Effectiveness of non-conventional methods for accelerated orthodontic tooth movement: A systematic review and meta-analysis
Introduction
Reduced treatment duration is important for care providers and orthodontic patients. It is also desirable that aesthetic concerns1 and time dependent adverse events such as discomfort, pain, external apical root resorption, suboptimal oral hygiene, white spot lesions and dental caries2 are held to the minimum.
Empirical evidence has indicated that 2 years is a representative of average orthodontic treatment duration with a significant variation which can be influenced by several factors including case severity, extraction versus non-extraction therapy, need for orthognathic surgery, clinical expertise, and patient cooperation.3, 4
Tooth movement induced by a physical stimulus/force consists of a series of phenomena involving biologic reactions of the alveolar bone, the periodontal ligament (PDL), the gingiva, and the vascular and neural networks.5 Under applied force the stress–strain distribution in the PDL is altered and tension and compression sites develop. A series of events resembling inflammation are initiated and regional osteoclastic and osteoblastic activity is observed leading to bone resorption and apposition that results in tooth movement through modelling–remodelling of the alveolar bone.6 Adjunct to the proper selection of brackets, wires, embiomechanic systems, force levels, and anchorage systems, an array of novel techniques has been introduced to accelerate orthodontic tooth movement. These techniques can be briefly categorized as surgical and non-surgical.
The surgical category includes alveolar decortication, corticotomy, distraction of the periodontal ligament, and distraction of the dento-alveolus.7 The idea of surgically accelerated tooth movement although more than a century old8 has only gained momentum and interest during the last 10 years.9, 10 Theoretically, selective surgical alveolar bone reduction induces a localized increase in turnover of alveolar cancellous bone, suggesting a possible mechanism underlying the observed acceleration of tooth movement.11 Another possible mechanism could be attributed to the removal of the hyaline zone formed soon after force application, which allows earlier bone resorption required for tooth movement.12
Non-surgical techniques include low-intensity laser irradiation,7, 13 resonance vibration,14 pulsed electromagnetic fields,15 electrical currents,16 and pharmacological approaches.17 Low laser therapy is reported to stimulate osteoblast and osteoclast cell proliferation, and enhance the velocity of tooth movement due to accelerated bone remodelling mediated by the RANK/RANKL/OPG system.18 Resonance vibration is also advocated to act through enhanced RANKL expression in the periodontal ligament.14
Over the years, several case reports, narrative reviews, and clinical research papers have discussed various aspects of techniques used for accelerated orthodontic tooth movement. The only systematic evaluation of all methods used on this rapidly moving field included a limited number of studies that were published until August 2011.19 Thus, a thorough systematic evaluation of the most recent clinical evidence related to accelerated orthodontic treatment is missing from the literature. The purpose of the present systematic review is to critically assess and systematically summarize the available evidence regarding clinical performance of surgical and non-surgical approaches for accelerated orthodontic tooth movement.
Section snippets
Materials and methods
The PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) reporting guidelines are followed in the systematic review.20, 21 A pilot Pubmed search followed by systematic evaluation of five potentially eligible randomly selected studies was performed in order to prepare the study protocol. Data extraction forms were constructed after the initial results of the pilot search.
The interventions for accelerated orthodontic tooth movement are relatively unexplored. It was,
Literature flow
The flow diagram of study selection is shown in Fig. 1. The literature search initially yielded 648 records. Following review of the titles and abstracts, it was decided that 52 studies should be examined in more detail. Thirty-four of the 52 studies were subsequently excluded following full-text reading of the article due to various reasons described in the chart. Finally, 18 papers were included in the review for qualitative and quantitative synthesis (Table 1). The kappa scores for the
Discussion
Reduction of orthodontic treatment time by means of accelerated tooth movement has attracted the interest of the orthodontic community in the recent years. Almost 80% of the included studies investigating techniques for accelerated orthodontic tooth movement were published in the last 4 years, clearly showing an increased interest on the topic.
In the past, attempts to accelerate the rate of tooth movement have involved the addition of specific molecules, such as PgE1, which had been found to be
Conclusion
There is moderate evidence on low laser therapy and low evidence on corticotomy regarding their effectiveness in acceleration of orthodontic tooth movement. The evidence on interseptal bone reduction is limited. The evidence on photobiomodulation or pulsed electromagnetic fields is also limited and of very low quality. Overall, the results should be interpreted with caution given the small number, quality, and heterogeneity of the included studies. There is a need for larger, high quality RCTs.
Conflict of interest and sources of funding statement
The authors declare that they have no conflict of interests. No funding was received by any source.
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