Background
Methods
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Problem specification
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Formulation of a plan for the literature search
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Literature search and retrieval of publications
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Data extraction, interpretation of data and evidence from the literature retrieved.
Problem specification
Formulation of a plan for the literature search
Tooth movement | Orthodontic relapse | Acute pain | |
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Search block | |||
#1 | Orthodontics OR Orthodontic OR Fixed Appliance | Orthodontics OR Orthodontic OR Fixed Appliance | Orthodontics OR Orthodontic OR Fixed Appliance |
#2 | Laser OR Low level laser therapy OR LLLT | Laser OR Low level laser therapy OR LLLT | Laser OR Low level laser therapy OR LLLT |
#3 | Tooth movement OR Velocity OR Rate OR Speed | Relapse OR Recurrence OR Retention | Pain OR Discomfort |
#4 | #1 AND #2 AND #3 | #1 AND #2 AND #3 | #1 AND #2 AND #3 |
Literature search and retrieval of publications
Tooth movement | Orthodontic relapse | Acute pain | |
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Inclusion criteria | |||
Study design | – | RCT, CCT | – |
Observation period | – | Unlimited | – |
Language | – | English, Scandinavian | – |
Population | – | Male/female, mean age 10–30 years, sample size ≥ 20/group | – |
Intervention | LLLT accelerate movement | LLLT prevent relapse | LLLT diminish acute pain |
Control | – | Control or placebo | – |
Outcome | Measurement in mm or per cent | – | Measurement in NRS or VAS |
Exclusion criteria | |||
Problem specification | – | Not addressed | – |
Research | – | Not original (editorial, review etc.), case series | – |
Data extraction, interpretation and evidence from the literature
Study | Country | Subjects (Laser/ Placebo/ Control) Age (yrs) Gender (M/F) | Study design | Orthodontic treatment | Placebo/ Control group | Measurement | Results (laser group, LG, Control group, C) | Type of laser | Wavelength (nm) | Time per point/ Total time per treatment | Frequency of laser treatment | Power (mW) | Dose (J/cm2) | Time per point/ Total time per treatment | Frequency of laser treatment |
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Doshi-Meht [7] (2012) | India | 20/20 12–23 y 8/12 | Single blinded RCT (Split mouth) | Maxillary and mandibular canine retraction NiTi closed-coil spring | Placebo | Digital caliper on model | Mean increased tooth movement rate end of 3 month: LG: Maxilla; 54 %. Mandible; 58 % Mean increased tooth movement rate at complete retraction LG: Maxilla; 29 %, Mandible; 31 % | AlGaAs | 800 | 10 s/1 min 40 s | Day 3, 7, and 14 in the first month. Thereafter on every 15th day until complete canine retraction on the experimental side, average 4.5 month | 0,25 | 5 | 10 s/Unclear | Day 3, 7, and 14 in the first month. Thereafter on every 15th day until complete canine retraction on the experimental side, average 4.5 month. |
Genc [9] (2013) | Turkey | 20/20 17,8 y 6/14 | Unblinded CCT (Split mouth) | Maxillary canine retraction NiTi closed coil spring (mini-implant) | Control | Digital calliper | Tooth movement LG; 20–40 % faster than C. | GaAlAs | 808 | 10 s/1 min 40 s | Day 0, 3, 7, 14, 21, 28 after activation | 20 | 0,71 | 10 s/1 min 40 s | Day 0, 3, 7, 14, 21, 28 after activation |
Heravi [10] (2014) | Iran | 20/20 22.1 y 3/17 | Single blinded CCT (Split mouth) | Maxillary canine retraction | Control | Computer measurements on photos of study models | No differences between LG and C after 56 days. | GaAlAs | 810 | 30 s/7 min 30 s | Day 4, 7, 11, 15 and 28 in the first month after Activation, Day 32, 25, 39, 43 and 56 in the second month | – | – | – | – |
Study | Country | Subjects (Laser/Placebo/Control) Age (yrs), Gender (M/F) | Study design | Orthodontic treatment | Placebo/control group | Pain measurement | Results (laser group, LG, laser side, LS, control, C, placebo, P) | Type of laser | Wavelength (nm) | Power (mW) | Time per point/ time per laser-treatment (second, s, minute, min) | Frequency of laser treatment (day, d, week, wk, month, mo) |
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Lim [20] (1995) | Singapore | 39/39 21–24 y Not reported | Double blinded placebo, RCT (split mouth) | Elastomeric separators | Placebo | VAS | No difference in pain sensation | GaAsAl | 830 | 30 | 15, 30, 60 s/ 1 min 15 s–5 min | One session/d during 5 d |
Harazaki [19] (1997) | Japan | 20/20/44 11–34 y 27/57 | Single blinded RCT | Fixed appliance | Placebo and control | NRS (1–5) | Pain onset later in LG approx. 3 h | HeNe | 632,8 | 6 | 30 s/ 12–24 min | One |
Harazaki [11] (1998) | Japan | 20/20 20,1 y 11/23 | Single blinded CCT | Fixed appliance | Placebo | NRS (1–5) | LG pain reduction rate: 48.4 % | HeNe | 832.8 | 6 | 30 s/ 2–5 min | One, until pain ceased |
Fujiyama [12] (2008) | Japan | 60/60/30 19,22 y 18/42 | Single blinded CCT (split mouth) | Elastomeric separators | Control | VAS | Lower VAS separators day 4. VAS: LS 36.1, C 60.1 | CO2 | Not reported | 2000 | 30 s/ 1 min | One |
Tortamano [17] (2009) | Brazil | 20/20/20 12–18 y 18/42 | Double blind RCT | Fixed appliance | Placebo and control | NRS (1–5) | Lower 1th day. LG: 1.95, Placebo: 1.7, C:2.05. ended earlier LG | GaAsAl | 830 | 30 | 16 s/ 32–37 min 30 s | One |
Doshi-Mehta [7] (2012) | India | 20/20 12–23 y 8/12 | Single blinded RCT (split mouth) | Upper, lower canine retraction | Placebo | Children’s VAS | Lower VAS day 3 and 30. Day 3: LG 0.8, C 3.2. Day 30: LG 1.5, C 2.4 | AlGaAs | 800 | 0,7 | 30 s/Unclear | Day 0, 3, 7, 14, every 15th d in 4.5 mo. |
Kim [13] (2012) | Korea | 28/30/30 22,7 y 23/65 | Single blinded RCT | Elastomeric separators | Placebo and control | VAS | LG lower VAS up to day 1. Overall mean VAS: LG:19.7, C:35.64 | AlGaInP | 635 | 6 | 30 s/ 28 min | 2 times/d for 1 wk |
Artés-Ribas [15] (2012) | Spain | 20/20 26,4 y 6/14 | Single blinded RCT (split mouth) | Elastomeric separators | Placebo | VAS | Overall mean VAS LG: 7.7, C:14.1 | GaAlAs | 830 | 100 | 20 s/ 3 min 20 s | One |
Domínguez [14] (2013) | Colombia | 60/60 24,3 y Not reported | Single blinded RCT (split mouth) | Fixed appliance | Placebo | VAS | Lower max pain on VAS. LG: 3.3, C: 6.9 | GaAlAs | 830 | 100 | 22 s/44 s | One |
Eslamían [16] (2013) | Iran | 37/37 24,97 y 12/25 | Single blinded RCT (split mouth) | Elastomeric separators | Placebo | VAS | Lower VAS 6 h, 24 h, 30 h, day 3. VAS: LG:0.86, PG:1.10 | AlGaAs | 810 | 100 | 20 s/ 3 min 20 s | Two |
Nóbrega [8] (2013) | Brazil | 30/30 17,5 y 12/18 | Double blinded RCT | Elastomeric separators | Placebo | VAS | LG Lower VAS VAS: LG:0.42, PG:1.88 | AlGaAS | 830 | 40,6 | 25–50 s/ 2 min 5 s | One |
Abtahi [18] (2013) | Iran | 29/29 12–22 y 24/5 | Single blinded RCT (split mouth) | Elastomeric separators | Placebo | VAS | Lower VAS day 2 LG: 4.5, PG: 7.45 | GaAs | 904 | 200 | 7.5 s/30 s | One session/d, 5 d |
Heravi [10] (2014) | Iran | 20/20 22.1 y 3/17 | Single blinded CCT (Split mouth) | Maxillary canine retraction | Control | – | No differences between groups after 56 days | GaAlAs | 810 | 200 | 30 s/ 7 min 30 s | Day 4, 7, 11, 15, 28 1th mo.. Day 32, 25, 39, 43, 56 2nd mo. |
Study | Adequate selection | Single blinded | Adequate assessment of result | Adequate report ofattrition | Adequate report of side effects | No conflict of interests | Adequate study population | TOTAL |
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Doshi-Mehta [7] (2011) | Yes | Yes | Yes | Not reported | No | Not reported | Yes | Moderate |
Genc [9] (2013) | Yes | No | Yes | Not reported | No | Not reported | Yes | Moderate |
Heravi [10] (2014) | Yes | Yes | Yes | Not reported | No | Not reported | Yes | Moderate |
Accelerating tooth movement | Modulation of acute pain | |
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Studies
| 3 | 13 |
Subjects
| 60 | 333 |
Study design
| RCT, CCT | RCT |
Preliminary grade of evidence
| ⊕ ⊕ ⊕ | ⊕ ⊕ ⊕⊕ |
Study quality
a
| 1 | 1 |
Inconsistency
a
| 0 | 1 |
Indirectness/Relevance
a
| 1 | 0 |
Imprecise data
b
| 0 | 0 |
Risk of publication bias
a
| 0 | 0 |
Large effect
c
| 0 | 0 |
Dose-response
d
| 0 | 0 |
Confounding factors
d
| 0 | 0 |
Overall quality of evidence
| ⊕ Very low | ⊕⊕ Low |
Study | Adequate selection | Single blinded | Double blinded | Adequate assessment of result | Adequate report of attrition | Adequate report of side effects | No conflict of interests | Adequate study population | TOTAL |
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Lim [20] (1995) | Yes | No | Yes | Yes | Not reported | No | Not reported | No | Moderate |
Harazki [19] (1997) | No | Yes | No | No | Not reported | No | Not reported | Yes | Low |
Harazaki [11] (1998) | No (CCT) | Yes | No | No | Not reported | No | Not reported | Yes | Low |
Fujiyama [12] (2008) | No (CCT) | Yes | No | Yes | Not reported | No | Not reported | Yes | Moderate |
Tortamano [17] (2009) | Yes | No | Yes | Yes | Not reported | No | Not reported | Yes | Moderate |
Doshi-Metha [7] (2012) | Yes | Yes | No | Yes | Not reported | No | Not reported | Yes | Moderate |
Kim [13] (2012) | Yes | Yes | No | Yes | Not reported | No | Not reported | Yes | Moderate |
Artés-Ribas [15] (2012) | Yes | Yes | No | Yes | Not reported | No | Not reported | Yes | Moderate |
Dominguez [14] (2013) | Yes | Yes | No | Yes | Not reported | No | Yes | Yes | Moderate |
Eslamian [16] (2013) | Yes | Yes | No | Yes | Not reported | No | Not reported | Yes | Moderate |
Nóbrega [8] (2013) | Yes | No | Yes | Yes | Yes | No | Yes | Yes | High |
Abtahi [18] (2013) | Yes | Yes | No | Yes | Not reported | No | Yes | No | Moderate |
Heravi [10] (2014) | Yes | Yes | No | Yes | Not reported | No | Not reported | Yes | Moderate |