Low-level laser therapy for treatment of pain associated with orthodontic elastomeric separator placement: a placebo-controlled randomized double-blind clinical trial

Clinical and preclinical evidence on the bioeffects and movement-related implications of photobiomodulation in the orthodontic tooth movement: A systematic review

Photobiomodulation (PBM) has been demonstrated as a non-invasive and painless technique with great potential to accelerate orthodontic tooth movement (OTM). However, there is a great inconsistency among PBM protocols and reported outcomes, probably due to the poor translatability of preclinical knowledge into early clinical practice. Hence, this review aims to fill this gap by establishing the state-of-the-art on both preclinical and clinical applications of PBM, and by comprehensively discussing the most suitable stimulation protocols described in the literature. This review was conducted according to PRISMA guidelines. A bibliographic search was carried out in the PubMed, Scopus and Cochrane databases using a combination of keywords. Only studies written in English were eligible and no time limit was applied. A total of 69 studies were selected for this review. The revised literature describes that PBM can effectively reduce orthodontic treatment time and produce analgesic and anti-inflammatory effects. We found that PBM of 640 ± 25, 830 ± 20 and 960 ± 20 nm, delivered at a minimum energy density per irradiation point of 5 J/cm2 daily or every other day sessions is robustly associated with increased tooth movement rate. Pain relief seems to be achieved with lower irradiation doses compared to those required for OTM acceleration. For the first time, the bioeffects induced by PBM for the acceleration of OTM are comprehensively discussed from a translational point of view. Collectively, the evidence from preclinical and clinical trials supports the use of PBM as a coadjuvant in orthodontics for enhancing tooth movement and managing treatment-associated discomfort. Overall, the revised studies indicate that optimal PBM parameters to stimulate tissue remodelling are wavelengths of 830 ± 20 nm and energy densities of 5-70 J/cm2 applied daily or every other day can maximize the OTM rate, while lower doses (up to 16 J/cm2 per session) delivered in non-consecutive days seem to be optimal for inducing analgesic effects. Future research should focus on optimizing laser parameters and treatment protocols customized for tooth and movement type. By fine-tuning laser parameters, clinicians can potentially reduce treatment times, improve patient comfort and achieve more predictable outcomes, making orthodontic care more efficient and patient-friendly, thus consolidating PBM usage in orthodontics.

Evaluation of Pain Perception During Orthodontic Debonding of Metallic Brackets with Simultaneous Application of TENS Therapy

Objective

The objective of the present study was to evaluate the effectiveness of transcutaneous electrical nerve stimulation (TENS) therapy on pain during the debonding procedure.

Methods

A placebo-controlled, randomized split - mouth study was conducted on 30 orthodontic patients. The right and left anterior teeth in the maxilla and mandible were randomly allocated to the control and experimental groups (EG) and were stimulated. TENS application was made through a modified electrode probe that was used from an ammeter. The control group (CG) received the mechanical application of the device with no current, whereas the EG received progressively increasing current from 0.1 mA to the point where the patient experienced a mild tingling sensation for 60 s for each tooth. This was followed by a debonding procedure using an orthodontic debonding plier. Pain perception was recorded on a numerical rating scale after debonding each tooth.

Results

The mean pain score was higher in the CG than in the EG, and the difference between the two groups was significant (p=0.001). The pain score was higher in the mandibular teeth than in the maxillary teeth, and the difference between the two groups was also significant (p=0.021). Pain score was higher in female subjects than in male subjects, and the difference between the two groups was significant (p=0.015).

Conclusion

The application of TENS therapy results in pain reduction during the debonding procedure. The female subjects experienced more pain. Higher pain scores were recorded for the mandibular anterior teeth than for the maxillary teeth.

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.

High-frequency near-infrared semiconductor laser irradiation suppressed experimental tooth movement-induced inflammatory pain markers in the periodontal ligament tissues of rats

High-frequency near-infrared (NIR) semiconductor laser-irradiation has an unclear effect on nociception in the compressed lateral periodontal ligament region, a peripheral nerve region. This study aimed to investigate the effects of NIR semiconductor laser irradiation, with a power of 120 J, on inflammatory pain markers and neuropeptides induced in the compressed lateral periodontal ligament area during ETM. A NIR semiconductor laser [910 nm wavelength, 45 W maximum output power, 300 mW average output power, 30 kHz frequency, and 200 ns pulse width (Lumix 2; Fisioline, Verduno, Italy)] was used. A nickel-titanium closed coil that generated a 50-g force was applied to the maxillary left-side first molars and incisors in 7-week-old Sprague-Dawley (280-300 g) rats to induce experimental tooth movement (ETM) for 24 h. Ten rats were divided into two groups (ETM + laser, n = 5; ETM, n = 5). The right side of the ETM group (i.e., the side without induced ETM) was evaluated as the untreated group. We performed immunofluorescent histochemistry analysis to quantify the interleukin (IL)-1β, cyclooxygenase-2 (COX2), prostaglandin E2 (PGE2), and neuropeptide [calcitonin gene-related peptide (CGRP)] expression in the compressed region of the periodontal tissue. Post-hoc Tukey-Kramer tests were used to compare the groups. Compared with the ETM group, the ETM + laser group showed significant suppression in IL-1β (176.2 ± 12.3 vs. 310.8 ± 29.5; P < 0.01), PGE2 (104.4 ± 14.34 vs. 329.6 ± 36.52; P < 0.01), and CGRP (36.8 ± 4.88 vs. 78.0 ± 7.13; P < 0.01) expression. High-frequency NIR semiconductor laser irradiation exerts significant effects on ETM-induced inflammation. High-frequency NIR semiconductor laser irradiation can reduce periodontal inflammation during orthodontic tooth movement.

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.

Effect of humic acid as a photosensitizer combined with low-energy laser on orthodontic tooth movement in rats

Background/purpose

Humic acid (HA) could promote light conversion reaction, and lasers accelerate orthodontic tooth movement. We investigated the effect of HA, as a photosensitizer, combined with low-energy laser on orthodontic tooth movement in rats.

Materials and methods

An orthodontic tooth movement model was established, and the upper left first molar was moved mesially by a nickel-titanium tension spring with a 50-g force. HA was injected into the rats’ abdominal cavity (80 mg/kg once daily). The periodontal tissue of the upper left upper first molar on the pressure side was irradiated (50 s once every 2 days) using a semiconductor laser (wavelength, 650 nm; power, 50 mV). Distance moved by the upper left first molar was measured at different time points, and the tissue of the first molar was sectioned and scanned by micro-computed tomography to evaluate the alveolar bone density. Tartrate-resistant acidic phosphatase staining was used to observe the osteoclast number, alveolar bone, and periodontal tissue.

Results

HA alone did not significantly affect orthodontic tooth movement, alveolar structure density, or periodontal tissue remodeling (P > 0.05). HA combined with a low-energy laser accelerated orthodontic tooth movement. The number of bone absorption lacunae and osteoclasts on the alveolar bone's pressure side increased significantly (P < 0.05), while the density decreased significantly (P < 0.05); however, no root absorption was observed.

Conclusion

HA can improve the conversion rate of low-energy lasers, enhance the low-energy laser effect, and promote orthodontic tooth movement and periodontal tissue reconstruction on the pressure side in rats, without causing root resorption.

The protocol of low-level laser therapy in orthodontic practice: A scoping review of literature

Low-level laser therapy (LLLT) has been widely investigated as an adjunct technique for orthodontic treatment due to photobiomodulation effect. LLLT appears to be supportive for an orthodontic practice in terms of tooth movement acceleration, pain relief, and root resorption management. The decrease in these adverse effects will enhance the compliance in orthodontic patients, which could positively impact treatment outcomes. However, there seemed to be inconsistency in the impact of LLLT as well as its laser and treatment parameters. This scoping review aimed to evaluate the impact of different irradiation parameters on tooth movement acceleration, pain relief, and root resorption as well as to construct a protocol of LLLT in orthodontic practice. The search was conducted across PubMed, Scopus, Web of Science, Embase, Google Scholar, and the reference lists of identified articles. The last search was conducted on October 10, 2021 to identify experiments in humans regarding the application of LLLT as noninvasive treatment in orthodontic practice published between 2010 and 2021. However, they were excluded if they were not clinical research, if they did not report the source of laser, or if they were not relevant to tooth movement, pain perception, and root resorption, or if they were not available in English or in full-text. Following the systematic search and selection process, 60 articles were included in this review. A majority of included articles were published in the past few years. The findings of this review supported the application of LLLT in orthodontic practice with purposes of tooth movement acceleration and pain reduction. The positive impact of LLLT on root resorption had not been clearly evident yet. As this review demonstrated heterogeneity of both laser and treatment parameters, further research should be required to ensure the effectiveness of its specific parameters in orthodontic practice.

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.

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.

Effect of verbal and written information on pain perception in patients undergoing fixed orthodontic treatment: a randomized controlled trial

BACKGROUND

Pain can discourage patients from seeking orthodontic treatment or compromise their compliance during therapy.

OBJECTIVES

To determine the effects of verbal and written information on orthodontic pain after fixed appliance placement.

TRIAL DESIGN

Two-arm parallel design randomized controlled trial.

METHODS

Healthy adolescents with permanent dentition enrolled for orthodontic treatment were assigned to the study or control group using computer-generated random lists and allocation concealment with sealed envelopes. Participants completed baseline questionnaires to assess anxiety (State-Trait Anxiety Inventory Trait Version, Form X-2) and somatosensory amplification (Somatosensory Amplification Scale). Brackets were placed in the maxillary arch, from first molar to first molar, and an Australian archwire 0.012 inch was used for alignment. General verbal information on orthodontic treatment was given to all patients by the same clinician. Participants included in the study group received also detailed verbal instructions on orthodontic pain together with a take-home information leaflet by another clinician. Outcome included assessments of pain intensity with a Numerical Rating Scale (NRS) on the day of appliance placement (Day 1, bedtime) and twice a day for the following 6 days (Day 2 to Day 7, morning, bedtime), and analgesic consumption. Participants, statistician, and clinicians who gave general verbal information on orthodontic treatment and instructions about how to score pain intensity were blinded to group assignment.

RESULTS

Sixty patients were assigned to the study (n = 30, mean age: 15.4 ± 1.3 years) or control group (n = 30, mean age: 14.7 ± 3.2 years). At baseline, no significant between-group differences were present in terms of anxiety and somatosensory amplification. Orthodontic pain scores were significantly lower in the study group compared with the control one, at bedtime on Day 1 (P < 0.05) and in the morning of Day 2 (P < 0.01). No significant between-group differences were found in following measurements. Overall, analgesic consumption was significantly lower in study compared with the control (P < 0.01).

CONCLUSION

A combination of verbal and written information on orthodontic pain after placement of fixed appliances reduced patient's self-reported pain in the early stages.

REGISTRATION

This study was not registered.

Effects of ibuprofen and low-level laser therapy on orthodontic pain by means of the analysis of interleukin 1-beta and substance P levels in the gingival crevicular fluid

OBJECTIVE

The goal of this study was to compare the effects of ibuprofen and low-level laser therapy in alleviating orthodontic pain observed after elastomeric separator placement (ESP) by means of the analysis of interleukin 1‑beta (IL-1β) and substance P (SP) levels in gingival crevicular fluid (GCF) and visual analog scale (VAS).

MATERIALS AND METHODS

A total of 60 subjects requiring ESP for the banding of maxillary first molars were randomly assigned to the ibuprofen, laser, and control groups. The ibuprofen and control groups received, respectively, 400 mg ibuprofen and placebo lactose tablets orally 1 h before ESP; the laser group received a single low-level laser irradiation session immediately after ESP. GCF samples were collected immediately after ESP (day 0) and on days 1, 3, and 7. Pain intensity was evaluated using the VAS immediately after ESP (baseline) and at hours 2 and 6, as well as on days 1, 3, and 7.

RESULTS

Although IL-1β levels increased significantly on days 1, 3, and 7 compared to day 0, intergroup comparison results revealed insignificant differences. SP levels indicated insignificant within-group differences. Only the SP levels of the ibuprofen group showed a significant decrease on days 0 and 1 compared to the laser and control groups. In all groups, VAS scores increased from baseline to a peak level on day 1, followed by a significant decrease on days 3 and 7. Intergroup comparison results of VAS scores indicated less pain intensity in the ibuprofen group compared to the control group at baseline.

CONCLUSIONS

Only the ibuprofen group exhibited significant decreases in SP levels on days 0 and 1, as well as in VAS scores at baseline.

A systematic review of the effective laser wavelength range in delivering photobiomodulation for pain relief in active orthodontic treatment

OBJECTIVE

This systematic review aimed to establish an effective wavelength range for PhotoBioModulation (PBM) to relieve pain in orthodontic treatments.

MATERIAL AND METHODS

The electronic literature search was carried out in the following databases: PubMed, ISI Web of Science, Scopus, and Cochrane. In the initial search, 255 papers were obtained. Deleting duplicates in the search left 180 items. One manually searched study was included for a total of 181 studies. According to PRISMA guidelines and a thorough analysis of their methodology, the final sample was composed of 13 RCTs. The final statistical analysis was performed in 11 studies. The statistical analysis sought to strengthen the collected data, determining the correlation coefficient (r) for the same time interval (24h) using a scale equivalent to the standard value (0-10cm). Aiming to reduce the effect of heterogeneity, the difference in cm between control group (GC) and experimental group (EG) averages was considered the outcome. This difference was correlated with the wavelength in nm, calculating the Pearson linear correlation coefficient, and calculating a logarithmic correlation.

RESULTS

The dispersion of the data obtained in the experimental groups at each given wavelength showed that the most significant number of studies were in the ranges of 780-830nm. The correlation between the wavelength and the difference between the control and experimental group averages, either linear (R2=0.0564, r=0.237) or logarithmic (R2=0.0688, r=0.262) was not significant (P>0.90). Therefore, pain reduction after 24h is not significantly dependent of wavelength.

CONCLUSION

The majority of RCTs related to pain relief in orthodontic treatment showed 780-830nm as the most effective photobiomodulation wavelength range for orthodontic pain relief. However, pain reduction after 24h is not significantly dependent of wavelength. The protocol was registered in PROSPERO (CRD42019119799).

Photobiomodulation Dose Parameters in Dentistry: A Systematic Review and Meta-Analysis

Objective: This systematic review and meta-analysis of published randomized controlled trials examines a possible relationship between optical spot size at surface tissue, irradiance, radiant exposure, total energy delivered, operator technique and reported clinical outcomes. Background: Clinical photobiomodulation (PBM) therapy has achieved a high level of evidence-based acceptance in the mitigation of oral mucositis associated with cancer radiotherapy and chemotherapy, and supportive clinical research in relation to orthodontic tooth movement, oral medical conditions, including burning mouth syndrome, xerostomia and lichen planus. Inconsistent outcomes have been reported not withstanding a substantial body of primary supportive research from clinical, in vitro and animal studies. Materials and Methods: PubMed, Cochrane Database of Reviews and Google Scholar search engines were applied to identify human clinical trials of PBM therapy in clinical dentistry. A total of 766 articles between February 2009 and June 2020 were identified and following a full text evaluation, 38 papers with sufficient data to permit analyses are included in this investigation. Results: Following a detailed assessment of potential factors that may have an influence in clinical outcome, a clear trend is apparent associating optical spot size to a positive or negative effect. Furthermore, there is a clear difference in the reported results in relation to total energy applied, delivery techniques and optical parameters, which merits further investigation. Factorial statistical analyses identified an association between smaller optical surface applications and an overall lower level of reported clinical success in treating superficial and deeper targets, and correspondingly sub-surface larger target tissues were found to be more responsive to therapy by use of a larger optical surface spot size. Moreover, use of multiple small diameter probe applications was found to provide inconsistent results. Conclusions: Many factors can confound clinical success including variations in anatomy, site location, clinical condition and subject individuality. To achieve higher levels of predictable outcome, a mature appreciation of these factors, plus an expanded understanding of laser parametry, tissue volume and target depth to deliver an adequate dose within current recommended guidelines, is essential.

A Clinical Trial of Photobiomodulation Effect on Orthodontic Microscrews Stability Using a 635 nm Red Laser Light

Background: One of the procedures enhancing implants stability can be photobiomodulation. Objective: To assess the effect of a 635 nm wavelength on orthodontic microscrews stability, survival rate, and an individual patient's pain score. Materials and methods: The study was done with 15 subjects, 30 orthodontic microscrews with a length of 10 mm and diameter 1.4 mm. Implants inserted on the right and left side of the maxilla. The implants in the test group (G1) were irradiated with the laser at palatal and buccal part of peri-implant area (two points). The diode laser (SmartM PRO; Lasotronix, Warsaw, Poland) was used with the following settings: power: 100 mW, spot size: 0.5 cm², mean power density (irradiance): 200 mW/cm², in continuous wave (CW) mode, energy per point: 4 J, radiant exposure: 8 J/cm², time per point: 40 sec, the total energy dose (radiant energy) per session: 8 J in contact mode, handpiece diameter: 8 mm. Laser sessions: day of surgery and 3, 6, 9, 12, 15, 30 days later. Cumulative radiant energy was 59 J. Periotest appliance was used to assess the microscrews stability at day of surgery and 3, 6, 9, 12, 15, 30, 60 days later. Each patient received a survey for individual pain assessment (NRS-11) promptly after the implantation. Results: The analysis after 60 days revealed significantly higher secondary stability for the laser-irradiated microscrews group in comparison with control implants (G2 group) (p = 0.0037). We observed significantly higher stability in the experimental group compared with the control after 30 days (p = 0.0218). Moreover, we noted significantly higher microimplants stability for the control group in comparison with the test group, 9 days after implantation (p = 0.0374). Laser application had no effect on pain reduction noted in the first day in comparison with the control sites (p = 0.6690). No microscrews were lost in the study. Conclusions: Application of a 635 nm laser on peri-implant soft tissue increased the microscrews stability after 30 and 60 days.

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.

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.

Systematic Review of Delivery Parameters Used in Dental Photobiomodulation Therapy

Objective: This systematic review of published data critically appraises the consistency in the reported delivery parameters used in photobiomodulation (PBM) therapies research within clinical dentistry and makes reporting recommendations for future clinical protocols. Background: Key to the standardization of randomized clinical trials and associated peer-reviewed articles is the disclosure of all laser and light-emitting diode operating parameters. The current status shows a lack of full parameters and significantly impacts on the ability to integrate published data with current and future investigation into clinical PBM therapy. Materials and methods: Search engines, PubMed, Google Scholar, and Cochrane, were scanned for investigation into the effects of PBM therapy research within clinical dentistry. Key words "Low-Level-Laser," "PBM," "Photobiomodulation," "Oral" and "Therapy" were used and a total of 754 articles identified, spanning a period of 9 years and 1 month between February 2009 and March 2018. Only human clinical trials were considered. Fifty-two articles were included in this investigation and the reported basic delivery parameters used in PBM therapies research were considered for each clinical trial. Results: The overall reported basic delivery parameters used in PBM therapies research were too inadequate to be able to be replicated in further studies. These included parameters related to the power meter, beam cross-sectional dynamics, fluence, and wider aspects of dosimetry. Conclusions: The delivery parameters used in PBM therapy research within clinical dentistry, investigated in this study, presented a wide variation in their recording or nonrecording of all significant elements needed to have scientific validity. A constant inconsistency in delivering valid, reliable, PBM therapy doses, to target tissues was also identified. The lack of consensus in delivering a sound protocol for PBM therapy, is partly due to the lack of adequate reported materials and methods, which are essential for replication of individual studies. One way to resolve this problem is for Journals to insist on all comprehensive parameter records, used in PBM therapies, to be part of author guidelines in submitting articles of studies on PBM therapy in clinical dentistry.

A transient protective effect of low-level laser irradiation against disuse-induced atrophy of rats

Satellite cells, a population of skeletal muscular stem cells, are generally recognized as the main and, possibly, the sole source of postnatal muscle regeneration. Previous studies have revealed the potential of low-level laser (LLL) irradiation in promoting satellite cell proliferation, which, thereby, boosts the recovery of skeletal muscle from atrophy. The purpose of this study is to investigate the beneficial effect of LLL on disuse-induced atrophy. The optimal irradiation condition of LLL (808 nm) enhancing the proliferation of Pax7^+ve cells, isolated from tibialis anterior (TA) muscle, was examined and applied on TA muscle of disuse-induced atrophy model of the rats accordingly. Healthy rats were used as the control. On one hand, transiently, LLL was able to postpone the progression of atrophy for 1 week through a reduction of apoptosis in Pax7^-veMyoD^+ve (myocyte) population. Simultaneously, a significant enhancement was observed in Pax7^+veMyoD^+ve population; however, most of the increased cells underwent apoptosis since the second week, which suggested an impaired maturation of the population. On the other hand, in normal control rats with LLL irradiation, a significant increase in Pax7^+veMyoD^+ve cells and a significant decrease of apoptosis were observed. As a result, a strengthened muscle contraction was observed. Our data showed the capability of LLL in postponing the progression of disuse-induced atrophy for the first time. Furthermore, the result of normal rats with LLL irradiation showed the effectiveness of LLL to strengthen muscle contraction in healthy control.

Low-Level Laser Therapy: A Noninvasive Method of Relieving Postactivation Orthodontic Pain-A Randomized Controlled Clinical Trial

Introduction

Pain is an unavoidable squeal of orthodontic treatment and it is known to decrease patient compliance and eventually affects treatment results. Numerous methods are available in literature to manage orthodontic pain after activation but they have their own limitations. This has led to exploring further options for management of pain.

Aim

The aim of this study was to evaluate the effectiveness of low-level laser therapy (LLLT) in alleviating orthodontic pain after activation.

Materials and Methods

20 subjects were randomly divided into an experimental and a control group. Each participant was given a retraction force of 200 gm/cm²/side. Subjects in the experimental group were exposed to low-level laser light at 980 nm and those in the control group were exposed to red LED light as placebo. The pain perceived after 0 hour, 1 hour, 3 hours, 48 hours, and 1 week of activation was recorded by patient using Visual Analog Scale. Statistical analysis was done using Mann-Whitney test.

Results

Results of the study showed that pain experienced by the subjects after orthodontic activation was higher in experimental group at T₀ than in placebo group. At T₁, T₂, T₄, and T₅, the pain experienced by the subjects was less in the experimental group compared to the placebo group. Pain experienced by the subjects in the experimental group at T₃ was significantly less as compared to those in the placebo group.

Conclusion

A single dose of LLLT at 980nm, 2.5 W/cm², and 600 J is effective in relieving orthodontic pain after activation.

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.

Effect of low-level laser therapy on tooth-related pain and somatosensory function evoked by orthodontic treatment

Low-level laser therapy (LLLT) may have an effect on the pain associated with orthodontic treatment. The aim of this study was to evaluate the effect of LLLT on pain and somatosensory sensitization induced by orthodontic treatment. Forty individuals (12–33 years old; mean ± standard deviations: 20.8 ± 5.9 years) scheduled to receive orthodontic treatment were randomly divided into a laser group (LG) or a placebo group (PG) (1:1). The LG received LLLT (810-nm gallium-aluminium-arsenic diode laser in continuous mode with the power set at 400 mW, 2 J·cm^–2) at 0 h, 2 h, 24 h, 4 d, and 7 d after treatment, and the PG received inactive treatment at the same time points. In both groups, the non-treated side served as a control. A numerical rating scale (NRS) of pain, pressure pain thresholds (PPTs), cold detection thresholds (CDTs), warmth detection thresholds (WDTs), cold pain thresholds (CPTs), and heat pain thresholds (HPTs) were tested on both sides at the gingiva and canine tooth and on the hand. The data were analysed by a repeated measures analysis of variance (ANOVA). The NRS pain scores were significantly lower in the LG group (P = 0.01). The CDTs, CPTs, WDTs, HPTs, and PPTs at the gingiva and the PPTs at the canine tooth were significantly less sensitive on the treatment side of the LG compared with that of the PG (P < 0.033). The parameters tested also showed significantly less sensitivity on the non-treatment side of the LG compared to that of the PG (P < 0.043). There were no differences between the groups for any quantitative sensory testing (QST) measures of the hand. The application of LLLT appears to reduce the pain and sensitivity of the tooth and gingiva associated with orthodontic treatment and may have contralateral effects within the trigeminal system but no generalized QST effects. Thus, the present study indicated a significant analgesia effect of LLLT application during orthodontic treatment. Further clinical applications are suggested.

Repeated applications of low-level laser therapy during and after orthodontic procedures could help reduce pain and discomfort. Many orthodontic patients experience pain in the hours and days following treatment, which impacts on treatment participation. Wenjing Chen at Nanjing Medical University and co-workers assessed whether low-level laser therapy (LLLT) can reduce pain and sensitivity in teeth and surrounding tissues. They divided 40 patients into two groups; one was given repeated LLLT in the hours and days following procedures, while the other group received a placebo course. They tested both groups for sensitivity to stimuli including heat and pressure, in the mouth and on the hands. LLLT significantly reduced pain in the mouth relative to the placebo group. No differences were found in tests on the hands, suggesting LLLT works as a targeted analgesia.

Placebo hypoalgesic effects in pain: Potential applications in dental and orofacial pain management

Placebo and nocebo effects are present within every treatment and intervention, and can be purposefully enhanced and reduced, respectively, in order to improve patients' clinical outcomes. A plethora of research has been conducted on the mechanisms of placebo hypoalgesia and nocebo hyperalgesia in experimental and clinical settings. However, its implications in particular clinical settings such as orthodontic pain management remain underexplored. We conducted a search of the literature regarding placebo analgesia, orthodontic pain management, and orofacial and dental pain. Articles were qualitatively assessed and selected based on the scope of this narrative review. Although no studies investigating the extent of the implications of the placebo and nocebo phenomena in the orthodontic clinical setting were found, we herein present a comprehensive review on the influences of placebo and nocebo effects in experimental and clinical pain management, as well as on the potential for engaging placebo-related endogenous pain modulation for orthodontic pain management. Ethical considerations for the clinical application of placebos are discussed, and future research directions are presented.

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.

Effects of single-dose, low-level laser therapy on pain associated with the initial stage of fixed orthodontic treatment: A randomized clinical trial

Objective

The aim of this study was to assess the analgesic effect of a single application of low-level laser therapy (LLLT) on spontaneous pain and pain on chewing after placement of initial archwires.

Methods

Forty-two patients (26 women, 16 men) were randomly recruited for this split-mouth randomized clinical trial. Each patient received super-elastic nickel-titanium (NiTi) initial archwires (0.012, 0.014, 0.016, and 0.018-inch [in]) in the maxilla for leveling and alignment for an interval of 4 weeks between archwires. One side of the mouth was randomly designated as experimental, while the other side served as placebo. After insertion of each archwire, the experimental side was irradiated with a diode laser for 3 seconds each on 5 points facially and palatally per tooth, from the central incisor to first molar. On the placebo side, the laser device was held the same way but without laser application. A numerical rating scale was used to assess the intensity of spontaneous and masticatory pain for the following 7 days. The Mann-Whitney U test was used to compare pain scores between sides.

Results

Patients in the LLLT group exhibited significantly lower mean scores for spontaneous pain after insertion of the initial two archwires (0.012-in and 0.014-in NiTi; p < 0.05), while there was no significant difference for 0.016-in and 0.018-in wires between the LLLT and placebo groups. LLLT significantly reduced chewing pain scores (p < 0.05) for all archwires.

Conclusions

A single dose of LLLT considerably lessened postoperative pain accompanying the placement of super-elastic NiTi wires for initial alignment and leveling.

Effects of low-level laser irradiation on the rate of orthodontic tooth movement and associated pain with self-ligating brackets

INTRODUCTION

The aim of this study was to evaluate the effect of low-level laser irradiation applied at 3-week intervals on orthodontic tooth movement and pain associated with orthodontic tooth movement using self-ligating brackets.

METHODS

Twenty-two patients (11 male, 11 female; mean age, 19.8 ± 3.1 years) with Angle Class II Division 1 malocclusion were recruited for this split-mouth clinical trial; they required extraction of maxillary first premolars bilaterally. After leveling and alignment with self-ligating brackets (SmartClip SL3; 3M Unitek, St Paul, Minn), a 150-g force was applied to retract the canines bilaterally using 6-mm nickel-titanium closed-coil springs on 0.019 x 0.025-in stainless steel archwires. A gallium-aluminum-arsenic diode laser (iLas; Biolase, Irvine, Calif) with a wavelength of 940 nm in a continuous mode (energy density, 7.5 J/cm²/point; diameter of optical fiber tip, 0.04 cm²) was applied at 5 points buccally and palatally around the canine roots on the experimental side; the other side was designated as the placebo. Laser irradiation was applied at baseline and then repeated after 3 weeks for 2 more consecutive follow-up visits. Questionnaires based on the numeric rating scale were given to the patients to record their pain intensity for 1 week. Impressions were made at each visit before the application of irradiation at baseline and the 3 visits. Models were scanned with a CAD/CAM scanner (Planmeca, Helsinki, Finland).

RESULTS

Canine retraction was significantly greater (1.60 ± 0.38 mm) on the experimental side compared with the placebo side (0.79 ± 0.35 mm) (P <0.05). Pain was significantly less on the experimental side only on the first day after application of LLLI and at the second visit (1.4 ± 0.82 and 1.4 ± 0.64) compared with the placebo sides (2.2 ± 0.41 and 2.4 ± 1.53).

CONCLUSIONS

Low-level laser irradiation applied at 3-week intervals can accelerate orthodontic tooth movement and reduce the pain associated with it.

Effectiveness of Low-Level Laser Therapy in Reducing Orthodontic Pain: A Systematic Review and Meta-Analysis

Objectives

To assess the effectiveness of low-level laser therapy (LLLT) in reducing orthodontic pain after the application of orthodontic force (OF).

Methods

A systematic search was conducted in the MEDLINE, EMBASE, Scopus, Cochrane Library, Web of Science, and EBSCOhost databases. The study included randomized clinical trials (RCT) which analysed the effectiveness of LLLT in reducing orthodontic pain assessed at 24 and 72 hrs after the application of OF. The risk of bias of the eligible trials was assessed using the Cochrane Collaboration's risk of bias tool. Standard mean difference was calculated and pooled by meta-analysis using random effect models.

Results

Of 467 identified articles, 20 RCT were finally included. In the risk of bias assessments, 13 studies presented a high risk, 5 an unclear risk, and 2 a low risk. The meta-analysis showed that in patients treated with laser versus placebo there was a difference in favour of LLLT in spontaneous pain 24 and 72 hrs after the installation of light archwires and spontaneous pain and chewing pain 24 and 72 hrs after the installation of elastomeric separators.

Conclusions

LLLT proved to be effective in promoting a reduction in spontaneous and chewing pain after the application of OF; however, the poor quality of the evidence requires these results to be treated with caution.

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.

Low-level laser therapy effects on pain perception related to the use of orthodontic elastomeric separators

INTRODUCTION:

Some patients refer to pre-banding orthodontic separation as a painful orthodontic procedure. Low-level laser therapy (LLLT) has been reported to have local analgesic effect.

OBJECTIVE:

The aim of this single-blind study was to investigate the perception of pain caused by orthodontic elastomeric separators with and without a single LLLT application (6J).

METHODS:

The sample comprised 79 individuals aged between 13 and 34 years old at orthodontic treatment onset. Elastomeric separators were placed in first maxillary molars at mesial and distal surfaces and kept in place for three days. The volunteers scored pain intensity on a visual analogue scale (VAS) after 6 and 12 hours, and after the first, second and third days. One third of patients received laser applications, whereas another third received placebo applications and the remaining ones were controls. Applications were performed in a split-mouth design. Thus, three groups (laser, placebo and control) were assessed.

RESULTS:

No differences were found among groups considering pain perception in all periods observed.

CONCLUSION:

The use of a single-dose of LLLT did not cause significant reduction in orthodontic pain perception. Overall pain perception due to orthodontic separator placement varied widely and was usually mild.

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.

Effect of a single dose of low-level laser therapy on spontaneous and chewing pain caused by elastomeric separators

INTRODUCTION

The aim of this study was to see the effect of a single dose of low-level laser therapy on spontaneous and chewing pain after the placement of elastomeric separators.

METHODS

Eighty-eight patients were randomly selected for this single-blind study. Elastomeric separators were placed mesial and distal to the permanent first molars in all quadrants. Both arches were divided into experimental and control sides. The experimental sides were treated with low-level laser therapy on 3 points on the buccal mucosa for 20 seconds each, with a 940-nm gallium-aluminum-arsenic diode laser on continuous mode and power set at 200 mW. The other side received placebo laser therapy without turning on the laser. A numeric rating scale was used to assess the intensity of spontaneous and chewing pain for the next 7 days. The independent sample t test and repeated-measures analysis of variance with the post hoc Tukey test was used to analyze the results.

RESULTS

Significant differences were found in spontaneous and chewing pain among both groups (P <0.05).

CONCLUSIONS

A single dose of low-level laser therapy can be an efficient modality to reduce the postoperative pain associated with the placement of elastomeric separators.

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.

Effect of single-dose low-level helium-neon laser irradiation on orthodontic pain: a split-mouth single-blind placebo-controlled randomized clinical trial

Background

Pain is the most common complication of orthodontic treatment. Low-level laser therapy (LLLT) has been suggested as a new analgesic treatment free of the adverse effects of analgesic medications. However, it is not studied thoroughly, and the available studies are quite controversial. Moreover, helium neon (He-Ne) laser has not been assessed before.

Methods

This split-mouth placebo-controlled randomized clinical trial was performed on 16 male and 14 female orthodontic patients requiring bilateral upper canine retraction. The study was performed at a private clinic in Sari, Iran, in 2014. It was single blind: patients, orthodontist, and personnel were blinded of the allocations, but the laser operator (periodontist) was not blinded. Once canine retractor was activated, a randomly selected maxillary quarter received a single dose of He-Ne laser irradiation (632.8 nm, 10 mw, 6 j/cm² density). The other quarter served as the placebo side, treated by the same device but powered off. In the first, second, fourth, and seventh days, blinded patients rated their pain sensed on each side at home using visual analog scale (VAS) questionnaires. There was no harm identified during or after the study. Pain changes were analyzed using two- and one-way repeated-measures ANOVA, Bonferroni, and t-test (α = 0.01, β > 0.99). This trial was not registered. It was self-funded by the authors.

Results

Sixteen males and 11 females remained in the study (aged 12–21). Average pain scores sensed in all 4 intervals on control and laser sides were 4.06 ± 2.85 and 2.35 ± 1.77, respectively (t-test P < 0.0001). One-way ANOVA showed significant pain declines over time, in each group (P < 0.0001). Two-way ANOVA showed significant effects for LLLT (P < 0.0001) and time (P = <0.0001).

Conclusions

Single-dose He-Ne laser therapy might reduce orthodontic pain caused by retracting maxillary canines.

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.

The effectiveness of low-level diode laser therapy on orthodontic pain management: a systematic review and meta-analysis

To assess the effectiveness of diode low-level laser therapy (LLLT) for orthodontic pain control, a systematic and extensive electronic search for randomised controlled trials (RCTs) investigating the effects of diode LLLT on orthodontic pain prior to November 2014 was performed using the Cochrane Library (Issue 9, 2014), PubMed (1997), EMBASE (1947) and Web of Science (1956). The Cochrane tool for risk of bias evaluation was used to assess the bias risk in the chosen data. A meta-analysis was conducted using RevMan 5.3. Of the 186 results, 14 RCTs, with a total of 659 participants from 11 countries, were included. Except for three studies assessed as having a ‘moderate risk of bias’, the RCTs were rated as having a ‘high risk of bias’. The methodological weaknesses were mainly due to ‘blinding’ and ‘allocation concealment’. The meta-analysis showed that diode LLLT significantly reduced orthodontic pain by 39 % in comparison with placebo groups (P = 0.02). Diode LLLT was shown to significantly reduce the maximum pain intensity among parallel-design studies (P = 0.003 versus placebo groups; P = 0.000 versus control groups). However, no significant effects were shown for split-mouth-design studies (P = 0.38 versus placebo groups). It was concluded that the use of diode LLLT for orthodontic pain appears promising. However, due to methodological weaknesses, there was insufficient evidence to support or refute LLLT’s effectiveness. RCTs with better designs and appropriate sample power are required to provide stronger evidence for diode LLLT’s clinical applications.

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.