Search

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

Play episode
Hosted by
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

 

Conclusion

  • Martyn wont be incorporating these intervention until further robust research
Join the discussion

More from this show