Dental and Medical Problems

Dent Med Probl
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Dental and Medical Problems

2020, vol. 57, nr 1, January-March, p. 45–52

doi: 10.17219/dmp/113332

Publication type: original article

Language: English

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Creative Commons BY-NC-ND 3.0 Open Access

Assessment of a single versus double application of low-level laser therapy in pain reduction following orthodontic elastomeric separation: A randomized controlled trial

Ocena pojedynczego lub podwójnego użycia lasera małej mocy w redukowaniu bólu związanego z separacją elastomerową – randomizowane badanie kontrolowane

Mai Mohammed Erfan Almallah1,B,C,D,E,F, Mohammad Younis Hajeer2,A,C,D,E,F, Wael Housam Almahdi1,A,D,E,F, Ahmad Sharaf Burhan2,C,D,E,F, Youssef Latifeh3,4,A,D,E,F, Suha Khaled Madkhaneh1,B,D,F

1 Department of Periodontics, Faculty of Dentistry, University of Damascus, Syria

2 Department of Orthodontics, Faculty of Dentistry, University of Damascus, Syria

3 Department of Psychiatry, Faculty of Medicine, University of Damascus, Syria

4 Department of Internal Medicine, Faculty of Medicine, Syrian Private University, Damascus, Syria


Background. Periodontal ligament (PDL) pain, associated with the insertion of elastomeric separators, is one of the most annoying experiences at the beginning of orthodontic treatment. Low-level laser therapy (LLLT) has recently been suggested as a method of controlling this pain.
Objectives. The aim of this study was to evaluate the effectiveness of LLLT on reducing the pain associated with elastomeric separation and to compare a single dose of LLLT (1 h before the insertion of elastomeric separators) vs 2 doses of LLLT (1 h before and immediately after the insertion).
Material and Methods. This randomized controlled trial was conducted at the Department of Orthodontics, Faculty of Dentistry of University of Damascus and at the Department of Orthodontics of Adib-Allaham Center in Damascus, Syria. The sample population was comprised of 36 patients, aged between 12 and 25 years (mean age: 17 ±3.7 years), and the patients were randomly divided into 2 groups. A split-mouth design was employed. One group received 1 dose of laser therapy 1 h before the insertion of elastomeric separators, whereas the other one received 2 doses of laser therapy – 1 h before and immediately after the insertion of elastomeric separators. A GaAlAs laser with a wavelength of 830 nm and a power of 100 mW was used. The pain levels were recorded using the Visual Analog Scale (VAS) after 1, 6, 24, 48, and 96 h. Student’s t-test and the repeated measures analysis of variance (ANOVA) were employed to detect significant differences.
Results. Low-level laser therapy significantly reduced post-separation pain when the experimental side was compared to the placebo side in the single-irradiation group (p < 0.05). Low-level laser therapy significantly reduced separation pain with no statistical difference between single and double irradiation protocols (p > 0.05).
Conclusion. Low-level laser therapy had a positive effect on reducing the pain associated with elastomeric separation, whether it was applied as a single dose before elastomeric separation or as a double dose before and after this procedure.

Key words

pain control, low-level laser therapy, elastomeric separators, periodontal ligament pain

Słowa kluczowe

kontrola bólu, terapia laserem małej mocy, separatory elastomeryczne, ból więzadeł przyzębnych

References (42)

  1. Johnson RB. Synthesis of alveolar bone Sharpey’s fibers during experimental tooth movement in the rat. Anat Rec A Discov Mol Cell Evol Biol. 2005;284(1):485–490.
  2. Bosshardt DD, Bergomi M, Vaglio G, Wiskott A. Regional structural characteristics of bovine periodontal ligament samples and their suitability for biomechanical tests. J Anat. 2008;212(3):319–329.
  3. Alhashimi N, Frithiof L, Brudvik P, Bakhiet M. Orthodontic tooth movement and de novo synthesis of proinflammatory cytokines. Am J Orthod Dentofacial Orthop. 2001;119(3):307–312.
  4. Singh G. Separators in dentistry. J Oral Hyg Health. 2013;1:e103.
  5. Kluemper GT, Hiser DG, Rayens MK, Jay MJ. Efficacy of a wax containing benzocaine in the relief of oral mucosal pain caused by orthodontic appliances. Am J Orthod Dentofacial Orthop. 2002;122(4):359–365.
  6. Scheurer PA, Firestone AR, Bürgin WB. Perception of pain as a result of orthodontic treatment with fixed appliances. Eur J Orthod. 1996;18(4):349–357.
  7. 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.
  8. Asiry MA, Albarakati SF, Al-Marwan MS, Al-Shammari RR. Perception of pain and discomfort from elastomeric separators in Saudi adolescents. Saudi Med J. 2014;35(5):504–507.
  9. Davidovitch M, Papanicolaou S, Vardimon AD, Brosh T. Duration of elastomeric separation and effect on interproximal contact point characteristics. Am J Orthod Dentofacial Orthop. 2008;133(3):414–422.
  10. Abraham J, Pierce C, Rinchuse D, Zullo T. Assessment of buccal sepa­rators in the relief of bruxist activity associated with myofascial pain-dysfunction. Angle Orthod. 1992;62(3):177–184.
  11. Malagan MA, P P B, Muddaiah S, et al. Comparison between efficacy of four different types of orthodontic separators. J Clin Diagn Res. 2014;8(8):ZC41–ZC44.
  12. Cureton SL, Bice RW. Comparison of three types of separators in adult patients. J Clin Orthod. 1997;31(3):172–177.
  13. Shetty N, Patil AK, Ganeshkar SV, Hegde S. Comparison of the effects of ibuprofen and acetaminophen on PGE2 levels in the GCF during orthodontic tooth movement: A human study. Prog Orthod. 2013;14:6.
  14. Ngan P, Kess B, Wilson S. Perception of discomfort by patients undergoing orthodontic treatment. Am J Orthod Dentofacial Orthop. 1989;96(1):47–53.
  15. Bondemark L, Fredriksson K, Ilros S. Separation effect and perception of pain and discomfort from two types of orthodontic separators. World J Orthod. 2004;5(2):172–176.
  16. Fujiyama K, Deguchi T, Murakami T, Fujii A, Kushima K, Takano-Yamamoto T. Clinical effect of CO(2) laser in reducing pain in orthodontics. Angle Orthod. 2008;78(2):299–303.
  17. Xiaoting L, Yin T, Yangxi C. Interventions for pain during fixed orthodontic appliance therapy. A systematic review. Angle Orthod. 2010;80(5):925–932.
  18. Law SL, Southard KA, Law AS, Logan HL, Jakobsen JR. An evaluation of preoperative ibuprofen for treatment of pain associated with orthodontic separator placement. Am J Orthod Dentofacial Orthop. 2000;118(6):629–635.
  19. Abtahi SM, Mousavi SA, Shafaee H, Tanbakuchi B. Effect of low-level laser therapy on dental pain induced by separator force in orthodontic treatment. Dent Res J (Isfahan). 2013;10(5):647–651.
  20. Bertolini A, Ferrari A, Ottani A, Guerzoni S, Tacchi R, Leone S. Paracetamol: New vistas of an old drug. CNS Drug Rev. 2006;12(3–4):250–275.
  21. Barbosa KGN, Sampaio TPD, Rebouças PRM, Catão MHCdV, Gomes DQdC, Pereira JV. Analgesia during orthodontic treatment with low intensity laser: Systematic review. Revista Dor São Paulo. 2013;14(2):137–141.
  22. Bruno MB, Bruno MAD, Krymchantowski AV, da Motta AFJ, Mucha JN. A double-blind, randomized clinical trial assessing the effects of a single dose of preemptive anti-inflammatory treatment in orthodontic pain. Prog Orthod. 2011;12(1):2–7.
  23. Mangnall LA, Dietrich T, Scholey JM. A randomized controlled trial to assess the pain associated with the debond of orthodontic fixed appliances. J Orthod. 2013;40(3):188–196.
  24. Montesinos M. Experimental effects of low power laser in encephalin and endorphin synthesis. J Eur Med Laser Assoc. 1988;1(3):2–7.
  25. Baxter GD, Walsh DM, Allen JM, Lowe AS, Bell AJ. Effects of low intensity infrared laser irradiation upon conduction in the human median nerve in vivo. Exp Physiol. 1994;79(2):227–234.
  26. Musch MW, Walsh-Reitz MM, Chang EB. Roles of ZO-1, occludin, and actin in oxidant-induced barrier disruption. Am J Physiol Gastrointest Liver Physiol. 2006;290(2):G222–G231.
  27. Honmura A, Yanase M, Obata J, Haruki E. Therapeutic effect of Ga‐Al‐As diode laser irradiation on experimentally induced inflammation in rats. Lasers Surg Med. 1992;12(4):441–449.
  28. Aimbire F, Albertini R, Pacheco MTT, et al. Low-level laser therapy induces dose-dependent reduction of TNFalpha levels in acute inflammation. Photomed Laser Surg. 2006;24(1):33–37.
  29. Asnaashari M, Mohebi S, Paymanpour P. Pain reduction using low level laser irradiation in single-visit endodontic treatment. J Lasers Med Sci. 2011;2(4):139–143.
  30. Ferrante M, Petrini M, Trentini P, Perfetti G, Spoto G. Effect of low-level laser therapy after extraction of impacted lower third molars. Lasers Med Sci. 2013;28(3):845–849.
  31. Marini I, Bartolucci ML, Bortolotti F, Innocenti G, Gatto MR, Alessandri Bonetti G. The effect of diode superpulsed low-level laser therapy on experimental orthodontic pain caused by elastomeric separators: A randomized controlled clinical trial. Lasers Med Sci. 2015;30(1):35–41.
  32. Farias RD, Closs LQ, Miguens SA Jr. Evaluation of the use of low-level laser therapy in pain control in orthodontic patients: A randomized split-mouth clinical trial. Angle Orthod. 2016;86(2):193–198.
  33. Furquim RD, Pascotto RC, Rino Neto J, Cardoso JR, Ramos AL. Low-level laser therapy effects on pain perception related to the use of orthodontic elastomeric separators. Dental Press J Orthod. 2015;20(3):37–42.
  34. Kim WT, Bayome M, Park JB, Park JH, Baek SH, Kook YA. Effect of frequent laser irradiation on orthodontic pain. A single-blind randomized clinical trial. Angle Orthod. 2013;83(4):611–616.
  35. Artés-Ribas M, Arnabat-Dominguez J, Puigdollers A. Analgesic effect of a low-level laser therapy (830 nm) in early orthodontic treatment. Lasers Med Sci. 2013;28(1):335–341.
  36. Nóbrega C, da Silva EMK, de Macedo CR. Low-level laser therapy for treatment of pain associated with orthodontic elastomeric sepa­rator placement: A placebo-controlled randomized double-blind clinical trial. Photomed Laser Surg. 2013;31(1):10–16.
  37. Esper MA, Nicolau RA, Arisawa EA. The effect of two phototherapy protocols on pain control in orthodontic procedure – a preliminary clinical study. Lasers Med Sci. 2011;26(5):657–663.
  38. Bjordal JM, Johnson MI, Iversen V, Aimbire F, Lopes-Martins RAB. Low-level laser therapy in acute pain: A systematic review of possible mechanisms of action and clinical effects in randomized placebo-controlled trials. Photomed Laser Surg. 2006;24(2):158–168.
  39. Chetruș V, Roman I, Ciobanu S. Early diagnosis of acute diffuse pulpitis, treatment success. Rom J Oral Rehab. 2014;6(1):49–52.
  40. Lim HM, Lew KK, Tay DK. A clinical investigation of the efficacy of low level laser therapy in reducing orthodontic postadjustment pain. Am J Orthod Dentofacial Orthop. 1995;108(6):614–622.
  41. Minor V, Marris CK, McGorray SP, et al. Effects of preoperative ibuprofen on pain after separator placement. Am J Orthod Dentofacial Orthop. 2009;136(4):510–517.
  42. Bernhardt MK, Southard KA, Batterson KD, Logan HL, Baker KA, Jakobsen JR. The effect of preemptive and/or postoperative ibuprofen therapy for orthodontic pain. Am J Orthod Dentofacial Orthop. 2001;120(1):20–27.