Photobiomodulation, Photomedicine, and Laser Surgery

Volume XX, Number XX, 2020 Review

ª Mary Ann Liebert, Inc.
Pp. 1–11
DOI: 10.1089/photob.2019.4779

Comparison of the Effects of Photobiomodulation

with Different Lasers on Orthodontic Movement
and Reduction of the Treatment Time with Fixed
Appliances in Novel Scientific Reports:
A Systematic Review with Meta-Analysis

Maciej Jedliński,1,2 Umberto Romeo, DDS, PhD,2 Alessandro del Vecchio, DDS, PhD,2
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Gaspare Palaia, DDS, PhD,2 and Gabriela Galluccio, DDS, PhD2

Abstract

Background: The duration of orthodontic treatment is one of the most important aspects considered by patients.
Photobiomodulation (PBM) depends upon the exposure of the tissue to particular, therapeutic wavelengths of
light in the ‘‘therapeutic window’’ (from 600 to 1200 nm). PBM increases cell metabolism, which leads to
higher ATP production. Increasing the amount of ATP in well-vascularized bone cells promotes cell prolif-
eration and differentiation, creating a favorable environment for tooth movement.
Objective: The aim of the study is to discuss and compare the use of PBM in accelerating the orthodontic
movement and reducing the time of treatment.
Materials and methods: A systematic review was conducted. Literature searches were performed using
Medline (PubMed), Web of Science, and Scopus (from September 13 to September 20, 2019). The quality
assessment was performed using the Jadad scale for reporting randomized controlled trials for randomized
clinical trial and randomized control clinical trial studies, and the Newcastle/Ottawa Quality Assessment Form
for case/control studies.
Results: Thirty-three articles from PubMed, 46 from Scopus, 5 from Web of Science were selected. After
removal of duplicates, 82 articles were analyzed. Subsequently, 74 articles were excluded because they did not
meet the inclusion criteria. The remaining eight articles were included in the qualitative synthesis.
Conclusions and summary: PBM is an efficient, effective, and noninvasive method to accelerate orthodontic tooth
movement. PBM should be introduced into the daily practice of treating various malocclusions as an additional
procedure. Intraoral application gives better results and its introduction to treatment seems more reasonable.

Keywords: laser, orthodontic movement, low-level laser therapy, acceleration

Introduction Surgical techniques for the acceleration of the orthodontic

movement have been investigated for a long time in clinical

T he duration of orthodontic treatment is one of the

most important aspects considered by patients before
they make up their mind to begin the therapy. Patients expect
practice. Nowadays, selective alveolar decortication is
considered the gold standard. Currently, there is a move
toward using the least invasive methods such as piezoelec-
high effectiveness of orthodontic treatment in the shortest tricity and corticision, which, in the absence of such inva-
possible time. Over time, the risk of complications increases siveness, allow to achieve the desired effect.2 Piezosurgery
and the patient’s cooperation decreases,1 and therefore, nu- does not require manual force, which therefore enables to
merous studies are conducted to identify the factors that control better the intraoperative control without generating
accelerate orthodontic tooth movement. We can consider frictional heat, which in turn hinders the postoperative regen-
surgical and nonsurgical methods. eration processes.3 Corticision is a neologism that comes from

1
Student Scientific Society at the Department of Interdisciplinary Dentistry, Pomeranian Medical University in Szczecin, Szczecin, Poland.
2
Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy.

1
 2 JEDLIŃSKI ET AL.

an abbreviation of ‘‘cortical bone incision.’’2 It is a flapless

technique, where the specially reinforced scalpel is used to
separate interproximal cortices transmucosally, ensuring
minimal tissue trauma.4
In addition, patients with systemic diseases such as dia-
betes may have problems with postoperative wound heal-
ing.5 However, both patients and clinicians prefer the
nonsurgical approach since it is less invasive and harmful.
Among these, we can distinguish methods using physical or
pharmacological factors.
The physical factors are, for example: sound resonance
vibration,6 light electrical currents, magnetic field forces,
low-level light therapy,7 while the known pharmacological
factors are as follows: prostaglandin E2,8 osteocalcin,9 and
vitamin D.10 It has been found that the low-magnitude,
constant supplementary vibration applied with a continuous
static force could intensify both osteoclast function and
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osteoclastogenesis via nuclear factor kappa B (NF-jB) ac-

tivation, leading to mild alveolar bone resorption and,
thanks to that, accelerated orthodontic tooth movement.7
The so-called pharmacological factors, however, increase
the activity of metabolic pathways leading to more intense
bone remodeling and new bone mass formation.8–10
Photobiomodulation (PBM) or low-level laser therapy
(LLLT) depends upon the exposure of the tissue to partic-
ular, therapeutic wavelengths of light of the length of 600 to
1200 nm. It has been shown that PBM increases cell me-
tabolism, which leads to higher ATP production.11 Mi-
tochondrial enzymes, such as oxidase c—are crucial for
ATP production. Oxidase is the primary light photoacceptor,
which emphatically increases its activity when the cell is
exposed to infrared light.12 Increasing the amount of ATP in
well-vascularized bone cells promotes cell proliferation and FIG. 1. The effects of photobiomodulation on bone tissue
differentiation, creating a favorable environment for tooth activity.
movement. PBM was also linked to the stimulation of
anagenesis in skin, muscles, and bone tissue.13
termined. The keywords used in the search strategy were as
A recent report states that the application of diode laser light
follows: ‘‘tooth movement acceleration OR orthodontic
at the initial stage of orthodontic treatment significantly re-
movement acceleration AND low-level laser stimulation OR
duces pain caused by orthodontic movement and improves the
photobiomodulation AND clinical trial AND dentistry.’’
patient’s quality of life at the same time.14 Shortening the time
Reference lists of primary research reports were cross-
of orthodontic treatment is now a significant problem for both
checked in an attempt to identify additional studies.
patients and clinicians. Hence, the search for methods mainly
for a nonsurgical acceleration of orthodontic movement. In
recent years, there are more and more attempts and proposals Eligibility criteria
for new ways of using lasers, also in orthodontic treatment. The following inclusion criteria were used for this sys-
tematic review: (1) randomized clinical trial (RCT); (2)
Aim of the Study cohort study; (3) case/control study; (4) articles published in
the last 5 years; (5) studies carried out on human subjects;
The aim of the study is to discuss and compare the use of
(6) results published in English; and (7) PBM studies.
PBM in accelerating the orthodontic movement and reduc-
The following were the exclusion criteria: (1) reviews;
ing the time of treatment (Fig. 1).
(2) case reports; (3) abstract and author debates or editorials;
(4) lack of effective statistical analysis; (5) articles not re-
Materials and Methods lated to orthodontics and dental movement; and (6) studies
Search strategy on animal subjects and in vitro studies.
This review was performed under the PRISMA
Data extraction
guidelines.15
An electronic search from September 13 to September 20, Two reviewers have selected the studies first by reading
2019, was performed on the PubMed, Scopus, and Web of titles and abstracts and then by studying the full text of
Science databases. All searches were conducted using a selected articles. Any doubt or disagreement between the
combination of subject headings and free-text terms: the two reviewers was resolved by discussion. All data extracted
final search strategy through several presearches was de- from the selected studies are shown in Table 1.
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Table 1. The Data Extraction

Type of laser Mean age
Study Type of treatment (ev. LED) device Duration of application Type of study No. of patients (years of age) Follow-up Test group Control group Results
Qamruddin Retraction of Diode laser (iLas; Five buccally and Split-mouth, 22 (11M, 11F) 12–25 (19.8 – 3.1) Three weeks for Self-ligating Self-ligating Canine retraction was
et al.16 canines with Biolase, Irvine, CA) palatally, intraorally RCT three more bracket bracket significantly greater
self-ligating with a wavelength of for 3 sec each consecutive appliance + PBT appliance (1.60 – 0.38 mm) on
brackets (+ 940 nm at 100 mW visits the experimental
LLLT) in CW. Diameter of side compared with
the optical fiber tip the placebo side
was 0.04 cm2. The (0.79 – 0.35 mm)
energy density ( p £ 0.05).
calculated at each
point was 7.5 J per
square centimeter
Nahas Alignment of LED device Twenty minutes a day Split-mouth, 34 (15M, 7F) 21.8 in test group Two weeks until the Self-ligating Self-ligating The test group exhibited
et al.17 crowding with (OrthoPulse; extraorally LED RCT 14 in test, 20 21.1 in control alignment was bracket bracket a significant
self-ligating Biolux Ltd, light therapy in control group group achieved appliance + PBT appliance reduction in the
brackets (+ Vancouver, treatment time
LLLT) Canada), with a required to align the
wavelength of lower anterior teeth
850 nm and a power by 22%. The
output of treatment duration
90 mW/cm2. The for the test group
estimated irradiation (mean age 21.8
dose per session on years) was 68.3 days

3
the surface of the (SD 28.7), and for
cheek was 108 J/cm2 the control group
(mean age 21.1
years), this time was
87.8 days (SD 24.7).
Shaughnessy Alignment of LED device 3.8 min a day Case–control 19 (6M, 13F) 11 13.9 – 2.9 Every 3 weeks till Self-ligating Conventionally The mean alignment
et al.18 crowding with (OrthoPulse; Biolux extraorally, LED study test group, 8 perfect bracket ligating rate for the PBM
self-ligating Ltd, Vancouver, light therapy with group alignment appliance + PBT brackets group was
brackets (+ Canada), with a power density of significantly higher
LLLT) wavelength of 42 mW/cm2 than that of the
850 nm and a power control group, with
output of an LII change rate of
90 mW/cm2. 1.27 mm/week
Average power density versus
of 42 mW/cm2 to 0.44 mm/week,
achieve a mean respectively. The
energy density of treatment time to
*9.3 J/cm2 at the alignment was
surface of the LED significantly smaller
array for the PBM group,
which achieved
alignment 48 days,
while the control
group took 104 days
on average.

(continued)
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Table 1. (Continued)

Type of laser Mean age

Study Type of treatment (ev. LED) device Duration of application Type of study No. of patients (years of age) Follow-up Test group Control group Results
Fernandes Intrusion of upper PBM at three different Ten points (five Case–control 30 (3 groups of 10 40.2 – 11.5 Every 30 days to G3—MBT G1—MBT The levels of IL-6, IL-8,
et al.19 molars with moments: vestibular, five study patients) achieve full brackets, MIA, brackets, and IL-1b increased
MBT brackets, immediately after palatal) intraorally, displacement elastic memory G2—MBT under orthodontic
MIA (+ LLLT) force application 10 sec/point, chain + PBT brackets, force (G2 and G3)
(T0), after 3 (T1) immediately, 3, and MIA, elastic when compared with
and 7 days (T2), 7 days after force memory chain control group (G1),
during a total of 3 application for 3 however, the
months. months cytokine levels were
Diode laser (Laser Duo; significantly higher
MMOptics, São after PBM (G3). The
Carlos, SP, Brazil) mean intrusion
808 nm, at 100 mW, velocity was
applied for 10 sec to 0.26 mm/month in
each point (energy the irradiated group
of 1 J per point). (G3), average
Irradiation along 10 duration of 8 months
points on the versus
gingival tissue 0.17 mm/month for
(5 points per the nonirradiated
vestibular and 5 per group (G2), average
palatine region) duration of 12
Laser beam months.
(area = 0.04 cm2)
positioned at each
point, creating an
energy density of
25 J/cm2 per
irradiation
Azzam Orthodontic Er:YAG laser (Key First irradiation: RCT 30 (15 + 15) Nonspecified, Three weeks until MBT fixed MBT fixed Significantly positive
et al.20 treatment of Laser, Kavo, 400 mJ, 10 Hz at patients between 15 the completion appliance + appliance + rate of intrusion in

4
deep bite MBT Germany) 2940 nm, 10 mm distance, and 25 of intrusion of MIA + ER:YAG MIA the experimental
brackets, MIA 1–25 Hz, pulse average power 4 W, incisors stimulation group and three
(+ the Er:YAG energy 600 mJ, pulse duration 300 l, (overbite 2.5– times faster
2
laser quratz tip 4 mm power density 100 3 mm) movement rate of
stimulation) W/cm2, fluence the experimental
10 J/cm2 group with respect
Second irradiation: to the control group.
400 mJ, 15 Hz at
10 mm distance,
average power 6 W,
pulse duration 300 l,
power density 150
W/cm2, fluence 10 J/
cm2
2 · 5-sec applications
buccally between
the roots of upper
incisors
Isola et al.21 Extraction of first Diode laser (Wiser; Six points; three Split mouth, Eighty-two canines 13.4 – 2.1 The distance was Extraction of first Extraction of first The mean space closures
upper premolars Doctor Smile, buccally and three RCT in 41 patients (21M, evaluated on the upper premolars upper of the maxillary
and distalization Brendola, Italy), palatally (distally, 20F) study cast after and distalization premolars and canines were
of upper canines 980 nm at 1 W in medially, and every month and of upper canines distalization comparable between
with Ni-Ti coil CW, Fluence mesially), in contact in the end of MBT brackets, of upper groups (Test,
spring, because 66.7 J/cm2, optic with gingival tissue leveling 16 · 22 SS wire, canines MBT 4.56 mm); (Control,
of dental fiber 0.6 mm starting from center with Ni-Ti coil brackets, 4.49 mm). The laser
crowding or of the root 15 sec spring + PBT 16 · 22 SS group yielded less
protrusion of each, immediately, wire, with Ni- mean time
upper incisors (+ 3, 7, and 14 days and Ti coil spring (84.35 – 12.34 days)
LLLT) every 15 days until to accomplish space
the space closed closure compared
with the control
group (97.49 – 11.44
days.).

(continued)
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Table 1. (Continued)

Type of laser Mean age

Study Type of treatment (ev. LED) device Duration of application Type of study No. of patients (years of age) Follow-up Test group Control group Results
Ekizer Extraction of first OsseoPulse1 LED LED, intraoral radiation Split mouth, 20 (7M, 13F) 16.77 – 1.41 The tests were MBT fixed MBT fixed Miniscrew stability was
et al.22 upper premolars device (Biolux was performed RCT 20 + 20 taken appliance with appliance with similar between
and distalization Research Ltd, extraorally, immediately, at Ni-Ti coil spring Ni-Ti coil control and LPT
of upper canines Vancouver, Canada) transcutaneously 1st and at 7th applied to MIA spring applied groups at baseline
with Ni-Ti coil 618 nm, output 20 min a day for 21 day and at 1st, and canine + to MIA and (T0) and the 1st
spring applied to power 20 mW/cm2 consecutive days 2nd, and 3rd PBT canine month (T1).
MIA and canine month However, miniscrew
(+ LLLT), then stability was
MIA stability significantly
and the level Il- increased in the LPT
1b in GCF was group in 2nd (T2)
measured six and 3rd (T3)
times months. Comparison
of tooth movement
during three
different time
intervals (T1–T0,
T2–T1, and T3–T2)
revealed that it
statistically
significantly
increased in every
time interval after

5
LPT. No statistically
significant change
was detected in the
IL-1b levels
between groups.
Caccianiga Dental crowding Diode laser (Wiser; Four dental segments RCCT 36 (14M, 22F) 16.2 Every 4 weeks till Self-ligating Self-ligating The alignment
et al.23 alignment (+ Doctor Smile, (right first premolar- perfect bracket bracket treatment time was
LLLT) Brendola, Italy) canine, right lateral- alignment appliance + PBT appliance significantly shorter
980 nm, at 1 W in central incisors, left ( p < 0.001) in the
CW, total energy central-lateral tested group (211.8
density = incisors, left canine- days) compared with
150 J/cm2; Doctor first premolar) were the control (284.1
Smile–Lambda consecutively days).
2
Spa), spot size 1 cm irradiated for 8 sec
and two dental
segments (right first
molar-second
premolar, left
second premolar-
first molar) for 9 sec,
for a total of 50 sec.
The procedure was
repeated three times
at intervals of 2 min.
Repeated every visit

CW, continuous wave; F, females; GCF, gingival cervical fluid; IL, interleukin; LLLT, low-level laser therapy; M, males; MBT, Mclaughlin Bennett Trevisi; MIA, microimplant anchorage;
PBM, photobiomodulation; RCCT, randomized control clinical trial; RCT, randomized clinical trial; SD, standard deviation; SS, stainless steel.
 6 JEDLIŃSKI ET AL.

Quality assessment are measures of treatment efficacy that can be simulta-

The quality assessment was performed using the Jadad neously evaluated by effect size (ES) that, in the case of
scale for randomized controlled trials24 for RCT and ran- SMDs, shows by how many standard deviations (SDs) the
domized control clinical trial studies. In assessment, it was mean increased (mm)/decreased (days) when PBM is used.
taken into account whether the study was randomized, ES is dimensionless quantity, because the mean and SD
double-blinded with appropriately described methods to find always have the same dimension, so it allows to compare
the level of risk of bias. A point was given for every char- results reported in different measures. All effectiveness
acteristic evaluated, when the possible assessment was from measurements of orthodontic treatment in both the test and
0 to 5, with a high score indicating good quality of a study. control groups in the included articles are presented in
Notwithstanding, for case/control studies, the Newcastle/ Table 4.
Ottawa Quality Assessment Form25 was used. The quality of
all included cases/controls was based on object selection, Results
comparability, and exposure. The possible quality assess- Search results
ment score ranged from 0 to 9 points, with a high score
indicating a good quality study. For each characteristic The search strategy identified potential articles: 33 from
evaluated, one point was given. PubMed, 46 from Scopus, and 5 from Web of Science. After
the removal of duplicates, 82 articles were considered.
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Subsequently, 74 articles were excluded because they did

Meta-analysis not meet the inclusion criteria. The remaining eight articles
were included in the qualitative synthesis (Flow diagram).
Meta-analysis was performed using a random-effect Six of them are RCTs, while two of them are case/control
model via metafor and compute.es R packages, with stan- studies. Table 1 summarizes the characteristics of each of
dardized mean differences (SMDs) and 95% confidence the eight included studies (Fig. 2).
intervals (95% CI) being calculated as effect estimates.
Heterogeneity was assessed quantitatively using I2-statistics
Quality assessment and risk of bias
and Cochran’s Q.26
There are two different methods of reporting orthodontic The results of the quality assessment are presented in
movement acceleration using PBM in the literature: treat- Tables 2 and 3 and in Figs. 2 and 3. It is clearly seen that
ment time and orthodontic movement in millimeters. Both split mouth RCTs get a higher score through the assurance

FIG. 2. PRISMA flow dia-

gram.
 PHOTOBIOMODULATION EFFECT ON ORTHODONTIC MOVEMENT 7

Table 2. Jadad Scale for Reporting Randomized Controlled Trials24

Qamruddin Nahas Azzam Isola Ekizer Caccianiga
Author et al.16 et al.17 et al.20 et al.21 et al.22 et al.23
Randomization present 1 1 1 1 1 1
Appropriate randomization used 1 1 1 1 1 1
Blinding present 1 1 0 1 1 0
Appropriate blinding used 1 1 0 1 1 0
Appropriate long-term follow-up 1 1 1 1 1 1
for all patients
Total 5 5 3 5 5 3

of an appropriate blinding method,16,17,21,22 especially in SMDs were calculated taking into account that the posi-
the field of testing the reaction of the human cells to PBM, tive effect of PBM usage is shown by a shorter treatment
which can slightly differ between the subjects. The included time, and so, in both cases, the positive values of SMD
case/control studies try to take into account many factors, indicate a greater efficacy in TG compared with CG.
including individual ones. However, both of them do not PBM usage appears to have large positive ES [1.47, CI:
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present the proper nonresponse rate.18,19 The study of (0.93, 2.0)], large according to Cohen’s interpretive guide-
Shaughnessy et al., however, does not use the same type lines.27 Heterogeneity is significant at p < 0.001 level. While
of brackets in all the subjects, which results in a greater risk in every research, the desired effect occurs faster in the test
of bias.18 All studies found a significant acceleration of group, the results of available studies are very different—
planned teeth orthodontic movement in groups in which PBM 75.2% of the variability, which come from heterogeneity
was used as a supportive element of treatment, which enabled (variability in effect sizes due to true differences among the
faster cure of malocclusion.15–23 Also, greater and longer studies).28 The possible cause could be the huge variety in
stability of microimplants in bone exposed to stimulation was PBM application protocols in cited studies, not only in ex-
also found.19 All studies, with the sole exception of two,17,19 posure time but also in the place of exposure, the length of
focus on research among adolescents younger than the age of therapy, the number of exposures, and the type and power of
20 (Fig. 4).16,18,20–23 the device (Fig. 5 and Table 4).

Meta-analysis Discussion
There were eight literature positions included in meta- Patients’ requirements for treatment are constantly in-
analysis. Six of them reported treatment time, and two other creasing. They want it to be performed quickly and com-
the orthodontic movement in millimeters. In the article by fortably and to end up with a significant improvement in
Fernandes et al.,19 mean treatment times were reported facial aesthetics. A literature review published in 2016
without SDs. SDs were imputed using medium SD/mean suggests that the quality of evidence supporting the fact that
ratio in five other literature positions. The ratio appears to be the use of LLLT to accelerate orthodontic tooth movement
0.351 for TG and 0.235 for CG. is very low.29 Therefore, it seems rational to look again at

Table 3. Newcastle/Ottawa Quality Assessment Form for Case/Control Studies21

Study Shaughnessy et al.18 Fernandes et al.19
Selection
Is the case definition adequate? 1 1
Representativeness of the cases 1 1
Selection of controls 0 1
Definition of controls 1 1
Comparability
Comparability of cases 2 2
and controls on the basis The Cox proportional hazard There were two control groups,
of the design or analysis models were used to compare in which is clear to distinguish
groups considering the factors such not only the efficiency of PBT
as age, sex, ethnicity, arch, and the level use but also MIA (skeletal anchorage)
of dental crowding between start as an important factor in creating
and outcome models teeth orthodontic movement
Outcome
Ascertainment of exposure 1 1
Same method of ascertainment 0 1
for cases and controls
Nonresponse rate No description No description
Total 6 8
 8 JEDLIŃSKI ET AL.
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FIG. 3. Jadad scale for reporting randomized controlled trial column diagram.

the latest original articles published in recent years, espe- acceleration of orthodontic movement seems to be a
cially since their results strongly indicate the correctness of promising prospect.
the thesis that LLLT has an impact on accelerating ortho- In case of intrusion, it was an acceleration of orthodontic
dontic movement.16–23 The authors of a big survey study in movement by 34.5% while using the cyclic LLLT expo-
2009 emphasized30 that the patient remains involved in a sure,19 and even three times faster compared with the con-
treatment with constant and fairly rapid effects, which in- trol group in case of exposure to the ER: YAG laser after
creases motivation, and hence, the effective and noninvasive bracket insertion.20 The movement of canine distalization

FIG. 4. Newcastle/Ottawa Quality Assessment Form for case/control study column diagram.
 PHOTOBIOMODULATION EFFECT ON ORTHODONTIC MOVEMENT 9

FIG. 5. Meta-analysis tree diagram.

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after the first premolar extraction also occurred significantly group.18 However, in the study by Shaughnessy et al.,18 the
faster in groups of patients who underwent PBM in the patients were adolescents only, and in the control group, the
analyzed studies, reducing time by 14.4%21 and 26%,22 conventional brackets were used in the place of self-ligating
respectively, relatively to the control groups. However, the brackets in the test group, which leaves the results of these
most frequently studied movement among the cited studies tests quite questionable and difficult to compare.
was decrowding of the lower incisors.17,18,21,23 Although in There is also a need to ask if, when dealing with patients
all cases the use of PBM significantly speeds up the desired in everyday practice, it is possible to encourage the patient
effects, the results differ significantly from each other. This to use a PBM device for 20 min every day. In the other
is probably caused by an extremely different methodology, study,23 the light was applied intraorally and did not re-
other applicable devices, and a different way of exposure. quire such frequent cooperation on the part of the patient.
In two studies, PBM was applied extraorally with the same Each intervention took <10 min and did not require daily
device (OrthoPulse device from Biolux Ltd.—850 nm and a regularity. The results of the study are still satisfactory—
power output of 90 mW/cm2)17,18; in the study of Nahas treatment time was reduced by about 25%.23 This suggests
et al.—20 min a day,17 while in the study of Shaughnessy that this method of treatment with comparable results with
et al.—3 min, 40 sec a day.18 As can be deduced, the time of the studies where the light was applied extraorally is more
exposure did not have a significant impact on the acceleration practical and possible to implement in practice. The im-
of teeth movement. In the first study, the test group exhibited proper position of canines in the dental arch is one of the
a significant reduction in the treatment time required to align most common reasons for visiting the orthodontist. Epide-
the lower anterior teeth by 22%,17 while in the second one, miologically, in a large part of society, there are impacted
the movement was almost three times faster in the test group or misaligned canines that are the cause of other types of
(1.27 mm/week), with only 0.44 mm/week in the control malocclusion.31

Table 4. Treatment Effectiveness Measurements

Days needed to carry
out a specific orthodontic Days needed to carry
movement in the group out a specific orthodontic
Study in which the laser was used movement, control group Type of movement
16
Qamruddin et al. 1.60 – 0.38 mm 0.79 – 0.35 mm Canine retraction
Nahas et al.17 68.3 days (SD 28.7) 87.8 days (SD 24.7) Lower incisors alignment
Shaughnessy et al.18 48 days (SD 39) 104 days (SD 55) Lower incisors alignment
Fernandes et al.19 240 days (SD not mentioned) 360 days (SD not mentioned) Intrusion of upper molars
Azzam et al.20 59 – 13.496 days 95.8 – 12.35 days Intrusion of upper incisors
Isola et al.21 84.35 – 12.34 days (95% CI) 97.49 – 11.44 days (95% CI) Canine retraction
Ekizer et al.22 1st month: 1.47 – 0.51 mm 1st month: 0.9 – 0.40 3mm Canine retraction
2nd month: 1.37 – 0.79 mm 2nd month: 1.13 – 1.11 mm
3rd month: 0.93 – 0.60 mm 3rd month: 0.71 – 0.5 mm
Caccianiga et al.23 211.8 – 31 days 284.1 – 33 days Lower incisors alignment
CI, confidence interval.
 10 JEDLIŃSKI ET AL.

The use of LLLT has proven effective in very often dif- supplementary high-frequency vibration applied with a
ficult and time-consuming canine tractions.16,21,22 In the static force in rats. Sci Rep 2017;7:13969.
split-mouth study, two times bigger (1.6–0.79 mm) canine 7. Kantarci A, Will L, Yen S. Tooth movement. Front Oral
retraction was obtained.16 In two other studies, distal ca- Biol 2016;18:80–91.
nines were significantly faster after removal of the first 8. Cağlaroğlu M, Erdem A. Histopathologic investigation of
premolar.21,22 The variety in treatment protocols shows that the effects of prostaglandin E2 administered by different
despite the positive test results, it is necessary to systematize methods on tooth movement and bone metabolism. Korean
the use of PBM. It is crucial to obtain satisfying treatment J Orthod 2012;42:118–128.
results in the most effective way. Comparing the ES of the 9. Hashimoto F, Kobayashi Y, Mataki S, Kobayashi K, Kato
studies included in the review, it cannot be said that the Y, Sakai H. Administration of osteocalcin accelerates or-
thodontic tooth movement induced by a closed coil spring
power of the device or exposure time has a direct impact on
in rats. Eur J Orthod 2001;23:535–545.
the effectiveness of PBM, because of the other variables
10. Collins MK, Sinclair PM. The local use of vitamin D to
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Author Disclosure Statement Husein A. Effects of low-level laser irradiation on the rate
of orthodontic tooth movement and associated pain with
No competing financial interests exist. self-ligating brackets. Am J Orthod Dentofacial Orthop
2017;152:622–630.
Funding Information 17. Nahas AZ, Samar SA, Rastegar-Lari TA. Decrowding of
No funding was received for this article. lower anterior segment with and without photobiomodula-
tion: a single center, randomized clinical trial. Lasers Med
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