Efficacy of Er,Cr Laser incision Corticotomy in Rapid Maxillary Canine Retraction: A Split-Mouth Randomized Clinical Trial

Abstract

Introduction: This study sought to evaluate the efficacy of lasercision corticotomy for the acceleration of canine movement. Our secondary objectives were assessing the canine rotation, the rate of anchorage control, the level of pain, and the gingival index (GI). Methods: Twelve orthodontic patients (9 females and 3 males) referring to the School of Dentistry and one dental clinic from May 2019 to September 2019 participated in this split-mouth randomized clinical trial. The allocation of the test and control sides was performed by flipping a coin. The mean age of patients was 18.91±3.87 years (range 15-30 years). The treatment plan included maxillary first premolar extraction. Following the initial leveling and alignment phase, an initial impression was made. Corticotomy was carried out with the erbium, chromium-doped yttrium scandium gallium garnet (Er, Cr: YSGG) laser (3.5 W, 30 Hz, 40% air, 80% water) in one maxillary quadrant (the laser side). Canine retraction was immediately initiated following surgery using nickel-titanium closed-coil springs with 150 g force. The impression was repeated 1 month after the onset of retraction. The casts were scanned, and the distance between the canine cusp tip and the rugae line was measured to quantify the amount of anteroposterior canine movement. The molar anchorage control was also evaluated by measuring the distance between the mesial contact of the permanent first molar and the rugae line. Gingival health was evaluated using the GI. The modified McGill pain questionnaire was used to assess the level of patients' pain. Results: Lasercision corticotomy accelerated canine retraction with no adverse effect on gingival health. Anchorage loss in the posterior teeth and pain scores were not significantly different between the control and laser sides. Conclusion: Laser corticotomy can effectively accelerate canine retraction with no complications or discomfort for the patients.

Systematic Review: Is High-Energy Laser Therapy (HELT) With Flapless Corticotomy Effective in Accelerating Orthodontic Tooth Movement?

“…Patient ages ranged between 16.9±2.5 and 21.7 years, noting that the study of Al-Jundi et al did not mention the mean age of its patients [18]. Extraction treatment (maxillary first-premolar extraction followed by a canine retraction) was performed in five studies [13,16,[23][24][25], and only one study evaluated the effect of HELT-based flapless corticotomy on upper incisors' intrusion; it was a non-extraction-based study [18].…”

“…Out of the six included trials, four trials assessed the effect of erbium lasers on canine retraction speed after premolar extraction [13,16,[24][25], the fifth trial evaluated the effect of Er: YAG laser on the incisors intrusion rate in a non-extraction treatment [18]; Table 3 and Appendix 3. The effect of erbium lasers in accelerating upper canine retraction: three split-mouth trials [16,[24][25] and one compound trial [13] assessed the efficacy of erbium lasers in accelerating upper canine retraction. Noteworthy, the results could not pool in a meta-analysis because of the differences in the way of orthodontic force delivery, types and parameters of lasers, and laser application protocol.…”

“…The amount of maxillary canine retraction at the first month was assessed by 3 trials [13,[24][25] The differences between the experimental and control sides were negligible and insignificant (p > 0.05).…”

“…C: confidence interval; PGD: parallel-group design; SMD: split-mouth design a Decline one level for risk of bias (unclear risk of bias of deviations from intended intervention in [13,[24][25]) and one level for indirectness* b Decline one level for risk of bias (unclear risk of bias of deviations from intended intervention in [13,24]), one level for indirectness*, and one level for imprecision** c Decline one level for risk of bias (unclear risk of bias of deviations from intended intervention in [18]), one level for indirectness*, and one level for imprecision**.…”

“…d Decline one level for risk of bias (unclear risk of bias of deviations from intended intervention in [18,[23][24][25]), one level for indirectness*, and one level for imprecision**.…”