The effect of two phototherapy protocols on pain control in orthodontic procedure--a preliminary clinical study

The effect of photobiomodulation on histamine and Mucuna pruriens-induced pruritus, hyperknesis and alloknesis in healthy volunteers: A double-blind, randomized, sham-controlled study

BACKGROUND

Photobiomodulation, also referred to as Low-Level Light Therapy (LLLT), has emerged as a promising intervention for pruritus, a prevalent and often distressing symptom.

OBJECTIVES

This study investigated the efficacy of low-level light therapy (LLLT) in alleviating pruritus, hyperknesis, and alloknesis induced by histamine and Mucuna pruriens.

METHODS

In a double-blind, randomized, sham-controlled trial with a split-body design, healthy volunteers underwent 6 minutes of LLLT and sham treatments in separate upper back quadrants. The histamine model was applied to the upper quadrants, and Mucuna pruriens to the lower quadrants. Pruritus intensity, alloknesis, hyperknesis, flare area, and skin temperature were measured pre and post treatment.

RESULTS

Seventeen individuals (eight females, nine males) participated in the study. In the histamine model, LLLT notably reduced itch intensity (difference = 13.9 (95% CI: 10.5 - 17.4), p = 0.001), alloknesis (difference = 0.80 (95% CI: 0.58-1.02), p = 0.001), and hyperknesis (difference = 0.48 (95% CI: 0.09-0.86), p = 0.01). Skin temperature changes were not significantly different between the two groups (difference = -2.0 (95% CI: -6.7-2.6), p = 0.37). For the Mucuna pruriens model, no significant differences were observed in any measures, including itch intensity (difference = 0.8 (95% CI: -2.3 - 3.8), p = 0.61) hyperknesis (difference = 0.08 (95% CI: -0.06-0.33), p = 0.16) and alloknesis (difference = 0. 0.09 (95% CI: -0.08-0.256), p = 0.27).

CONCLUSIONS

LLLT effectively reduced histamine-induced pruritus, alloknesis, and hyperknesis; however, LLLT was ineffective against Mucuna pruriens-induced pruritus. Further investigations are required to determine LLLT's effectiveness of LLLT in various pruritus models.

Comparative analysis of Laser and LED phototherapies pain control after insertion of elastomeric separators in orthodontics patients: Clinical trial

The aim of this study was to evaluate the effectiveness of pain modulation following Laser or LED phototherapies during the process of tooth separation. This was a longitudinal randomized controlled clinical trial in four observational times carried out in 60 patients (15 males, 45 females, average 24.1 years old) who were randomly divided into three groups: G1 (LED, AsGaAl, λ850 ± 10 nm, 150 mW, 17 J/cm², 57 s per session), G2 (Laser, AsGaAl, λ780 nm, 70 mW, 20.0 J/cm², 240 s per session) and G3 (Non-irradiated Control). All patients were submitted to tooth separation using elastomeric separators. The pain level was measured by using a visual analogue scale (VAS) immediately after insertion (T1) of the elastic, at 48 (T2), 96 (T3) hours and 6 days (T4). It was observed an increase of the pain on the Control group from T1 to T2, with statistical significance. Pain levels in the LED and Laser groups were always significantly lower (<0.001), except for T1. According with the results of the present study it may be concluded that, either LED or Laser phototherapies, were effective in reducing the pain level after dental separation process when compared to the control group.

Full-Body Photobiomodulation Therapy Is Associated with Reduced Sleep Durations and Augmented Cardiorespiratory Indicators of Recovery

Research is emerging on the use of Photobiomodulation therapy (PBMT) and its potential for augmenting human performance, however, relatively little research exists utilizing full-body administration methods. As such, further research supporting the efficacy of whole-body applications of PBMT for behavioral and physiological modifications in applicable, real-world settings are warranted. The purpose of this analysis was to observe cardiorespiratory and sleep patterns surrounding the use of full-body PBMT in an elite cohort of female soccer players. Members of a women’s soccer team in a “Power 5 conference” of the National Collegiate Athletic Association (NCAA) were observed across one competitive season while wearing an OURA Ring nightly and a global positioning system (GPS) sensor during training. Within-subject comparisons of cardiorespiratory physiology, sleep duration, and sleep composition were evaluated the night before and after PBMT sessions completed as a standard of care for team recovery. Compared to pre-intervention, mean heart rate (HR) was significantly lower the night after a PBMT session (p = 0.0055). Sleep durations were also reduced following PBMT, with total sleep time (TST) averaging 40 min less the night after a session (p = 0.0006), as well as significant reductions in light sleep (p = 0.0307) and rapid eye movement (REM) sleep durations (p = 0.0019). Sleep durations were still lower following PBMT, even when controlling for daily and accumulated training loads. Enhanced cardiorespiratory indicators of recovery following PBMT, despite significant reductions in sleep duration, suggest that it may be an effective modality for maintaining adequate recovery from the high stress loads experienced by elite athletes.

Pain Reduction during Rapid Palatal Expansion Due to LED Photobiomodulation Irradiation: A Randomized Clinical Trial

Objective: The purpose of this research is to assess the analgesic efficiency of Photobiomodulation (PBM) in pain reduction in young patients during rapid maxillary expansion therapy. Materials and Methods: Thirty patients were included and allocated to an experimental group [Rapid Palatal Expansion (RPE) and PBM] and a control group (RPE only) at random. Inclusion criteria were skeletal age from CVS1 to CVS3, examined on the cephalometric lateral teleradiography, with cervical vertebra staging and completed eruption of upper first molar. Exclusion criteria were previous orthodontic treatment, bone disease, disability, or skeletal age from CVS4. Patients referred the pain they felt using a Numerical scale rate (NRS), ranging from 0 to 10, with specific intervals of time: 6 h, 12 h, 24 h, and from days 2 to 7. The Wilcoxon-Mann-Whitney test was used to evaluate differences in NRS reported values between the two groups. Results: The final sample included 30 patients, 14 males and 16 females, with a mean age of 7.8 ± 1.2 years. The pain that was felt at each time interval and the maximum score of pain were significantly lower in the experimental group (p < 0.05) and decreased faster in the experimental group, with a score test near to 0 after 2/3 days. Conclusions: PBM is efficient in reducing the intensity and the time of pain felt by young patients that undergo rapid maxillary expansion.

An Efficacy of Photobiomodulation of 850 nm on Pain Reduction in a Human Oral Capsaicin Pain Model

Objective: The aim of this clinical trial was to evaluate the efficacy of photobiomodulation (PBM) to reduce oral pain initiated by capsaicin. Background: PBM has been used for pain reduction in oral regions; however, its clinical efficacy to alleviate burning sensations is still unknown. Methods: This clinical study was divided into two phases. There were 10 subjects in each phase. In Phase I, the burning sensation was stimulated using 0.05% in 95% ethanol capsaicin (prepared by the Faculty of Pharmaceutical Sciences, Khon Kaen University, Thailand) on filter paper and recorded with a 10-cm horizontal visual analog scale (VAS) every 1 min until the subject experienced no more pain. The area under the curve (AUC) of the graph between VAS and time was calculated. The washout period was 24 h. In Phase II, a crossover clinical trial was conducted in subjects who received the pain model as stated. Four interventions were included: (1) PBM before & after pain stimulation, (2) PBM before pain stimulation, (3) PBM after pain stimulation, and (4) Placebo. For PBM intervention, a single exposure of 850 nm Laser (AsGaAl; TOP 250 Soft Laser, Berkmed Medikal, distributed by Medical Innovation-MI, Istanbul, Turkey) with 0.10 cm² spot size laser probe continuous wave at 1 W/cm² and 30 J/cm² for 30 sec was used. Results: In Phase I, there was no statistically significant difference (p = 0.09) between the average AUC of day 1 [55.63 (23.38)] and day 2 [48.99 (27.20)]. In phase II, there was no statistical difference (p = 0.20) of the average AUC among the interventions and the placebo; group 1 [56.24 (30.11)], group 2 [45.46 (45.46)], group 3 [64.15 (32.89)], and group 4 [58.59 (30.16)]. Conclusions: The human capsaicin model was suitable for a crossover design clinical trial. The PBM used in this study did not reduce oral burning sensations from capsaicin.

The Effectiveness of Low-Level Laser Therapy in Pain Induced by Orthodontic Separator Placement: A Systematic Review

Introduction: This systematic review was conducted to evaluate the effectiveness of low-level laser therapy (LLLT) in orthodontic separator pain. Methods: This article was written according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Electronically and manually 3 databases, namely PubMed, Scopus and Google Scholar, were searched by the keywords that were selected based on population, intervention, comparison and outcome (PICO) on October 10, 2020. Studies were appraised by Cochrane version 5.2.0 with 7 domains and were checked by these inclusion criteria: 1. Randomized clinical trial (RCT) that examined the efficacy of LLLT in separator pain, 2. Split-mouth design, 3. LLLT application in the first hours after separator placement, 4. LLLT application to both sides of the teeth, 5. Patients receiving elastomeric separators between the premolars and molars, 6. Lasers with a wavelength of 800-899 nm, 7. Studies conducted from 2010 to 2020, and 8. Participants who went through orthodontic treatment without limitation in gender, age and social-economic status. Results: 299 studies were screened. 34 full-text papers were read by 2 authors independently. In the end, 4 articles met the inclusion criteria. All 4 articles showed LLLT has a significant impact on pain reduction. Conclusion: The exact protocol for laser therapy is still not clear. Therefore, more studies with a meticulously designed method are needed.

The Optimal Energy Density of Photobiomodulation Therapy in Decreasing Orthodontic-Related Pain: A Systematic Review and Network Meta-Analysis

Objective: The aim of this network meta-analysis (NMA) was to explore the optimal energy density (ED) for relief of orthodontic-related pain by photobiomodulation therapy. Background: Orthodontic treatment corrects the deformity of teeth, dental arch, jaw, and face using various orthodontic devices under the action of biomechanics. Materials and methods: A computerized literature search was conducted within the MEDLINE, EMBASE, Scopus, Cochrane Library, Web of Science, CNKI, Wanfang, VIP, and CBM databases to identify randomized controlled trials (RCTs) that used photobiomodulation therapy to relieve pain during orthodontic treatment. Particular inclusion and exclusion criteria were connected to recognize relevant articles. The information was extricated autonomously by two reviewers, and a quality assessment was carried out by utilizing the Cochrane Collaboration "risk of bias" tool. The RevMan 5.4 software and STATA 15.0 were utilized for data analysis. Also, the NMA was performed with mvmeta commands in Stata (StataCorp, TX). Results: Of the 1024 recognized articles, 21 RCTs were at long last included. Within the risk-of-bias assessments, 2 studies displayed a high risk, 17 an unclear risk, and 2 a low risk. The global and local inconsistency of the NMA in 1 and 2 days was not significant; however, the NMA in 3 days showed a significant inconsistency. Laser with lower ED (0-10 J/cm²) appeared to be the most noteworthy possibility to become the optimal intervention, and it also had the highest mean rank in the rankogram and the biggest value of surface under the cumulative ranking in all three NMA structures. Conclusions: On account of the limited evidence of included trials, laser with lower ED (0-10 J/cm²) appeared to be more valid than the remaining treatment modalities (laser with higher ED, placebo, and control) for pain reduction in 1, 2, and 3 days after orthodontic procedures were applied. In the future, more high-quality research with consistency in research design is needed for further evaluation.

Viability of Photobiomodulaton Therapy in Decreasing Orthodontic-Related Pain: A Systematic Review and Meta-Analysis

Objective: To assess the viability of photobiomodulation therapy (PBMT) in decreasing orthodontic-related pain after different orthodontic procedures. Methods: A computerized literature search was conducted within the MEDLINE, EMBASE, Scopus, Cochrane Library, Web of Science, CNKI, WanFang, VIP, and CBM databases to identify randomized controlled trials (RCTs), which used PBMT to relieve pain during orthodontic treatment. Particular inclusion and exclusion criteria were connected to recognize relevant articles. The information was extricated autonomously by two reviewers, and a quality assessment was carried out by utilizing the Cochrane Collaboration "risk of bias" tool. Meta-analysis was conducted with fixed- or random-effects models as suitable. Statistical heterogeneity was also examined. The RevMan 5.4 software was utilized for data analysis. Results: Of 1024 recognized articles, 25 RCT were at long last included. Within the risk-of-bias assessments, 1 study displayed a high risk, 22 an unclear risk, and 2 a low risk. The meta-analysis appeared that in patients treated with photobiomodulation (PBM) versus control there was a distinction in support of PBMT in placement of elastomeric separators, canine retraction, and archwire placement during 1 week. Conclusions: PBMT demonstrated to be effective in advancing a reduction pain after elastomeric separators placement, canine retraction, and archwire placement within 1 week. In the future, more high-quality research with consistency in research design is needed for further evaluation.

Effect of experimental orthodontic pain on gray and white matter functional connectivity

AIM

Over 90% of patients receiving orthodontic treatment experience clinically significant pain. However, little is known about the neural correlates of orthodontic pain and which has therefore been investigated in the present study of healthy subjects using an experimental paradigm.

METHODS

Resting-state functional magnetic resonance imaging (rsfMRI) was performed in 44 healthy subjects 24 hours after an elastic separator had been introduced between the first and the second molar on the right side of the lower jaw and in 49 age- and sex-matched healthy control (HC) subjects. A K-means clustering algorithm was used to identify functional gray matter (GM) and white matter (WM) resting-state networks, and differences in functional connectivity (FC) of GM and WM between the group of subjects with experimental orthodontic pain and HC were analyzed.

RESULTS

Twelve GM networks and 14 WM networks with high stability were identified. Compared with HC, subjects with orthodontic pain showed significantly increased FC between WM12, which includes posterior thalamic radiation and posterior cingulum bundle, and most GM networks. Besides, the WM12 network showed significant differences in FC with three GM-WM loops involving the default mode network, dorsal attention network, and salience network, respectively.

CONCLUSIONS

Orthodontic pain is shown to produce an alteration of FC in networks relevant to pain processing, which may be mediated by a WM network relevant to emotion perception and cognitive processing.

Efficacy of Photobiomodulation Therapy for Orthodontic Pain Control Following the Placement of Elastomeric Separators: A Randomized Clinical Trial

Introduction: Controlling pain in orthodontic patients has gained special attention. This study assessed the efficacy of photobiomodulation therapy (PBMT) for pain control following the placement of elastomeric separators. Methods: This split-mouth single-blind randomized clinical trial evaluated 30 orthodontic patients who required posterior elastomeric separators. The two maxillary quadrants were randomized into the laser and control groups. In the laser quadrant, an 808 nm diode laser (400 mW, 15.60 J/cm² , 11 seconds, continuous-wave, contact mode) was irradiated to the cervical third of the maxillary first molar roots 24 hours prior to the placement of separators. The control quadrant received placebo radiation by a light-curing unit. The patients received the second laser cycle right before the placement of separators 24 hours later. The level of self-perceived pain was recorded at 0, 2, 6, 24, and 72 hours and 5 days after the intervention in the laser and control quadrants using a visual analog scale (VAS). Data were analyzed using the analysis of variance (ANOVA) and paired-samples t test. Results: The trend of change in the pain score was similar in both groups. The pain score was significantly lower in the laser group than the control group at all-time points (P <0.05) except at time 0. The pain score increased in the first 6 hours and reached its maximum level in 24 hours in both groups. Conclusion: PBMT by an 808 nm diode laser can effectively decrease pain following the placement of elastomeric separators.

The Effect of Low-Level Light Therapy on Capsaicin-Induced Peripheral and Central Sensitization in Healthy Volunteers: A Double-Blinded, Randomized, Sham-Controlled Trial

Introduction

Several clinical trials have demonstrated that low-level light therapy (LLLT), a method of photobiomodulation, is an effective analgetic treatment. However, the mechanism of action has not yet been finally clarified. In particular, unanswered questions include whether it only affects peripheral or whether it also affects the spinal or supraspinal level. This study aimed to evaluate the effect of low-level light therapy on primary and secondary hyperalgesia in a human pain model.

Methods

This study was planned as a randomized, sham-controlled, and double-blinded trial with repeated measures within subject design. Capsaicin was applied on both forearms of ten healthy volunteers to induce peripheral and central sensitization. One forearm was treated with low-level light therapy; the other served as sham control.

Results

Low-level light therapy significantly increased the mechanical pain threshold, heat pain threshold, and decreased pain intensity.

Conclusions

Our data indicate that low-level light therapy is effective at reducing the heat and mechanical pain threshold in a human pain model, pointing to a significant modulating effect on peripheral and central sensitization. These effects—especially in the absence of reported side effects—make low-level light therapy a promising tool in pain management. The application of low-level light therapy to treat chronic pain should be considered for further clinical trials.

Low-level laser therapy effectiveness in reducing initial orthodontic archwire placement pain in premolars extraction cases: a single-blind, placebo-controlled, randomized clinical trial

Background

The objective of this randomized clinical trial was to evaluate Low-Level Laser Therapy (LLLT) effectiveness in spontaneous and chewing pain reduction following initial orthodontic archwire placement.

Methods

26 patients (mean age 20.07 ± 3.13 years) with maxillary Little’s Irregularity Index (LII) of 7 mm or more that indicates first maxillary premolars extraction and no medications intake were eligible for this trial. Patients were randomly assigned with 1:1 ratio using simple randomization technique to receive either LLL or placebo treatment. Blinding was applicable for patients only. In the laser group, patients received a single LLL dose (wavelength 830 nm, energy 2 J/point) in four points (2 buccal, 2 palatal) for each maxillary anterior tooth root. Patients in the placebo group had the same laser application procedure without emitting the laser beam. Patients were asked to score spontaneous and chewing pain intensity by filling out a questionnaire with a 100-mm Visual Analogue Scale (VAS) after 1, 6, 24, 48, and 72 h of treatment application. Independent t-test was used to compare the mean pain scores between the laser and placebo groups for both spontaneous and chewing pain at each studied time point.

Results

No dropout occurred so the results of the 26 patients were statistically analyzed. Despite some clinical differences observed between the two groups, no statistical significance was found for each studied time point (p > 0.05) for both spontaneous and chewing pain except after 72 h for chewing pain with a VAS score of (18.84 ± 13.44) mm for the laser group compared to (38.15 ± 27.06) mm for the placebo group.

Conclusions

LLLT, with the suggested parameters, is not effective in pain reduction following initial orthodontic archwire placement.

Trial registration

Name of the registry:Clinicaltrials.gov

Trial registration number:NCT02568436.

Date of registration: 26 September 2015 ‘Retrospectively registered’.

Photobiomodulation and Pain Reduction in Patients Requiring Orthodontic Band Application: Randomized Clinical Trial

Purpose

The aim of this study was to investigate the effect of Photobiomodulation (PBM) in managing orthodontic pain intensity over time in patients requiring band application on upper first molars.

Methods

Maxillary first molars were banded. In the trial group, each molar received single-session PBM on two buccal and two palatal points (λ = 830 ± 10 nm; 150 mW, 7.5 J/cm²; spot of 0.1 cm²; 5 sec per point), while the control group received a placebo treatment. All patients were asked to answer five pain rating scales to assess pain intensity at 5 minutes and 1, 12, 24, and 72 hours and completed a survey describing the type of pain and its temporal course in the next 7 days.

Results

26 patients (mean age 11.8 years) were randomly assigned to a control or a trial group. The trial group showed significantly lower pain intensities (p < 0.05) at 5 min (M = 0.92, SD = 1.32), 1 h (M = 0.77, SD = 1.01), and 12 h (M = 0.77, SD = 1.54) after band application compared to the control group (5 min: M = 1.62, SD = 1.26; 1 h: M = 1.77, SD = 1.92; and 12 h: M = 1.77, SD = 2.17), whereas no difference between groups (p > 0.05) was found at 24 h (trial: M = 0.62, SD = 1.71; control: M = 1.08, SD = 1.75) and 72 h (trial: M = 0.31, SD = 0.75; control: M = 0.15, SD = 0.55). Patients in the control group reported more frequently the presence of “compressive pain” (58.8%, p < 0.05) from the appliance during the week after the application, while the trial group showed higher frequency of “no pain” (46.2%, p < 0.05). However, PBM did not affect the pain onset (trial: M = 10.86, SD = 26.97; control: M = 5.25, SD = 7.86), peak (trial: M = 15.86, SD = 26.29; control: 6.17, SD = 7.96), and end time (trial: 39.57, SD = 31.33; control: M = 22.02, SD = 25.42) reported by the two groups (p > 0.05).

Conclusions

PBM might be considered a promising alternative to decrease general pain intensity, although not affecting the typical pain cycle, in terms of the onset, peak, and ending times.

A Comparative Assessment of Pain Caused by the Placement of Banded Orthodontic Appliances with and without Low-Level Laser Therapy: A Randomized Controlled Prospective Study

Patients still refuse or discontinue orthodontic treatment due to related pain and discomfort. In this study, we investigate if low-level laser therapy (LLLT) can reduce pain caused by orthodontic bands. Sixty subjects who needed bands placed on the upper permanent first molars were assigned randomly to the LLLT group, placebo, and control groups. Inclusion criteria were: age range 10–14 years, fully erupted upper first molars in healthy condition, presence of tight mesial proximal contact. Exclusion criteria were: systemic or metabolic diseases, chronic pain or neurological or psychiatric disorders, use of pharmacological agents interfering with pain perception, previous orthodontic treatment or the simultaneous presence of other devices in the patient’s mouth. The assessment of pain was performed by using a numeric rating scale (NRS) considering different time intervals, i.e., immediately after bands placement, 6 h, 24 h, and from day 2 to day 5. Differences in the maximum pain and in pain experienced at each time-point, among the three groups, was assessed by using the Kruskal–Wallis H. The final sample included 56 patients, 29 males, and 27 females, with a mean age of 12.03 ± 1.3 years. Patients were randomly allocated into three groups (tested, control, and placebo group) with each group consisting respectively of 19, 20, and 17 individuals. Subjects in the LLLT experienced less pain at each time interval as well as the maximum pain score being lower in the LLLT compared to control and placebo groups. These findings were all statistically significant (p < 0.05). LLLT can alleviate the intensity of pain after the placement of orthodontic bands.

Laser-Assisted Orthodontic Tooth Movement in Saudi Population: A Prospective Clinical Intervention of Low-Level Laser Therapy in the 1st Week of Pain Perception in Four Treatment Modalities

Background

This first-in-human study in Saudi orthodontic patients has evaluated the role of low-level laser therapy (LLLT) in pain perception (PP). The outcome of single application of LLLT with 4 different treatment modalities (TM) on PP are evaluated following orthodontic bracket bonding on maxilla.

Materials and Methods

A prospective clinical intervention with implementation of parallel technique in each group, 32 orthodontic patients with ectopic canine requiring fixed orthodontic appliance were enrolled and randomly allocated to the 4 groups: LLLT + self-ligating (SL) bracket, LLLT + conventional (Conv.) bracket, non-LLLT + SL bracket, and non-LLLT + Conv. bracket. Orthodontic bracket bonding from 1st molar to 1st molar and superelastic 0.012 inch NiTi were applied for the maxilla. For each patient, maxillary 1st molar to molar received a single application of LLLT using a 940 nm Ga-Al-As laser device on 5 different points labially/buccally and palatally. Main outcome measure was the degree of PP score during the 1st week of orthodontic tooth movement (OTM) after 4 hours, 24 hours, 3 days, and 7 days of both LLLT and non-LLLT treatment applications. A questionnaire with an 11-point numeric rating scale (NRS) was used for PP.

Results

Mean ± SD of PP in the LLLT + SL group was 3.33 ± 1.4, 3.58 ± 1.06, 2.31 ± 0.67, and 1.89 ± 0.54 in 4 hours, 24 hours, 3 days, and 7 days, respectively. Compared to all 4 TM groups, LLLT groups showed better PP. More statistically significant differences were found in LLLT groups. No harms were encountered.

Limitations

The intervention provider and the patient were not blinded to the intervention.

Conclusion

The LLLT + SL group revealed significantly promising benefits on PP during OTM.

Photobiomodulation in acceleration of orthodontic tooth movement: A systematic review and meta analysis

BACKGROUND

Photobiomodulation therapy, a non invasive method with no adverse effects, has been used to accelerate tooth movement in orthodontia. However, the specific characteristics of laser settings used in studies documented have reported varied inconsistent conflicting results.

OBJECTIVES

We decided to undertake a systematic review to eliminate this inconsistency by quantifying the literature studies that indicated the link between photobiomodulation and acceleration of tooth movement and to assess if there is any association of photobiomodulation therapy in accelerating tooth movement.

SEARCH STRATEGY

We systematically searched for articles of existing literatures on Photobiomodulation therapy and acceleration of tooth movement over Cochrane library, Pubmed central, EMBASE, Scopus and Web of sciences from 2000 to 2017. Mesh search terms using various descriptors were used to identify the studies.

SEARCH CRITERIA

We included randomized control trial and clinical control trail studies that used Ga-Al-As diode laser and Oseeopulse laser with specific characteristics and company specifications, addressing relevant efficiency and safety outcomes.

DATA COLLECTION AND ANALYSIS

Eligible studies were reviewed and data was extracted on a standard from. We used Cochrane review manager software (Revman version 5.3) to assess the qualities of each included trials. Data were analyzed using an inverse variance method with random effects model effect.

RESULTS

We observed a statistical significant difference between the photobiomodulation therapy compared to non laser group in the acceleration of tooth movement (Mean difference 0.59 (95%CI- 0.24 to 0.95) I² 95%). However, these results need caution while generalizing in clinical practice due to the large amount of heterogeneity across the studies.

CONCLUSION

Findings of the current systematic review suggest a possible benefit with photobiomodulation therapy and tooth movement in orthodontia. However these findings need to be further validated in larger trials using specific standardized characteristics of laser settings to uniform the methodological design that can be used in routine clinical practice.

Infrared Light-Emitting Diode (LED) Effects on Orthodontic Tooth Movement

The present study aimed to analyze the effect of LED phototherapy on the presence of hyalinization and root resorption during orthodontic tooth movement (OTM) in rats and to measure the amount of tooth movement. Eighty rats were allocated into two groups: LED and control (CON), where the LED rats were irradiated with infrared LED (850 nm, 30 mW) for 5 min during the first five days of OTM and where controls were not irradiated. Both groups were subdivided into four subgroups (n=10) according to the date of euthanasia (4, 7, 14 and 21 days). Five out of ten LED21 and five of ten CON21 rats were submitted to micro-computed tomography (μCT); μCT scans were taken on days 0, 7, 14 and 21. For histological study, maxillae were processed to light microscopy using Hematoxylin-Eosin (HE) and Tartrate-Resistant Acid Phosphatase (TRAP) histochemistry. The amount of tooth movement did not differ between LED and CON. Hyalinization was observed at the pressure areas in both groups, and it did not show a statistically significant difference between the groups. Root resorption was also observed in both groups after 7 days and it did not represent any differences between the two groups. LED phototherapy was not able to increase the amount of OTM. Similar characteristics of hyalinization and root resorption were observed in both groups.

Photodynamic inactivation of planktonic cultures and Streptococcus mutans biofilms for prevention of white spot lesions during orthodontic treatment: An in vitro investigation

INTRODUCTION

This study evaluated the efficacy of photodynamic inactivation (PDI) with hematoporphyrin IX (H) and modified hematoporphyrin IX (MH) at 10 μmol/L, using a blue light-emitting diode (LED), fluence of 75 J/cm,² over planktonic cultures and biofilm of Streptococcus mutans (UA 159).

METHODS

Suspensions containing 107 cells/mL were tested under different experimental conditions: a) H and LED (H+L+), b) MH and LED (MH+L+), c) only LED (P-L+), d) only H (H+L-), e) only MH (MH+L-), and f) control group, no LED or photosensitizer treatment (P-L-). The study also evaluated the effect of PDI on S mutans biofilm on metallic or ceramic brackets bonded on specimens of human teeth. The strains were seeded onto Mitis salivarius-bacitracin-sacarose agar to determine the number of colony-forming units.

RESULTS

H and MH under LED irradiation were effective on planktonic cultures (P <0.0001). H and MH (H+L+ and MH+L+) caused a reduction of 3.80 and 6.78 log¹⁰ CFU/mL. PDI with the use of H or MH and LED exerted a strong antimicrobial effect over S mutans showing 54% and 100% reduction, respectively. PDI on S mutans biofilm on metallic and ceramic brackets with the use of H was not effective (P = 0.0162, P = 0.1669), however, MH caused a significant reduction of 44% and 53% of the cell count on metallic and ceramic brackets, respectively (P = 0.0020, P = 0.004).

CONCLUSIONS

In vitro planktonic cultures with the use of H or MH and LED exerted significant antimicrobial activity. No effect was observed on S mutans biofilm on either bracket type with the use of H, MH showed better results, suggesting a promising use against dental caries and white spot lesions.

Evaluating low-level laser therapy effect on reducing orthodontic pain using two laser energy values: a split-mouth randomized placebo-controlled trial

Background

No randomized controlled trial before has evaluated the role of low-level laser energy in its analgesic effects in orthodontics.

Objective

To evaluate the effect of single application of low-level laser with 4-Joule or 16-Joule energy on pain reduction following elastomeric separators placement.

Trial design

A two-arm parallel-group single-blind placebo-controlled randomized controlled trial, with implementation of split-mouth technique in each group.

Materials and methods

Twenty-six patients in need of orthodontic treatment with a fixed orthodontic appliance were enrolled and randomly allocated to either the 4-Joule or the 16-Joule laser energy group. Elastomeric separators were applied for the mandibular first molars. For each patient one molar received a single low-level laser dose using an 830-nm Ga-Al-As laser device with either 4-Joule or 16-Joule laser beam energy, while the other molar received a placebo treatment by applying the laser device in the same method and parameters as the counterpart molar without emitting the laser beam. The molar to be irradiated was also randomly chosen using simple randomization technique. Allocation was concealed and patients were blinded to which side would receive the laser irradiation. Main outcome measure was the degree of pain scored during mastication for each mandibular first molar after 1, 6, 12, 24, 48, and 72 hours of both laser and placebo treatments application. A questionnaire with an 100-mm Visual Analogue Scale (VAS) was used for pain assessment.

Results

Thirty-six patients were evaluated for eligibility, 10 of them were excluded making the final randomized number 26 patients. One patient dropped out later for not completing the questionnaire. Accordingly, the results of 25 patients were statistically analysed. No statistical significance was found for both low-level laser energy values in comparison to the corresponding placebo treatments. No harms were encountered.

Limitations

Intervention provider was not blinded to the intervention.

Conclusion

Low-level laser therapy, applied at two different laser energy values, is ineffective in relieving elastomeric separators induced orthodontic pain.

Trial registration

This trial was not registered.

Funding

No funding to be declared.

Photobiomodulation: lasers vs. light emitting diodes?

Photobiomodulation (PBM) is a treatment method based on research findings showing that irradiation with certain wavelengths of red or near-infrared light has been shown to produce a range of physiological effects in cells, tissues, animals and humans. Scientific research into PBM was initially started in the late 1960s by utilizing the newly invented (1960) lasers, and the therapy rapidly became known as "low-level laser therapy". It was mainly used for wound healing and reduction of pain and inflammation. Despite other light sources being available during the first 40 years of PBM research, lasers remained by far the most commonly employed device, and in fact, some authors insisted that lasers were essential to the therapeutic benefit. Collimated, coherent, highly monochromatic beams with the possibility of high power densities were considered preferable. However in recent years, non-coherent light sources such as light-emitting diodes (LEDs) and broad-band lamps have become common. Advantages of LEDs include no laser safety considerations, ease of home use, ability to irradiate a large area of tissue at once, possibility of wearable devices, and much lower cost per mW. LED photobiomodulation is here to stay.

Photobiomodulation: lasers vs. light emitting diodes?

Photobiomodulation (PBM) is a treatment method based on research findings showing that irradiation with certain wavelengths of red or near-infrared light has been shown to produce a range of physiological effects in cells, tissues, animals and humans. Scientific research into PBM was initially started in the late 1960s by utilizing the newly invented (1960) lasers, and the therapy rapidly became known as "low-level laser therapy". It was mainly used for wound healing and reduction of pain and inflammation. Despite other light sources being available during the first 40 years of PBM research, lasers remained by far the most commonly employed device, and in fact, some authors insisted that lasers were essential to the therapeutic benefit. Collimated, coherent, highly monochromatic beams with the possibility of high power densities were considered preferable. However in recent years, non-coherent light sources such as light-emitting diodes (LEDs) and broad-band lamps have become common. Advantages of LEDs include no laser safety considerations, ease of home use, ability to irradiate a large area of tissue at once, possibility of wearable devices, and much lower cost per mW. LED photobiomodulation is here to stay.

Optimal management of orthodontic pain

Pain is an undesirable side effect of orthodontic tooth movement, which causes many patients to give up orthodontic treatment or avoid it altogether. The aim of this study was to investigate, through an analysis of the scientific literature, the best method for managing orthodontic pain. The methodological aspects involved careful definition of keywords and diligent search in databases of scientific articles published in the English language, without any restriction of publication date. We recovered 1281 articles. After the filtering and classification of these articles, 56 randomized clinical trials were selected. Of these, 19 evaluated the effects of different types of drugs for the control of orthodontic pain, 16 evaluated the effects of low-level laser therapy on orthodontic pain, and 21 evaluated other methods of pain control. Drugs reported as effective in orthodontic pain control included ibuprofen, paracetamol, naproxen sodium, aspirin, etoricoxib, meloxicam, piroxicam, and tenoxicam. Most studies report favorable outcomes in terms of alleviation of orthodontic pain with the use of low-level laser therapy. Nevertheless, we noticed that there is no consensus, both for the drug and for laser therapy, on the doses and clinical protocols most appropriate for orthodontic pain management. Alternative methods for orthodontic pain control can also broaden the clinician's range of options in the search for better patient care.

Role of low-level laser therapy added to facial expression exercises in patients with idiopathic facial (Bell's) palsy

The aim of the present study was to investigate the efficacy of low-level laser therapy in conjunction with conventional facial exercise treatment on functional outcomes during the early recovery period in patients with facial paralysis. Forty-six patients (mean age 41 ± 9.7 years; 40 women and 6 men) were randomized into two groups. Patients in the first group received low-level laser treatment as well as facial exercise treatment, while patients in the second group participated in facial exercise intervention alone. Laser treatment was administered at a wavelength of 830 nm, output power of 100 Mw, and frequency of 1 KHz using a gallium-aluminum-arsenide (GaAIAs, infrared laser) diode laser. A mean energy density of 10 J/cm² was administered to eight points of the affected side of the face three times per week, for a total of 6 weeks. The rate of facial improvement was evaluated using the facial disability index (FDI) before, 3 weeks after, and 6 weeks after treatment. Friedman analysis of variance was performed to compare the data from the parameters repeatedly measured in the inner-group analysis. Bonferroni correction was performed to compare between groups as a post hoc test if the variance analysis test result was significant. To detect the group differences, the Bonferroni Student t test was used. The Mann-Whitney U test was used to compare numeric data between the groups. In the exercise group, although no significant difference in FDI scores was noted between the start of treatment and week 3 (p < 0.05), significant improvement was observed at week 6 (p < 0.001). In the laser group, significant improvement in FDI scores relative to baseline was observed at 3 and 6 weeks (p < 0.001). Improvements in FDI scores were significantly greater at weeks 3 and 6 in the laser group than those in the exercise group (p < 0.05). Our findings indicate that combined treatment with low-level laser therapy (LLLT) and exercise therapy is associated with significant improvements in FDI when compared with exercise therapy alone.

Non-pharmacological interventions for alleviating pain during orthodontic treatment

BACKGROUND

Pain is prevalent during orthodontics, particularly during the early stages of treatment. To ensure patient comfort and compliance during treatment, the prevention or management of pain is of major importance. While pharmacological means are the first line of treatment for alleviation of orthodontic pain, a range of non-pharmacological approaches have been proposed recently as viable alternatives.

OBJECTIVES

To assess the effects of non-pharmacological interventions to alleviate pain associated with orthodontic treatment.

SEARCH METHODS

Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 6 October 2016), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2016, Issue 9), MEDLINE Ovid (1946 to 6 October 2016), Embase Ovid (1980 to 6 October 2016) and EThOS (to 6 October 2016). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases.

SELECTION CRITERIA

Randomised controlled trials (RCTs) comparing a non-pharmacological orthodontic pain intervention to a placebo, no intervention or another non-pharmacological pain intervention were eligible for inclusion. We included any type of orthodontic treatment but excluded trials involving the use of pre-emptive analgesia or pain relief following orthognathic (jaw) surgery or dental extractions in combination with orthodontic treatment. We excluded split-mouth trials (in which each participant receives two or more treatments, each to a separate section of the mouth) and cross-over trials.

DATA COLLECTION AND ANALYSIS

At least two review authors independently assessed risk of bias and extracted data. We used the random-effects model and expressed results as mean differences (MD) with 95% confidence intervals (CI). We investigated heterogeneity with reference to both clinical and methodological factors.

MAIN RESULTS

We included 14 RCTs that randomised 931 participants. Interventions assessed included: low-level laser therapy (LLLT) (4 studies); vibratory devices (5 studies); chewing adjuncts (3 studies); brain wave music or cognitive behavioural therapy (1 study) and post-treatment communication in the form of a text message (1 study). Twelve studies involved self-report assessment of pain on a continuous scale and two studies used questionnaires to assess the nature, intensity and location of pain.We combined data from two studies involving 118 participants, which provided low-quality evidence that LLLT reduced pain at 24 hours by 20.27 mm (95% CI -24.50 to -16.04, P < 0.001; I² = 0%). LLLT also appeared to reduce pain at six hours, three days and seven days.Results for the other comparisons assessed are inconclusive as the quality of the evidence was very low. Vibratory devices were assessed in five studies (272 participants), four of which were at high risk of bias and one unclear. Chewing adjuncts (chewing gum or a bite wafer) were evaluated in three studies (181 participants); two studies were at high risk of bias and one was unclear. Brain wave music and cognitive behavioural therapy were evaluated in one trial (36 participants) assessed at unclear risk of bias. Post-treatment text messaging (39 participants) was evaluated in one study assessed at high risk of bias.Adverse effects were not measured in any of the studies.

AUTHORS' CONCLUSIONS

Overall, the results are inconclusive. Although available evidence suggests laser irradiation may help reduce pain during orthodontic treatment in the short term, this evidence is of low quality and therefore we cannot rely on the findings. Evidence for other non-pharmacological interventions is either very low quality or entirely lacking. Further prospective research is required to address the lack of reliable evidence concerning the effectiveness of a range of non-pharmacological interventions to manage orthodontic pain. Future studies should use prolonged follow-up and should measure costs and possible harms.

Evaluation of Low Level Laser Therapy on Pain Perception Following Orthodontic Elastomeric Separation: A Randomized Controlled Trial

INTRODUCTION

Periodontal pain caused by elastomeric separators is a very common problem in the commencement of orthodontic treatment. Previous studies have shown good results in reducing this pain by Low Level Laser Therapy (LLLT) and different protocols of application have been suggested in the literature.

AIM

This trial aimed to evaluate LLLT on managing orthodontic pain caused by elastomeric separators and to compare single versus double irradiation in possible pain reduction.

MATERIALS AND METHODS

A clinical randomized compound (parallel-group and split-mouth design) trial was conducted on 36 patients between 12 and 26 years of age. Elastomeric separators were placed at the mesial and distal surfaces of the first molars in one jaw (upper or lower) for each patient and in only one side of the mouth (the other side served as the placebo side). The trial had two groups: the first group received single irradiation of LLLT [Gallium Aluminum Arsenide (GaAlAs): 830 nm, 4J/cm², 100mW] immediately after separators insertion, where as the second group received double irradiation immediately after separators insertion and after 24hours. All patients were instructed to rate the level of pain at 1, 6, 24, 48, 96 hours on a Visual Analog Scale (VAS). The student 't' tests, repeated measures ANOVA and LSD post-hoc tests were employed.

RESULTS

LLLT was successful in reducing post-separation pain when the experimental side was compared to the placebo side at all assessment times in each group (p<0.05). There were no statistically significant differences between single and double irradiation groups in terms of pain reduction (p>0.05).

CONCLUSION

GaAlAs LLLT application reduced early orthodontic pain caused by elastomeric separators by single or double irradiation.

Efficacy of low-level laser therapy in accelerating tooth movement, preventing relapse and managing acute pain during orthodontic treatment in humans: a systematic review

BACKGROUND

Recently low-level laser therapy (LLLT) has been proposed to improve orthodontic treatment. The aims of this systematic review were to investigate the scientific evidence to support applications of LLLT: (a) to accelerate tooth movement, (b) to prevent orthodontic relapse and (c) to modulate acute pain, during treatment with fixed appliances in children and young adults.

METHODS

To ensure a systematic literature approach, this systematic review was conducted to Goodman's four step model. Three databases were searched (Medline, Cochrane Controlled Clinical Trials Register and Scitation), using predetermined search terms. The quality of evidence was rated according to the GRADE system.

RESULTS

The search identified 244 articles, 16 of which fulfilled the inclusion criteria: three on acceleration of tooth movement by LLLT and 13 on LLLT modulation of acute pain. No study on LLLT for prevention of relapse was identified. The selected studies reported promising results for LLLT; elevated acceleration of tooth movement and lower pain scores, than controls. With respect to method, there were wide variations in type of laser techniques.

CONCLUSIONS

The quality of evidence supporting LLLT to accelerate orthodontic tooth movement is very low and low with respect to modulate acute pain. No studies met the inclusion criteria for evaluating LLLT to limit relapse. The results highlight the need for high quality research, with consistency in study design, to determine whether LLLT can enhance fixed appliance treatment in children and young adults.

Low-Level Laser and Light-Emitting Diode Therapy for Pain Control in Hyperglycemic and Normoglycemic Patients Who Underwent Coronary Bypass Surgery with Internal Mammary Artery Grafts: A Randomized, Double-Blind Study with Follow-Up

OBJECTIVE

This study aimed to evaluate the efficacy of low-level laser therapy (LLLT) and light-emitting diodes (LEDs) for reducing pain in hyperglycemic and normoglycemic patients who underwent coronary artery bypass surgery with internal mammary artery grafts.

METHODS

This study was conducted on 120 volunteers who underwent elective coronary artery bypass graft (CABG) surgery. The volunteers were randomly allocated to four different groups of equal size (n = 30): control, placebo, LLLT [λ = 640 nm and spatial average energy fluence (SAEF) = 1.06 J/cm(2)], and LED (λ = 660 ± 20 nm and SAEF = 0.24 J/cm(2)). Participants were also divided into hyperglycemic and normoglycemic subgroups, according to their fasting blood glucose test result before surgery. The outcome assessed was pain during coughing by a visual analog scale (VAS) and the McGill Pain Questionnaire.

RESULTS

The patients were followed for 1 month after the surgery. The LLLT and LED groups showed a greater decrease in pain, with similar results, as indicated by both the VAS and the McGill questionnaire (p ≤ 0.05), on the 6th and 8th postoperative day compared with the placebo and control groups. The outcomes were also similar between hyperglycemic and normoglycemic patients. One month after the surgery, almost no individual reported pain during coughing.

CONCLUSIONS

LLLT and LED had similar analgesic effects in hyperglycemic and normoglycemic patients, better than placebo and control groups.

Light-Emitting Diode Phototherapy Reduces Nocifensive Behavior Induced by Thermal and Chemical Noxious Stimuli in Mice: Evidence for the Involvement of Capsaicin-Sensitive Central Afferent Fibers

Low-intensity phototherapy using light fonts, like light-emitting diode (LED), in the red to infrared spectrum is a promising alternative for the treatment of pain. However, the underlying mechanisms by which LED phototherapy reduces acute pain are not yet well understood. This study investigated the analgesic effect of multisource LED phototherapy on the acute nocifensive behavior of mice induced by thermal and chemical noxious stimuli. The involvement of central afferent C fibers sensitive to capsaicin in this effect was also investigated. Mice exposed to multisource LED (output power 234, 390, or 780 mW and power density 10.4, 17.3, and 34.6 mW/cm², respectively, from 10 to 30 min of stimulation with a wavelength of 890 nm) showed rapid and significant reductions in formalin- and acetic acid-induced nocifensive behavior. This effect gradually reduced but remained significant for up to 7 h after LED treatment in the last model used. Moreover, LED (390 mW, 17.3 mW/cm²/20 min) irradiation also reduced nocifensive behavior in mice due to chemical [endogenous (i.e., glutamate, prostaglandins, and bradykinin) or exogenous (i.e., formalin, acetic acid, TRPs and ASIC agonist, and protein kinase A and C activators)] and thermal (hot plate test) stimuli. Finally, ablating central afferent C fibers abolished LED analgesia. These experimental results indicate that LED phototherapy reduces the acute painful behavior of animals caused by chemical and thermal stimuli and that LED analgesia depends on the integrity of central afferent C fibers sensitive to capsaicin. These findings provide new information regarding the underlying mechanism by which LED phototherapy reduces acute pain. Thus, LED phototherapy may be an important tool for the management of acute pain.

Evaluation of the use of low-level laser therapy in pain control in orthodontic patients: A randomized split-mouth clinical trial

OBJECTIVE

To evaluate the effect of using low-level laser therapy (LLLT) to control pain and discomfort during orthodontic treatment.

MATERIALS AND METHODS

A randomized, split-mouth clinical trial was conducted with 30 volunteers in need of orthodontic treatment, of both genders, aged between 18 and 40 years, who were randomly divided into two groups. One hemiarch was considered the exposed group (EG) and the other, the placebo group (PG). Both groups had elastic separators placed mesially and distally to the first molars of the two hemiarches at different times. The EG received an AIGaAs diode LLLT (810 nm, 100 mW, 2J/cm(2)) application for 15 seconds per point (interdental papilla at the mesial, distal, and near the root apex) immediately after separator placement on the maxillary right side. The PG also had elastics placed around the maxillary right molars, but received only simulated LLLT application. The elastics were left in place for 5 days, and after a waiting period of 1 week, they were inserted on the left side in both groups; however, the order of laser application was changed. While the separator remained in place, the patient marked his degree of perceived discomfort on a Visual Analog Scale (VAS) at 5 minutes (T0), 24 hours (T1), and 120 hours (T2), after LLLT application.

RESULTS

A statistically significant difference was observed (P < .005) in reducing discomfort in the exposed group compared with the placebo group. This reduction of discomfort in the EG was observed at all time intervals.

CONCLUSIONS

A sincle AIGaAs diode LLLT application may be indicated for the control or reduction of pain in the early stages of orthodontic treatment.

A randomized clinical trial comparing the efficacy of bite wafer and low level laser therapy in reducing pain following initial arch wire placement

Background and aims: This study aimed to evaluate the efficacy of ibuprofen, bite wafer and low power red and infrared lasers in orthodontic pain management. Subjects and methods: One hundred subjects were randomly assigned to 5 groups of 20 each. The patients in each group received one of the following treatments after the placement of fixed orthodontic appliances: 1. placebo medication, 2. ibuprofen, 3. bite wafer, 4. irradiation from a low level red laser (LLRL; 660 nm, 200 mW, 1 J/point, 6 points), 5. irradiation from a low level infrared laser (LLIL; 810 nm, 200 mW, 1 J/point, 6 points). A Visual Analogue Scale (VAS) was used to record pain intensity while chewing, biting, fitting front teeth, and fitting back teeth at 2 hours, 6 hours, bedtime, 24 hours, 2 days, 3 days and 7 days following arch wire placement. Results: Significant between-group differences were found in pain at chewing, biting, fitting front teeth and fitting back teeth at all time points (p<0.001). Generally, VAS scores in the LLIL, ibuprofen and bite wafer groups were close to each other and significantly lower than those in the LLRL and control groups (p<0.05), which showed comparable pain level at most intervals. The infrared laser group (LLIL) showed significantly lower pain than all other groups at some points over the experiment (p<0.05). Conclusions: A single irradiation from a low level infrared laser proved to be the best strategy for orthodontic pain control. Alternatively, chewing on a bite wafer could be recommended. These methods should be considered as suitable alternatives for ibuprofen in orthodontic patients.

Does low level laser therapy relieve the pain caused by the placement of the orthodontic separators?--A meta-analysis

OBJECTIVE

Pain caused by orthodontic treatment can affect patient's compliance and even force them to terminate treatments. The aim of this meta-analysis is to evaluate of the analgesic effect of low level laser therapy (LLLT) after placement of the orthodontic separators.

METHODS

Five databases: PubMed, Embase, Cochrane library, China Biology Medicine disc (SinoMed CBM), China National Knowledge Infrastructure (CNKI) were searched for all the appropriate studies in June, 2014. Two reviewers screened the research results under our inclusion criteria and evaluated the risk of bias independently. Then the data of the included studies was extracted for quantitative analysis by the Review Manager 5.1 software.

RESULTS

Six studies were included in our meta-analysis finally. Comparing to the placebo group, the LLLT has good analgesic effect at 6 h, 1d, 2d, 3d after placement of separators which is of statistical significance. While at 2 h, 4d, 5d after the placement, the results tend to support LLLT, but not statistically significant.

CONCLUSION

Based on current included studies, LLLT can reduce the pain caused by the placement of separators effectively. However, because of the high heterogeneity, well designed RCTs are required in the future.

Systematic literature review: influence of low-level laser on orthodontic movement and pain control in humans

OBJECTIVE

The purpose of this study was to systematically review the literature to check the influence of low-level laser (LLL) on orthodontic movement and pain control in humans, and what dose ranges are effective for pain control and increased speed of orthodontic movement.

METHODS

Computerized and manual searches were conducted up to January 4, 2014 for clinical studies that addressed these objectives. The selection criteria required that these studies (1) be prospective controlled clinical trials (CCT) and randomized clinical trials (RCT); (2) only use LLL in both infrared and visible red wavelengths, a laser with emission of constant wave; (3) have all main parameters of dose described, or at least conditions for calculation of the energy, in Joules; and (4) be published in Portuguese, English, or Spanish and be meta-analyses.

RESULTS

Seven studies met the eligibility criteria for orthodontic movement/LLL and 11 studies met the inclusion criteria for analgesia/LLL, totaling 18 prospective randomized studies that were selected for detailed analysis. The most common and effective energy input was the interval of 0.2-2.2 J per point/2-8 J per tooth at a frequency of application 1-5 days per month to accelerate the orthodontic movement. For pain control, the recommended energy per points varied from 1-2 J when only one tooth was irradiated to 0.5-2.25 J per point when all teeth in the dental arch were irradiated.

CONCLUSIONS

LLL seems to have a demonstrated efficacy, but further studies are warranted to determine the best protocols with regard to energy and frequency.

Low-level laser therapy for orthodontic pain: a systematic review

This review aimed to evaluate the clinical outcome of different lasers management on orthodontic pain. Cochrane Library (Issue 7, 2014) and MEDLINE (1966-2014.7) were searched to collect randomized controlled trials on lasers for orthodontic pain. Studies meeting the inclusion criteria were systematically evaluated. The Cochrane Collaboration tools RevMan5.1.7 and GRADEpro 3.6 were used in this systematic review and meta-analysis. As a result, 11 randomized controlled trials (RCTs) studying on low-level laser therapy (LLLT) for orthodontic pain control were included. Meta-analysis and risk of bias assessment were implemented using RevMan5.1.7, and level of evidence assessments was measured by GRADEpro 3.6. In the outcome of the score of the most painful day, the comparison of laser versus placebo (pain associated with tooth movement) demonstrated that LLLT reduced the pain score significantly compared with placebo groups (MD = -4.39, 95% CI range -5.9--2.88, P < 0.00001). In the same way, the most painful day was significantly brought forward in laser versus control group (MD = -0.42, 95% CI range -0.74--0.10, P = 0.009). Furthermore, the outcome of the end of pain day showed a trend of pain termination earlier in laser versus control and placebo groups, but without statistical significance (MD = -1.37, 95% CI range -3.37-0.64, P = 0.18 and MD = -1.04, 95% CI range -4.22-2.15, P = 0.52). However, for the reason of downgrade factors, all the GRADE level of evidences of eight comparisons for three outcomes showed a very low quality. Therefore, for the methodological shortcomings and risk of bias of RCTs included, insufficient evidence was submitted to judge whether LLLT was effective in relieving orthodontic pain. Further and more perfect researches should be done in order to recommend LLLT as a routine method for orthodontic pain.

Developments in low level light therapy (LLLT) for dentistry

OBJECTIVES

Low level light/laser therapy (LLLT) is the direct application of light to stimulate cell responses (photobiomodulation) in order to promote tissue healing, reduce inflammation and induce analgesia. There have been significant studies demonstrating its application and efficacy at many sites within the body and for treatment of a range of musculoskeletal injuries, degenerative diseases and dysfunction, however, its use on oral tissues has, to date, been limited. The purpose of this review is to consider the potential for LLLT in dental and oral applications by providing background information on its mechanism of action and delivery parameters and by drawing parallels with its treatment use in analogous cells and tissues from other sites of the body.

METHODS

A literature search on Medline was performed on laser and light treatments in a range of dental/orofacial applications from 2010 to March 2013. The search results were filtered for LLLT relevance. The clinical papers were then arranged to eight broad dental/orofacial categories and reviewed.

RESULTS

The initial search returned 2778 results, when filtered this was reduced to 153. 41 were review papers or editorials, 65 clinical and 47 laboratory studies. Of all the publications, 130 reported a positive effect in terms of pain relief, fast healing or other improvement in symptoms or appearance and 23 reported inconclusive or negative outcomes. Direct application of light as a therapeutic intervention within the oral cavity (rather than photodynamic therapies, which utilize photosensitizing solutions) has thus far received minimal attention. Data from the limited studies that have been performed which relate to the oral cavity indicate that LLLT may be a reliable, safe and novel approach to treating a range of oral and dental disorders and in particular for those which there is an unmet clinical need.

SIGNIFICANCE

The potential benefits of LLLT that have been demonstrated in many healthcare fields and include improved healing, reduced inflammation and pain control, which suggest considerable potential for its use in oral tissues.

Chemotherapy-induced oral mucositis: effect of LED and laser phototherapy treatment protocols

BACKGROUND AND OBJECTIVE

Over the last few decades, many studies have focused on the effect of lasers on the management of oral mucositis in oncologic patients treated with chemotherapy and/or radiotherapy. However, the effect of light-emitting diode (LED) has been poorly studied, and was not compared with that of laser phototherapy (LPT). For this reason, the aim of the present study was to clinically compare the effect of these two therapies on chemotherapy-induced oral mucositis (CIOM) and pain.

METHODS

Forty patients with CIOM were divided into two groups: G1, patients treated with LPT; G2, patients treated with LED. The treatment was administered during 10 consecutive days, with exception of weekends. LPT was applied using an InGaAlP laser (660 nm/40 mW/6.6 J cm-(2)/0.24 J per point/0.036 cm(2) of spot size). LED phototherapy was applied using 0.24 J per point/80 mW/630 nm/1 cm(2) of spot size. CIOM was assessed during each session in accordance to the World Health Organization (WHO) score. The patient self-assessed pain was scored on a visual analog scale (VAS).

RESULTS

The mean VAS and WHO scores were significantly smaller in the LED group (p<0.05). However, both groups required the same number of days to reach score zero for mucositis and pain (p>0.05). Moreover, in the group with severe mucositis (score III), there was a lower frequency of patients with complete healing and pain relief, with the exception of analgesia in G2, in which almost all patients were completely relieved from pain.

CONCLUSIONS

These findings suggest that LED therapy is more effective than LPT in the treatment of COIM, with the parameters used in the present study.

The analgesic effect of benzocaine mucoadhesive patches on orthodontic pain caused by elastomeric separators, a preliminary study

OBJECTIVES

To study the effect of benzocaine mucoadhesive patches (20%) on orthodontic pain caused by elastomeric separators.

SUBJECTS AND METHODS

A split-mouth design was used in 30 patients (12 female, 18 male, aged 23 ± 3.75 years). They were instructed to apply benzocaine and placebo patches randomly for right or left first permanent molars of maxillary/mandibular arches for 20 min and repeat this procedure every 6 h with a similar type patch. A 10 cm Visual Analogue Scale (VAS) was used for pain perception assessment in patients who were given benzocaine (benzocaine group) or placebo (placebo group) patches. Pain perception (VAS) was recorded immediately after separator placement and after 2, 6, 12, 18, 24, 48 and 72 h.

RESULTS

The mean VAS (SD) for the placebo and benzocaine groups were 2.28 (1.08) and 1.63 (0.67), respectively. The pain peaked at 24 h. Significant pain perception differences were observed between groups at 2, 18, 24, 48 and 72 h. Pain perception was not different between genders or jaws investigated (p > 0.05). The Friedman test revealed significant differences in pain perception among various time intervals for benzocaine (χ (2) = 99.84, p = 0.000) and placebo (χ (2) = 102.361, p = 0.000) groups. Significant negative correlations (ρ) were found only between pain perception scores and patient's ages in the placebo group at 18 (-0.438), 24 (-0.526), 48 (-0.565) and 72 h (-0.458).

CONCLUSION

The recorded mean VAS values were relatively low; however, the benzocaine 20% patches significantly reduced the post-separation orthodontic pain.

Effect of frequent laser irradiation on orthodontic pain. A single-blind randomized clinical trial

OBJECTIVE

To analyze the effect of low-level laser therapy (LLLT) on perception of pain after separator placement and compare it with perceptions of control and placebo groups using a frequent irradiation protocol.

MATERIALS AND METHODS

Eighty-eight patients were randomly allocated to a laser group, a light-emitting diode (LED) placebo group, or a control group. Elastomeric separators were placed on the first molars. In the laser and LED groups, first molars were irradiated for 30 seconds every 12 hours for 1 week using a portable device. Pain was marked on a visual analog scale at predetermined intervals. Repeated measure analysis of variance was performed for statistical analysis.

RESULTS

The pain scores of the laser group were significantly lower than those of the control group up to 1 day. The pain scores in the LED group were not significantly different from those of the laser group during the first 6 hours. After that point, the pain scores of the LED group were not significantly different from those of the control.

CONCLUSIONS

Frequent LLLT decreased the perception of pain to a nonsignificant level throughout the week after separator placement, compared with pain perception in the placebo and control groups. Therefore, LLLT might be an effective method of reducing orthodontic pain.

The effect of diode superpulsed low-level laser therapy on experimental orthodontic pain caused by elastomeric separators: a randomized controlled clinical trial

The aim of this study was to evaluate the efficacy of diode superpulsed low-level laser therapy (SLLLT) in reducing experimentally induced orthodontic pain. Overall, 120 subjects (23.01 ± 1.39 years) were enrolled for a clinical trial. Subjects were randomly assigned to upper (U, N = 60) or lower (L, N = 60) jaw groups. All subjects received 4 elastomeric separators mesial and distal to the upper (U group) or lower (L group) right first molar and bicuspids. Each subject of the U and L groups was randomly assigned to laser (Ul, N = 20 and Ll, N = 20), placebo (Up, N = 20 and Lp, N = 20) or control (Uc, N = 20 and Lc, N = 20) sub-groups. Subjects in laser groups received a single GaAs diode SLLLT application (910 nm, 160 mW, beam diameter of 8 mm, applied for 340 s) immediately after placing orthodontic separators. Placebo groups received a simulated SLLLT and controls did not receive any therapy. All participants compiled a survey on pain duration and a 100-mm visual analogue scale immediately after the separators placement and after 12, 24, 36, 48, 72, and 96 h. Pain intensity of laser groups was significantly lower compared to placebo and control groups (p = 0.0001). In the laser group, 70% of subjects felt pain, while in the placebo and control groups all subjects felt pain (p = 0.0001). The end of pain occurred earlier in laser compared to placebo and control groups (p = 0.021). A single-diode SLLLT application appeared to be effective in reducing the intensity and duration of experimentally induced orthodontic pain and could be used in daily orthodontic practice.