Low-level-laser-therapy as an adjuvant therapy for bone regeneration during rapid maxillary expansion and its benefits for the patient : a systematic review
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Abstract
Background: Over the past years, Low-Level-Laser-Therapy (LLLT) has become a topic of research as an adjuvant therapy to Rapid Maxillary Expansion (RME). The objective of this systematic review is to investigate the benefits of LLLT on bone regeneration of the sutura palatina in patients undergoing RME.
Methods: Systematic literature research was conducted until 08.09.2023. The databases National Library of Medicine (via PubMed®), Cochrane Database (via The Cochrane Library) and Web of Sciences Core Collection (via Web of Sciences) were used. Additionally, a manual search was conducted. The inclusion criteria were LLLT as adjuvant therapy for RME in clinical studies (CS) or animal studies. The language of the included studies was limited to German or English. No further limitations were applied. A Risk of Bias (RoB) assessment was conducted for the CS. In addition, a GRADE (Grades of Recommendation, Assessment, Development and Evaluation) assessment was performed for the question of the benefits of LLLT in RME on the upregulation of bone regeneration of the sutura palatina.
Results: A total of five CS and twelve animal studies were included. The RoB assessment resulted in the classification for three studies with some concerns and two studies with high. All CS were included into the GRADE evaluation, either completely or as a subgroup. The result was a very low quality of evidence. Both the animal studies and the CS, demonstrated heterogeneity in the laser treatment, laser protocol and evaluation methods used. Regardless, the consensus in the animal studies seems to be that LLLT as an adjuvant therapy for RME shows a positive effect on the bone regeneration of the sutura palatina at the molecular, histological and radiological evaluation. The evaluation methods of the CS were conducted using bone density measurement in cone beam computed tomography (CBCT) or occlusal radiographs, or measurement of the distances of the sutura palatina and qualitative assessment of the shape of the sutura margins in CBCT. The results indicated a tendency of the positive effect on bone regeneration of the sutura palatina in the CS. Since the laser parameters and laser protocol varied among the studies, no conclusion could be drawn about its effective application.
Conclusion: Taking the overall low level of evidence into account, the results suggest that LLLT as an adjuvant therapy for RME might upregulate the bone regeneration of the sutura palatina. It has not yet been clarified which laser parameters and laser protocol are most suitable. No potential benefit for the reduction of relapse or treatment duration can be drawn from these results. Further studies dedicated to these issues, as well as more clinical studies investigating the effect of LLLT on the bone regeneration of the sutura palatina, are needed.