Kristianne Porta Santos Fernandes

Introduction: Dental caries remains one of the most prevalent chronic diseases in childhood worldwide. In Brazil, untreated carious lesions continue to affect oral health and quality of life in school-aged children. Minimally invasive approaches for caries management have demonstrated feasibility in community settings and may expand access to preventive and restorative care in socially vulnerable populations. Methods: This multicentre longitudinal intervention study will recruit 50 000 children aged 6–12 years from public schools in five Brazilian cities (Santos, Ponta Grossa, Brasília, Fortaleza and Belém). All participants will undergo clinical examination using the International Caries Detection and Assessment System (ICDAS) and will receive preventive and educational measures, including oral health counselling, supervised toothbrushing with fluoridated toothpaste (1100 ppm F), toothbrushes, toothpaste and application of Duraphat fluoride varnish to permanent molars and incisors. Among children with active carious lesions, 2500 will enter the longitudinal minimally invasive treatment phase according to lesion severity: fluoride varnish for ICDAS 1–2 lesions; fluoride varnish or atraumatic restorative treatment (ART) sealants for ICDAS 3 lesions; and ART with high-viscosity glass ionomer cement for ICDAS 4–6 lesions. Participants will be re-evaluated every 3 months for up to 24 months. Expected outcomes: The primary outcome will be control of caries activity assessed longitudinally using ICDAS criteria. Secondary outcomes include inactivation of white spot lesions, survival of restorations and sealants and adherence to preventive measures. The study is expected to generate evidence to support public oral health policies and minimally invasive strategies for school-based caries management in Brazil. Ethics and dissemination: This protocol has been approved by the human research ethics committee of Universidade Metropolitana de Santos—UNIMES (protocol number: 7.630.345. Approved on 10 June 2025). Results will be submitted to international peer-reviewed journals and presented at international conferences. Trial registration number: NCT06999005 (registered on 14 May 2025).

This report describes the excisional biopsy of a lower lip mucocele using a dual‐wavelength super‐pulsed diode laser (810/980 nm). The procedure was performed under local anesthesia using a 400 μm fiber tip with peak power of 100 W, pulse frequency of 20 Hz, pulse width of 0.05 ms, and average power of 1.2 W. The super‐pulsed emission enabled precise tissue incision, effective intraoperative hemostasis, and clear visualization of the surgical field. The excised specimen showed preserved morphology without carbonization, allowing histopathological confirmation of mucocele. After excision, photobiomodulation therapy was applied using a 7‐mm adapter (0.3 W, 2 J, 7 s per point, 5.5 J/cm ² ) to promote postoperative analgesia and tissue repair. Healing was uneventful, with no postoperative pain, edema, or recurrence at 90 days. The dual‐wavelength super‐pulsed diode laser represents a minimally invasive approach for oral mucocele excision while preserving tissue integrity for histopathological analysis.

The aim of the present study was to investigate the effects of photobiomodulation (PBM), dexamethasone (DEXA), and their combination on cellular metabolic activity and inflammatory cytokines in LPS/IFN-γ-stimulated J774 macrophages.Cells were stimulated with lipopolysaccharide (LPS) and interferon-gamma (IFN-γ) and treated with PBM (780 nm) and/or DEXA (2 or 4 μM). Cellmorphology, metabolic activity assessed by the 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide (MTT) assay, and total protein, tumornecrosis factor-alpha (TNF-α), and interleukin-6 (IL-6) levels measured by enzyme-linked immunosorbent assay (ELISA) were analyzed at 24 and 48hours. PBM combined with DEXA at 2 μM increased MTT metabolic activity at 24 hours and was associated with preserved morphology and maintainedhigher total protein levels, with consistent superiority over DEXA alone. PBM + DEXA 2 μM produced the strongest reduction in TNF-α and IL-6 at 24hours, and IL-6 levels remained lower at 48 hours compared to the M1 + PBM group. The 4 μM dose demonstrated lower efficacy and signs of functionalimpairment, which were partially mitigated by PBM. These findings indicate that PBM may enhance the anti-inflammatory effects of low-dose DEXA while supporting a favorable cellular metabolic response, suggesting its potential as an adjunct strategy to optimize the glucocorticoid-based modulation ofinflammatory responses.

Introduction: Genitourinary syndrome of menopause (GSM) is a chronic, oestrogen-deficient condition that is frequently underdiagnosed and undertreated. Although low-dose vaginal estriol improves epithelial trophism and microbial balance, a substantial proportion of women report persistent symptoms. High-quality randomised evidence evaluating combined therapeutic strategies remains scarce. Energy-based modalities, including the erbium:YAG (Er:YAG) laser (λ=2940 nm), have been proposed as adjunctive treatments. This trial aims to assess the efficacy of Er:YAG laser therapy combined with vaginal estriol compared with estriol alone in postmenopausal women with GSM. Methods and analysis: This is a single-centre, randomised, double-blind, controlled clinical trial. Postmenopausal women aged 45–70 years with vaginal pH ≥5.0 and at least one moderate GSM symptom (Visual Analogue Scale ≥4) will be eligible. Exclusion criteria include current systemic or local hormone therapy, previous vaginal energy-based treatment, abnormal cervical cytology and body mass index ≥35 kg/m ² . All participants will receive vaginal estriol cream (0.5 mg per dose) daily for 14 days, followed by twice-weekly administration for 16 weeks. Participants will be randomised (1:1) to receive either estriol plus sham Er:YAG laser or estriol plus active Er:YAG laser. Three laser sessions will be delivered at approximately 4-week intervals. Assessments will occur at baseline, monthly during treatment and 4 months after the final session. The primary outcome is the Vulvovaginal Health Index, with the primary endpoint defined as the change from baseline to 4 months post-treatment, reflecting sustained effect. Secondary outcomes include GSM symptom severity, vaginal microbiome composition (16S rRNA sequencing), quality of life (Menopause Rating Scale) and sexual function (Female Sexual Function Index). Data will be analysed using repeated-measures analysis of variance or appropriate non-parametric tests, with significance set at p<0.05. Ethics and dissemination: Ethical approval has been obtained from the Human Research Ethics Committee of UNINOVE. Written informed consent will be obtained. Findings will be disseminated via peer-reviewed journals and scientific meetings. Trial registration number: NCT06873971 .

Objectives: The aim of this study was to compare the effectiveness of two antimicrobial photodynamic therapy (aPDT) protocols using different methylene blue formulations in the treatment of initial pericoronitis. The research question was whether the new methylene blue formulation provides superior clinical outcomes compared to the conventional formulation. Materials and methods: This randomized, controlled, double-blind clinical trial involved 34 healthy young patients with pericoronitis. The following groups were established: G1 (positive control, n = 17), irrigation with saline solution and aPDT with conventional methylene blue (0.005%, laser λ = 660 nm, 9 J per point, 318 J/cm²); and G2 (experimental, n = 17), using the same therapy but with a patented new formulation of methylene blue. Pain assessed using the Visual Analog Scale (VAS) was defined as the primary outcome. Secondary outcomes include mouth opening, edema, and quality of life (OHIP-14). Microbiological and immunological analyses were performed to complement clinical outcomes. All outcomes were assessed at baseline and on the fourth day after aPDT. Results: Both groups showed statistically significant improvement in pain (G1: p = 0.022; G2: p = 0.001) and mouth opening (G1: p < 0.001; G2: p = 0.002) after treatment. However, no statistically significant differences were observed between the groups in final pain and mouth-opening outcomes ( p = 0.845 and p = 0.318, respectively). Conclusions: Within the limitations of this study, both aPDT protocols were associated with improvements in clinical outcomes. No between-group differences were observed in clinical outcomes; differences were limited to microbiological and immunological parameters, with no clinical superiority of the new formulation. Clinical relevance: Both methylene blue formulations may be used as adjunctive treatment options for the management of initial pericoronitis. However, no additional clinical benefit was observed with the new formulation, and these findings do not support a change in current clinical practice.

Introduction Oedema and ecchymosis are common after rhinoplasty and may delay recovery. Photobiomodulation (PBM) has been shown to have analgesic, anti-inflammatory and regenerative effects; however, its role in rhinoplasty remains underexplored. This study aims to evaluate the effectiveness of PBM in reducing periorbital oedema in patients undergoing rhinoplasty. Methods and analysis This is a single-centre, randomised, controlled, double-blind clinical trial that will include 60 participants allocated into two groups: a control group (n=30), receiving sham PBM before surgery, and an intervention group (n=30), receiving preoperative PBM followed by rhinoplasty. PBM will be delivered using a cluster device containing three red low-level laser diodes (660 nm, 150 mW each) and three infrared low-level laser diodes (808 nm, 150 mW each), applying 12 J per point for 80 s at three standardised facial sites. The intervention (PBM or sham) will be applied 1 hour before the surgical procedure. The primary outcome will be periorbital oedema on postoperative day 3, assessed using the Hoffmann clinical scale. Standardised photographic analysis using ImageJ software will be employed as a complementary measure. Secondary outcomes will include oedema at additional follow-up time points, ecchymosis, postoperative pain assessed using the visual analogue scale, nasal tip skin thickness, analgesic consumption and patient-reported aesthetic and functional outcomes assessed using the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) questionnaire. Follow-up assessments will be conducted at 3, 7, 30, 60 and 90 days, as well as at 6 and 12 months. Data will be analysed using parametric or non-parametric tests according to data distribution. Ethics and dissemination The study was approved by the Research Ethics Committee of Irmandade da Santa Casa de São Paulo (protocol number: 7503097), will be conducted in accordance with the Declaration of Helsinki and current Brazilian regulations for research involving human participants and registered at ClinicalTrials.gov (NCT07033039). Written informed consent will be obtained from all participants prior to enrolment. The results will be disseminated through peer-reviewed scientific publications, presentations at national and international scientific conferences, and communication of findings to interested participants. Trial registration number NCT07033039.

This clinical, randomized, controlled, and blinded trial evaluated photobiomodulation (PBM) using 850 nm (infrared) and 660 nm (red) LED clusters on cervical and mandibular mobility and masticatory muscles in temporomandibular disorder (TMD) patients. PBM was applied to the temporomandibular joint (TMJ) region, masseter, temporal, scalene, and trapezius muscles over six non‐consecutive sessions over 2 weeks. The Research Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) were used to determine the presence of TMD. A caliper and goniometer were used to measure the mandibular and cervical range of motion, respectively. Pain was assessed with the visual analog scale (VAS) before and after intervention. Results showed pain reduction only in the LED group post‐intervention; the placebo group showed no difference. No differences were observed in mouth opening, right laterality, flexion, or extension between groups, but left laterality increased in the LED group. In conclusion, PBM with LEDs effectively reduced pain in TMD patients. Trial Registration: ClinicalTrials.gov identifier: NCT06068959

Ankyloglossia is a congenital condition characterized by restricted tongue mobility due to an abnormal lingual frenum, which may impair breastfeeding in newborns and infants. Early diagnosis and treatment are essential to prevent functional complications. This case series describes 35 newborns and infants with ankyloglossia who underwent frenectomy using a super‐pulsed dual‐wavelength diode laser. The procedures were performed using a diode laser operating at wavelengths of 810 nm (1.2 W) and 980 nm (1.4 W), delivering a final output power of 1.1 W, in super‐pulsed mode (20 Hz frequency, 0.05 ms pulse width), with a 400‐μm fiber optic tip. Healing and tongue mobility were evaluated immediately after surgery and at seven and 15 days. Most cases showed balanced tissue repair, absence of fibrosis, and improved tongue mobility, resulting in effective breastfeeding. Unfavorable outcomes were associated with external factors such as pathological healing history and poor adherence to postoperative care.

Introduction Sleep quality is a fundamental determinant of human health and well-being.