Accelerated Orthodontics: A Faster Way to Straighten Teeth

Table of contents

1. What is tracking in clear aligners?
2. How do I know if my aligners fit properly? (Easy Tutorial)
3. What is poor tracking and what causes poor tracking?
4. How do I make my aligners fit better? Solutions for tracking issues

Clinical orthodontics is an ever-evolving field of dentistry with the introduction of new techniques and approaches aimed at reducing treatment duration combined with the enhanced restoration of esthetics and function. Accelerated orthodontics is a recent approach to speed up tooth movement, and includes different modalities such as physical stimulation or surgical intervention.

While these modalities are still under study and require sufficient clinical evidence to be utilized in day to day orthodontics, there seems to be much scope for it in the future. This article will give you a deeper insight into various accelerated orthodontic techniques.

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^{What is accelerated orthodontics?}

Accelerated orthodontics is an innovative approach to orthodontics that focuses on shortening the duration of straightening teeth using different techniques like physical stimulation (vibrations or laser therapy) and surgery.(7)

^{History and evolution of accelerated orthodontics tooth movement}

The concept of accelerated orthodontics dates back to 1893 (1). Since then, accelerated orthodontics has evolved phenomenally by introducing better techniques that could accelerate tooth movement with minimal disadvantages and maximum acceptability from both patients and doctors.

When bringing about new modifications, special considerations have been given to reduce patient chair time and increase patient comfort. Corticotomies is one such procedure that has undergone significant modifications. Today, corticotomies can be performed as a flapless procedure instead of raising a flap, and the decortication can be done using a piezoelectric tool instead of a bur.

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^{Factors affecting accelerated orthodontic therapy}

Factors that can affect accelerated orthodontic therapy are:

• Environmental
• Genetic
• Severity of malocclusion
• Type of treatment

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Candidates

Ideal candidates for accelerated orthodontics should have healthy alveolar bone and permanent teeth. A few questions that can be considered while deciding on the right candidate are:

• Is the patient looking for quick results through braces or clear aligners?
• Is the patient looking for less chairside time?
• Does the patient want a modification in his existing orthodontic treatment plan to achieve the results at a faster rate?

In adults, tooth movement and biological response are slower than in adolescents. This makes both young and adult patients good candidates for accelerated orthodontics (2).

Accelerated orthodontic treatments

1. Pharmacological methods

Orthodontic forces cause bone remodeling, which leads to the movement of teeth. Several pharmacological agents can act as biomodulators and enhance orthodontic tooth movement. Examples of such biomodulators are-

• Prostaglandin E2- It can increase orthodontic tooth movement and facilitate bone resorption (3).
• Prostaglandin E1- Similarly, this prostaglandin has been observed to be induced under mechanical stress and increase orthodontic tooth movement by causing bone remodeling.
• Parathyroid hormone (PTH)- It can increase osteoblast activity directly and can activate osteoclast activity through an indirect effect resulting in bone remodeling.
• 1,25-Dihydroxycholecalciferol- It is also called calcitriol and is the most active Vitamin D metabolite. It causes the proliferation of osteoblasts and enhances osteoblast function (4).
• Intravenous immunoglobulins- They have the potential of modulating tooth movement through PGE2 synthesis.

2. Surgical methods

1. Periodontally accelerated osteogenic orthodontics (PAOO)

In this technique, orthodontic treatment can be started one week before the surgery. The surgery involves the reflection of a full-thickness flap and decortication using low-speed round burs. On the areas of decortication, demineralized freeze-dried bone allograft (DFDBA) is placed and the flaps are sutured (1).

2. Corticision

To minimize the drawbacks of PAOO, corticision was introduced. In this technique, a reinforced scalpel and a mallet are used to go through the gingiva and cortical bone without raising a flap. Hence, a surgical injury is created that can facilitate increased orthodontic movement (1).

3. Piezocision

As PAOO and corticision were invasive in nature, practitioners were looking for a procedure that is minimally invasive but has the advantage of placing bone grafts. That’s how piezocision was introduced. This flapless procedure involves using a piezoelectric knife to make micro-incisions for decortication. Then, selective tunneling can be done to allow the placement of hard tissue or soft tissue grafts to rectify bone deficiencies and gingival recessions respectively.

4. Micro-osteoperforations (alveocentesis)

Alveocentesis is a procedure that involves the creation of very tiny pinhole-sized perforations within the alveolar bone of some teeth. The perforations is reportedto cause the release of cytokines which induces osteoclasts to increase bone resorption. This reaction accelerates orthodontic tooth movement.

The perforation site is usually the buccal cortical plate, on the mesial and distal aspects of the roots of the teeth that need to be moved. A minimum of 2 to 4 perforations are made, which has a depth in the range of 3mm to 7mm (3).

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3. Physical methods

1. Vibratory stimulus

It has been observed that the rate of bone remodeling increases when the bone is subjected to vibrations or low-level mechanical oscillatory impulses (5).

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On the basis of this observation, a vibratory device was created, which had two parts, a mouthpiece, and an activator. While the patient bites on the mouthpiece, the activator imparts vibrations of 0.2N at 30 Hz. The cyclic forces produced by the device lead to accelerated bone remodeling thereby speeding up the treatment.

2. Low-level laser therapy

Low-level laser therapy or LLLT utilises the biostimulation property of laser irradiation. LLLT can not only accelerate orthodontic tooth movement but also improve the stability of orthodontic mini-implants, decrease post-adjustment pain and induce bone growth in the mid-palatal suture region after rapid maxillary expansion.

3. Low-intensity pulsed ultrasound (LIPUS)

Low-intensity pulsed ultrasound uses acoustic pressure waves to bring about biochemical changes in both hard and soft tissues. An increase in alveolar bone remodeling has been observed from LIPUS, resulting in enhanced orthodontic tooth movement. It may cause reduced root resorption by causing the deposition of dentin and cementum on the roots, and protecting them from resorption (8).

4. Light-accelerated orthodontics (photobiomodulation)

Light-accelerated orthodontics or LAO involves the use of low-intensity infrared light to stimulate the bone around the roots of the teeth to expedite orthodontic treatment. One of the studies revealed that photobiomodulation accelerated the distalisation of the canines by 32%.(6) Based on LAO technology, a device was created, which could be operated and used by the patients themselves. The device consists of a silicon mouthpiece to be placed inside the patient’s mouth and used for at least 10 minutes (6).

Not only is photobiomodulation therapy safe to use, but it also puts the treatment on fastrack with an activation period of just 10 minutes per day. It can be used in combination with any fixed or removable device. Patients find it very comfortable as it can be used in the comfort of his/her home.

Benefits of accelerated orthodontics

One of the most significant benefits of accelerated orthodontics is reduced treatment duration. Another benefit is that this approach can be used for any kind of orthodontic treatment

Advice for doctors

Doctors should employ accelerated orthodontic techniques only in selected cases. Before deciding on the technique to be used, doctors should consider factors like the invasiveness and the post-operative complications of the procedure. The aim should be to choose a procedure in which the benefits outweigh the potential risks.

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