Accelerated Orthodontics

orthodontics In summary

Join me for a summary looking at accelerating orthodontic tooth movement, this podcast is a summary of two lectures from the AAO, by Ali Darendelier and Peter Buschang. Mechanical acceleration through vibration, photobiomodulation, minisurgery (Peizocision and Micro-Osteoperforation MOP) and Distraction.

1. Vibrational mechanical

1. Low magnitude / high frequency, used for 20 minutes per day 25g at 30Hz/ 50 Hz,

2. Canine retraction: 30Hz NS, 50Hz 15% quicker, Significant but not clinically

3. No increase in root resorption - split mouth study, except for 50Hz, reduced RRRR Tan 2011, Yilmaz 2021

1. Photobiomodulation (PBM)

1. Low level laser therapy: LED device used for 20-30 minutes her day

2. Tooth movement increase rate of 1.73mm over 2-3 months Yavagal 2021 SR

3. Root resorption no difference Sambevski 2022

1. Minisurgery: Piezocision/ Micro-osteperforation(MOP)

1. Piesocision – series of vertical bone cuts of 2-3mm depth vary lengths, Vs MOP – round punctures of 2-3mm depth. With or without flaps.

2. The movements were twice as fast (Lino et al 2017, Cho et al 2007, Mostafa et al 2009)

3. But limited duration of effect Buschang 2010

1. Peak at around 3-4 weeks

2. No differences after 6 weeks - Similar to human trials: Aboul-Ela 2011

4. Root resorption Patterson 2017

1. Peizocision and MOP produced significantly (44% / 42%) MORE root resorption.

2. Peizocision 36% additional iatrogenic damage (performed by periodontist)

1. Distraction

Mechanical removal of the bony obstruction

• Remove all or most of the bone in a way so that you can move teeth faster reliably

• Osteotomy, callus formation followed by Rapid separation of distal and proximal bone and healing with new bone formation.

• 1mm per day Moore 2011

• Teeth vial with Dappler meter

• Vitality through histology as electronic pulp test not reliable during orthodontic treatment, Alomari 2011, increase in treatment but return to normal in retention.

What do we know reliably extents treatment duration are 3:

1. Wrong diagnosis

2. Wrong mechanics

3. Bracket position

Conclusion:

Distraction is the most reliable method at increasing tooth movement but the most invasive

Peizocision / Micro-osteoperforation: Increases tooth movement but greatest risk of root resorption

Photobiomodulation: Modest increase in tooth movement, no root resorption

Vibration: No increase in tooth movement or root resorption

Contributions

Content creation: Shanya Kapoor

Editing and production: Farooq Ahmed