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

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.

Current protocol to achieve dental movement acceleration and pain control with Photo-biomodulation

When designing a study on dental movement acceleration or pain control during orthodontic treatment, it is crucial to consider effective parameters. The objective of this editorial is to compile the most effective parameters supported by evidence that should be considered in future studies to achieve complete parameter homogenization. The protocol currently recommended to homogenize the parameters and facilitate the development of further meta-analysis in terms of acceleration of movement and pain control in orthodontics is Wavelength: 810 nm, 2.2 J per surface, 0.1 W in continuous mode/0.1 W average power in a super-pulsed, sweeping movement, 1mm from the mucosa, 22 seconds along the vestibular surface and 22 seconds along the lingual surface, the recommended speed of movement is 2 mm/sec, 1 application during each orthodontic control, to achieve dental movement acceleration and repeat the dose at 24 h to ensure pain elimination. The energy density and power density will depend on the spot size used in the equipment and the distance from the mucosa. It will strengthen the evidence of photobiomodulation as the best therapy to accelerate tooth movement and at the same time control the pain produced by orthodontic treatments.

Current protocol to achieve dental movement acceleration and pain control with Photo-biomodulation

When designing a study on dental movement acceleration or pain control during orthodontic treatment, it is crucial to consider effective parameters. The objective of this editorial is to compile the most effective parameters supported by evidence that should be considered in future studies to achieve complete parameter homogenization. The protocol currently recommended to homogenize the parameters and facilitate the development of further meta-analysis in terms of acceleration of movement and pain control in orthodontics is Wavelength: 810 nm, 2.2 J per surface, 0.1 W in continuous mode/0.1 W average power in a super-pulsed, sweeping movement, 1mm from the mucosa, 22 seconds along the vestibular surface and 22 seconds along the lingual surface, the recommended speed of movement is 2 mm/sec, 1 application during each orthodontic control, to achieve dental movement acceleration and repeat the dose at 24 h to ensure pain elimination. The energy density and power density will depend on the spot size used in the equipment and the distance from the mucosa. It will strengthen the evidence of photobiomodulation as the best therapy to accelerate tooth movement and at the same time control the pain produced by orthodontic treatments.

Patient-Reported Outcome Measures of Flapless Corticotomy with Low-Level Laser Therapy in En Masse Retraction of Upper Anterior Teeth: A Three-Arm Randomized Controlled Trial

(1) Background: This study aimed to compare patient-reported outcome measures when accelerating en masse retraction between the piezocision procedure and the subsequent application of low-level laser therapy (FC+LLLT), with the piezocision alone (FC), and in a control group. (2) Methods: A three-arm randomized controlled trial (RCT) was conducted involving 60 patients (41 females and 19 males) with Class II division I malocclusion. The en masse retraction was performed using NiTi closed coil springs attached to miniscrews. The LLLT was performed using an 808 nm Ga-Al-As diode laser. Patient responses regarding pain, discomfort, swelling, and chewing difficulties were reported at ten assessment points. (3) Results: The greatest pain levels were observed 24 h after the application of force during the first and third months of retraction. The mean pain, discomfort, swelling, and chewing difficulties were significantly smaller in the control group than in the FC and FC+LLLT groups. High satisfaction levels were reported in all three groups (p < 0.05). (4) Conclusions: The accelerated en masse retraction via piezocision, followed by a small course of LLLT, was accompanied by significantly fewer pain, discomfort, and chewing difficulties than the control group. LLLT is a valuable addition to piezocision, with an improved patient experience.