Efficacy of Photobiomodulation Therapy Versus Soft Acrylic Wafer for Reduction of Pain Associated with Orthodontic Metal Bracket Removal: A Clinical Trial

Objective: This study compared the efficacy of photobiomodulation therapy versus soft acrylic wafer for reduction of pain associated with orthodontic metal bracket removal. Background: It has been demonstrated that different methods of bracket removal are associated with different levels of pain. Photobiomodulation decreases the level of pain due to its biological effects. Methods: This split-mouth randomized clinical trial evaluated 28 orthodontic patients. The four quadrants in each patient were randomly assigned to four groups of diode laser (940 nm, 31.7 J/cm2 energy density, 1.7 cm2 spot size, 300 mW power, continuous-wave, contact mode) irradiated to the buccal and palatal surfaces of each tooth, soft acrylic wafer, laser in off mode (placebo), and no intervention (control). The severity of pain experienced by patients was assessed immediately after bracket removal from each tooth using a visual analog scale. Data were analyzed using the generalized estimating equation (α = 0.05). Results: The mean pain score in the soft acrylic wafer (p = 0.017), control (p < 0.001), and placebo (p < 0.001) groups was significantly higher compared with the laser group. Gender (p = 0.209), age (p = 0.095), and laterality (right/left quadrant; p = 0.383) had no significant effect on the pain score. The pain score in the mandible was significantly lower compared with the maxilla (p = 0.027). The first and second premolars had significantly lower pain scores (p < 0.05). Conclusions: Within the limitations of this study, photobiomodulation therapy and soft acrylic wafer can both decrease the pain associated with metal bracket removal, but laser is more effective.