Orthodontic Separators Research Articles

The Hall technique: knowledge, practice, and concerns of dentists in primary care settings in the State of Qatar-a questionnaire-based survey.

To assess the knowledge, practice, and concerns about the Hall Technique among pediatric dentists (PDs) and general dental practitioners (GDPs) working in primary care settings in the State of Qatar. A prospective questionnaire-based survey was distributed to all GDPs and PDs working at different Primary Health Care Corporation centers in Qatar between 1 November and 10 December 2023. Descriptive data analysis was carried out. The response rate was 49% among GPDs and 100% among PDs. Approximately 85% of PDs and 48% of GDPs were familiar with the HT although only 58% of the PDs and 4% of the GDPs applied HT preformed metal crowns (HTPMCs) in their current primary care practice. Majority of both PDs and GDPs did not consider HTPMCs as the treatment of choice for restoring asymptomatic carious primary molars and preferred applying the HT for cavitated carious lesions over non-cavitated lesions. Regarding HT practices, 57.7% of PDs and 48% of GDPs always planned on taking a pre-operative radiograph before the procedure, while only 15.4% of PDs and 8% of GDPs would always consider using an orthodontic separator prior to placing an HTPMC. The main concerns among the respondents about the HT included sealing in caries (PDs 31%; GDPs 50%), high occlusion (PDs 57.7%; GDPs 53.3%), and gingival damage (27% PDs; 47% GDPs.) Endorsement by professional bodies and further research evidence were seen as ways to promote wider adoption of the HT. The HT is recognised but not widely used among primary care dentists working in the State of Qatar. HTPMCs are often seen as secondary options for restoring carious primary molars with dentists still having a number of concerns regarding the HT.

The effectiveness of low-level laser therapy and low-intensity pulsed ultrasound in reducing pain induced by orthodontic separation: a randomized controlled trial

BackgroundThe low-level laser therapy (LLLT) and low-intensity pulsed ultrasound (LIPUS) have been recently applied to control pain during orthodontic treatment.ObjectiveTo evaluate and compare the effectiveness of LLLT and LIPUS in reducing pain induced by orthodontic separation.Study designA single-blinded randomized controlled trial.MethodsOne hundred and fifty patients were randomly assigned into three groups; LLLT group, LIPUS group, and control group. After 5 min from the separators’ placement, the first dose of the laser or the ultrasound was applied, the second dose was applied after 24 h, and the third dose was applied after 48 h on both maxillary and mandibular first molars. The exposure of laser was for 20 s at each point (maxillary and mandibular first molars), with an 810-nm aluminum-gallium-arsenide (AlGaAs) diode laser on continuous mode. The output power set at 150 mW, the energy density of 4 J/cm2, and a laser spot diameter of 7 mm were applied. Whereas the frequency of ultrasonic toothbrush was 1.6 MHz; and average output intensity was 0.2 W/cm2. The application was for 20 min (5 min on each first molar). The control group received the separators without another intervention. A Visual Analog Scale (VAS 100 mm) was used to assess pain intensity at several time intervals during the first four days after the separators’ placement.ResultsA total of 145 patients were assessed. There was a significant difference in pain perception among the three groups after 5 min (P = .002). The maximum pain level was reached after 24 h. However, the laser group and the ultrasound group showed a statistically significant decrease in pain scores compared to the control group at all the assessment time points (P < .001). Whereas there was no difference between the laser group and the ultrasound group in reducing the pain scores (P > .05).ConclusionsThe LLLT and the LIPUS effectively reduce the separation pain when applied in multiple doses without differences between them.Trial registrationThis trial was registered with the German Clinical Trials Register (DRKS). (https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID= DRKS00029991). Date of registration: 26/08/2022.

Hyperbaric Oxygen Therapy to Minimize Orthodontic Relapse in Rabbits.

The purpose of the present study was to discover how hyperbaric oxygen therapy (HBOT) could reduce orthodontic relapse by altering the expressions of hypoxia-inducible factor (HIF)-1 messenger ribonucleic acid (mRNA), type I collagen (Col I), and matrix metalloproteinase-1 (MMP-1) in the gingival supracrestal fibers in rabbits. This study involved 44 male rabbits (Oryctolagus cuniculus) randomly divided into the normal group (K0), the orthodontic group without HBOT (K1), and the orthodontic group with HBOT (K2). Following orthodontic separation of the two upper central incisors, a retention phase and relapse assessment were performed. The HBOT was performed for a period of 2, 4, 6, 8, and 10 days after retention. HIF-1α transcription was assessed employing real-time polymerase chain reaction, whereas Col I and MMP-1 proteins were examined using immunohistochemistry. The orthodontic relapse was measured clinically using a digital caliper. We used the one-way analysis of variance followed by Tukey's post hoc for multiple comparisons to measure differences between pairs of means; a p-value of 0.05 was considered statistically significant. HBOT significantly increased the HIF-1α mRNA expression (p = 0.0140), increased Col I (p = 0.0043) and MMP-1 (p = 0.0068) on the tensioned and pressured side of the gingival supracrestal fibers, respectively, and clinically decreased the relapse (p = 3.75 × 10-40). HBOT minimizes orthodontic relapse by influencing HIF-1α expression, collagen synthesis (Col I), and degradation (MMP-1). This result suggests that HBOT has the potential to be used as an adjunctive method in the orthodontic retention phase.

The effectiveness of interventions in reducing pain related to orthodontic separation: a systematic review and meta-analysis.

Pain is an unpleasant experience and annoying sensation. To control this pain during orthodontic separation, different pharmacological and non-pharmacological methods have been used. This systematic review and meta-analysis aimed to critically assess the evidence of the effectiveness of pharmacological and non-pharmacological methods in reducing pain induced by orthodontic separation. An electronic search was conducted using the following databases: PubMed® (Medline), Scopus®, EMBASE®, Web of ScienceTM, Google ScholarTM, ProQuest, and Cochrane Central Register of controlled trials (CENTRAL) searching for the studies published between January 2012 and April 2023. Only randomized controlled trials (RCTs) were included, each experimental group included patients who received elastomeric separators and one kind of pharmacological or non-pharmacological interventions for pain reduction during the separation stage. Cochrane's risk of bias tool (RoB2 tool) was applied. The Grading of Recommendations Assessment, Development, and Evaluation [GRADE] approach was used to evaluate the strength of the evidence. Thirty-one studies (RCTs) were included in this systematic review. Nineteen of them were appropriate for quantitative synthesis and used VAS for pain assessment. Meta-analysis showed that low-level laser therapy (LLLT) was an effective approach for pain relief after separators placement with standard mean difference of 13.79 mm (95% confidence interval (CI): -15.64, -11.94) at 6 h and 23.34 mm at 24 h (95% CI: -25.91, -20.77). LLLT was also effective when applied in split-mouth and the standard mean difference was 8.9 mm at 6 h (95% CI: -12.86, -3.33) and 17.15 mm at 24 h (95% CI: -30.12, -4.17). Ibuprofen had a pain control effect at 6 h and at 24 h compared with the placebo group. The standard mean difference was 14.37 mm (95% CI: -20.54, -8.19) and 20.46 mm (95% CI: -27.79, -13.13), respectively. There was no difference in pain control between ibuprofen and acetaminophen. Naproxen had lower visual analog scale scores in pain perception at 6 h and the standard mean difference was 7.03 mm (95% CI: -12.67, -1.40). The application of LLLT decreased the pain induced by the separation during the first day of teeth separation; the pain reduction showed an increase from 6 h to the end of the 24 h. However, the evidence is weak to moderate. The analgesics reduced the pain compared to placebo; this pain reduction had shown an increase from 6 h to the end of the 24 h. The strength of the evidence is moderate. Naproxen gel effectively reduced the pain compared to placebo; the evidence in this regard is moderate. Naproxen gel effectively reduced the pain compared to placebo, but it was less effective than the oral intake of non-steroidal anti-inflammatory drugs. However, the evidence in this regard is moderate. This systematic review was registered with PROSPERO (CRD42022335553) during the first stages of its conduction.

Comparative Evaluation of Effect of TENS on Controlling Pain Associated with Orthodontic Separator Placement-A Clinical Study.

To assess and contrast the efficacy of transcutaneous electrical nerve stimulation (TENS) therapy and topical anesthetic gel in reducing the level of pain associated with the placement of orthodontic separators. A cohort of 40 individuals, aged between 16 and 20 years, who were in need of fixed orthodontic treatment, was chosen for the study. Elastomeric separators were positioned bilaterally adjacent to the first molars in all participants, who were subsequently separated into two distinct cohorts. Those in group I received topical anesthetic gel, while those in group II underwent TENS therapy. After the placement of separators, the assessment of pain was conducted using the Visual Analog Scale (VAS) at specific intervals: Immediately after placement, 6, 12, 24, and 48 hours. TENS group showed a significantly lower VAS score compared to the local anesthetic gel group at immediate, 6 hours, and 12 hours. Following the placement of elastomeric separators, it was found that TENS was more successful at reducing pain.

Acupressure versus NSAID for relief of orthodontic pain : A randomized controlled clinical trial.

To compare ibuprofen and acupressure for pain relief after insertion of elastomeric orthodontic separators. Arandomized control clinical trial was conducted in an orthodontic clinic. Atotal of 75orthodontic patients aged 12-16years participating in the study were randomly allocated to receive either 400 mg of oral ibuprofen, applying acupressure therapy, or no pain-relief approach. Pain scores were recorded on visual analog scales (10 cm) over aweek at different times (4,10, 18, 24 h, and 1week). The margin of equivalence was defined as 10 mm. For all timepoints, the control group recorded the highest pain. For the ibuprofen and acupressure group, after 4 h, 18 h, and 1week, no significant difference was noted. However, after 10 h, no significant difference in pain between the control and acupressure groups was noted and the ibuprofen group showed significantly lower pain. In the acupressure group, the highest pain was noted at 10 h. After this timepoint, pain progressively decreased with time and the lowest pain was noted after 1week. In the control and ibuprofen groups, the highest pain was after 4 h, and then progressively decreased with time and the lowest pain was noted after 1week. There was no significant difference in pain perception between participants using ibuprofen or acupressure and both groups recorded significantly lower pain than the control group at most of the observed timepoints. Results support the analgesic effect of the acupressure approach.

The Effect of Chlorhexidine on Bacterial Contamination of Hall Technique Elastomeric Orthodontic Separators and Gingival Health: A Pilot Study

The Effect of Chlorhexidine on Bacterial Contamination of Hall Technique Elastomeric Orthodontic Separators and Gingival Health: A Pilot Study

Influence of anxiety and catastrophizing on pain perception in orthodontic treatment and its association with inflammatory cytokines.

Pain is common in orthodontic treatment, is subject to individual variation, and is associated with anxiety and stress, which can potentially become catastrophizing. The aim of the present study was to determine the variability of pain response after the insertion of orthodontic separators and to assess the association of pain levels with dental anxiety, catastrophizing, tooth sensitivity, and genetic expression of cytokines. To this end, 70 patients of both genders were divided into two equal groups according to the elastomeric separator used: G1 (Dentaurum) and G2 (Orthometric). Two separators were inserted in the mesial and distal sides of the lower right first molar. Participants were instructed to rate the level of pain at T0 (before insertion), T1 (just after insertion), and T2 (24 hours after insertion) on a visual analog scale. The gingival crevicular fluid was collected at T0 and T2. The levels of anxiety, catastrophizing, tooth sensitivity, and cytokine expression were also assessed. Statistical analysis was performed with the Fisher-Freeman-Halton, chi-squared, Spearman's correlation, and dependent and independent t tests (α=5%). Pain intensity was higher at T2 than at T1, in both groups (P<.05). An association was established (P<.05) between pain intensity at T1 and catastrophizing, and at T2 with anxiety and catastrophizing. Within-group differences in cytokine expression were found between T0 and T2. There was no correlation between cytokine expression and pain levels, anxiety, catastrophizing, and sensitivity at T2. Tooth separation produced variable pain levels, which were influenced by anxiety and catastrophizing, however, pain level was not correlated with increased cytokine expression.

The Effect of Lavender Inhalation on the Pain Perception of Orthodontic Separator Placement: An Open-Label Randomized Controlled Trial

Lavandula angustifolia Mill. (lavender) is known for its antibacterial, muscle relaxant, antispasmodic, sedative, and anesthetic effects, and is also proposed to be used as an analgesic agent. Despite several studies on the analgesic activity of lavender, this is the first experiment in patients with orthodontic pain. This "2-arm parallel" study aims to evaluate the effect of lavender oil inhalation on reducing pain after elastomeric separator placement as a part of orthodontic treatment. Patients who needed elastic separator placement in mesial and distal of first permanent molars of all quadrants prior to their first-ever fixed orthodontic treatment, with the age range of 20 to 24, were randomly assigned to one of the two study groups: lavender oil and sesame oil. Participants had to breathe in their medication for 2 minutes just before separator insertion, as well as 4, 8, 12, 24, 36, and 48 h afterward. A visual analog scale (VAS) was used to measure the level of pain during three oral situations, including rest, fitting posterior teeth, and chewing at the following periods: just before separator placement (T0), immediately after insertion (T1), 3 h post-insertion (T2), 12 h post-(T3), 24 insertion h post-insertion (T4), and 48 h after separator placement (T5). The current study indicated the effectiveness of lavender oil inhalation in reducing pain perception while chewing 48 h after elastic separator placement. The pain level in lavender inhalation was lower from 12 h to 48 h after separator insertion, although not considerable, indicating the probability of its effectiveness on delayed responses to orthodontic pain.

Three-dimensional characterization of naturally developed early caries lesions using high-resolution micro-computed tomography

ObjectivesThe goal of this micro-Computed-Tomography (μCT) study was to characterize the structural parameters of natural, early proximal enamel caries lesions and correlate them with two-dimensional radiographic findings. MethodsExtracted human premolar teeth with ICDAS score 2 proximal lesions were examined using visual-tactile, μCT and simulated bitewing radiographs (BTX). Sound enamel and caries-lesions’ structural and mineral density (MD) parameters were analyzed which included surface layer (SL) status and thickness, depth of lesion, and MD. ResultsThirty-six extracted premolars with 54 proximal early enamel caries lesions were analyzed. Lesions varied notably in lesion depth and MD. SL thickness ranged between 20 and 139μm. Three teeth (5.6%) had micro-cavitations upon the μCT examination despite being “clinically” non-cavitated. Cavitation status had no significant association with μCT nor BTX radiographic depth. Depth of lesions correlated weakly but statistically significantly with mineral loss (ML) at body of lesion (r=0.301, p=0.027). SL thickness also correlated negatively with ML at SL (r=-0.501, p<0.001). ConclusionsEarly proximal enamel lesions with ICDAS 2 score as determined by visual-tactile examination exhibited a wide range of lesion parameters and cavitation status when examined by μCT. Visual-tactile examination may fail to detect micro-cavitations in enamel surface that are detectable by μCT. Clinical SignificanceClinicians have direct access to early proximal enamel lesions during orthodontic separation, exfoliation, extraction or restoration of adjacent teeth. This study invites the clinician to consider more decisive management options in high risk individuals (e.g. micro-invasive techniques), given the finding of vast structural variability of such lesions.

LOW-LEVEL LASER THERAPY MAY REDUCE PAIN ASSOCIATED WITH ORTHODONTIC SEPARATOR PLACEMENT.

Farzan, A. K. Khaleghi (2021). "The Effectiveness of Low-Level Laser Therapy in Pain Induced by Orthodontic Separator Placement: A Systematic Review." J Lasers Med Sci 12: e29. None. Systematic review.

Separation Effect and Perception of Pain and Discomfort from Kesling and Elastomeric Orthodontic Separators: An In Vivo Study

To scrutinize Kesling and elastomeric orthodontic separators, focusing on the separating effect as well as patients' perception of pain together with discomfort. The separators tested were elastomeric as well as Kesling separators. Thirty subjects, scheduled for treatment having a fixed orthodontic appliance, were categorized into two groups. In group I subjects, elastomeric separators were placed, whereas in group II subjects, Kesling separators were placed. After 3 days, the extent of separation was recorded with a leaf gauge. A questionnaire of eight questions and visual analog scale were used to note the patient perceptions of pain and discomfort. The mean separation formed by elastomeric and Kesling separator was 0.0457 and 0.0437 mm, respectively, of which elastomeric separator had made highest separation than the other separator used for the generation of separation at day 1 whereas the mean separation created by the elastomeric and Kesling separator at day 2 was 0.2327 mm and 0.1903 mm, respectively. 46.7% of patients on day 1, and on day 2, 56.7% of patients reported discomfort but not pain, while 73.3% of patients on day 3 reported discomfort but not pain from both types of separator. On day 1, 6.7% of patients, 13.3% on day 2, and 6.7% again on day 3 reported feeling pressure but no pain or discomfort. Elastomeric separators exhibited the highest separation compared to Kesling used for the separation, at all three days. The Kesling separator was a separator of choice in cases where the interproximal contact was tight. Discomfort and pain due to separator will be minimized by reducing the duration of separator placement. Hence treatment acceptability will be more. There is no significant difference found in separation by increasing the day.

Effect of menthol on pain perception after placing brass wire separators: A split-mouth randomized controlled trial

ABSTRACT Purpose Pain caused by the orthodontic separators is one of the most common complaints among orthodontic patients. Pain management can increase patients’ comfort and quality of life during orthodontic treatment. The present study aimed to assess the effect of local menthol patches on pain caused by brass wire separators. Methods We performed a split-mouth clinical trial from May 2018 to January 2019 (IRCT2016080129155N1). The study population comprised thirty-two 14- to 25-year-old healthy patients with intact dentition in mandible, without a history of chronic pain or regular consumption of analgesics. After placing brass wire separators on both mandibular first molars, we gave each patient two series of patches – containing menthol and placebo – to use on the right and left sides. Researchers as well as patients were unaware of each patch’s contents as they were identified by randomly assigned numbers. The main outcome, patients’ pain perception, was evaluated by Visual Analog Scale (VAS) at 0, 2, 6, 12, 24, 36, 48 and 72 hours after placing separators. Data were analysed by the paired T-test. Significance was considered as 0.05. Results Thirty-two patients completed the study. Data analysis suggests that patients’ pain perception significantly (P-value <0.05) lowered on the menthol side at 2 (mean difference: 1.18 ± 1.31), 6 (mean difference: 0.91 ± 1.06) and 12 (mean difference: 0.5 ± 1.37) hours after placing separators. None of the patients experienced pain at 72 hours. Conclusion Menthol patch could significantly reduce pain perception in patients who receive brass wire separators prior to orthodontic bonding.

The efficacy of low-level laser therapy versus paracetamol–caffeine in controlling orthodontic separation pain and changes in the oral-health-related quality of life in Class I malocclusions: A 3-arm, randomized, placebo-controlled clinical trial

This study evaluated the analgesic effects of low-level laser therapy (LLLT) and paracetamol-caffeine in controlling orthodontic pain induced by elastomeric separators, as well as changes in oral health-related quality of life (OHRQoL). A total of 54 patients (22 male, 32 female; mean age [standard deviation]: 21.68 [±2.77]) participated in the study. Elastomeric separators were placed mesially and distally to the first molars in the upper and lower dental arches. The first group (n=18) received a single dose of aluminum gallium arsenide (GaAlAs) laser irradiation (808 nm; 350 milliwatts; 3.5 joule/point) with a placebo medication. The laser beam was applied buccally and lingually at the center of the first molar roots and the adjacent teeth (2nd molar and 2nd premolar) in both the upper and lower dental arches bilaterally. The second group (n=18) received paracetamol-caffeine tablets (3 times daily for the first couple of days after separator insertion, and as needed for the rest of the week), with a placebo light-emitting diode (LED) light; patients in the third group (n=18) were exposed to the 2 placebo procedures. An 11-point numeric rating scale was used to assess spontaneous and chewing pain perception immediately and at 1 hour, 24 hour, 48 hours, and 1 week after separator placement. The short version of the oral health impact profile (OHIP-14) was used to evaluate OHRQoL at 48 hours and at 1 week after separator placement. Pain perception reached its peak at 24 hours after separator placement (median values: 3, 3, 6.5 for spontaneous pain, and 6, 6, 8 for chewing pain in the LLLT, drug, and control groups, respectively). LLLT relieved the induced pain more than did the placebo procedures (P=0.002 for spontaneous pain, P=0.012 for chewing pain). Orthodontic separators worsened patients' OHRQoL scores during the entire week, especially at 48 hours after placement (median OHIP-14 score: 21, 25, 24 in the LLLT, drug, and control groups, respectively). In comparison with the control group, LLLT slightly increased the "physical pain" domain score (P=0.015) and the "psychological disability" domain score of the scale (P=0.010) after 48 hours, as well as the "psychological disability" domain score 1 week after separator placement. The pain levels were similar in the laser and drug groups. The LLLT group had decreased pain, compared with the placebo group. Paracetamol-caffeine and LLLT were unable to enhance the overall OHRQoL.

Impact of Stress and Trait Anxiety on the Sensory and Jaw Motor Responses to a Tonic Orofacial Nociceptive Stimulus.

To investigate how trait anxiety and stress jointly affect the sensory and jaw motor responses to a tonic orofacial nociceptive stimulus. Orthodontic separators were placed between the first molars in 45 adults with low (n = 14), intermediate (n = 17), and high (n = 14) trait anxiety. Tooth pain, occlusal discomfort, tooth clenching (as a jaw motor behavior), and situational stress were measured three times a day for 5 days using visual analog scales. Mixed-effects regression models were used to evaluate the sensory and motor outcome measures. Pain, discomfort, and frequency of tooth-clenching trajectories were affected by trait anxiety (P = .007, P < .001, and P = .055, respectively) and stress (P < .001, P < .001, and P = .044, respectively). Individuals with high anxiety reported their highest pain (17.7 ± 2.9 mm) and discomfort (35.2 ± 4.1 mm) 24 hours earlier than those with low anxiety (pain: 15.9 ± 2.6 mm, discomfort: 28.8 ± 3.7 mm). Tooth clenching decreased progressively in response to the stimulus (P < .001). A tonic orofacial nociceptive stimulus triggers an avoidance jaw motor behavior. Both trait anxiety and situational stress heighten the sensory response to such a stimulus, but weakly affect the motor response to it.

Effects of toothbrush-generated vibration and ultrasound on pain perception following orthodontic elastomeric separation: a randomized controlled clinical trial

Effects of toothbrush-generated vibration and ultrasound on pain perception following orthodontic elastomeric separation: a randomized controlled clinical trial

Does green tea (Camellia Sinesis) mouthwash reduce pain after placement of orthodontic separators? A randomized controlled trial

Does green tea (Camellia Sinesis) mouthwash reduce pain after placement of orthodontic separators? A randomized controlled trial

ASSESSMENT OF PAIN CONTROL DURING SEPARATORS PLACEMENT USING TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION DEVICE (TENS) : A SPLIT – MOUTH STUDY (Research Article)

AIM : To assess the level of pain control achieved using transcutaneous electric nerve stimulation device (TENS) during orthodontic elastomeric separator placement. Methods : Ninety subjects were randomly assigned to three groups, the first group received low-frequency TENS and placebo, the second group received high-frequency TENS and placebo, the third group received high- and low-frequency TENS respectively. In each group, elastomeric separators were placed mesial and distal to the maxillary first molar in both the quadrants. A scientific medical system TENS was used to deliver the electric current. A visual analogue scale (VAS) was used to evaluate the pain. Result : There was a statistically significant difference correlation between TENS group and control group. No statistically significant results between high and low frequency TENS group. Conclusion: The present study suggests that orthodontic separator pain can be effectively reduced by TENS, either at high frequency or at low frequency.

Effect of Low- Laser Therapy on Dental Pain and NO Level in GCF Induced by Separator in Orthodontic Treatment

Introduction: The placement of an orthodontic separator induces pain and discomfort inpatients. The use of Nsaids for its analgesic effect was along with side effects. The aim of study evaluation of the effect of low power laser therapy on pain reduction and NO level in GCF induced by separator force in orthodontic treatment. Materials &amp; Methods: This experimental laboratory study was performed on 30 patients in the age range of 15-35 who required placement of the separator on the right maxillary molars. Patients were randomly divided into two groups of laser and placebo. Gingival groove fluid sampling was performed on 0-3-0 days in both groups. Laser irradiation was performed on days 2 and 4, in the placebo group, the device was used off. The amount of pain was recorded by patients with a VAS questionnaire on a daily basis. Data were analyzed by t-test and ANOVA (α = 0.05). Results: VAS score in laser group was more than placebo group but it wasn’t statistically different (p-value = 0.067), NO level further decrease in laser group compared with placebo group but it wasn’t statistically different (p-value = 0.286). Conclusion: The effect of low level laser therapy on pain reduction was very low and it wasn’t statistically different.

The Effectiveness of Low-Level Laser Therapy in Pain Induced by Orthodontic Separator Placement: A Systematic Review.

Introduction: This systematic review was conducted to evaluate the effectiveness of low-level laser therapy (LLLT) in orthodontic separator pain. Methods: This article was written according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Electronically and manually 3 databases, namely PubMed, Scopus and Google Scholar, were searched by the keywords that were selected based on population, intervention, comparison and outcome (PICO) on October 10, 2020. Studies were appraised by Cochrane version 5.2.0 with 7 domains and were checked by these inclusion criteria: 1. Randomized clinical trial (RCT) that examined the efficacy of LLLT in separator pain, 2. Split-mouth design, 3. LLLT application in the first hours after separator placement, 4. LLLT application to both sides of the teeth, 5. Patients receiving elastomeric separators between the premolars and molars, 6. Lasers with a wavelength of 800-899 nm, 7. Studies conducted from 2010 to 2020, and 8. Participants who went through orthodontic treatment without limitation in gender, age and social-economic status. Results: 299 studies were screened. 34 full-text papers were read by 2 authors independently. In the end, 4 articles met the inclusion criteria. All 4 articles showed LLLT has a significant impact on pain reduction. Conclusion: The exact protocol for laser therapy is still not clear. Therefore, more studies with a meticulously designed method are needed.