COMPARISON OF RATE OF TOOTH MOVEMENT DURING INDIVIDUAL CANINE RETRACTION USING FLAPLESS MICRO-OSTEOPERFORATION AND PIEZOCISION ASSISTED BY LOW LEVEL LASER THERAPY - A RANDOMISED CLINICAL TRIAL

An increasing number of patients are demanding orthodontic treatment for improved aesthetics as it affects their professional and social life. But one of the main challenges of orthodontic treatment faced by the patients and the orthodontists is the prolonged treatment duration. Long duration of fixed orthodontic treatment, which usually lasts for 2-3 years, is accompanied by side effects such as root resorption, gingival inflammation and dental caries.1For rapid canine retraction ,various researchers proposed different surgical techniques such as dentoalveolar distraction-based on principles of distraction osteogenesis, selective alveolar decortication etc.3 But all these surgical procedures lead to increase risk of  tissue necrosis. Later to identify minimally invasive surgical procedures for inducing RAP researchers have introduced micro-osteoperforation, to Control the micro-trauma micro-osteoperforations (MOP) will amplify the expression of inflammatory markers that are normally expressed during orthodontic treatment and that this amplified response will accelerate both bone resorption and tooth movement.5 Recently kim et al and Dibart et al introduced a minimally invasive technique , piezocision as an alternative to the highly invasive surgical techniques which involves the use of scalpel into the gingiva  without raising the flap and further placement of incisions using an ultrasonic tool.1Low-level visible red or infrared light energy is absorbed by mitochondria, which stimulates cells to generate more energy in the form of ATP and help undergo self-repair through cell proliferation, release of growth factors and collagen synthesis. This phenomenon is also known as Photobiomodulation (PBM) therapy.With regards to orthodontic tooth movement, the effects of the LLLT on osteoblasts, osteoclasts and fibroblasts are of more interest. LLLT shows a biostimulatory effect on osteoblasts with an increase in their differentiation, DNA replication and bone matrix production. Also, LLLT facilitated that LLLT facilitated differentiation and activation of osteoclasts via RANK expression and stimulation of expression of Macrophage colony-stimulating factor (M-CSF) and its receptor system.