Intraoral photobiomodulation-induced orthodontic tooth alignment: a preliminary study

Timothy Shaughnessy, Alpdogan Kantarci, Chung How Kau, Darya Skrenes, Sanjar Skrenes, Dennis Ma, Timothy Shaughnessy, Alpdogan Kantarci, Chung How Kau, Darya Skrenes, Sanjar Skrenes, Dennis Ma

Abstract

Background: Numerous strategies have been proposed to decrease orthodontic treatment time. Photobiomodulation (PBM) has previously been demonstrated to assist in this objective. The aim of this study was to test if intraoral PBM increases the rate of tooth alignment and reduces the time required to resolve anterior dental crowding.

Methods: Nineteen orthodontic subjects with Class I or Class II malocclusion and Little's Irregularity Index (LII) ≥ 3 mm were selected from a pool of applicants, providing 28 total arches. No cases required extraction. The test group (N = 11, 18 arches, 10 upper, 8 lower) received daily PBM treatment with an intraoral LED device (OrthoPulse™, Biolux Research Ltd.) during orthodontic treatment, while the control group (N = 8, 10 arches, 3 upper, 7 lower) received only orthodontic treatment. The PBM device exposed the buccal side of the gums to near-infrared light with a continuous 850-nm wavelength, generating an average daily energy density of 9.5 J/cm(2). LII was measured at the start (T0) of orthodontic treatment until alignment was reached (T1, where LII ≤ 1 mm). The control group was mostly bonded with 0.018-in slot self-ligating SPEED brackets (Hespeler Orthodontics, Cambridge, ON. Canada), while conventionally-ligating Ormco Mini-Diamond twins were used on the PBM group (Ormco, Glendora, Calif. USA). Both groups progressed through alignment with NiTi arch-wires from 0.014-in through to 0.018-in (Ormco), with identical arch-wire changes. The rate of anterior alignment, in LII mm/week, and total treatment time was collected for both groups. Cox proportional hazards models were used to compare groups and while considering age, sex, ethnicity, arch and degree of crowding.

Results: The mean alignment rate for the PBM group was significantly higher than that of the control group, with an LII change rate of 1.27 mm/week (SD 0.53, 95 % CI ± 0.26) versus 0.44 mm/week (SD 0.20, 95 % CI ± 0.12), respectively (p = 0.0002). The treatment time to alignment was significantly smaller for the PBM group, which achieved alignment in 48 days (SD 39, 95 % CI ± 39), while the control group took 104 days (SD 55, 95 % CI ±19, p = 0.0053) on average. These results demonstrated that intraoral PBM increased the average rate of tooth movement by 2.9-fold, resulting in a 54 % average decrease in alignment duration versus control. The average PBM compliance to daily treatments was 93 % during alignment.

Conclusions: Under the limitations of this study, the findings suggest that intraoral PBM could be used to decrease anterior alignment treatment time, which could consequently decrease full orthodontic treatment time. However, due to its limitations, further research in the form of a large, randomized trial is needed.

Trial registration: ClinicalTrials.gov NCT02267837 . Registered 10 October 2014.

Figures

Fig. 1
Fig. 1
CONSORT flowchart showing patient and arch flow during the trial
Fig. 2
Fig. 2
OrthoPulse™ mouthpiece. Panel a displays a view of the back of the device. Panel b showcases the LED array when the device is switched on. Panel c provides a view of the device in situ
Fig. 3
Fig. 3
Two representative cases treated with conventional orthodontic method (Panels a and b) or with PBM (Panels c and d). Panel a Baseline (Day 0); LII is 8.80 mm. Panel b. Day 131; LII is 0.00 mm. Panel c. Baseline (Day 0); LII is 9.07 mm. Panel d. Day 50; LII is 0.00 mm
Fig. 4
Fig. 4
Boxplots showing alignment rates (mm/week) for control and PBM treated patients. Whiskers represent 1.5-times the interquartile ranges. Outliers are included. A statistically significant difference (p = 0.0002) in alignment rate was found between the two groups. The PBM group’s mean alignment rate was 1.27 (Interval of 1.01-1.53 at 95 % confidence), compared to a control rate of 0.44 (Interval of 0.30-0.59 at 95 % confidence) with a comparison group of 10 control arches and 18 PBM-treated arches
Fig. 5
Fig. 5
Kaplan-Meier survival curves for the two groups used in the study. The y-axis gives the proportion of patients still in treatment (not aligned) over time (days on x-axis). By drawing a line perpendicular to the x-axis at a given time value, the proportion of patients not completed for each group is determined from the corresponding y-axis. There is clear separation occurring as early as 20 days. This separation is maintained throughout the duration of the study

References

    1. Skidmore KJ, Brook KJ, Thomson WM, Harding WJ. Factors influencing treatment time in orthodontic patients. Am J Orthod Dentofacial Orthop. 2006;129:230–238. doi: 10.1016/j.ajodo.2005.10.003.
    1. Doshi-Mehta G, et al. Efficacy of low-intensity laser therapy in reducing treatment time and orthodontic pain: A clinical investigation. Am J Orthod Dentofacial Orthop. 2012;141(3):289–297. doi: 10.1016/j.ajodo.2011.09.009.
    1. Nimeri G, Kau CH, Abou-Kheir NS, Corona R. Acceleration of tooth movement during orthodontic treatment - a frontier in orthodontics. Prog Orthod. 2013;14:42. doi: 10.1186/2196-1042-14-42.
    1. Kawakami M, Takano-Yamamoto T. Local injection of 1,25-dihydroxyvitamin D3 enhanced bone formation for tooth stabilization after experimental tooth movement in rats. J Bone Miner Metab. 2004;22:541–546. doi: 10.1007/s00774-004-0521-3.
    1. Sefi M, Eslami B, Saffar AS. The effect of prostaglandin E2 and calcium gluconate on orthodontic tooth movement and root resorption in rats. Eur J Orthod. 2003;25:199–204. doi: 10.1093/ejo/25.2.199.
    1. Hashimoto F, Kobayashi Y, Mataki S, Kobayashi K, Kato Y, Sakai H. Administration of osteocalcin accelerates orthodontic tooth movement induced by closed coil springs in rats. EUR Orthod Soc. 2001;23:525–545.
    1. Madan MS, Liu ZJ, Gu GM, King GJ. Effects of human relaxin on orthodontic tooth movement and periodontal ligaments in rats. Am J Orthod Dentofacial Orthop. 2007;131(8):e1–e10.
    1. Dias FJ, Issa JPM, de Carvalho Vicentini FTM, Fonseca MJV, Leão JC, Siéssere S, et al. Effects of low-level laser therapy on the oxidative metabolism and matrix proteins in the rat masseter muscle. Photomed Laser Surg. 2011;29(10):677–684. doi: 10.1089/pho.2010.2879.
    1. Silveira PC, Silva LA, Fraga DB, Freitas TP, Streck EL, Pinho R. Evaluation of mitochondrial respiratory chain activity in muscle healing by low-level laser therapy. J Photochem Photobiol B. 2009;95(2):89–92. doi: 10.1016/j.jphotobiol.2009.01.004.
    1. Tuby H, Maltz L, Oron U. Low-level laser irradiation (LLLI) promotes proliferation of mesenchymal and cardiac stem cells in culture. Lasers Surg Med. 2007;39(4):373–378. doi: 10.1002/lsm.20492.
    1. Zhang R, Mio Y, Pratt PF, Lohr N, Warltier DC, Whelan HT, et al. Near infrared light protects cardiomyocytes from hypoxia and reoxygenation injury by a nitric oxide dependent mechanism. J Mol Cell Cardiol. 2009;46:4–14. doi: 10.1016/j.yjmcc.2008.09.707.
    1. He WL, Li CJ, Liu ZP, Sun JF, Hu ZA, Yin X, et al. Efficacy of low-level laser therapy in the management of orthodontic pain: a systematic review and meta-analysis. Lasers Med Sci. 2013;28(6):1581–1589. doi: 10.1007/s10103-012-1196-y.
    1. Eslamian L, Borzabadi-Farahani A, Hassanzadeh-Azhiri A, Badiee MR, Fekrazad R. The effect of 810-nm low-level laser therapy on pain caused by orthodontic elastomeric separators. Lasers Med Sci. 2014;29(2):559–564. doi: 10.1007/s10103-012-1258-1.
    1. Panhoca VH, Lizarelli Rde F, Nunez SC, Pizzo RC, Grecco C, Paolillo FR, et al. Comparative clinical study of light analgesic effect on temperomandibular disorder (TMD) using red and infrared led therapy. Lasers Med Sci. 2015;30(2):815–822. doi: 10.1007/s10103-013-1444-9.
    1. Ferraresi C, Dos Santos RV, Marques G, Zangrande M, Leonaldo R, Hamblin MR, et al. Light-emitting diode therapy (LEDT) before matches prevents increase in creatine kinase with a light dose response in volleyball players. Lasers Med Sci. 2015;30(4):1281–1287. doi: 10.1007/s10103-015-1728-3.
    1. Pinheiro AL, Soares LG, Cangussú MC, Santos NR, Barbosa AF, Silveira JL. Effects of LED phototherapy on bone defects grafted with MTA, bone morphogenetic proteins and guided bone regeneration: a Raman spectroscopic study. Lasers Med Sci. 2012;27(5):903–916. doi: 10.1007/s10103-011-1010-2.
    1. Pinheiro AL, Soares LG, Aciole GT, Correia NA, Barbosa AF, Ramalho LM, et al. Light microscopic description of the effects of laser phototherapy on bone defects grafted with mineral trioxide aggregate, bone morphogenic proteins, and guided bone regeneration in a rodent model. J Biomed Mater Res A. 2011;98(2):212–221. doi: 10.1002/jbm.a.33107.
    1. Corazza AV, Paolillo FR, Groppo FC, Bagnato VS, Caria PH. Phototherapy and resistance training prevent sarcopenia in ovariectomized rats. Lasers Med Sci. 2013;28(6):1467–1474. doi: 10.1007/s10103-012-1251-8.
    1. Rojas JC, Gonzalez-Lima F. Low-level light therapy of the eye and brain. Eye and Brain. 2011;3:49–67.
    1. Eells JT, Wong-Riley MT, Ver Hoeve J, Henry M, Buchman EV, Kane MP, et al. Mitochondrial signal transduction in accelerated wound and retinal healing by near-infrared light therapy. Mitochondrion. 2004;4(5–6):559–567. doi: 10.1016/j.mito.2004.07.033.
    1. Masha RT, Houreld NN, Abrahamse H. Low-intensity laser irradiation at 660 nm stimulates transcription of genes involved in the electron transport chain. Photomed Laser Surg. 2013;31(2):47–53. doi: 10.1089/pho.2012.3369.
    1. Eells JT, Henry MM, Summerfelt P, Wong-Riley MT, Buchmann EV, Kane M, et al. Therapeutic photobiomodulation for methanol-induced retinal toxicity. Proc Natl Acad Sci U S A. 2003;100(6):3439–3444. doi: 10.1073/pnas.0534746100.
    1. Kawasaki K, Shimizu N. Effects of low-energy laser irradiation on bone remodeling during experimental tooth movement in rats. Laser Surg Med. 2000;26:282–291. doi: 10.1002/(SICI)1096-9101(2000)26:3<282::AID-LSM6>;2-X.
    1. Cruz DR, Kohara EK, Ribeiro MS, Wetter NU. Effects of low-intensity laser therapy on the orthodontic movement velocity of human teeth: a preliminary study. Lasers Surg Med. 2004;35(2):117–120. doi: 10.1002/lsm.20076.
    1. Sousa MV, Scanavini MA, Sannomiya EK, Velasco LG, Angelieri F. Influence of low-level laser on the speed of orthodontic movement. Photomed Laser Surg. 2011;29(3):191–196. doi: 10.1089/pho.2009.2652.
    1. Youssef M, Ashkar S, Hamade E, Gutnecht N, Lampert F, Mir M. The effect of low-level laser therapy during orthodontic movement: a preliminary study. Lasers Med Sci. 2008;1:27–33.
    1. Kalemaj Z, Debernardl CL, Buti J. Efficacy of surgical and non-surgical interventions on accelerating orthodontic tooth movement: a systematic review. Eur J Oral Implantol. 2015;8(1):9–24.
    1. Carvalho-Lobato P, Garcia VJ, Kasem K, Ustrell-Torrent JM, Tallón-Walton V, Manzanares-Céspedes MC. Tooth movement in orthodontic treatment with low-level laser therapy: a systematic review of human and animal studies. Photomed Laser Surg. 2014;32(5):302–309. doi: 10.1089/pho.2012.3439.
    1. Domínguez A, Velásquez SA. Tooth movement in orthodontic treatment with low-level laser therapy: systematic review imprecisions. Photomed Laser Surg. 2014;32(8):476–477. doi: 10.1089/pho.2014.9857.
    1. Gkantidis N, Mistakidis I, Kouskoura T, Pandis N. Effectiveness of non-conventional methods for accelerating orthodontic tooth movement: a systematic review and meta-analysis. J Dent. 2014;42(10):1300–1319. doi: 10.1016/j.jdent.2014.07.013.
    1. Kau CH, Kantarci A, Shaughnessy T, Vachiramon A, Santiwong P, de la Fuente A, et al. Photobiomodulation accelerates orthodontic alignment in the early phase of treatment. Prog Orthod. 2013;14:30. doi: 10.1186/2196-1042-14-30.
    1. Little RM. The irregularity index: a quantitative score of mandibular anterior alignment. Am J Orthod. 1975;68(5):554–63.
    1. Bernabé E, Flores-Mir C. Estimating arch length discrepancy through Little's Irregularity Index for epidemiological use. Eur J Orthod. 2006;28(3):269–273. doi: 10.1093/ejo/cji112.
    1. Almasoud N, Bearn D. Little’s irregularity index: Photographic assessment vs study model assessment. Am J Orthod Dentofacial Orthop. 2010;138:787–794. doi: 10.1016/j.ajodo.2009.01.031.
    1. Pandis N, Polychronopoulou A, Katsaros C, Eliades T. Comparative assessment of conventional and self-ligating appliances on the effect of mandibular intermolar distance in adolescent nonextraction patients: a single-center randomized controlled trial. Am J Orthod Dentofacial Orthop. 2011;140(3):e99–e105. doi: 10.1016/j.ajodo.2011.03.019.
    1. Pandis N, Polychronopoulou A, Makou M, Eliades T. Mandibular dental arch changes associated with treatment of crowding using self-ligating and conventional brackets. Eur J Orthod. 2010;32:248–253. doi: 10.1093/ejo/cjp123.
    1. Babyak MA. What you see may not be what you get: a brief, nontechnical introduction to overfitting in regression-type models. Psychosom Med. 2004;66(3):411–421.
    1. Turbill EA, Richmond S. The time-factor in orthodontics: What influences the duration of treatments in National Health Service practices? Community Dent Oral Epidemiol. 2001;29(1):62–72. doi: 10.1034/j.1600-0528.2001.00010.x.
    1. Reddy VB, Kumar TA, Prasad M, Nuvvula S, Patil RG, Reddy PK. A comparative in-vivo evaluation of the alignment efficiency of 5 ligation methods: A prospective randomized clinical trial. Eur J Dent. 2014;8(1):23–31. doi: 10.4103/1305-7456.126236.
    1. Fleiss JL. The Design and Analysis of Clinical Experiments. New York: John Wiley Sons; 1986. pp. 1–31.
    1. Bredin R. Light Transmission Profiles; Meat and Bone. Prepared for Biolux Research Ltd. August 2013.
    1. Lanzafame RJ, Stadler I, Kurtz AF, Connelly R, Peter TA, Sr, Brondon P, et al. Reciprocity of exposure time and irradiance on energy density during photoradiation on wound healing in a murine pressure ulcer model. Lasers Surg Med. 2007;39:534–542. doi: 10.1002/lsm.20519.
    1. Mester E, Nagylucskay S, Waidelich W, Tisza S, Greguss P, Haina D, et al. Effects of direct laser radiation on human lymphocytes. Arch Dermatol Res. 1978;263:241–245. doi: 10.1007/BF00446940.
    1. Hamblin MR, Demidova TN. Mechanisms for low-light therapy. Proc SPIE. 2006;6140:1–12.
    1. Sommer AP, Pinheiro AL, Mester AR, Franke RP, Whelan HT. Biostimulatory windows in low-intensity laser activation: lasers, scanners, and NASA's light-emitting diode array system. J Clin Laser Med Surg. 2001;19:29–33. doi: 10.1089/104454701750066910.
    1. Goulart CS, Nouer PRA, Martins LM, Garbin IUL Lizarelli RFZ. Photoradiation and orthodontic movement: experimental study with canines. Photomed. Laser Surg. 2006;24:192–196. doi: 10.1089/pho.2006.24.192.
    1. Garino F, Favero L. Control of tooth movements with the Speed system. Prog Orthod. 2003;4:23–30. doi: 10.1034/j.1600-9975.2002.02032.x.
    1. Fleming P, DiBiase AT, Grammati S, Lee RT. Efficiency of mandibular arch alignment with 2 preadjusted edgewise appliances. Am J Orthod Dentofacial Orthop. 2009;135(5):597–602. doi: 10.1016/j.ajodo.2007.06.014.
    1. Miles PG, Weyant RJ, Rustveld L. A Clinical Trial of Damon 2 vs Conventional Twin Brackets during Initial Alignment. Angle Orthod. 2006;76(3):480–485.
    1. Ong E, McCallum H, Griffin MP, Ho C. Efficiency of self-ligating vs conventionally ligated brackets during initial alignment. Am J Orthod Dentofacial Orthop. 2006;138(2):e1–e.7.
    1. Papageorgiou SN, Konstantinidis I, Papadopoulou K, Jäger A, Bourauel C. Clinical effects of pre-adjusted edgewise orthodontic brackets: a systematic review and meta-analysis. Eur J Orthod. 2014;36(3):350–363. doi: 10.1093/ejo/cjt064.
    1. Sebastian B. Alignment efficiency of superelastic coaxial nickel-titanium vs superelastic single-stranded nickel-titanium in relieving mandibular anterior crowding: a randomized controlled prospective study. Angle Orthod. 2012;82(4):703–708. doi: 10.2319/072111-460.1.

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