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Photobiomodulation (PBM) is a form of treatment that uses low-power red and near-infrared light to stimulate tissue repair and regeneration at the cellular level. 32 subjects (198 teeth examined), 10 males and 22 females aged 14.6 ± 2.0 years, with mild dental crowding were included in a randomised, controlled clinical trial. The patients were treated with a fixed orthodontic appliance (FOA). Subjects were randomised into an experimental group (a PBM group irradiated with an LED light source with wavelengths of 625 nm, 660 nm and 850 nm simultaneously and an irradiance of 16 mW/cm²) and a placebo control group that received non-therapeutic irradiation with visible light. PBM therapy began within the first 2 days of appliance insertion and was administered twice weekly for 4 weeks. The rate of tooth movement (a change in distance at the same selected point on the occlusal plane of the tooth determined by measurements on 3D models), the presence of gingival hypertrophy (with a free gingival margin of at least 1 mm occlusal to the enamel-cement junction), the plaque index (PI), the sulcus bleeding index (SBI) and the subjective pain sensation using the visual analogue scale (VAS) were monitored. In the experimental PBM group ( N  = 14), the rate of movement with the FOA was statistically significantly higher at both 1 week of placement (0.5 mm [95%CI: 0.4–0.8]) and 4 weeks (1.1 mm [95%CI: 0.8–1.4]) than in the placebo group ( N  = 18), where the values were (0.4 mm [95%CI: 0.2–0.5]) at 1 week and (0.6 mm [95%CI: 0.4–0.9]) at 4 weeks. A lower incidence of gingival hypertrophy was observed in the PBM group (21.4%) than in the placebo group (55.6%) after 4 weeks (Mann-Whitney U-test, p  < 0.05). PBM with LED accelerated orthodontic tooth movement during the levelling and alignment phase and reduced the incidence of gingival hypertrophy.

Objective To evaluate external apical root resorption (EARR) and periodontal indices during en‐masse retraction of maxillary anterior teeth stimulated with low‐intensity electrical currents. Trial Design A two‐arm randomized controlled trial. Methods Young adult patients who visited the Department of Orthodontics at Damascus University between November 2023 and March 2024 and met predefined inclusion criteria were randomly allocated into two groups using block randomization. The study included 34 patients, with 17 assigned to the electrically stimulated en‐masse retraction (ESER) group and 17 to the conventional en‐masse retraction (CER) group. The force for the en‐masse retraction technique in both groups was 250 g per side. The force was applied through bilateral closed‐coil nickel‐titanium springs anchored to an orthodontic mini‐screw on each side. In the ESER group, each upper anterior tooth was subjected to a continuous electrical stimulation of 15–20 µA for 5 h daily, utilizing an intraoral removable electrical stimulation device. EARR was assessed using digital panoramic radiographs. Four periodontal indices were also used to assess periodontal status. Blinding was confined to data analysis. Results Thirty‐four patients (26 females and 8 males) were analyzed with a mean age of 21.12 ± 2.41 years. At the end of the en‐masse retraction phase, no significant difference in EARR was observed between the two groups (p > 0.05). The observed root resorption in the ESER and CER ranged between 0.27 and 0.64 and 0.32 and 0.71 mm, respectively. Also, insignificant differences were found in all periodontal indices studied at all measurement points between the two groups (p > 0.05). Conclusions Low‐intensity electrical stimulation had no significant effect on root resorption during the en‐masse retraction of the six upper anterior teeth. Both groups exhibited comparable slight root resorption without any significant difference between them. Additionally, low‐intensity electrical stimulation did not affect the periodontal status during en‐masse retraction. Trail Registration Clinical Trials database (NCT06873490).

Background Controversial results have been reported regarding the impact of photobiomodulation (PBM) on orthodontically induced inflammatory root resorption (OIIRR). The aim of this study was to evaluate the influence of two PBM protocols, one of them requiring a high application frequency (on days 0, 3, 7, 14, then every 2 weeks), while the second requires less frequent applications (every 3 weeks), on OIIRR accompanying orthodontic treatment. Methods Twenty female patients were recruited for this randomized controlled trial, requiring the therapeutic extraction of maxillary first premolars, and they were randomly divided into 2 equal groups. In Group A, one side of the maxillary arch randomly received PBM on days 0, 3, 7, 14, and every 2 weeks thereafter, while in Group B, one side was randomly chosen to receive PBM every 3 weeks. The laser applied was a Diode laser with a wavelength of 980 nm, in a continuous mode. Canine retraction in both groups was carried out using closed-coil springs, delivering 150 g of force, and the force level was checked every 3 weeks, over a 12-week study period. Pre-retraction and post-retraction cone-beam computed tomography (CBCT) was done for the evaluation of OIIRR. Results No significant differences in the amount of OIIRR have been reported between the laser and control sides in both groups A and B. Also, no significant differences have been reported between the laser sides in both groups. Conclusions Photobiomodulation does not affect OIIRR, whether by increasing or decreasing its occurrence, with both laser application protocols. Therefore, it can be stated that PBM does not result in root resorption less than the commonly observed range elicited with conventional orthodontic treatment, and that it has no effect on OIIRR. Trial registration Two Low-level Laser Irradiation Protocols on the Rate of Canine Retraction (NCT04926389), 15/06/2021—retrospectively registered. https://clinicaltrials.gov/ct2/show/NCT04926389 .

Background One of the most undesirable side effects of comprehensive orthodontic treatment is white spot lesions (WSLs). Despite many attempts at prevention of WSLs, its prevalence remains very high on debonding. There are many agents like fluoride toothpastes, fluoride varnishes, and fluoride mouth rinses, and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) is frequently used for the remineralization of WSLs. However, there is no consensus in the literature with respect to the success rates of these agents. Thus, the present study was designed to evaluate the efficacy of fluoride toothpaste alone and in combination with fluoride varnish and CPP-ACP plus crème in the remineralization of post-orthodontic WSLs. Methods Forty-five subjects in the age range of 16–25 years having at least one post-orthodontic WSL were included in the study. All the subjects were randomly divided into three groups (toothpaste group, varnish group, and CPP-ACP group). The efficacy of various remineralizing agents on the remineralization of WSLs was evaluated clinically and by DIAGNOdent immediately after debonding and subsequently after 1, 3, and 6 months of their use. Results Twice daily use of fluoride toothpaste alone had no significant effect on remineralization of WSLs at various intervals of observations ( P  = 0.078). Application of fluoride varnish along with twice daily use of fluoride toothpaste for 6 months significantly decreased the severity of WSLs ( P  < 0.01). Twice daily use of CPP-ACP plus crème along with fluoride toothpaste had significant effect on remineralization of WSLs at the end of 6 months of observation ( P  < 0.05). Between the group comparison showed that the mean visual and DIAGNOdent scores at various time intervals of observations were decreased more when fluoride varnish and CPP-ACP crème were used in addition to daily use of fluoride toothpaste, but the differences were not statistically significant ( P  > 0.05). Conclusions The use of fluoride varnish and CPP-ACP plus crème in addition to twice daily use of fluoride toothpaste had no additional benefit in the remineralization of post-orthodontic WSLs.

Background. This first-in-human study in Saudi orthodontic patients has evaluated the role of low-level laser therapy (LLLT) in pain perception (PP). The outcome of single application of LLLT with 4 different treatment modalities (TM) on PP are evaluated following orthodontic bracket bonding on maxilla. Materials and Methods. A prospective clinical intervention with implementation of parallel technique in each group, 32 orthodontic patients with ectopic canine requiring fixed orthodontic appliance were enrolled and randomly allocated to the 4 groups: LLLT + self-ligating (SL) bracket, LLLT + conventional (Conv.) bracket, non-LLLT + SL bracket, and non-LLLT + Conv. bracket. Orthodontic bracket bonding from 1st molar to 1st molar and superelastic 0.012 inch NiTi were applied for the maxilla. For each patient, maxillary 1st molar to molar received a single application of LLLT using a 940 nm Ga-Al-As laser device on 5 different points labially/buccally and palatally. Main outcome measure was the degree of PP score during the 1st week of orthodontic tooth movement (OTM) after 4 hours, 24 hours, 3 days, and 7 days of both LLLT and non-LLLT treatment applications. A questionnaire with an 11-point numeric rating scale (NRS) was used for PP. Results. Mean ± SD of PP in the LLLT + SL group was 3.33 ± 1.4, 3.58 ± 1.06, 2.31 ± 0.67, and 1.89 ± 0.54 in 4 hours, 24 hours, 3 days, and 7 days, respectively. Compared to all 4 TM groups, LLLT groups showed better PP. More statistically significant differences were found in LLLT groups. No harms were encountered. Limitations. The intervention provider and the patient were not blinded to the intervention. Conclusion. The LLLT + SL group revealed significantly promising benefits on PP during OTM.

Background An orthodontic device that moves teeth with pulsating force was invented and underwent a single center, controlled, clinical trial to test its safety and efficacy for treatment. The device has a custom-made thermo-plastic mouthpiece which fits over the teeth with an inflatable silicone element. A console that measures and controls the pulsating force level in real-time controls the air pressure that delivers a pulsating force. In this study, the effect of the device on root resorption during orthodontic treatment was evaluated using 3D cone beam computed tomography and compared with a control group of patients who received Invisalign treatment. Methods Twenty-eight subjects were enrolled in the investigational arm and 15 in the control group. Subjects were followed until the average score of the mandibular and maxillary teeth achieved a Little’s Irregularity Index of 1.5 mm or less. Results There were no adverse events reported throughout the study for either treatment arm. No clinically significant root resorption was observed for either group. The investigational device did not cause root resorption greater than the control group. Both devices produced a safety profile compared to current orthodontic techniques. Conclusion The investigational device did not produce more root resorption than similar conventional orthodontic appliances. Trial registration ClinicalTrials.gov, NCT03421886 . Registered 12 January 2018 - Retrospectively registered.

Phototherapy with low-level coherent light (laser) has been reported as an analgesic and anti-inflammatory as well as having a positive effect in tissue repair in orthodontics. However, there are few clinical studies using low-level LED therapy (non-coherent light). The aim of the present study was to analyze the pain symptoms after orthodontic tooth movement associated with and not associated with coherent and non-coherent phototherapy. Fifty-five volunteers (mean age = 24.1 ± 8.1 years) were randomly divided into four groups: G1 (control), G2 (placebo), G3 (protocol 1: laser, InGaAlP, 660 nm, 4 J/cm 2 , 0.03 W, 25 s), G4 (protocol 2: LED, GaAlAs, 640 nm with 40 nm full-bandwidth at half-maximum, 4 J/cm 2 , 0.10 W, 70 s). Separators were used to induce orthodontic pain and the volunteers pain levels were scored with the visual analog scale (VAS) after the separator placement, after the therapy (placebo, laser, or LED), and after 2, 24, 48, 72, 96, and 120 h. The laser group did not have statistically significant results in the reduction of pain level compared to the LED group. The LED group had a significant reduction in pain levels between 2 and 120 h compared to the control and the laser groups. The LED therapy showed a significant reduction in pain sensitivity (an average of 56%), after the orthodontic tooth movement when compared to the control group.

Background Pain is the most common complication of orthodontic treatment. Low-level laser therapy (LLLT) has been suggested as a new analgesic treatment free of the adverse effects of analgesic medications. However, it is not studied thoroughly, and the available studies are quite controversial. Moreover, helium neon (He-Ne) laser has not been assessed before. Methods This split-mouth placebo-controlled randomized clinical trial was performed on 16 male and 14 female orthodontic patients requiring bilateral upper canine retraction. The study was performed at a private clinic in Sari, Iran, in 2014. It was single blind: patients, orthodontist, and personnel were blinded of the allocations, but the laser operator (periodontist) was not blinded. Once canine retractor was activated, a randomly selected maxillary quarter received a single dose of He-Ne laser irradiation (632.8 nm, 10 mw, 6 j/cm 2 density). The other quarter served as the placebo side, treated by the same device but powered off. In the first, second, fourth, and seventh days, blinded patients rated their pain sensed on each side at home using visual analog scale (VAS) questionnaires. There was no harm identified during or after the study. Pain changes were analyzed using two- and one-way repeated-measures ANOVA, Bonferroni, and t -test ( α  = 0.01, β  > 0.99). This trial was not registered. It was self-funded by the authors. Results Sixteen males and 11 females remained in the study (aged 12–21). Average pain scores sensed in all 4 intervals on control and laser sides were 4.06 ± 2.85 and 2.35 ± 1.77, respectively ( t -test P  < 0.0001). One-way ANOVA showed significant pain declines over time, in each group ( P  < 0.0001). Two-way ANOVA showed significant effects for LLLT ( P  < 0.0001) and time ( P  = <0.0001). Conclusions Single-dose He-Ne laser therapy might reduce orthodontic pain caused by retracting maxillary canines.

The aim of this randomized clinical study was to investigate the effectiveness of acetaminophen 650 mg or liquefied ibuprofen 400 mg in pain control of orthodontic patients during separation with an elastic separator. A total of 101 patients with specific inclusion criteria were divided randomly into three groups (acetaminophen, liquefied ibuprofen, and placebo). They were instructed to take their drugs one hour before separator placement and every six hours afterward (five doses in total). They recorded their discomfort on visual analog scales immediately after separator placement, 2 hours later, 6 hours later, at bedtime, and 24 hours after separator placement. Repeated measure analysis of variance (ANOVA) was used to compare the mean pain scores between the three groups. Data were collected from 89 patients. The pain increased with time in all groups. Pain scores were statistically lower in the analgesic groups compared with the placebo group (P.value<0.001), but no statistically significant difference was found in mean pain scores between the two drug groups (acetaminophen and liquefied ibuprofen) (P.value=1). Acetaminophen and liquefied ibuprofen have similar potential in pain reduction during separation.

Objectives To evaluate the efficacy of low-intensity pulsed ultrasound (LIPUS) in orthodontic tooth movement (OTM) and orthodontically induced root resorption (OIRR) across animal and human studies. Materials and methods An electronic search in MEDLINE, Embase, Web of Science, Cochrane Library, National Knowledge Infrastructure, and Wanfang Database up to May 2024 identified 931 records screened using predefined PICOS criteria. 18 animal and 8 human studies met the inclusion criteria, with 12 suitable for meta-analysis. Methodological qualities for animal studies were assessed using the SYRCLE tool and ARRIVE guidelines. For clinical trials, the Cochrane RoB 2.0 tool and ROBINS-I were applied to evaluate the risk of bias in randomized clinical trials (RCTs) and controlled clinical trials (CCTs), respectively. Evidence quality was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach, and quantitative analysis employed RevMan software with an inverse variance method and random effects models for all included studies. Results Most animal and human studies had a high or unclear risk of bias. LIPUS significantly accelerated OTM in rats, showing increases of 0.08 mm (95% CI, 0.02 to 0.13; P  = 0.006), 0.11 mm (95% CI, 0.04 to 0.17; P  = 0.001), and 0.11 mm (95% CI, 0.06 to 0.16; P  < 0.0001) on days 5, 7, and 14. In clinical trials, LIPUS reduced treatment duration with clear aligners by 352.07 days (95% CI, -524.81 to -179.34; P  < 0.0001), but had no significant effect on OIRR ( P  > 0.05). GRADE analysis indicated very low evidence quality for both outcomes. Conclusions LIPUS may accelerate OTM but shows weak evidence for alleviating OIRR. More well-designed studies with standardized methodology are needed. Clinical relevance LIPUS could benefit OTM acceleration, but its effect on OIRR remains inconclusive.