Title	Low-Level Laser Therapy: An Efficient Method for Controlling Pain in Orthodontic Patients
Clinical Question	In orthodontic patients, is low-level laser therapy effective in controlling pain after placement of the first orthodontic archwire, compared to placebo?
Clinical Bottom Line	Low-level laser therapy efficiently controls pain caused by placement of the first orthodontic arch wire.
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 19892282 Tortamano/2009 60 orthodontic patients (ages, 12-18 years; mean, 15.9 years) Randomized Controlled Trial Key results Orthodontic patients who received low-level laser therapy (LLLT) after placement of the first archwire experienced less pain and for a shorter period of time when compared with the placebo (simulated laser treatment) and control (no laser intervention) groups (p<0.001). However, the onset of pain was not significantly delayed by LLLT. No statistically significant difference was found in pain onset among the experimental, control, and placebo groups. Also, analysis of each evaluated parameter revealed no significant difference between maxillary and mandibular arches.
Evidence Search	(lower level laser therapy) AND (orthodontic treatment) AND pain
Comments on The Evidence	This randomized controlled trial provides clinical evidence of effectiveness of LLLT in pain control in orthodontic patients. Sixty orthodontic patients participated in this study. They received MBT straight-wire orthodontic treatment in only one arch (maxillary or mandibular). The participants were then randomly assigned to the experimental (laser treatment), placebo (simulated laser treatment), or control group (no laser therapy). All patients were instructed to complete a pain assessment survey during the next 7 days. To minimize the bias in pain perception, the participants in each group were matched for sex. The participants, however, were not matched for age, but most of the participants, according to the authors, were around the mean age (15.9 years). Also, severity of malocclusion, a potential confounding factor, was not addressed by the investigators. The placebo group received simulated laser therapy and could hear a sound every 10 seconds. The control group had no laser intervention. Although the authors claimed that the study was double-blind, they provided no explanation on how the investigators were blinded. Determining pain with a questionnaire was also another limitation of this study.
Applicability	LLLT is a non-invasive approach to relieve pain in orthodontic patients and could be used as an effective alternative to analgesics and anti-inflammatory drugs. However, the cost and the total application time (32 – 37.5 minutes for both arches) can limit its clinical usage.
Specialty	(Orthodontics)
Keywords	Low-level laser therapy, orthodontic treatment, pain
ID#	2321
Date of submission	08/12/2012
E-mail	najibfard@uthscsa.edu
Author	Kaveh Najibfard
Co-author(s)
Co-author(s) e-mail
Faculty mentor	Clarence C. Bryk, DDS, MS
Faculty mentor e-mail	BRYKC@UTHSCSA.EDU
Basic Science Rationale (Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) by Kaveh Najibfard (San Antonio, TX) on 09/17/2012 There is strong and consistent evidence that anti-inflammatory effects of low-level laser therapy (LLLT) are the principal mechanisms for short-term pain relief (publication PMID: 16706694). LLLT suppresses inflammation by reduction of biochemical inflammatory markers (PGE2, mRNA Cox 2, IL-1β, TNF), inflammatory cell influx, edema, hemorrhage, and necrosis. As a result of minimizing inflammation, LLLT can provide effective pain relief in the short-term.
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) None available