Evaluation of low-level laser therapy and piezocision in the en-masse retraction of upper anterior teeth

Abstract Background Orthodontic treatment involving tooth extractions typically spans 25–35 months in adult patients. While various methods have been explored to accelerate this process, the outcomes remain inconsistent. This study focuses on evaluating the efficacy of these methods specifically in adult populations. Objectives This study aimed to evaluate the effects of flapless piezocision combined with low-level laser therapy (LLLT) on the rate of en-masse retraction, comparing it to piezocision alone and conventional. Materials and methods This single-center, three-arm, parallel-group randomized controlled trial involved adult patients with Class II Division 1 malocclusion who required upper premolar extractions. The study included healthy males and females aged 17–28. Participants were randomly assigned to one of three groups in a 1:1:1 ratio through seven blocks of nine participants each: (1) Piezocision-assisted en-masse retraction with low-level laser therapy (FC + LLLT), (2) Piezocision-assisted en-masse retraction (FC), and (3) Conventional en-masse retraction (CONV). After completing the leveling and alignment phase, piezocision procedures were performed using buccal and palatal vertical incisions made with a piezosurgery microsaw in FC and FC + LLLT groups. Six weeks later, in the FC + LLLT group, low-level laser therapy (LLLT) utilizing a GaAlAs diode laser was administered regularly until en-masse retraction. The primary outcome was the rate of en-masse retraction; secondary outcomes included changes in first molar positions and inter-molar and inter-canine widths. Results In this RCT of 80 patients, 63 (16 males and 47 females, mean age: 21.46 ± 3.16 years) were recruited. The FC + LLLT group had the greatest retraction rate at 1.32 ± 0.19 mm/month, significantly greater than the FC (1.09 ± 0.13 mm/month) and CONV groups (0.75 ± 0.06 mm/month). No significant differences were found in first molar distal movement or inter-molar width changes. Conclusion Combining LLLT with flapless piezocision significantly boosts upper anterior teeth retraction by 43.8%, compared to 31.8% with piezocision alone. This approach remains effective throughout the retraction period, while piezocision benefits were mainly seen in the initial two months. All methods cause slight distal movement of first molars and minor increases in inter-canine and intermolar widths, with no significant differences. Harms No harms were reported. Trial registration number This trial protocol was registered in the Clinical Trials database (NCT05655169).