Evaluation of the Levels of Pain and Discomfort and Periodontal Status Between Two Acceleration Methods of Upper Anterior Teeth Retraction

57 patients will be treated by extraction of maxillary first premolars by applying mini-screws between the maxillary second premolar and first molar as temporary skeletal anchorage devices (TSADs). They will be divided randomly into three groups in this trial. The prolonged duration of the treatment period can cause many side effects such as white spots, caries, periodontal diseases, and pain and discomfort. So many efforts have been made to reduce the treatment time. Many procedures have been introduced to accelerate orthodontic tooth movement, which can category as surgical or non-surgical. Piezocision is a minimally invasive surgical method for accelerating orthodontic tooth movement and shortening treatment time. Low-level laser therapy (LLLT) is one of the physical acceleration methods that have contributed to decreasing treatment time.

Inclusion Criteria:Adult healthy patients, Male and female, Age range: 17-28 years.Class II Division 1 malocclusion :Mild/moderate skeletal Class II (sagittal discrepancy angle ≤7)Overjet ≤10Normal or excessive facial height (Clinically and then cephalometrically assessed using these three angles: mandibular/cranial base angle, maxillary/mandibular plane angle, and facial axis angle)Mild to moderate crowding ≤ 4Permanent occlusion.Existence of all the upper teeth (except third molars).Good oral and periodontal health:Probing depth < 4 mmNo radiographic evidence of bone loss.Gingival index ≤ 1Plaque index ≤ 1Exclusion Criteria:Medical problems that affect tooth movement (corticosteroid, nonsteroidal anti-inflammatory drugs (NSAIDs), …)Presence of primary teeth in the maxillary archMissing permanent maxillary teeth (except third molars).Poor oral hygiene or Current periodontal disease:Probing depth ≥ 4 mmradiographic evidence of bone lossGingival index > 1Plaque index > 1The patient had previous orthodontic treatment