Evaluation of the Best Method for Orthodontic Correction of Skeletal Deep Bites in Growing Patients: A Systematic Review.

This review aimed to evaluate the currently available evidence regarding the best method of correcting deep bites in growing patients. In September 2023, a search was conducted electronically across the following databases: PubMed®, Web of Science™, Scopus®, Embase®, Google™ Scholar, and Cochrane Library. In this systematic review, randomized control trials (RCTs), controlled clinical trials (CCTs), and cohort studies of growing patients with deep bite malocclusion who received treatment with the primary objective of treating the deep bite were included. Risk of bias of the included studies was assessed using two different tools; one tool was applied for RCTs and the other one for the CCTs and cohort studies. One RCT, one CCT, and one cohort study were included (85 patients). The flat fixed acrylic bite plane was superior in terms of duration of treatment when compared to the inclined fixed acrylic bite plane and the utility arch with posterior intermaxillary elastics. Limited evidence indicates that the inclined fixed acrylic bite plane causes a significant increase in the lower incisor inclination and a significant increase in the angle between the mandible and the anterior cranial base (SNB). However, limited evidence indicates that the utility arch with posterior intermaxillary elastics causes a significant decrease in the angle between the maxilla and the anterior cranial base (SNA). Regarding the vertical skeletal changes, it was found that the three methods were comparable; in each case, the vertical dimension of the face increased because of a significant increase in the lower first molar height. There is a need for further studies to strengthen the evidence of the treatment efficacy of the employed methods, with more RCTs to be conducted in this regard.

Digital setup accuracy for moderate crowding correction with fixed orthodontic appliances: a prospective study.

OBJECTIVES: To evaluate the accuracy of a semi-automatic 3D digital setup process in predicting the orthodontic treatment outcome achieved by labial fixed appliances. SUBJECTS AND METHODS: Twenty-five adult patients (18 to 24 years old) with class I malocclusion and moderate crowding were prospectively enrolled and received treatment on both jaws through the straight-wire technique. Prior to treatment commencement, a semi-automatic digital setup simulating the predicted treatment outcome was performed for each patient through Orthoanalyzer software (3Shape®, Copenhagen, Denmark) to obtain the prediction model. This was compared to the final outcome model through 3D superimposition methods. Metric variables and inspection of color-coded distance maps were used to detect how accurately the digital setup predicts the actual treatment outcome. RESULTS: The mean absolute distances (MAD) between the superimposed dental arches of the predicted and the final models were: 0.77 ± 0.13 mm following superimposition on the palate, 0.52 ± 0.06 mm following superimposition on the maxillary dental arch, and 0.55 ± 0.15 mm following superimposition on the mandibular dental arch. The MAD at the palatal reference area was 0.09 ± 0.04 mm. Visualization of color-coded distance maps indicated that the digital setup accurately predicted the final teeth position in a few cases. Almost half of the cases had posteriorly wider upper and lower dental arches and palatally/lingually positioned or inclined anterior teeth, whereas the rest still showed errors within 2-3 mm, distributed over the entire dental arches with no distinct pattern. CONCLUSIONS: The accuracy of semi-automatic prediction of the labial fixed appliance treatment outcome in Class I cases with moderate crowding is not yet sufficient. While average measures showed deviations less than 1 mm, examination of individual color-coded distance maps revealed significant disparities between the simulated and the actual results.

The effectiveness of interventions in reducing pain related to orthodontic separation: a systematic review and meta-analysis.

BACKGROUND: Pain is an unpleasant experience and annoying sensation. To control this pain during orthodontic separation, different pharmacological and non-pharmacological methods have been used. OBJECTIVE: This systematic review and meta-analysis aimed to critically assess the evidence of the effectiveness of pharmacological and non-pharmacological methods in reducing pain induced by orthodontic separation. SEARCH STRATEGY: An electronic search was conducted using the following databases: PubMed® (Medline), Scopus®, EMBASE®, Web of ScienceTM, Google ScholarTM, ProQuest, and Cochrane Central Register of controlled trials (CENTRAL) searching for the studies published between January 2012 and April 2023. SELECTION CRITERIA: Only randomized controlled trials (RCTs) were included, each experimental group included patients who received elastomeric separators and one kind of pharmacological or non-pharmacological interventions for pain reduction during the separation stage. DATA COLLECTION AND ANALYSIS: Cochrane's risk of bias tool (RoB2 tool) was applied. The Grading of Recommendations Assessment, Development, and Evaluation [GRADE] approach was used to evaluate the strength of the evidence. RESULTS: Thirty-one studies (RCTs) were included in this systematic review. Nineteen of them were appropriate for quantitative synthesis and used VAS for pain assessment. Meta-analysis showed that low-level laser therapy (LLLT) was an effective approach for pain relief after separators placement with standard mean difference of 13.79 mm (95% confidence interval (CI): -15.64, -11.94) at 6 h and 23.34 mm at 24 h (95% CI: -25.91, -20.77). LLLT was also effective when applied in split-mouth and the standard mean difference was 8.9 mm at 6 h (95% CI: -12.86, -3.33) and 17.15 mm at 24 h (95% CI: -30.12, -4.17). Ibuprofen had a pain control effect at 6 h and at 24 h compared with the placebo group. The standard mean difference was 14.37 mm (95% CI: -20.54, -8.19) and 20.46 mm (95% CI: -27.79, -13.13), respectively. There was no difference in pain control between ibuprofen and acetaminophen. Naproxen had lower visual analog scale scores in pain perception at 6 h and the standard mean difference was 7.03 mm (95% CI: -12.67, -1.40). CONCLUSIONS: The application of LLLT decreased the pain induced by the separation during the first day of teeth separation; the pain reduction showed an increase from 6 h to the end of the 24 h. However, the evidence is weak to moderate. The analgesics reduced the pain compared to placebo; this pain reduction had shown an increase from 6 h to the end of the 24 h. The strength of the evidence is moderate. Naproxen gel effectively reduced the pain compared to placebo; the evidence in this regard is moderate. Naproxen gel effectively reduced the pain compared to placebo, but it was less effective than the oral intake of non-steroidal anti-inflammatory drugs. However, the evidence in this regard is moderate. REGISTRATION: This systematic review was registered with PROSPERO (CRD42022335553) during the first stages of its conduction.

Adult patient expectations and satisfaction: Can they be influenced by viewing the three-dimensional predicted outcome before fixed orthodontic treatment of dental crowding?

BACKGROUND: Investigating the possible changes in patients' expectations of and satisfaction with the orthodontic treatment outcomes when they were given the three-dimensional digital prediction of their teeth alignment before the beginning of treatment. METHODS: A prospective non-controlled single-group clinical trial was conducted on 28 (18 females, 10 males, mean age: 20.68 ± 1.91 years) patients with Class I malocclusion and moderate dental crowding who required a nonextraction orthodontic treatment. Patients were given the expectations questionnaire on their first visit (T0). Then, patients were shown a three-dimensional digital setup-created by Orthoanalyzer software (3Shape, Copenhagen, Denmark)-of the proposed treatment results before orthodontic treatment (T1) and received two questionnaires, the second expectations questionnaire and the satisfaction with the proposed changes questionnaire. Treatment was then initiated using the fixed appliances and completed. After debonding, a question about patients' satisfaction with the achieved changes was completed (T2). RESULTS: Patients' expectations level significantly increased after watching the predicted alignment of teeth compared with the initial levels in terms of chewing (x¯ = 5.54 and x¯= 6.71), speech (x‾ =5.93 and x¯= 6.93), and oral hygiene improvement (x‾= 7.93 and x¯=8.61 ± 1.06; at T0 and T1, respectively). The remaining items showed no significant differences between the two assessment times. Patients had a higher level of satisfaction at the end of treatment than after watching the proposed outcome. There were significant statistical differences in the items related to teeth appearance (x¯= 9.12 and x¯= 9.60 at T1 and T2, respectively), and teeth engagement (x¯= 8.92 and x¯= 9.40 at T1 and T2, respectively) CONCLUSIONS: Watching the predicted alignment outcome increased patients' expectations of chewing, speech, and oral hygiene improvement compared with the initially recorded levels. Patients were more satisfied with the final result than what was recorded after viewing the predicted plan. However, these results were not clinically significant.

Effectiveness of Two Intensity Levels of Diode Laser in Debonding Metallic Brackets Regarding Enamel Surface Integrity and Pulpal Temperature: An Ex-Vivo Study.

INTRODUCTION: The traditional methods of deboning metal brackets exert excessive force, resulting in enamel scratches, fractures, and patient discomfort. The objective of this study was to evaluate the effectiveness of using two intensity levels of a diode laser for debonding metallic orthodontic brackets as an alternative to the conventional debonding method. MATERIALS AND METHODS: Sixty intact, extracted human premolar teeth were used in this study, and metal orthodontic brackets were bonded to the buccal surface of these teeth. The teeth were divided into three groups for the experiment: (1) the control group, where conventional bracket debonding was performed using a debonding plier, (2) the first experimental group, where a diode laser (2.5W, 980nm) was utilized for laser debonding, and (3) the second experimental group, where a diode laser (5W, 980nm) was used for laser debonding. The laser was applied using a sweeping movement for 5 seconds. After debonding, the adhesive remnant index (ARI), the lengths, and the frequency of enamel cracks were compared among the groups. Additionally, an increase in intra-pulpal temperature was measured. RESULTS: In all groups, there were no instances of enamel fractures. Laser debonding resulted in a significant reduction in both the frequency and length of newly formed enamel cracks compared to the conventional debonding method. The laser debonding group exhibited increases in intra-pulpal temperature of 2.37°C and 3.60°C in the second and third groups, respectively. These temperature increases were significantly lower than the threshold of 5.5°C. There were no significant differences observed in the ARI scores among the groups. CONCLUSION: With all debonding methods, an increase in the length and frequency of enamel cracks should be anticipated. However, laser-assisted debonding of metal brackets offers the advantage of reducing the risk of enamel damage while avoiding thermal damage to the pulp.

Treatment Effectiveness of Clear Aligners in Correcting Complicated and Severe Malocclusion Cases Compared to Fixed Orthodontic Appliances: A Systematic Review.

This systematic review aimed to critically assess the available evidence regarding the effectiveness and efficiency of clear aligners in the comprehensive treatment of complex cases accompanied by premolars extraction. An electronic literature search by two reviewers was independently done on 27 February 2023 in the following databases without time and language limitations: Pubmed®, Scoups®, Google Scholar, Cochrane Library database, Web of Science™, and Proquest Database Open. Randomized controlled trials (RCTs) of any type, non-randomized clinical trials (CCT), cohort studies, and prospective, retrospective, and cross-sectional studies were reviewed. The risk of bias in included studies was assessed using the Risk of Bias (RoB 2.0) tool for randomized trials and the Risk of Bias in Non-randomized Studies (ROBINS-I) tool for non-randomized studies. After carefully searching the literature, six trials were included in this systematic review, three RCTs, two retrospective cohort studies, and one CCT. Two hundred eighty-three patients were included (186 females, 97 males). Three studies found that there were no differences between the clear aligners and fixed appliances when evaluations were done using the American Board of Orthodontists Objective Grading System (ABO-OGS) or the Peer Assessment Rating (PAR) index. Two studies found that there were some differences between predicted and achieved tooth movements when clear aligners were used in premolars extraction cases. Based on the included studies, the duration of treatment was shorter with fixed appliances than the clear aligners when applied to orthodontic extraction cases. Both clear aligners and fixed appliances were found effective in the orthodontic treatment of premolar extraction-based cases. Fixed appliances have the advantage of achieving better buccolingual inclination and occlusal contacts in a shorter treatment duration. Treatment with clear aligners might be associated with differences between predicted and achieved tooth movements. Therefore, the characteristics of these techniques should be considered when making a treatment decision.

Evaluation of the Patient-Reported Outcome Measures (PROMs) With Temporary Skeletal Anchorage Devices in Fixed Orthodontic Treatment: A Systematic Review.

Analysis of patient-reported outcome measures (PROMs) is essential to ensure that the skeletal and traditional anchoring methods are appropriately and effectively utilized in the context of patient acceptance and satisfaction. This review's objective was to assess the available data on the levels of discomfort, soft-tissue irritation, functional impairment, and other patient-reported outcomes related to the usage of mini-implants in the context of fixed orthodontic treatment for adult patients. A total of seven electronic bibliographic databases were searched between January 1995 and February 2022. Moreover, a manual search was done in the selected orthodontic journals. This systematic review (SR) covered cohort studies, retrospective studies, randomized clinical trials (RCTs), and controlled clinical trials (CCTs) that studied the use of mini-implants, mini-plates, or onplants as anchorage devices on patients receiving orthodontic treatment. The risk of bias was assessed using Cochrane's risk of bias tool (RoB2 tool). Three RCTs and two cohorts were included in this SR with a total of 468 patients. Three of the four included studies were at high risk of bias. The pain level was in the "mild-to-moderate" category on the first day following the insertion of mini-implants, then decreased to a mild level from the fifth day to the seventh day of insertion (mean values are 36.61, 16.36, and 11.33, respectively). The levels of functional impairments were found to be located between the "mild-to-moderate" and "moderate" categories after the placement of mini-plates and intermaxillary fixation screws, while they experienced a mild level with mini-implants. The greatest pain levels were found after the insertion of the temporary anchorage devices (TADs) and then decreased until they became mild or disappeared completely after one month. Speaking, chewing, and cleaning difficulties were more problematic when using TADs compared to conventional anchorage. To obtain good evidence in this area, more high-quality RCTs are needed.

Investigating the Effectiveness of Low-Level Laser in Reducing Root Resorption of the Upper Incisors During Intrusion Movement Using Mini-Implants in Adult Patients With Deep Overbite: A Randomized Controlled Clinical Trial.

BACKGROUND: Deep bite is a common characteristic of malocclusion, and many methods are used to treat it, including mini-implants used for the intrusion of the upper incisors. Orthodontically induced inflammatory root resorption (OIIRR) is an inevitable and unexpected side effect of orthodontic therapy. However, resorption of the root could be affected by the type of tooth movement, such as intrusion. Several studies have indicated the effectiveness of low-level laser therapy (LLLT) in accelerating orthodontic movement, but studies that have evaluated the role of this laser in reducing the risk of OIIRR have been limited. This trial aimed to investigate the effectiveness of LLLT in reducing the resorption of the roots of the upper incisors during their intrusion in the context of deep bite correction. MATERIALS AND METHODS: Thirty patients (13 males, 17 females; mean age 22.4±3.37 years) with deep overbite were recruited and allocated to the laser or the control groups. Mini-implants were inserted between the roots of the upper central incisors and the lateral incisors from the labial aspect at the gingival-mucosal junction on both sides with a force of 40 g on each side through an NiTi coil spring. A low-level laser (Ga-Al-As) with 808 nm wavelength in a continuous mode, with the parameters 250 milliwatt power output, 4 Joules/point energy density, and 16 seconds irradiation per point, was applied to the root of each of the upper incisors. The laser was applied on the first day of the upper incisor intrusion (T1), then on days 3, 7, and 14 of the first month. In the second month, the laser was applied every 15 days, adjusting the spring strength every four weeks until the end of the intrusion stage (T2), which was determined by reaching a normal overbite. As for patients in the control group, the strength of the nickel-titanium springs was adjusted every four weeks to the required strength of 40 g on each end until reaching a normal overbite. RESULTS: There was a volumetric decrease in both groups' upper central and lateral incisors roots, and this decrease was statistically significant (P<0.001). However, the difference between the two groups was not statistically significant in each central and lateral incisor volume root (P=0.345 and 0.263 for U1 and U2, respectively). Also, both groups had a linear decrease in upper central and lateral incisors roots, which was statistically significant (P<0.001). At the same time, the difference between the two groups was not statistically significant in each central and lateral incisor root length (P=0.343 and 0.461 for U1 and U2, respectively). CONCLUSION: The low-level laser irradiation using the current protocol did not significantly affect the amount of root resorption induced by incisor intrusion in the experimental group compared to the control group.

The Efficacy of Accelerating Orthodontic Tooth Movement by Combining Self-Ligating Brackets With One or More Acceleration Methods: A Systematic Review.

This review aimed to evaluate the effectiveness of using one or more acceleration methods with self-ligating brackets to accelerate orthodontic tooth movement in adults and the associated effects of these interventions. An electronic search of the following databases (PubMed, Scopus, Google Scholar, EMBASE) was performed (From January 1990 to November 2021). ClinicalTrials.gov and the International Clinical Trials Registry Platform were also electronically searched to find any unpublished studies and ongoing trials. The selected randomized controlled trials (RCTs) involved adult patients treated using self-ligating brackets combined with one or more acceleration methods compared with self-ligating brackets or conditional brackets alone. The risk of bias was assessed using Cochrane's risk of bias tool. A total of seven RCTs and one controlled clinical trial (CCT) were included in this review. Combining self-ligating brackets with flapless corticotomy, low-level laser therapy (LLLT), and infrared light accelerated orthodontic movement by 43% and 50% for surgical methods, 20-50% for LLLT, and 22% for infrared light. Regarding side effects on periodontal tissues, neither flapless corticotomy nor low-frequency vibrational forces caused any damage. Combining self-ligating brackets and flapless corticotomy, low-level laser, or infrared light effectively accelerated orthodontic movement by 20% to 50 %. In contrast, the combination of self-ligating brackets with vibrational forces did not affect speeding tooth movement. The acceleration methods did not have any side effects on the periodontal tissues, but the available evidence was insufficient. There is a need for further primary research regarding the effectiveness of combining self-ligating brackets with acceleration methods and the possible untoward side effects.

Low-level laser therapy effectiveness in reducing initial orthodontic archwire placement pain in premolars extraction cases: a single-blind, placebo-controlled, randomized clinical trial.

BACKGROUND: The objective of this randomized clinical trial was to evaluate Low-Level Laser Therapy (LLLT) effectiveness in spontaneous and chewing pain reduction following initial orthodontic archwire placement. METHODS: 26 patients (mean age 20.07 ± 3.13 years) with maxillary Little's Irregularity Index (LII) of 7 mm or more that indicates first maxillary premolars extraction and no medications intake were eligible for this trial. Patients were randomly assigned with 1:1 ratio using simple randomization technique to receive either LLL or placebo treatment. Blinding was applicable for patients only. In the laser group, patients received a single LLL dose (wavelength 830 nm, energy 2 J/point) in four points (2 buccal, 2 palatal) for each maxillary anterior tooth root. Patients in the placebo group had the same laser application procedure without emitting the laser beam. Patients were asked to score spontaneous and chewing pain intensity by filling out a questionnaire with a 100-mm Visual Analogue Scale (VAS) after 1, 6, 24, 48, and 72 h of treatment application. Independent t-test was used to compare the mean pain scores between the laser and placebo groups for both spontaneous and chewing pain at each studied time point. RESULTS: No dropout occurred so the results of the 26 patients were statistically analyzed. Despite some clinical differences observed between the two groups, no statistical significance was found for each studied time point (p > 0.05) for both spontaneous and chewing pain except after 72 h for chewing pain with a VAS score of (18.84 ± 13.44) mm for the laser group compared to (38.15 ± 27.06) mm for the placebo group. CONCLUSIONS: LLLT, with the suggested parameters, is not effective in pain reduction following initial orthodontic archwire placement. TRIAL REGISTRATION: Name of the registry: Clinicaltrials.gov Trial registration number: NCT02568436. Date of registration: 26 September 2015 'Retrospectively registered'.

Efficacy of injectable platelet-rich plasma in reducing alveolar bone resorption following rapid maxillary expansion: A cone-beam computed tomography assessment in a randomized split-mouth controlled trial.

OBJECTIVES: To evaluate the effectiveness of platelet-rich plasma (PRP) with its growth factors in minimizing the side effects of rapid maxillary expansion (RME) on the periodontal tissue of anchoring teeth using cone-beam computed tomography (CBCT). MATERIALS AND METHODS: A randomized, split-mouth clinical trial was conducted on 18 patients aged 12-16 years (14 ± 1.65) with a skeletal maxillary constriction who underwent RME using a Hyrax appliance. The sample was randomly divided into two groups: intervention and control sides. PRP was prepared and injected on the buccal aspect of supporting teeth in the intervention group. High-resolution CBCT imaging (H-CBCT) was carried out preoperatively (T0) and after 3 months of retention (T1) to study the buccal bone plate thickness (BBPT) and buccal bone crest level (BBCL) of anchoring teeth. Changes induced by expansion were evaluated using paired sample t-test (P < .05). RESULTS: Results showed that there was no significant difference in BBPT and BBCL between the two groups after RME (P > .05). The prevalence of dehiscence and fenestrations was increased at (T1) in both groups and the percentage was higher in the PRP group. CONCLUSIONS: RME induced vertical and horizontal bone loss. PRP did not minimize alveolar defects after RME.

An Evaluation of Mandibular Dental and Basal Arch Dimensions in Class I and Class II Division 1 Adult Syrian Patients using Cone-beam Computed Tomography.

Aim: The aim of this study is (1) to inspect any difference in mandibular arch widths between males and females in class I and class II division 1 (class malocclusions using cone-beam computed tomography (CBCT), (2) to compare the mandibular dental and basal widths between the two groups, and (3) to investigate any possible correlation between dental and basal arch widths in both groups. Materials and methods: The CBCT images of 68 patients aged between 18 and 25 years consisted of 34 class I (17 males and 17 females) and 34 class (17 males and 17 females) who were recruited at the Department of Orthodontics, University of Damascus Dental School (Syria). Using on-demand three-dimensional (3D) on axial views, facial axis points for dental measurements and basal bone center (BBC) points for basal measurements were identified on lower canines and first molars. Dental and basal intercanine width (ICW) and intermolar width (IMW) were measured. Results: Independent t-test showed a statistically significant difference between males and females in several variables in both groups and a statistically significant difference between class I and class groups in the basal ICW for both genders and in the dental ICW for females only (p < 0.05). In class I group, Pearson's correlation coefficients between dental and basal measurements showed a strong correlation in the IMW for both genders (r > 0.73; p < 0.01) and a moderate correlation in females' ICW (r = 0.67; p < 0.01). In the class group, a moderate correlation in females' IMW (r = 0.67; p < 0.01) was found. Conclusion: Females compared with males had narrower dimensions. Class I patients had larger ICW than class II-1 patients in all measurements and had narrower IMW than class in most measurements for both genders. There were moderate-to-strong correlations between dental and basal dimensions. BBC points might be landmarks that accurately represent the basal bone arch. Clinical significance: CBCT-based assessments of dental and basal arch dimensions provide a great opportunity to accurately evaluate these aspects, to enhance clinicians' decisions regarding proper tooth movements, and to achieve good dentoalveolar intra-arch harmony. Keywords: Basal arch, Class I, Class Cone-beam computed tomography, Dental arch, Intercanine width, Intermolar width.

Evaluating low-level laser therapy effect on reducing orthodontic pain using two laser energy values: a split-mouth randomized placebo-controlled trial.

Background: No randomized controlled trial before has evaluated the role of low-level laser energy in its analgesic effects in orthodontics. Objective: To evaluate the effect of single application of low-level laser with 4-Joule or 16-Joule energy on pain reduction following elastomeric separators placement. Trial design: A two-arm parallel-group single-blind placebo-controlled randomized controlled trial, with implementation of split-mouth technique in each group. Materials and methods: Twenty-six patients in need of orthodontic treatment with a fixed orthodontic appliance were enrolled and randomly allocated to either the 4-Joule or the 16-Joule laser energy group. Elastomeric separators were applied for the mandibular first molars. For each patient one molar received a single low-level laser dose using an 830-nm Ga-Al-As laser device with either 4-Joule or 16-Joule laser beam energy, while the other molar received a placebo treatment by applying the laser device in the same method and parameters as the counterpart molar without emitting the laser beam. The molar to be irradiated was also randomly chosen using simple randomization technique. Allocation was concealed and patients were blinded to which side would receive the laser irradiation. Main outcome measure was the degree of pain scored during mastication for each mandibular first molar after 1, 6, 12, 24, 48, and 72 hours of both laser and placebo treatments application. A questionnaire with an 100-mm Visual Analogue Scale (VAS) was used for pain assessment. Results: Thirty-six patients were evaluated for eligibility, 10 of them were excluded making the final randomized number 26 patients. One patient dropped out later for not completing the questionnaire. Accordingly, the results of 25 patients were statistically analysed. No statistical significance was found for both low-level laser energy values in comparison to the corresponding placebo treatments. No harms were encountered. Limitations: Intervention provider was not blinded to the intervention. Conclusion: Low-level laser therapy, applied at two different laser energy values, is ineffective in relieving elastomeric separators induced orthodontic pain. Trial registration: This trial was not registered. Funding: No funding to be declared.

Low-level laser therapy effectiveness in accelerating orthodontic tooth movement: A randomized controlled clinical trial.

OBJECTIVE: To evaluate the effectiveness of low-level laser therapy (LLLT) in accelerating orthodontic tooth movement of crowded maxillary incisors. MATERIALS AND METHODS: This two-arm, parallel-group, randomized controlled trial involved 26 patients with severe to extreme maxillary incisors irregularity according to Little's irregularity index, indicating two first premolars extraction. Patients were randomly assigned to either the laser group or the control group (13 each). Following premolars extraction, orthodontic treatment with fixed appliances was initiated for both groups. Immediately after insertion of the first archwire, patients in the laser group received a LLL dose from an 830-nm wavelength Ga-Al-As semiconductor laser device with energy of 2 J/point. The laser was applied to each maxillary incisor's root at four points (two buccal, two palatal). Application was repeated on days 3, 7, 14, and then every 15 days starting from the second month until the end of the leveling and alignment stage. Alignment progress was evaluated on the study casts taken before inserting the first archwire (T0), after 1 month of treatment commencement (T1), after 2 months (T2), and at the end of the leveling and alignment stage (T3). The outcome measures were the overall time needed for leveling and alignment and the leveling and alignment improvement percentage. RESULTS: A statistically significant difference was found between the two groups in the overall treatment time (P < .001) and the leveling and alignment improvement percentage at T1 (P = .004) and T2; (P = .001). CONCLUSION: LLLT is an effective method for accelerating orthodontic tooth movement.