BACKGROUND:Hemoporfin-mediated photodynamic therapy (HMME-PDT) is one of the primary treatment modalities for pediatric patients with port wine capillary malformations (port wine CMs) in China. However, it carries a substantial scarring formation risk, particularly in children with delicate skin. Current clinical practice primarily focuses on intraoperative parameter optimization, while postoperative management often remains passive. OBJECTIVES:To highlight the clinical significance of early postoperative signs indicative of impending scarring based on empirical experience, and to emphasize the critical role of early recognition and timely intervention. METHODS:Based on our experience with approximately 3550 pediatric patients undergoing HMME-PDT since 2017, we retrospectively analyzed 15 representative cases to evaluate the clinical course and management outcomes of high-risk signs. Clinical data, photographic documentation, and management outcomes were evaluated to identify key risk factors of scarring and effective interventions. RESULTS:Among the 33 patients (1%) who developed scarring, approximately 88% (29/33) exhibited rapid darkening or gray-white discoloration prior to scar formation. Immediate intervention with topical corticosteroids under occlusion reversed this sign within 72 h. At the median follow-up of 2 months, significant improvement of the original lesions and no scars formation were observed. However, a reference case with only basic wound care resulted in severe scarring. CONCLUSION:Early post-treatment darkening or gray-white discoloration is a key indicator of high scarring risk. Early recognition of this sign, followed by prompt and active postoperative care, is essential to prevent scarring. This study provides important clinical insights into improving safety outcomes for pediatric patients with port wine CMs undergoing HMME-PDT.
OBJECTIVES:Conventional ablative and photothermal lasers are commonly used to treat superficial pigmentary lesions but often induce thermal injury and post-inflammatory hyperpigmentation (PIH), particularly in Asian skin. Picosecond 755-nm alexandrite lasers with diffractive lens arrays (DLA) create laser-induced optical breakdown (LIOB) through a non-thermal photomechanical effect. However, the efficacy and adverse events of small-spot, high-fluence, ablation-dominant LIOB remain poorly defined in Asian patients. Ablation-dominant LIOB refers to high-fluence LIOB in which photomechanical effects predominate and produce direct tissue disruption with minimal thermal injury. This study aimed to evaluate a 5-mm high-fluence LIOB approach in Asian patients. MATERIALS AND METHODS:A retrospective chart review was conducted on patients who received 5-mm high-fluence LIOB. Demographics, diagnoses, treatment parameters, and serial photographs were collected. Clinical outcomes were independently assessed by two dermatologists using the Global Aesthetic Improvement Scale (GAIS) and pigmentation clearance rate (PCR). Treatments were delivered with a 5-mm 755-nm picosecond laser at 1.3-1.5 J/cm2 and 750 ps. All adverse events were documented. RESULTS:Thirty-three patients met the inclusion criteria. Superficial pigmentary lesions associated with photoaging or melasma were the most common indications. A mean of 1.45 treatment sessions had been completed by the efficacy evaluation day, with a mean follow-up of 66 days. The mean GAIS score was 3.67, and the mean PCR was 68.25%, with 80.65% of pigmentary lesions achieving good-to-excellent clearance. Non-pigmentary conditions demonstrated limited clinical responses. In selected complex photoaging cases, adjunctive large-spot (8-mm) low-fluence treatment was used before primary 5-mm LIOB-based ablation, with a mean GAIS score of 3.59. One patient developed a mild allergic reaction; no cases of scarring or PIH were observed. CONCLUSION:A high-fluence, 5-mm small-spot picosecond LIOB treatment protocol suggests a favorable safety and efficacy profile for superficial skin ablation in pigmentary and photoaging-related lesions in Asian patients, with minimal adverse effects. Pigmentary lesions showed more favorable responses than non-pigmentary lesions. Selected complex photoaging cases treated with adjunctive large-spot therapy showed favorable clinical improvement, supporting further investigation of this combined approach. This technique may broaden the role of picosecond lasers from pigment clearance to overall skin rejuvenation. Prospective controlled studies are warranted to confirm these preliminary findings.
OBJECTIVES:Bioactive surface pre-reacted glass-ionomer (S-PRG) technology and high-power laser irradiation have been investigated as promising preventive approaches. S-PRG particles exhibit multifunctional bioactive glass properties, with the ability to release and recharge ions. High-power laser irradiation of dental enamel induces chemical and structural modifications that enhance enamel resistance. Thus, this study evaluated the effect of Er:YAG laser irradiation, used alone or combined with the bioactive PRG Pro-Care gel, on the reduction of enamel demineralization under cariogenic challenge. METHODS:Human enamel specimens were randomly assigned to five groups (n = 12): control (C), Herjos prophylactic paste (H), laser (L), PRG Pro-Care gel (PRG), and laser + PRG Pro-Care gel (LP). After the treatments, the blocks were subjected to an 8-day pH cycling protocol. The percentage of surface hardness loss (%SHL) was determined through surface microhardness analysis and qualitative analysis was performed by scanning electronic microscopy. RESULTS:Groups L, PRG, and LP showed a significant reduction in mineral loss compared with the control group (p < 0.05), with the LP protocol being superior to PRG alone (p = 0.002). No statistically significant difference was observed between groups L and LP (p = 0.928). Group H did not differ significantly from group C- (p = 0.205). Treated groups presented physical surface alterations after irradiation and bioactive treatment. CONCLUSIONS:Er:YAG laser irradiation, whether used alone or in combination with the PRG gel, promoted a significant protective effect against enamel demineralization, indicating its potential clinical application in the prevention of dental caries.
OBJECTIVES:The 675-nm diode laser has emerged as a novel wavelength for non-ablative skin rejuvenation, with potential advantages in selective dermal targeting and minimal epidermal injury. However, integrated clinical and biologic evidence across multiple esthetic domains remains limited. This study aimed to evaluate the efficacy and safety of high-powered 675-nm laser treatment for facial rejuvenation in a real-world clinical setting. MATERIALS AND METHODS:In this prospective single-center study, 22 adults with facial erythema, fine wrinkles, enlarged pores, and textural irregularities underwent 3 monthly sessions of 675-nm non-ablative diode laser treatment. Objective outcomes were assessed using three-dimensional imaging at baseline and the 3-month follow-up (T3). Blinded Global Esthetic Improvement Scale (GAIS) evaluations were performed for pigmentation and erythema. An exploratory histologic analysis was conducted in a subset of participants. RESULTS:Eighteen participants completed the paired imaging analysis. Significant improvements were observed in wrinkle (+0.73 ± 0.86, p = 0.002), pore (+1.54 ± 2.24, p = 0.010), and smoothness scores (+2.18 ± 2.35, p = 0.001), with large effect sizes (Cohen's dz 0.69-0.93). Blinded GAIS assessments demonstrated ≥ 50% improvement in 61.1% of participants for both pigmentation and erythema. Treatment-related pain was mild (median visual analog scale score: 2.0), and no serious adverse events or post-inflammatory hyperpigmentation were observed. Histologic findings suggested increased dermal collagen components. CONCLUSION:High-powered 675-nm non-ablative diode laser treatment significantly improved objective skin texture parameters and provided clinically perceptible improvements in pigmentation and erythema, with favorable tolerability. These findings support its role as a versatile and effective modality for comprehensive facial rejuvenation.
OBJECTIVES:To evaluate whether erbium-doped yttrium aluminum garnet (Er:YAG) laser conditioning of clinically derived supragingival biofilm-fouled sandblasted, large-grit, acid-etched (SLA) titanium reduces residual biofilm, improves apparent wettability, and supports early osteoblast adhesive retention and osteogenic maturation. METHODS:Supragingival plaque biofilms were generated on SLA titanium discs after 48 h of intraoral splint wear and treated with an Er:YAG laser under saline irrigation. Surface morphology, roughness, wettability, and residual biofilm were assessed by scanning electron microscopy, atomic force microscopy, water contact angle measurement, live/dead fluorescence imaging, and 16S ribosomal RNA gene quantitative polymerase chain reaction. MC3T3-E1 cells were evaluated for spreading, adhesive retention, adhesion- and osteogenesis-related gene expression, alkaline phosphatase activity, and mineralized matrix deposition. RNA sequencing (RNA-seq) was performed at 4 h after cell seeding without detachment challenge and on Day 7 under osteogenic induction. RESULTS:Er:YAG treatment preserved local SLA roughness, reduced residual biofilm burden, and improved apparent wettability. Laser conditioning enhanced early osteoblast spreading and adhesive retention, accompanied by time-dependent changes in Fn1, Col1a1, and Ptk2. 4-h RNA-seq showed limited exploratory transcriptional differences without a coordinated up-regulated focal adhesion or PI3K-Akt signature. On Day 7 under osteogenic induction, laser-treated biofilm-fouled surfaces showed higher Runx2, Alpl, and Spp1 expression and broader enrichment of extracellular matrix-receptor interaction, focal adhesion, regulation of actin cytoskeleton, Rap1/Ras, PI3K-Akt, and mTOR-related pathways. These surfaces also showed higher alkaline phosphatase activity on Day 7 and greater mineralized matrix deposition on Day 14. CONCLUSIONS:Within this supragingival-biofilm model, Er:YAG conditioning preserved local SLA roughness, reduced residual biofilm burden, improved apparent wettability, enhanced early osteoblast adhesive retention, and supported osteogenic maturation. Integrated qRT-PCR and RNA-seq findings indicated stage-specific extracellular matrix-, focal adhesion-, cytoskeleton-, and osteogenesis-related responses, with PI3K-Akt-mTOR representing an exploratory component of the osteogenic-phase network rather than a continuous or causal mechanism.
