Evaluation of the effects of photobiomodulation on orthodontic movement of molar verticalization with mini-implant
Authors: Murakami-Malaquias-Silva Felipe , Rosa Ellen Perim , Almeida Paulo André , Schalch Tânia Oppido , Tenis Carlos Alberto , Negreiros Renata Matalon , Horliana Ricardo Fidos , Garcez Aguinaldo Silva , Fernandes Marcella Ueda R. , Tortamano Andre , Motta Lara Jansiski , Bussadori Sandra Kalil , Horliana Anna Carolina Ratto Tempestini 
Published: March 2020

Abstract

Introduction:
Loss of a dental element can generate several repercussions in the stomatognathic system. According to the latest survey by the Ministry of Health, in 2010, Brazilian adults had, on average, 7 missing teeth. This loss may lead to movement of the adjacent teeth and the antagonist, which would make prosthetic rehabilitation harder to do. Anchoring systems, such as mini-implants, have been increasingly used as a treatment option because they act with heavy but controlled forces and without side effects. Recent studies have shown that photobiomodulation (PBM) can accelerate orthodontic movement in molar intrusion. The objective of this study will be to evaluate the effect of PBM on the acceleration of the orthodontic movement of molar verticalization and its effect on pain and inflammation of the periodontal tissues.

Patient concerns:
the concerns assessments will be done over the study using anamnesis interviews and specific questionnaire.

Diagnosis:
verticalization will be evaluated by clinical and radiographic analysis.

Interventions:
Thirty four healthy patients aged 30 to 60 years, who need to recover the prosthetic space for oral rehabilitation after loss of the posterior inferior dental elements and inclination of the adjacent element, will be randomly divided into 2 groups: G1 (control group) - verticalization by mini-implant + PBM simulation (placebo); G2 (experimental group) - verticalization by mini-implant + PBM. The movements will occur with the aid of mini-implants and elastomeric chains ligatures. The PBM will occur with diode laser application, 808 nm, 100 mW, receiving 1J per point, 10 seconds, 10 points (5 per buccal and 5 per lingual) and radiant exposure of 25 J/cm2. The orthodontic forces of verticalization (corresponding to any exchange of elastomeric ligation) will be applied every 30 days and the PBM will be applied immediately, 3 and 7 days of each month, for a period of 3 months. The crevicular gingival fluid (CGF) will be collected on the 1st, 3rd, and 7th days after the first activation, and then on the 3rd day of the following 2 months.

Outcomes:
Interleukins IL1β, IL-6, IL-8, IL-10, and TNF-α will be analyzed by ELISA. Panoramic radiography will be performed at baseline and 90 afterwards to ascertain the amount (in degrees) of verticalization. To evaluate the pain, the Visual Analog Scale (VAS) will be used in all the consultations, and to evaluate the quality of life, the Oral Health Impact Profile (OHIP-14) questionnaire will be applied. Analgesics will be given and the quantity of drugs will be counted. If the data are normal, they will be submitted to Student t test. The data will be presented as means ± SD and the value of p will be defined as <0.05.Discussion: This protocol will determine the effectiveness of photobiomoduation regarding the orthodontic movement of molar verticalization.

Ethics and dissemination:
This protocol received approval from the Human Research Ethics Committee of Universidade Nove de Julho (certificate number: 3 533 219). The data will be published in a peer-reviewed periodical.