The Effect of Low-Level Laser Therapy on Pain and the Repair of Orthodontically Induced Inflammatory Root Resorption: a Randomised Controlled Trial with Temporary Bite Raisers

INTERVENTION: Low level laser therapy with a 650nm diode laser will be used to investigate the effect on pain and the development of root resorption on teeth with orthodontic adhesive bite raisers. This study will employ a split mouth design with a true and sham laser. A 650nm soft tissue diode laser (Wuhan Pioon Technology Co Ltd; Wuhan, China) will be used in this study. The sham laser will emit a light beam. The application protocol will be as described by Ng et al. (2018). There will be 8 points of contact, with 4 on the buccal side, and 4 on the palatal/lingual side on the mucosa directly above the root surface of each tooth. These will consist of 2 points at the cervical portion (mesial and distal), 1 at midroot, and 1 at the ape Xof the tooth per buccal and palatal/lingual sides. The application points aim to cover the periodontal fibers and alveolar process around the first premolar teeth. Each application will be 15 seconds with a total treatment time of 2 minutes. A continuous beam will used. The laser tip will be held perpendicularly contacting the gingival mucosa during the laser irradiation. Eye protection of the patient, operator, and dental assistants will be ensured by wearing laser safety glasses. The laser therapy will be administered by orthodontic registrars. The procedure will take place at in the treatment rooms at the Sydney Dental Hospital, Orthodontics Department located at 2 Chalmers Street, Surry Hills, New South Wales, Australia 2010. Bite raisers will be placed with light‐cured glass ionomer cement (Transbond Plus Light Cure Band Adhesive; 3M Unitek, Monrovia, Calif) onto the occlusal surface of the mandibular first premolar so that the cement was in contact with the maxillary first premolar. The thickness of this cement will be adjus CONDITION: Oral and Gastrointestinal ‐ Other diseases of the mouth, teeth, oesophagus, digestive system including liver and colon Pain;Pulp chamber volume;Root resorption;Orthodontics; ; Pain ; Pulp chamber volume ; Root resorption ; Orthodontics PRIMARY OUTCOME: Pain [Visual Analogue Score Day 0 (treatment commences, 7, 21, 28 (after removal of temporary bite raisers)] Root Resorption[Root resorption volume as measured by micro‐computed tomography of the extracted teeth 28 days after removal of temporary bite raisers] SECONDARY OUTCOME: Pulp chamber volume[Pulp chamber volume measured from the micro‐computed tomography of extracted teeth Day 28 (after removal of temporary bite raisers)] INCLUSION CRITERIA: INCLUSION CRITERIA: • Indicated for extraction of all first premolars (four teeth) as part of an orthodontic management plan, where the first premolars are in occlusion with each other. • Permanent dentition • Complete apexification of the first premolar teeth • Similar degree of minimal crowding • Absence of previous orthodontic and/or orthopaedic treatment. • No craniofacial or dental anomalies, no missing teeth • No previous observed or reported dental treatment involving the first premolars • No history of trauma, bruxism or parafunction • No past or present signs of periodontal disease • Maintenance of overall health with no significant medical history or medication that would affect the dentition.