Adjuncts To Orthodontic Tooth Movement Are They Really Worth The Bother Martyn T. Cobourne. Episode 42. IOC 2020

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Farooq Ahmed

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
    1. Favour conventional ligation 2.01 (95% 0.45-3.57) – small difference


  • Archwire sequence Cochrane RV Wang 2018
    1. No difference in archwire sequence


  • Customised appliance

Considered more efficient; planned final outcome, customised archwires, bespoke prescription, less finishing bends.

  1. 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.

  1. Systematic RV Gill 2018 reduction in treatment from 8 months Vs 16 months BUT evidence poor
  2. Systematic RV Fleming 2015 – significant effect on space closure 2mm over 3 months, BUT evidence poor


  • Micro-osteoperforation
    1. Systematic RV Sirarajan 2020 – no significant effect to canine retraction
    2. 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

  1. Systematic RV Afzal 2020 – significant effect of 46 days faster of anterior tooth alignment correction
  2. 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

  1. RCT Miles 2018: no difference
  2. RCT Woodhouse 2015: no difference in rate of alignment and space closure in fixed
  3. RCT Katchooi 2018: no difference in aligner treatment


  • Photobiomodulation

Wavelength of light activates Cytochrome c oxidase enzyme = increase cellular activity

  1. Systematic RV AlShahrani 2019 – no clinically significant difference, but statistically significant



  • Martyn wont be incorporating these intervention until further robust research
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