint to our experience, above said mild laser of 10mW compared with strong lasers such as 60 or 100mW is said to be much more suitable for the treatment of Rheumatism patients. As Rheumatism patients are very sensitive to any stimulations, a stronger laser is feared to cause negative results such as the increase of pains etc..
Another important factor to overcome this illness is the mental strength of patients. Patience is required in order to continue the laser therapy.
We would like to introduce a voice of patient who recovered from Rheumatism by the help of laser therapy in our clinic.

"An adverse effect of medicine-moon face was improved by the laser therapy" female,
48 years olds

My Rheuatism started 4 years ago and my face was deformed as to look like the moon while taking medicines prescribed by a hospital. Not only the moon face, my internal organs were also damaged and I was mentally deranged. After looking for beter treatments, one of my friends introduced me the low power laser therapy. After the treatment of one month, the pain of my ankle disappeared and the moon face was recovered after 2 monts irradiation of low power laser. My husband delighted very much saying I was restored to life by the help of the laser light.

LaserWorld Guest Editorial, 6 1999.

Lymphoedema and Laser Therapy

By Ann Thelander A.U.A. (Dipl. Physio), M.A.P.A. Mitcham Rehab Clinic 9 Princes Road Kingswood S.A 5062, Australia

Lymphoedema develops in people born with inadequate lymphatic systems which have difficulty transporting the lymphatic load. This can be from hypoplasia (not enough vessels or nodes), and what they have does not work very well. This is primary lymphoedema and tends to be genetically inherited. A secondary form of lymphoedema is more common in which the lymphatic system has been damaged by surgery or radiotherapy or other trauma. The trauma of removal of varicose veins or other veins for heart surgery can lead to overload of the previously normal lymphatic system. Spider bites from several spiders can lead to lymphoedema.

Lymphoedema is a progressive condition with four main characteristics (1):

1. excessive protein in the tissues
2. excessive fluid in the tissues (both intra and extracellular fluid)
3. excessive deposition of fibrous tissue
4. chronic inflammatory reactions.

The excess fluid and fibre are immediately under the skin and well within the reach of the laser beam. New lymph vessels cannot grow through scar tissue or fibrosed tissues. Following laser therapy there is a softening of the tissues and reduction in the fluid. New lymph vessels can grow (2). The limbs do not reduce in size until there is softening.

In 1993 a pilot study was undertaken to determine the effect of laser therapy in large post mastectomy arms of 4 or more years duration. (3). This trial found that the arms responded well to laser therapy - there was reduction in the amount of oedema and the volume of extracellular fluid as measured by bioimpedence, the tissues became softer as measured by tonometry and the patients perceived an improvement in symptoms of bursting pains, tightness, heaviness, cramps, pins and needles, mobility and limb circumference. The arms lost a mean 19.7% collectively during the 16 treatments and we then continued to measure them and a further loss of 7% occurred over the following 6 months. During this 6 months there was no treatment of any kind and they did not wear support sleeves.

With improved measuring techniques (perometry, tonometry, and bioimpedence and sometimes lymphoscintigraphy) we can detect areas of fibrosis and blockages and can target these areas with the laser, to get better results. In the trial all the patients had identical treatment.

The current assessment and treatment used at Mitcham Rehab Clinic and The Lymphoedema Assessment Clinic at Flinders Surgical Oncology Clinic at Flinders Medical Centre is a full assessment of external measurements, volume and circumference at 200 positions using the Perometer. The resistancce of the tissues to compression is measured by the tonometer. Bioimpedence shows the fat, fluid (intra and extracellular) and fibre in the tissues. Measurements are taken on both arms or both legs. Subjective information on heaviness, cramps, pins and needles and range of movement are all recorded.
Laser therapy then targets the areas of blockage or fibrosis starting over the chest wall and axilla and moving distally in the arm or, for the leg, lymphoedema abdominal scars and the inguinal region are treated first and then progress distally. Fifty minutes of scanning laser precedes an hour of Complex Physical Therapy - massage.

The laser used is a Space M3 with an output of 9 mW He Ne at 832.8 nm and peak power of 4 x 27mW GaAs at 904 nm scanning laser which covers an area of 20 x 30 cm. The energy density was 2-4 J per cm2.

Interesting Observations

Most of the patients with lymphoedema feel the effect of the laser at the time of treatment - what they feel is pulsing in the limb distal to where the laser is shining. Several people with whole body primary lymphoedema can feel pulsing in their face or arms while the laser is on their leg, proving the generallized stimulating effect on the whole lymphatic system in an under active lymphatic system.

Lymphoedema patients tend to get skin infections like cellulitis which often requires hospitalization, but following laser and massage their tissues become healthier (less fibre and fluid) and their rate of infection drops dramatically.

A few people - about 7 out of over 700 treated with laser for lymphoedema have suffered a reaction - overdose. They all describe themselves are sensitive and cannot take drugs, even non prescription drugs. Several had drastic reactions to Radiotherapy. The reaction these people have had is feeling very tired and sleepy for 24 hours after the laser. On subsequent treatments the laser power level has been reduced considerably and they get a normal treatment effect with no sleepiness. Could this effect be from stimulating light sensitive areas that regulate the body's clock as described in Newscientist?(5).

An exciting reaction we found when a 43 year old woman who developed lymphoedema of the face neck and left arm following surgery and 2 courses of radiotherapy for cancer of the thyroid 9 years before (6). Her vocal cords were badly affected by the radiotherapy and for 9 years she could not talk but only whisper. She could not use the phone and working at a whisper was tiring and difficult. After the first treatment of laser to her neck she could talk!! After 10 treatments she could start speech therapy and sing a little. She now speaks normally and her lymphoedema has reduced considerably.

References.

1. Piller N B (1994): The Management and Treatment of Lymphoedemas. Journal of the National Womens¹ Health Group, Australian Physiotherapy Association, Volume 13, page 17 - 25
2. Lievens P (1987):The Influence of Laser Treatment on the Lymphatic System and Wound Healing. Medical Laser Report 5/6 Torino, Italy, p 29-31.
3. Piller N B, Thelander A (1995): Treating Chronic Post Mastectomy Lymphoedema with LLLT: a Cost Effective Strategy to Reduce Severity and Improve the Quality of Survival. Laser Therapy Vol 7 No 4 p163-168

LaserWorld Guest Editorial, 7 1999.

The possibility of reducing the patients' pain and anxiety through low level laser applications has been the main objective of my research within laser therapy. This Editorial deals with the low level laser as an indispensable and irreplaceable tool for the dentist nowadays in the dental office, focusing on an innovative operator modality: its preventive performance.

Clinically, the use of low level laser therapy has demonstrated excellent results. In terms of tissue healing, largely discussed, it shows evidence of the acceleration process in up to three times, mainly for those patients with physiological disturbances,. This may be considered as an indispensable and preventive procedure. Furthermore, the patient's temporary dysfunction, provoked by a wound, being surgically or not, is reduced. This fact causes a comfort that can be achieved only by low level laser.

My double-blinded study compared a group without laser and with systemic analgesic medication with two other groups with laser: one group with laser only after the surgical procedure and the other with laser therapy before and after the surgery. This study clarified that 790 nm laser therapy with a dose of 1,5 J/cm2 was as effective with regards to the analgesic and anti-inflammatory effect as conventional medication, both for the pain and oedema control.

To accomplish the present study, 45 clinical situations were selected during the Graduation Course of in Implant and Prosthesis of 3i Implants Innovations, Inc., in Ribeirão Preto, São Paulo, Brazil. The selection approach was just constituted in writing in the consent on the part of the patient taking the responsibility in coming back for the follow up care, and also in executing the rules imposed by the methodology of the research. To all the patients it was instituted a systemic medication of preventive anti-bioticotherapy was instituted and also continued after the surgical procedure for 6 days to the base of penicillin, and for the allergic ones, to the clindamicin base.

The piece of equipment of low powered laser chosen was a semiconductor diode of GaAlAs (galium, aluminum and arsenium), that emits in the infra-red close with wavelength of 790 nm and pick power of 30 mW. The emission type is continuous and the application form should be accomplished contacting the gingival tissue; the area of the active point of the crystal of quartz is of 0.13 cm2 (Compact Laser, J. Morita Co., Japan).

The patients were divided in three different groups, constituted of 15 clinical situations each one, as follows:

• Group I: Control, the laser application was simulated, without working the "start", just leaving a "bip" ring. All the patients from that group received that simulation during one minute scanning the operated area. Those patient were well informed with the analgesic and anti-inflammatory systemic medication to the piroxican base (Cicladol 20 mg) twice a day in the postoperative for a period of three days.
• Group II: Lasertherapy sessions in the postoperative immediate, of 24 hs and of 48 hs. It was not instituted the analgesic and anti-inflammatory systemic medication.
• Group III: Lasertherapy sessions in the pre-operative of -48 hs, -24 hs and minutes before the surgical intervention and also in the postoperative in the same way that in the Group II. The patients were equally well educated and have not taken the analgesic and anti-inflammatory systemic medication.
  

The Group III was elaborated based in NICCOLI FILHO's studies (1995) that used the low power of density laser radiation with prevention.

All the applications were accomplished using the same energy parameters and for the same operator and the way of the application was accomplished sweeping the whole area of the tissue to be irradiated, which should be dry preferentially to allow the minimum reflection of the light for the energy not to be lost and absorbed by the tissue. The point of the equipment that contacted the tissue was involved with plastic by hygiene measure and of infection control (in the same way as it is made clinically) which promotes the loss of 10% of energy, that however is not important.

The time of each application was calculated in agreement with the formula of density power ( or intensity). The area of each clinical situation had been calculated associating the clinical exam to the radiographic, determining the same for the probable operative field that would be explored. The chosen energy was based on the studies of Kubasova that says the energy of 0.5 to 5.0 J/cm2 is enough for obtaining of the analgesia effects and of bioestimulation effects. Being like this, the chosen energy density was of 1.5 J/cm2.

The measures, with relationship to the pain and the edema, were accomplished in the immediate postoperative and in the postoperative of 72 hours, always for the same examiner. The examiner asked the patient previously to the laser application what the pain degree was in that moment considering the values of the table 1. with relationship to the edema analysis, the examiner checked the value to each case, according to the table 2.

When we irradiated the area to be operated, like suggested by Niccoli Filho (1995), we believed that we were "preparing" the cells, mainly for the chemical mediators liberation, especially for the histamine, which acts by increasing the vascular permeability. According to Ovsiannikov, this procedure stimulates the immune system. Mikailov and Denisov compared three groups of 112 patients with stages IV of stomach cancer; 32 patients received LLLT before surgery, 38 received it after surgery, and 29 patients did not receive LLLT at all. The laser therapy before the operation was slightly more effective. LLLT increased T-active rosette cells and T-helpers, and decreased T-suppressor cells. The life span of the LLLT patients, as compared to the control group increased by a factor of 2 if surgery was performed and by a factor of 3 if surgery was not performed.

The statistical analysis was just accomplished to check the clearly observed clinical discoveries scientifically. The non-parametric Test of Wilcoxon which compares equal of samples, and with significance degree at level of 5.0% (Tab. 3) was chosen.

With relationship to the painful sensitivity, when we compared GI with GII, and GI with GIII, so much in the immediate postoperative as in the postoperative of 72 hours, we observed there were not significant statistical differences.

Even so, in the immediate postoperative, GIII shows a tendency in being significant, suggesting a superior behavior to GII.

With relationship to the edematous formation, we compared GI with GIII, so much in the immediate postoperative as in the postoperative of 72 hours, we didn't observe significant statistical difference; differently to what we compared, in that situation, GI with GII, where a great tendency to the significance happens.

Table 3 - Statistical results with significance degree at level of 5.0%, when Tc = 138

In agreement with the applied methodology and with the obtained results, the use of low power density laser in implanted patients suggested:

1 - A similar behavior to the analgesic and anti-inflammatory systemic medication, suggesting the possibility of replacement;

2 - for pain control, lasertherapy sessions in the pre-operative were more effective than the postoperative lasertherapy sessions, as executed in GIII;

3 - for tumor formation control, lasertherapy sessions in the postoperative were enough, as executed in GII. Cells with acid pH are more susceptible to light. Furthermore, the possible mechanism at a cellular level probably is depending on the monochromatic carachter of the light, which the organisms are not adapted to evolutionwise. Thus, laser light is one of the environment factors (external agents) capable of modifying the cellular proliferation. The stimulus or inhibition caused by the light may be regarded as a sensorial answer to accommodate to the environmental conditions.

So the question is: why don't we prepare the target tissue through low level laser irradiation as a preventive procedure prior to the trauma?

Dra. Rosane de Fátima Zanirato Lizarelli, DDS

NILO - Núcleo Integrado de Laser em Odontologia

Rua Henrique Dumont no. 1141 - 14.090-200

Ribeirão Preto - SP BRASIL Tel/Fax: 00 55 16 627 0918

E-mail: lizarelli@hotmail.com; or lizarelli@neomundi.com.br

1. KARU, T. I. Photobiological fundamentals of low-power laser therapy". Journal of Quantum Eletronics, v. QE-23, 10, October, 1987.
2. KARU, T. I. Molecular mechanism of the therapeutic effect of low-intensity laser radiation. Lasers in the Life Sciences; 2(1): 53-74, 1988.
3. LIZARELLI, R. F. Z.; LAMANO-CARVALHO, T. L.; BRENTEGANI, L. G. Histometrical evaluation of the healing of the dental alveolus in rats after irradiation with a low-powered GaAlAs laser. In: Lasers in Dentistry V, John D. B. Featherstone, Peter Rechmann, D.D.S., Daniel Fried, Editors, Proc SPIE Vol. 3593, p. 49-56, 1999.
4. LIZARELLI, R. F. Z.; CICONELLI, K. P. C.; BRAGA, C. A.; BERRO, R. J. Low-powered laser therapy associated to oral Implantology. in Lasers in Dentistry V, John D. B. Featherstone, Peter Rechmann, D.D.S., Daniel Fried, Editors, Proc SPIE Vol. 3593, p. 69-73, 1999.
5. NAVRATIL, L.; DYLEVSKY, I. Mechanisms of the analgesic effect of therapeutic lasers in vivo. Laser Therapy, 9: 33-40, 1997.
6. NICCOLI FILHO, W. D. Eficácia da radiação de dois diferentes tipos de laser de baixa energia (HeNe e GaAlAs) na prevenção de mucosites orais em pacientes submetidos a transplantes de medula óssea. Tese de Livre Docéncia. São José dos Campos: Faculdade de Odontologia de São José dos Campos UNESP, 1995. 68p.
7. OVSIANNIKOV, V. A. Analysis of the low-energy laser treatment of some cancers and infections diseases. Journal of Clinical Laser Medicine and Surgery, 15(1):39-44, 1997.
8. MIKHAILOV, V. A., DENISOV, I. N. Activation of the immune system by low level laser therapy (LLLT) for treating patients with stomach cancer in advanced form. Laser and Technology;7,(1): 31-44, 1997.

Dra. Rosane de Fátima Zanirato Lizarelli, DDS
NILO - Núcleo Integrado de Laser em Odontologia
Rua Henrique Dumont no. 1141 - 14.090-200
Ribeirão Preto - SP BRASIL Tel/Fax: 00 55 16 627 0918
E-mail: lizarelli@hotmail.com; or lizarelli@neomundi.com.br

Low Level Laser Therapy in Children's Allergic Purpura
by C. Ailioaie, Laura Ailioaie, Iassy, Romania

A LITERATURE REVIEW OF POSSIBLE EFFECTIVE INTERVALS OF RED AND INFRARED LASER IRRADIATION FOR ENHANCED TISSUE REPAIR IN THE HUMAN LOCOMOTOR SYSTEM
By Bjordal- Jan M.*, Couppe-Christian, Ljunggren-Elisabeth A.

Laser therapy in coronary medicine - a brief look at the literature
By Jan Tunér DDS

8th International Congress of the European Medical Laser Association in Moscow
Miroslav Prochazka, Member of EMLA Parliament, Prague, CZ, Premysl Fryda, Member of EMLA Parliament, Prague, CZ No:  17-19

Biostimulatory Windows in Low Intensity Laser Activation:
Lasers, Scanners and NASA's Light Emitting Diode Array System
By Dr. Andrei P. Sommer.

The Cochrane analyses - can they be improved?
Jan Tunér DDS

The mangement of diabetic neuropathic ulceration by HeNe laser.
The following photo sequence has been contributed
By Dr. Ali Abaci, Turkey

Laser irradiation of the blood
By Levon Gasparyan, MD, PhD

Laser Treatment for Tendinitis
By Jan M. Bjordal, PT-MSc,

LOW INTENSITY LASER THERAPY TO TREAT DENTIN HYPERSENSITIVITY - COMPARATIVE CLINICAL STUDY USING DIFFERENT LIGHT DOSES
By Rosane de Fátima Zanirato Lizarellia ; Marcelo de Oliveira Mazzettob ; Vanderlei Salvador Bagnatoa

LLLT and the healthy rat model for wound healing research -
is it a feasible idea?
Interview with Dr. Farouk Al-Watban