Photobiomodulation for Pain Control after Placement of Elastomeric Spacers in Orthodontics:A Report of Two Cases

Abstract

A case series of two patients aimed to evaluate the effect of a single session of photobiomodulation on pain control 24 hours after the placement of elastomeric separators using the Visual Analog Scale (VAS). Two patients aged 27 years old who required the placement of orthodontic bands on the first lower molars were included. The elastomeric separators were placed on the mesial and distal surfaces of the molars on the right and left sides. The treatment was randomized for the molar on the right side, while the opposite treatment was performed on the left side. The study groups were: Experimental - elastomeric separators + PBM (diode laser, 808 nm, 707 J/cm², 100 mW, with 4 J per point, three buccal points, and three palatal points, in a single session) and a Control - -elastomeric separators + PBM (diode laser, 808 nm, 707 J/cm², 100 mW, with 2 J per point, three buccal points and three palatal points, in a single session) at the opposite side. The patient and the evaluator were blinded to the intervention performed. The primary outcome variables were spontaneous and chewing pain after placing elastomeric separators, measured by the Visual Analog Scale (VAS). The secondary outcome variables were the count of analgesics taken (paracetamol) and local temperature (digital thermometer), and to assess the impact of oral health on the participant's quality of life, the OHIP-14 questionnaire was applied. These results were evaluated at baseline, 24 hours, and 48 hours after the placement of elastomeric separators. Despite an increase in all pain levels compared to baseline, there was a reduction of over 70% in spontaneous pain parameters at all time points, reaching zero at 48 hours.  There was a significant reduction on the experimental side of spontaneous pain (more than 78%) and pain when chewing (more than 76%) when receiving 4J concerning the molar that received 2J, which received elastic separators followed by photobiomodulation at 24 hours measurement. There was no need for analgesics in any case. It is concluded that PBM may be an analgesic alternative for controlling local pain and inflammation generated by the placement of elastomeric separators. Larger studies are needed for a more comprehensive analysis of pain.