Low-Level Laser Therapy with a 635 nm Diode Laser Affects Orthodontic Mini-Implants Stability: A Randomized Clinical Split-Mouth Trial

Abstract

Background: The study aimed to clinically estimate an influence of a 635 nm diode laser on the stability of orthodontic mini-implants, to assess mini-implants loss, and to evaluate a pain level after the treatment. Materials and Methods: The randomized clinical split-mouth trial included 20 subjects (13 women and 7 men; age: 32.5 ± 6.1 years), 40 implants (RMO, West Colfax Ave., Denver, CO, USA) with a diameter 1.4 mm and length of 10 mm. Mini-implants were placed in the area of the attached gingiva between the second premolar and first molar teeth, 2 mm below the mucogingival junction of both sides of the maxilla. Each implant on the right side (G1, n = 20) of the maxilla was irradiated with a diode laser, and the implants on the opposite side (left, G2, n = 20) were a control group (without laser irradiation). The 635-nm laser parameters; dose: 10 J per point (20 J/cm2), time: 100 s per point, two points (irradiation on a buccal, and a palatal side of the alveolus/implant), the total energy per session 20 J. Laser application protocol: immediately and 3, 6, 9, 12, 15, and 30 days after surgery. The total energy after all therapeutic sessions was 140 J. The implants’ stability was measured employing a Periotest device (Periotest Test Value—PTV) immediately and 3, 6, 9, 12, 15, 30, and 60 days after the insertion of the mini-implants. Results: We found significantly higher secondary stability, lower mean PTV (6.18 ± 5.30) and (1.51 ± 2.25), for self-drilling mini-implants (G1, test group) in contrast to the control, G2 group (9.17 ± 8.25) and (5.00 ± 3.24), after 30 (p = 0.0003) and 60 days (p = 0.0000). Moreover, the analysis of the mini-implants stability after 635-nm diode laser application revealed significant higher stability in comparison with none irradiated implants (G2 group) after 3 days. (p = 0.0000) There was no significant difference in pain level measured on the NRS-11 scale on both sides of the maxilla. (p = 0.3665) An important finding was that all inserted mini-implants survived during a two-month observation period. Conclusions: 635-nm diode laser at laser irradiation increases the secondary stability of orthodontic mini-implants.

Effects of low-level laser therapy on the orthodontic mini-implants stability: a systematic review and meta-analysis

“…The full texts of eight articles were retrieved and the eligibility was assessed. At the end of the study selection, six studies were included for the qualitative and quantitative synthesis [5,6,10,[14][15][16]. The level of agreement between reviewers was excellent (ĸ = 0.98 for screening, ĸ = 0.85 for eligibility, and ĸ = 1.0 for included) ( Fig.…”

“…By Cochrane Collaboration's tool, five RCTs had a low risk of selection bias (random sequence generation and allocation concealment) [5,10,[14][15][16]. In performance (blinding of participants and personnel) and detection bias (blinding of outcome assessor), two studies had a low risk [10,14] and three had an unclear risk [5,15,16]. All RCTs had a low risk of attrition bias (incomplete outcome data), reporting bias (selective reporting), and other bias [5,10,[14][15][16] (Fig.…”

“…The studies were conducted in Egypt [10,15], Turkey [14], Poland [5,16], and Brazil [6], involving 108 patients of both sexes between 14 and 32.5 years [5,6,10,[14][15][16]. A total of 206 OMI, with diameter variation of 1.4 and 1.6 mm and length variation of 8 and 10 mm, were exposed to LLLT or placebo [5,6,10,[14][15][16]. Maxilla was the site of placement of the OMIs in six studies [5,6,10,[14][15][16].…”

“…Primary stability is conferred shortly after the procedure for placement of the device and secondary stability is expressed after the healing phase. The retention of OMI in bone depends on numerous factors, such as bone density and thickness of the insertion site, device surface morphology, surgical technique, and physiological repair process [3,5,6].…”

“…The low-level laser therapy (LLLT) is a non-invasive and painless method, consisting of the use of nonionizing light sources of the visible or infrared spectrum that acts under mitochondrial photoreceptors, increasing adenosine triphosphate production and cell proliferation [7]. Recent ex vivo and in vivo studies have demonstrated that the LLLT has promising effects in orthodontics, accelerating orthodontic movement, reducing orthodontic pain, and increasing the primary and secondary stability of OMIs [5,[8][9][10][11]. This last topic has great clinical interest, but there are still no systematic reviews aiming to elucidate the true effects of this therapy on skeletal anchorage.…”