|Year : 2020 | Volume
| Issue : 3 | Page : 48-51
Need for speed in orthodontics: A review of noninvasive methods to accelerate the orthodontic tooth movement
T Sri Santosh1, Konkati Srikanth2, Dasagari Haritha1, Mandadi Lohith Reddy3, Bukkarayasamudram Ravi Chandra4, Reshu Parmar5
1 Department of Orthodontics and Dentofacial Orthopaedics, Malla Reddy Institute of Dental Sciences, Hyderabad, Telangana, India
2 Family Dental Care, Department of Orthodontics and Dentofacial Orthopaedics, Hyderabad, Telangana, India
3 Family Dental Care, Department of Periodontics and Implantology, Hyderabad, Telangana, India
4 Department of Orthodontics and Dentofacial Orthopaedics, Panineeya Institute of Dental Sciences and Hospital, Hyderabad, Telangana, India
5 Department of Orthodontics and Dentofacial Orthopaedics, Pandit Deendayal Upadhyay Dental College and Hospital, Solapur, Maharashtra, India
|Date of Submission||14-Jun-2020|
|Date of Acceptance||09-Jul-2020|
|Date of Web Publication||28-Sep-2020|
Dr. T Sri Santosh
Department of Orthodontics and Dentofacial Orthopaedics, Malla Reddy Institute of Dental Sciences, Room number 203, Suraram, Hyderabad, Telangana.
Source of Support: None, Conflict of Interest: None
Orthodontic treatment improves facial and smile esthetics along with oral function and psychosocial well being of an individual. Prolonged treatment time is one of the greatest challenges in orthodontics which declines patient’s satisfaction and increases the exposure of the patient to oral health risks such as decalfication of teeth, dental caries, periodontal disease, and root resorption. Most of the orthodontists are interested in noninvasive procedures which will also increase the acceptance of the treatment for both orthodontists and patients. Noninvasive methods that have shown promising results to accelerate the orthodontic tooth movement are vibrational forces, photobiomodulation, and low-intensity pulsed ultrasound (LIPUS). The current evidence presented in this review have shown successful results which is fascinating, further research is needed to explore the utility of these methods as an adjunct in the speciality of orthodontics to reduce the overall treatment duration, risks associated with prolonged treatment and increase patient’s compliance.
Keywords: Accelerated orthodontics, literature review, low-intensity pulsed ultrasound, noninvasive, photobiomodulation, vibrational forces
|How to cite this article:|
Sri Santosh T, Srikanth K, Haritha D, Lohith Reddy M, Ravi Chandra B, Parmar R. Need for speed in orthodontics: A review of noninvasive methods to accelerate the orthodontic tooth movement. Int J Oral Care Res 2020;8:48-51
|How to cite this URL:|
Sri Santosh T, Srikanth K, Haritha D, Lohith Reddy M, Ravi Chandra B, Parmar R. Need for speed in orthodontics: A review of noninvasive methods to accelerate the orthodontic tooth movement. Int J Oral Care Res [serial online] 2020 [cited 2020 Oct 22];8:48-51. Available from: https://www.ijocr.org/text.asp?2020/8/3/48/296221
| Introduction|| |
The long duration of orthodontic treatment is one of the major discouraging factors for the patients to accept it. Prolonged duration of treatment is associated with certain risks or complications such as decalcification of teeth, caries, root resorption, and periodontal issues. This also has a major impact on the compliance and satisfaction of the patient.
To overcome the problems associated with increased duration of treatment, several methods have been used to accelerate the tooth movement such as pharmacological intervention by injecting prostaglandins, vitamin D, osteoocalcin around the alveolar socket. However, due to their systemic effects and because of limited studies on them, their application is not vindicated. Surgical technique that includes decortications of alveolar bone has shown to increase the rate of tooth movement, but there is a limited time frame of intervention for accelerated tooth movement after the surgical procedures. Corticotomy is invasive, can be painful, causes discomfort, and is linked with postsurgical morbidity.
There is a need for noninvasive method to accelerate the orthodontic treatment. Various methods such as mechanical vibrations, photobiomodulation, and low-intensity pulsed ultrasound (LIPUS) are being studied and explored. All these noninvasive methods have been shown to increase the rate and quality of remodeling of alveolar bone. Even though there is significant supportive literature from animal and in vivo studies, there is the need for further studies to offer a general consensus among Orthodontists.
| Vibrational Forces|| |
Shapiro et al. were the first to introduce pulsating forces in orthodontics to stimulate tooth movement. Kurz  devised dental vibrations applying apparatus and claimed that applying a dynamic load shortens the orthodontic treatment period.
Mechanism of action
Mechanical loading initiates cellular signaling pathways in bone. Osteocytes are considered to be mechanoresponsive cells that are triggered by shear stress and bone bending which occurs during vibrational stimulus. It is followed by differentiation of osteoblasts and stimulation of bone genes. Vibrational stimulus enhances interleukin-1β secretion which induces receptor activator of nuclear factor kappa-Β ligand (RANKL) expression in osteoblasts and periodontal ligament and promotes the differentiation of preosteoclasts. Orthodontic tooth movement is accelerated as vibrations promote osteoclast formation and alveolar bone remodeling.
Effect on tooth movement
Kau et al. in an uncontrolled clinical trial on 14 patients reported that by using the acceledent device (Orthoaccel Technologies, California) on regular basis for 6-month-study period, the rate of displacement of teeth (measured as a reduction in Little’s irregularity index score) which was used as a measure to assess rate of tooth movement was found to be 0.526 mm per week or 2.1 mm per 28 days in the mandibular arch which is significantly higher than normal rates of tooth movement which is about 1 mm per month.
Bowman in his study found that average time needed to achieve alignment was 93 days in acceledent group compared to 120 days in study control group which was statistically significant. Similarly, time taken to achieve leveling in acceledent group was 168 days compared to 208 days in control group. On an average, there was 30% increase in rate of tooth movement compared to controls which is statistically and clinically significant. Pavlin and Gluhak-Heinrich in his study concluded that by applying cyclic loading force of 0.25N with 30 Hz frequency using acceledent device the rate of orthodontic tooth movement can be increased, ultimately reducing the overall treatment time.
Effect on pain perception
Studies by Miles et al. and Woodhouse et al. found no significant difference in pain intensities between acceledent group and control group using visual analog scale. On the contrary, Lobre et al. evaluated the pain intensities during four months treatment period concluded that patients using acceledent perceived pains of lower intensities during the treatment period.
| Photobiomodulation|| |
Photobiomodulation is a form of light therapy that involves therapeutic application of light in visible and near-infrared spectrum. It is also known as low-level light therapy. Light in the red to near-infrared range (600–1000nm) have positive biological outcomes. Photobiomodulation improves mitochondrial metabolism, promotes wound healing and angiogenesis in skin, bone, nerve, and skeletal muscle in primary neurons. The optical window for biological tissues lies between 600-1200nm.
Mechanism of action
It is reported that cytochrome C oxidase (CCO) in mitochondria of cells absorb photons following the application of light which leads to proton pumping and increased adenosine triphosphate (ATP) production which ultimately increases cellular metabolism due to increased energy available to the cells in the form of ATP and also accelerates the rate of remodeling of the bone. Findings of few in vitro studies on bone metabolism suggested that low-level light increases differentiation and proliferation of human osteoblasts, increases bone nodule formation, alkaline phosphatase (ALP) activity, and gene expression, and also enhances osteoblastic activity and ostoclastic activity.
Effect on tooth movement
Animal studies showed that low-level light therapy in the wavelength between 650 and 940nm increased the rate of tooth movements two to three times when compared with the controls and it was supported by histological evidence., Kau et al. conducted a multicenter clinical trial with a sample size of 90 human subjects. An extraoral device emitting near-infrared light of continuous wavelength of 850nm was used for test subjects. The cheek surface was exposed to light with a power density of 60 mW/cm2 for 20–30 min per day. Little’s index of irregularity was used to measure the rate of change of tooth movement during alignment phase. The study concluded that in photobiomodulation group the rate of tooth movement during alignment phase was 1.12 mm per week compared to control group which was 0.49 mm per week which is clinically significant.
Shaughnessy et al. studied the effects of intraoral photobiomodulation on initial alignment phase in subjects by using a device Orthopulse (OrthoPulse, Biolux Research Ltd., Vancouver, Canada). According to this study, photobiomodulation increased the rate of tooth movement by almost 3 folds and decreased the duration by 54% than controls during initial alignment.
Effect of photobiomodulation on root resorption
Nimeri et al. evaluated the effect of photobiomodulation on root resorption using cone beam computed tomography (CBCT) which showed no significant root resorption in photobiomodulation group which is one of the common sequalae of orthodontic treatment.
Ekizer et al. performed an experimental study to assess the effects of light-emitting diode mediated photobiomodualtion on orthodontic tooth movement and root resorption in rats. The results showed that percentage of relative root resorption affecting the maxillary molars on the tooth movement side was 0.098 ± 0.066 in the photobiomodulation group and 0.494 ± 0.224 in the control group which indicated statistically significant reduction of root resorption.
Effect on pain modulation
Recently proposed theories might offer insights into the phototransduction processes associated with laser-induced analgesia. It is stated that successful clinical trials involved applications of low-level light therapy at multiple points at the apices and around the crown of the tooth. It is recommended that a safe range for therapeutic exposure should be kept to 10–30 J/cm2 at a low-power output and an exposure of less than 500 mW/cm2.
| Low-intensity Pulsed Ultrasound|| |
Ultrasound is a form of mechanical energy, which is transmitted as acoustic pressure waves beyond the range of human hearing. It can be used for both diagnostic and therapeutic purposes at different intensities. LIPUS with intensities ranging between 30 and 100 W/cm2 induce biochemical changes at cellular and molecular level. LIPUS is a noninvasive technique. It is neither thermal in nature, nor it uses any ionizing radiation. Therapeutic use of LIPUS is approved by U.S. Food and drug administration. The parameters which are used to bring out beneficial effects of LIPUS include a 30-mW/cm2 intensity, 1.5-MHz frequency repeated at 1kHz, and a pulse width of 200 μs administered for 20 min each day.
Mechanism of action
Many studies have elucidated the therapeutic benefits of LIPUS on fracture healing. LIPUS possess a biostimulatory effect. Following the application of LIPUS, It induces microstream signals and mechanical stresses which stimulates cell membranes, cytoskeleton leading to signal transduction and gene transcription. LIPUS increases the response of certain osteogenic markers such as Interleukin-8 (IL-8), Basic fibroblastic growth factor (BFGF), vascular endothelial growth factor (VEGF), transforming growth factor beta (TGF-β), ALP, and suppresses osteoclastic markers.
LIPUS auguments orthodontic tooth movement by elevation of the Hepatocyte Growth factor (HGF)/Runt related transcription factor2 (RUNX2)/Bone Morphogenic Protein-2 (BMP-2) signaling pathway gene expression and RANKL expression, which facilitate an increase in the rate of remodeling of alveolar bone.
Effect on tooth movement
Study performed by Xue et al. on 48 male Wistar rats showed that the rate of orthodontic tooth movement in LIPUS application group was increased by approximately 45% compared to control group at the end of 14 days. In vitro study by Hu et al. from the isolated periodontal ligament tissue from the extracted premolars following the application of LIPUS showed that LIPUS facilitates the osteogenic differentiation of human periodontal ligament cells and helps in periodontal regeneration.
El- Bialy et al. performed a randomized controlled trial on human subjects. LIPUS was applied using a handheld device with an intraoral mouthpiece. CBCTs were taken to measure the dimensions of the extraction space for every four weeks till the end of space closure. The results showed that the rate of tooth movement on LIPUS side was 0.266 ± 0.92 mm per week compared with 0.232 ± 0.085 mm per week in control group, with an approximate increase of tooth movement by 29%.
Effect on root resorption
LIPUS has been shown to decrease root resorption in humans as it enhances cementum and predentin formation and an increase in sub-odontoblast and periodontal ligament cell numbers. Raza et al. evaluated the effects of LIPUS on orthodontically induced root resorption in human subjects. Less volume of resorption lacunae was seen in LIPUS treated teeth when compared with the controls by a mean difference of 0.54 ± 0.9 mm3 which was statistically and clinically significant.
| Conclusion|| |
Vibrational forces, photobiomodulation, and LIPUS offer a noninvasive approach to accelerate the orthodontic treatment and reduce the overall treatment time. Current evidence indicates their potential to accelerate tooth movement, which is quite fascinating, though further research is required to fully understand their use, gain acceptance, and apply them as an adjunctive therapy in the field of orthodontics.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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