Methods of Accelerating orthodontic treatment – A Review

Prolonged treatment duration is one of the main deterants in orthodontics. Lengthy orthodontic treatment prompts many patients, especially adults, to either avoid treatment or to seek shorter alternative solutions with compromised results. Therefore, the treatment modalities that decrease treatment time without compromising the treatment outcome is an active area of research in orthodontics today.Various methods have been introduced to enhance the rate of tooth movement which include surgical methods, mechanical stimulation methods and some drugs.The aim of this article is to enumerate and discuss different methods to accelerate orthodontic tooth movement. Introduction The Prolonged treatment duration is one of the main deterants in orthodontics. Lengthy orthodontic treatment prompts many patients, especially adults, to either avoid treatment or to seek shorter alternative solutions with compromised results. Therefore, the treatment modalities that decrease treatment time without compromising the treatment outcome is an active area of research in orthodontics today . [1] Fixed orthodontic treatment can last upto 2 to 3 years which further poses the risk of complications associated with the treatment such as external root resorption, periodontal problems and patient compliance. Clinicians are constantly striving towards developing potential strategies to enhance the rate of orthodontic tooth movement. [2] Recently, numerous methods have been proposed to enhance the rate of orthodontic tooth movement so that faster and better treatment options can be provided to the patients. The aim of this article is to enumerate and discuss different methods to accelerate orthodontic tooth movement and also to discuss advantages and shortcomings of each method. Methods to accelerate orthodontic tooth movement can be discussed under the following categories: 1. Surgical Methods. 2. Device assisted therapy or Mechanical stimulation methods. 3. Drugs. 1. Surgical Methods The surgical technique has been documented in many case reports. It is a clinically effective technique used for adult patients, where duration of orthodontic treatment may be critical. Periodontal ligament (PDL) and alveolar bone remodeling are the important METHODS OF ACCELERATING ORTHODONTIC TREATMENT 2(1);2016 177 Journal Of Applied Dental and Medical Sciences 2(1);2016 parameters in tooth movement and bone turnover is known to increase after bone grafting, fracture, and osteotomy. Several surgical approaches that have been tried in order to accelerate tooth movement are Corticotomy and Piezocision technique. [3] The idea of surgical acceleration came into being after the introductionof Regional Acceleratory Phenomena (RAP) by Frost in 1983. RAP is a local response to noxious stimulus, by which tissue forms faster than the normal regional regeneration process. This phenomenon causes healing to occur 2–10 times faster than normal physiologic healing by enhancing the various healing stages. [4] Corticotomy It was first tried inorthodontics by Kole. [5] Conventional corticotomy is one of the surgical procedures that is commonly used, in which only the cortical bone is cut and perforated but not the medullary bone. This will reduce the resistance of the cortical bone and accelerate tooth movement.It was suggested that bony blocks were created as a result of the corticotomy, hence causing faster tooth movement. [5] The conventional corticotomy procedure involves elevationof full thickness mucoperiosteal flaps, bucally and/orlingually, followed by placing the corticotomy cuts using eithermicromotor under irrigation, or piezosurgical instruments.This can be followed by placement of a graft material,wherever required, to augment thickness of bone. [6] Until 2001, the “bony block” concept prevailed as a misconception. However, Wilcko et al 7 reported that tooth movement was not the result of bony block, but rather a process of transient remineralization/demineralization which is a concept of reversible osteopenia in the bony alveolar housing consistent with wound healing pattern of RAP. He also introduced the term “bone matrix transportation” and developedpatent techniques which were called Accelerated OsteogenicOrthodontics (AOO) and Periodontal AcceleratedOsteogenic Orthodontics. Modification of RAP wasdone by adding bioabsorbable grafting material over theinjured bone to enhance healing. [7] Advantages 1. Corticotomy procedure causes minimal changes in theperiodontal attachment apparatus. [8] 2. It has been proven successfully by many authors to accelerate tooth movement. [6,9] 3. Bone can be augmented; thereby preventing periodontal defects. [10] Disadvantages 1. Invasive procedure leading to high morbidity. 2. Chances of damage to adjacent vital structures. 3. Postoperativepain and swelling. 4. Chances of infection or avascularnecrosis. 5. Low acceptance by the patient. 11]