In this presentation analgesic effect of low level laser therapy was discussed.
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1. Evaluating low-level laser therapy effect on
reducing orthodontic pain using two laser energy
values: a split-mouth randomized placebo-
controlled trial
Departments of Orthodontics and Oral Medicine, Faculty of Dental
Medicine and Institute for Laser Researches and Applications,
Damascus University,Faculty of Dental Medicine, Damascus University.
Presented by: Dr. Turgut Novruzlu
3. Introduction
•Orthodontic treatment involves application of
various forces to the PDL, which makes the
orthodontic treatment a painful procedure.
•This study mainly aims at evaluating analgesic effect
LLLT ( Low Level Laser Therapy) especially from pain
generated by elastomeric separators.
4. Materials and methods
• Trial design: Two parallel group single-blind placebo controlled
randomized trial was applied.
• Split mouth technique was implemented for each group in order to
apply laser and placebo treatments for each patient.
5. Materials and methods
PARTICIPANTS AND ELIGIBILITY CRITERIA
• Overall 26 Patients
• 19 Female and 7 Male all with fixed orthodontic appliance.
• As for the selection of patients there were set of rules and
restrictions
6. Materials and methods
PARTICIPANTS AND ELIGIBILITY CRITERIA
• Inclusion criteria:
Age 16-22 years
Good oral hygiene
No systemic or periodontal disease
No intake of analgesics a week prior to trial
Intact mandibular first molars with healthy contact points
7. Materials and methods
PARTICIPANTS AND ELIGIBILITY CRITERIA
• Exclusion criteria:
Intake of NSAIDs or analgesics during the study
Failing to complete the questionnaire a
Patient who received previous orthodontic treatment.
8. Materials and methods
RANDOMIZATION
• Patients were randomly assigned to either the 4-Joule*
laser energy or the 16-Joule laser energy
• They chose closed papers and according to randomly
chosen papers 16-J or 4 J Laser energy.
• The molar to be irradiated was also chosen randomly.
*Joule, unit of energy: it is equal to the work done by a force of one newton acting through one metre.
9. Methods and materials
CLINICAL INTERVETIONS
• A 0.5-mm elastomeric separators were inserted at the
mesial and distal of each mandibular first molar.
• For the molar to be irradiated, a single LLL dose was
applied using a Ga–Al–As semi conductor laser device of
the continuous emission mode with a wavelength of 830
nm and a power of 150 mW.
10. Methods and materials
CLINICAL INTERVETIONS
• 13 patients received 2 J/point laser energy with an
irradiation dose of 2.25 J/cm2 and an exposure time of 15
seconds/point
• The other 13 patients received 8J/point laser energy with
an irradiation dose of 9 J/cm2 and an exposure time of 60
seconds/point.
11. MATERIALS AND METHODS
CLINICAL INTERVETIONS
•Laser beam was applied to one point on both the
mesial and distal sides of the molar at the level of the
cervical third of the root, perpendicular to the mucosa
and in direct contact with it (Figure 1).
13. MATERIALS AND METHODS
CLINICAL INTERVETIONS
•Application was done on the buccal side only resulting
in two application.
•For first group- 4J
•For second group- 16J
Ga Al As semiconductor
14. MATERIALS AND METHODS
CLINICAL INTERVETIONS
• Placebo treatment was implemented by applying laser device to other
mandibular first molar with same manner and exposure time as for
the irradiated molar by turning on the device without emitting laser
beam to obtain the placebo effect.
• Patients did not know which molar was being irradiated and
which one would receive placebo treatment
15. MATERIALS AND METHODS
OUTCOME MEASURE
• At each evaluation time point patients were instructed to bite
on piece of bread on both sides which requires a degree of
pressure to be chewed.
• This way the mastication procedure was initiated and pain was
provoked.
• Later according to VAS score of the degree of pain for each
molar was separately estimated.
16. MATERIALS AND METHODS
OUTCOME MEASURE
• Evaluation was done by using (VAS) Visual Analogue Scale: 0 means no pain
and 100 indicating worst possible pain.
• Laser and placebo treatments were applied at app. the same time
• Each patient was given a questionnarie containing the evaluation time
points
18. Results
Main findings
• No statistical significance was found between laser and the
placebo treatments for each evaluation time point.
• This finding indicates that LLL at these energy values has no effect
in pain reduction.
• Furthermore, the difference in mean pain scores between laser
and placebo treatments was not statistically significant in 16J
laser energy group also.
21. Discussion
• This study aimed to evaluate the effect of applying LLL with two
different energy values on reducing orthodontic pain caused by
elastomeric separators placement. It was found that LLL with both
energies used was not effective in reducing orthodontic pain
22. Discussion
The importance of the study
• In this exact study the role of LLL energy was evaluated by studying
the use of two different LLL energy values (16 Joule and 4 Joule) to
determine the effect of LLLT.
• Many previous studies evaluated the effect of LLL on reducing pain
caused by elastomeric separators placement.
• This particular study used more exact parametres and restricted
protocol to exclude random results.
23. Discussion
Factors affecting LLLT results
• Results of studies investigating orthodontic pain reduction using
LLL depend on three principle factors: individual variations, study
methodology and laser beam parameters.
24. Discussion
The importance of the study
• Some investigators postulated that pain assessment is affected by
many individual factors including age, gender, psychological state,
pain threshold, previous pain experience, the emotional state and the
importance of placebo effect. The results of previous studies showed
no effect of age and gender on pain scores.
25. Discussion
Factors affecting LLLT results
• In this study, pain was evaluated during the mastication procedure.
Many studies proved that pain problems with orthodontic treatment
emerges during function - especially during the chewing of foods -
rather than it being spontaneous, forming the most difficult
deterrents for patient’s activities (33). Besides, most studies
evaluated spontaneous pain perception and only few evaluated pain
perception during function (3, 22).
26. Discussion
Factors affecting LLLT results
• The results showed close degrees of scores
between the laser and the placebo
treatments in the 16-Joule laser energy
group.
27. Discussion
Factors affecting LLLT results
• Especially after 6 hours of treatments
application when the recorded pain scores
were significantly lower in the placebo
group compared to the laser group.
28. Discussion
Factors affecting LLLT results
• Higher energy of the laser beam concentrated in two points exceeded
the therapeutic window which may lead to local damage and photo-
inhibitory effect in the targeted tissues leading to negative reactions
in them, which may indicate that the 16-Joule laser energy value is
too high and may provoke additional pain instead of reliving it
29. Conclusion
• According to the results of this study we can conclude that LLL
energy does not have effect as previously postulated on LLL
effectiveness in reducing orthodontic pain after elastomeric
separators placement.
• However, we cannot generalize that LLL is not effective at all in
reducing orthodontic pain because changing other parameters like
the wavelength or even changing the application protocol like the
exposure time per point or the frequency of laser application
might lead to effective results.
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