Low Level Laser Therapy With Injectable Platelet Rich Fibrin in Management of Oral Lichen Planus

Oral Lichen Planus

Oral Lichen Planus, Low level laser therapy with Injectable Platelet Rich Fibrin, TNF-alpha

The Injectable PRF (i-PRF) is a variant of PRF, which is a liquid blood derivative rich in leukocytes and acts as a growth factor release, with its potential anti-inflammatory role, it may alleviate the symptoms of OLP. Low Level Laser Therapy (LLLT) emits short wavelength red or infrared light between (500-1100 nm) with a low water absorption. This light can reach a depth of 3 mm to 15 mm in both soft and hard tissues, the biostimulatory effect of laser irradiation results in physiological, metabolic, and functional changes in living microorganisms. The investigators compared the clinical effectiveness of LLLT combined with (i-PRF) to the application of (i-PRF) alone and to that of topical corticosteroid regimen in symptomatic OLP and investigated therapeutic mechanism by examining treatment effect on expression of Tumor necrosis factor alpha (TNF-alpha) and Vascular endothelial growth factor (VEGF) in salivary samples from OLP patients.

Thirty nine patients diagnosed histopathologically with OLP will be included in this study where a topical anesthetic gel containing 20% benzocaine will be applied to the OLP region, then 10 ml of peripheral venous blood will be collected from each patient and placed in dry sterile 13 ml plastic i-PRF tubes, without using an anticoagulant and centrifuged immediately (Process for PRF, Nice, France) at room temperature using a low relative centrifugal force (700 rpm for 3 min, 60 g force). The yellow- orange top portion of the tube will be then collected in an insulin syringe connected to a 27G needle to obtain approximately 1ml of i-PRF, which then will be injected once weekly for one month at four different endpoints at the periphery of the lesion into the subepithelial tissue underlying the lesion and adjacent to the normal mucosa (group 1), in addition to the (i-PRF) treatment, LLLT will also be delivered by the (Biolase diode laser 940 nm) with the following parameters: wavelength= 940 nm, duration = 180s, with a power of 100 mw/cm2, in a continuous non- contact mode, 0.5 cm away from tissues, with a power of 1.5 J/cm2. LLLT will be applied twice per week for one month in eight sessions (group 2). In control group, Triamcinolone acetonide injection (40 mg/ml) will be injected once weekly for one month with an insulin syringe 27-gauge needle at the same four endpoints. Each injection will be 0.5 mL per session (group 3). A clinical assessment will be carried out at baseline and once weekly up to one month within the treatment period, and once every 15 days up to 3 months (during the follow up period), where the marker lesion in each patient will be assessed for areas of erosion and ulceration by visual examination and the scoring will be recorded as follows: 0: represented no lesion/normal mucosa 1. mild white striae/no erythematous area 2. white striae with atrophic area less than 1 cm2 3. white striae with atrophic area more than 1 cm2 4. white striae with erosive area less than 1 cm2 5. white striae with erosive area more than 1 cm2. Salivary samples of whole unstimulated saliva (WUS) will be collected from all patients in three groups at baseline and 1 week after end of treatment period between 9:00 and 11:00 a.m, where the patients will be refrained from eating, drinking, using chewing gum, mints, etc. for at least 1½ h prior to the evaluation. Samples will be obtained by requesting patients to swallow first, tilt their head forward, and expectorate into a 50 ml polypropylene sterile tubes for 5 min without swallowing. After collection, all samples will be kept on ice until assayed, where TNF-alpha and VEGF concentrations will be determined using commercially available quantitative sandwich ELISA kits.

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