ACCELERATED ORTHODONTICS in orthodontic tooth movemnet

Very gif IZC

1. ACCELERATED
ORTHODONTICS
Presented by
Deepali Jain
PG 2
nd
year
1
Guided by:
Dr.Ranjith Manne

2. CONTENTS
Introduction
Biological principles behind accelerated tooth movement
Methods Of Accelerating Tooth Movement
➢Biological approach
Cytokines
Prostaglandin
Vitamin D3
PTH
➢Surgical approach
Interseptalalveolar surgery
Osteotomyand Corticotomy
Micro-osteoperforation
Piezocisiontechnique
2

3. ➢Device-assisted treatment
Cyclical force device effect on tooth
movement.
Direct electric current effect on tooth
movement.
Photobiostimulation
•Conclusion
•References
3

4. Introduction
Thedreamofabeautifulsmileiscurrentlynot
difficulttofulfill,asinterdisciplinarytreatment
makessuccessfulestheticeffectspossibleinthe
majorityofcases.
However,orthodonticshaveafundamental
disadvantage:prolongedtherapytime.
Comprehensiveorthodontictreatmentlastson
averagecloseto2years.
4
AlicjaKacprzak,AdrianStrzecki.Methodsofacceleratingorthodontictoothmovement:
Areviewofcontemporaryliterature.DentMedProbl.2018;55(2):197–206

5. Thishasanegativeimpactonthepatient’s
compliance.
Ontheclinicallevel,long-termtherapymaylead
toiatrogeniccomplications.
5
AlicjaKacprzak,AdrianStrzecki.Methodsofacceleratingorthodontictoothmovement:
Areviewofcontemporaryliterature.DentMedProbl.2018;55(2):197–206

6. Inlightofcontemporaryliterature,usingincreasedforce
toacceleratethemovementofteethisdiscouraged.
Itisthereforenecessarytoaffectthesurroundingsofthe
tooththatensureitsstablepositionintheneutralzone−
thealveolarbone.
6
AlicjaKacprzak,AdrianStrzecki.Methodsofacceleratingorthodontictoothmovement:
Areviewofcontemporaryliterature.DentMedProbl.2018;55(2):197–206

7. Methodsofacceleratingtoothmovementarebasedon
stimulatingbiologicaltissueresponse,i.e.,enhanced
metabolismandacceleratedboneremodeling.
Anumberofattemptshavebeenmadetocreatedifferent
approaches.
Mostattemptscanbroadlybecategorizedintobiological,
biomechanical,andsurgicalapproaches.
7
Nimeriet al. Acceleration of tooth movement during orthodontic treatment -a frontier in
Orthodontics. Progress in Orthodontics 2013,14:42-50

8. Before going into details of these attempts, we need to
understand the basics of orthodontic tooth movements and
the factors that initiate inhibition and delayed tooth
movement.
Nimeriet al. Acceleration of tooth movement during orthodontic treatment -a frontier in
Orthodontics. Progress in Orthodontics 2013,14:42-50
8

9. BIOLOGICAL PRINCIPLES BEHIND
ACCELERATED TOOTH MOVEMENT
9

10. Orthodontictoothmovementoccursinthepresence
ofamechanicalstimuli.
Theforceappliedontheteethwillcausechangesin
themicroenvironmentaroundthePDL.
Orthodonticappliancesarenotintentionallybuiltto
activateorinhibitspecificremodelingpathwaysin
specificcells.
Rather,theyarebuilttogeneratebiomechanicalforce
systemsthatproducethedesiredtoothandjaw
movements.
Alansari, Sarah et al. Biological principles behind accelerated tooth movement.
Seminars in Orthodontics 2015,21(3):151 -161
10

11. Orthodontistsarenowdesigninginnovativeappliances
andtreatments.
Byidentifyingandharnessingreactionsofthetarget
cells,twodifferentapproachestoacceleratetherateof
toothmovement:
directlystimulatethetargetcellsbyartificial,
physical,orchemicalmeanstoincreasetheirnumbers
andtheiractivity,
orindirectlystimulatethebodytorecruitandactivate
moretargetcells.
Ineitherscenario,identifyingthetargetcellsand
understandinghowtheyareactivatediscrucial.
Alansari, Sarah et al. Biological principles behind accelerated tooth movement.
Seminars in Orthodontics;21(3):151 -161
11

12. METHODS OF ACCELERATING TOOTH
MOVEMENT
12
•BIOLOGICAL
•SURGICAL
•DEVICE ASSISTED

13. BIOLOGICAL
Cytokines
Prostaglandins
Vitamin D3
PTH
13

14. CYTOKINES
•CytokinesfamilyincludesIL,Tumornecrosis
factors,colonystimulatingfactorsandGrowth
factors.
•Prominentcytokinesthatshowdemonstrated
effectsonboneremodelingareIL-1α,IL-1β,IL-6,
TNF-alpha.
•Thesecytokineshavebeenshowntostimulatebone
resorptionandinduceosteoclastproliferation.
Krishnan V, DavidovitchZ. Cellular, molecular, and tissue-level reactions to orthodontic force. Am J Orthod
DentofacialOrthop. 2006;129:469.e1–32
14

15. Thesecytokinesstimulatesosteoclastfunctionthroughits
receptoronosteoclasts.
Othercytokineswhicharealsoinvolvedinthe
accelerationoftoothmovementareRANKL.
Nimeriet al. Acceleration of tooth movement during orthodontic treatment -a frontier in Orthodontics.
Progress in Orthodontics 2013, 14:42
15

16. Ontheotherhand,osteoprotegerin(OPG)competeswith
RANKL inbindingtoosteoclasttoinhibit
osteoclastogenesis.
Theprocessofboneremodelingisabalancebetween
(RANKL-RANK)systemandOPGcompound.
Nimeriet al. Acceleration of tooth movement during orthodontic treatment -a frontier in Orthodontics.
Progress in Orthodontics 2013, 14:42
16

17. 17

18. Juvenileteethmovefasterthanadults,whichisdueto
theloweramountofRANKL/OPGratiointhe
gingivalcrevicularfluid(GCF)inadultpatients
measuredbytheenzyme-linkedimmunosorbentassay
method.
Yamaguchi M. RANK/RANKL/OPG during orthodontic tooth movement. OrthodCraniofacRes.
2009; 12(2):113–9.
18

19. PROSTAGLANDIN EFFECT ON TOOTH
MOVEMENT
Prostaglandins(PGs)areinflammatorymediatoranda
paracrinehormonethatactsonnearbycells;
Itstimulatesboneresorptionbyincreasingdirectlythe
numberofosteoclasts.
DrugsthateffectPGactivityfallsintotwocategories:
CorticosteroidsandNSAIDS
Agentsthathavemixedagonisticandanatagonisticeffecton
PGs.
Proffit
19

20. Corticosteroidsinhibittheformationof
arachidonicacid.
NSAIDsinhibittheconversionofarachidonic
acidintoPG.
Proffit
20

21. InjectingPGsintothePDLinrodentsincreases
thenumberofosteoclastsandtherateoftooth
movement.
Systemicapplicationofmisoprostol,aPGE1
analog,toratsundergoingtoothmovementfor2
weeks,significantlyincreasedtherateoftooth
movement.
21
Alansari, Sarah et al. Biological principles behind accelerated tooth movement. Seminars
in Orthodontics 2015;21(3):151 -161

22. InjectionofPGstoincreasetherateoftooth
movementhaslimitations.
First,duetotheirveryshorthalf-life,PGsmust
bedeliveredrepeatedly.
Second,localPGsinjectionscancause
hyperalgesia.
22
Alansari, Sarah et al. Biological principles behind accelerated tooth movement. Seminars
in Orthodontics 2015;21(3):151 -161

23. EFFECT OF VITAMIN D3 ON
TOOTH MOVEMENT
1,25dihydroxycholecalciferolisahormonalformof
vitaminD.
VitaminDmetabolitewasinjectedonthePDLof
catsforseveralweeks;Collinsetalfoundedthat
vitaminDhadacceleratedtoothmovementat60%
morethanthecontrolgroup.
Duetotheincreaseofosteoclastsonthepressuresite
asdetectedhistologically.
Collins MK, Sinclair PM. The local use ofvitamin D to increase the rate oforthodontic tooth
movement. Am J OrthodDentofacial Orthop. 1988;94:278–284.
23

24. AcomparisonbetweenlocalinjectionofvitaminDand
PGEsontwodifferentgroupsofratswasalso
investigated.
Itwasfoundthatthereisnosignificantdifferencein
accelerationbetweenthetwogroups.
However,thenumberofosteoblastsonthepressureside
whichwasinjectedbyvitaminDwasgreaterthanonthe
PGE2side.
ThisindicatesthatvitaminDmaybemoreeffectivein
boneturnover.
Kale S, KocadereliI, AtillaP, AsanE. Comparison of the effects of 1,25 dihydroxycholecalciferoland
prostaglandin E2 on orthodontic tooth movement. Am J OrthodDentofacialOrthop. 2004; 125(5):607–14
24

25. PTH EFFECT ON TOOTH
MOVEMENT
PTHhasbeenshowntoaccelerateorthodontic
toothmovementonrats,whichwasstudiedby
continuousinfusionandthemolarsweremoved
2to3foldfaster.
Somestudieshaveshownthatlocallyinjected
PTHinduceslocalboneresorption.
Therfore,itismoreadvantageoustogivePTH
locallyratherthansystemically.
SomaS,MatsumotoS,HiguchiY,etal.LocalandchronicapplicationofPTH
acceleratestoothmovementinrats.JDentRes.2000;79(9):1717-24.
25

26. SURGICAL APPROACH
26

27. 27
INTERSEPTAL
ALVEOLAR SURGERY
OSTEOTOMY and
CORTICOTOMY
MICRO-
OSTEOPERFORATIONS
PIEZOCISION
TECHNIQUE
SURGICAL
APPROACH

28. Nimeriet al. Acceleration of tooth movement during orthodontic treatment -a frontier in Orthodontics.
Progress in Orthodontics 2013, 14:42
28
INTERSEPTAL
ALVEOLAR
SURGERY
DISTRACTION OF
ALVEOLAR BONE
DISTRACTION OF
PERIODONTAL
LIGAMENT

29. DISTRACTION OF PDL
Liouand Huang. Rapid canine retraction through distraction of the periodontal ligament. Am J Orthod
Dentofacial Orthop1998;114:372-82.
29
IntherapidcaninedistractionofPDL,theinterseptalbonedistal
tothecanineisunderminedsurgicallyatthesametimeof
extractionofthefirstpremolars.
Thus,thiswillreducetheresistanceonthepressuresite.
Inthisconceptthecompactboneisreplacedbythewovenbone,
andtoothmovementiseasierandquickerduetoreduced
resistanceofthebone.

30. Inthistechnique,theinterseptalboneisundermined1to1.5
mminthicknessdistaltothecanineandthesocketis
deepenedbyaroundburtothelengthofthecanine.
Theretractionofthecanineisdonebytheactivationofan
intraoraldevicedirectlyafterthesurgery.
Liouand Huang. Rapid canine retraction through distraction of the periodontal ligament. Am J Orthod
DentofacialOrthop1998;114:372-82.
30

31. Activated0.5to1mm/dayaftertheextractionuntilthe
caninewasdistractedintothedesiredpositionand
amount.
Ittook3weekstoachieve6to7mmoffullretraction
ofthecaninetothesocketoftheextractedfirst
premolars.
Liouand Huang. Rapid canine retraction through distraction of the periodontal ligament. Am J OrthodDentofacial
Orthop1998;114:372-82.
31

32. ALVEOLAR BONE DISTRACTION
Thisprocedurewasusedasearlyas1905byCodivillaand
laterpopularizedbytheclinicalandresearchstudiesof
Ilizarov.
Rapidcaninedistractionofthedentoalveolarboneisdoneby
thesameprincipleofthedistractionofPDL,withtheaddition
ofmoredissectionandosteotomiesperformedatthevestibule.
SukuricaY, KaramanA, GurelHG, DolanmazD. Rapid canine distalizationthrough segmental alveolar distraction osteogenesis. Angle
Orthod. 2007; 77(2):226–36.
32

33. SukuricaY, KaramanA, GurelHG, DolanmazD. Rapid canine distalizationthrough segmental alveolar distraction
osteogenesis. Angle Orthod. 2007; 77(2):226–36.
33

34. Averticalosteotomywasmadeinasimilarmanneralongthe
posterioraspectofthecaninetooth.
Thefirstpremolarwasextractedatthisstage.
Thebuccalbonewascarefullyremovedthroughthe
extractionsocketusinglarge,roundbursbetweenthebonecut
atthedistalcanineregionanteriorlyandthesecondpremolar
posteriorly.
SukuricaY, KaramanA, GurelHG, DolanmazD. Rapid canine distalizationthrough segmental alveolar distraction
osteogenesis. Angle Orthod. 2007; 77(2):226–36.
34

35. Thedistractiondevicefittedandcementedtothefirst
molarandcanineteethattheendofthesurgical
procedure.
Dentoalveolardistractionwasstartedonthedayofthe
surgeryandcontinuedatarateof0.4mmtwiceaday.
35

36. Inallthestudiesdone,bothtechniquesacceleratedtooth
movementwithnoevidenceofsignificantrootresorption,
ankylosis,androotfracture.
Buttherearestillsomeuncertaintiesregardingthis
technique.
36
SukuricaY, KaramanA, GurelHG, DolanmazD. Rapid canine distalizationthrough segmental alveolar distraction
osteogenesis. Angle Orthod. 2007; 77(2):226–36.

37. OSTEOTOMY
ASSOCIATED TOOTH
MOVEMENT
37

38. Osteotomyisdefinedasasurgicalcutthroughboththe
corticalandtrabecularbones.
Inorthodontics,osteotomieshavebeenusedtoenhance
andacceleratetoothmovement.
Inthe1950s,Koleintroducedhis‘bonyblock’technique.
AlmpaniK,KantarciA. Surgical Methods for the Acceleration of the Orthodontic Tooth Movement.FrontOral Biol2016.
38

39. Cunninghamin1893usedmesialanddistalinterseptal
osteotomiestorepositionpalatallyinclinedmaxillaryteeth
andstabilizedthemincorrectocclusionwithwireligatures
ormetalsplints.
Itreducedtheproceduretimetoonethirdthatof
conventionaltreatmentandallowedmorepredictable
treatmentinolderpatients.
AlmpaniK,KantarciA.SurgicalMethodsfortheAccelerationoftheOrthodonticToothMovement.FrontOralBiol2016.
39

40. Verticalandhorizontalosteotomieshavehadan
increasedriskofpostoperativetoothdevitalizationor
evenbonenecrosis,dependingontheseverityofinjury
tothetrabecularbone.
Thereisalsoanincreasedriskofperiodontaldamage.
AlmpaniK,KantarciA. Surgical Methods for the Acceleration of the Orthodontic Tooth Movement.FrontOral Biol2016.
40

41. CORTICOTOMY ASSISTED
ORTHODONTIC TOOTH
MOVEMENT
41

42. Commonlyused.
Onlythecorticalboneiscutandperforatedbutnotthe
medullarybone.
Whereasinosteotomiesbothcorticalandtrabecular
bonematerialisremovedinconsiderablequantities.
Oliveira D, Oliveira B. F, Rodrigo VS. Alveolar corticotomiesin orthodontics: Indications and effects on tooth movement.
Dental Press J Orthod2010 July-Aug;15(4):144-57.
42

43. INDICATIONS
1.Acceleratingcorrectiveorthodontictreatment
2.Facilitatingcomplexorthodonticmovements
3.Intrusionofposteriorteeth
4.Corticotomiescombinedwithskeletal
anchoragedevices
5.Enhancingthecorrectionofskeletal
malocclusions.
Oliveira D, Oliveira B. F, Rodrigo VS. Alveolar corticotomiesin orthodontics: Indications and effects on tooth movement.
Dental Press J Orthod2010 July-Aug;15(4):144-57.
43

44. CONTRAINDICATIONS
1.Patientsshowinganysignofactiveperiodontal
disease
2.Individualswithinadequatelytreated
endodonticproblems
3.Patientsmakingprolongeduseof
corticosteroids
4.Personswhoaretakinganymedicationsthat
slowdownbonemetabolism,suchas
bisphosphonatesandNSAIDs.
Oliveira D, Oliveira B. F, Rodrigo VS. Alveolar corticotomiesin orthodontics: Indications and effects on tooth movement.
Dental Press J Orthod2010 July-Aug;15(4):144-57.
44

45. However,Wilckoetaldescribedaninnovativestrategy
ofcombiningcorticotomyalveolarsurgerywith
alveolargraftinginatechnique.
Referredto,initially,asacceleratedosteogenic
orthodonticsand,morerecently,asperiodontally
acceleratedosteogenicorthodontics.
Oliveira D, Oliveira B. F, Rodrigo VS. Alveolar corticotomiesin orthodontics: Indications and effects on tooth movement.
Dental Press J Orthod2010 July-Aug;15(4):144-57.
45

46. Groovesaremadeinthecorticalbone,bothonthebuccal
andlingualsurfaces.
Followedbyplacementoflyophilizedbonegraftsbefore
repositioningandsuturingthegingivalflap.
Theboneaugmentationhasbeenproposedto
increasethevolumeofthealveolarprocess,
tofacilitatearchdevelopment,
topreventoreventreatfenestrations.
Oliveira D, Oliveira B. F, Rodrigo VS. Alveolar corticotomiesin orthodontics: Indications and effects on tooth movement.
Dental Press J Orthod2010 July-Aug;15(4):144-57.
46

47. HOW DOES CORTICOTOMY WORK ?
Localinjurytothealveolarprocessreducesresistancetotooth
movementandgeneratesRapidAcceleratoryPhenomenon.
•In2001,Wilckoreportedthattheaccelerationoftooth
movementisnotduetothebonyblockmovementas
postulatedbyKole.
•Itwasratheraprocessofboneremodelingatthesurgicalsite,
whichwascalledregionalacceleratoryphenomenon.
Nimeriet al. Acceleration of tooth movement during orthodontic treatment -a frontier in Orthodontics.
Progress in Orthodontics 2013, 14:42
47

48. RAPID ACCELERATORY
PHENOMENON
Theregionalacceleratoryphenomenon(RAP)isa
tissuereactiontoanoxiousstimulusthatincreases
thehealingcapacitiesoftheaffectedtissues.
Itistypicalnotonlyofhardtissuessuchasbone
andcartilage,butalsoofsofttissues.
Atthetissuelevel,theRAPischaracterizedbythe
productionofwovenbone,withthetypical
unorganizedpattern,thatwillbereorganizedinto
lamellarboneatalaterstage.
Verna C. Regional Acceleratory Phenomenon.Front Oral Biol.2016;18:28-35.
48

49. HeraldFrostcollectivelymentionedtheeventsin
physiologichealingandcalleditas“TheRegional
acceleratoryphenomenon”.
Followingsurgicalinjuryinhumanbone,RAPbegins
withinafewhours,maximumactionisusuallyreachedin
1-2monthsandusuallymaytake6-24monthsto
complete.
NishaN. et al. Wilckodontics-A Magical Wand for Rapid Success-A Review. Annals of International Medical and Dental
Research, Vol(1), Issue (3)
49

50. Applicationoforthodonticforcecanstimulateortrigger
mildRAPactivity.
RAPcanbemaximizedwhenselectivedecorticationis
combinedwithtoothmovement.
NishaN. et al. Wilckodontics-A Magical Wand for Rapid Success-A Review. Annals of International
Medical and Dental Research, Vol(1), Issue (3)
50

51. SURGICAL TECHNIQUE
1.Flapdesign
Fullthicknessflapiselevatedtowardsthecoronalaspect
andpartialthicknesstowardstheapicalportionto
avoidtensionatthetimeofclosure.
NishaN. et al. Wilckodontics-A Magical Wand for Rapid Success-A Review. Annals of International Medical and Dental
Research, Vol(1), Issue (3)
51

52. 2.Decortication
Corticotomiesaredoneinmidinterdentalareas,usingno2
carbideburwhichareconnectedwithcircularcuts.
NishaN. et al. Wilckodontics-A Magical Wand for Rapid Success-A Review. Annuals of International Medical and
Dental Research, Vol (1), Issue (3)
52

53. 3.BoneGraft
Commonlyde-proteinizedbovinebone,decalcifiedfree-
driedboneallograftandautogenousbonegraftsare
used.
NishaN.etal.Wilckodontics-AMagicalWandforRapidSuccess-AReview.AnnalsofInternationalMedicaland
DentalResearch,Vol(1),Issue(3)
53

54. 4.Primaryclosure
Forpredictableboneaugmentation,flapshouldbeclosed
withoutexcessivetension.Flapisusuallysuturedatthe
midlineintheinterproximalareasfollowedbyotherareas.
NishaN. et al. Wilckodontics-A Magical Wand for Rapid Success-A Review. Annals of International
Medical and Dental Research, Vol(1), Issue (3)
54

55. Advantages
1.Corticotomyprocedurecausesminimalchangesinthe
periodontalattachmentapparatus.
2.Ithasbeenprovensuccessfullybymanyauthorsto
acceleratetoothmovement.
3.Bonecanbeaugmented;therebypreventingperiodontal
defects.
ShrikanthB.etal.MethodsofAcceleratingorthodontictreatment–AReview.JournalofAppliedDental
andMedicalSciences.2016;2(1):15-20
55

56. Disadvantages
1.Invasiveprocedureleadingtohighmorbidity.
2.Chancesofdamagetoadjacentvital
structures.
3.Postoperativepainandswelling.
4.Chancesofinfectionoravascularnecrosis.
5.Lowacceptancebythepatient.
56

57. PIEZOCISION TECHNIQUE
57

58. Dibartin2009wasamongthefirsttoapplythe
Piezocisiontechnique.
Itstartswithprimaryincisionplacedonthebuccalgingiva
byPiezosurgicalknifetothebuccalcortexandinitiatethe
regionalacceleratoryphenomenon.
MittalS.K.,SharmaR,SinglaA.PiezocisionAssistedOrthodontics:Anewapproachtoaccelerated
orthodontictoothmovement.JournalofInnovativeDentistry2011;Vol1,(1):201-210
58

59. Technique
Asmallverticalincisionismadebuccallyand
interproximally.
Thismid-levelincision,betweentherootsoftheteeth
willallowfortheinsertionofthepiezoelectricknife.
ThetipofthePiezotomeisinsertedinthegingival
openingspreviouslymadeanda3mmdeep
piezoelectricalcorticotomyisdone.
Dibart, Serge et al. Piezocision™-assisted orthodontics: Past, present, and future. Seminars in Orthodontics , Volume 21 ,
Issue 3 , 170 -175
59

60. Thedecorticationhastopassthecorticallayerandreach
themedullarybonetogetthefulleffectoftheregional
acceleratoryphenomenon(RAP).
Dibart,Sergeetal.Piezocision™-assistedorthodontics:Past,present,andfuture.SeminarsinOrthodontics,Volume21,
Issue3,170-175
60

61. Thepatientisseeneveryoneortwoweeksaftersurgery
bytheorthodontist.
Thisresultsinfastertoothmovementandearly
completionoftreatment.
Afterthe5thor6thmonthoftreatment,thetooth
movementappearstoslowdown.
Dibart,Sergeetal.Piezocision™-assistedorthodontics:Past,present,andfuture.SeminarsinOrthodontics,Volume21,
Issue3,170-175
61

62. Clinical Applications
Generalized:Ifthecorrectionofthemalocclusionrequires
movingalloftheteethinbothmaxillaandmandibleatthe
sametime.
Localized:Ifthemalocclusionaffectsonlyonepartofthe
dentitionoronearch(i.e.Ananteriorcrowdingcasewitha
perfectposteriorocclusion,singletoothextrusionsintrusions,
etc.)
Dibart,Sergeetal.Piezocision™-assistedorthodontics:Past,present,andfuture.SeminarsinOrthodontics,Volume21,
Issue3,170-175
62

63. Sequential:Ifthecorrectionofthemalocclusion
requiresa“staged”approach,whereselected
areasorsegmentofthearcharebeing
demineralizedatdifferenttimesduring
orthodontictreatmenttohelpachievespecific
results.
63

64. Contra-Indications:
1.Medicallycompromisedpatients
2.Patientstakingdrugsmodifyingnormalbonephysiology
(i.e.biphosphonates)
3.Bonepathology
4.Ankylosedteeth
5.Non-compliantpatients
6.Patientand/oroperatorhavingapacemakeroranyother
activeimplant.
Dibart, Serge et al. Piezocision™-assisted orthodontics: Past, present, and future. Seminars in Orthodontics , Volume 21 ,
Issue 3 , 170 -175
64

65. MICRO-OSTEOPERFORATIONS65

66. Micro-traumaintheformofmicro-osteoperforations
(MOPs)willamplifytheexpressionofinflammatory
markers.
Inhumansubjects,MOPsincreasedtherateofcanine
retractionconcomitantwithincreasedTNFandIL-1levels
ingingivalcrevicularfluid.
Thedeviceusedduringthetreatmentwasdesignedby
PropelOrthodontics.
Alikhani,Manietal.Micro-osteoperforations:Minimallyinvasiveacceleratedtoothmovement
SeminarsinOrthodontics2015,Volume21;(3):162-169
66

67. Advantages
Moreefficientapproachtoacceleratetooth
movement.
Lessinvasivethanpiezoincisionorcorticotomy
Repeatableasneededbyorthodontist
Limitedpainordiscomfort
67

68. DEVICE-ASSISTED TREATMENT
Cyclicalforcedeviceeffectontooth
movement.
Directelectriccurrenteffectontooth
movement.
Photobiostimulation
68

69. Cyclical force device effect on
tooth movement.
Low-levelmechanicaloscillatorysignals(vibrations)havebeen
showntoincreasetherateofremodelinginmechanicalloaded
longbones.
Dynamicloadingimprovesboneformationandincreases
orthodontictoothmovementcomparedtoastaticforce.
Pavlin,Dubravkoetal.Cyclicloading(vibration)acceleratestoothmovementinorthodonticpatients:Adouble-blind,
randomizedcontrolledtrial.SeminarsinOrthodontics,Volume21,Issue3,187-194
69

70. AcceleDent®device
AcceleDentisadevice
thatusessoftpulse
technologyandcyclic
forcestoacceleratethe
movementofteeth.
Pavlin, Dubravkoet al.Cyclicloading (vibration) accelerates tooth movement in orthodontic patients: A double-blind, randomized
controlled trial. Seminars in Orthodontics 2015 Volume 21 , Issue 3 , 187 -194
70

71. DIRECT ELECTRIC CURRENT
EFFECT ON TOOTH MOVEMENT
71

72. Anotherapproachistousedirectelectriccurrent.
Thistechniquewastestedonlyonanimalsbyapplying
directcurrenttotheanodeatthepressuresitesand
cathodeatthetensionsites(by7V).
Generatedlocalresponsesandaccelerationofbone
remodeling.
Thebulkofthedevicesandthesourceofelectricity
madeitdifficulttobetestedclinically
Nimerietal.Accelerationoftoothmovementduringorthodontictreatment-afrontierinOrthodontics.Progressin
Orthodontics2013,14:42
72

73. ENZYMATICMICROBATTERY
Utilizesglucoseasafueland
enzymeasacatalyst.
Placedonthegingivanearthe
alveolarbone.
KolahiJ,AbrishamiM,DavidovitchZ.Microfabricatedbiocatalyticfuelcells:anewapproachtoacceleratingthe
orthodontictoothmovement.MedHypotheses2009Sep;73(3):340-1
73

74. Acombinedforce–electrictreatmentmayprovidea
powerfulandpracticaltechniqueforenhancingthevelocity
oforthodontictoothmovement,regardlessthetypeofthe
orthodonticappliance.
DISADVANTAGES:
Shortlifespan
Poorpowerdensity
KolahiJ,AbrishamiM,DavidovitchZ.Microfabricatedbiocatalyticfuelcells:anewapproachtoacceleratingthe
orthodontictoothmovement.MedHypotheses2009Sep;73(3):340-1
74

75. LOW LEVEL LASER
THERAPY
75

76. Alsoknownasphotobiostimulation.
Photobiostimulationreferstothealterations,producedby
relativelylowlevelsofirradiationintargettissueswith
littleornotemperaturechanges.
Chung,Seanetal.Photobiostimulationasamodalitytoaccelerateorthodontictoothmovement
SeminarsinOrthodontics2015Volume21,Issue3,195–202.
76

77. Photobiomodulationorlowlevellasertherapy
(LLLT)isoneofthemostpromisingapproaches
today.
Laserhasabiostimulatoryeffectonbone
regeneration.
Nimerietal.Accelerationoftoothmovementduringorthodontictreatment-afrontierinOrthodontics.
ProgressinOrthodontics2013,14:42
77

78. Twophotobiostimulationmodalities:
LOW-LEVELLASERTHERPAY(LLLT)
LIGHTEMITTINGDIODES(LED)
Bothtypesofapplicationsutilizeanear-infrared
wavelengthofapproximately600-1000nm.
Therelativelynarrowwavelengthrangeallowsfor
greaterabsorptionbytargettissues.
Chung,Seanetal.Photobiostimulationasamodalitytoaccelerateorthodontictoothmovement
SeminarsinOrthodontics2015Volume21,Issue3,195–202.
78

79. Photobiostimulationisnotassociatedwithany
harmfuleffectsontheperiodontiumandteeth.
Theapparentincreaseintoothmovementcanbe
significantintheclinicprovidedthatmore
rigorousresearch,inbothanimalmodelsand
humans,isconductedtoimprovetheconsistency
andpredictabilityoflaserandLEDtherapy
usage.
Chung,Seanetal.Photobiostimulationasamodalitytoaccelerateorthodontictoothmovement
SeminarsinOrthodontics2015Volume21,Issue3,195–202.
79

80. BioluxOrthoPulse®
OrthoPulseisdevicethat
useslowlevelsoflight
energytostimulatethe
bonesurroundingtheroots
andfacilitatestooth
movementwhichmay
reducetreatmenttimefor
bracesorclearaligners.
KauCH, KantarciA, ShaughnessyT et al.Photobiomodulationaccelerates orthodontic alignment in the early phase of
treatment.Progress in Orthodontics2013, 14:30
80

81. LIPUS
Recently,low-intensitypulsedultrasound(LIPUS)
hasbeenshowntoincreasetherateoftooth
movementinex-vivomandiblesliceorganculture
andinanimalsanddecreaseOITRR.
Ultrasoundisaformofmechanicalenergythatcan
betransmittedthroughdifferenttissuesaspressure
waves.
Thefrequencyofthesewavesisabovethelimitof
humanhearing.
Ultrasoundhasbeenusedinmedicineinsurgical
operation,therapeuticapplication,anddiagnostic.
81
El-Bialy T et al. Effect of Low Intensity Pulsed Ultrasound (LIPUS) on Tooth Movement and Root Resorption: A
Prospective Multi-CenterRandomized Controlled Trial. J Clin Med. 2020;9(3):e804

82. 82

83. AccordingtoMauryaetal,intermittentuseof
LIPUS(atdays0,3,5,7,14,andevery15days
afterward)hadanincreasedrateoftooth
movement.
83
Maurya,R.K.;Singh,H.;Kapoor,P.;Jain,U.;Mitra,R.Effectsoflow-levellaserandlow-intensity
pulsedultrasoundtherapyontreatmentdurationandpainperception.J.Clin.Orthod.2019,53,154–
162.

84. CONCLUSION
Toothaccelerationphenomenonisstillarelatively
newhorizonandresearchershaveyettoseekasingle
mostidealandprudenttechniqueforthepatient.
Thesurgicaltechniqueshavemostofthehumantrials
andalsoshowveryfavorableandlongtermeffects
addingtothestabilityandretentionoftheorthodontic
therapy.Howevertheinvasivenessandcostofthese
mightmakeitlittlelessviableoptionforthepatients.
84

85. Microsteoperforation,Piezocisionontheother
handaretheleastdiscomfortingamongallthe
surgicalprocedures.
Yetatthesametimeanyofthesetechniquesonce
adapteddependinguponclinician’schoiceand
patient’spreference;canprovetobeimmensely
beneficialinreducingorthodontictreatmenttime.
85

86. References
1.AlicjaKacprzak,AdrianStrzecki.Methodsof
acceleratingorthodontictoothmovement:Areview
ofcontemporaryliterature.DentMedProbl.
2018;55(2):197–206
2.Nimerietal.Accelerationoftoothmovement
duringorthodontictreatment-afrontierin
Orthodontics.ProgressinOrthodontics2013,14:42-
50
3.Alansari,Sarahetal.Biologicalprinciplesbehind
acceleratedtoothmovement.Seminarsin
Orthodontics2015,21(3):151-161

87. 4.KrishnanV,DavidovitchZ.Cellular,molecular,and
tissue-levelreactionstoorthodonticforce.AmJOrthod
DentofacialOrthop.2006;129:469.e1–32
5.YamaguchiM.RANK/RANKL/OPG during
orthodontictoothmovement.OrthodCraniofacRes.
2009;12(2):113–9.
6.WilliamProffit.Contemporaryorthodontics.Fifth
edition.Elsevier2013
7.CollinsMK,SinclairPM.ThelocaluseofvitaminD
toincreasetherateoforthodontictoothmovement.Am
JOrthodDentofacialOrthop.1988;94:278–284.

88. 8.KaleS,KocadereliI,AtillaP,AsanE.Comparisonof
theeffectsof1,25dihydroxycholecalciferoland
prostaglandinE2onorthodontictoothmovement.AmJ
OrthodDentofacialOrthop.2004;125(5):607–14
9.SomaS,MatsumotoS,HiguchiY,etal.Localand
chronicapplicationofPTHacceleratestoothmovement
inrats.JDentRes.2000;79(9):1717-24.
10.LiouandHuang.Rapidcanineretractionthrough
distractionoftheperiodontalligament.AmJOrthod
DentofacialOrthop1998;114:372-82.

89. 11.SukuricaY,KaramanA,GurelHG,DolanmazD.Rapid
caninedistalizationthroughsegmentalalveolardistraction
osteogenesis.AngleOrthod.2007;77(2):226–36
12.AlmpaniK,KantarciA.SurgicalMethodsforthe
AccelerationoftheOrthodonticToothMovement.Front
OralBiol2016.
13.OliveiraD,OliveiraB.F,RodrigoVS.Alveolar
corticotomiesinorthodontics:Indicationsandeffectson
toothmovement.DentalPressJOrthod2010July-
Aug;15(4):144-57.
14.VernaC.RegionalAcceleratoryPhenomenon.Front
OralBiol.2016;18:28-35.

90. 15.NishaN.etal.Wilckodontics-AMagicalWandfor
RapidSuccess-AReview.AnnalsofInternational
MedicalandDentalResearch,Vol(1),Issue(3)
16.ShrikanthB.etal.MethodsofAccelerating
orthodontictreatment–AReview.JournalofApplied
DentalandMedicalSciences.2016;2(1):15-20
17.MittalS.K.,SharmaR,SinglaA.Piezocision
AssistedOrthodontics:Anewapproachtoaccelerated
orthodontictoothmovement.JournalofInnovative
Dentistry2011;Vol1,(1):201-210

91. 18.Dibart,Sergeetal.Piezocision™-assisted
orthodontics:Past,present,andfuture.Seminarsin
Orthodontics,Volume21,Issue3,170-175
19.Alikhani,Manietal.Micro-osteoperforations:
Minimallyinvasiveacceleratedtoothmovement.
SeminarsinOrthodontics2015,Volume21;(3):162–
169
20.Pavlin,Dubravkoetal.Cyclicloading(vibration)
acceleratestoothmovementinorthodonticpatients:A
double-blind,randomizedcontrolledtrial.Seminarsin
Orthodontics,Volume21,Issue3,187-194

92. 21.KolahiJ,AbrishamiM,DavidovitchZ.
Microfabricatedbiocatalyticfuelcells:anewapproach
toacceleratingtheorthodontictoothmovement.Med
Hypotheses2009Sep;73(3):340-345
22.Chung,Seanetal.Photobiostimulationasamodality
toaccelerateorthodontictoothmovement.Seminarsin
Orthodontics2015Volume21,Issue3,195–202.
23.KauCH,KantarciA,ShaughnessyTet
al.Photobiomodulationacceleratesorthodontic
alignmentintheearlyphaseoftreatment.Progressin
Orthodontics2013,14:30

93. 25.Maurya,R.K.;Singh,H.;Kapoor,P.;Jain,U.;Mitra,
R.Effectsoflow-levellaserandlow-intensitypulsed
ultrasoundtherapyontreatmentdurationandpain
perception.J.Clin.Orthod.2019,53,154–162.
26 El-Bialy T et al. Effect of Low Intensity Pulsed
Ultrasound (LIPUS) on Tooth Movement and Root
Resorption: A Prospective Multi-CenterRandomized
Controlled Trial. J Clin Med. 2020;9(3):e804
93

94. Thankyou
94