Bukhari S.A.A. et al. - Photobiomodulation in Orthodontics: An Umbrella Review on Tooth Movement, Pain, and Root Resorption

For patients undergoing orthodontic treatment, the available evidence on photobiomodulation is of low certainty and is considered insufficient for routine clinical use. This umbrella review analyzes 20 systematic reviews and meta-analyses and concludes that there is a possible but unestablished effect on tooth movement, pain, and root resorption.

What this study measured

The objective was to synthesize data from systematic reviews and meta-analyses on two noninvasive orthodontic adjuncts: photobiomodulation, also known as low-intensity laser therapy, and vitamin D. The criteria examined were the acceleration of orthodontic tooth movement, pain, treatment-induced inflammatory root resorption, and bone biomarkers. The authors searched PubMed, Embase, Scopus, Web of Science, and the Cochrane Library from their inception through November 18, 2025. Twenty systematic reviews and meta-analyses, primarily focusing on randomized trials conducted in humans, were included. Methodological quality was assessed using AMSTAR-2, ROBIS, and GRADE. The protocol is registered in PROSPERO under number CRD42024591253.

Key Findings

The high degree of heterogeneity led the authors to conduct a narrative review. Therefore, no overall effect size or confidence interval is reported in the study abstract.

• 20 systematic reviews and meta-analyses were included, covering a large number of human orthodontic trials.
• Photobiomodulation: Evidence of low certainty supporting accelerated orthodontic tooth movement.
• Photobiomodulation: a slight reduction in orthodontics-induced inflammatory root resorption, though the evidence for this is also limited.
• Photobiomodulation: short-term pain relief, with the same low level of certainty.
• Vitamin D: Inconsistent results depending on the criteria, with no reliable overall clinical benefit.
• The authors' conclusion: There is insufficient evidence to recommend the routine clinical use of either adjuvant.

How photobiomodulation works for this indication

The proposed mechanisms remain hypothetical and have not been tested in this umbrella review. Red and near-infrared light is thought to be absorbed by mitochondrial cytochrome c oxidase, which could increase ATP availability in the cells of the periodontal ligament and alveolar bone. This additional energy would support the bone remodeling that accompanies tooth movement by modulating the activity of osteoblasts and osteoclasts. An effect on oxidative stress and inflammatory mediators is also suggested to explain reduced discomfort following the activation of an orthodontic appliance. These hypotheses do not explain why the level of certainty remains low.

Limits You Should Know

The main finding of this study is negative from a decision-making perspective: the evidence is deemed insufficient to recommend photobiomodulation for routine orthodontic practice. The certainty of the evidence is rated as low according to GRADE, which means that future research could change these conclusions. Heterogeneity among the reviews prevented any quantitative synthesis. Some reviews combined randomized trials and controlled clinical trials. Finally, an umbrella review inherits the weaknesses of the reviews it aggregates, including overlaps in the trials.

What This Means in Practice

As it stands, these data do not justify systematically incorporating photobiomodulation into an orthodontic treatment plan. There is evidence across three criteria—tooth movement, short-term pain, and root resorption—but it is too inconclusive to form the basis of a recommendation. Vitamin D does not provide a reliable benefit in this context. Any decision should be made in consultation with the orthodontist treating the patient.

Frequently Asked Questions

Does photobiomodulation really speed up tooth movement in orthodontics?

This umbrella review of 20 systematic reviews reports evidence of low certainty suggesting an acceleration of orthodontic tooth movement. Low certainty means that the findings may change as new studies become available. The authors conclude that there is insufficient evidence to recommend this practice for routine use.

Does photobiomodulation reduce the pain caused by braces?

Short-term pain relief has been reported, but with the same low level of certainty as the other outcomes. No numerical values are provided in the study summary. This evidence is insufficient to establish a reliable clinical benefit.

Does vitamin D help during orthodontic treatment?

The authors describe inconsistent results across different criteria, with no reliable overall clinical benefit. Vitamin D is therefore treated in this review as an adjunct whose value in orthodontics has not been demonstrated. As with photobiomodulation, no recommendation for routine use is made.

Reference

Bukhari SAA, Ruslan AHB, Hassan R. Umbrella review of photobiomodulation/low-level laser therapy and vitamin D in orthodontics: effects on tooth movement, pain, root resorption, and bone biomarkers. BMC Oral Health, 2026. PMID 42464185. View the study on PubMed

This summary is provided for informational purposes only and does not constitute medical advice. Photobiomodulation is not a substitute for prescribed treatment. Consult a healthcare professional.