Lasers Med Sci (2013) 28:1581–1589
DOI 10.1007/s10103-012-1196-y
REVIEW ARTICLE
Efficacy of low-level laser therapy in the management
of orthodontic pain: a systematic review and meta-analysis
W. L. He & C. J. Li & Z. P. Liu & J. F. Sun & Z. A. Hu &
X. Yin & S. J. Zou
Received: 21 January 2012 / Accepted: 3 September 2012 / Published online: 22 September 2012
# Springer-Verlag London Ltd 2012
Abstract This review aimed to identify the efficacy of low-
level laser therapy (LLLT) in the management of orthodontic
pain. This systematic review and meta-analysis was carried out
in accordance with Cochrane Handbook and the PRISMA
statement. An extensive literature search for RCTs, quasi-
RCTs, and CCTs was performed through CENTRAL, PubMed,
Embase, Medline, CNKI, and CBM up to October 2011. Risk of
bias assessment was performed via referring to the Cochrane
tool for risk of bias assessment. Meta-analysis was implemented
using Review Manager 5.1. As a result, four RCTs, two quasi-
RCTs, and two CCTs were selected from 152 relevant studies,
including 641 patients from six countries. The meta-analysis
demonstrated that 24 % risk of incidence of pain was reduced by
LLLT (RR00.76, 95 % CI range 0.63–0.92, P00.006). In
addition, compared to the control group, LLLT brought forward
“the most painful day” (MD0−0.42, 95 % CI range −0.74–−
0.10, P00.009). Furthermore, the LLLT group also implied a
trend of earlier end of pain compared with the control group
(MD0−1.37, 95 % CI range −3.37–0.64, P00.18) and the
W. L. He : C. J. Li : Z. P. Liu : J. F. Sun : Z. A. Hu : X. Yin :
S. J. Zou (*)
State Key Laboratory of Oral Diseases,
Department of Orthodontics, West China School of Stomatology,
Sichuan University,
14 Section 3 Ren Min Nan Lu,
Chengdu 610041, China
e-mail: shujuanzou@yahoo.com.cn
W. L. He : Z. P. Liu : J. F. Sun : Z. A. Hu : X. Yin : S. J. Zou
Department of Orthodontics, West China School of Stomatology,
Sichuan University,
Chengdu, China
C. J. Li
Department of Oral and Maxillofacial Surgery,
West China School of Stomatology, Sichuan University,
Chengdu, China
pseudo-laser group (MD0−1.04, 95 % CI range −4.22–2.15,
P00.52). However, because of the methodological shortcom-
ings and risk of bias of included trials, LLLT was proved with
limited evidence in delaying pain onset and reducing pain
intensity. In the future, larger and better-designed RCTs will be
required to provide clearer recommendations.
Keywords Low-level laser therapy . Orthodontic pain .
Systematic review . Meta-analysis
Introduction
By the help of mechanical force, orthodontic treatment
improves the function and arrangement of the teeth. How-
ever, owing to these forces, acute ischemia and edema
reaction also appear in these periodontal tissues [1]. The
following inflammatory reaction causes the release of in-
flammatory mediators and makes orthodontic treatment a
painful experience. Due to the pain, approximately 50 % of
patients have problems with their daily activities and get
moderate to severe difficulty in chewing and biting foods
[2]. Pain is regarded as the worst aspect of the treatment. At
the same time, research also indicates that pain is the fore-
most reason of discontinue care or early termination [3]. The
control of pain becomes an urgent demand. Consequently, a
great number of methods were developed to control it. The
methods include non-steroidal anti-inflammatory drugs
(NSAIDs), anesthetic gel, bite wafers, transcutaneous elec-
trical nerve stimulation, and vibratory stimulation [4].
Among these methods, only the use of NSAIDs has been
supported by existing literatures with reliable effect [3, 4].
However, side effects of drugs, including gastric or duode-
nal ulceration, coagulation disorders, congestive heart prob-
lems, and allergic effects, are always a big obstruction [5].
On the other hand, low-level laser therapy (LLLT) has been
1582
developed as a new technology for pain control treatment
for decades. LLLT is defined as a laser treatment in which
the energy output is low enough to avoid temperature of the
treated tissue arising above 36.5 °C [6]. Compared to
NSAIDs, LLLT has a lot of advantages. Clinic trials con-
firmed that LLLT could delay the onset of pain [7] and
reduce scores of pain intensity and duration [8, 9]. Incidence
of adverse effects is also low, with no reports of serious
events [10]. Moreover, LLLT was proved to accelerate tooth
movement by increasing alveolar bone remodeling [11, 12].
All of these advantages could make LLLT own higher
patient-satisfaction rates than NSAIDs. However, there
was still lack of firm clinical evidence to support the effica-
cy of LLLT. Systematic review and meta-analysis is an
appropriate method of assessing the evidence on actual out-
comes of clinical efficacy and safety. In this perspective, an
in-depth review would be indispensable. The aim of this
review is to systematically assess the efficacy of LLLT in the
management of orthodontic pain.
Materials and methods
This systematic review and meta-analysis are carried out
and reported in accordance with Cochrane Handbook for
Systematic Reviews of Interventions, Version 5.1 [13] and
the Preferred Reporting Items for Systematic Reviews and
Meta-Analyses (PRISMA) [14].
Study inclusion and exclusion criteria
Inclusion criteria were as follows:
(1) The study designs are randomized controlled trials
(RCTs), quasi-RCTs, controlled clinical trials (CCTs);
(2) Participants went through orthodontic treatment without
limitation in gender, age, race, and social economic status;
(3) Interventions used a laser device to deliver irradiation
to mucosa covering the dental root;
(4) Control groups were given either no treatment or
pseudo-laser, in which an identical laser device had
an active operating panel with the laser emission
deactivated;
(5) Outcome variables were the incidence of pain, the
initiation of pain, the most painful day, the end of pain,
and scores of pain intensity (e.g., visual analog scale
(VAS)).
Exclusion criteria were as follows:
(1) Studies were cohort studies, review articles, case reports,
descriptive studies, opinion articles, and abstracts;
(2) Participants had any acute or chronic dental, periodon-
tal or gingival problems which could cause pain;
Lasers Med Sci (2013) 28:1581–1589
(3) Participants had systemic disease or chronic pain or
history of neurologic and psychiatric disorders.
Literature search
We designed the search strategy, and the search had no
language restrictions. The literature search was performed
within the Cochrane Central Register of Controlled Trials
(CENTRAL; Issue 3, 2011), MEDLINE (via OVID, 1948 to
Oct 2011), Embase (1984 to Oct 2011), China National
Knowledge Infrastructure (CNKI; 1979 to Oct 2011), and
China Biology Medicine disc (CBM; 1978 to Oct 2011).
Hand-searching was also performed in relevant Chinese
journals. In order to find ongoing clinical trials, World
Health Organization International Clinical Trials Registry
Platform was searched.
MeSH heading words and free text words were combined.
They included “orthodontic”, “tooth movement”, “pain”,
“discomfort”, “toothache”, and “facial pain”. We combined
these words with synonyms for LLLT: “low-level laser”,
“low-output laser”, “low-intensity laser”, “semiconductor/soft
laser”, “laser irradiation”, “light/ phototherapy”, “GaAs”,
“GaAlAs”, and “HeNe”. Reference lists of the retrieved articles
were also checked.
Study inclusion
Two reviewers (WLH and CJL) independently screened the
titles and abstracts. The full reports were then further eval-
uated for all studies that appeared to meet the inclusion
criteria or when there was insufficient information to make
a clear decision or disagreement between the reviewers
about eligibility. The reviewers were not blind to trial au-
thor(s), institution, or site of publication.
Assessment of risk of bias
Risk of bias assessment was performed by referring to the
Cochrane tool for risk of bias assessment, with the following
domains: sequence generation, allocation concealment,
blinding of participants, personnel, outcome assessment,
incomplete outcome, selective data reporting, and other
biases. If statements were unclear, authors of the included
studies were contacted by e-mail to acquire information on
the risk of bias of the studies. The risk of bias of included
studies was classified in the following categories:
(a) Low risk of bias if seven domains were granted as “low
risk”;
(a) Moderate risk of bias if one or more domains were
granted as “unclear risk”;
(a) High risk of bias if one or more domains were granted
as “high risk”.
Lasers Med Sci (2013) 28:1581–1589
Data extraction
The following data were extracted: method of randomiza-
tion, concealment and blinding, the study's eligibility, cen-
ters involved, demographic data, lost to follow-up, laser
parameters, pain outcome measurements, time intervals at
which the variables were recorded, and the baseline status.
Statistical analysis
Statistical analyses were implemented using Review man-
ager 5.1. Heterogeneity was evaluated by a test for hetero-
geneity (I2 statistic) on the level of α00.10. If there was
substantial or considerable heterogeneity (I2 >50 %), the
results were assessed by random effects model; if not, the
fixed effects model was used. The measurements of treat-
ment effect for dichotomous data would be expressed as
relative risks (RR) along with 95 % confidence intervals
(CIs); for continuous data, mean difference (MD) with 95 %
CIs was adopted. The statistical significance for the hypoth-
esis test was set at α00.05 (2-tailed z tests). Subgroup
analysis was performed according to different types of
LLLT used in the intervention group. Sensitivity analysis
would be conducted to test the stability of the results.
Publication bias would be assessed by drawing funnel plot
if the number of included studies exceeded 10.
Results
Search results
A total of 152 studies were collected through initial liter-
atures and hand search. After selection according to the
inclusion and exclusion criteria, five articles were qualified
for the review analysis. The flow of the inclusion process
was shown in Fig. 1.
Characteristics of included studies
Four randomized controlled trials were finally included with
one [6] split mouth design and three parallel designs. Two
quasi-RCTs and two CCTs were also included. All of the
enrolled participants completed their evaluation without any
dropouts or withdrawals. Tables 1 and 2 show the character-
istics and laser parameters of the included studies, respectively.
Assessment of risk of bias
Within the studies included, four RCTs exhibit a moderate
risk of bias, while two quasi-RCTs and two CCTs show a
high risk of bias (Fig. 2). The study of Lim et al. [6] used
Latin square method of randomization, and the study of
1583
Tortamano et al. [8] applied random number table for
randomization.
The effect of laser therapy
The incidence of pain
A detailed number of patients with pain after orthodontic
treatment are reported in three studies. The data is pooled
and synthesized through a meta-analysis, and forest plot is
demonstrated in Fig. 3. The outcome shows that LLLT
reduces 24 % risk of incidence of pain compared with
control or pseudo-laser group (RR00.76, 95 % CI range
0.63–0.92, P00.006).
The delayed pain onset
The pain onset is delayed by LLLT in four studies. Turhani
et al. [7] showed significantly fewer patients reporting pain
at 6 h in LLLT group than that in the control group (RR0
0.48, 95 % CI range 0.31–0.76, P00.002). The differences
had persisted for 30 h (RR00.67, 95 % CI range 0.49–0.90,
P00.008). Compared with the other two groups (placebo
group03.4 h, control group03.5 h), Harazaki and Isshiki [9]
found the starting time of pain in laser group (6.3 h) was
significantly postponed. The result was in agreement with
the clinical studies of Shao [15] and Sun [16] (P<.01),
although Tortamano et al. could not find a statistical differ-
ence among the LLLT and control group (MD01.31, 95 %
CI range −2.06–4.68, P00.45), and the pseudo-laser group
(MD03.89, 95 % CI range 0.48–7.30, P00.03). The data
still indicated a trend of delayed onset of pain [8]. Meta-
analysis is not feasible because of inadequate data in some
studies [9, 15, 16].
The most painful day
Continuous data for “the most painful day” is available in
two RCTs [8, 9]. Meta-analysis is done, and the forest plot is
demonstrated in Fig. 4. The most painful day was signifi-
cantly brought forward in LLLT group (MD0−0.42, 95 %
CI range −0.74–−0.10, P00.009), with low heterogeneity
detected (χ2 00.98, P00.32, I2 00 %). However, in compar-
ison with the pseudo-laser group, there is no statistical
difference (MD00.04, 95 % CI range −0.24–0.33, P00.76).
The end-of-pain day
Continuous data for “the end of pain day” is available from
two trials [8, 9]. The result of meta-analysis is shown in
Fig. 5. Comparison between the LLLT group and the control
group implies a trend of earlier end of pain without statisti-
cal significance (MD0−1.37, 95 % CI range −3.37–0.64,
1584
Fig. 1 Flow diagram of the study inclusion of the systematic review and meta-analysis
P00.18). A similar trend is shown in the comparison between
the LLLT group and the pseudo-laser group (MD0−1.04,
95 % CI range −4.22–2.15, P00.52).
The score for the most painful day
Two studies report the score for the most painful day.
Tortamano et al. [8] reported a lower score in the LLLT
group compared with the pseudo-laser group (MD0−5.25,
95 % CI range −6.27–−4.23, P<0.00001) and the control
group (MD 0−3.95, 95 % CI range −5.15– − 2.75, P <
0.00001). At the same time, Harazaki and Isshiki [9] also
showed patients with most severe pain (degree04 or 5) in
the laser group was 70 %, while those in the placebo and
Lasers Med Sci (2013) 28:1581–1589
control groups were 100 % and 93 %, respectively. Meta-
analysis is not provided because of incomplete data.
The mean score of pain
Four trials report the mean score of pain. Tortamano et al.
[8] showed that LLLT reduced the mean score of pain
compared with both control groups (MD0−1.40, 95 % CI
range −1.86–−0.94, P<0.00001), and pseudo-laser groups
(MD0−2.05, 95 % CI range −2.55–−1.55, P<0.00001).
Fujiyama et al. [17] showed that the mean VAS scores of
irradiated sides were much lower than the control sides (48
and 40 at 30 s, 61 and 37 at 6 h, 72 and 42 at 12 h, 79 and 44
at 24 h, 70 and 38 at 2 days, 59 and 34 at 3 days, and 32 and
Lasers Med Sci (2013) 28:1581–1589 1585

Table 1 Characteristics of included studies

Study ID Country Age (years) Total number Study design Number Orthodontic treatment Intervention and Evaluation
(M/F) (I/P/B) control group intervals

Lim 1995 Singapore 21–24 39 RCT (split 39/39 Elastic separator 15, 30, and 60 s laser 1, 2, 3, 4, 5 days
mouth design) irradiation group; and
30 s pseudo-irradiation
group
Turhani 2006 Austria 23.1 76 (30/46) RCT 38/38 0.016-in Ni–Ti archwire Pseudo-irradiation group 6, 30, and 54 h
Tortamano 2009 Brazil 15.9 60 (18/42) RCT 20/20/20 0.014-in stainless steel Pseudo-irradiation group; 1, 2, 3, 4, 5, 6,
individualized archwire blank control group 7 days
Harazaki 1997 Japan 11–34 84 (27/57) RCT 20/20/44 0.012, 0.014, or 0.016- Pseudo-irradiation group; 14 day
in Ni–Ti archwire blank control group
Shao 2003 China Unclear 128 (49/79) CCT 63/65 0.012, 0.014, or 0.016- Blank control group Unclear
in Ni–Ti archwire
Sun 2001 China Unclear 149 (61/88) CCT 71/78 0.012, 0.014, or 0.016- Blank control group Unclear
in Ni–Ti archwire
Youssef 2008 Syria 14–23 15 quasi-RCT 30/30 Maxillary canines Laser irradiation on Unclear
retraction using right side of jaws,
Ricketts springs pseudo-laser irradiation
on the left side
Fujiyama 2008 Japan 19.22–18.8 90 (30/60) quasi-RCT 60/30 Elastic separator Laser irradiation on left 7 days
side of jaws, no
irradiation on

the right side

M male, F female, I intervention group, P placebo control group, B blank control group

18 at 4 days for the control and irradiated sides, respective-
ly), with statistical difference of P<0.01. Youssef et al. [11]
also showed the mean score of pain during three combined
treatment stages (16.83, 15.83, and 16.22 in LLLT side;
44.17, 45.17, and 44.78 in the control side) with significant
difference proved by the Mann–Whitney U test (P<0.05).
However, Turhani et al. [7] showed no statistical difference
in pain intensity between the laser and placebo groups.
Because of the clinical heterogeneity and lack of sufficient
outcome data, the meta-analysis is not possible.

Table 2 Laser parameters and treatment regimen of included studies

Study ID Type of laser Wavelength Power density Dose (J/cm2); Total time per point Frequency of laser treatment
(nm) (mW/cm2) irradiation side

Lim 1995 GaAs-A1 diode laser, 830 59.7 0.45 J/cm2, 0.95 J/cm2, 15, 30, and 60 s First, second, third, fourth,
constant wave and 1.8 J/cm2 for the and fifth days.
15, 30, and 60 s,
respectively (only
on buccal mucosa)
Turhani 2006 Semiconductor laser, 670 at 5.5 cm is 140 Not reported 30 s/tooth at a distance Only once (Immediately
constant wave of 5–8 mm after ligation of the
archwires)
Tortamano 2009 GaAr-A1 diode laser, 830 Not reported 2.5 J/cm2 (on both 80 s/tooth, 37.5 or 32 Only once (Immediately
constant wave buccal and lingual min/patient after ligation of the
sides) archwires)
Harazaki 1997 He–Ne gas laser 632.8 Not reported Not reported (on both 1 min /tooth, 12–24 Only once (Immediately
buccal and lingual min/patient after ligation of the
sides) archwires)
Shao 2003 Semiconductor laser, 650 Not reported Not reported 18–30 min/patient Only once (Immediately
constant wave after ligation of the
archwires)
Sun 2001 He–Ne gas laser He–Ne laser Not reported Not reported 15–30 min/patient Only once (Immediately
and CO2 laser 632.8 nm, after ligation of the
CO2 laser archwires)
10.6 μm
Youssef 2008 GaAlAs semiconductor 809 Not reported 8 J/tooth 80 s/tooth 0,3,7,14 day/21 days,
Fujiyama 2008 CO2 laser Not reported Not reported Not reported 60 s/tooth Once (immediately
after separation)
1586
Fig. 2 Risk of bias summary. Review of author's judgments about
each risk of bias item for each included study
Side effects and adverse reactions
There were no adverse events reported by the trials. Treat-
ments were generally well tolerated.
Fig. 3 Forest plots of comparison. Laser versus control/pseudo-laser. Outcome: the risk ratio pain
Lasers Med Sci (2013) 28:1581–1589
Discussion
Mechanical force is the key factor of orthodontic treatment.
During fixed treatment, mechanical force is applied through
brackets and arch wires, and moves teeth slowly in the alve-
olar bone. However, this force also results in compression of
periodontal ligaments and subsequently induces ischemia, in-
flammation, and edema in these periodontal tissues [18]. Dur-
ing this inflammatory response, noxious agents such as
prostaglandins, histamine, serotonin, and substance P are re-
leased from nerve endings, which then cause pain [19, 20].
Patients can experience an acute pain immediately after the
placement of separators, or patients express “medium pain” for
1–2 days in each appointment every 4–6 weeks [21]. Among
orthodontists, NSAIDs remain the most preferred method for
pain relief. However, adverse effects are very common as
reported. Besides common drug side effects, researches also
revealed that NSAIDs significantly inhibited the extracellular
collagen remodeling activity by suppressing the release of
prostaglandins, and then cause a reduction in tooth movement
velocity [22, 23]. For the sake of drug adverse effects and the
expense of reduction in the rate of tooth movement, NSAIDs
might not be an ideal choice for pain control for orthodontic
patients. Thus, LLLT may be a better choice than NSAIDs.
The application of low-level lasers in the field of dentistry has
been available for nearly 4 decades [6, 24]. LLLT activates
both local microcirculation and cellular metabolism, and pro-
duces anti-inflammatory and regenerative effects [25, 26]. In
vitro studies, LLLT inhibits the production of inflammatory
factors and pain-related neurotransmitters [27]. Furthermore,
LLLT is found to combat pain by accelerating the removal of
pain-inducing substances like substance P, histamine, dopa-
mine, and prostaglandins; and decrease pain through the re-
duction of PGE2 levels and the inhibition of cyclooxygenase-2
[28, 29]. There also has been several clinical trials regarding
the pain relief ability of LLLT in orthodontic treatment, but
their outcomes differed. Therefore, a systematic review in this
field is required to provide reliable evidence.
In this systematic review, moderate risk of bias was
detected in four RCTs, and high risk of bias was detected in
two quasi-RCTs and two CCTs. These risks of bias brought
down the reliability of the outcomes. However, three meta-
Lasers Med Sci (2013) 28:1581–1589 1587

Fig. 4 Forest plots of comparison. Laser versus control/pseudo-laser. Outcome: most painful day

analyses were all in consistency in confirming the superiority
of LLLT. One of them indicated that LLLT decreased 8–37 %
of the incidence of pain compared to the control group. The
other two meta-analyses were done by combining the results
from two RCTs. The high quality of the included RCTs
indicated a high reliability of the meta-analyses. One meta-
analysis revealed that LLLT made the most painful day much
earlier, and this suggested that the intensity of pain decreased
much sooner. Furthermore, the meta-analysis of the end of
pain day also implied a trend of earlier end of pain. All of them
suggested LLLT was effective in orthodontic pain manage-
ment. However, no superiority was found in comparing LLLT

Fig. 5 Forest plots of comparison: Laser versus control/pseudo-laser. Outcome: the end pain day
1588
with pseudo-laser in terms of the most painful day, which
might be due to psychological effects like the Hawthorne
and placebo effects that had influenced patients in the
pseudo-laser group and caused a certain extent of pain relief
effect. On the other hand, the lack of statistical significance in
meta-analysis of the end of pain day might be due to method-
ological heterogeneity. Between two included RCTs, the well-
designed double blind one confirmed the efficacy of LLLT.
However, the other one which had several defects in study
design showed no superiority of LLLT. So, it might be clear
that LLLT was useful in shortening the duration of pain when
the study with high risk bias was excluded. This outcome was
also confirmed by other two CCTs [15, 16]. In this review,
since there were both split mouth design and parallel design in
the included studies, the methods for RCT varied mostly.
However, because there were some data defections in the
study of Lim 1995 which used split mouth design, those data
were not used for meta-analysis. Therefore, for the part of
result, the meta-analysis was not influenced.
Clinical results of laser therapy depend on wavelength,
energy density (J/cm2), treatment time, and treatment repe-
tition rate [30]. The wavelength of 809–830 nm (e.g., GaAs-
A1 laser) was used in three studies, and the wavelength of
632.8–670 nm (e.g., He–Ne laser) was used in four studies.
All of these were in the optimal optical window of 500–
1,200 nm for the transmission through tissue. As suggested
by Turhani, GaAs-A1 laser was more widely used than He–
Ne laser presently [7]. The energy density used in those
trials was among 0.45–2.5 J/cm2 [6, 8]. In order to improve
pain relief effect, it was possible to increase the energy
density, as long as it was within the range of 0.5–10 J per
treatment point recommended by Kert and Rose [6]. Fur-
thermore, most of the trials investigating the pain relief
effect used only a single course of laser irradiation within
7–14 days of follow-up. It is possible to improve pain
control effect by increasing the irradiation frequency.
The perception of pain is so subjective that the results almost
depend on the patients' personal responses. So, binding of
participants is very important. On the other hand, the individual
variability in pain threshold and sensitivity are easily influenced
by psychological effects. The operator's performance and indi-
cation, which transfer subconsciously to the patients, might
make patients distinguish between real laser and pseudo-laser.
In order to bring down this Hawthorne effect, excellent random
sequence generation and allocation concealment are required
[7]. However, as a matter of fact, all the included studies
demonstrated disadvantages in the above two points. Only
two of the studies described methods of randomization. Ad-
ditionally, none of them stated allocation concealment. There
were also many limitations in methodology and study design.
First, it was inappropriate to induce pain using elastic separa-
tors. The pain induced by separators was very mild to perceive
that their changes could result in no significant findings [6,
Lasers Med Sci (2013) 28:1581–1589
17]. Second, VAS as the method for evaluation of pain inten-
sity was proved to be the most reliable of the scales used [31];
however, only two trials [6] used VAS for pain measurement
among eight included studies. With statistical considerations,
the use of VAS could be more significant. Determining pain
with a questionnaire was a limitation of those studies. Third,
only dental students who were from a highly defined popula-
tion were included in one trial [6], and the conclusions drawn
from this sample might not apply to the general orthodontic
patients. These disadvantages reduced the reliability of evi-
dence and should have been avoided in future design.
Assessing scientific evidence from clinical trials has al-
ways been a complex matter. Although this systematic review
used extensive literature search for RCTs, quasi-RCTs, and
CCTs, it did have some limitations. The weakest point of this
review was the heterogeneity in treatment procedures, pain
measurements, shortcomings in the methodology, and study
design of the research. All the included studies were small
sample sizes and had moderate to high risks of bias. Therefore,
this systematic review proves that LLLT is effective in treating
orthodontic pain with limited evidence. In the future, well-
designed RCTs are required to confirm the efficacy of low-
level laser therapy in the management of orthodontic pain.
Conclusions
This systematic review and meta-analysis demonstrated that
LLLT was effective in reducing the incidence of pain, bringing
forward the most painful and the end-of-pain days during
orthodontic treatment. Although the heterogeneity and risk of
bias of the trial results called for caution, LLLT seemed to be
effective in delaying the pain onset, shortening the pain duration
and reducing the average pain intensity. More and larger well-
designed RCTs will be needed to draw a stable conclusion.
Conflict of interest None.
References
1. Erdinç AM, Dinçer B (2004) Perception of pain during orthodontic
treatment with fixed appliances. Eur J Orthod 26(1):79–85
2. Ngan P, Bradford K, Wilson S (1989) Perception of discomfort by
patients undergoing orthodontic treatment. Am J Orthod Dentofa-
cial Orthop 96:47–53
3. Xiaoting L, Yin T, Yangxi C (2010) Interventions for pain during
fixed orthodontic appliance therapy. A systematic review. Angle
Orthod 80(5):925–932
4. Krishnan V (2007) Orthodontic pain: from causes to management—a
review. Eur J Orthod 29(2):170–179
5. Polat O, Karaman AI (2005) Pain control during fixed orthodontic
appliance therapy. Angle Orthod 75:214–219
6. Lim HM, Lew KK, Tay DK (1995) A clinical investigation of the
efficacy laser therapy in reducing orthodontic postadjustment pain
of low level. Am J Orthod Dentofacial Orthop 108:614–622
Lasers Med Sci (2013) 28:1581–1589
7. Turhani D, Scheriau M, Kapral D, Benesch T, Jonke E, Bantleon
HP (2006) Pain relief by single low-level laser irradiation in
orthodontic patients undergoing fixed appliance therapy. Am J
Orthod Dentofacial Orthop 130(3):371–377
8. Tortamano A, Lenzi DC, Haddad AC, Bottino MC, Dominguez
GC, Vigorito JW (2009) Low-level laser therapy for pain caused
by placement of the first orthodontic archwire: a randomized
clinical trial. Am J Orthod Dentofacial Orthop 136(5):662–667
9. Harazaki M, Isshiki Y (1997) Soft laser irradiation effects on pain
reduction in orthodontic treatment. Bull Tokyo Dent Coll 38
(4):291–295
10. Chow RT, Johnson MI, Lopes-Martins RA, Bjordal JM (2009)
Efficacy of low-level laser therapy in the management of neck pain:
a systematic review and meta-analysis of randomised placebo or
active-treatment controlled trials. Lancet 374(9705):1897–1908
11. Youssef M, Ashkar S, Hamade E, Gutknecht N, Lampert F, Mir M
(2008) The effect of low-level laser therapy during orthodontic
movement: a preliminary study. Lasers Med Sci 23(1):27–33
12. Cruz DR, Kohara EK, Ribeiro MS, Wetter NU (2004) Effects of low-
intensity laser therapy on the orthodontic movement velocity of
human teeth: a preliminary study. Lasers Surg Med 35(2):117–120
13. Higgins JPT, Green S (2009) Cochrane handbook for systematic
reviews of interventions. Wiley, Chichester
14. Moher D, Liberati A, Tetzlaff J et al (2009) Preferred reporting
items for systematic reviews and meta-analyses: the PRISMA
statement. PLoS Med 6(7):e1000097
15. Juping S, Xueqin B, Hongbin L (2003) The clinical observation on
the semiconductor laser irradiation in reducing pain accompanying
with orthodontic treatment [Article in Chinese]. J Dent Prev Treat
11(4):249–250
16. Xinhua S, Baijuan G (2001) The clinical study on the low reaction
level laser irradiation in reducing pain accompanying orthodontics
treatment [Article in Chinese]. Chin J Orthod 8(4):175–177
17. Fujiyama K, Deguchi T, Murakami T, Fujii A, Kushima K,
Takano-Yamamoto T (2008) Clinical effect of CO2 laser in reduc-
ing pain in orthodontics. Angle Orthod 78(2):299–303
18. Vandeska-Radunovic V, Kristiansen AB, Heyeraas KJ (1994)
Changes in blood circulation in teeth supporting tissues incident
to experimental tooth movement. Eur J Orthod 16:361–369
19. Vandevska-Radunovic V (1999) Neural modulation of inflamma-
tory reactions in dental tissues incident to orthodontic tooth move-
ment—a review of the literature. Eur J Orthod 21:231–247
1589
20. Nicolay OF, Davidovitch Z, Shanfeld JL, Alley K (1990) Sub-
stance P immune reactivity in periodontal tissues during orthodon-
tic tooth movement. Bone Miner 11:19–29
21. Bernhardt MK, Southard KA, Batterson KD, Logan HL, Baker
KA, Jakobsen JR (2001) The effect of preemptive and/or postop-
erative ibuprofen therapy for orthodontic pain. Am J Orthod Den-
tofacial Orthop 120(1):20–27
22. Walker JB Jr, Buring SM (2001) NSAIDs impairment of ortho-
dontic tooth movement. Ann Pharmacother 35:113–115
23. Kehoe MJ, Cohen SM, Zarrinnia K, Cowan A (1996) The effect of
acetaminophen, ibuprofen, and misoprostol on prostaglandin E2
synthesis and the degree and rate of orthodontic tooth movement.
Angle Orthod 66:339–350
24. Pesevska S, Nakova M, Ivanovski K, Angelov N, Kesic L, Obra-
dovic R, Mindova S, Nares S (2010) Dentinal hypersensitivity
following scaling and root planning: comparison of low-level laser
and topical fluoride treatment. Lasers Med Sci 25(5):647–650
25. Silveira PC, Silva LA, Freitas TP, Latini A, Pinho RA (2010) Effects
of low-power laser irradiation (LPLI) at different wavelengths and
doses on oxidative stress and fibrogenesis parameters in an animal
model of wound healing. Lasers Med Sci 26(1):125–131
26. Alghamdi KM, Kumar A, Moussa NA (2011) Low-level laser
therapy: a useful technique for enhancing the proliferation of
various cultured cells. Lasers Med Sci 27(1):237–249
27. Pallotta RC, Bjordal JM, Frigo L, Leal Junior EC, Teixeira S et al
(2011) Infrared (810-nm) low-level laser therapy on rat experimen-
tal knee inflammation. Lasers Med Sci 27(1):71–78
28. Sakurai Y, Yamaguchi M, Abiko Y (2000) Inhibitory effect of low-
level laser irradiation on LPS-stimulated prostaglandin E2 produc-
tion and cyclooxygenase-2 in human gingival fibroblasts. Eur J
Oral Sci 108:29–34
29. Pires D, Xavier M, Araújo T, Silva JA Jr, Aimbire F, Albertini R
(2010) Low-level laser therapy (LLLT; 780 nm) acts differently on
mRNA expression of anti- and pro-inflammatory mediators in an
experimental model of collagenase-induced tendinitis in rat. Lasers
Med Sci 26(1):85–94
30. Lucas C, Stanborough RW, Freeman CL (2000) Efficacy of low-
level laser therapy on wound healing in human subjects: a system-
atic review. Lasers Med Sci 15:84–93
31. Price DD, McGrath PA, Rafii A, Buckingham B (1983) The
validation of visual analogue scales as ratio scale measures for
chronic and experimental pain. Pain 17:45–56