Evaluation of Treatment Outcome of Lower Incisors Crowding Using Clear Aligners With Laser Acceleration (Randomized Control Study) .
Phase: NA
Conditions: Tooth Movement
Sponsor: Huda Abdelhakim

 
  
Evaluation of Treatment Outcome of Lower Incisors 
Crowding Using Clear Aligners with Laser Acceleration 
(Randomized Control Study.) .  
  
                                           A Proposal  
Submitted to the Faculty of Dental Medicine for Girls, Al- Azhar University in Partial 
Fulfillment of the Requirement for Master Degree  
  
In  
Orthodontics  
  
By  
Huda Abd Elhakim Ramadan Mohamed  
BDS 2017  
Modern Science and Arts University - MSA Dentist 
at Ministry of Health  
  
Orthodontic Department  
Faculty of Dental Medicine for Girls 
Al-Azhar University 
1443H- 2022G  
  
  
  
 
  
Code   
 
  
ORTHO-109-2-K  

 
  
  
Supervisors:  
  
Prof. Dr. Samir A. Ibrahim .  
Professor and Head of Orthodontic Department  
Faculty of Dental Medicine for Girls Al-Azhar 
University  
  
                                Prof. Dr. Abeer Saad Gaweish .  
Professor of Oral Medicine and Periodontology Department  
Faculty of Dental Medicine for Girls Al-Azhar 
University  
  
  Dr. Maha Mostafa Mohamed Ali .  
Lecturer at Orthodontic Department  
Faculty of Dental Medicine for Girls  
Al-Azhar University 

  
1  
Introduction :  
  
        One of the world's greatest novelists , once said, "Every tooth in a man's head is 
more valuable than a diamond." (1)  
        This statement makes sense because teeth are the most  attractive part of the face 
.which gives the appearance of perfection .Any inconsistency or flaws in the teeth, such 
as dental crowding, can change one's beauty , which is undesirable. In this regard 
orthodontic treatment became very important. (1)  
        A deviation from an ideal occlusion or an accepted societal norm is referred to as 
malocclusion . Malocclusion is widely accepted to be multifactorial, with genetic 
factors as well as habits, dietary preferences, habitual oral or tongue posture, and 
swallowing characteristics all playing a role. Dental malocclusion is very common in 
children and adolescents all over the world . It is linked not only to oral disorders, but 
also affects  patient's psychological, social, and functional health  . (2,3)  
         Dental crowding, also known as Swarming  ,can be explained as an inconsistency 
between tooth size and arch dimension .(1)  
         Modern orthodontic treatments strive to provide patients with a comfortable and 
enjoyable treatment experience . As a result, several studies have recently emerged that 
focused on patient-centered outcomes during a wide range of orthodontic interventions.  
(2)  
         The rise in the number of adult orthodontic patients has increased demand for 
aesthetic and comfortable alternatives to traditional fixed appliances. Clear aligners that 
meet this demand are also vulnerable to rapid technological advancements in aligner 
materials and manufacturing techniques. The removable appliance was used solely to 
move teeth in the first generation of aligners. Following that, a second generation of 
aligners was developed that relied more on attachments bonded to teeth. The most 

  
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recent, third generation, has been modified to automatically place various types of 
attachments where difficult tooth movements are required. These technology 
advancements have increased the number and complexity of cases treated with this 
method.(4,5)  
            Since the introduction of Invisalign in 1997, treatment with clear aligners has 
become a rapidly growing sector in orthodontics. Clear aligners offer more aesthetically 
pleasing and comfortable treatment experience, improve oral hygiene, cause less pain 
than fixed orthodontic appliances, reduce the number and duration of appointments, and 
necessitate fewer emergency visits. However, the cost of production, reliance on patient 
cooperation, and inability to treat certain malocclusions limit their use.(6,7)   
          Orthodontic treatment typically lasts between 24 and 36 months. In general, 
patients reject this treatment modality due to the lengthy treatment period. In extended 
treatment protocols, root resorption, caries, and decreased patient compliance are more 
common. As a result, accelerating orthodontic tooth movement is appropriate to avoid 
those side effects and can encourage patients to complete the treatment . Acceleration 
of orthodontic tooth movement (OTM) has been used successfully to reduce levelling 
and alignment time using surgical interventions such as corticotomy, corticision, 
piezocision, and micro-osteoperforation.  (6,8)  
           Orthodontic treatment is generally based on the rule of bone remodeling that 
occurs as a result of applying forces to a tooth, creating areas of tension and pressure 
on the periodontal ligament. The events that lead to tooth movement are intricate, 
incorporating interactions between cells in the alveolar bone and the periodontal 
ligament. The process is characterized by acute inflammation, followed by chronic 
inflammation, and then by acute inflammation (after reactivation of orthodontic forces). 
These changes in periodontal tissues cause bone remodeling, which is necessary for 
orthodontic tooth movement. Many studies have now been conducted to investigate 
various methods of accelerating tooth movement, such as drug injections, electric 

  
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stimulation, corticotomy, pulsed electromagnetic fields, and mechanical and physical 
methods. (6,9)  
            Low-Level Laser Therapy is one of these interventions (LLLT). Low-Level 
Laser (LLL) has analgesic, anti-inflammatory, and bio stimulatory properties.  Among 
all methods studied to accelerate induced dental movement and thus reduce orthodontic 
treatment time, Low-Level Laser is the least invasive, easiest, safest, and fastest to 
apply. Initially, histological studies revealed that LLLT promotes remodeling processes 
in alveolar bone by increasing the number of osteoblasts and osteoclasts.  As a result, 
there has been an exponential increase in the number of studies conducted to investigate 
the effectiveness of laser treatment in accelerating tooth movement. LLLT, on the other 
hand, has a high patient acceptability and is simple to use, especially with the 
availability of small portable devices.  (10,11)   
         Low-Level Laser Therapy (LLLT) is a simple, localized, nonsurgical, noninvasive 
method with no side effects that is gaining popularity among OTM researchers. LLLT 
has been shown in numerous studies to improve vascularization, collagen fiber 
organization, and osteoblastic activity. (12)  
          Laser is an abbreviation for "light amplification by simulated emission of 
radiation," one of the greatest technological advances of the twentieth century. Lasers 
were first used in medicine in 1963. One year later, the first laser applications in the 
field of dentistry were performed using a ruby laser on hard issues . (13)  
        The effects of LLLT on tooth movement were studied in both clinical  and animal 
studies . Numerous human studies have shown that LLLT can simulate the velocity of 
tooth movement . At that point, it is emphasized that the effects of laser application on 
bio simulation is dose dependent . (13)  
       By reviewing the available Literature ,  little studies demonstrated the acceleration 
of orthodontic tooth movement  by aligner associated with LLLT , so the goal of the 

  
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present study is directed to evaluate the rate of correction of lower incisor crowding by 
clear aligner and LLLT versus clear aligner alone .    
Aim of the study :  
  
     The present study will be performed to evaluate the effect of low-level laser 
therapy (LLLT) on the rate of orthodontic tooth movement through the correction of   
lower incisors crowding using clear aligners . 
 

  
5  
Subjects and methods :  
    Patients with lower anterior mild to moderate crowding will be collected from 
AlAzhar University from Faculty of Dental Medicine for Girls and post records will 
be collected after relieve of crowding .  
  
Study design: Randomized Control Study.  
Randomization will be done by using Microsoft Office Excel 2007 .  
patients information will be entered into a computer ,then the computer randomly 
assigns the patients to two groups that helping to prevent bias.  
Control group (n=11) patients will receive a conventional therapy with 
clear aligners and the investigational group (n=11) will receive the new treatment 
therapy by using clear aligners for the treatment of mild to moderate lower 
anterior crowding with laser acceleration .  
  
Sample size calculation(14):  
  
This power analysis used leveling and alignment improving % as the primary 
outcome. Based upon the results of . AlSayed Hassan MMAA et al (7102); the mean 
(Standard deviation) values were 89.42 (7.16) and 71.7 (16.18) %, respectively. The 
effect size (d) was 1.416. Using alpha (α) level of (5%), β level of 0.8 (Power = 80%); 
the minimum estimated sample size was 9 subjects per group. Sample size was increased 
to 11 subjects per group to compensate for a dropout rate of 20% after 6 months. Sample 
size calculation was performed using G*Power version 3.1.9.2.  
  
  
  
  

  
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Ethical approval:  
  
The research protocol approved by ethical committee of Faculty of Dental 
Medicine, girls, Al-Azhar University, (  P-OR-22-05  ). The steps of the procedure 
will be explained to the patients / parents and an informed consent will be signed  
.  
  
Inculsion criteria(15) :  
  
1. A well-behaved, compliant, and motivated patient.  
2. Patients from 16 to 23 years old .  
3. Patients with mild to moderate anterior lower crowding.   
4. Full complement of teeth  (except for wisdom teeth).  
5. Class I Angle malocclusion  .  
  
Exclusion criteria (16):  
  
  
1. Patients with missed anterior teeth .   
2. Class II or III Malocclusion (dental or skeletal ) .  
3. Any systemic diseases that may interfere with assigned treatment plan .    
4. Periodontal affection especially at lower anterior teeth .   
Method:  
  
Each patient will have the following record taken before the delivery 
:  
o Orthodontic casts (upper and lower).  
o Photography, both intraoral and extraoral o lateral cephalometric X-ray .  
o Panoramic X-ray   

  
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Treatment groups:  
  
The sample will be divided into two groups according to laser application, 11 patients 
each group  :  
Group (A): Clear aligners will be used to treat patients with lower anterior 
crowding with low level laser acceleration .  
Group (B): Clear aligners will be used to treat patients with lower anterior 
crowding without laser acceleration .  
  
Statistical analysis :  
Measurements will be taken and the collected data will be tabulated and 
analyzed statistically.  
   
  
  

  
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With Clear Aligners Versus Fixed Appliances on Oral Health-Related Quality of 
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malocclusion . Angle Orthod. 2016 ;86:697-705 .  
  
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The Scientific Reality Behind Their Marketing: A Literature Review . 
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fixed appliances. Angle Orthod .2021;91:718-24.  
  
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