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 Table of Contents  
ORIGINAL RESEARCH
Year : 2021  |  Volume : 12  |  Issue : 4  |  Page : 179-184

The Effect of 660-nm Low Level Laser Therapy on Mandibular Lateral Movement After Orthognathic Surgery: A Randomized Phase 1 Trial


Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran

Date of Submission15-Mar-2021
Date of Decision30-Mar-2021
Date of Acceptance11-Apr-2021
Date of Web Publication21-Dec-2021

Correspondence Address:
Hasan Momeni
Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/denthyp.denthyp_39_21

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  Abstract 


Introduction: Limited jaw motion is a common complication after orthognathic surgeries that can negatively affect the patients’ quality of life, thus it is required to be properly treated. Regarding the growing interests in laser application in density, we aimed to evaluate the effects of 660nm LLLT on mandibular lateral movements after orthognathic surgery. Materials and Methods: Twelve candidates of bimaxillary orthognathic surgery were included in a split-mouth, triple-blind phase 1 trial. On 1, 4, and 7 days after the surgery, a 660-nm diode low-level laser was applied to one facial side of patients, whereas the other side was kept untreated as placebo. Then, rightward and leftward mandibular movements from the maxillary midline were measured in millimeters (mm) on 2, 7, and 14 after the surgery. The measurements were then compared between the study groups using ANCOVA analysis. Results: Despite the constant improvement in mandibular lateral movements in both study groups, the rightward mandibular movements in LLLT group were significantly better than in placebo group on second (3.9 versus 3.2 mm, P = 0.015), seventh (5.6 versus 4.2 mm, P = 0.018), and 14th (7.1 versus 5.2 mm, P = 0.005) days after the surgery. Also, the leftward mandibular movements in LLLT group were significantly better than in placebo group on second (3.7 versus 2.1 mm, P = 0.021), seventh (4.9 versus 2.9 mm, P = 0.019), and 14th (6.7 versus 4.2 mm, P = 0.002) days after the surgery. Conclusion: LLLT can effectively improve both rightward and leftward movements of mandibular after an orthognathic surgery.

Keywords: Orthognathic surgery, low level laser therapy, mandibular lateral movement, jaw lateral movement


How to cite this article:
Noshirvani F, Momeni H, Sadighi A. The Effect of 660-nm Low Level Laser Therapy on Mandibular Lateral Movement After Orthognathic Surgery: A Randomized Phase 1 Trial. Dent Hypotheses 2021;12:179-84

How to cite this URL:
Noshirvani F, Momeni H, Sadighi A. The Effect of 660-nm Low Level Laser Therapy on Mandibular Lateral Movement After Orthognathic Surgery: A Randomized Phase 1 Trial. Dent Hypotheses [serial online] 2021 [cited 2022 Jan 22];12:179-84. Available from: http://www.dentalhypotheses.com/text.asp?2021/12/4/179/333017




  Introduction Top


Orthognathic surgery is widely used to treat or correct the jaws function[1]; However, the limited mandibular lateral movement is reported as a frequent postoperative complication of orthognathic surgeries,[2],[3],[4] which can disturb the masticatory muscles function and negatively affect the patients’ lives by nutritional disorders, oral health problems, speech disorders, etc.[4],[5],[6] For treating this issue, different therapies such as heat therapy, drug therapy, and low-level laser therapy (LLLT) has been offered.[2],[3],[7] LLLT is a non-invasive, rapid, safe, non-pharmacological technique in dentistry with a broad therapeutic effects.[8],[9],[10],[11],[12],[13],[14] Although it has been indicated that LLLT after orthognathic surgery speeds the wound healing and decreases the pain, inflammation, and swelling,[15],[16] yet its effectiveness on postoperative limited jaw lateral movements has not been well investigated. Thus, we aimed to explore the effect of 660-nm LLLT on mandibular lateral movements after orthognathic surgery.


  Materials and Methods Top


Study design and patients

The current study was designed as a split-mouth randomized phase 1 trial study. Twelve patients with dentofacial deformities, who were candidates of bimaxillary orthognathic surgery, were randomly required from the dentistry clinic of Isfahan Islamic Azad University during June to September 2020. The sample size was determined using Pocock formula for crossover trials[17] based on 95% confidence interval, 80% study power, and 10% dropout rate for the study. Plus, the random selection of patients prevented the study from sample selection bias.

As inclusion criteria, the patients had to be in an age range of 18 to 49 years old with a jaw discrepancy range of <10 mm who did not need any genioplasty and also did not take any wound healing medications within at least 6 months prior to the surgery or 14 days after the surgery. The exclusion criteria were set as having dental or jaws asymmetries; oral or systemic diseases; facial trauma; any medical histories of oral cavity or oropharyngeal malignancies, thyroid tumors, seizures, or allergies to laser therapy; any bad fractures during the surgery; and postoperative infection. In addition, the pregnant or smoker patients were not eligible to participate in the study.

Before the patients’ inclusion, the study information was provided for each of them and an informed consent form was acquired. The research ethics board of Isfahan Islamic Azad University ethically approved the study, and the Iranian Registry of Clinical Trials approved the study protocol (http://www.irct.ir/ No. IRCT20180312039060N4).

Randomization and blinding

Regarding the split-mouth design of the study, one facial side of the patients was treated with post-operative LLLT and the other facial side was considered as placebo (control group) and did not receive any therapy. True Random Generator software was occupied for random allocation of patients’ facial sides into LLLT and placebo groups.

In this triple-blind trial, the groups allocation was managed by a nonclinical investigator, the patients were blinded to their facial side of laser application, a group-blinded investigator measured the study outcomes, and a group-blinded analysis ran the data analysis.

Study procedure

After settling down with study patients, an oral and maxillofacial surgeon administrated all of the orthognathic surgeries through bilateral sagittal split osteotomy and Le Fort I osteotomy at Kashani teaching hospital. All jaws were fixed with four 2 mm L-shaped plates and screws (7 mm, 13 mm). Then, 3-0 VICRYL was used for wounds suturing. Any postoperative medications (e.g., antibiotics and analgesics) were dosed based on patients’ weight for adjusted their effects on study subjects.

On three sessions of 1, 4, and 7 days after the surgery, a 660-nm diode low-level laser device (Hamerz, Iran) was operated by an oral and maxillofacial specialist and LLLT was applied to patients while they were sat in upright position and put a IPL laser safety glasses. The applied laser protocol included red light, 660 nm wave length, 5 J/cm2 energy density, 100 s/point exposure time, and 50 mw laser power. Although the laser device was moved forward and backward 1 cm apart the incision lines on both facial sides of patients, it was set online only for LLLT group. After each LLLT session, the patients were tracked for any side effects.

The postoperative levels of mandibular lateral movements were assessed as study outcomes. Thus, the mean distances of mandibular movements to left and right from the maxillary midline were measured in millimeters (mm) by a soft ruler. The baseline measurements for mandibular lateral movements were gathered 1 day after the surgery and before the first session of LLLT. The measurements were then repeated on 2, 7, and 14 days after the surgery.

Statistical analysis

The distribution of data was assessed by one-sample Kolmogorov–Smirnov test and normally distributed data were reported as mean (SD: standard deviation). Baseline measurements were compared between groups using independent Student t test. Outcomes were compared between groups by ANCOVA analysis adjusted for baseline measurements. P values < 0.05 were considered as statistically significant. Stata version 15.1 software was used for data analysis.


  Results Top


Patients

An overall of six females and six males with a mean age of 29.5 ± 7.9 years old took part in the study. Bimaxillary orthognathic surgeries lasted 125.1 ± 8.4 minutes on average with no critical complications during or after the surgery. No patients’ exclusion happened during the three post-operative sessions of LLLT [Figure 1]. No adverse effects of LLLT were observed in study patients.
Figure 1 Trial profile based on CONSORT flow diagram

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Beacuse the study was designed as a split-mouth trial, the two study groups were greatly matched regarding the baseline characteristics. Examining the baseline measurements of mandibular lateral movements to right [TABLE 1] and left [TABLE 2] also did not show any significant differences between LLLT and placebo groups.
TABLE 1 Postoperative mandibular lateral movement to right (n = 12)

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TABLE 2 Postoperative mandibular lateral movement to left (n = 12)

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Mandibular lateral movement to right

The average measures of mandibular lateral movements to right in placebo and LLLT groups are provided in [TABLE 1]. Although both groups kept a constant improvement in rightward mandibular movements over the time [Figure 2], the level of rightward movements in LLLT group were significantly better than in placebo group during the second (P < 0.05), seventh (P < 0.05), and 14th (P < 0.05) days after the surgery [TABLE 1]. Two weeks after the surgery, the average rightward movement of the jaws in LLLT treated facial sides was 7.1 mm, whereas it was limited to 5.2 mm in placebo group [TABLE 1].
Figure 2 Rightward mandibular movement in study groups

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Mandibular lateral movement to left

The average measures of mandibular lateral movements to left for placebo and LLLT groups are provided in [TABLE 2]. Although both groups kept a constant improvement in leftward mandibular movements over the time [Figure 3], the level of leftward movements in LLLT group were significantly better than in placebo group during the second (P < 0.05), seventh (P < 0.05), and 14th (P < 0.05) days after the surgery [TABLE 2]. Two week after the surgery, the average leftward movement of the jaws in LLLT treated facial sides was 6.7 mm, whereas it was limited to 4.2 mm in placebo group [TABLE 1].
Figure 3 Leftward mandibular movement in study groups

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  Discussion Top


LLLT is now a user-friendly therapeutic approach with an easy application and a light-weighted apparatus.[18],[19] Moreover, LLLT is favored for its trivial side effects as it keeps the tissue temperature within the normal range of 37°C and prevents thermal injuries, genetic mutation, or metabolic alterations.[20],[21] However, in spite of being used in different fields of dentistry as an axillary treatment,[13],[22],[23],[24] the controversies on application of this relatively new and demanding approach on different postoperative complications of orthognathic surgeries lead the current to explore the effectiveness of 660nm LLLT on mandibular lateral movements after orthognathic surgeries. Our investigation yielded effectiveness of LLLT on lateral movements of mandibular after orthognathic surgeries.

Since the limited jaw movements can reduce the patients’ quality of life,[22] some studies drew attentions to laser therapy as a noninvasive therapy for this issue. Sun[13] demonstrated that the application of infrared laser for patients with trismus can significantly enhance their mandibular mobility. Mazzetto et al.[25] investigated the impact of LLLT (Ga-Al-As laser 830nm) on mandibular movements in cases with temporomandibular disorders and indicated the effectiveness of LLLT on improving the mandibular lateral movements in these patients. de Rezende et al.[26] studied the efficacy of LLLT (Ga-Al-As laser 780 nm) on treating trismus (mouth opening) after bimaxillary orthognathic surgery and showed an improvement in mouth opening. Borsa et al.[27] and Leal-Junior et al.[28] separately reviewed the LLLT literature and introduced the adequate application of LLLT as an efficient mean for improving muscle performance and recovery. Parallel to previous studies, our study showed that 660-nm LLLT can significantly improve the ranges of rightward and leftward mandibular movements after orthognathic surgeries.

We observed that LLLT group kept a constant enhancement in mandibular movements over the time and reached the maximum points (7.1 mm rightward and 6.7 leftward) 2 weeks after the surgery by only three sessions of laser application. Furthermore, our findings suggested the immediate effect of laser therapy because even the first session of LLLT (2 days after the surgery) could make a significant difference between LLLT and placebo groups in both rightward and leftward movements of mandibular. The effectiveness of LLLT in our study was probably due to the anti-inflammatory, anti-swelling, healing, and analgesic effects of LLLTs that together could reduce the muscle tension in surgery place and improve the jaw movements.[22],[29],[30]

During the LLLT, a low-intensity laser penetrates in applied tissue and delivers a distributed energy. This delivered energy affects the enzymatic activities and initiates some photochemical reactions to reach out therapeutic purposes.[8],[18],[19] The usefulness of LLLT in treating postoperative muscular tension can be attributed to two biologic processes. First, the LLLT controls the induced postoperative pain from limiting the movements of joints and muscles through decreasing the analgesic substances and raising the beta endorphin level and pain discharge threshold in surgery place. Second, the LLLT promotes the muscle relaxation after the invasive surgery and make it easier for joints and muscles to move through decreasing the swelling substances, bradykinin level, histamine release and inflammation duration, as well as increasing the lymphatic flow and blood supply in surgery place.[22],[25],[29],[30],[31] Several studies have confirmed the effectiveness of LLLT on pain management,[15],[16],[25],[30],[32] and inflammation and swelling reduction.[15],[16],[33]On the other hand, mitochondria are of the primary cell organelles affected by laser light. The effected mitochondria provoke the electrons transfer by cytochrome oxidase and increases the ATP production that enhances the cell metabolism and proliferation and accelerates the wound healing process.[8],[34],[35] Sadighi et al.[15] indicated a faster postorthognathic surgery recovery of wounds following the LLLT on surgery place. Thereby, an accelerated recovery of injured muscles after orthognathic surgery might help the elimination of barriers against the movement of muscles and joints.[22],[36]

Although our study could follow up the patients for 2 weeks after the surgery while they were still in postoperative recovery period, yet our study was limited to a relatively small sample size. Therefore, we call for further investigations on effects of post-operative LLLT on mandibular lateral movements after orthognathic surgery using a greater number of patients and different devices for LLLT.


  Conclusion Top


The current study measured the effects of 660nm LLLT on rightward and leftward movements of mandibular after orthognathic surgery. The results indicated that LLLT can significantly improve lateral movements of mandibular through three sessions of LLLT. These findings could be applied by clinical policy makers as well as oral and maxillofacial specialists for developing post- orthognathic surgery guidelines and prescriptions to accelerate the patients’ recovery and enhance their satisfaction.

Acknowledgement

We greatly thank the Isfahan (Khorasgan) branch of Islamic Azad University for founding the study, and the patients for taking part in the study and completing the all LLLT sessions. We also sincerely appreciate Raana Zakeri’s efforts toward data analysis and manuscript improvement.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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  [Figure 1], [Figure 2], [Figure 3]
 
 
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