Dental Asia March/April 2022

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CLINICAL FEATURE Photobiomodulation: An updated literature review with a case report Garnering positive feedback and support across various literature, photobiomodulation can serve as an effective aid to help patients with reduced pain and discomfort during treatment. By Dr Kevin Ng, Dato’ Dr How Kim Chuan Orthodontic tooth movements cause pain and discomfort. It also takes a long time to complete, the average treatment time being usually two to three years to achieve satisfactory results. These factors hinder patients from seeking treatment. To avoid long-term suffering and to enhance patient co-operation and compliance, photobiomodulation (PBM) offers the possibility of shortening treatment times. Although different clinicians hold different views regarding the application of PBM to influence orthodontics effects and outcomes, a case is reported here with satisfactory patient feedback and acceptable clinical outcome. The PBM device was used contained 42 LED cores that produced 828nm wavelength light and stimulate four minutes on each arch daily. It was found that 50% of the treatment time for the entire Invisalign course reported improved results with no pain. THE PBM DEVICE The bite plane device consists of 42 LED cores and a power input of 2.1V. The current of each LED core is 30mA. The LED Cores produced 855nm wavelengths to stimulate the target sites. The energy absorbed after four minutes per arch was 249.9 joules. The manufacturer claimed that PBM could enhance the biology of the treatment area and improve the healing of bone and soft tissues and further enhance tooth movement. CASE REPORT A male patient CST, aged 20, was presented with Class I Molars, moderate anterior crowding of upper and lower arches, and rotation of 12, 23, 33 and 43. There was a lower mid-line shift to the left about 2mm, in addition to an overjet of 1mm, and an overbite of 3mm. The patient did not want an extraction and requested the shortest possible time to finish the treatment. An iTero scanning was performed, and arch expansions were designed to improve the arches form to create spaces for alignments. Forty-five 40 DENTAL ASIA MARCH / APRIL <strong>2022</strong>
CLINICAL FEATURE sets of aligners were prepared and treatment time was to be about a year, with one aligner each week. PBM lights were prescribed, and two aligners were used for each week. The 45 aligners should be finished wearing by 23 weeks. The PBM device was applied for four minutes daily on each arch, and the patient was advised to return to the clinic monthly to check and ensure fittings. The patient was to record the degree of pain or discomfort monthly in the given form during the aligner treatment. The feedback pain scores were rated two to three for the whole period. Orthopantomograms (OPGs) were taken before and after treatment and no root absorption occurred. DISCUSSION Surgical corticotomy was used to accelerate orthodontic tooth movement before the application of PBM. However, post-operative pain and complications were concerns to the patient. In 2013, Kau assessed 73 patients and 17 controls fitted with traditional orthodontic brackets and wires and treated with 850nm wavelength, near-infrared light with a power density of 60mW/cm 2 for 20-30 minutes per day. He observed that PBM achieved clinically significant accelerated tooth movements compared to the control group. Lao proposed PBM as a non-invasive stimulation of the dentoalveolar complex with mitochondrial adenosine triphosphate (ATP) production at the mitochondrial cells. Due to the increased level of metabolic activity, ATP is increased at a localised level. Infrared light doubles cytochrome oxidase levels, mediating ATP production. Higher ATP availability accelerates cell turnover, resulting in a faster remodelling process and tooth movement. A 1.12mm movement per week for the DENTAL ASIA MARCH / APRIL <strong>2022</strong> 41
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Dental Asia March/April 2022

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