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The effectiveness of low-level diode laser therapy on orthodontic pain management: a systematic review and meta-analysis.

Ren C, McGrath C, Yang Y - Lasers Med Sci (2015)

Bottom Line: Of the 186 results, 14 RCTs, with a total of 659 participants from 11 countries, were included.Except for three studies assessed as having a 'moderate risk of bias', the RCTs were rated as having a 'high risk of bias'.However, no significant effects were shown for split-mouth-design studies (P = 0.38 versus placebo groups).

View Article: PubMed Central - PubMed

Affiliation: Faculty of Dentistry, The University of Hong Kong, 34 Hospital Road, Sai Ying Pun, Hong Kong SAR, China.

ABSTRACT
To assess the effectiveness of diode low-level laser therapy (LLLT) for orthodontic pain control, a systematic and extensive electronic search for randomised controlled trials (RCTs) investigating the effects of diode LLLT on orthodontic pain prior to November 2014 was performed using the Cochrane Library (Issue 9, 2014), PubMed (1997), EMBASE (1947) and Web of Science (1956). The Cochrane tool for risk of bias evaluation was used to assess the bias risk in the chosen data. A meta-analysis was conducted using RevMan 5.3. Of the 186 results, 14 RCTs, with a total of 659 participants from 11 countries, were included. Except for three studies assessed as having a 'moderate risk of bias', the RCTs were rated as having a 'high risk of bias'. The methodological weaknesses were mainly due to 'blinding' and 'allocation concealment'. The meta-analysis showed that diode LLLT significantly reduced orthodontic pain by 39 % in comparison with placebo groups (P = 0.02). Diode LLLT was shown to significantly reduce the maximum pain intensity among parallel-design studies (P = 0.003 versus placebo groups; P = 0.000 versus control groups). However, no significant effects were shown for split-mouth-design studies (P = 0.38 versus placebo groups). It was concluded that the use of diode LLLT for orthodontic pain appears promising. However, due to methodological weaknesses, there was insufficient evidence to support or refute LLLT's effectiveness. RCTs with better designs and appropriate sample power are required to provide stronger evidence for diode LLLT's clinical applications.

No MeSH data available.


Related in: MedlinePlus

a Risk of bias summary: review authors’ judgments about each risk of bias item for each included study. b Risk of bias graph: review authors’ judgments about each risk of bias item presented as percentages across all included studies
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Fig2: a Risk of bias summary: review authors’ judgments about each risk of bias item for each included study. b Risk of bias graph: review authors’ judgments about each risk of bias item presented as percentages across all included studies

Mentions: The results of the methodological quality assessment were shown in Figs. 2a, b. Of the 14 included studies, only 3 were assessed as having a moderate risk of bias, whereas the rest all implied a high risk of methodological drawbacks [32, 38, 43]. Among all seven domains, ‘blinding of key personnel’ accounted for the principal risk factor affecting methodology quality. Only four studies reported that a double-blind method was used to prevent participants and key personnel from perceiving the assignment to diode LLLT or placebo (control) [32, 41, 43, 44]. One study failed to explicitly mention the blinding measure adopted in the experiment and assessment process [38]. However, the majority of studies applied a single-blind method, in which the participant was blinded and the operator who performed the intervention was aware of the grouping information. Although all of the studies were presented as randomised, one study used an inadequate sequence generation method [33]. The most commonly used randomisation methods were based on computer programs [37, 38, 43] and random number tables [36, 44]. Three trials used block randomisation to ensure a balance in the assignments to the experimental or placebo (control) groups [32, 39, 43]. One study used the Latin Square method for randomisation [41]. Another key risk factor was that most studies failed to state which method they used to conceal the allocation sequence, except four studies [32, 37, 41, 43]. Moreover, one study presented incomplete outcome data without adequately addressing the missing information [44]. Apart from these clearly defined categories of bias risk, one trial recruited participants among dental students, limiting the generalisation of the conclusion to the entire population [41]. The laser was applied by the participants instead of by a well-trained clinician, suggesting a risk of bias induced by a potential inconsistency in intervention [42]. None of these included studies provided sufficient information for the judgement of ‘selective outcome reporting’.Fig. 2


The effectiveness of low-level diode laser therapy on orthodontic pain management: a systematic review and meta-analysis.

Ren C, McGrath C, Yang Y - Lasers Med Sci (2015)

a Risk of bias summary: review authors’ judgments about each risk of bias item for each included study. b Risk of bias graph: review authors’ judgments about each risk of bias item presented as percentages across all included studies
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4562996&req=5

Fig2: a Risk of bias summary: review authors’ judgments about each risk of bias item for each included study. b Risk of bias graph: review authors’ judgments about each risk of bias item presented as percentages across all included studies
Mentions: The results of the methodological quality assessment were shown in Figs. 2a, b. Of the 14 included studies, only 3 were assessed as having a moderate risk of bias, whereas the rest all implied a high risk of methodological drawbacks [32, 38, 43]. Among all seven domains, ‘blinding of key personnel’ accounted for the principal risk factor affecting methodology quality. Only four studies reported that a double-blind method was used to prevent participants and key personnel from perceiving the assignment to diode LLLT or placebo (control) [32, 41, 43, 44]. One study failed to explicitly mention the blinding measure adopted in the experiment and assessment process [38]. However, the majority of studies applied a single-blind method, in which the participant was blinded and the operator who performed the intervention was aware of the grouping information. Although all of the studies were presented as randomised, one study used an inadequate sequence generation method [33]. The most commonly used randomisation methods were based on computer programs [37, 38, 43] and random number tables [36, 44]. Three trials used block randomisation to ensure a balance in the assignments to the experimental or placebo (control) groups [32, 39, 43]. One study used the Latin Square method for randomisation [41]. Another key risk factor was that most studies failed to state which method they used to conceal the allocation sequence, except four studies [32, 37, 41, 43]. Moreover, one study presented incomplete outcome data without adequately addressing the missing information [44]. Apart from these clearly defined categories of bias risk, one trial recruited participants among dental students, limiting the generalisation of the conclusion to the entire population [41]. The laser was applied by the participants instead of by a well-trained clinician, suggesting a risk of bias induced by a potential inconsistency in intervention [42]. None of these included studies provided sufficient information for the judgement of ‘selective outcome reporting’.Fig. 2

Bottom Line: Of the 186 results, 14 RCTs, with a total of 659 participants from 11 countries, were included.Except for three studies assessed as having a 'moderate risk of bias', the RCTs were rated as having a 'high risk of bias'.However, no significant effects were shown for split-mouth-design studies (P = 0.38 versus placebo groups).

View Article: PubMed Central - PubMed

Affiliation: Faculty of Dentistry, The University of Hong Kong, 34 Hospital Road, Sai Ying Pun, Hong Kong SAR, China.

ABSTRACT
To assess the effectiveness of diode low-level laser therapy (LLLT) for orthodontic pain control, a systematic and extensive electronic search for randomised controlled trials (RCTs) investigating the effects of diode LLLT on orthodontic pain prior to November 2014 was performed using the Cochrane Library (Issue 9, 2014), PubMed (1997), EMBASE (1947) and Web of Science (1956). The Cochrane tool for risk of bias evaluation was used to assess the bias risk in the chosen data. A meta-analysis was conducted using RevMan 5.3. Of the 186 results, 14 RCTs, with a total of 659 participants from 11 countries, were included. Except for three studies assessed as having a 'moderate risk of bias', the RCTs were rated as having a 'high risk of bias'. The methodological weaknesses were mainly due to 'blinding' and 'allocation concealment'. The meta-analysis showed that diode LLLT significantly reduced orthodontic pain by 39 % in comparison with placebo groups (P = 0.02). Diode LLLT was shown to significantly reduce the maximum pain intensity among parallel-design studies (P = 0.003 versus placebo groups; P = 0.000 versus control groups). However, no significant effects were shown for split-mouth-design studies (P = 0.38 versus placebo groups). It was concluded that the use of diode LLLT for orthodontic pain appears promising. However, due to methodological weaknesses, there was insufficient evidence to support or refute LLLT's effectiveness. RCTs with better designs and appropriate sample power are required to provide stronger evidence for diode LLLT's clinical applications.

No MeSH data available.


Related in: MedlinePlus