Martyn describes different methods of accelerated tooth movement, the evidence behind them and the bottom line of their use in orthodontics.
Conventional orthodontic treatment duration Tsichlaki 2016
- Mean duration 19.9 months
- Mean visits: 17.8
Patient expectations Uribe 2014
- Most want treatment for 6-12 months
- 70% of orthodontists interested in adjuncts to reduce amount of time
Stages of treatment require different types of tooth movement
Optimal force to move teeth – Systematic RV Theodorou 2019
- Suggested 50cN-100cN
- 9-1.4mm of movement per week
- But evidence poor
Adjuncts to accelerate tooth movement
- Self ligating brackets systematic RV: Papageorgiou 2013
- Favour conventional ligation 2.01 (95% 0.45-3.57) – small difference
- Archwire sequence Cochrane RV Wang 2018
- No difference in archwire sequence
- Customised appliance
Considered more efficient; planned final outcome, customised archwires, bespoke prescription, less finishing bends.
- Penning 2017 – appliance does not influence speed of treatment: the orthodontist does.
- Corticotomy
Bone cuts: based on the regional acceleration phenomenon, turn over and metabolism increased, increased cellular activity and therefore bone turnover and tooth movement.
- Systematic RV Gill 2018 reduction in treatment from 8 months Vs 16 months BUT evidence poor
- Systematic RV Fleming 2015 – significant effect on space closure 2mm over 3 months, BUT evidence poor
- Micro-osteoperforation
- Systematic RV Sirarajan 2020 – no significant effect to canine retraction
- Systematic RV Shahabee 2019 – significant effect 45 increase in canine retraction per month
Corticotomy and microperforation: evidence poor and heterogenous
- Piezocision
Less interventional than corticotomy, using a ultrasonic bone saw
- Systematic RV Afzal 2020 – significant effect of 46 days faster of anterior tooth alignment correction
- Systematic RV Mheissen – significant effect on canine retraction of reduced time in treatment of 100 days, no significant difference on en mass retraction
- Vibrational device 30Hz
5-30 minutes per day. Non-surgical
- RCT Miles 2018: no difference
- RCT Woodhouse 2015: no difference in rate of alignment and space closure in fixed
- RCT Katchooi 2018: no difference in aligner treatment
- Photobiomodulation
Wavelength of light activates Cytochrome c oxidase enzyme = increase cellular activity
- Systematic RV AlShahrani 2019 – no clinically significant difference, but statistically significant
Conclusion
- Martyn wont be incorporating these intervention until further robust research
