## 5 Discussion  
Through a systematic review, this study developed an analysis of the many variables associated with PBM therapy, applied in three areas of dental/oral surgical treatments, using randomised clinical human trials [25; 26; 27; 28; 29; 30; 31; 32; 33; 34; 35; 36; 37; 38; 39; 40; 41; 42; 43; 44; 45; 46; 47; 48; 49; 50; 51; 52; 53; 54; 55; 56; 57; 58; 59; 60; 61; 62; 63; 64; 65; 66; 67; 68; 69; 70; 71; 72; 73; 74; 75; 76; 77; 78]. The basis of this investigation sought treatments related to the underlying nature of inflammation in general, whether acute, chronic or, in the case of elective orthodontic tooth movement, pre-operatively non-existent, to determine if any pertinent conclusions might be drawn. Although rather simplistic in its generalisation, the application of PBM may be seen to address conditions that are standalone pathologies or conditions contemporary with and consequent of surgical intervention with oral, dental hard and soft tissue diseases or trauma. As such, the presence of acute or chronic inflammation, with associated tissue imbalance (pain, oedema and trismus), may present an opportunity for beneficial PBM therapy. In addition, there may be opportunities to positively influence the status of otherwise 'normal' tissue that may be associated with a clinical procedure, such as orthodontic therapy as well as adjunctive applications associated with regenerative therapies such as stem cells [79] and the hard and soft tissue graft osseointegration of dental implants [80]; other areas of PBM influence include burning mouth syndrome [17], following nerve damage caused by oral surgery [81] and idiopathic tooth hypersensitivity [82; 83]. The data extraction and groupings were subjected to a statistical evaluation in order to seek those elements of therapy that represent possible significance and allow meaningful comparisons to be identified. The focus of selection of published papers was to identify  
Figure 12: TMJ qualitative variables—bistimulation. Plot of estimated standardised coefficients \(\pm\) 95% confidence intervals (CIs) for qualitative explanatory variables evaluated using the ANOVA models employed for predicting the outcome variable for biostimulation (0 for no effect, and +1 for a statistically significant influence). the empirical use of laser photobiomodulation within three areas of adjunctive therapy; the intention was to conduct a refine analysis to enable direct comparisons across the three treatment groups. Additionally, the short time frame of the published randomised clinical trials reflects the high level of research activity during the past five years; however, when compared to the extended span of decades of preceding research, it is questionable as to how little consensus has emerged in terms of a standardisation of laser application techniques, or of the many elements of a general PBM light dose during all phases of treatment. The objectives of this systematic review originated around three areas of interest: 'Was the influence of PBM therapy primarily related to the presenting condition? ', 'Was any benefit influenced by the reported operating technique and surgical anatomy? ', and 'Was any benefit of PBM therapy related to the chosen operating parameters?'. As seen from the statistical analysis, there appears to be no significant difference between the three treatment groups to allow for an indication regarding the comparative usefulness of PBM therapy with any underlying clinical condition. Therefore, to draw any significance concerning tissue status appears equivocal. The prime PBM outcomes of reduced inflammation, analgesia and uneventful healing are potent claims that have been refined through many studies, offering the promise of adjunctive support in the clinical management of disease, disorder or injury.