Shahid, Fazal
(2020)
Effects of low-level laser therapy on orthodontic tooth movement: a randomised clinical trial.
PhD thesis, Universiti Sains Malaysia.
Abstract
The purpose of this study was to evaluate the effects of low-level laser therapy
(LLLT) on Little Irregularities Index, acceleration of tooth movement, dental arch
dimensional changes, pain perception, inter radicular and buccolingual bony changes,
root resorption, bone densities and chairside time in orthodontic extraction cases using
self-ligating and conventional bracket systems with three-dimensional (3D) evaluation
via cone beam computed tomography (CBCT) and digital dental models (DDM). A
randomised clinical trial was performed with a total of thirty-two patients (eight
patients in each group) with the mean age of 22.41 (4.18) years. The patients were
further divided in four groups randomly [A= self-ligating laser (SLL), B =
conventional bracket laser (CBL), C = self-ligating non laser group (SLNL), D =
conventional non laser bracket (CBNL)]. A 940 nm wavelength laser device (iLase;
Biolase, Irvine, Calif) was used. Laser irradiation applied for both upper and lower
incisors and canine tooth for 6 seconds at mesial and distal side of apical, middle,
mesial and distal side of cervical area with 100mW laser output and energy density
was 75J/cm2 per tooth. Patient’s pre-treatment and at the end of levelling and alignment
stage, the CBCT and DDM acquisition were taken and measured via Planmeca
RomexisTM Software 2.3.1.R (Helsinki, Finland). DDM assessed the acceleration of
tooth movement and dental arch dimensional changes. The root resorption, inter
radicular, buccolingual bony changes and bone densities measured via CBCT
acquisitions of patients. Visual analogue scale (VAS) was given to the patients to
record their pain intensity for seven days. The normality of the data was evaluated with
the Shapiro–Wilk test. Intra-class correlation (ICC) coefficient test was applied to
check the reliability for all the variables. For the intragroup comparison, the paired
sample t-test and Wilcoxon signed-rank test were performed. Descriptive statistic was
applied for assessment of pain perception based on the different wire placement up to
seven consecutive days. For the intergroup comparison, regardless of a bracket system
and LLLT application, an independent t-test and Mann Whitney test were performed.
One-way ANOVA with Post Hoc Bonferroni correction and Kruskal Wallis with pair
wise comparison were performed to assess the comparison of four groups. The intraclass
correlation (ICC) values for intra and inter-examiner reliability were in the range
of excellent correlation of all variables. Most of the variables showed significant
differences in intra group comparison. However, few variables exhibited significant
differences during intergroup comparison regardless of the bracket system
(acceleration of tooth movement, root resorption on 22, bone density on CM11, AD11)
and LLLT application (mandibular IMW, pain on 0.017×0.025 NiTi wire and bone
density on MM33, CD31, CD 41, MP33). Moreover, when comparing all four groups,
significant difference (P<0.05) observed in accelerating tooth movement, inter
radicular bony changes (42 to 41 for CBNL vs CBL), pain (0.014 NiTi archwire), bone
density (AM22, AD12, CP21, AM42, MM33) and chairside time. Other variables
showed no significant differences. In conclusion, LLLT group needed less mean time
to complete levelling and alignment than the non LLLT group. LLLT does not affect
dental arch dimensional changes, inter radicular and buccolingual bony changes, root
resorption and bone density. Bracket system has no effects on the acceleration of the
tooth movement, dental arch dimensional changes, orthodontic pain, inter radicular,
buccolingual bony changes, root resorption and bone density. Self-ligating bracket
takes less chair side time compared to the conventional bracket.
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