Laser treatment can remove wrinkles better than some newer procedures, dermatologists reported last month.

Carbon dioxide laser resurfacing was very effective and while there are some side effects, such as lightening or darkening of the skin, they almost always cleared up, Dr. Daniel Ward and Dr. Shan Baker of the University of Michigan reported.

"Use of the laser allows precise treatment, giving the surgeon more control over the resurfacing procedure than is possible with other techniques such as chemical peels and dermabrasion," they wrote in the journal Archives of Facial Plastic Surgery.

FILLS IN WRINKLES
Carbon dioxide lasers vaporize water molecules inside and outside of cells, damaging the surrounding tissue. Skin cells respond by producing collagen, which in turn fills in wrinkles.

Dermatologists had been looking for alternatives, because the process can either bleach the color out of the skin or cause uneven darkened patches. It can also cause outbreaks of herpes simplex virus, which causes cold sores and skin blistering.

Ward and Baker studied 42 women and five men with an average age of 52 who had laser resurfacing of the entire face between 1996 and 2004.

Most had complications but 45 percent had none. Most of the complications were acne or milia -- the appearance of small, white bumps, most of which disappeared when treated.

Only one had a herpes outbreak and one developed sagging eyelids, they reported.

"The efficacy of treating facial rhytids (wrinkles) with the carbon dioxide laser is well established, and the short- and long-term utility of the carbon dioxide laser in treating solar facial aging has previously been documented," they wrote.

PERIODONTITIS TREATMENT
In other laser-related news - laser therapy for severe gum disease may help regenerate the diseased tissue that normally secures the teeth, a small study suggests.

Researchers found that among six patients who had one tooth treated with a laser and another by traditional means, the laser-treated tooth showed evidence of new connective tissue growing within the gums around the tooth.

The findings add to evidence that laser-assisted therapy is a viable alternative to traditional treatment of severe gum disease, according to the researchers, led by Dr. Raymond A. Yukna of the Louisiana State University School of Dentistry in New Orleans.

The study was funded by Millennium Dental Technologies, which makes the laser used in the study; the company also has a patent on the treatment protocol the researchers followed -- known as the laser-assisted new attachment procedure, or LANAP.

The study included six patients with moderate to severe periodontitis, an infection of the gums that causes the gums to pull away from the teeth and form infected "pockets." Over time, the bones and connective tissue supporting teeth can wear away and cause tooth loss.

Dentists often treat periodontitis with a technique called scaling and root planing, in which bacteria-harboring tartar is removed from the teeth above and below the gums, and rough spots on the roots of the affected teeth are pared down to remove the bacteria that dwell there.

In some cases, they turn to surgery, which involves lifting back the gums to remove tartar, then suturing the gums back into place so that the tissue fits tightly against the teeth again.

Laser surgery has in recent years been considered a possible alternative to traditional surgery; the LANAP approach was approved by the U.S. Food and Drug Administration in 2004.

The laser works by first clearing diseased tissue and killing bacteria between the teeth and gums; tartar is removed with an ultrasound instrument. The laser is then passed through the diseased pockets again to encourage blood clotting, which helps seal the gum tissue to the teeth.

For their study, published in the International Journal of Periodontics & Restorative Dentistry, Yukna's team treated each patient with two approaches. One affected tooth was treated with traditional scaling and root planing only, and a second was treated with LANAP.

Three months later, all of the laser-treated teeth showed evidence of new connective tissue attachments and regeneration of tissue covering the tooth root. The traditionally treated teeth, by comparison, did not.

ACHILLES TENDON HEALING
In more laser news - laser therapy may speed Achilles tendon healing. Researchers found that among 52 active adults with Achilles tendinopathy, those treated with exercise and laser therapy for eight weeks improved more quickly than those treated with exercise therapy alone.

The findings are published in the American Journal of Sports Medicine.

Achilles tendinopathy is a general term for chronic, overuse injuries to the strong band of tissue that connects the calf muscles to the heel bone. Calf-muscle exercises are a standard treatment, but the benefits are often slow to appear, and the exercises themselves can initially worsen the pain of the injury.

This is where low-level laser therapy could be helpful, according principal investigator Dr. Jan Magnus Bjordal of Bergen University College in Norway and colleagues.

The therapy involves placing a laser probe, which emits infrared light, on various points of the skin around the Achilles tendon. There is evidence that this may both reduce inflammation in the area and stimulate the body's natural healing process -- helping to trigger the synthesis of collagen fibers in the tendon.

Bjordal and colleagues in Norway, Greece and Brazil randomly divided 52 recreational athletes with chronic Achilles tendinopathy to undergo eccentric exercise training plus laser therapy, or exercise training plus "placebo" laser therapy, in which the probe did not emit infrared energy. The patients also underwent laser therapy twice a week for four weeks, then once weekly for another four weeks.

"Eccentric" exercise refers to activities that cause a muscle to contract at the same time it is being lengthened. In this case, all of the patients performed eccentric exercises for the calf muscles four times per week for eight weeks, under supervision.

At the end of the study, the researchers found that the combination therapy group reported less pain during physical activity than their counterparts. They also tended to have less morning stiffness in the ankle, less tenderness and greater flexibility in the joint.

The results suggest that laser therapy may accelerate the benefits of eccentric exercise, which is becoming the "gold standard" treatment for Achilles tendinopathy, according to Bjordal's team.

AUGUST 2008