Efficiency of Er:YAG utilization in accelerating deep bite orthodontic treatment

Enhancing Root Canal Disinfection with Er:YAG Laser: A Systematic Review

Background: The quest for minimally invasive disinfection in endodontics has led to using Erbium:Yttrium-Aluminum-Garnet (Er:YAG) lasers. Conventional approaches may leave bacterial reservoirs in complex canal anatomies. Er:YAG's strong water absorption generates photoacoustic streaming, improving smear layer removal with lower thermal risk than other laser systems. Methods: This systematic review followed PRISMA 2020 guidelines. Database searches (PubMed/MEDLINE, Embase, Scopus, Cochrane Library) identified studies (2015-2025) on Er:YAG laser-assisted root canal disinfection. Fifteen articles met the inclusion criteria: antibacterial efficacy, biofilm disruption, or smear layer removal. Data on laser settings, irrigants, and outcomes were extracted. The risk of bias was assessed using a ten-item checklist, based on guidelines from the Cochrane Handbook for Systematic Reviews of Interventions. Results: All studies found Er:YAG laser activation significantly improved root canal disinfection over conventional or ultrasonic methods. Photon-induced photoacoustic streaming (PIPS) and shock wave-enhanced emission photoacoustic streaming (SWEEPS) yielded superior bacterial reduction, especially apically, and enabled lower sodium hypochlorite concentrations without sacrificing efficacy. Some research indicated reduced post-operative discomfort. However, protocols, laser parameters, and outcome measures varied, limiting direct comparisons and emphasizing the need for more standardized, long-term clinical trials. Conclusions: Er:YAG laser-assisted irrigation appears highly effective in biofilm disruption and smear layer removal, supporting deeper irrigant penetration. While findings are promising, further standardized research is needed to solidify guidelines and confirm Er:YAG lasers' long-term clinical benefits.

Effect of low-level laser therapy on orthodontic dental alignment: a systematic review and meta-analysis

The aim of this study is to systematically summarize the available evidence regarding low-level laser therapy (LLLT) speed-up effect on dental alignment in comprehensive orthodontic treatment. An extensive electronic search was conducted in PubMed, ScienceDirect, Cochrane, Web of Science, and Scopus up to February 20, 2023. The Cochrane risk of bias tool and the Newcastle-Ottawa Quality Assessment Form were used by two authors independently to assess the risk of bias (RoB). Statistical analysis was performed by Review Manager 5.3. The eight eligible trials were reviewed and included in qualitative synthesis. Four studies reported the overall time of leveling and alignment (OLAT, days), enabling a synthesizing of the data. The meta-analysis results showed that LLLT significantly reduced the overall time of leveling and alignment compared to control group (MD=-30.36, 95% CI range -41.50 to -19.22, P<0.0001), with moderate heterogeneity (χ2=4.10, P=0.25, I2=27%). Based on the data available, statistically significant evidence with moderate risk of bias suggests that LLLT may have a positive effect on accelerating dental alignment. However, due to the differences in intervention strategy and evaluating method, the conclusions should be interpreted with caution.

Non-surgical adjunctive interventions for accelerating tooth movement in patients undergoing orthodontic treatment

BACKGROUND

Deviation from a normal bite can be defined as malocclusion. Orthodontic treatment takes 20 months on average to correct malocclusion. Accelerating the rate of tooth movement may help to reduce the duration of orthodontic treatment and associated unwanted effects including orthodontically induced inflammatory root resorption (OIIRR), demineralisation and reduced patient motivation and compliance. Several non-surgical adjuncts have been advocated with the aim of accelerating the rate of orthodontic tooth movement (OTM).         OBJECTIVES: To assess the effect of non-surgical adjunctive interventions on the rate of orthodontic tooth movement and the overall duration of treatment.

SEARCH METHODS

An information specialist searched five bibliographic databases up to 6 September 2022 and used additional search methods to identify published, unpublished and ongoing studies.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) of people receiving orthodontic treatment using fixed or removable appliances along with non-surgical adjunctive interventions to accelerate tooth movement. We excluded split-mouth studies and studies that involved people who were treated with orthognathic surgery, or who had cleft lip or palate, or other craniofacial syndromes or deformities.

DATA COLLECTION AND ANALYSIS

Two review authors were responsible for study selection, risk of bias assessment and data extraction; they carried out these tasks independently. Disagreements were resolved by discussion amongst the review team to reach consensus.  MAIN RESULTS: We included 23 studies, none of which were rated as low risk of bias overall. We categorised the included studies as testing light vibrational forces or photobiomodulation, the latter including low level laser therapy and light emitting diode. The studies assessed non-surgical interventions added to fixed or removable orthodontic appliances compared to treatment without the adjunct. A total of 1027 participants (children and adults) were recruited with loss to follow-up ranging from 0% to 27% of the original samples.  Certainty of the evidence For all comparisons and outcomes presented below, the certainty of the evidence is low to very low. Light vibrational forces  Eleven studies assessed how applying light vibrational forces (LVF) affected orthodontic tooth movement (OTM). There was no evidence of a difference between the intervention and control groups for duration of orthodontic treatment (MD -0.61 months, 95% confidence interval (CI) -2.44 to 1.22; 2 studies, 77 participants); total number of orthodontic appliance adjustment visits (MD -0.32 visits, 95% CI -1.69 to 1.05; 2 studies, 77 participants); orthodontic tooth movement during the early alignment stage (reduction of lower incisor irregularity (LII)) at 4-6 weeks (MD 0.12 mm, 95% CI -1.77 to 2.01; 3 studies, 144 participants), or 10-16 weeks (MD -0.18 mm, 95% CI -1.20 to 0.83; 4 studies, 175 participants); rate of canine distalisation (MD -0.01 mm/month, 95% CI -0.20 to 0.18; 2 studies, 40 participants); or rate of OTM during en masse space closure (MD 0.10 mm per month, 95% CI -0.08 to 0.29; 2 studies, 81 participants). No evidence of a difference was found between LVF and control groups in rate of OTM when using removable orthodontic aligners. Nor did the studies show evidence of a difference between groups for our secondary outcomes, including patient perception of pain, patient-reported need for analgesics at different stages of treatment and harms or side effects.  Photobiomodulation Ten studies assessed the effect of applying low level laser therapy (LLLT) on rate of OTM. We found that participants in the LLLT group had a statistically significantly shorter length of time for the teeth to align in the early stages of treatment (MD -50 days, 95% CI -58 to -42; 2 studies, 62 participants) and required fewer appointments (-2.3, 95% CI -2.5 to -2.0; 2 studies, 125 participants). There was no evidence of a difference between the LLLT and control groups in OTM when assessed as percentage reduction in LII in the first month of alignment (1.63%, 95% CI -2.60 to 5.86; 2 studies, 56 participants) or in the second month (percentage reduction MD 3.75%, 95% CI -1.74 to 9.24; 2 studies, 56 participants). However, LLLT resulted in an increase in OTM during the space closure stage in the maxillary arch (MD 0.18 mm/month, 95% CI 0.05 to 0.33; 1 study; 65 participants; very low level of certainty) and the mandibular arch (right side MD 0.16 mm/month, 95% CI 0.12 to 0.19; 1 study; 65 participants). In addition, LLLT resulted in an increased  rate of OTM during maxillary canine retraction (MD 0.01 mm/month, 95% CI 0 to 0.02; 1 study, 37 participants). These  findings were not clinically significant. The studies showed no evidence of a difference between groups for our secondary outcomes, including OIIRR, periodontal health and patient perception of pain at early stages of treatment. Two studies assessed the influence of applying light-emitting diode (LED) on OTM. Participants in the LED group required a significantly shorter time to align the mandibular arch compared to the control group (MD -24.50 days, 95% CI -42.45 to -6.55, 1 study, 34 participants). There is no evidence that LED application increased the rate of OTM during maxillary canine retraction (MD 0.01 mm/month, 95% CI 0 to 0.02; P = 0.28; 1 study, 39 participants ). In terms of secondary outcomes, one study assessed patient perception of pain and found no evidence of a difference between groups.   AUTHORS' CONCLUSIONS: The evidence from randomised controlled trials concerning the effectiveness of non-surgical interventions to accelerate orthodontic treatment is of low to very low certainty. It suggests that there is no additional benefit of light vibrational forces or photobiomodulation for reducing the duration of orthodontic treatment. Although there may be a limited benefit from photobiomodulation application for accelerating discrete treatment phases, these results have to be interpreted with caution due to their questionable clinical significance. Further well-designed, rigorous RCTs with longer follow-up periods spanning from start to completion of orthodontic treatment are required to determine whether non-surgical interventions may reduce the duration of orthodontic treatment by a clinically significant amount, with minimal adverse effects.

Investigating the Effectiveness of Low-Level Laser in Reducing Root Resorption of the Upper Incisors During Intrusion Movement Using Mini-Implants in Adult Patients With Deep Overbite: A Randomized Controlled Clinical Trial

BACKGROUND

Deep bite is a common characteristic of malocclusion, and many methods are used to treat it, including mini-implants used for the intrusion of the upper incisors. Orthodontically induced inflammatory root resorption (OIIRR) is an inevitable and unexpected side effect of orthodontic therapy. However, resorption of the root could be affected by the type of tooth movement, such as intrusion. Several studies have indicated the effectiveness of low-level laser therapy (LLLT) in accelerating orthodontic movement, but studies that have evaluated the role of this laser in reducing the risk of OIIRR have been limited. This trial aimed to investigate the effectiveness of LLLT in reducing the resorption of the roots of the upper incisors during their intrusion in the context of deep bite correction.

MATERIALS AND METHODS

Thirty patients (13 males, 17 females; mean age 22.4±3.37 years) with deep overbite were recruited and allocated to the laser or the control groups. Mini-implants were inserted between the roots of the upper central incisors and the lateral incisors from the labial aspect at the gingival-mucosal junction on both sides with a force of 40 g on each side through an NiTi coil spring. A low-level laser (Ga-Al-As) with 808 nm wavelength in a continuous mode, with the parameters 250 milliwatt power output, 4 Joules/point energy density, and 16 seconds irradiation per point, was applied to the root of each of the upper incisors. The laser was applied on the first day of the upper incisor intrusion (T1), then on days 3, 7, and 14 of the first month. In the second month, the laser was applied every 15 days, adjusting the spring strength every four weeks until the end of the intrusion stage (T2), which was determined by reaching a normal overbite. As for patients in the control group, the strength of the nickel-titanium springs was adjusted every four weeks to the required strength of 40 g on each end until reaching a normal overbite.

RESULTS

There was a volumetric decrease in both groups' upper central and lateral incisors roots, and this decrease was statistically significant (P<0.001). However, the difference between the two groups was not statistically significant in each central and lateral incisor volume root (P=0.345 and 0.263 for U1 and U2, respectively). Also, both groups had a linear decrease in upper central and lateral incisors roots, which was statistically significant (P<0.001). At the same time, the difference between the two groups was not statistically significant in each central and lateral incisor root length (P=0.343 and 0.461 for U1 and U2, respectively).

CONCLUSION

The low-level laser irradiation using the current protocol did not significantly affect the amount of root resorption induced by incisor intrusion in the experimental group compared to the control group.

Systematic Review: Is High-Energy Laser Therapy (HELT) With Flapless Corticotomy Effective in Accelerating Orthodontic Tooth Movement?

The objective of this review was to critically and systematically appraise the available evidence regarding the effectiveness of high-energy laser therapy (HELT) with flapless corticotomy in accelerating orthodontic tooth movement and the associated untoward effects.

We searched eight databases electronically in August 2021: PubMed®, Medline®, Google Scholar, Cochrane Library, Scopus®, Web of Science™, Trip, and PQDT OPEN from ProQuest. Another search was done in the reference lists of the included studies. Randomized controlled trials (RCTs) were included in which patients had received fixed orthodontic treatment combined with HELT-assisted corticotomy in comparison with traditional orthodontic treatment. Cochrane’s risk of bias (RoB2) tool was used to assess the risk of bias.

Five RCTs and one CCT were included in this review (155 patients). The HELT-based corticotomy around the upper canines led to a greater canine retraction at the first and second months (P < 0.001). In the third month, no statistically significant differences were noticed. In one RCT focusing on incisor intrusion, the irradiated upper incisors showed a greater intrusion speed than that of the control group (4.587 mm in 59 days vs. 3.78 mm in 95.8 days, respectively). No significant side effects associated with the application of HELT were reported. According to the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) approach, the quality of evidence supporting these findings was low to moderate.

Although the acceleration of tooth movement appeared to be significant at least in the first two months, there was low to moderate evidence concerning the efficacy of HELT-based flapless corticotomy in the acceleration of orthodontic tooth movement. There is a need for more well-conducted high-quality RCTs.

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

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 proliferation 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.