Orthotown August 2017 - 39

Fig. 4

Fig. 5

shield was placed over the delivery area of the bleaching wand or a
clear cellophane was wrapped between patients.
In 2007, the initial treatment intervals were the historically
standard (or classical) orthodontic reactivation appointments. This
was once a month, with the standard activation (using only very
light forces) of the orthodontic wires incorporating elastic ties,
chains and rubber bands. Other monthly appointments would entail
appropriate adjustments of any removable appliances. The laser
was applied at the end of the appointment, so teeth were generally
exposed to the new stresses applied for a period of 15-30 minutes
beforehand. Usual orthodontic precautions and instructions were
covered with the patient at each appointment.
After approximately two years of using this protocol, photographs,
study models and radiographs were studied, and a decision was
made to change the time interval for the reactivation appointments.
This new interval was every two weeks with standard orthodontic
reactivation appointment work, which was performed as usual. The
laser was then applied again at each appointment, and progress notes,
photographs and occasionally radiographs were produced. As these
records were studied and new background scientific knowledge on
laser interaction was learned, new protocols were contemplated for
future changes.
After following cases post-treatment, radiographs were studied
and no detrimental effects were noted. This follow-up occurred for
two to three years, and another protocol change was designed and
implemented. The interval for reactivation appointment was changed
to once every week. Any of the standard orthodontic bracketing
changes or changes to wires, ties or chains were performed each visit.
Alternately, removable appliances and appropriate adjustments also
were made at those weekly appointments. The laser was then applied
at that time and was performed as previously described. The rapid
changes seen prompted treatment photographs and radiographs to
be taken to follow cases for progress and safety (root resorption,
root shorting and bone changes).
The weekly orthodontic appointment interval also was evaluated
for two to three years. With no detrimental effects seen, a fi nal
change was implemented in the protocol. This included once-a-week
orthodontic standard reactivation appointment changes, with the
application of the laser again at the end of the appointment, as well

Fig. 6

as a midweek laser application over teeth that needed the greatest
amount of movement. This allowed a twice-a-week exposure to
the laser energy in the most active movement areas.
With research showing total dose having an effect on tooth
movement, the more energy applied within specific parameters, the
more movement could be seen. This was applied in this protocol
change, doubling up on weekly exposures of energy. These laser
application appointments were generally 5 minutes long and were
also targeted at orthodontic pain control as well as accelerated
tooth movement.

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Table of Contents for the Digital Edition of Orthotown August 2017
