Photobiomodulation accelerates orthodontic alignment in the early phase of treatment

Photobiomodulation in Orthodontics: Mechanisms and Clinical Efficacy for Faster Tooth Movement

Accelerated orthodontics has revolutionized traditional dental practices by employing innovative techniques to expedite tooth movement and enhance treatment outcomes. Among these advancements, low-level laser therapy (LLLT) has emerged as a promising adjunctive method that offers a non-invasive and efficient approach to accelerate orthodontic tooth movement. By harnessing the power of low-level lasers, LLLT aims to stimulate cellular activity, promote bone remodeling, and reduce treatment duration, thereby revolutionizing the landscape of orthodontic care. In this review, we discuss the mechanism of action, methods, efficacy, advantages, limitations, and future scope of LLLT, uncovering its transformative impact on the field of accelerated orthodontics.

In Vitro Effect of Photobiomodulation Therapy with 980 nm Diode Laser on Gene Expression of Key Regulators of Bone Remodeling by Human Periodontal Ligament Cells under Mild Orthodontic Forces

This study investigated the effect of photobiomodulation (PBM) with 980 nm diode laser as monotherapy and in combination with compressive and tensile orthodontic forces on expression of osteoprotegerin (OPG), receptor activator of nuclear factor-κB ligand (RANKL), sclerostin (SOST) and periostin (POSTN), by human periodontal ligament cells. Isolated cells were cultured and subjected to either tensile (10% elongation) or compressive forces (25 g cm-2 ) for 24 and 48 h. Subsequently, the cells received PBM (100 mW power, 3 or 6 J cm-2 energy density) immediately after load cycle. RT-PCR was applied to assess the genes expression. Data were analyzed by one-way ANOVA, followed by post hoc Tukey test (P ≤ 0.05). We found that PBM in combination with orthodontic forces led to upregulation of bone resorption genes (RANKL and SOST) at the pressure side and their downregulation at the tension side. The expression of osteogenic genes (OPG and POSTN) increased at the tension side and decreased at the pressure side. PBM alone did not affect gene expression. In conclusion, these findings suggest that this PBM protocol may be effective in enhancement of the gene expression in favor of bone remodeling acceleration that should be confirmed in future animal and human studies.

Effects of low level laser on periodontal tissue remodeling in hPDLCs under tensile stress

This study aimed to investigate the effect of Low-Level Laser Therapy (LLLT) on human Periodontal Ligament Cells (hPDLCs) under tension stress. Primary hPDLCs were obtained using the tissue culture method, and P3 cells were utilized for the subsequent experiments. The study comprised four groups: a blank control group (Group B), a laser irradiation group (Group L), a tension stress group (Group T), and a laser + tension stress group (Group LT). Mechanical loading was applied using an in-vitro cell stress loading device at a frequency of 0.5 Hz and deformation of 2% for two hours per day for two days. Laser irradiation at 808 nm GaAlAs laser was administered 1 h after force loading. Cell samples were collected after the experiment. Bone and fiber remodeling factors were analyzed using PCR and Western blot. Flow cytometry was employed to assess the cell cycle, while ROS and Ca2+ levels were measured using a multifunctional enzyme labeling instrument. The results revealed that laser intervention under tension stress inhibited the expression of osteogenic differentiation factors, promoted the expression of osteoclast differentiation factors, and significantly increased the production of collagen factors, MMPs, and TIMPs. The LT group exhibited the most active cell cycle (P < 0.05). LLLT not only enhanced Ca2+ expression in hPDLCs under tension stress, but also stimulated the production of ROS. Overall, our findings demonstrate that LLLT effectively accelerated the proliferation of hPDLCs and the remodeling of periodontal tissue, possibly through the regulation of ROS and Ca2+ levels in hPDLCs.

Vibrational Force on Accelerating Orthodontic Tooth Movement: A Systematic Review and Meta-Analysis

This study aimed to systematically gather and analyze the current level of evidence for the effectiveness of the vibrational force in accelerating orthodontic tooth movement (OTM). This systematic review was conducted using three electronic databases: Scopus, PubMed, and Google Scholar until March 2022. The search was done through the following journals: European Journal of Orthodontics, American Journal of Orthodontics and Dentofacial Orthopedics, The Angle Orthodontist, Progress in Orthodontics, and Seminars in Orthodontics. Human or animal studies that have evaluated the effect of vibrational force on the rate of OTM were selected. A meta-analysis was performed for the rate of canine movement per month. Database research, elimination of duplicate studies, data extraction, and risk of bias assessment were performed by authors independently and in duplication. A fixed and random-effect meta-analysis was performed to evaluate the effect of vibrational forces. A total of 19 studies (6 animal and 13 human studies) that met the inclusion criteria were included. Meta-analysis was performed based on four human clinical trials. Three out of four studies showed no significant difference in the rate of canine movement between vibrational force and control groups. The limitation of this study was the small sample size and significant heterogeneity among the studies. Although vibrational forces have been shown to accelerate OTM in experimental studies, the results are inconsistent in clinical studies. The inability to apply desired peak load to the targeted teeth may be the main factor in inconsistent clinical outcomes.

Effect of light-emitting photobiomodulation therapy on the rate of orthodontic tooth movement : A randomized controlled clinical trial

PURPOSE

The aim of this study was to evaluate the effect of light-emitting photobiomodulation therapy (LPT) on the rate of canine distalization.

METHODS

This study was performed on 60 extraction spaces formed by extraction of the upper first premolars of 30 patients (15 in the LPT group and 15 in the control group). Paul Gjessing (PG)-segmented canine retraction springs were used for canine distalization. In the LPT group, the Biolux OrthoPulse™ (Biolux Research Ltd, Vancouver, Canada) intraoral device (wavelength 850 nm LED light and an energy density of 63 mW/cm2 [±13 mW/cm2]) was used for 5 min per day over a period of 84 days. For each patient, the diagnosis was based on standard orthodontic documentation with photographs, digital model casts, and cephalometric and panoramic radiographs. The anchorage loss, canine rotations, canine inclinations, and molar inclinations were also evaluated on plaster models obtained on days 0, 21, 42, 63, and 84. The models were measured by using 3Shape OrthoAnalyzer software (3Shape, Copenhagen, Denmark). Measurements were made by a researcher and a blinded clinician. For statistical comparison, a paired-samples t‑test and one-way analysis of variance (ANOVA) were used at the p < 0.05 level.

RESULTS

The mean canine distalization rates were 1.36 mm/21 days and 1.02 mm/21 days in the LPT and control groups, respectively, and were statistically greater in the LPT group (p < 0.001). The amount of anchorage loss, canine rotations, canine inclinations and molar inclinations were not significantly different between the LPT and control groups at any of the timepoints.

CONCLUSION

LPT has the potential to accelerate orthodontic tooth movement by 33%.

Photobiomodulation therapy assisted orthodontic tooth movement: potential implications, challenges, and new perspectives

Over the past decade, dramatic progress has been made in dental research areas involving laser therapy. The photobiomodulatory effect of laser light regulates the behavior of periodontal tissues and promotes damaged tissues to heal faster. Additionally, photobiomodulation therapy (PBMT), a non-invasive treatment, when applied in orthodontics, contributes to alleviating pain and reducing inflammation induced by orthodontic forces, along with improving tissue healing processes. Moreover, PBMT is attracting more attention as a possible approach to prevent the incidence of orthodontically induced inflammatory root resorption (OIIRR) during orthodontic treatment (OT) due to its capacity to modulate inflammatory, apoptotic, and anti-antioxidant responses. However, a systematic review revealed that PBMT has only a moderate grade of evidence-based effectiveness during orthodontic tooth movement (OTM) in relation to OIIRR, casting doubt on its beneficial effects. In PBMT-assisted orthodontics, delivering sufficient energy to the tooth root to achieve optimal stimulation is challenging due to the exponential attenuation of light penetration in periodontal tissues. The penetration of light to the root surface is another crucial unknown factor. Both the penetration depth and distribution of light in periodontal tissues are unknown. Thus, advanced approaches specific to orthodontic application of PBMT need to be established to overcome these limitations. This review explores possibilities for improving the application and effectiveness of PBMT during OTM. The aim was to investigate the current evidence related to the underlying mechanisms of action of PBMT on various periodontal tissues and cells, with a special focus on immunomodulatory effects during OTM.

Efficiency of photobiomodulation on accelerating the tooth movement in the alignment phase of orthodontic treatment-A systematic review and meta-analysis

Objectives

To investigate the efficiency of photobiomodulation on accelerating the tooth movement in the alignment phase of orthodontic treatment.

Materials and methods

The data search was performed with PubMed, Embase, Scopus, and the Cochrane Library. Randomized clinical trials and controlled clinical trials evaluating the efficiency of photobiomodulation on accelerating tooth movement in the alignment phase were selected, and the characteristics of the included studies were collected in a customized data form. Data analysis was conducted by the random-effects model after risk of bias and certainty of evidence were assessed.

Results

Five randomized clinical trials and three controlled clinical trials were included in the final analysis. All included studies reported positive results except the study of Shehawy et al. The results of the analysis showed that photobiomodulation significantly increased the rate of tooth movement and reduced the treatment duration, compared with the control group. Although the heterogeneity was large among the included studies, it was improved after subgroup analysis.

Conclusions

This systematic review offered evidence that photobiomodulation can accelerate tooth movement in alignment procedures and reduce treatment time. Future studies are needed to find the best PBM protocol for orthodontic practice.

Applications of regenerative techniques in adult orthodontics

Management of the growing adult orthodontic patient population must contend with challenges particular to orthodontic treatment in adults. These include a limited rate of tooth movement, increased incidence of periodontal complications, higher risk of iatrogenic root resorption and pulp devitalisation, resorbed edentulous ridges, and lack of growth potential. The field of regenerative dentistry has evolved numerous methods of manipulating cellular and molecular processes to rebuild functional oral and dental tissues, and research continues to advance our understanding of stem cells, signalling factors that stimulate repair and extracellular scaffold interactions for the purposes of tissue engineering. We discuss recent findings in the literature to synthesise our understanding of current and prospective approaches based on biological repair that have the potential to improve orthodontic treatment outcomes in adult patients. Methods such as mesenchymal stem cell transplantation, biomimetic scaffold manipulation, and growth factor control may be employed to overcome the challenges described above, thereby reducing adverse sequelae and improving orthodontic treatment outcomes in adult patients. The overarching goal of such research is to eventually translate these regenerative techniques into clinical practice, and establish a new gold standard of safe, effective, autologous therapies.

Predictability of Invisalign® Clear Aligners Using OrthoPulse®: A Retrospective Study

This preliminary retrospective study evaluates how effective the OrthoPulse^® (Biolux Technology, Austria) is in increasing the predictability of orthodontic treatment in patients treated with Invisalign^® clear aligners (Align Technology Inc., Tempe, AZ, USA). A group of 376 patients were treated with Invisalign^® orthodontic clear aligners in association with an OrthoPulse^®. The OrthoPulse^® was prescribed for 10 min a day for the entire duration of the orthodontic treatment. The OrthoPulse^® App remotely tracked the percentage compliance of each patient. The number of aligners planned with the ClinCheck software at the beginning of the treatment and the number of total aligners (including the adjunctive aligners) used to finish the treatment were then considered. After applying inclusion/exclusion criteria, a total of 40 patients remained in the study and were compared with a control group of 40 patients with the same characteristics as the study group. A statistical analysis was carried out to investigate whether using OrthoPulse^® led to a statistical reduction in the number of adjunctive aligners, thus leading to a more accurate prediction of the treatment. The statistical analysis showed that patients who used OrthoPulse^® needed fewer finishing aligners and a greater predictability of the treatment was obtained. In fact, in the treated group the average number of additional aligners represented 66.5% of the initial aligners, whereas in the control group 103.4% of the initially planned aligners were needed. In conclusion, in patients treated with clear aligners, OrthoPulse^® would appear to increase the predictability of orthodontic treatment with clear aligners, thus reducing the number of finishing phase requirements.

Adverse Effects of Surgically Accelerated Orthodontic Techniques: A Systematic Review

Evidence on the potential adverse effects of surgically accelerated orthodontic techniques is scarce. The aim of this review was to evaluate the available scientific evidence regarding the adverse effects on periodontium, tooth vitality, and root resorption, associated with these surgical procedures in children, adolescents, and adults. The reporting of this review was based on the PRISMA2020 guidelines. Seven databases and three registers were searched for randomized clinical trials (RCTs) and controlled clinical trials (CCTs) published up to 22 June 2022. Hand searching of the reference lists of the included studies was also performed. The quality of the evidence was assessed with the Cochrane risk of bias and ROBINS-I tools. A total of 887 records were initially screened. Finally, 33 RCTs (713 patients), six CCTs (103 patients), and six ongoing protocols were eligible for this systematic review. The current review indicated that there are no significant adverse effects of surgically accelerated orthodontic techniques on periodontium, root length, or tooth vitality. High-quality clinical trials with less risk of bias should be conducted to allow reliable conclusions regarding the adverse effects of the surgical procedures associated with the acceleration of orthodontic treatment on children, adolescents, and adults.

Three-Dimensional Assessment of the Temporomandibular Joint Changes Following Reversed Twin Block Therapy of Patients With Skeletal Class III Malocclusion in Conjunction With the Photobiomodulation Therapy: A Randomized Controlled Clinical Trial

Background: Despite the positive effect of the photobiomodulation therapy (PBMT) application on animals, the primary role of this technique on the human condyle is still unclear. Several experimental reports have shown the efficacy of PBMT in inducing cellular changes in the temporomandibular joint (TMJ) region during functional treatment of patients with skeletal deformities. Still, the lack of information about its effects on human condyles requires further studies.

Objectives: This study aimed to evaluate the effect of PBMT on the TMJ components following Class III treatment with the reversed twin block (RTB) appliance in growing patients. 

Materials and Method: Forty children (12 females, 28 males) between the age of nine and eleven years with skeletal Class III were assigned randomly to the RTB group with photobiomodulation (RTB+PBMT) or the control group (RTB). The PBMT was applied to the TMJ region using an 808-nm wavelength Ga-Al-As semiconductor laser device with 5 Joules/cm² energydensity on days 1, 3, 7, and 14 of the first month. Afterwards, the irradiation was conducted every 15 days until the end of the treatment. Cone-beam computerized tomography (CBCT) images were taken before (T1) treatment and following the end of treatment (T2) to assess TMJ and skeletal changes.

Results: Condylar volume was significantly increased in the RTB group only by a mean of 287.97 mm³ (p<0.001). The significantly backward and upward condylar movement was observed in the RTB and RTB+PBMT groups (superior joint space (SJS): 0.26 mm, 0.15 mm; posterior joint space (PJS): 0.42mm, 0.11mm, respectively). The RTB group showed the most remarkable changes. Significant improvement of the sagittal maxilla-mandibular relationship was greater in the RTB+PBMT group compared to the RTB group (p=0.02).

Conclusion: There were no considerable differences in the condylar position after Class III treatment between the RTB and the RTB+PBMT groups. But a difference in the condylar volume was noticed between the two group.

Evaluation of the effectiveness of modified aligner appliance with nickel-titanium springs in treatment of mild crowding of lower incisors: A randomized controlled clinical trial

BACKGROUND

This study aimed to evaluate the effectiveness of modified aligner appliances with nickel-titanium springs (MAAs) in treating mild mandibular crowding and assess the overall alignment treatment duration, alignment improvement percentage, and mandibular incisor proclination.

METHODS

This two-armed, parallel-group randomized controlled trial included 36 patients (7 men, 29 women) with mild mandibular incisor crowding according to Little's Irregularity Index. Patients were randomly assigned to two groups: the MAA group (mean age = 22.56 ± 3.50 years) and the conventional fixed bracket group (control group; mean age = 20.89 ± 2.90 years). The duration of alignment treatment of the lower anterior teeth was calculated. The progress of alignment was evaluated every 2 weeks on the study casts, which were taken at fixed intervals: pretreatment (T0) and 2 (T1), 4 (T2), 6 (T3), and 8 (T4) weeks after beginning the treatment. Change of mandibular incisor proclination was evaluated by measuring and comparing pretreatment and postalignment lateral cephalograms.

RESULTS

No statistically significant difference was detected between the two groups in terms of alignment treatment duration (P = 0.097), whereas a significant difference was observed in the alignment improvement percentage at T1 (P = 0.000), T2 (P = 0.001), and T3 (P = 0.022). In addition, the MAA group had a lower change of mandibular incisor proclination than the control group (P = 0.000).

CONCLUSIONS

The clinical application of MAAs may be effective in lower incisor decrowding, with a reduction in lower incisor inclination compared with conventional fixed brackets. This trial was registered at ClinicalTrials.gov (identifier: NCT04988373).

Effect of the photobiomodulation for acceleration of the orthodontic tooth movement: a systematic review and meta-analysis

To determine whether the application of photobiomodulation (PBM), as an adjunctive treatment for patients with orthodontic fixed appliances, decreased the total treatment time compared to conventional orthodontics. Studies were collected from four electronic databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews. Eligibility criteria were full-text articles in English or Spanish with the design of randomized (RCT), non-randomized clinical trials (non-RCT), and retrospective cohort, without any restriction regarding the publication time, in which the effect of PBM using low-level laser irradiation (LLLI) and light-emitting diode (LED) for the acceleration of the orthodontic movement had been evaluated. Data collection and analysis: Two authors independently extracted data for the characteristics and outcomes of the studies selected for inclusion. The risk of bias (RoB 2 and Robins-I) and the quality assessments (GRADE) were performed. For the quantitative synthesis, the standardized mean difference was calculated for each individual study selected and then the data were combined using a random-effects meta-analysis. The total number of included studies was n = 22 (only RCT and non-RCT were found) with a total of 515 participants. The included studies exhibited high risk of bias and some concerns, though none of them presented a low risk of bias. The quality of the studies was very low. The meta-analysis showed that the means (mm) and 95% confidence intervals (95% CI) of acceleration of tooth movement at 1, 2, and 3 months were 0.50 (- 0.28, 1.28), 1.40 (0.27, 2.53), and 0.46 (- 0.33, 1.24), respectively. The analysis showed that there is no evidence to support the use of LLLI to accelerate the orthodontic movement. LED for the acceleration of orthodontic movement does not have sufficient evidence to generate conclusions about it.

Effect of vibration on orthodontic tooth movement in a double blind prospective randomized controlled trial

The purpose of the present study was to investigate the effect of vibration on orthodontic tooth movement and safety assessment based on our previous basic research in animal experiments. A double-blind prospective randomized controlled trial using split-mouth design was conducted in patients with malocclusion. The left and right sides of maxillary arch were randomly assigned to vibration (TM + V) and non-vibration (TM) groups. After leveling, vibrations (5.2 ± 0.5 g-forces (gf), 102.2 ± 2.6 Hertz (Hz)) were supplementary applied to the canine retracted with 100 gf in TM + V group for 3 min at the monthly visit under double-blind fashion, and the canine on the other side without vibration was used as TM group. The amount of tooth movement was measured blindly using a constructed three-dimensional dentition model. The amount of canine movement per visit was 0.89 ± 0.55 mm in TM group (n = 23) and 1.21 ± 0.60 mm in TM + V group (n = 23), respectively. There was no significant difference of pain and discomfort, and root resorption between the two groups. This study indicates that static orthodontic force with supplementary vibration significantly accelerated tooth movement in canine retraction and reduced the number of visits without causing side effects.

Evaluation of the acceleration, skeletal and dentoalveolar effects of low-level laser therapy combined with fixed posterior bite blocks in children with skeletal anterior open bite: A three-arm randomised controlled trial

OBJECTIVES

To evaluate the effectiveness of the low-level laser therapy (LLLT) in accelerating the early treatment of the skeletal anterior open bite (AOB) and to evaluate the associated skeletal and dentoalveolar changes.

MATERIALS AND METHODS

A three-arm, parallel-group, randomized controlled trial was conducted on 42 patients aged 8-10 years with skeletal AOB. Patients were randomly allocated to three groups: the fixed posterior bite block+low-level laser therapy (FPBB+LLLT) group; the fixed posterior bite block (FPBB) group; and the untreated control group (UCG) in a 1:1:1 allocation ratio. The LLLT dose in the FPBB+LLLT group was applied using 808-nm wavelength Ga-Al-As semiconductor laser device with the energy of 4-joules/point and irradiation time of 16 seconds/point. LLLT was applied in the first visit; then, it was applied on day 3, 7 and 14 of the first month. Afterwards, it was applied every 15 days until the end of the treatment. Lateral cephalometric images were taken at the beginning of the treatment (T0) and at the end of the active phase (T1). The primary outcome measures were the overall time needed to correct the AOB and the skeletal and dentoalveolar changes.

RESULTS

The correction of the AOB required significantly less mean time in the FPBB+LLLT group compared to the FPBB group (x̅=7.07, x̅=9.42 months, respectively; P=0.001). The mean upper first molar intrusion in the FPBB+LLLT group was 1.21mm and significantly greater than that of the FPBB group (0.82mm; P=0.018). However, there was a slight mean extrusion of the upper first molar in the UCG (0.32mm).

CONCLUSIONS

The overall time needed to correct the AOB was shorter in the FPBB+LLLT group. The LLLT appeared to be effective in accelerating orthodontic tooth movement. FPBB alone or LLLT were effective in the early treatment of anterior open bite (AOB). The two interventional groups produced similar dentoalveolar and skeletal changes; most of which were dentoalveolar in the correction of the anterior open bite.

Effect of 970 nm low-level laser therapy on orthodontic tooth movement during Class II intermaxillary elastics treatment: a RCT

This prospective randomized clinical trial aimed to evaluate the effect of low-level laser therapy on tooth movement during Class II intermaxillary elastics treatment. Forty-two patients with Class II malocclusion were included, and their maxillary quadrants were allocated into two groups: treatment with an active diode laser and a placebo group. In each group, the time taken to obtain Class I occlusion after 6 months, rate of movement, total displacement of the maxillary canine to Class I occlusion and pain were recorded. The time to reach Class I occlusion in the active laser group (2.46 ± 2.1 months) was not significantly different from that in the placebo group (2.48 ± 2.0 months) (p = 0.938). Interestingly, the total distance of movement on the active laser side (2.27 ± 1.5 mm) was significantly greater than that on the placebo side (1.64 ± 1.3 mm) (p = 0.009). The pain levels on days 1, 2 and 3 were not significantly different between the laser and placebo sections. The rate of distance change toward Class I occlusion in the laser group (1.1 ± 0.7 mm/month) was significantly higher than that in the placebo group (0.74 ± 0.6 mm/month) (p = 0.037). Low-level laser therapy (970 nm) did not reduce the time needed to obtain Class I occlusion, but a significant acceleration in tooth movement was observed in the irradiated group.

Trial registration: NCT02181439. Registered 04 July 2014—https://www.clinicaltrials.gov/ct2/results?term=cinelaser.

Local hormones and growth factors to enhance orthodontic tooth movement: A systematic review of animal studies

BACKGROUND

Prolonged treatment times are the main reason capable of affecting patient compliance with orthodontic treatment.

OBJECTIVES

A systematic review was made to determine whether the local administration of hormones and growth factors effectively enhances orthodontic tooth movement, and to identify possible adverse effects in animal studies.

MATERIALS AND METHODS

Five databases (PubMed, Scopus, EMBASE, Web of Science and Cochrane Library) were checked for experimental studies reporting one of the following outcomes: orthodontic tooth movement, histological outcomes and side effects. After data extraction, orthodontic tooth movement linked to adjunctive substances was analysed using forest plots. The risk of bias and the quality of evidence were determined with the SYRCLE tool and the GRADE tool, respectively.

RESULTS

Twenty-four studies were included in the systematic review. On a specific dose level, epidermal growth factor + liposomes, fibroblast growth factor and prostaglandin E₂  + Ca were supported by a moderate level of evidence and rated as highly effective in increasing tooth movement in animal models. Likewise, there was histological evidence of increased bone remodelling after the administration of these substances. Other compounds were supported by a low to very low level of evidence.

CONCLUSIONS

Hormones and growth factors may have a relevant impact upon orthodontic tooth movement rate. In specific formulations, prostaglandin E₂ , fibroblast growth factor and epidermal growth factor showed promising results.

The effect of intra-oral LED device and low-level laser therapy on orthodontic tooth movement in young adults: A randomized controlled trial

INTRODUCTION

This randomized controlled clinical trial aimed to assess the effect of LED⁵ and LLLT⁶ in a three-arm parallel setting.

METHODS

Sixty patients who needed the maxillary first premolar extraction were allocated to three groups using the stratified block randomization method. In the LED group, a custom-made device with a wavelength of 640nm and a power density of 40 mW/cm² was used 5min/day. In the laser group, Ga Al As⁷ laser with a wavelength of 810nm and a power of 100 mW was used on days 0, 3, 30, and 60 each time for 18seconds. Patients in the control group received placebo treatment as the laser group protocol, using a coated light cure device. Models were made at baseline and monthly until the end of the retraction. The rate of canine retraction was the primary outcome, while canine rotation and pain were secondary outcomes. The final data were anonymous for the outcome assessor and statistical consultant. Data were analyzed per protocol using a linear mixed model.

RESULTS

The rate of canine retraction significantly increased by 60.8% in the laser group, while it increased not significantly by 26% in the LED group compared with the control group. There was no significant difference among the groups in terms of tooth rotation and pain.

CONCLUSIONS

LLLT can accelerate orthodontic tooth movement (OTM). LED with the present setting couldn't increase the rate of OTM. LLLT and LED did not affect canine rotation or pain.

TRIAL REGISTRATION

IRCT20120220009086N4. On 1 June 2019 was retrospectively registered.

Impact of photobiomodulation and low-intensity pulsed ultrasound adjunctive interventions on orthodontic treatment duration during clear aligner therapy: A retrospective study

OBJECTIVE

To assess the efficiency of low-intensity pulsed ultrasound (LIPUS) and photobiomodulation (PBM) interventions in accelerating orthodontic tooth movement during clear aligner therapy (CAT).

MATERIALS AND METHODS

This retrospective study was carried out on the records of 84 subjects who were treated using CAT. Twenty-eight patients were treated using CAT with a daily use of LIPUS for 20 minutes, 28 patients were treated using CAT with a daily use of PBM for 10 minutes, and 28 patients were treated using CAT alone. The total duration of treatment was recorded for all patients. One-way analysis of variance and post hoc Tukey test were used to assess whether there was any significant difference in total treatment duration among the three groups (P < .05).

RESULTS

The mean treatment durations in days were 719 ± 220, 533 ± 242, and 528 ± 323 for the control, LIPUS, and PBM groups, respectively. The LIPUS group showed a 26% reduction, on average, in treatment duration when compared with the control group, whereas the PBM group showed an average 26.6% reduction in the treatment duration when compared with the control group. The results showed that there were statistically significant differences among the groups (P = .011). Treatment durations were significantly reduced in the LIPUS and PBM groups as compared with the control (P = .027 and P = .023, respectively), with no statistically significant differences between the LIPUS and PBM groups (P = .998).

CONCLUSIONS

Daily use of LIPUS or PBM as adjunctive interventions during CAT could reduce the duration of orthodontic treatment.

Effect of light-emitting diode-mediated photobiomodulation on extraction space closure in adolescents and young adults: A split-mouth, randomized controlled trial

INTRODUCTION

This split-mouth trial aimed to examine the effects of light-emitting diode (LED)-mediated photobiomodulation compared with no photobiomodulation on maxillary canine distalization.

METHODS

Twenty participants (10 males and 10 females; aged 11-20 years) requiring bilateral extraction of maxillary first premolars were included from the Sydney Dental Hospital waiting list. After premolar extractions, leveling, and alignment, canines were retracted on 0.020-in stainless steel wires with coil springs delivering 150 g of force to each side. Each patient's right side was randomly assigned to experimental or control using www.randomisation.com, and allocation concealment was performed with sequentially numbered, opaque, sealed envelopes. The experimental side received 850 nm wavelength, 60 mW/cm² power, continuous LED with OrthoPulse device (Biolux Research Ltd, Vancouver, British Columbia, Canada) for 5 min/d. For the control side, the device was blocked with opaque black film. Patients were reviewed at 4-week intervals for force reactivation and intraoral scanning over 12 weeks. The primary outcome was the amount of tooth movement, and secondary outcomes were anchorage loss and canine rotation, all measured digitally. Blinding for study participants and the treating clinician was not possible; however, blinding was done for the measurements by deidentifying the digital scans. Linear mixed models were implemented for the data analysis.

RESULTS

Nineteen participants concluded the study. Data analysis showed that the treatment × time interaction was not significant, suggesting no difference in space closure (unstandardized regression coefficient [b], 0.12; 95% confidence interval [CI], -0.05 to 0.29; P = 0.17), canine rotation (b, 0.21; 95% CI, -0.82 to 1.25; P = 0.69), and anchorage loss (b, -0.01, 95% CI, -0.28 to 0.26, P = 0.94). No harms were noted.

CONCLUSIONS

Daily 5-minute application of LED did not result in clinically meaningful differences during extraction space closure compared with no LED application.

REGISTRATION

Australian New Zealand Clinical Trials Registry (ACTRN12616000652471).

PROTOCOL

The protocol was not published before trial commencement.

FUNDING

This research was funded by the Australian Society of Orthodontists Foundation for Research and Education.

The effect of platelet-rich fibrin (PRF) on maxillary incisor retraction rate

OBJECTIVE

To investigate the efficiency of platelet-rich fibrin (PRF) injection on maxillary incisor retraction rate.

MATERIALS AND METHODS

The study included 40 patients (23 women and 17 men; mean age; 20.7 ± 1.45) with Class II Division 1 malocclusion. The treatment plan for all patients was extraction of the maxillary first premolars and canine distalization, followed by retraction of the maxillary incisors. Patients were randomly divided into two groups. The study group received injectable platelet-rich fibrin (i-PRF) two times with an interval of 2 weeks; the control group did not receive i-PRF. In both groups, the measurements were bilaterally assessed as the distances between the lateral and canine teeth on the plaster models at five time points. The rate of incisor movement was evaluated by Student's t-test, analysis of variance, and Tukey honestly significant difference tests. Statistical significance was set as P < .05.

RESULTS

The average movements of incisors were significantly higher in the study group than the control group at all time points (P < .05). According to the within-group comparison, none of the measurements showed any significant differences between the right and left sides in both groups at all time points (P > .05). While the movement of incisors was significantly higher in the study group in the week following the PRF injection compared to the other weeks (P < .05), there were no significant differences in the control group at all-time points (P > .05).

CONCLUSIONS

Applying i-PRF significantly increased the rate of maxillary incisor retraction at all time intervals. Platelet-rich fibrin injection can be an effective method for shortening treatment duration.

Is Inflammation a Friend or Foe for Orthodontic Treatment?: Inflammation in Orthodontically Induced Inflammatory Root Resorption and Accelerating Tooth Movement

The aim of this paper is to provide a review on the role of inflammation in orthodontically induced inflammatory root resorption (OIIRR) and accelerating orthodontic tooth movement (AOTM) in orthodontic treatment. Orthodontic tooth movement (OTM) is stimulated by remodeling of the periodontal ligament (PDL) and alveolar bone. These remodeling activities and tooth displacement are involved in the occurrence of an inflammatory process in the periodontium, in response to orthodontic forces. Inflammatory mediators such as prostaglandins (PGs), interleukins (Ils; IL-1, -6, -17), the tumor necrosis factor (TNF)-α superfamily, and receptor activator of nuclear factor (RANK)/RANK ligand (RANKL)/osteoprotegerin (OPG) are increased in the PDL during OTM. OIIRR is one of the accidental symptoms, and inflammatory mediators have been detected in resorbed roots, PDL, and alveolar bone exposed to heavy orthodontic force. Therefore, these inflammatory mediators are involved with the occurrence of OIIRR during orthodontic tooth movement. On the contrary, regional accelerating phenomenon (RAP) occurs after fractures and surgery such as osteotomies or bone grafting, and bone healing is accelerated by increasing osteoclasts and osteoblasts. Recently, tooth movement after surgical procedures such as corticotomy, corticision, piezocision, and micro-osteoperforation might be accelerated by RAP, which increases the bone metabolism. Therefore, inflammation may be involved in accelerated OTM (AOTM). The knowledge of inflammation during orthodontic treatment could be used in preventing OIIRR and AOTM.

Impact of intraoral non-pharmacological non-surgical adjunctive interventions on orthodontically induced inflammatory root resorption in humans: A systematic review

BACKGROUND

The current systematic review aimed to assess the impact of intraoral non-surgical non-pharmacological adjunctive interventions on orthodontically induced inflammatory root resorption (OIIRR).

SEARCH METHODS

Search without restrictions was performed up to November 2020 in three electronic databases (Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE) for randomized controlled trials (RCTs), prospective and retrospective non-randomized studies. The ROB 2.0 tool was used to assess the quality of the included RCTs, and the ROBINS-I tool was applied to non-randomized clinical studies. The strength of evidence was ranked using GRADE.

RESULTS

Three hundred and sixteen records were initially retrieved. A total of 10 studies, with 236 patients, were finally considered. These studies assessed the effects of mechanical vibration (low-frequency and high-frequency), low-intensity pulsed ultrasound (LIPUS), low-level laser therapy (LLLT) and photobiomodulation (light-emitting devices (LED). While the low-frequency vibration and LED do not seem to affect OIIRR, OIIRR has been reported to be reduced in high-frequency vibration, and LIPUS-treated teeth (differences may not likely be considered clinically relevant). The potential positive effect of LLLT on OIIRR is still debatable. Overall, the existing evidence suggests that the amount of OIIRR observed while using these interventions with traditional orthodontic treatment was not more than that was observed without it.

CONCLUSIONS

Based on a very low level of confidence, it seems that intraoral non-pharmacological non-surgical adjunctive interventions do not affect the amount of OIIRR either positively or negatively to a clinically relevant degree when compared to what is seen with conventional orthodontic treatment alone.

MicroRNA-125a-5p modulates macrophage polarization by targeting E26 transformation-specific variant 6 gene during orthodontic tooth movement

OBJECTIVE

The aim of this study was to investigate the role of microRNA-125a-5p (miR-125a-5p) in macrophages during orthodontic tooth movement (OTM).

DESIGN

Periodontal ligament tissues were collected from patients underwent OTM. Periodontal ligament cells were isolated from periodontal ligament tissues. Periodontal ligament stem cells were isolated from normal human impacted third molars. The miR-125-5p levels were measured by real-time quantitative polymerase chain reaction. The impact of miR-125-5p on macrophage polarization was tested by alizarin red staining assay. The effects of miR-125-5p and E26 transformation-specific variant 6 gene (ETV6) on M1/M2 macrophages phenotype markers were determined by real-time quantitative polymerase chain reaction, western blot, and flow cytometry analyses. The interaction between miR-125-5p and ETV6 was verified using luciferase reporter and RNA immunoprecipitation assays.

RESULTS

Periodontal miR-125a-5p was upregulated under the force. Macrophage polarization facilitated osteogenesis by cocultured system. Moreover, miR-125a-5p was upregulated in macrophages polarized with M2 conditions. MiR-125a-5p downregulation promoted the expression of M1 phenotype markers, while suppressed the expression of M2 markers. Mechanistically, ETV6 was confirmed to be a target of miR-125a-5p. ETV6 overexpression increased the expression of M1 polarized markers, while decreased the expression of M2 polarized markers. Furthermore, ETV6 knockdown reversed the effects of miR-125a-5p inhibitor on both M1 macrophages and M2 macrophages.

CONCLUSIONS

Overall, miR-125a-5p facilitates bone healing by targeting ETV6 to promote macrophage M2 polarization.

Surgically accelerated orthodontic techniques and periodontal response: a systematic review

BACKGROUND

Reduction in orthodontic treatment time is gaining popularity due to patient demands. Several new techniques of acceleratory orthodontic treatment have been introduced to effectively treat the malocclusion in a shorter time period with minimal adverse effects.

OBJECTIVE

The objective of this systematic review is to critically evaluate the potential effect of accelerated surgically assisted orthodontic techniques on periodontal tissues.

MATERIALS AND METHODS

Electronic databases used to perform the search were Medline (Ovid), EMBASE, PubMed, Scopus, Cochrane, Google Scholar, and hand searching of the literature was also performed.

SELECTION CRITERIA

Only randomized control trials (RCTs) that assessed the relationship between accelerated surgically assisted orthodontic techniques and its effects on periodontium were included.

DATA COLLECTION AND ANALYSIS

The Joanna Briggs Institute (JBI) critical appraisal checklist tool (2016) was used to assess the finally selected studies. Among these studies, five evaluated corticotomy-facilitated orthodontics, two tested accelerated tooth movement with piezocision, one compared corticotomy-facilitated orthodontics with piezocision, and one studied the effects of periodontally accelerated osteogenic orthodontics. The duration of these studies was relatively short and had moderate to high risk of bias.

RESULTS

Literature search identified 225 records from 5 databases and 50 articles from the partial grey literature (Google scholar) search. Finally, nine eligible RCTs were included in the review.

LIMITATIONS

Most of the included studies were of a high risk of bias due to high experimental heterogeneity and small sample size. Long-term follow-up of the periodontal response to these interventions was also lacking.

CONCLUSIONS

There is an absence of evidence considering the lack of long-term follow-up and small sample size therefore, the results of this review should be carefully interpreted.

IMPLICATIONS

Due to the need for more studies with less risk of bias, these techniques should be implemented in dental practice with caution. With stronger evidence, the study may be confirmed to provide quicker desired results for orthodontic patients.

REGISTRATION

This study protocol was not registered.

FUNDING

No funding was obtained for this systematic review.

NIR light-assisted phototherapies for bone-related diseases and bone tissue regeneration: A systematic review

Recently, the rapid development of biomaterials has induced great interest in the precisely targeted treatment of bone-related diseases, including bone cancers, infections, and inflammation. Realizing noninvasive therapeutic effects, as well as improving bone tissue regeneration, is essential for the success of bone‑related disease therapies. In recent years, researchers have focused on the development of stimuli-responsive strategies to treat bone-related diseases and to realize bone regeneration. Among the various external stimuli for targeted therapy, near infrared (NIR) light has attracted considerable interests due to its high tissue penetration capacity, minimal damage toward normal tissues, and easy remote control properties. The main objective of this systematic review was to reveal the current applications of NIR light-assisted phototherapy for bone-related disease treatment and bone tissue regeneration. Database collection was completed by June 1, 2020, and a total of 81 relevant studies were finally included. We outlined the various therapeutic applications of photothermal, photodynamic and photobiomodulation effects under NIR light irradiation for bone‑related disease treatment and bone regeneration, based on the retrieved literatures. In addition, the advantages and promising applications of NIR light-responsive drug delivery systems for spatiotemporal-controlled therapy were summarized. These findings have revealed that NIR light-assisted phototherapy plays an important role in bone-related disease treatment and bone tissue regeneration, with significant promise for further biomedical and clinical applications.

Outcome of photodynamic therapy on orthodontic leveling and alignment of mandibular anterior segment: A controlled clinical trial

BACKGROUND

Photodynamic therapy (PDT) is a non-invasive approach that has drawn attention to accelerate orthodontic tooth movement (OTM). However, no studies have been published that evaluates the outcome of PDT on orthodontic leveling and alignment. Therefore, the present study aimed to evaluate outcome of PDT on orthodontic leveling and alignment of mandibular anterior segment.

MATERIALS AND METHODS

Thirty patients (18 females and 12 males) were included who had moderate mandibular crowding with average age was 19.23 ± 3.1 years. They were randomly divided into a control group without PDT intervention and a laser group. All patients followed non-extraction approach using one category of fixed appliance and matching NiTi archwire sequence for 3 months. In PDT group, methylene blue mediated gallium aluminum arsenide laser was applied with 635 nm, 6.5 J/cm², for 10 s at 10 points (0.2 J/point) started immediately after first wire then at days 3,7,14 of first month and repeated for additional 2 months. Relief of crowding was assessed by Little`s irregularity index (LII) scores after 4, 8, and 12 weeks through scanned 3-dimensional models via a software.

RESULTS

Both groups showed improvements in mandibular crowding as evidenced by significant decreases (p ≤ 0.001) in LII scores during all observation intervals with no significant differences (p > 0.05). Moreover, the alignment`s rate showed no significant differences between groups.

CONCLUSION

PDT produced a negligible effect concerning alignment of crowded mandibular anterior teeth. Besides, OTM's rate at different observation intervals showed an equivalent pattern either with or without PDT.

Comparison of rate of orthodontic tooth movement in adolescent patients undergoing treatment by first bicuspid extraction and en-mass retraction, associated with low level laser therapy in passive self-ligating and conventional brackets: A randomized controlled trial

BACKGROUND

Low Level Laser Therapy (LLLT) is one of the various interventions to accelerate the rate of Orthodontic Tooth Movement (OTM) in adolescent patients who are undergoing en-mass retraction after all first bicuspid extractions.

OBJECTIVES

To assess the efficacy of LLLT in increasing the rate of OTM.

MATERIALS AND METHODS

Setting and sample population: Institutional Department of Orthodontics and Dentofacial Orthopaedics. Participants, study design and methods: 65 Patients requiring all first premolar extractions were randomly allocated to three groups. Two groups (Comprising of passive self-ligating brackets and conventional brackets) were treated with LLLT and one group served as the control (conventional brackets). The allocation ratio was 1:1:1.32. Eligibility criteria: adolescent patients with sound and healthy permanent dentition with Little's Irregularity Index<5mm.

MAIN OUTCOME

rate of tooth movement in mm/month. Randomization and blinding: computer-generated random allocation sequence; only the data analyser was blinded by coding the digital models. Patients were reviewed once every month till the completion of space closure.

STATISTICS

data normality was checked using Shapiro-Wilks test and Q-Q Plot. Parametric tests were applied for the inferential statistics (ANCOVA) with Dunnett's t test being used for post hoc analysis.

RESULTS

There was a statistically significant enhancement in the rate of OTM in the 2 experimental groups (0.68/0.67mm/month in the right and left side of the maxilla and 0.66/0.65mm/month in the right and left side of the mandible) when compared with the control group (0.48mm/month in the maxilla and 0.48mm/month in the mandible) (P<0.05), but when the 2 experimental groups were compared no difference was observed (P>0.05). No serious harms were reported.

CONCLUSION

A significant increase in the rate of OTM was observed with the application of LLLT. No difference was observed in the rate of OTM when comparing different ligation methods treated with LLLT.

REGISTRATION

National Trial Registry (CTRI No- CTRI/2018/04/013156). Protocol was not published before trial commencement.

Photobiomodulation Therapy on Orthodontic Movement: Analysis of Preliminary Studies with a New Protocol

This study aimed to investigate the effectiveness of photobiomodulation therapy (PBMT) on the acceleration of orthodontic movements, deriving from its biostimulating and regenerative capacity on soft tissues, consequent to the increase in differentiation, proliferation, and activity of cells that are involved with alveolar bone remodeling. The present randomized controlled trial was conducted on six patients who required extractive orthodontic therapy because their ectopic canines had erupted. A total of eight canines were analyzed, four of which received laser irradiation (i.e., experimental group). Two weeks after the extractions, all canines of the experimental and placebo groups were distalized simultaneously and symmetrically with the laceback retraction technique. The PBMT protocol consisted of four cycles of laser applications, one each on days 0, 3, 7, and 14 of the study, with session treatment durations of 2–4 min. The results of the descriptive analysis on the distal displacement speed of the canines after 1 month of follow-up indicate an average displacement of 1.35 mm for the non-irradiated group and 1.98 mm for the irradiated group. Through inferential analysis, a statistically significant difference (p < 0.05) was found between the average speed of the irradiated canines and the control canines. The low energy density laser used in this study, with the parameters set, was found to be a tool capable of statistically significantly accelerating the distal displacement of canines.

The Effect of Low-Level Laser Therapy on the Acceleration of Orthodontic Tooth Movement

In clinical practice, low-level laser therapy (LLLT) is widely used. The main aim of this review is to assess the effectiveness of LLLT in accelerating tooth movement in human subjects. The PRISMA checklist was utilized as a guideline to carry out this systematic review. The electronic databases were searched from Google Scholar (2014-2018) and PubMed, and comprehensive research on this topic was also manually conducted. Therefore, 77 articles randomized clinical trials (RCTs) or controlled clinical trials (CCTs) were selected. After screening studies, consequently, eleven trials met the inclusion criteria. Eight out of 11 studies showed LLLT has a significant impact on the acceleration of orthodontic tooth movement, and there was no statistically significant difference in the rate of tooth movement between the laser group and the control group in the two remaining studies. Furthermore, five out of 11 articles showed that LLLT has no adverse effects. Although we have some degree of understanding from a cellular point of view to LLLT effects, we still do not know whether these cellular level changes have any effect on the clinical acceleration of orthodontic tooth movement. The results are inconclusive and cannot be generalized to the public community; therefore, well-structured studies are required.

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

BACKGROUND

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

OBJECTIVES

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

SEARCH STRATEGY

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

SEARCH CRITERIA

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

DATA COLLECTION AND ANALYSIS

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

RESULTS

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

CONCLUSION

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

Effectiveness of electric toothbrush as vibration method on orthodontic tooth movement: a split-mouth study

Objective:

To investigate the effects of application of vibratory stimuli, using an electric toothbrush, on the rate of orthodontic tooth movement during maxillary canine retraction.

Methods:

A split-mouth study was conducted in 28 subjects (mean age = 20.8 years; ranging from 18 to 24 years) whose bilateral maxillary first premolars were extracted with subsequent canine retraction. On the Vibration side, light force (100 g) was applied to the canine for 90 days, in combination with vibratory stimuli provided by an electric toothbrush; only orthodontic force was applied to the canine on the non-vibration side. Amount of canine movement was measured monthly. Related to electronic toothbrush usage, a diary was provided to each patient for recording discomfort during experimental period, having 100-mm visual analogue scale (VAS). The paired t-test was used to assess the differences in amount of tooth movement between canines of the vibration and non-vibration sides.

Results:

The amount of tooth movement was similar for canines on the vibration side and on the non-vibration side (mean 0.81 ± 0.10 mm and 0.82 ± 0.11 mm, respectively, p> 0.05). Plaque accumulation was minimal in any subject throughout the study. No subject reported discomfort as a result of using the electric toothbrush.

Conclusions:

This study demonstrates that application of vibratory stimuli using an electric toothbrush, in combination with light orthodontic force, do not accelerate orthodontic tooth movement.

Effects of low magnitude high frequency mechanical vibration combined with compressive force on human periodontal ligament cells in vitro

Objective

Vibration can be used to accelerate tooth movement, though the exact mechanisms remain unclear. This study aimed to investigate the effects of low magnitude high frequency (LMHF) vibration combined with compressive force on periodontal ligament (PDL) cells in vitro.

Materials and methods

Human PDL cells were isolated from extracted premolar teeth of four individuals. To determine the optimal frequency for later used in combination with compressive force, three cycles of low-magnitude (0.3 g) vibrations at various frequencies (30, 60, or 90 Hz) were applied to PDL cells for 20 min every 24 h. To investigate the effects of vibration combined with compressive force, PDL cells were subjected to three cycles of optimal vibration frequency (V) or 1.5 g/cm2 compressive force for 48 h (C) or vibration combined with compressive force (VC). Cell viability was assessed using MTT assay. PGE2, soluble RANKL (sRANKL), and OPG production were quantified by ELISA. RANKL, OPG, and Runx2 expression were determined using real-time PCR.

Results

Cell viability was decreased in groups C and VC. PGE2 and RANKL, but not OPG, were increased in groups V, C, and VC, thus increasing the RANKL/OPG ratio. The highest level was observed in group VC. sRANKL was increased in groups V, C, and VC; however, no significant different between the experimental groups. Runx2 expression was reduced in groups C and VC.

Conclusions

Vibration increased PGE2, RANKL, and sRANKL, but not OPG and Runx2. Vibration had the additive effects on PGE2 and RANKL, but not sRANKL in compressed PDL cells.

Periodontal Accelerated Osteogenic Orthodontics Technique for Rapid Orthodontic Tooth Movement: A Systematic Review

Aim:

The aim of this review was to analyze the data in the available literature regarding aspects of periodontally accelerated orthodontic therapy such as reduction in treatment time, variation in surgical techniques, and patient satisfaction.

Materials and Methods:

An internet-based search was performed for the articles published between January 2008 and August 2018 using keywords periodontal accelerated orthodontic tooth movement, corticotomy, bone grafting, tooth movement, and treatment duration. A total of 84 articles were obtained from MEDLINE and Embase search engines, of which 31 articles were eligible to be included for the systematic review.

Results:

On analysis, it was observed that the earlier studies were predominantly pertaining to case reports. In the later part of the decade considered in this review, it was observed that the emphasis was given to clinical and animal studies.

Conclusions:

Most of the studies included in the review concluded that there was a significant reduction in orthodontic treatment duration using periodontal accelerated techniques compared to conventional orthodontic treatment.

Extracorporeal shockwave treatment impedes tooth movement in rats

Background

Accelerated tooth movement has been a topic of interest for orthodontic research recently. Surgically facilitated orthodontic treatment has been shown to be an effective approach to accelerate tooth movement; however, it remains invasive, requires additional surgery, and may increase post-operative complications. In this study, we evaluate the effects of extracorporeal shockwave treatment (ESWT), a non-invasive approach to regenerate alveolar bone, on orthodontic tooth movement in rats.

Materials and methods

Seventy-two male rats, aged 10 weeks old, were subjected to 10-cN closed-coil nickel-titanium springs for unilateral maxillary first molar tooth movement. One group of rats received a single treatment of extracorporeal shockwave treatment at 500 impulses at energy flux density 0.1 mJ/mm², with a pulse rate of 5 pulses per second immediately after spring installation while the non-ESWT-treated group served as a control group. The rats were sacrificed at day 3, 7, 14, 21 and 28 for tooth movement evaluation and sample analyses. Faxitron radiography, histological, double bone labeling and gene expression analyses were performed. Serum biochemistry was evaluated at day 3, 7 and 28 of the study. Kruskal-Wallis analysis of variance was used to determine the mean difference among groups, and multiple comparisons were analyzed by Mann-Whitney-U tests with a significance level = 0.05.

Results

The results demonstrated that tooth movement in the ESWT-treated rats (0.11 ± 0.07 mm) was impeded compared to the tooth movement in the non-ESWT-treated rats (0.44 ± 0.09 mm). ESWT up-regulated several osteoblastic and osteoclastic gene markers and cytokines; however, the effects on osteoclasts were only transient. Double-fluorescence bone labeling demonstrated that osteoblastic activity increased after ESWT treatment. There was no difference in systemic RANKL/OPG ratio between groups.

Conclusions

ESWT at 500 impulse at energy flux density 0.1 mJ/mm² increased osteoblast and osteoclast activities and imbalanced bone remodeling resulting in impeded tooth movement in rats.

Comparison of piezocision and discision methods in orthodontic treatment

Background

Discision method may provide an alternative to the piezocision approach in accelerated orthodontic treatment. The purpose of this study was to investigate the efficacy of discision on accelerated orthodontic tooth movement in comparison to the piezocision method in moderate crowding Angle Class I malocclusions.

Methods

Thirty-five female individuals were included in this clinical study. The participants were classified into three groups as conventional fixed non-extraction orthodontic treatment only (OT, n = 14), piezocision in addition to fixed non-extraction orthodontic treatment (PG, n = 9), and discision in addition to fixed non-extraction orthodontic treatment (DG, n = 12). The piezocisions and discisions were performed 1 week after placement of bonding brackets. The patients were seen at 2–3 week-intervals. Initial Little’s irregularity index scores were recorded from dental casts. Periodontal parameters were measured initially, after the 1-month orthodontic treatment. Probing pocket depth, bleeding on probing, plaque index, and gingival index were recorded. Visual analog scale (VAS) was performed over the first month at different times following the bracket bonding for pain assessment. The total orthodontic treatment duration was noted.

Results

The duration of orthodontic treatment was statistically decreased in PG and DG compared to OT (P = 0.003). There was no statistical difference between PG and DG in orthodontic treatment duration (P > 0.05). There was no statistical difference between the two experimental groups in terms of VAS and periodontal parameter values (P > 0.05).

Conclusions

This is the first clinical orthodontic study to assess the effect of discision on the rate of orthodontic tooth movement. Discision is comparable to piezocision in terms of tooth movement acceleration, pain level, and periodontal status. The discision seems to be effective in reducing the time of orthodontic treatment.

Bacteremia after micro-osteoperforation

OBJECTIVE

To find out the presence of bacteremia following micro-osteoperforation.

MATERIAL AND METHODS

The sample consisted of 28 Class I orthodontic patients (21 women, 7 men; mean age, 18.11±0.4 years). The micro-osteoperforation was performed 4 weeks following bonding of fixed orthodontic appliances. Using aseptic technique, 20-mL blood sample was collected before the micro-osteoperforation and another 20-mL, 60 seconds after the first micro-osteoperforation. The blood was inoculated into culture bottles and incubated at 37°C for 1 week. Bacterial growth was investigated by using Gram staining technique. The results were analysed using the McNemar test.

RESULT

No significant difference between the preoperative and postoperative samples was found with respect to bacteremia (P=0.229).

CONCLUSION

Micro-osteoperforation technique is not related to transitory bacteremia.

Effect of Photobiomodulation on Maxillary Decrowding and Root Resorption: A Randomized Clinical Trial

Purpose

The effects of low-level laser therapy (LLLT) with light-emitting diode (LED) delivery (Biolux OrthoPulse® device) were tested for no differences from sham-controlled conventional orthodontics in maxillary anterior alignment treatment efficiency and maxillary central incisor root resorption after 6 months of treatment.

Materials and Methods

Two prospective clinical trial samples were matched for pretreatment irregularity index with (n = 14) and without (n = 12) photobiomodulation therapy (850 nm wavelength, 0.065 J/cm2, 5 min per-arch-per-day) and examined every 2 weeks for reduction of irregularity index to <1 mm. The sham control sample was provided with LED devices that did not deliver infrared light. Standardized periapical radiographs of maxillary central incisors were compared at initial and 6 months of treatment.

Results

Photobiomodulation resolved maxillary anterior crowding with 35.2% greater efficiency (41.0 vs. 63.3 days, P = 0.028) at nearly double the tooth movement rate-per-week (1.02 vs. 62 mm/week, P = 0.045). Mean maxillary central incisor root lengths were significantly shorter at the 6-month treatment interval after LLLT (19.63 vs. 20.85 mm, P = 0.021).

Conclusions

LED photobiomodulation therapy at 850 nm wavelength resulted in 1.7X more rapid maxillary anterior alignment.

Osseous outgrowth on the buccal maxilla associated with piezosurgery-assisted en-masse retraction: A case series

Piezoelectric surgery is a novel surgical approach used in orthodontic treatment for rapid tooth movement. This paper presents a case series wherein osseous outgrowths were observed in response to piezosurgery-assisted en-masse retraction. Sixteen patients requiring upper premolar extractions were treated with miniscrew-supported en-masse retraction and received minimally invasive decortication via piezosurgery. Computed tomography (CT) of the maxillary anterior region was performed to investigate the nature of the outgrowths. In 8 of the 16 patients, hemispheric or disc-shaped osseous outgrowths were observed on the sites where piezosurgery was performed during retraction. CT images revealed that these outgrowths were alveolar bone. This case series presents a previously unreported osseous response to piezosurgery-assisted tooth movement during orthodontic treatment. The response is mostly transient and is observed in 50% of the treated patients, suggesting a bone turnover that can be assessed clinically and radiographically.

The effectiveness of vibrational stimulus to accelerate orthodontic tooth movement: a systematic review

BACKGROUND

In recent years, it has been a hot research topic to accelerate orthodontic tooth movement (OTM) through vibration. This review was therefore aimed to systematically evaluate the available evidences on the efficacy of vibrational stimulus to accelerate OTM.

METHODS

Randomized controlled trials and controlled clinical trials that evaluated the efficacy of vibration on OTM acceleration were searched through electronic and manual search. Two review authors independently conducted the study inclusion, quality assessment and data extraction. The quality of synthesized evidence was assessed according to GRADE system.

RESULTS

Eight clinical trials were included in this systematic review. Four studies found that vibration did not enhance the rate of OTM during alignment phase. Two studies revealed that the use of vibratory stimulation accelerated canine retraction. No deleterious effects including pain perceptions and root resorptions were reported.

CONCLUSIONS

Within the limitations of this review, weak evidence indicates that vibrational stimulus is effective for accelerating canine retraction but not for alignment. The effects of vibration on pain intensity and root resorption during orthodontic treatment are inconclusive. Future high-quality clinical trials are needed before warranting recommendations to clinical application.

Hydrogen sulfide regulates bone remodeling and promotes orthodontic tooth movement

Hydrogen sulfide (H₂S) is a gas signaling molecule that has multiple influences on physiological and pathological processes in the mammalian body, including vasodilation, neurotransmission, inflammation, hypoxia sensing and bone remodeling. Our previous studies suggested that H₂S might be involved in the periodontal tissue remodeling during the orthodontic tooth movement (OTM) via increasing periodontal ligament cell differentiation, tissue mineralization, bone formation and collagen synthesis. The aim of the present study was to investigate the effects of H₂S on alveolar bone remodeling that is associated with tooth movement. Experiments were performed in an OTM mouse model. Sodium hydrosulfide (NaHS), which is a donor of H₂S and DL-propargylglycine (PAG) and a cystathionine-γ-lyase (CSE) inhibitor, which could also decrease H₂S expression, were administered intraperitoneally and respectively. A total of 60 male C57BL6/J mice were divided into 4 groups; Control, NaHS, PAG and combination (PAG+NaHS). The rate of OTM and the bone mineral density (BMD) of alveolar bone were scanned and measured by micro-computed tomography (micro-CT). The number of osteoclasts and expression of the tumor necrosis factor ligand superfamily member-11 (RANKL), alkaline phosphatase (ALP), osteocalcin (OCN) and osteoprotegerin (OPG) in alveolar bone were accessed to evaluate the osteoclastic activity and osteogenesis with histochemistry of tartrate-resistant acid phosphatase staining, immunohistochemistry and reverse transcription-quantitative polymerase chain reaction. In the alveolar bone, NaHS increased the OTM and decreased the BMD, respectively. PAG significantly decrease OTM and increased the BMD. NaHS combined with PAG rescued the PAG-induced changes in the OTM and the BMD. Additionally, the number of osteoclasts, the expression of RANKL, ALP, OCN and the ratio of RANKL/OPG were significantly up-regulated in the NaHS group. In contrast, PAG down-regulated the number of osteoclasts, the expression of RANKL, ALP, OCN and the ratio of RANKL/OPG. These findings suggested that H₂S might facilitate the OTM by enhancing alveolar bone remodeling as a result of an increased osteoclastic activity and osteogenesis.

Assessment of the changes in arch perimeter and irregularity in the mandibular arch during initial alignment with the AcceleDent Aura appliance vs no appliance in adolescents: A single-blind randomized clinical trial

INTRODUCTION

The purpose of this 2-arm parallel trial was to assess the effects of the AcceleDent Aura (OrthoAccel Technologies, Houston, Tex) appliance on the increase in mandibular anterior arch perimeter, the reduction in mandibular arch irregularity, and the amount of discomfort during initial alignment of the mandibular arch with fixed appliances.

METHODS

Forty Class II adolescent patients with full fixed appliances and treated with maxillary premolar extractions and no extractions in the mandibular arch participated in this randomized clinical trial. They were recruited in a private practice and treated by 1 clinician. Randomization to either a no-appliance group or the AcceleDent Aura appliance group was accomplished with permuted blocks of 10 patients with the allocations concealed in opaque, sealed envelopes. Both the operator and the outcome assessor were blinded, but it was not feasible to blind the patients. Discomfort was recorded during the first week of treatment. Mandibular anterior arch perimeter and anterior irregularity were measured from plaster models taken at the start of treatment and after 5, 8, and 10 weeks.

RESULTS

No patients were lost to follow-up, and no data were missing. There was no difference in anterior arch perimeter at the start of treatment (P = 0.85; median, 0.6 mm; 95% confidence interval [CI], -1.6, +1.8 mm) or at any other time point (5 weeks: P = 0.84; median, -0.2 mm; 95% CI, -1.6, +1.2 mm; 8 weeks: P = 0.56; median, -0.3 mm; 95% CI, -1.6, +0.7 mm; 10 weeks: P = 0.67; median, -0.1 mm; 95% CI, -1.5, +1.1 mm). There was also no difference between groups for incisor irregularity (P = 0.46; median, -0.5 mm; 95% CI, -2.2, +2.8 mm; P = 0.80; median, 0.0 mm; 95% CI, -1.0, +1.1 mm; P = 0.70; median, 0.1 mm; 95% CI, -0.7, +0.8 mm; P = 0.65; median, 0.2 mm; 95% CI, -0.6, +0.6 mm). No difference was detected at any time during the first week for discomfort (baseline: P = 0.84; median, -1.5 mm; 95% CI, -15.9, +9.8 mm; 6 hours: P = 0.96; median, 0.3 mm; 95% CI, -23.5, +21.8 mm; 1 day: P, 0.75; median, -3.5 mm; 95% CI, -27.1, +26.9 mm; 3 days: P = 0.98; median, -0.6 mm; 95% CI, -20.6, +20.0; 7 days: P = 0.57; median, 0.5 mm; 95% CI, -5.0, +5.3 mm). However, significantly fewer participants in the AcceleDent Aura group used analgesics at day 1 (P = <0.01).

CONCLUSIONS

The AcceleDent Aura appliance had no effect compared with no appliance on increasing anterior arch perimeter, or reducing irregularity or perceived discomfort during initial alignment with fixed appliances, although more subjects used painkillers at 24 hours in the no-appliance group.

REGISTRATION

This trial was not registered.

PROTOCOL

The protocol was not published before trial commencement.

FUNDING

A special research grant was obtained from the Australian Society of Orthodontists Foundation for Research and Education to purchase the AcceleDent Aura appliances and fund the statistical analysis.

Effectiveness of minimally invasive surgical procedures in the acceleration of tooth movement: a systematic review and meta-analysis

OBJECTIVE

The objective of this study was to assess systematically the available scientific evidence relating the efficiency of minimally invasive surgical procedures in accelerating orthodontic tooth movement and the adverse effects associated with these procedures.

METHODS

Electronic search of these databases CENTRAL, EMBASE, Scopus, PubMed, Web of Science, Google Scholar Beta, Trip, OpenGrey and PQDT OPEN was performed (last updated January 2016). The reference lists of the included studies were hand searched. Unpublished literature and ongoing studies were also checked electronically through ClinicalTrials.gov and (ICTRP). Randomized controlled trials (RCTs) with patients who received minimally invasive surgical procedures combined with fixed orthodontic appliances compared with conventional treatment were included. Cochrane's risk of bias tool was used to assess risk of bias.

RESULTS

Four RCTs (61 patients) and nine ongoing protocols were included in this review. Only three RCTs were suitable for quantitative synthesis. Higher tooth movement rate was found with the minimally invasive surgical procedures by a weighted mean difference of 0.65 mm for 1 month of canine retraction (WMD = 0.65: 95 % CI (0.54, 0.76), p < 0.001) and by a weighted mean difference 1.41 mm for 2 months (WMD = 1.41: 95 % CI (0.81, 2.01), p < 0.001). No adverse effects associated with these procedures were reported.

CONCLUSIONS

There is limited available evidence about the effectiveness of minimally invasive surgically accelerated orthodontics (MISAO). Although the current review indicated that MISAO can help in accelerating canine retraction, further research in this domain should be performed before it can be recommended in everyday clinical practice.

Low-level laser therapy effectiveness in accelerating orthodontic tooth movement: A randomized controlled clinical trial

OBJECTIVE

To evaluate the effectiveness of low-level laser therapy (LLLT) in accelerating orthodontic tooth movement of crowded maxillary incisors.

MATERIALS AND METHODS

This two-arm, parallel-group, randomized controlled trial involved 26 patients with severe to extreme maxillary incisors irregularity according to Little's irregularity index, indicating two first premolars extraction. Patients were randomly assigned to either the laser group or the control group (13 each). Following premolars extraction, orthodontic treatment with fixed appliances was initiated for both groups. Immediately after insertion of the first archwire, patients in the laser group received a LLL dose from an 830-nm wavelength Ga-Al-As semiconductor laser device with energy of 2 J/point. The laser was applied to each maxillary incisor's root at four points (two buccal, two palatal). Application was repeated on days 3, 7, 14, and then every 15 days starting from the second month until the end of the leveling and alignment stage. Alignment progress was evaluated on the study casts taken before inserting the first archwire (T0), after 1 month of treatment commencement (T1), after 2 months (T2), and at the end of the leveling and alignment stage (T3). The outcome measures were the overall time needed for leveling and alignment and the leveling and alignment improvement percentage.

RESULTS

A statistically significant difference was found between the two groups in the overall treatment time (P < .001) and the leveling and alignment improvement percentage at T1 (P = .004) and T2; (P = .001).

CONCLUSION

LLLT is an effective method for accelerating orthodontic tooth movement.

Predictors of postretention stability of mandibular dental arch dimensions in patients treated with a lip bumper during mixed dentition followed by fixed appliances

OBJECTIVE

To identify which dental and/or cephalometric variables were predictors of postretention mandibular dental arch stability in patients who underwent treatment with transpalatal arch and lip bumper during mixed dentition followed by full fixed appliances in the permanent dentition.

MATERIALS AND METHODS

Thirty-one patients were divided into stable and relapse groups based on the postretention presence or absence of relapse. Intercuspid, interpremolar, and intermolar widths; arch length and perimeter; crowding; and lower incisor proclination were evaluated before treatment (T0), after lip bumper treatment (T1), after fixed appliance treatment (T2), and a minimum of 3 years after removal of the full fixed appliance (T3). Logistic regression analyses were performed to evaluate the effect of changes between T0 and T1, as predictive variables, on the occurrence of relapse at T3.

RESULTS

The model explained 53.5 % of the variance in treatment stability and correctly classified 80.6 % of the sample. Of the seven prediction variables, intermolar and interpremolar changes between T0 and T1 (P = .024 and P = .034, respectively) were statistically significant. For every millimeter of increase in intermolar and interpremolar widths there was a 1.52 and 2.70 times increase, respectively, in the odds of having stability. There was also weak evidence for the effect of sex (P = .047).

CONCLUSIONS

The best predictors of an average 4-year postretention mandibular dental arch stability after treatment with a lip bumper followed by full fixed appliances were intermolar and interpremolar width increases during lip bumper therapy. The amount of relapse in this crowding could be considered clinically irrelevant.

Visible red and infrared light alters gene expression in human marrow stromal fibroblast cells

OBJECTIVES

This study tested whether or not gene expression in human marrow stromal fibroblast (MSF) cells depends on light wavelength and energy density.

MATERIALS AND METHODS

Primary cultures of isolated human bone marrow stem cells (hBMSC) were exposed to visible red (VR, 633 nm) and infrared (IR, 830 nm) radiation wavelengths from a light emitting diode (LED) over a range of energy densities (0.5, 1.0, 1.5, and 2.0 Joules/cm2) Cultured cells were assayed for cell proliferation, osteogenic potential, adipogenesis, mRNA and protein content. mRNA was analyzed by microarray and compared among different wavelengths and energy densities. Mesenchymal and epithelial cell responses were compared to determine whether responses were cell type specific. Protein array analysis was used to further analyze key pathways identified by microarrays.

RESULT

Different wavelengths and energy densities produced unique sets of genes identified by microarray analysis. Pathway analysis pointed to TGF-beta 1 in the visible red and Akt 1 in the infrared wavelengths as key pathways to study. TGF-beta protein arrays suggested switching from canonical to non-canonical TGF-beta pathways with increases to longer IR wavelengths. Microarrays suggest RANKL and MMP 10 followed IR energy density dose-response curves. Epithelial and mesenchymal cells respond differently to stimulation by light suggesting cell type-specific response is possible.

CONCLUSIONS

These studies demonstrate differential gene expression with different wavelengths, energy densities and cell types. These differences in gene expression have the potential to be exploited for therapeutic purposes and can help explain contradictory results in the literature when wavelengths, energy densities and cell types differ.