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      Effects of laser-assisted cosmetic smile lift gingivectomy on postoperative bleeding and pain in fixed orthodontic patients: a controlled clinical trial

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          Abstract

          Background and objective

          Diode lasers are becoming popular in gingival treatment following orthodontic treatments. Despite their merit and clinical implications, postoperative pain and bleeding after surgery with diode lasers are not assessed except in few controversial studies.

          Method

          This controlled clinical trial was conducted on 30 healthy orthodontic patients aged 17–29 years, needing esthetic-only gingivectomy in the anterior maxilla. The patients were randomly divided into two groups of 15 each: experimental (laser-assisted surgery) and control (traditional surgery using scalpels). The bleeding rate following the surgery was assessed using the bleeding criteria established by the World Health Organization. The postsurgical pain level was recorded using visual analog scales immediately after the surgery and in patients who consumed analgesics, also 2 h after the analgesic consumption. The data were analyzed using the independent-samples t, Mann-Whitney U, and chi-square tests (α = 0.05).

          Results

          The average bleeding rates were 1.15 and 0.36 in the conventional and laser groups, respectively (Mann-Whitney U P < 0.05). Experimental patients had no postsurgical pain (VAS1 and VAS2 = 0). In the control group, the average VAS1 pain was 5.2 out of 10. The difference between VAS1 values in the control/experimental groups was significant (Mann-Whitney U P < 0.001).

          Conclusion

          940-nm diode laser seems promising in reducing postoperative bleeding and pain of patients needing cosmetic smile lift surgeries.

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          Most cited references43

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          Orthodontic pain: from causes to management--a review.

          Orthodontic pain, the most cited negative effect arising from orthodontic force application, is a major concern for parents, patients, and clinicians. Studies have reported this reaction to be a major deterrent to orthodontic treatment and an important reason for discontinuing treatment. Surprisingly this area, which requires attention in clinical practice as well as in research, is ignored as evidenced by the scarcity of publications on the topic in comparison with other areas of orthodontic research. This review attempts to organize the existing published literature regarding pain, which appears as part of orthodontic mechanotherapy and to address questions that might arise in a clinical setting from the viewpoint of clinicians and patients/parents. It also provides an overview of current management strategies employed for alleviating orthodontic pain.
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            Perception of pain during orthodontic treatment with fixed appliances.

            The aims of this study were to investigate the initial time at which pain occurs after insertion of two initial wires of different sizes, the duration of the pain, the areas affected within the mouth, the level of self-medication, the effect of this pain on daily life, and whether gender is important in the perception of pain. The study group consisted of 109 patients (52 boys, 57 girls) with a mean chronological age of 13.6 years for boys and 14.7 years for girls. Insertion of either a 0.014 or 0.016 inch wire was by random selection. Following insertion of the archwires, a questionnaire comprising a total of 49 questions was given to the patients. They described the time of initial pain in the first question, answered the next 24 questions as 'yes' or 'no', and used a visual analogue scale for the final 24 questions. No significant differences were found in terms of gender, in the perception period of initial pain as regards the areas affected within the mouth or the effect of pain on daily living when the 0.014 and 0.016 inch wire groups were compared at 6 hours, 1, 2, 3, 4, 5, 6 and 7 days. At 24 hours, which was found to be statistically significant, more pain relief was used in the 0.014 inch archwire group. The results show that in both groups, initial pain was perceived at 2 hours, peaked at 24 hours and had decreased by day 3.
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              Acceleration of tooth movement during orthodontic treatment - a frontier in Orthodontics

              Nowadays, there is an increased tendency for researches to focus on accelerating methods for tooth movement due to the huge demand for adults for a shorter orthodontic treatment time. Unfortunately, long orthodontic treatment time poses several disadvantages like higher predisposition to caries, gingival recession, and root resorption. This increases the demand to find the best method to increase tooth movement with the least possible disadvantages. The purpose of this study is to view the successful approaches in tooth movement and to highlight the newest technique in tooth movement. A total of 74 articles were reviewed in tooth movement and related discipline from 1959 to 2013. There is a high amount of researches done on the biological method for tooth movement; unfortunately, the majority of them were done on animals. Cytokine, PTH, vitamin D, and RANKL/RANK/OPG show promising results; on the other hand, relaxin does not accelerate tooth movement, but increases the tooth mobility. Low-level laser therapy has shown positive outcome, but further investigation should be done for the best energy and duration to achieve the highest success rate. Surgical approach has the most predictable outcomes but with limited application due to its aggressiveness. Piezocision technique is considered one of the best surgical approaches because it poses good periodontal tissue response and excellent aesthetic outcome. Due to the advantages and disadvantages of each approach, further investigations should be done to determine the best method to accelerate tooth movement.
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                Author and article information

                Contributors
                f_sobouti@dental.mumsiau.ac.ir
                vahid.rakhshan@gmail.com
                nasim.chiniforoush@dentaliau.tums.ac.ir
                mzkhatami@gmail.com
                Journal
                Prog Orthod
                Prog Orthod
                Progress in Orthodontics
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                1723-7785
                2196-1042
                9 December 2014
                9 December 2014
                2014
                : 15
                : 1
                : 66
                Affiliations
                [ ]Orthodontic Department, Dental Faculty, Mazandaran University of Medical Sciences, Sari, Iran
                [ ]Iranian Tissue Bank and Research Center, Tehran University of Medical Sciences, Tehran, Iran
                [ ]Department of Dental Anatomy and Morphology, Dental Branch, Islamic Azad University, Tehran, Iran
                [ ]Laser Research Center of Dentistry, Dental Research Institute, Tehran University of Medical Sciences, Tehran, Iran
                [ ]Department Of Periodontics, Dental Faculty, Mazandaran University of Medical Sciences, Sari, Iran
                Article
                66
                10.1186/s40510-014-0066-5
                4259980
                25487965
                c776669c-2973-4114-a21f-f9db552ab592
                © Sobouti et al.; licensee Springer. 2014

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in anymedium, provided the original work is properly credited.

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                Research
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                © The Author(s) 2014

                cosmetic smile lift,gingivectomy,diode laser,orthodontics,periodontics

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