The efficacy of low-level laser therapy versus paracetamol–caffeine in controlling orthodontic separation pain and changes in the oral-health-related quality of life in Class I malocclusions: A 3-arm, randomized, placebo-controlled clinical trial

Comparative assessment between chewing gum, bite wafers, and ibuprofen in pain control following separators placement among orthodontic patients

Objective

This study aimed to evaluate the efficiency of chewing gum and using bite wafers in reducing pain after the placement of separators in orthodontic patients and to compare that efficiency with ibuprofen use. Additionally, this study evaluated the effect of non-pharmacological pain control methods on the frequency of separators falling out.

Methods

The study sample comprised 105 female patients between 15 and 35 years of age. The patients were randomly selected and classified into three groups (35 each). Each group was given either ibuprofen, viscoelastic bite wafers, or chewing gum immediately after the placement of separators and every 8 h for 1 week, as needed. The patients were asked to record their pain perception using a visual analog scale following separator placement at 2 h, 6 h, bedtime, 24 h, and at 2, 3, and 7 days. Analysis of variance testing was used for the data analysis.

Results

Among the three studied groups, there were no significant differences in pain perception at any time point. The patients experienced significantly higher pain scores at bedtime and 24 h after separator placement. In addition, there were statistically significant findings in pain perception at different time points within each pain relief method (p = 0.000, p < 0.05).

Conclusion

The use of chewing gum and bite wafers in alleviating orthodontic pain was beneficial and comparable to ibuprofen use following the placement of separators before orthodontic treatment among orthodontic patients.

Patient-reported outcomes during accelerating the en-masse retraction of the upper anterior teeth using low-intensity electrical stimulation: a randomized controlled trial

BACKGROUND

Low-intensity electrical stimulation (LIES) is considered a relatively recent technology that has received little attention in orthodontics as a method of acceleration. This study aimed to evaluate patient-reported outcome measures when LIES is used to accelerate the en-masse retraction of the upper anterior teeth.

MATERIALS AND METHODS

The sample consisted of 40 patients (8 males, 32 females; mean age 21.1 ± 2.3 years), with Class II division I malocclusion who required extraction of the first premolars to retract upper anterior teeth. They were randomly assigned to the LIES group (n = 20) and the conventional en-masse retraction group (CER; n = 20). Patient responses regarding pain, discomfort, burning sensation, swelling, chewing difficulty, speech difficulty, and painkillers' consumption were recorded at these nine assessment times: 24 h (T1), 3 days (T2), and 7 days (T3) after force application, then in the second month after 24 h (T4), 3 days (T5), and 7 days (T6) of force re-activation, and finally after 24 h (T7), 3 days (T8), and 7 days (T9) of force re-activation in the third month.

RESULTS

The mean values of pain perception were smaller in the LIES group than those in the CER group at all assessment times with no statistically significant differences between the two groups except during the second and third months (T5, T6, T8, and T9; P < 0.005). However, discomfort mean values were greater in the LIES group with significant differences compared to CER group during the first week of the follow-up only (T1, T2, and T3; P < 0.005). Burning sensation levels were very mild in the LIES group, with significant differences between the two groups at T1 and T2 only (P < 0.001). Speech difficulty was significantly greater in the LIES group compared to CER group at all studied times (P < 0.001). High levels of satisfaction and acceptance were reported in both groups, without any significant difference.

CONCLUSION

Both the LIES-based acceleration of en-masse retraction of upper anterior teeth and the conventional retraction were accompanied by mild to moderate pain, discomfort, and chewing difficulty on the first day of retraction. These sensations gradually decreased and almost disappeared over a week after force application or re-activation.

TRIAL REGISTRATION

ClinicalTrials.gov, ClinicalTrials.gov, NCT05920525. Registered 17 June 2023 - retrospectively registered, http://clinicaltrials.gov/study/NCT05920525?term=NCT05920525&rank=1 .

Comparison of the Effects of Ketorolac and Acetaminophen on RANK-L Levels in the Gingival Crevicular Fluid during Orthodontic Tooth Movement: A Pilot Study

Background: Patients usually present pain due to the release of different inflammatory mediators such as prostaglandin E2 and RANK-L. Analgesics such as acetaminophen and ketorolac can inhibit RANK-L expression and this can affect orthodontic treatment by decreasing bone remodeling and slowing orthodontic dental movement. Several studies have reported a decrease in dental movement after administering some non-steroidal anti-inflammatory drugs. Proposal: The objective was to evaluate the RANK-L levels and a possible modulation by administering acetaminophen and ketorolac in patients starting orthodontic treatment. Methodology: A double-blind, randomized clinical trial was carried out with 24 subjects divided into three study groups: calcined magnesia as a placebo, acetaminophen, and ketorolac. Gingival crevicular fluid was obtained at four time points: before pharmacological intervention, at 24 h, at 48 h, and on the 5th day. RANK-L concentrations were evaluated through ELISA analysis. Also, interproximal space generated by the elastic separator at the end of the study was recorded in the different study groups using the visual analog scale. Results: An increase in RANK-L at 24 h was observed in the placebo group compared to the ketorolac and acetaminophen groups. However, no significant differences were observed in the interproximal space at day 5 in the three study groups. Conclusion: Patients who do not take analgesics at the start of orthodontic treatment have higher levels of RANK-L. Therefore, the use of ketorolac or acetaminophen could decrease bone remodeling and interfere with orthodontic dental movement.

The effectiveness of low-level laser therapy and low-intensity pulsed ultrasound in reducing pain induced by orthodontic separation: a randomized controlled trial

BACKGROUND

The low-level laser therapy (LLLT) and low-intensity pulsed ultrasound (LIPUS) have been recently applied to control pain during orthodontic treatment.

OBJECTIVE

To evaluate and compare the effectiveness of LLLT and LIPUS in reducing pain induced by orthodontic separation.

STUDY DESIGN

A single-blinded randomized controlled trial.

METHODS

One hundred and fifty patients were randomly assigned into three groups; LLLT group, LIPUS group, and control group. After 5 min from the separators' placement, the first dose of the laser or the ultrasound was applied, the second dose was applied after 24 h, and the third dose was applied after 48 h on both maxillary and mandibular first molars. The exposure of laser was for 20 s at each point (maxillary and mandibular first molars), with an 810-nm aluminum-gallium-arsenide (AlGaAs) diode laser on continuous mode. The output power set at 150 mW, the energy density of 4 J/cm2, and a laser spot diameter of 7 mm were applied. Whereas the frequency of ultrasonic toothbrush was 1.6 MHz; and average output intensity was 0.2 W/cm2. The application was for 20 min (5 min on each first molar). The control group received the separators without another intervention. A Visual Analog Scale (VAS 100 mm) was used to assess pain intensity at several time intervals during the first four days after the separators' placement.

RESULTS

A total of 145 patients were assessed. There was a significant difference in pain perception among the three groups after 5 min (P = .002). The maximum pain level was reached after 24 h. However, the laser group and the ultrasound group showed a statistically significant decrease in pain scores compared to the control group at all the assessment time points (P < .001). Whereas there was no difference between the laser group and the ultrasound group in reducing the pain scores (P > .05).

CONCLUSIONS

The LLLT and the LIPUS effectively reduce the separation pain when applied in multiple doses without differences between them.

TRIAL REGISTRATION

This trial was registered with the German Clinical Trials Register (DRKS). ( https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID= DRKS00029991). Date of registration: 26/08/2022.

Effect of low-level laser therapy on pain reduction in orthodontic patients during molar distalization: A randomized controlled trial

Aim

To investigate the effects of low-level laser therapy (LLLT) on pain reduction in orthodontic patients during molar distalization.

Materials and methods

Twenty patients requiring bilateral maxillary first molar distalization were randomly assigned to two groups: the intervention group (mean age 15.61 ± 1.03 years) received multiple LLLT after every activation of the distalizing appliance (immediately and on the 3rd, 7th, and 14th days) and the control group (mean age 15.64 ± 1.08 years) who did not receive LLLT. Patients reported pain levels every day for 7 days following activation of the appliance using an 11-point numeric rating scale (NRS), then the pain experience of both the intervention and control groups was compared using Mann-Whitney U test.

Results

The mean pain scores on the 1st day were higher in the intervention group (9.27 ± 1.01) compared to that of the control group (8.80 ± 1.03). However, the mean pain scores of the intervention group (6.55 ± 1.29, 4.00 ± 1.26, 2.55 ± 1.29, 0.91 ± 1.04, 0.00 ± 0.00 and 0.00 ± 0.00, respectively) were lower than the control group (7.40 ± 1.90, 5.60 ± 2.07, 4.20 ± 1.99, 2.80 ± 1.93, 1.60 ± 1.58 and 0.40 ± 0.84, respectively) from the 2nd to the 7th day. All the differences were not statistically significant except on the 6th day (P-value = 0.003). The peak pain level was experienced by both groups on the 1st day, followed by a statistically significant gradual decrease in pain levels. Patients in the intervention group reported a shorter overall duration of pain.

Conclusion

Although LLLT, with the used parameters, reduced the overall duration of pain experience following maxillary first molar distalization, it was not effective during peak pain levels.

Evaluation of the Patient-Reported Outcome Measures (PROMs) With Temporary Skeletal Anchorage Devices in Fixed Orthodontic Treatment: A Systematic Review

Analysis of patient-reported outcome measures (PROMs) is essential to ensure that the skeletal and traditional anchoring methods are appropriately and effectively utilized in the context of patient acceptance and satisfaction. This review's objective was to assess the available data on the levels of discomfort, soft-tissue irritation, functional impairment, and other patient-reported outcomes related to the usage of mini-implants in the context of fixed orthodontic treatment for adult patients. A total of seven electronic bibliographic databases were searched between January 1995 and February 2022. Moreover, a manual search was done in the selected orthodontic journals. This systematic review (SR) covered cohort studies, retrospective studies, randomized clinical trials (RCTs), and controlled clinical trials (CCTs) that studied the use of mini-implants, mini-plates, or onplants as anchorage devices on patients receiving orthodontic treatment. The risk of bias was assessed using Cochrane's risk of bias tool (RoB2 tool). Three RCTs and two cohorts were included in this SR with a total of 468 patients. Three of the four included studies were at high risk of bias. The pain level was in the "mild-to-moderate" category on the first day following the insertion of mini-implants, then decreased to a mild level from the fifth day to the seventh day of insertion (mean values are 36.61, 16.36, and 11.33, respectively). The levels of functional impairments were found to be located between the "mild-to-moderate" and "moderate" categories after the placement of mini-plates and intermaxillary fixation screws, while they experienced a mild level with mini-implants. The greatest pain levels were found after the insertion of the temporary anchorage devices (TADs) and then decreased until they became mild or disappeared completely after one month. Speaking, chewing, and cleaning difficulties were more problematic when using TADs compared to conventional anchorage. To obtain good evidence in this area, more high-quality RCTs are needed.

Pain, Discomfort, and Functional Impairments When Retracting Upper Anterior Teeth Using Two-Step Retraction With Transpalatal Arches Versus En-Masse Retraction With Mini-implants: A Randomized Controlled Trial

Background This study aimed to evaluate the levels of pain and discomfort associated with employing mini-implants as a temporary skeletal anchorage device compared to the traditional transpalatal arches (TPAs) during upper anterior teeth retraction in patients with upper dentoalveolar protrusion and to determine the level of acceptance of both techniques among patients. Methodology The study sample consisted of 38 patients (29 women and nine men) with an average age of 21.7 years. The patients were randomly and equally distributed into two groups. In the first group: upper anterior teeth were en-masse retracted using mini-implants (the TAD group), whereas, in the second group, TPAs were used during the two-step retraction of upper anterior teeth (the TPA group). Standardized questionnaires were distributed to all patients after 24 hours of mini-implant application. The questionnaire asked the patients to rate their pain perception, swelling sensation, eating difficulties, talking impairments, and cleansing difficulties on a four-point Likert scale on the third-day, one-week, two-week, and one-month follow-ups after the anchorage application. Wilcoxon matched-pairs signed-rank tests were used to evaluate intragroup changes, whereas Mann-Whitney U tests were employed to examine intergroup differences. Results Patients in the TAD group had higher pain and swelling levels than those in the TPA group, and differences were statistically significant at the first three assessment time points. The differences between the two groups were statistically insignificant regarding eating and talking difficulties, whereas differences were statistically significant for brushing difficulties. These impairments decreased to almost normal levels after one month of treatment initiation. Conclusions TPAs, when used for anchorage in the two-step retraction technique, were less problematic compared to mini-implants with en-masse retraction, where the sensation of pain or swelling around the mini-implants did not last for more than a week. The difficulties of cleaning, chewing, and speaking in the presence of mini-implants were temporary and mostly disappeared within two weeks of mini-implant application.

The Efficacy of Accelerating Orthodontic Tooth Movement by Combining Self-Ligating Brackets With One or More Acceleration Methods: A Systematic Review

This review aimed to evaluate the effectiveness of using one or more acceleration methods with self-ligating brackets to accelerate orthodontic tooth movement in adults and the associated effects of these interventions. An electronic search of the following databases (PubMed, Scopus, Google Scholar, EMBASE) was performed (From January 1990 to November 2021). ClinicalTrials.gov and the International Clinical Trials Registry Platform were also electronically searched to find any unpublished studies and ongoing trials. The selected randomized controlled trials (RCTs) involved adult patients treated using self-ligating brackets combined with one or more acceleration methods compared with self-ligating brackets or conditional brackets alone. The risk of bias was assessed using Cochrane's risk of bias tool. A total of seven RCTs and one controlled clinical trial (CCT) were included in this review. Combining self-ligating brackets with flapless corticotomy, low-level laser therapy (LLLT), and infrared light accelerated orthodontic movement by 43% and 50% for surgical methods, 20-50% for LLLT, and 22% for infrared light. Regarding side effects on periodontal tissues, neither flapless corticotomy nor low-frequency vibrational forces caused any damage. Combining self-ligating brackets and flapless corticotomy, low-level laser, or infrared light effectively accelerated orthodontic movement by 20% to 50 %. In contrast, the combination of self-ligating brackets with vibrational forces did not affect speeding tooth movement. The acceleration methods did not have any side effects on the periodontal tissues, but the available evidence was insufficient. There is a need for further primary research regarding the effectiveness of combining self-ligating brackets with acceleration methods and the possible untoward side effects.

Efficacy of Low-Level Laser Therapy in Reducing Pain in the Initial Stages of Orthodontic Treatment

Purpose

There is no consensus about the mechanism and efficacy in alleviating pain of the lower-level laser therapy (LLLT) during orthodontic treatment. This study aimed to evaluate the LLLT effectiveness clinically in reducing pain caused by orthodontic movement that occurs in the early stages of treatment.

Methods

The sample consisted of 54 patients in need of orthodontic treatment divided into two groups. A 28 experimental patients group (initial mean age: 26.84 years old) was undergone gallium-aluminum-arsenide infrared laser application on 12 points for each tooth immediately after the installation of the first alignment archwire, and a 26 patients control group (initial mean age: 29.13 years old) was undergone to no pain control intervention at all. Pain intensity was measured by using a visual analog scale, which was marked pain level (mm) reported in 06, 24, 48, and 72 hours. The perception of pain (beginning, peak, decline, and absence) was evaluated by filling up a questionnaire. To compare the intensity and perception of pain between groups, a nonparametric Mann-Whitney has been performed.

Results

The experimental group showed levels (mm) at 6 (p < 0.001), 24 (p=0.004), and 48 hours (p=0.007) and perception of pain (hours) in the peak (p=0.026), decline (p=0.025), and absence (p=0.008) significantly lower compared to the group control.

Conclusion

Low-level laser therapy is effective in reducing pain severity caused by orthodontic forces activation, and it promotes the analgesic action lasting effect during the most painful feeling time.