2940-nm Er Research Articles

Energy-Based Medical Devices in Plastic Surgery: A Comparison of FDA Approved Indications to Advertised Claims

Abstract Background Lasers and energy-based devices are commonly employed in aesthetic medicine. In the United States, the Food and Drug Administration (FDA) regulates lasers as medical devices, restricting marketing to approved indications and making off-label claims illegal. Despite this, no comprehensive analysis of off-label marketing prevalence exists. Objectives This study aims to compare the FDA-approved indications for two popular aesthetic lasers to their online advertising claims. Additionally, it seeks to educate aesthetic providers on the current regulatory restrictions surrounding off-label advertising. Methods FDA-approved indications for two lasers – Helium Plasma Dermal Resurfacing (HPDR) and 2940-nm Fractional Er:Yag – were obtained from the publicly available Establishment Registration & Device Listings Database. Online advertisements regarding the capabilities of each laser were collected from practice websites in the United States. Results Our analysis of 100 online claims for each laser revealed that more than half of the websites advertising helium plasma (n=59) and 44 websites advertising fractional lasers made at least one off-label claim. Both plastic surgeons and non-plastic surgeons made at least one off-label claim, with no statistically significant difference between the groups. Conclusions Despite FDA regulation of medical devices, online advertising regarding the indications and capabilities of popular medical lasers varies widely. Patients who seek information regarding aesthetic laser treatments may encounter inaccurate and differing claims for these treatments, potentially leading to false expectations and poor patient outcomes.

Effectiveness and safety of the ablative fractional 2940-nm Er: YAG laser for the treatment of androgenetic alopecia.

Laser sources have established their potential effect in inducing hair regrowth. No large cohort study has evaluated the effect of ablative fractional 2940-nm erbium yttrium aluminum garnet (Er: YAG) laser in the treatment of androgenetic alopecia (AGA). To investigate the efficacy and safety of the ablative fractional 2940-nm Er: YAG laser in combination with medication therapy for the treatment of AGA. We performed a retrospective study between first July 2021 to 30th December 2021. All included patients received oral finasteride and topical minoxidil, or combined with six sessions of Er: YAG laser at 2-week intervals. Patients were divided into medication or combined therapy groups. The efficacy of the two therapies was evaluated by the investigator's Global Assessment (IGA) scores and the patient's Likert satisfaction scale at week 12 and week 24. Changes in total, terminal and villous hair count, total and terminal hair diameter, and AGA grade were also recorded. Adverse events were evaluated at each follow-up. A total of 192 male patients with AGA were included, including 67 receiving combination treatment, and 125 receiving medication treatment. At week 24, the combination treatment afforded superior outcomes in the IGA score, patient's global assessment, total and terminal hair counts, and diameters (all P<0.05). No severe adverse events were reported in both groups. The combined therapy of ablative fractional Er: YAG laser and medication was superior in treating male AGA than single medication therapy without serious adverse effects.

Efficacy and safety of bipolar fractional radiofrequency vs. 2940-nm Er:YAG ablative fractional laser in striae distensae treatment: A split abdomen study.

Striae distensae (SD) is a challenging cosmetic condition. Ablative fractional laser (AFL) is an effective method for treating SD. Recently, fractional radiofrequency (FRF) has been shown to be a promising treatment for SD; however, few studies have shown the differences between FRF and AFL in the treatment of SD. This study aimed to evaluate and compare the clinical efficacy and safety of bipolar FRF with 2940-nm erbium yttrium aluminum garnet (Er:YAG) AFL in the treatment of SD. Twenty volunteers with abdominal SD were enrolled in this study. One half of the abdomen was treated with 2940-nm Er:YAG AFL, whereas the other half was treated with bipolar FRF, with three sessions at 4-week intervals. Photographic evaluations of clinical improvement were conducted by two independent investigators before and after treatment, and the patients provided self-assessments. Two participants underwent three punch biopsies, one before treatment and two obtained from bilateral representative skin lesions on the abdomen 3 months following the final treatment. Clinical improvements were observed in SD on both sides of the abdomen after the two treatments. Post-treatment skin biopsies revealed increased thickness in the epidermis and dermis, and higher collagen and elastin density compared to those at the baseline. No statistically significant differences were observed in the clinical outcomes between the two treatment approaches. The efficacy and safety of bipolar FRF treatment are comparable to those of 2940-nm Er:YAG AFL treatment, providing an alternative and effective treatment for SD.

Efficacy of erbium yttrium aluminium garnet laser on post-traumatic scars among Indian population – A non-randomized study

Objectives: The post-trauma scar is a common problem; it can produce physical and psychological difficulties to the patient. The use of ablative and non-ablative lasers based on the fractional approach is emerging as a method to treat scars. However, very limited data are available of the same in patients of South India. In this study, the authors demonstrated the efficacy of ablative fractional resurfacing (AFR) for traumatic scars using a 2940-nm erbium: yttrium-aluminum-garnet (Er: YAG) laser for the treatment of post-traumatic scars in patients of south India. Material and Methods: Seventy-three scars were enrolled in adults of age between 18 and 60 years. Each scar was treated four times at 1-month intervals with a fractional ablative 2940-nm Er: YAG laser using the same parameters. Pre-treatment evaluation before the initiation of the treatment and post-treatment evaluation was performed 1 month after the fourth treatment session of laser. The scar was evaluated using Vancouver scar scale (VSS). Results: All 73 scars completed the study. After ablative fractional laser treatment, all treated portions of the scars showed improvements, as demonstrated by the VSS. Conclusion: This study shows that ablative fractional application of Er: YAG laser treatment of scars reduces scars fairly. The authors suggest that treatment using AFR can be a adjuvant scar management method for improving the quality of life of patients with post-traumatic scars in patients of south India.

Comparison of 1064-nm Nd:YAG picosecond laser using fractional micro-lens array vs. ablative fractional 2940-nm Er:YAG laser for the treatment of atrophic acne scar in Asians: a 20-week prospective, randomized, split-face, controlled pilot study.

The 1064-nm Nd:YAG picosecond lasers using fractional micro-lens array (P-MLA) was a promising therapy for skin resurfacing. However, no studies have compared P-MLA with ablative fractional 2940-nm Er:YAG lasers (AF-Er) in the treatment of atrophic acne scars. To evaluate the efficacy and safety of P-MLA and AF-Er for the treatment of atrophic acne scars. We performed a prospective, randomized, split-face, controlled pilot study. Thirty-one Asian patients with mild to moderate atrophic acne scars underwent four consecutive sessions of randomized split-face treatment with P-MLA and AF-Fr at 4-week intervals. The efficacy of the two devices were evaluated by Echelle d'Evaluation Clinique des Cicatrices d'acne (ECCA) grading scale, Investigator's Global Assessment (IGA) score and patient's satisfaction. VISIA analysis was also performed to evaluate the pore and skin texture. Adverse events were recorded at each follow-up. The P-MLA afforded comparable clinical responses in scar appearance as AF-Er based on the investigator's assessments (ECCA percent reduction: 39.11% vs. 43.73%; IGA score: 2.97 ± 0.65 vs. 3.16 ± 0.68; P > 0.05 for both). However, the result of patient satisfaction indicated the AF-Er-treated side achieved a slightly greater improvement in scar appearance (3.97 ± 0.78 vs. 3.55 ± 0.71; P < 0.05). Overall, the two devices did not differ largely in terms of efficacy. VISIA analysis revealed similar changing patterns of the pore and skin texture between two devices. For safety profiles, no serious side effects were reported on both sides. The P-MLA showed lower pain level, shortened duration of crust shed and edema, and less occurrence of PIH (P < 0.05 for all). Compared with AF-Er, P-MLA afforded comparable effect and more safety profiles in treating atrophic acne scars in Asian patients. ClinicalTrials.gov, identifier NCT05686603.

A systematic review and meta-analysis of efficacy, safety, and satisfaction rates of laser combination treatments vs laser monotherapy in skin rejuvenation resurfacing.

Laser therapies have been well-established in ameliorating skin-aging consequences. This systematic review aims to determine the efficacy, safety profile, and satisfaction rates of laser combination therapies on skin rejuvenation resurfacing. A systematic search was performed in four major databases up to September 2022. Skin rejuvenation studies were eligible comprising at least one laser combination arm, inclusive of all laser types (ablative or non-ablatives), and one monotherapy arm selected from one of the combined modalities. Studies combining one laser modality with radiofrequency (RF) or intense pulse light (IPL) were also assessed. Trials that did not encompass a monotherapy control arm were evaluated independently as single-arm studies. Eighteen clinical trials recruiting 448 cases were included after screening. A total of 532nm KTP + 1064nm Nd:YAG and 2940nm Er:YAG + Nd:YAG were the two most utilized laser combinations and exerted higher improvements and milder adverse events, compared to their monotherapy in most studies. Combining CO2 with rhodamine-IPL or gallium arsenide laser increased efficacy and satisfaction and brings about faster skin recovery time. Augmenting CO2 + RF did not increase improvement vs CO2 laser alone but prolonged skin erythema. Our meta-analysis revealed the pooled prevalence of quartile improvement rates as 0%, 28%, 40%, 27% in laser combination group, and 0%, 9%, 31%, 17% in laser monotherapy group, respectively. The satisfaction within each quartile category was 39%, 25%, 15%, 7% in laser combination and 20%, 25%, 16%, 17% in laser monotherapy, respectively, suggestive of the higher efficacy and satisfaction of laser combination group. The pain scores were lower in laser combination group than monotherapy (4.8 ± 1.18 vs 7.18 ± 0.7, converted on a scale of 0 to 10). Post-laser skin erythema lasted less longer in the combination group (12.8 vs 15.24days). Laser combination therapies were discovered to be superior to their monotherapies in terms of clinical improvement rates, diminished adverse events such as pain and erythema and patients satisfaction rates. Due to paucity of high-quality reportings, additional trials are warranted to corroborate these results.

604 Comparison of 1064-nm Nd:YAG picosecond lasers using fractional micro-lens array vs. ablative fractional 2940-nm Er:YAG lasers for the treatment of atrophic acne scar in Asians: A 20-week prospective, randomized, split-face, controlled trial

604 Comparison of 1064-nm Nd:YAG picosecond lasers using fractional micro-lens array vs. ablative fractional 2940-nm Er:YAG lasers for the treatment of atrophic acne scar in Asians: A 20-week prospective, randomized, split-face, controlled trial

Erbium YAG Laser in the Treatment of Androgenetic Alopecia

The article presents data on the effectiveness of the 2940 nm wavelength erbium-doped yttrium aluminum garnet laser (Er:YAG) in the treatment of androgenetic alopecia (AA) in 85 men. All AA patients underwent a video trichodermatoscopy examination of the scalp using an Aramo-SG video camera (Korea) with ×60 and ×200 lenses, and the Trichoscience diagnostic program. The results of the study were evaluated by videotrichodermatoscopy by the presence of atrophied HF before and after 3 months of laser therapy. A 3-month erbium laser treatment using a 2940-nm Er:YAG laser along with the conventional therapy showed a high efficiency, which was expressed in a decrease in microfibrosis around the hair follicles and an increase in hair growth in the anagen stage.

Laser therapy in the treatment of melasma: a systematic review and meta-analysis.

Melasma is a highly prevalent and cosmetically disfiguring pigmented skin disease. The post-treatment results are often unsatisfactory. A large number of clinical trials have tried to prove the effectiveness of the combination therapy involving laser therapy, but the results have been indeterminate. This study aimed to evaluate the effectiveness of laser treatment for melasma via a systematic review and meta-analysis. We respectively searched 4 databases and clinicaltrials.gov as of June 8, 2021. Two researchers independently searched for literature and extracted data. Study outcomes were computed by weighted mean differences (WMD). All statistical analyses were performed by the Review Manager version 5.3, STATA version 14 software at 95% confidence interval. We obtained 22 eligible studies which involved a total of 694 patients. After the heterogeneity test and sensitivity analysis, we took a subgroup meta-analysis on the before and after treatment of different laser types. We found that most lasers and laser-based combinations were associated with reduced melasma area and severity index (MASI), such as low-fluence Q-switch 1,064-nm Nd: YAG laser (QSNYL) (WMD: - 2.76; 95% CI: - 3.53 to - 1.99), fractional ablative CO2 laser (WMD: - 9.36; 95% CI: - 12.51 to - 6.21), and fractional ablative 2940-nm Er: YAG laser (WMD: - 2,72; 95% CI: - 3.94 to - 1.49). Significant decrease was seen in neither MASI score of non-ablative 1550-nm fractional laser (WMD: - 1.29; 95% CI: - 2.80 to 0.21) and picosecond laser (WMD: - 0.58; 95% CI: - 1.43 to 0.27), nor melanin index (MI) of low-fluence QSNYL treatment (WMD: 10.17; 95% CI: - 4.11 to 24.46). When using laser to treat melasma, various adverse reactions may occur, most of which will resolve quickly without subsequent treatment, such as edema, erythema, scaling, and burning sensation after treatment. However, for patients with darker skin, there are risks of postinflammatory hyperpigmentation and hypopigmentation. The laser and laser-based combination treatment for melasma could significantly reduce the MASI score, which was showed by our systematic review and meta-analysis.

Effectiveness and Safety of Combined Application of Three Modes of 2940-nm Erbium:YAG and 1064-nm Neodymium:YAG Lasers in Treatment of Meibomian Gland Dysfunction.

PurposeTo study the effectiveness and safety of upper and lower eyelid treatment with combined application of three modes of 2940-nm erbium-doped yttrium aluminium garnet (Er:YAG) and 1064-nm neodymium-doped yttrium aluminium garnet (Nd:YAG) lasers in patients with baggy eyelids (formed by intraorbital fat herniation) who exhibited meibomian gland dysfunction (MGD).Patients and MethodsIn this prospective cohort study, patients with baggy eyelid who exhibited MGD received combined laser treatment at baseline, as well as at the 4-, 8-, and 12-week follow-ups. The primary endpoint was meibum quality score at 16- and 24-week follow-ups; secondary endpoints were ocular surface index scores, tear film lipid layer thicknesses, tear break up times (TBUTs), Oxford scheme grades, and meibography grades at 16- and 24-week follow-ups. Adverse events, uncorrected visual acuities, best-corrected visual acuities, and intraocular pressures were also recorded.ResultsSixteen patients (four men and 12 women; mean age, 56.38 ± 8.64 years) were included. Meibum quality scores at the 16-week follow-up were significantly lower than scores at baseline (p=0.043) and at the 24-week follow-up (p=0.015). TBUT was significantly exacerbated at the 24-week follow-up, compared with baseline (p=0.001) and the 16-week follow-up (p=0.006). There were no significant changes in other parameters. All adverse events were mild and resolved without additional treatment.ConclusionCombined application of three modes of 2940-nm Er:YAG and 1064-nm Nd:YAG lasers on upper and lower eyelids significantly improved meibum quality in patients with MGD; it ameliorated symptoms and signs of dry eye disease at 4 weeks after completion of laser treatment.

The Effects of Aesthetic Lasers on Three Study Materials Used for Ocular Protection.

It is dangerous, although not uncommon, in some clinical settings for laser operators to place gauze underneath external patient protective eyewear when performing laser procedures. The purpose of this study was to evaluate 4 lasers, commonly used for aesthetic facial procedures, on 3 materials commonly found in the clinical setting. We performed tests with 4 lasers: the 2940-nm erbium-doped yttrium aluminum garnet (Er:YAG) laser, the 532-nm potassium titanyl phosphate (KTP) laser, the 1064-nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser, and a Lumenis UltraPulse 10,600-nm carbon dioxide (CO2) laser. Their effects were evaluated on dry gauze pads, wet gauze pads, and adhesive external eye shields. When exposed to the 2940-nm Er:YAG and 10,600-nm CO2 lasers, dry gauze smoked on the first pulse and ignited on the second pulse, whereas no damage occurred to the wet gauze or adhesive eye shields after 8 and 4 pulses, respectively. No damage to any material or the underlying surface was seen after 30 pulses of the 532-nm KTP laser. After 2 pulses of the 1064-nm Nd:YAG laser, the adhesive eye shields sparked; dry gauze smoked after 1 pulse, but no damage to the underlying surface occurred after 30 pulses. The results of our study highlight the inherent flammability of gauze when exposed to lasers commonly used to address aesthetic facial concerns. Although moistened gauze conveyed more protection than dry gauze, these results do not guarantee patient ocular safety. Therefore, we do not recommend the use of any gauze under protective eyewear.

Pathologies of the oral area in newborns and infants: frenula and contributions of laser systems

The purpose of this article is to improve our knowledge about the structures and function of the different elements present in the mouth of newborns since dentists sometimes do not remember the importance of the mouth in the general development of infants and the need for an early intervention with lasers to help them obtain a good state of their Oral System. We performed a comprehensive clinical exploration of the patient in order to make a more accurate diagnosis. When surgery is necessary, we recommend to use erbium lasers when possible (2780nm Er, Cr: YSGG laser or a 2940nm Er: YAG), as they are a quick and effective option to treat these oral lesions, especially lip or tongue ties which can risk the act of breastfeeding; moreover, we can also use diode lasers (810nm, 940nm or a 1064nm Nd:YAG laser) al lof them with their specifical safety goggles. These laser systems used by a certified professional, in collaboration with a properly trained staff, are a very important factor during the surgery.By having proper knowledge of the oral structures and their pathologies, we are able to diagnose whether those disorders should be surgically treated and if so, how to proceed with laser systems as they are minimally invasive procedures; or if we should recommend parents to visit a myofunctional therapist in order to help recover the normal function.The understanding of oral structures of newborns is very important in order to improve the development of craniofacial growth and provide an important service to mothers by giving their babies a right start in life from a very early stage. We need to improve collaboration between professionals from different disciplines in order to enhance our knowledge

Treatment of alopecia areata with 2940-nm fractional erbium:yttrium-aluminum-garnet laser.

Various laser therapies have been used for the treatment of alopecia areata (AA). Enhanced hair regrowth was reported with the use of ablative fractional 2940-nm erbium:yttrium-aluminum-garnet (Er:YAG) laser in a murine model. However, clinical effectiveness of fractional Er:YAG laser for hair disorders has not been investigated in human studies. The aim of our study was to assess the effectiveness of 2940-nm fractional Er:YAG laser in the treatment of chronic AA that is unresponsive to conventional therapies. Twenty-five AA patients underwent three sessions, each 4 to 6 weeks apart, of fractional Er:YAG laser. Clinical evaluation was done at baseline and 1 month post-treatment (follow-up) by photographic assessment. Subjective evaluation by patient satisfaction score was also performed. Photographic evaluation of the patients revealed a mean percent change in SALT score of 17.4 ± 3.5% at follow-up. A total of 16 patients who were treated for patchy AA of the scalp showed 27.8 ± 31.3% regrowth. Five patients who were treated for AA of the beard had 39 ± 34.2% regrowth. Fractional Er:YAG laser might be a therapeutic alternative for patients with patchy AA of the scalp and beard that is unresponsive to conventional therapies.

Fractional 2940-nm Er:YAG laser-assisted drug delivery of timolol maleate for the treatment of deep infantile hemangioma

Objective To study the efficacy and safety of fractional 2940 nm laser-assisted drug delivery of timolol maleate 0.5% solution for the treatment of deep IHs. Methods In this study, 30 deep IHs were included, and a fractional 2940 nm laser was applied with 2-weeks intervals. Topical timolol maleate 0.5% was applied under occlusion for 30 min four times/day for 24 weeks. The plasma concentration of timolol maleate was monitored for 0.5 h after the first treatment. The HAS scores and the depth, lateral diameter, vertical diameter of hemangiomas were evaluated before treatment, at 8 weeks and 24 weeks of treatment, and at 4 weeks after treatment. Results Twenty-three patients (76.7%) demonstrated excellent regression, 4(13.3%) showed good response, and 3(10%) experienced moderate regression. The HAS score was declined from 3.6 ± 0.7 to 2.3 ± 0.6 at 8 weeks, and from 1.3 ± 0.5 to 0.8 ± 0.5 at 24 weeks (p < .05). Plasma timolol concentration was not detected in 11 infants, and the rest ranged from 1.580 pg/mL to 14.718 pg/mL, which were <1 ng/mL. No systemic complications were observed in any patients. Conclusion Fractional 2940 nm laser-assisted drug delivery of timolol maleate 0.5% is considered to be an effective and safe method for treating deep IHs.

Safety and Efficacy of Hybrid Fractional Laser (1470nm And 2940nm) for Symptoms of Genitourinary Syndrome of Menopause: 12 Month Prospective Multi-Center Study

Study Objective Evaluate efficacy and safety of hybrid fractional laser treatment (1470nm diode and 2940nm Er:YAG) in women with genitourinary syndrome of menopause (GSM). Design Baseline demographics, quality-of life, exam data recorded including: pelvic exam, vaginal maturation index (VMI), vaginal health index scale (VHIS), female sexual function index questionnaire (FSFI), day-to-day Impact of vaginal aging questionnaire (DIVA) and histology (2/site). Setting Prospective, single arm, non-blinded, multi-center study was conducted across 5 clinical sites. Patients or Participants 55 peri- and post-menopausal females with mean age 58±7 years and at least 2 self-reported symptoms of GSM were enrolled. 40 patients completed 3 month, 38 completed 6 month and 31 completed 1 year follow up. Interventions Each patient received 3 treatments at 4 weeks interval (settings: 1470nm – 200-600 um [density 6-15%], 2940nm – 200-300 um [density 7-14%]) with follow-up visits at 1, 3, 6 and 12 months post third treatment. Measurements and Main Results FSFI scores demonstrated significant improvement in all domains and overall at 1, 3, 6 and 12 months (p Conclusion Hybrid fractional laser appears to be safe and effective for treatment of GSM.

Treating Hypertrophic Burn Scar With 2940-nm Er:YAG Laser Fractional Ablation Improves Scar Characteristics as Measured by Noninvasive Technology.

Their group previously demonstrated high-patient satisfaction for the treatment of hypertrophic burn scar (HBS) with the erbium: yttrium aluminum garnet (Er:YAG) laser, but this and other literature supporting the practice suffer from a common weakness of a reliance on subjective assessments by patients or providers. Herein, they sought to prospectively study the effects of Er:YAG fractional ablation on HBS using noninvasive, objective technologies to measure outcomes. Patients with HBS had identical regions of scar designated for treatment by the Er:YAG laser (TREAT) or to be left untreated (CONTROL). They prospectively collected scar measurements of TREAT and CONTROL regions preoperatively, 3 weeks, and 3 months after Er:YAG treatment. Scar measurements included viscoelastometry, transepidermal water loss, optical coherent tomography, and high-frequency ultrasound. Outcomes were measured for the aggregate difference between the TREAT group vs the CONTROL group, as well as within each group in isolation. Seventeen patients were seen preoperatively, followed by n = 15 at 3 weeks and n = 11 at 3 months. A mixed-model repeated measures analysis showed no significant effect of fractional ablation when comparing the overall TREAT group measurements with those of the CONTROL group. However, when considered as within-group measurements, TREAT scars showed significant improvement in viscoelastic deformity (P = .03), elastic deformity (P = .004), skin roughness (P = .05), and wrinkle depth (P = .04) after fractional ablation, whereas CONTROL scars showed no such within-group changes. HBS treated by the Er:YAG laser showed objective improvements, whereas no such changes were seen within the untreated scars over the same time frame.

The use of 2940-nm ER:YAG laser for the treatment of lentigo maligna.

Lentigo maligna is a common in situ malignancy in elderly patients, with a low risk of progression to an invasive tumor. Surgical treatment may be complicated or refused. Non-surgical treatment options (such as lasers) may therefore be needed. We report on 17 patients treated with a 2940-nm Er:YAG (erbium-doped yttrium aluminum) laser for histopathologically confirmed lentigo maligna. The lesions were ablated with a 5mm margin of adjacent skin under local anesthesia with a 3.5mm overlapping spot, energy density of 6.5J/cm2 and a repetition rate of 5Hz. If clinically visible pigmentation was seen in the ablated area during the following three months, the lesion was re-treated. All patients were followed up for residual or recurrent tumors. We achieved clinical clearance in all 17 patients. There were three recurrences during the follow-up period (9, 30 and 36 months after laser therapy). All patients were satisfied with the treatment course and cosmetic outcome. The mean follow-up duration was 28 months. Laser ablation is an interesting alternative method for treatment of lentigo maligna. It can be used for selected cases where surgery is contraindicated, complicated or declined by the patient.

Treatment of vaginal relaxation syndrome with an Erbium:YAG laser 360° scanning scope via automatic dual mode technique

Vaginal relaxation syndrome (VRS) is a common phenomenon affecting women and their partners which may lead to decreased sexual satisfaction. Recently, the use of 2940-nm Erbium:YAG laser (Er:YAG) has been extended to cosmetic gynecology to treat VRS. This study evaluated the efficacy of this non-surgical laser procedure. From October 2014 till January 2017, 39 females with vaginal relaxation syndrome (VRS) were treated with the 2940-nm Er:YAG. Their ages ranged from 27 to 47. Those 39 patients received one to four treatment sessions at 2–3-week intervals. The sessions were performed with a 360° scope via automatic dual step technique. The first step consisted of three passes of multiple pulses ranging from 1.7 to 2.2 J per pulse. The second step consisted of two passes of long-pulsed wave of 3.7 J and a pulse width of 1 s. The improvement in sexual satisfaction was assessed subjectively by patients’ questionnaire. Improvement in sexual satisfaction was reported by 78% of the patients. A few minor side effects were reported such as vaginal ecchymosis and mild burning sensation. In patients suffering from VRS, the use of automatic dual pass technique Er:YAG is a convenient non-surgical method to obtain reasonable tightening of vaginal wall and improve sexual satisfaction. Level of Evidence: Level IV, case series study.

Efficacy of sonically, ultrasonically and laser‐activated irrigation in removing a biofilm‐mimicking hydrogel from an isthmus model

To evaluate the efficacy of sonically, ultrasonically and laser-activated irrigation (LAI) in removing a biofilm-mimicking hydrogel from the isthmus in a root canal model. Transparent resin blocks containing two standardized root canals (apical diameter of 0.3mm, 6% taper, 16mm long, with a coronal reservoir) connected by an isthmus (0.15mm wide, 2mm high) were used as the test model. The isthmus was filled with a hydrogel-containing dentine debris. The canals were filled with irrigant, and the models were randomly assigned to the following activation groups (n=20): EndoActivator (EA), Eddy, ultrasonically activated irrigation (UAI) with an Irrisafe 25mm length, size 25 file and LAI with a 2940nm Er:YAG-laser (20Hz, 50μs, 20mJ, PIPS tip at the canal entrance). All protocols were executed for 3×20s. Needle irrigation (NI) with a 27G needle served as the control. Standardized images of the isthmus were taken before and after irrigation, and the amount of removed hydrogel was determined using image analysis software and compared across groups using Welch anova (P≤0.05). Hydrogel removal was greatest in the LAI group (90.2%) and was significantly greater than that with UAI, EA and NI (P≤0.014), but not significantly different from Eddy (P=0.498). Hydrogel removal with Eddy (85.9%) was significantly greater than that with NI and EA (P<0.05), but not significantly different from UAI (P=0.07). There was no significant difference between the NI and EA groups (P=1). Laser-activated irrigation and Eddy resulted in the greatest hydrogel removal and performed better than EA and UAI. The effect of LAI was also not dependent on deep intracanal tip placement.

Efficacy of photon-initiated photoacoustic streaming on apically extruded debris with different preparation systems in curved canals.

To determine the effect of photon-initiated photoacoustic streaming (PIPS) on the extrusion of debris using multiple-file (ProTaper Next-PTN) and single-file (One Shape-OS) continuous rotary systems in curved canals in human molar teeth. Sixty extracted maxillary first molar teeth with curved mesial roots, mature apices and of similar lengths were selected. Teeth having canals with apical diameters larger than size 15 were discarded. The teeth were randomly divided into four experimental groups (n=15 teeth per group) according to the file used and irrigation systems: (i) OS with PIPS with a 2940nm Er:YAG laser (0.3W, 15Hz, and 20mJ), (ii) OS with conventional needle irrigation (CNI) with a 27-G needle, (iii) PTN with PIPS and (iv) PTN with CNI. The PIPS and CNI was applied during each file change for 20s. Total irrigation and activation time was 1min, and a total volume of 7.5mL of bidistilled water was used as the irrigant. The apically extruded debris was collected into pre-weighed Eppendorf tubes. The tubes were then stored in an incubator at 70°C for 5days. The weight of dry extruded debris was assessed by subtracting the initial weight of the tube from the final weight. The results were analysed statistically using one-way analysis of variance and Tukey's post hoc tests. Bonferroni correction was used to compare the groups. The PIPS irrigation technique was associated with significantly more debris extrusion than the CNI system (P<0.05). The single-file (One Shape-OS) rotary system was associated with more debris than the multiple-file (ProTaper Next-PTN) rotary systems when the same irrigation system was used (P>0.05). The total amount of debris extruded apically by PIPS activation was significantly greater than that by CNI (P<0.05). All file and irrigation systems extruded debris apically. PIPS activation was associated with significantly more extrusion debris in curved canals compared with no activation.