Evaluation of Efficacy of Low-Level Laser Therapy

Abstract

Introduction: Given the inconsistencies in the literature regarding laser performance in non-surgical treatments, this study investigated the available literature to determine the advantages and disadvantages of low-power lasers in treating non-surgical complications and diseases.
Methods: Authentic information from articles was extracted and evaluated to assess low-power laser performance for non-surgical treatments. A systematic search of studies on low-level laser therapy (LLLT) for non-surgical treatments was conducted mainly in PubMed and google scholar articles.
Results: Four categories of diseases, including brain-related diseases, skin-related diseases, cancers, and bone-related disorders, which were treated by LLLT were identified and introduced. The various types of LLLT regarding the studied diseases were discussed.
Conclusion: Positive aspects of LLLT versus a few disadvantages of its application imply more investigation to find better and efficient new methods.

Full text

Please cite this article as follows: Mansouri V, Arjmand B, Rezaei Tavirani M, Razzaghi M, Rostami-Nejad M, Hamdieh M. Evaluation of
efficacy of low-level laser therapy. J Lasers Med Sci. 2020;11(4):369-380. doi:10.34172/jlms.2020.60.
Review Article
doi 10.34172/jlms.2020.60
Evaluation of Efficacy of Low-Level Laser Therapy
Vahid Mansouri1, Babak Arjmand2, Mostafa Rezaei Tavirani1*, Mohammadreza Razzaghi3, Mohammad
Rostami-Nejad4, Mostafa Hamdieh5
1Proteomics Research Center, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2Cell Therapy and Regenerative Medicine Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences
Institute, Tehran University of Medical Sciences, Tehran, Iran
3Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
4Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid
Beheshti University of Medical Sciences, Tehran, Iran
5Department of Psychosomatic, Taleghani Hospital, Faculty of Medicine, Shahid Beheshti University of Medical Sciences,
Tehran, Iran
Abstract
Introduction: Given the inconsistencies in the literature regarding laser performance in non-
surgical treatments, this study investigated the available literature to determine the advantages and
disadvantages of low-power lasers in treating non-surgical complications and diseases.
Methods: Authentic information from articles was extracted and evaluated to assess low-power laser
performance for non-surgical treatments. A systematic search of studies on low-level laser therapy
(LLLT) for non-surgical treatments was conducted mainly in PubMed and google scholar articles.
Results: Four categories of diseases, including brain-related diseases, skin-related diseases, cancers,
and bone-related disorders, which were treated by LLLT were identified and introduced. The various
types of LLLT regarding the studied diseases were discussed.
Conclusion: Positive aspects of LLLT versus a few disadvantages of its application imply more
investigation to find better and efficient new methods.
Keywords: Low-level laser therapy; Photobiomodulation; Disorders; Treatment; Side effects.
*Correspondence to
Mostafa Rezaei Tavirani,
Email: tavirany@yahoo.com
Published online October 3,
2020
Journal of
Lasers
in Medical Sciences
J Lasers Med Sci 2020 Autumn;11(4):369-380
http://journals.sbmu.ac.ir/jlms
Introduction
Laser treatment covers various fields in the clinic.
Different types of lasers are used in this regard, including
cold or low-level laser therapies (LLLT or class III laser)
and high-power laser therapy (class IV).1-4 LLLT is widely
used in the clinic and encompasses a range of non-
invasive therapeutic aspects. LLLT is commonly used
clinically as a red light near-infrared wave with a length of
600 to 1000 nm and 5 to 500 mW.5 On the contrary, lasers
used in surgery have a wavelength of 300 nm.6 Low-power
lasers are capable of penetrating deep into the skin so that
the surface of the skin does not burn and damage.7 Low-
power or cold lasers have been enhanced to the point of
being able to produce analgesia and healing acceleration
for many clinical conditions.8 A wide range of LLLT and
related techniques have been used. Therefore, the results
of treatment with low-power lasers may contradict
each other.9 LLLT may be administrated by many
dermatologists, physical and occupational therapists,
physicians and chiropractic doctors.10 The biostimulatory
healing effect of LLLT may cause the treatment of chronic
pain, commonly associated with carpal tunnel syndrome,
arthritis, tissue injuries and severe wounds.11-15 On
the other hand skin rejuvenation also may be another
administration of lasers.16 There are many pieces of
evidence about LLLT usage for the treatment of wound
healing,17 tuberculosis,18 pain, tinnitus,19 epicondylitis,20
smoking cessation,21 Achilles tendinitis,22 back pain,23
plantar heel pain,24 Carpal tunnel syndrome,25 and the
primary Raynaud’s phenomenon.26 However, others
published documents revealed inadequate efficiency
of LLLP for wound healing,27 arthritis,28 tinnitus,29
tuberculosis,30 epicondylitis,31 and plantar heeling pain.32
Therefore, a comprehensive research study on the
evaluation of laser function in therapeutic interventions
seems necessary.
Methods
Articles that explain the effects of laser therapy on
non-surgical disorders and complications in the online
journals published from 1990 until 2019 were considered.
An online search in google scholar and PubMed using
the keywords “Non-surgical”, “laser”, “side effects”
“treatment” “assessment”, and “photobiomodulation”

Mansouri et al
Journal of Lasers in Medical Sciences Volume 11, Number 4, Autumn 2020370
was performed. The titles and abstracts of 320 collected
articles in the English language were studied and 253
appropriate articles were selected to be included in the
study. Subsequently, the articles related to the inclusion
criteria established previously were chosen. Finally, 164
documents were evaluated and considered as the related
article. However, there are many related articles which
have overlap with the studied documents.
Results
According to the finding, LLLT is applied to treat at least
four categories of diseases including nervous system
complications, skin and mucosal disorders, bone and
joint disorders, and cancers. These four classes of diseases
are tabulated in Table 1. We evaluated and studied the
selected articles that have researched these categories of
disorders.
Nervous System Complications
Brain Photobiomodulation
Researches in intracranial photobiomodulation have
shown that the use of infrared or near-infrared light can
promote cell repair.33 Near-infrared waves are capable
of passing through the human skull and the cerebral
cortex which could receive a small amount of energy.34
The abundant mitochondria present in neurons are the
primary receptors for near-infrared and infrared wave
energy. Subsequently, mechanisms such as increased
ATP production, CMP activity and increased oxidative
activation work together to prevent cell death during
ischemic failure, brain injury, and neurodegeneration.35,36
This process can be mediated by increased expression of
genes involved in the cell survival process, such as the
production of antioxidant enzymes, heat shock proteins,
and cell death-preventing proteins.37 Transcranial
light therapy has been developed to increase neuron
proliferation in the hippocampus following a stroke or
ischemia.38
Trigeminal Nerve Neuralgia
Trigeminal nerve neuralgia (TN) is the major cause of
face and mouth pains.39 The pathogenesis of TN neuralgia
is not well understood and high vascular pressure causes
demyelination of nerves following pons entrance.40 LLLT
could decrease acute neuralgia via mechanisms such as
decreasing histamine, serotonin, and bradykinin and
increasing acetylcholinesterase, aerobic metabolism, ATP,
encephalin, and endorphins production.41,42 Lasers could
significantly increase the pain threshold and stimulate
the synthesis of endorphins.43 Limited studies have been
designed to assess the effects of LLLT on TN analgesia
treatment with controversial results.
Traumatic Brain Injury
Traumatic brain injury (TBI) — the other subject that is
treated via LLLT — is one of the main causes of morbidity
and mortality in young military staff or athletes along
with accidents.44 Several cell and tissue interactions lead
to inflammation and brain edema and cerebral perfusion.
The combination of defects results in brain ischemia
and diminishing oxygen and glucose transportation to
the neurons. Membrane channel transportation changes
together with voltage postsynaptic enhancement.45
Calcium rises inside the neurons with mitochondrial
malfunction and apoptosis happens simultaneously in
TBI.46
Neuropathic Pain
Primary lesions and dysfunctions of the nervous system
may cause neuropathic pain. It seems that LLLT may
cause the treatment of this kind of pain; however, there
are controversies between different applications. LLLT is a
suitable method for neuropathic pain treatment; different
wavelengths of lasers which are reported in several
studies revealed increased analgesia significantly.47-50
The importance of LLLT in the treatment of diabetic
neuropathy was investigated due to the antioxidant and
biomodulation effects of lasers as a non-pharmacological
treatment.51, 52 Another study carried out different
mechanisms of LLLT in pain relief as inflammatory
process modulation, excitation alteration, and endorphins
secretion.53 Bradykinin reduction with the modulation of
the inflammatory process according to the LLLT pain
relief mechanism is reported through researches.54,55
The β-endorphin expression seems to be a secondary
action of LLLT in analgesia.56 Red and infra-red laser
effects on analgesia amplification have been reported
with a controversy between two lasers.57,58 The density
of LLLT energy seems to be an effective value in pain
relief. However, there are some discrepancies between the
results of the assessments.48, 59
Table 1. Summary of Different Complications Treated by LLLT
Nervous System Complications Skin and Mucosal Disorders Cancers Bone and Joint Disorders
Brain photobiomodulation Skin burn Breast cancer lymphoma Bone disorders
Trigeminal nerve neuralgia Hair loss Head & neck cancer Tendon repair
Traumatic Brain Injury Pemphigus vulgaris Carpal tunnel syndrome
Neuropathic pain Diabetic foot ulcers
Herpes labialis

Journal of Lasers in Medical Sciences Volume 11, Number 4, Autumn 2020 371
Low-Level Laser Therapy in Clinic
Skin And Mucosal Disorders
Skin Burns
Burn with the thermal origin which is a traumatic
injury could affect human organs.60 LLLT is a useful
method for treating burning injuries, especially skin
burns; however, there are some controversies between
application parameters of LLLT in the treatment of skin
burns. There are many factors causing skin burns, such
as chemical, physical and biological factors, which lead
to pain, infection, and even death.61 The mechanism
of wound healing in cutaneous burns is the interaction
between the cascade release of cytokines and the
extracellular matrix and involves these steps: spontaneous
and interdependent inflammation, proliferation, and
remodeling.62 Early stages of repair are proliferation and
edema and may modulate complications such as the
reduction of leukocytes and macrophages, fibroblasts, and
angiogenesis simultaneously.63 Those complications may
lead to scar and tissue adhesions.64 Recent studies have
shown that LLLT can be effective in the treatment of skin
burns as a low-price and non-invasive treatment.65 The
mechanism of laser action on biological tissues is mainly
related to stimulating cytochrome oxidase releasing, and it
activates intracellular cascade reactions and increases the
intracellular and molecular synthesis and subsequently
increases the synthesis of RNA and DNA which, in turn,
increases cell proliferation and migration in the injured
tissue restoration.66-68 Lab experimental researches revealed
that LLLT increases fibroblasts proliferation and collagen
synthesis along with tissue granulation. These cellular
events resulted in the acceleration of wound contraction
and re-epithelization.69-71 The study on laser therapy for
wound healing has been the subject of researches since
its inception and its first report was published in 1971.66
In the following years, many studies were performed in
this area and the upward trend of laser burn and wound
healing methods was studied too; however, differences in
the methods, including the wavelength and energy used
and the power of radiation and duration of treatment in
different studies, were significant.72,73 The 600-700 nm
wavelengths have less penetrating power than the 700-
1000 nm wavelengths within the tissue.68 Researchers have
used different wavelengths for LLLT.74, 75 Some researchers
have considered the 660 nm wavelength for the initial
stages of skin wound healing and the 780 nm wavelength
effective for the formation of tissue granulation.76
Hair Loss
Recent investigations have revealed that LLLT could
evaluate hair growth stimulation. Studies on hair loss of
male and female cases, chemotherapy-induced alopecia
and alopecia aerate have demonstrated the effectiveness
of LLLT in hair re-growth. The first study about hair
growth was published by Ferrando et al in 2002.77 They
used IPL photomodulation to remove unwanted hair but
the results were paradoxically positive for hair growth.
However, studies on the LLLT treatment of alopecia are
limited in numbers of documents and the wavelengths
from 600 to 1000 nm were in preference. Leavitt et al
assessed the effects of a laser with the wavelengths of 635
and 660 nm and a combination of both on the hair growth
of the forearm. The results revealed the positive effects
of LLLT on hair follicle growth compared to the control
group.78 In another study, it was revealed that evaluated
laser devices could increase hair growth elongation on day
3 of treatment compared to the control group.79 The very
low incidence of LLLT side effects made it safe to use for
hair growth.80 In animal experiments, results revealed the
positive effects of LLLT on hair growth for alopecia aerate
AA),81 and chemotherapy-induced alopecia.82 On the
other hand, King et al did not have positive results for AA
treatment by LLLT in mice, as opposed to the results of a
study by Wikramanayake et al.83 Clinical trials revealed
the positive effects of LLLT on hair re-growth.84-90
Pemphigus Vulgaris
Pemphigus vulgaris (PV) is a chronic blistering disease
with antibodies directed against keratinocytes.91
Management of PV is difficult. Steroid therapy is still the
basic treatment of disease with some adverse effects.92
Various laser devices have been used to treat PV. There
are some reports about wounds that are related to PV.93
Based on previous investigations the mouth is affected
by PV. Lesions of gingiva and mucosa of mouth and the
other parts of body are reported in the PV patients.94,95
The assessment of LED laser therapy of PV with a 660 nm
wavelength in a continuous wave and 30 mW energy in 10
patients revealed the efficiency of LLLT in the treatment
of PV ulcers.96
Diabetic Foot Ulcers
One of the complications in diabetes mellitus is long-
lasting or non-healing skin ulcers of the foot and the results
of treatments are not satisfactory for patients.97 LLLT
as an effective and noninvasive tool could be seemingly
manageable for a diabetic foot ulcer.98 Multifactorial
occurrences such as peripheral neuropathy and arterial
occlusive disorders may cause foot diabetic syndrome.99
As it is shown in Table 2, diabetic ulcers (DUs) could
be classified according to Wagner and Armstrong ulcer
classifications.100
Conventional treatments as wound cleaning, skin
grafting, vasodilators, and antibiotics could be still
unsatisfactory.101 LLLT has been introduced as a painless
and noninvasive treatment without major side effects
for DU treatment. Low-power lasers with low-energy
radiation stimulate cell activity, but high-power lasers
have adverse effects on cell activity, and in non-healing
DUs, the application of lasers to stimulate wound healing
has been recommended.102 The laser needle is a new
method of laser acupuncture which its therapeutic effects
are similar to manual needle acupuncture.103 A unique

Mansouri et al
Journal of Lasers in Medical Sciences Volume 11, Number 4, Autumn 2020372
laser therapy mode determination to treat diabetic foot
ulcers is not explained yet. Kajagar et al compared pulsed
LLLT on 85 diabetic wound healing patients on the basis
of wound size, duration of exposure and used energy
in the surface of the wound (2-4 J/cm2 at 60 mW for 15
days). There was a significant ulcer reduction in LLLT
compared with traditional treatment methods.98 Another
review of wound treatments focusing on venous leg ulcers
and decubitus ulcers claimed LLLT could not improve
wound healing and suggested that researches should
focus on molecular and cellular mechanisms of wound
healing with more investigation in humans to find precise
laser parameters and treatment protocols.104
Herpes Labialis
This is a viral disease, which could not be treated
completely and anti-viral drugs acyclovir, valacyclovir,
and famciclovir could not eliminate the virus.105 Different
kinds of laser therapy and several protocols have been
proposed for the treatment of herpes labialis (HL) based
on successful clinical trials recently. Different studies
reported the wavelengths between 630 and 980 nm
and power of 20 to 300 mW with radiation duration
between 10 seconds and 15 minutes respectively for HL
treatment.106 All the researchers reported that LLLT is
an effective tool in the management of HL prevention
without any side effects.
Cancers
Breast Cancer Lymphedema
Early diagnosis and treatment of breast cancer result
in the survival of more than 82% patients in developed
countries.107 However, more survived patients suffer
from secondary lymphedema due to the following cancer
Table 2. Wagner & Armstrong Ulcer Classification in Summary
Wagner Grade Lesion Armstrong Ulcer Grades
0 No open wounds A: Without infection or ischemia
1 Superficial wounds B: With infection
2 Ulcer extension C: With Ischemia
3 Deep ulcer D: With infection and ischemia
4 Localized Gangrene
5 Extensive Gangrene
therapies.108 Despite efforts to reduce breast cancer
lymphedema (BCL) by treatments such as surgery or
radiotherapy, BCL remained relevant.109 During the
past few years, LLLT has been introduced as suitable
noninvasive phototherapy for the treatment of BCL, with
the wavelength between 650 and 1000 nm to be delivered
into the target tissue to reduce inflammation and promote
lymphatic vessel regeneration and lymphatic mortality
reduction.110-112 LLLT was more effective than compression
bandage for pain relief in BCL post-treatment 113. Based
on previous studies infrared radiation (808 to 905 nm)
is applied to LLLT of BCL post treatment (Table 3). The
range of energy usage was 1.5 J/ cm2 to 2.4 J/cm2.114.
Head and Neck Cancer
Several types of related complications of head and neck
cancer (HNC), which are treated via LLLT, are tabulated
in Table 3.
1. Oral Mucositis
Most of the patients with HNC treated by radiotherapy
(RT) or chemotherapy (CT) suffered from orofacial
and oropharyngeal complications.115 Most patients
confront multiple complications, leading to a negative
impact on their lifestyle.116 Supportive care for these
complications should be considered in different stages
of the disease. Photobiostimulation with various kinds
of light energy as LLLT and LED and visible light has
shown a promising efficiency for the treatment of HNC
complications.117 Oral mucositis almost appears in all of
the HNC patients treated by CT.118 Some investigations
have claimed that photobiomodulation is efficient for oral
mucositis, a complication that appears after HNC routine
treatments.119,120 There are several complications resulted
from HNC such as “Oral mucositis,121 dermatitis,122
dysphagia,123 hyposalivation and xerostornia,124 taste
alterations,125 osteoradionecrosis,126 trismus,127 soft tissue
necrosis,128 head and neck lymphedema,129 and voice
alterations.”130 All of those complications could be treated
by photomodulation (see Table 3). Oral mucositis affects
patients with HNC, treated by oral CT from mild to severe
conditions.131 ROS production starting cascade reactions
leads to microvascular injuries and ECM alterations in
mucositis.132 Different meta-analysis assessments revealed
Table 3. Different Complications Resulted From Head and Neck Cancer Treated by Photobiomodulation
Head & Neck Cancer Complications Photobiomodulation Therapy Wavelengths Power Supply Efficiency
Oral mucositis IR & NIR & LLLT 630-830 nm 10-150 mW Positive
Dermatitis IR LED
Red & IR LED
630-680 nm
630-680 nm
20-150 mW
20-80 mW
Positive
Positive
Dysphagia IR-NIR 980nm - Positive
Osteoradio necrosis Red & IR 660-800 nm 100 mW Positive
Trismus Diode Laser
Ga-Al-As
980 nm
830 nm
30 mW
30 mW
Positive
Negative
Head & neck lymphedema LLLT
LLLT
650-1000 nm
808-905 nm
20-80 mW
20-80 mW
Positive
Positive

Journal of Lasers in Medical Sciences Volume 11, Number 4, Autumn 2020 373
Low-Level Laser Therapy in Clinic
the efficiency of photobiomodulation in mucositis
reduction and pain-relieving with different doses of light
energy consumption.133 IR (630-680 nm) and NIR (780-
830 nm) lights had the same efficiency for the treatment
of mucositis.134
2. Dermatitis
HNC patients treated by RT mostly have dermatitis.
Radiotherapy leads to the release of inflammatory
cytokines as interleukin I & VI and this process causes
the development of edema, erythema and possibly
ulceration.135 Radiation of the skin could damage basal
epithelial cells and connective tissue vascular components.
Photobiomodulation may reduce the severity of
radiation dermatitis.68 Damage to the skin developed
by radiation may be ameliorated by multi-wavelength
photobiomodulation.136 In a review by Bensadon et al,
the effects of the red laser diode cluster and the IR LED
cluster on radiation dermatitis were evaluated positively
due to reduction of pain and inflammation and also
promotion of tissue repair after LLLT administration.
However, more investigations were suggested to reduce
the side effects of LLLT and the photobiomodulation
treatment of dermatitis.137
3. Dysphagia
Dysphagia is an impairment of swallowing and could
be seen in patients with head and neck malignancy
as a side effect of cancer therapy.138 Dysphagia is
associated with inflammation, edema, and fibrosis.139
Photobiomodulation is a promising technique for
dysphagia treatment.140 Dysphagia has different stages
from 0 to V. According to references, treatment could be
intraoral and extraoral photobiomodulation.141 Using an
IR laser with a wavelength of 980 nm (Table 3), Mobadder
et al reported the effectiveness of LLLT in cancer resulted
from a dysphagia case in pre- and post-operative stages.141
4. Osteoradionecrosis
Oral cancers may need different treatments such as
surgery, radiotherapy, chemotherapy or a combination
of these techniques. Chronic side effects of an oral
cavity may cause bone repair capacity to diminish.142, 143
Osteoradionecrosis (ORN) means a condition that the
irradiated bone be exposed into the oral cavity more
than 12 weeks and this process occurs in the suppression
of tumor recurrence or tumor necrosis in RT.144 There
is no cure for ORN and only clinical control treatments
as surgical debris removing, antibiotic therapy, and
ultrasound could be performed.144-146 LLLT with increasing
metabolism capacity, cell proliferation, angiogenesis and
wound healing is a suitable method for assisting ORN
treatment.147 LLLT also has analgesic effects and improves
lymphatic flow.148 Riberio et al in a study analyzed ORN
treatment by LLLT. The objective of the study was the
stimulation of the affected area to homeostasis, leading
to oral mucosa healing. Red light and IR lasers (see Table
3) were used for bone exposure and the affected jaw
subsequently. LLLT improved the healing process of bone
and accelerated the covering of bone with oral mucosa
in most cases.149 Positive results of LLLT as an adjuvant
therapy suggested for ORN treatment.
5. Trismus
Lockjaw or trismus is a limited jaw range of motion. It
may be caused by HNC. LLLT is an efficient tool to reduce
pain, edema and inflammation without adverse effects to
promote damaged tissue repairing.150 Petrini et al revealed
the effect of LLLT treatment with the aid of an 890 nm
(Table 3) diode laser on pain and edema reduction.151
Bone and Joint Disorders
Bone Disorders
Bone regeneration is accelerated by laser treatment in
Wistar rats relative to the controls.152 Improvement of
closed bone fracture healing in human wrist and hand via
LLLT is reported by Chang et al.153
Tendon Repair
As it is reported, a low-level laser in combination with
adipose‐derived mesenchymal stem cells improves the
initial phase of tendon repair.154 Based on the investigation
by Badawy et al, laser therapy can be used to recover hand
flexor tendon repair.155
Carpal Tunnel Syndrome
Tezcan et al investigated the effect of LLLT on 34 patients
with carpal tunnel syndrome. On the basis of this report,
the LLLT strain ratio and the cross‐sectional area of the
median nerve in patients decreased after LLLT. They
concluded that nerve regeneration and development
of the vascular supply effects of laser therapy led to the
improvement of patients’ condition.156
Discussion
As noted in the introduction, the types of complications
which can be treated with low-power lasers include
disorders of the nervous system, skin and mucous
membranes of the body, bones and joints, and finally
cancers. It should be noted that according to the
reviewed articles, one of the common treatments for the
above complications by low-power laser is pain relief.
Given the variety of sources studied, the conclusion
that the wavelengths and energy used in different low-
power lasers for the treatment of these diseases are
different is a point that needs to be considered because
there are no specific protocols to treat each of the
above-introduced side effects by low-laser and much
research is still needed in this regard. As it is presented
in Table 1, four types of nervous system complications

Mansouri et al
Journal of Lasers in Medical Sciences Volume 11, Number 4, Autumn 2020374
including Brain photobiomodulation, trigeminal nerve
neuralgia, traumatic brain injury, and neuropathic pain
are treated via LLLT. According to the studied sources,
photobiomodulation modulates nerve cells, but in
relation to trigeminal neuralgia, some articles reported
positive effects of LLLT on TN treatment and others
didn’t have any significant difference between tested
groups. The wavelength of light and the size of samples
are the factors that need more investigations.39 TBI treated
by LLLT leads to increasing the brain neurotrophic factor
and synaptogenesis.157 LLLT may cause neuropathic pain
treatment but there are some controversies. However, there
is a lack of detail on laser and energy density parameters in
the reviewed articles to assess the LLLT effect on analgesia.
According to Arnold Shultz law, the biological responses
in tissues could change (stimulate or inhibit) according to
the dose of energy absorption158 and more investigation
is necessary to define the protocols for optimizing LLLT
in neuropathic pain relief as different doses of energy are
provided by different instruments. In the field of skin and
mucosal disorders, skin burns revealed that the size of the
wound and classification of the lesion may explain total
energy discrepancy in different studies; however, it could
be concluded that LLLT could promote the wound healing
process, but the gap in the current literature may cause the
limitation of opening a window to suggest a suitable and
precise method for the specifications of skin burn healing
by LLLT. Hair loss treatment with LLLT also reminds us
that the phenomenon named “paradoxical hypertrichosis”
was the result of low influences of different types of lasers,
being enough for hair growth but not enough to induce
thermolysis with the range of 0.6% to 10 %.159 Suitable
randomized controlled trials in a clinic are required to
assess the efficiency of LLLT for hair growth.160 However,
more studies are required to create optimal protocols
for such parameters as wavelengths, flounce, pulse type,
time and power density of LLLT evaluation for hair
re-growth.80 Combined treatment of drugs and LLLT
needs more clinical trials suggested by researchers.80
Diabetic foot ulcer treatment with LLLT is a subject of
controversy. Unique laser therapy mode determination
to treat diabetic foot ulcers is not explained yet. It could
be generally concluded that the laser effects are generally
different in certain ulcers,161 and animal studies revealed
the promotion of wound healing by laser irradiation
due to different factors such as cellular, morphological
and collagen synthesis improvement.162, 163 However,
further investigations and clinical trials are required to
understand efficacy of LLLT on diabetic wound healing
according to the available positive results of studies. HL
has different treatments and dissimilar protocols which
implies more precise clinical trials with standard laser
parameters be considered. As mentioned in Table 3 for
breast cancer, different wavelengths and power supplies to
use in LLLT treatments should be considered. A need to
identify the optimal parameters of photobiomodulation
for oral mucositis and dermatitis treatment is still required
because of the controversies in different laser parameters
that have been used by researchers (see Table 3) and the
reduction of treatment side effects is still a problem. ORN
treatment by LLLT is suggested by clinicians because of the
proliferation and angiogenesis characters of laser therapy
in this regard. Trismus treatment by LLLT was suggested,
but some studies have not confirmed the effect of low-
power lasers on muscle spasm reduction, which may be
due to differences in sample type and other standards
such as radiation intensity and the dose and depth of
penetration.164 Further research is required to introduce
standard LLLT therapy for trismus treatment. It can be
concluded that LLLT is in the initial step to be applied in
a clinic in spite of the considerable development of related
methods and theories.
Conclusion
Based on the studies of the low-power laser in the treatment
of non-surgical diseases, it can be concluded that most
studies have shown its positive effects on the treatment of
such diseases, but lack of consistency in the choice of laser
standards such as the wavelength, the amount of energy
consumed, the surface of laser contact, and the duration
of treatment is seen. Most researchers believe that in
relation to each of the diseases, the efficiency of the low-
power laser is positive. Standard research with qualitative
and quantitative assumptions in the clinical setting should
be undertaken to achieve original protocols to treat non-
surgical diseases with LLLT and photobiomodulation. It
seems that LLLT is a useful therapeutic method with a
high degree of capacity for progression in future.
Ethical Considerations
Not applicable.
Conflict of Interests
The authors declare no conflict of interest.
Acknowledgment
Shahid Beheshti University of Medical Sciences supported
this research.
References
1. Khalkhal E, Razzaghi M, Rostami-Nejad M, Rezaei-
Tavirani M, Heidari Beigvand H, Rezaei Tavirani M.
Evaluation of laser effects on the human body after laser
therapy. J Lasers Med Sci. 2020;11(1):91-7. doi: 10.15171/
jlms.2020.15.
2. Rezaei-Tavirani M, Tavirani MR, Zamanian Azodi M,
Moravvej Farshi H, Razzaghi M. Evaluation of skin
response after Erbium:yttrium–aluminum–garnet laser
irradiation: a network analysis approach. J Lasers Med Sci.
2019;10(3):194-99. doi: 10.15171/jlms.2019.31.
3. Mansouri V, Rezaei-Tavirani M, Zadeh-Esmaeel MM,
Rezaei-Tavirani S, Razzaghi M, Okhovatian F, et al.
Analysis of laser therapy effects on squamous cell

Journal of Lasers in Medical Sciences Volume 11, Number 4, Autumn 2020 375
Low-Level Laser Therapy in Clinic
carcinoma patients: A system biology study. J Lasers Med
Sci. 2019;10(Suppl 1):S1-S6. doi: 10.15171/jlms.2019.S1.
4. Safaei A, Rezaei Tavirani M, Zamanian Azodi M, Lashay A,
Mohammadi SF, Broumand MG, et al. Diabetic retinopathy
and laser therapy in rats: A protein-protein interaction
network analysis. J Lasers Med Sci. 2017;8(Suppl 1):S20-S21.
doi: 10.15171/jlms.2017.s4.
5. Seifi M, Shafeei HA, Daneshdoost S, Mir M. Effects of two
types of low-level laser wave lengths (850 and 630 nm) on
the orthodontic tooth movements in rabbits. Lasers Med
Sci. 2007;22(4):261-4. doi: 10.1007/s10103-007-0447-9.
6. Kabnick LS. Outcome of different endovenous laser
wavelengths for great saphenous vein ablation. J Vasc Surg.
2006;43(1):88-93. doi: 10.1016/j.jvs.2005.09.033.
7. Esnouf A, Wright PA, Moore JC, Ahmed S. Depth of
penetration of an 850nm wavelength low level laser in
human skin. Acupunct Electrother Res. 2007;32(1-2):81-6.
doi: 10.3727/036012907815844165.
8. Ferreira DM, Zângaro RA, Villaverde AB, Cury Y, Frigo
L, Picolo G, et al. Analgesic effect of He-Ne (632.8 nm)
low-level laser therapy on acute inflammatory pain.
Photomed Laser Surg. 2005;23(2):177-81. doi: 10.1089/
pho.2005.23.177.
9. Navratil L, Kymplova J. Contraindications in noninvasive
laser therapy: truth and fiction. J Clin Laser Med Surg.
2002;20(6):341-3. doi: 10.1089/104454702320901134.
10. Kitchen SS, Partridge CJ. A review of low level laser
therapy: Part I: background, physiological effects and
hazards. Physiotherapy. 1991;77(3):161-8. doi: 10.1016/
S0031-9406(10)61694-X.
11. Walker J. Relief from chronic pain by low power laser
irradiation. Neurosci Lett. 1983;43(2-3):339-44. doi:
10.1016/0304-3940(83)90211-2.
12. Shooshtari SMJ, Badiee V, Taghizadeh SH, Nematollahi
AH, Amanollahi AH, Grami MT. The effects of low level
laser in clinical outcome and neurophysiological results of
carpal tunnel syndrome. Electromyogr Clin Neurophysiol.
2008;48(5):229-31.
13. Van Dinten LC, Wassenaar AL, Gorbalenya AE, Spaan WJ,
Snijder EJ. Processing of the equine arteritis virus replicase
ORF1b protein: identification of cleavage products
containing the putative viral polymerase and helicase
domains. J Virol. 1996;70(10):6625-33. doi: 10.1128/
jvi.70.10.6625-6633.1996.
14. Garavello-Freitas I, Baranauskas V, Joazeiro PP, Padovani
CR, Dal Pai-Silva M, da Cruz-Höfling MA. Low-power
laser irradiation improves histomorphometrical parameters
and bone matrix organization during tibia wound healing
in rats. J Photochem Photobiol B. 2003;70(2):81-9. doi:
10.1016/s1011-1344(03)00058-7.
15. Hawkins D, Houreld N, Abrahamse H. Low level laser
therapy (LLLT) as an effective therapeutic modality
for delayed wound healing. Ann N Y Acad Sci.
2005;1056(1):486-93. doi: 10.1196/annals.1352.040.
16. Lubart R, Friedmann H, Lavie R, Longo L, Jacobi J,
Baruchin O, et al. A reasonable mechanism for visible light-
induced skin rejuvenation. Lasers Med Sci. 2007;22(1):1-3.
doi: 10.1007/s10103-006-0406-x.
17. Vaghardoost R, Momeni M, Kazemikhoo N, Mokmeli S,
Dahmardehei M, Ansari F, et al. Effect of low-level laser
therapy on the healing process of donor site in patients with
grade 3 burn ulcer after skin graft surgery (a randomized
clinical trial). Lasers Med Sci. 2018;33(3):603-7. doi:
10.1007/s10103-017-2430-4.
18. Bhagwanani NS, Bhatia CC, Sharma N, Hemvani N,
Chitnis DS. Low level nitrogen laser therapy in pulmonary
tuberculosis. Laser ther. 2015;24(3):209-14. doi: 10.5978/
islsm.15-OR-14.
19. Nakashima T, Ueda H, Misawa H, Suzuki T, Tominaga
M, Ito A, et al. Transmeatal low-power laser irradiation
for tinnitus. Otol Neurotol. 2002;23(3):296-300. doi:
10.1097/00129492-200205000-00011.
20. Bjordal JM, Lopes-Martins RA, Joensen J, Couppe C,
Ljunggren AE, Stergioulas A, et al. A systematic review
with procedural assessments and meta-analysis of low
level laser therapy in lateral elbow tendinopathy (tennis
elbow). BMC Musculoskelet Disord. 2008;9(1):75. doi:
10.1186/1471-2474-9-75.
21. Kerr CM, Lowe PB, Spielholz NI. Low level laser for
the stimulation of acupoints for smoking cessation: a
double blind, placebo controlled randomised trial and
semi structured interviews. Journal of Chinese Medicine.
2008;86:46.
22. Tumilty S, McDonough S, Hurley DA, Baxter GD.
Clinical effectiveness of low-level laser therapy as
an adjunct to eccentric exercise for the treatment of
Achilles’ tendinopathy: a randomized controlled trial.
Arch Phys Med Rehabil. 2012;93(5):733-9. doi: 10.1016/j.
apmr.2011.08.049.
23. Gur A, Karakoc M, Cevik R, Nas K, Sarac AJ, Karakoc M.
Efficacy of low power laser therapy and exercise on pain
and functions in chronic low back pain. Lasers Surg Med.
2003;32(3):233-8. doi: 10.1002/lsm.10134.
24. Ordahan B, Karahan AY, Kaydok E. The effect of high-
intensity versus low-level laser therapy in the management
of plantar fasciitis: a randomized clinical trial. Lasers Med
Sci. 2018;33(6):1363-9. doi: 10.1007/s10103-018-2497-6.
25. Dincer U, Cakar E, Kiralp MZ, Kilac H, Dursun H. The
effectiveness of conservative treatments of carpal tunnel
syndrome: splinting, ultrasound, and low-level laser
therapies. Photomed Laser Surg. 2009;27(1):119-25. doi:
10.1089/pho.2008.2211.
26. Hirschl M, Katzenschlager R, Francesconi C, Kundi M. Low
level laser therapy in primary Raynaud’s phenomenon--
results of a placebo controlled, double blind intervention
study. J Rheumatol. 2004;31(12):2408-12.
27. Cullum N, Nelson EA, Flemming K, Sheldon T. Systematic
reviews of wound care management: (5) beds; (6)
compression; (7) laser therapy, therapeutic ultrasound,
electrotherapy and electromagnetic therapy. Health Technol
Assess. 2001;5(9):1-221. doi: 10.3310/hta5090.
28. Meireles SM, Jones A, Jennings F, Suda AL, Parizotto NA,
Natour J. Assessment of the effectiveness of low-level
laser therapy on the hands of patients with rheumatoid
arthritis: a randomized double-blind controlled trial. Clin
Rheumatol. 2010;29(5):501-9. doi: 10.1007/s10067-009-
1347-0.
29. Tauber S, Schorn K, Beyer W, Baumgartner R. Transmeatal
cochlear laser (TCL) treatment of cochlear dysfunction:
a feasibility study for chronic tinnitus. Lasers Med Sci.
2003;18(3):154-61. doi: 10.1007/s10103-003-0274-6.
30. Vlassov VV, Pechatnikov LM, MacLehose HG. Low level
laser therapy for treating tuberculosis. Cochrane Database
of Syst Rev. 2002(3).

Mansouri et al
Journal of Lasers in Medical Sciences Volume 11, Number 4, Autumn 2020376
31. Coates VH, Turkelson CM, Chapell R, Bruening W,
Mitchell MD, Reston JT, et al. Diagnosis and treatment
of worker-related musculoskeletal disorders of the upper
extremity. Evid Rep Technol Assess (Summ). 2002(62):1-12.
32. Salvioli S, Guidi M, Marcotulli G. The effectiveness of
conservative, non-pharmacological treatment, of plantar
heel pain: A systematic review with meta-analysis. Foot
(Edinb). 2017;33:57-67. doi: 10.1016/j.foot.2017.05.004.
33. Salehpour F, Mahmoudi J, Kamari F, Sadigh-Eteghad
S, Rasta SH, Hamblin MR. Brain photobiomodulation
therapy: a narrative review. Mol Neurobiol. 2018;55(8):6601-
36. doi: 10.1007/s12035-017-0852-4.
34. Wan S, Parrish JA, Anderson RR, Madden M.
Transmittance of nonionizing radiation in human tissues.
Photochem Photobiol. 1981;34(6):679-81. doi: 10.1111/
j.1751-1097.1981.tb09063.x.
35. Eells JT, Henry MM, Summerfelt P, Wong-Riley
MTT, Buchmann EV, Kane M, et al. Therapeutic
photobiomodulation for methanol-induced retinal toxicity.
Proc Natl Acad Sci U S A. 2003;100(6):3439-44. doi:
10.1073/pnas.0534746100.
36. Wong-Riley MTT, Liang HL, Eells JT, Chance B, Henry MM,
Buchmann E, et al. Photobiomodulation directly benefits
primary neurons functionally inactivated by toxins: role of
cytochrome c oxidase. J Biol Chem. 2005;280(6):4761-71.
doi: 10.1074/jbc.M409650200.
37. Naeser MA, Hamblin MR. Potential for transcranial laser
or LED therapy to treat stroke, traumatic brain injury,
and neurodegenerative disease. Photomed Laser Surg.
2011;29(7):443-6. doi: 10.1089/pho.2011.9908.
38. Lapchak PA. Taking a light approach to treating acute
ischemic stroke patients: transcranial near-infrared laser
therapy translational science. Ann Med. 2010;42(8):576-86.
doi: 10.3109/07853890.2010.532811.
39. Ebrahimi H, Najafi S, Khayamzadeh M, Zahedi A,
Mahdavi A. Therapeutic and analgesic efficacy of laser in
conjunction with pharmaceutical therapy for trigeminal
neuralgia. J lasers Med Sci. 2018;9(1):63-8. doi: 10.15171/
jlms.2018.13.
40. de Leeuw R. Orofacial Pain: Guidelines for Assessment,
Diagnosis and Management. 4th ed. Chicago: Quintessence
Publishing; 2008.
41. Ohno T. Pain suppressive effect of low power laser
irradiation. A quantitative analysis of substance P in
the rat spinal dorsal root ganglion. Nihon Ika Daigaku
Zasshi. 1997;64(5):395-400. [In Japanese]. doi: 10.1272/
jnms1923.64.395.
42. Brondon P, Stadler I, Lanzafame RJ. Melanin density affects
photobiomodulation outcomes in cell culture. Photomed
Laser Surg. 2007;25(3):144-9. doi: 10.1089/pho.2007.2045.
43. Asnaashari M, Safavi N. Application of low level lasers in
dentistry (endodontic). J Lasers Med Sci. 2013;4(2):57-66.
44. Taylor CA, Greenspan AI, Xu L, Kresnow MJ.
Comparability of national estimates for traumatic brain
injury-related medical encounters. J Head Trauma Rehabil.
2015;30(3):150-9. doi: 10.1097/HTR.0000000000000105.
45. Ross ST, Soltesz I. Selective depolarization of interneurons
in the early posttraumatic dentate gyrus: involvement of
the Na+/K+-ATPase. J Neurophysiol. 2000;83(5):2916-30.
doi: 10.1152/jn.2000.83.5.2916.
46. Bramlett HM, Dietrich WD. Pathophysiology of cerebral
ischemia and brain trauma: similarities and differences.
J Cereb Blood Flow Metab. 2004;24(2):133-50. doi:
10.1097/01.WCB.0000111614.19196.04.
47. Zinman LH, Ngo M, Ng ET, Nwe KT, Gogov S, Bril V. Low-
intensity laser therapy for painful symptoms of diabetic
sensorimotor polyneuropathy: a controlled trial. Diabetes
Care. 2004;27(4):921-4. doi: 10.2337/diacare.27.4.921.
48. Gustafsson H, Flood K, Berge OG, Brodin E, Olgart L,
Stiller CO. Gabapentin reverses mechanical allodynia
induced by sciatic nerve ischemia and formalin-induced
nociception in mice. Exp Neurol. 2003;182(2):427-34. doi:
10.1016/s0014-4886(03)00097-9.
49. Ali-Asgarzadeh A, Agha-Mohammadi D, Movasaghi R,
Shahsavari P. Effect of low-intensity laser on lower limb
neuropathic pain in patients with diabetes mellitus. Journal
of Anesthesiology and Pain. 2011;1(4):48-60. [In Persian].
50. Bertolini GRF, Artifon EL, da Silva TS, Cunha DM,
Vigo PR. Low-level laser therapy, at 830 nm, for pain
reduction in experimental model of rats with sciatica. Arq
Neuropsiquiatr. 2011;69(2B):356-9. doi: 10.1590/s0004-
282x2011000300017.
51. Kalinina OV, Alekseeva NV, Burtsev EM. Infrared laser
therapy in distal diabetic polyneuropathy. Zh Nevrol
psikhiatr Im S S Korsakova. 1998;98(6):23-5. [In Russian]
52. Alcântara CC, Gigo‐Benato D, Salvini TF, Oliveira AL,
Anders JJ, Russo TL. Effect of low‐level laser therapy
(LLLT) on acute neural recovery and inflammation‐related
gene expression after crush injury in rat sciatic nerve. Lasers
Surg Med. 2013;45(4):246-52. doi: 10.1002/lsm.22129.
53. Bjordal JM, Johnson MI, Iversen V, Aimbire F, Lopes-
Martins RAB. Low-level laser therapy in acute pain: a
systematic review of possible mechanisms of action and
clinical effects in randomized placebo-controlled trials.
Photomed Laser Surg. 2006;24(2):158-68. doi: 10.1089/
pho.2006.24.158.
54. Jimbo K, Noda K, Suzuki K, Yoda K. Suppressive effects of
low-power laser irradiation on bradykinin evoked action
potentials in cultured murine dorsal root ganglion cells.
Neurosci Lett. 1998;240(2):93-6.
55. Chow R, Armati P, Laakso EL, Bjordal JM, Baxter GD.
Inhibitory effects of laser irradiation on peripheral
mammalian nerves and relevance to analgesic effects: a
systematic review. Photomed Laser Surg. 2011;29(6):365-
81. doi: 10.1089/pho.2010.2928.
56. Hagiwara S, Iwasaka H, Hasegawa A, Noguchi T. Pre-
irradiation of blood by gallium aluminum arsenide (830
nm) low-level laser enhances peripheral endogenous
opioid analgesia in rats. Anesth Analg. 2008;107(3):1058-
63. doi: 10.1213/ane.0b013e31817ee43e.
57. Yan W, Chow R, Armati PJ. Inhibitory effects of visible
650‐nm and infrared 808‐nm laser irradiation on
somatosensory and compound muscle action potentials in
rat sciatic nerve: implications for laser‐induced analgesia. J
Peripher Nerv Syst. 2011;16(2):130-5. doi: 10.1111/j.1529-
8027.2011.00337.x.
58. Masoumipoor M, Jameie S, Janzadeh A, Nasirinezhad F,
Soleimani M, Kerdary M. Effects of 660-and 980-nm low-
level laser therapy on neuropathic pain relief following
chronic constriction injury in rat sciatic nerve. Lasers Med
Sci. 2014;29(5):1593-8. doi: 10.1007/s10103-014-1552-1.
59. Cidral‐Filho FJ, Martins DF, Moré AOO, Mazzardo‐Martins
L, Silva MD, Cargnin‐Ferreira E, et al. Light‐emitting diode
therapy induces analgesia and decreases spinal cord and
sciatic nerve tumour necrosis factor‐α levels after sciatic
nerve crush in mice. Eur J Pain. 2013;17(8):1193-204. doi:

Journal of Lasers in Medical Sciences Volume 11, Number 4, Autumn 2020 377
Low-Level Laser Therapy in Clinic
10.1002/j.1532-2149.2012.00280.x.
60. Catarino HR, de Godoy NP, Scharlack NK, Neves LM,
de Gaspi FO, Esquisatto MA, et al. InGaP 670-nm laser
therapy combined with a hydroalcoholic extract of
Solidago chilensis Meyen in burn injuries. Lasers Med Sci.
2015;30(3):1069-79. doi: 10.1007/s10103-014-1707-0.
61. Ezzati A, Bayat M, Taheri S, Mohsenifar Z. Low-level
laser therapy with pulsed infrared laser accelerates third-
degree burn healing process in rats. J Rehabil Res Dev.
2009;46(4):543-54. doi: 10.1682/jrrd.2008.09.0121.
62. Brassolatti P, Bossini PS, Oliveira MCD, Kido HW, Tim CR,
Almeida‐Lopes L, et al. Comparative effects of two different
doses of low‐level laser therapy on wound healing third‐
degree burns in rats. Microsc Res Tech. 2016;79(4):313-20.
doi: 10.1002/jemt.22632.
63. Chiarotto GB, Neves LMG, Esquisatto MAM, do Amaral
MEC, dos Santos GMT, Mendonça FAS. Effects of laser
irradiation (670-nm InGaP and 830-nm GaAlAs) on burn
of second-degree in rats. Lasers Med Sci. 2014;29(5):1685-
93. doi: 10.1007/s10103-014-1573-9.
64. Fu L, Zhang Y, Li C, Wu Z, Zhuo Q, Huang X, et al. Skin tissue
repair materials from bacterial cellulose by a multilayer
fermentation method. J Mater Chem. 2012;22(24):12349-
57. doi: 10.1039/c2jm00134a.
65. Fiório FB, Albertini R, Leal-Junior ECP, de Carvalho Pde T.
Effect of low-level laser therapy on types I and III collagen
and inflammatory cells in rats with induced third-degree
burns. Lasers Med Sci. 2014;29(1):313-9. doi: 10.1007/
s10103-013-1341-2.
66. de Vasconcelos Catão MHC, Nonaka CFW, de Albuquerque
RLC, Bento PM, de Oliveira Costa R. Effects of red laser,
infrared, photodynamic therapy, and green LED on
the healing process of third-degree burns: clinical and
histological study in rats. Lasers Med Sci. 2015;30(1):421-8.
doi: 10.1007/s10103-014-1687-0.
67. Bayat M, Vasheghani MM, Razavi N, Taheri S, Rakhshan M.
Effect of low-level laser therapy on the healing of second-
degree burns in rats: a histological and microbiological
study. J Photochem Photobiol B. 2005;78(2):171-7. doi:
10.1016/j.jphotobiol.2004.08.012.
68. Avci P, Gupta A, Sadasivam M, Vecchio D, Pam Z, Pam
N, et al. Low-level laser (light) therapy (LLLT) in skin:
stimulating, healing, restoring. Semin Cutan Med Surg.
2013;32(1):41-52.
69. Ezzati A, Bayat M, Khoshvaghti A. Low-level laser therapy
with a pulsed infrared laser accelerates second-degree burn
healing in rat: a clinical and microbiologic study. Photomed
Laser Surg. 2010;28(5):603-11. doi: 10.1089/pho.2009.2544.
70. Karu TI, Pyatibrat LV, Afanasyeva NI. Cellular effects of low
power laser therapy can be mediated by nitric oxide. Lasers
Surg Med. 2005;36(4):307-14. doi: 10.1002/lsm.20148.
71. Ranjbar R, Ashrafzadeh Takhtfooladi M. The effects of low
level laser therapy on Staphylococcus aureus infected third-
degree burns in diabetic rats. Acta Cir Bras. 2016;31(4):250-
5. doi: 10.1590/S0102-865020160040000005.
72. Núñez SC, França CM, Silva DFT, Nogueira GEC, Prates RA,
Ribeiro MS. The influence of red laser irradiation timeline
on burn healing in rats. Lasers Med Sci. 2013;28(2):633-41.
doi: 10.1007/s10103-012-1105-4.
73. Karu T, Pyatibrat L, Kalendo G. Irradiation with He-
Ne laser increases ATP level in cells cultivated in vitro.
J Photochem Photobiol B. 1995;27(3):219-23. doi:
10.1016/1011-1344(94)07078-3.
74. Renno ACM, Iwama AM, Shima P, Fernandes KR,
Carvalho JG, De Oliveira P, et al. Effect of low-level laser
therapy (660 nm) on the healing of second-degree skin
burns in rats. J Cosmet Laser Ther. 2011;13(5):237-42. doi:
10.3109/14764172.2011.606466.
75. Gupta A, Keshri GK, Yadav A, Gola S, Chauhan S,
Salhan AK, et al. Superpulsed (Ga‐As, 904 nm) low‐level
laser therapy (LLLT) attenuates inflammatory response
and enhances healing of burn wounds. J Biophotonics.
2015;8(6):489-501. doi: 10.1002/jbio.201400058.
76. Meireles GC, Santos JN, Chagas PO, Moura AP, Pinheiro
AL. Effectiveness of laser photobiomodulation at 660 or
780 nanometers on the repair of third-degree burns in
diabetic rats. Photomed Laser Surg. 2008;26(1):47-54. doi:
10.1089/pho.2007.2051.
77. Moreno‐Arias G, Castelo‐Branco C, Ferrando J. Paradoxical
effect after IPL photoepilation. Dermatol Surg. 2002;
28(11):1013-6. doi: 10.1046/j.1524-4725.2002.02101.x.
78. Leavitt M. Evaluation of the activity of laser light doses
compared to an inactive control dose on ex vivo hair
growth. J Am Acad Dermatol. 2010;62(3): P2109.
79. Hamblin M. Evaluation of activity of laser doses on ex-vivo
hair growth. http://www.hairmax.com/downloads/PDF/
EX_VIVO_ STUDY_SLIDES_7_09.pdf. Accessed October
19, 2014.
80. Zarei M, Wikramanayake TC, Falto-Aizpurua L, Schachner
LA, Jimenez JJ. Low level laser therapy and hair regrowth:
an evidence-based review. Lasers Med Sci. 2016;31(2):363-
71. doi: 10.1007/s10103-015-1818-2.
81. Wikramanayake TC, Rodriguez R, Choudhary S, Mauro
LM, Nouri K, Schachner LA, et al. Effects of the Lexington
LaserComb on hair regrowth in the C3H/HeJ mouse
model of alopecia areata. Lasers Med Sci. 2012;27(2):431-6.
doi: 10.1007/s10103-011-0953-7.
82. Wikramanayake TC, Villasante AC, Mauro LM, Nouri K,
Schachner LA, Perez CI, et al. Low-level laser treatment
accelerated hair regrowth in a rat model of chemotherapy-
induced alopecia (CIA). Lasers Med Sci. 2013;28(3):701-6.
doi: 10.1007/s10103-012-1139-7.
83. King Jr LE, Silva KA, Kennedy VE, Sundberg JP. Lack of
response to laser comb in spontaneous and graft-induced
alopecia areata in C3H/HeJ mice. J Invest Dermatol.
2014;134(1):264-66. doi: 10.1038/jid.2013.252.
84. Satino JL, Markou M. Hair regrowth and increased hair
tensile strength using the HairMax LaserComb for low-
level laser therapy. Int J Cosmet Surg Aesthetic Dermatol.
2003;5(2):113-7. doi: 10.1089/153082003769591209.
85. Leavitt M, Charles G, Heyman E, Michaels D. HairMax
LaserComb laser phototherapy device in the treatment
of male androgenetic alopecia: A randomized, double-
blind, sham device-controlled, multicentre trial. Clin
Drug Investig. 2009;29(5):283-92. doi: 10.2165/00044011-
200929050-00001.
86. Kim H, Choi JW, Kim JY, Shin JW, Lee Sj, Huh CH. Low‐
level light therapy for androgenetic alopecia: A 24‐week,
randomized, double‐blind, sham device–controlled
multicenter trial. Dermatol Surg. 2013;39(8):1177-83. doi:
10.1111/dsu.12200.
87. Lanzafame RJ, Blanche RR, Bodian AB, Chiacchierini
RP, Fernandez‐Obregon A, Kazmirek ER. The growth of
human scalp hair mediated by visible red light laser and
LED sources in males. Lasers Surg Med. 2013;45(8):487-95.
doi: 10.1002/lsm.22173.

Mansouri et al
Journal of Lasers in Medical Sciences Volume 11, Number 4, Autumn 2020378
88. Lanzafame RJ, Blanche RR, Chiacchierini RP, Kazmirek
ER, Sklar JA. The growth of human scalp hair in females
using visible red light laser and LED sources. Lasers Surg
Med. 2014;46(8):601-7. doi: 10.1002/lsm.22277.
89. Jimenez JJ, Wikramanayake TC, Bergfeld W, Hordinsky
M, Hickman JG, Hamblin MR, et al. Efficacy and safety
of a low-level laser device in the treatment of male and
female pattern hair loss: a multicenter, randomized, sham
device-controlled, double-blind study. Am J Clin Dermatol.
2014;15(2):115-27. doi: 10.1007/s40257-013-0060-6.
90. Munck A, Gavazzoni MF, Trüeb RM. Use of low-level
laser therapy as monotherapy or concomitant therapy for
male and female androgenetic alopecia. Int J Trichology.
2014;6(2):45-49. doi: 10.4103/0974-7753.138584.
91. Nguyen VT, Ndoye A, Grando SA. Pemphigus vulgaris
antibody identifies pemphaxin a novel keratinocyte
annexin-like molecule binding acetylcholine. J Biol Chem.
2000;275(38):29466-76. doi: 10.1074/jbc.M003174200.
92. Scully C, Challacombe SJ. Pemphigus vulgaris: update on
etiopathogenesis, oral manifestations, and management.
Crit Rev Oral Biol Med. 2002;13(5):397-408. doi:
10.1177/154411130201300504.
93. Minicucci EM, Miot HA, Barraviera SRCS, Almeida-Lopes
L. Low-level laser therapy on the treatment of oral and
cutaneous pemphigus vulgaris: case report. Lasers Med Sci.
2012;27(5):1103-6. doi: 10.1007/s10103-012-1101-8.
94. Scully C, De Almeida OP, Porter SR, Gilkes JJ. Pemphigus
vulgaris: the manifestations and long‐term management of
55 patients with oral lesions. Br J Dermatol. 1999;140(1):84-
9. doi: 10.1046/j.1365-2133.1999.02612.x.
95. Davenport S, Chen SY, Miller AS. Pemphigus vulgaris:
clinicopathologic review of 33 cases in the oral cavity. Int J
Periodontics Restorative Dent. 2001;21(1):85-90.
96. Yousef M, Mansouri P, Partovikia M, Esmaili M, Younespour
S, Hassani L. The effect of low level laser therapy on
Pemphigus vulgaris lesions: A Pilot Study. J Lasers Med Sci.
2017;8(4):177-80. doi: 10.15171/jlms.2017.32.
97. Jeffcoate WJ, Harding KG. Diabetic foot ulcers.
Lancet. 2003;361(9368):1545-51. doi: 10.1016/S0140-
6736(03)13169-8.
98. Kajagar BM, Godhi AS, Pandit A, Khatri S. Efficacy of
low level laser therapy on wound healing in patients with
chronic diabetic foot ulcers—a randomised control trial.
Indian J Surg. 2012;74(5):359-63. doi: 10.1007/s12262-011-
0393-4.
99. Beckmann KH, Meyer-Hamme G, Schröder S. Low level
laser therapy for the treatment of diabetic foot ulcers: a
critical survey. Evid Based Complement Alternat Med.
2014;2014:626127. doi: 10.1155/2014/626127.
100. Lipsky BA, Berendt AR, Cornia PB, Pile JC, Peters EJ,
Armstrong DG, et al. 2012 Infectious Diseases Society
of America clinical practice guideline for the diagnosis
and treatment of diabetic foot infections. Clin Infect Dis.
2012;54(12):e132-e73.
101. Rüttermann M, Maier-Hasselmann A, Nink-Grebe B,
Burckhardt M. Local treatment of chronic wounds:
in patients with peripheral vascular disease, chronic
venous insufficiency, and diabetes. Dtsch Arztebl Int.
2013;110(3):25-31. doi: 10.3238/arztebl.2013.0025.
102. Litscher G. Integrative laser medicine and high-
tech acupuncture at the Medical University of Graz,
Austria, Europe. Evid Based Complement Alternat Med.
2012;2012:103109. doi: 10.1155/2012/103109.
103. Ebrahimi T, Moslemi N, Rokn A, Heidari M,
Nokhbatolfoghahaie H, Fekrazad R. The influence of low-
intensity laser therapy on bone healing. J Dent (Tehran).
2012;9(4):238-48.
104. Sobanko JF, Alster TS. Efficacy of low‐level laser therapy
for chronic cutaneous ulceration in humans: A review
and discussion. Dermatol Surg. 2008;34(8):991-1000. doi:
10.1111/j.1524-4725.2008.34197.x.
105. de Paula Eduardo C, Aranha ACC, Simões A, Bello-
Silva MS, Ramalho KM, Esteves-Oliveira M, et al. Laser
treatment of recurrent herpes labialis: a literature review.
Lasers Med Sci. 2014;29(4):1517-29. doi: 10.1007/s10103-
013-1311-8.
106. Al-Maweri SA, Kalakonda B, AlAizari NA, Al-Soneidar
WA, Ashraf S, Abdulrab S, et al. Efficacy of low-level laser
therapy in management of recurrent herpes labialis: a
systematic review. Lasers Med Sci. 2018;33(7):1423-30. doi:
10.1007/s10103-018-2542-5.
107. Pinto AC, De Azambuja E. Improving quality of life
after breast cancer: dealing with symptoms. Maturitas.
2011;70(4):343-8. doi: 10.1016/j.maturitas.2011.09.008.
108. Cormier JN, Askew RL, Mungovan KS, Xing Y, Ross
MI, Armer JM. Lymphedema beyond breast cancer: A
systematic review and meta‐analysis of cancer‐related
secondary lymphedema. Cancer. 2010;116(22):5138-49.
doi: 10.1002/cncr.25458.
109. Fu MR. Breast cancer-related lymphedema: Symptoms,
diagnosis, risk reduction, and management. World J Clin
Oncol. 2014;5(3):241-7. doi: 10.5306/wjco.v5.i3.241.
110. Nouri K, Jimenez GP, Harrison‐Balestra C, Elgart GW.
585‐nm pulsed dye laser in the treatment of surgical
scars starting on the suture removal day. Dermatol Surg.
2003;29(1):65-73. doi: 10.1046/j.1524-4725.2003.29014.x.
111. Assis L, Moretti AIS, Abrahão TB, de Souza HP, Hamblin
MR, Parizotto NA. Low-level laser therapy (808 nm)
contributes to muscle regeneration and prevents fibrosis in
rat tibialis anterior muscle after cryolesion. Lasers Med Sci.
2013;28(3):947-55. doi: 10.1007/s10103-012-1183-3.
112. Jang DH, Song DH, Chang EJ, Jeon JY. Anti-inflammatory
and lymphangiogenetic effects of low-level laser therapy on
lymphedema in an experimental mouse tail model. Lasers
Med Sci. 2016;31(2):289-96. doi: 10.1007/s10103-015-
1854-y.
113. Maiya AG, Olivia E, Dibya A. Effect of low energy
laser therapy in the management of post-mastectomy
lymphoedema. Physiotherapy Singapore. 2008;11(1):2-5.
114. Tumilty S, Munn J, McDonough S, Hurley DA, Basford
JR, Baxter GD. Low level laser treatment of tendinopathy:
a systematic review with meta-analysis. Photomed Laser
Surg. 2010;28(1):3-16. doi: 10.1089/pho.2008.2470.
115. Epstein JB, Thariat J, Bensadoun RJ, Barasch A, Murphy
BA, Kolnick L, et al. Oral complications of cancer and
cancer therapy: from cancer treatment to survivorship. CA
Cancer J Clin. 2012;62(6):400-22. doi: 10.3322/caac.21157.
116. Hunter KU, Schipper M, Feng FY, Lyden T, Haxer M,
Murdoch-Kinch CA, et al. Toxicities affecting quality of life
after chemo-IMRT of oropharyngeal cancer: prospective
study of patient-reported, observer-rated, and objective
outcomes. Int J Radiat Oncol Biol Phys. 2013;85(4):935-40.
doi: 10.1016/j.ijrobp.2012.08.030.
117. Zecha JA, Raber-Durlacher JE, Nair RG, Epstein JB,
Elad S, Hamblin MR, et al. Low-level laser therapy/
photobiomodulation in the management of side effects of

Journal of Lasers in Medical Sciences Volume 11, Number 4, Autumn 2020 379
Low-Level Laser Therapy in Clinic
chemoradiation therapy in head and neck cancer: part 2:
proposed applications and treatment protocols. Support
Care Cancer. 2016;24(6):2793-805. doi: 10.1007/s00520-
016-3153-y.
118. Elting LS, Keefe DM, Sonis ST, Garden AS, Spijkervet F,
Barasch A, et al. Patient‐reported measurements of oral
mucositis in head and neck cancer patients treated with
radiotherapy with or without chemotherapy: demonstration
of increased frequency, severity, resistance to palliation,
and impact on quality of life. Cancer. 2008;113(10):2704-
13. doi: 10.1002/cncr.23898.
119. Clarkson JE, Worthington HV, Furness S, McCabe M,
Khalid T, Meyer S. Interventions for treating oral mucositis
for patients with cancer receiving treatment. Cochrane
Database Syst Rev. 2010(8):CD001973.
120. Riley P, Glenny AM, Worthington HV, Littlewood A,
Clarkson JE, McCabe MG. Interventions for preventing
oral mucositis in patients with cancer receiving treatment:
oral cryotherapy. Cochrane Database of Syst Rev.
2015(12):CD011552. doi: 10.1002/14651858.CD011552.
pub2.
121. Bayer S, Kazancioglu HO, Acar AH, Demirtas N, Kandas
NO. Comparison of laser and ozone treatments on oral
mucositis in an experimental model. Lasers Med Sci.
2017;32(3):673-7. doi: 10.1007/s10103-017-2166-1.
122. Burdelya LG, Gleiberman AS, Toshkov I, Aygun-Sunar
S, Bapardekar M, Manderscheid-Kern P, et al. Toll-like
receptor 5 agonist protects mice from dermatitis and oral
mucositis caused by local radiation: implications for head-
and-neck cancer radiotherapy. Int J Radiat Oncol Biol Phys.
2012;83(1):228-34. doi: 10.1016/j.ijrobp.2011.05.055.
123. Chen AY, Frankowski R, Bishop-Leone J, Hebert T,
Leyk S, Lewin J, et al. The development and validation
of a dysphagia-specific quality-of-life questionnaire for
patients with head and neck cancer: the MD Anderson
dysphagia inventory. Arch Otolaryngol Head Neck Surg.
2001;127(7):870-6.
124. Dirix P, Nuyts S, Van den Bogaert W. Radiation‐induced
xerostomia in patients with head and neck cancer: a
literature review. Cancer. 2006;107(11):2525-34.
125. Halyard MY, Jatoi A, Sloan JA, Bearden III JD, Vora SA,
Atherton PJ, et al. Does zinc sulfate prevent therapy-
induced taste alterations in head and neck cancer patients?
Results of phase III double-blind, placebo-controlled trial
from the North Central Cancer Treatment Group (N01C4).
Int J Radiat Oncol Biol Phys. 2007;67(5):1318-22. doi:
10.1016/j.ijrobp.2006.10.046.
126. Ben-David MA, Diamante M, Radawski JD, Vineberg
KA, Stroup C, Murdoch-Kinch C-A, et al. Lack of
osteoradionecrosis of the mandible after intensity-
modulated radiotherapy for head and neck cancer: likely
contributions of both dental care and improved dose
distributions. Int J Radiat Oncol Biol Phys. 2007;68(2):396-
402. doi: 10.1016/j.ijrobp.2006.11.059.
127. Bensadoun RJ, Riesenbeck D, Lockhart PB, Elting LS,
Spijkervet FK, Brennan MT. A systematic review of trismus
induced by cancer therapies in head and neck cancer
patients. Support Care Cancer. 2010;18(8):1033-8. doi:
10.1007/s00520-010-0847-4.
128. Hee LY, Kim YS, Chung MJ, Yu M, Jung SL, Yoo IR, et al.
Soft tissue necrosis in head and neck cancer patients after
transoral robotic surgery or wide excision with primary
closure followed by radiation therapy. Medicine (Baltimore).
2016;95(9):e2852. doi: 10.1097/MD.0000000000002852.
129. Deng J, Ridner SH, Dietrich MS, Wells N, Wallston KA,
Sinard RJ, et al. Prevalence of secondary lymphedema
in patients with head and neck cancer. J Pain
Symptom Manage. 2012;43(2):244-52. doi: 10.1016/j.
jpainsymman.2011.03.019.
130. Campos RJ, Maciel CT, Cesca MG, Leite IC. Voice analysis
after cancer treatment with organ preservation. Head Neck
Oncol. 2011;3(1):19. doi: 10.1186/1758-3284-3-19.
131. Naidu MUR, Ramana GV, Rani PU, Mohan IK, Suman A,
Roy P. Chemotherapy-induced and/or radiation therapy-
induced oral mucositis—complicating the treatment
of cancer. Neoplasia. 2004;6(5):423-31. doi: 10.1593/
neo.04169.
132. Al-Dasooqi N, Sonis ST, Bowen JM, Bateman E, Blijlevens
N, Gibson RJ, et al. Emerging evidence on the pathobiology
of mucositis. Supportive Care Cancer. 2013;21(7):2075-83.
doi: 10.1007/s00520-013-1810-y.
133. Bjordal JM, Bensadoun RJ, Tunèr J, Frigo L, Gjerde K,
Lopes-Martins RA. A systematic review with meta-analysis
of the effect of low-level laser therapy (LLLT) in cancer
therapy-induced oral mucositis. Supportive Care Cancer.
2011;19(8):1069-77. doi: 10.1007/s00520-011-1202-0.
134. Bensadoun RJ, Nair RG. Low-level laser therapy
in the prevention and treatment of cancer
therapy-induced mucositis: 2012 state of the art
based on literature review and meta-analysis.
Curr Opin Oncol. 2012;24(4):363-70. doi: 10.1097/
CCO.0b013e328352eaa3.
135. Kim JH, Kolozsvary AJ, Jenrow KA, Brown SL. Mechanisms
of radiation-induced skin injury and implications for
future clinical trials. Int J Radiat Biol. 2013;89(5):311-8.
doi: 10.3109/09553002.2013.765055.
136. Rezvani M, Robbins M, Hopewell J, Whitehouse E.
Modification of late dermal necrosis in the pig by treatment
with multi-wavelength light. Br J Radiol. 1993;66(782):145-
9. doi: 10.1259/0007-1285-66-782-145.
137. Bensadoun RJ. Photobiomodulation or low-level laser
therapy in the management of cancer therapy-induced
mucositis, dermatitis and lymphedema. Curr Opin Oncol.
2018;30(4):226-32. doi: 10.1097/CCO.0000000000000452.
138. Russi EG, Corvo R, Merlotti A, Alterio D, Franco P,
Pergolizzi S, et al. Swallowing dysfunction in head and
neck cancer patients treated by radiotherapy: review and
recommendations of the supportive task group of the
Italian Association of Radiation Oncology. Cancer Treat
Rev. 2012;38(8):1033-49. doi: 10.1016/j.ctrv.2012.04.002.
139. Cullins MJ, Connor NP. Reduced tongue force and
functional swallowing changes in a rat model of post stroke
dysphagia. Brain Res. 2019;1717:160-6. doi: 10.1016/j.
brainres.2019.04.023.
140. El Mobadder M, Farhat F, El Mobadder W, Nammour S.
Photobiomodulation Therapy in the Treatment of Oral
Mucositis, Dysphagia, Oral Dryness, Taste Alteration, and
Burning Mouth Sensation Due to Cancer Therapy: A Case
Series. Int J Environ Res Public Health. 2019 Jan;16(22):4505.
doi:10.3390/ijerph16224505
141. El Mobadder M, Farhat F, Nammour S. Photobiomodulation
therapy in the treatment of chronic dysphagia post
hormonal therapy in a breast cancer patient. Dent J (Basel).
2019;7(2):53. doi: 10.3390/dj7020053.
142. Huang SH, Hahn E, Chiosea SI, Xu ZY, Li JS, Shen L, et al.
The role of adjuvant (chemo-) radiotherapy in oral cancers

Mansouri et al
Journal of Lasers in Medical Sciences Volume 11, Number 4, Autumn 2020380
in the contemporary era. Oral Oncol. 2020;102:104563. doi:
10.1016/j.oraloncology.2019.104563.
143. Geiger JL, Adelstein DJ. Chemotherapy in the definitive
management of oral cancers: Where do we stand
today? Oral Oncol. 2020;102:104584. doi: 10.1016/j.
oraloncology.2020.104584.
144. O’Dell K, Sinha U. Osteoradionecrosis. Oral Maxillofac
Surg Clin North Am. 2011;23(3):455-64. doi: 10.1016/j.
coms.2011.04.011.
145. Harris M. The conservative management of
osteoradionecrosis of the mandible with ultrasound
therapy. Br J Oral Maxillofac Surg. 1992;30(5):313-8. doi:
10.1016/0266-4356(92)90181-h.
146. Oh HK, Chambers MS, Martin JW, Lim HJ, Park HJ.
Osteoradionecrosis of the mandible: treatment outcomes
and factors influencing the progress of osteoradionecrosis.
J Oral Maxillofac Surg. 2009;67(7):1378-86. doi: 10.1016/j.
joms.2009.02.008.
147. Magalhães IA, Forte CPF, Viana TSA, Teófilo CR, Verde
RDM, Magalhães DP, et al. Photobiomodulation and
antimicrobial photodynamic therapy as adjunct in
the treatment and prevention of osteoradionecrosis of
the jaws: a case report. Photodiagnosis Photodyn Ther.
2020;31:101959. doi: 10.1016/j.pdpdt.2020.101959.
148. Chow R. Low level laser therapy-mechanism of action:
analgesia. In: Freitas PM, Simões A, editors. Lasers in
Dentistry: Guide for clinical practice. Weinheim: Wiley-
Blackwell; 2015. p. 34-9.
149. Ribeiro GH, Minamisako MC, da Silva Rath IB, Santos
AMB, Simões A, Pereira KCR, et al. Osteoradionecrosis of
the jaws: case series treated with adjuvant low-level laser
therapy and antimicrobial photodynamic therapy. J Appl
Oral Sci. 2018;26:e20170172. doi: 10.1590/1678-7757-
2017-0172.
150. Sierra SO, Deana AM, Ferrari RAM, Albarello PM,
Bussadori SK, Fernandes KPS. Effect of low-level laser
therapy on the post-surgical inflammatory process after
third molar removal: study protocol for a double-blind
randomized controlled trial. Trials. 2013;14(1):373. doi:
10.1186/1745-6215-14-373.
151. Ferrante M, Petrini M, Trentini P, Perfetti G, Spoto G. Effect
of low-level laser therapy after extraction of impacted
lower third molars. Lasers Med Sci. 2013;28(3):845-9. doi:
10.1007/s10103-012-1174-4.
152. Barbosa D, Villaverde AGJB, LoschiavoArisawa EÂ, de
Souza RA. Laser therapy in bone repair in rats: analysis of
bone optical density. Acta Ortop Bras. 2014;22(2):71-4. doi:
10.1590/1413-78522014220200438.
153. Chang WD, Wu JH, Wang HJ, Jiang JA. Therapeutic
outcomes of low-level laser therapy for closed bone
fracture in the human wrist and hand. Photomed Laser
Surg. 2014;32(4):212-8. doi: 10.1089/pho.2012.3398.
154. Lucke LD, Bortolazzo FO, Theodoro V, Fujii L, Bombeiro
AL, Felonato M, et al. Low‐level laser and adipose‐derived
stem cells altered remodelling genes expression and
improved collagen reorganization during tendon repair.
Cell Prolif. 2019;52(3):e12580. doi: 10.1111/cpr.12580.
155. Badawy FA, ElSayed WH, Saidi AA, Wadee AN, Al Balah
OF, Abd El Azim ER. Effect of different doses of low-
intensity laser therapy on total active range of motion after
hand flexor tendon repair. J Med Sci Res. 2019;2(1):29-35.
doi: 10.4103/JMISR.JMISR_5_19.
156. Tezcan S, Ulu Ozturk F, Uslu N, Nalbant M, Umit Yemisci
O. Carpal tunnel syndrome: evaluation of the effects of
low‐level laser therapy with ultrasound strain imaging.
J Ultrasound Med. 2019;38(1):113-22. doi: 10.1002/
jum.14669.
157. Xuan W, Agrawal T, Huang L, Gupta GK, Hamblin MR.
Low‐level laser therapy for traumatic brain injury in mice
increases brain derived neurotrophic factor (BDNF) and
synaptogenesis. J Biophotonics. 2015;8(6):502-11. doi:
10.1002/jbio.201400069.
158. Karu T. Primary and secondary mechanisms of
action of visible to near-IR radiation on cells.
J Photochem Photobiol B. 1999;49(1):1-17. doi: 10.1016/
S1011-1344(98)00219-X.
159. Bernstein EF. Hair growth induced by diode laser
treatment. Dermatol Surg. 2005;31(5):584-6. doi: 10.1111/
j.1524-4725.2005.31168.
160. Schulz KF, Altman DG, Moher D. CONSORT 2010
statement: updated guidelines for reporting parallel
group randomised trials. BMC Med. 2010;8(1):18. doi:
10.1186/1741-7015-8-18.
161. Schindl M, Kerschan K, Schindl A, Schön H, Heinzl
H, Schindl L. Induction of complete wound healing
in recalcitrant ulcers by low‐intensity laser irradiation
depends on ulcer cause and size. P Photodermatol
Photoimmunol Photomed. 1999;15(1):18-21. doi: 10.1111/
j.1600-0781.1999.tb00047.x.
162. Vinck EM, Cagnie BJ, Cornelissen MJ, Declercq HA,
Cambier DC. Increased fibroblast proliferation induced by
light emitting diode and low power laser irradiation. Lasers
Med Sci. 2003;18(2):95-9. doi: 10.1007/s10103-003-0262-x.
163. Pinheiro ALB, Pozza DH, Oliveira MGD, Weissmann
R, Ramalho LMP. Polarized light (400–2000 nm) and
non-ablative laser (685 nm): a description of the wound
healing process using immunohistochemical analysis.
Photomed Laser Surg. 2005;23(5):485-92. doi: 10.1089/
pho.2005.23.485.
164. Brignardello-Petersen R, Carrasco-Labra A, Araya I,
Yanine N, Beyene J, Shah PS. Is adjuvant laser therapy
effective for preventing pain, swelling, and trismus after
surgical removal of impacted mandibular third molars? A
systematic review and meta-analysis. J Oral Maxillofac Surg.
2012;70(8):1789-801. doi: 10.1016/j.joms.2012.01.008.