ACCELERATED ORTHODONTICS: THE FUTURE?

accelerated orthodontics ?

When people think about doing something to straighten up their smiles, their big concern is how long it’ll take. There are several reasons this is the number one worry. People naturally prefer fast results, for one thing. We like to see that an effort we’re making gets results. That’s what accelerated orthodontics addresses.

In addition to the natural wish for fast results, there are a few things about braces that are just not pleasant. Sometimes they cause soreness. The appointments are an added demand on patients’ valuable time. Extra effort has to go into keeping braces and teeth clean. Finally, there’s the issue of braces’ effect on personal appearance during treatment.

Newer solutions like “invisible” aligners and tooth-colored ceramic brackets have addressed the appearance concern. Orthodontists are seeing shorter treatment times, in some cases, with the Invisalign technology. Still, the quest for faster results and shorter treatment times goes on. To understand the issues involved in speeding up orthodontic treatment, we need to review how teeth move. Then we can look at the latest developments in this area.

HOW TEETH MOVE

Teeth are set in bone. The lower teeth in the mandible. The upper teeth in the maxilla. Teeth are held in their sockets in two ways. Cementum is a connective tissue that binds a tooth’s root to the gums and bone. A periodontal ligament is a group of fibers holding the tooth to the bone. The fit to the bone is tight. Teeth are not supposed to wiggle when we chew. Thus, changing the position of a tooth means moving it through bone.

If bone were like concrete, this would seem impossible. However, bone is alive. Unlike concrete bone responds and adapts to changing conditions. Simply put, if we apply constant pressure to the left side of a tooth, the bone breaks down and rebuilds itself to adapt. It literally makes way for the tooth to move right. This is called “remodeling”. It’s what makes orthodontics work. The speed of remodeling is, basically, the speed limit for orthodontic treatment. If we try to break this speed limit with more pressure, it causes damage. Enough pressure and it causes avulsion. That is, it knocks the tooth out! This has been the roadbloack to accelerated orthodontics.

In any event, this raises the question of how to increase the speed of bone remodeling in orthodontics. If we can’t break the speed limit, can we increase it? This calls for a closer look at how remodeling happens.

BONE REMODELING

In fact, our bones are remodeling all the time. Older bone tissue is removed in a process called resorption. New bone tissue is added by ossification. This is also how bones are repaired when they’re fractured. Actually, about 10% of an adult’s bone tissue is replaced over a year’s time.  Bones also change their shape and mass to adapt to changes in physical loads. This adaptation is what orthodontists use by applying precise pressure to teeth. As has been noted, this pressure is limited by the speed of the remodeling response. That’s why braces are too slow to suit some people.

Zooming in closer, we learn that two types of bone cells control the remodeling process. Osteoclasts dissolve old bone. Osteoblasts deposit new bone. Close coordination of the activities of these cell types is critical. A signaling system of chemicals including hormones, cytokines, growth factors, and even vitamin D gets this done. These chemicals “tell” the osteoclasts and osteoblasts what to do.

ACCELERATED ORTHODONTICS?

Knowing the details of this chemical signaling suggests an opportunity. What if we could increase levels of the chemicals that step on the remodeling gas pedal? What if we could do this in a way that didn’t require excess pressure on teeth? In fact, this is what some of the latest approaches to accelerated orthodontics are based on.

ACCELEDENT

The Acceledent device uses micropulse technology to deliver gentle vibration to the bones near the teeth. The key finding was that these micropulses stimulate remodeling. Osteoblasts respond to the vibrations, and levels of key remodeling chemicals go up. The speed limit for tooth movement increases because resistance to it goes down.

Researchers first learned that mild stimulation could stimulate jaw bone remodeling for accelerated orthodontics in 1979.  Acceledent reported its first successful treatment in the US in 2010. The device itself is like a mouthpiece that the patient uses at home. For 20 minutes each day, the patient gently bites the mouthpiece and activates the micropulsing. It’s an FDA–approved prescription-only item. Acceledent doesn’t replace braces or aligners. It aims to speed up their effects.

The company claims that Acceledent speeds up treatment with braces or invisible aligners by as much as 50%.  This may or may not be a reasonable expectation for all or even most patients. It’s simply too soon to tell.  There hasn’t been enough research yet. Some findings are positive regarding faster tooth movement. The claim that Acceledent reduces patients’ discomfort during treatment is accepted by many orthodontists and some research. Since Acceledent adds less than $1,000 to the cost of treatment, the comfort effect may be enough for some patients.

PROPEL

The Propel Orthodontics device uses a different method of gently stimulating jaw bone remodeling. In contrast with Acceledent, this in-office treatment makes micro-osteoperforations (MOP) in these bones. In other words, it punches tiny Holes. Researchers found this increases levels of cytokines around the tooth. This stimulates remodeling.

The orthodontist performs this procedure in the office. He/she uses local anesthesia. Patients can resume normal activity right away. It sounds more invasive than it is. These micro-osteoperforations are just that: micro. Moreover, for some patients, the orthodontist does it only once or twice during the whole treatment. Like Acceledent, Propel aims to turbocharge aligners or braces, not replace them.

It is, however, a different approach from the Acceledent. A positive report on the speed-up of treatment appeared in the final 2013 issue of the Journal of the American Orthodontic Society. However, it’s worth noting that in 2016 a federal court in Texas ruled against Proper Orthodontics in a suit filed by the Acceledent makers. The court ordered Propel to stop making certain claims in its advertising while the lawsuit was still going on. From the other side, Propel Orthodontics has asked the US Patent Office to invalidate an Acceledent patent.

The Propel treatment has (according to the company) been adopted by about 5,000 dentists and orthodontists across the USA.  Acceledent has sold over 100,000 of their devices. It’ll be some years until more studies paint a better picture of these two approaches to accelerated orthodontics. Meanwhile, your Lake Worth orthodontist is staying up-to-date in this area. Call to learn more.

There are more drastic surgical approaches to accelerated orthodontics. These are not common, however. Not many practitioners do these procedures.

MEANWHILE

Meanwhile, there are easy ways to speed things up with braces and aligners, there are ways to speed things up. Or at least, keep things from slowing down. Follow your orthodontist’s instructions. Play by the rules for changing elastics, avoiding certain foods, wearing appliances. Keep your appointments! If your braces break, call your orthodontist right away. Whatever you do, don’t try to move your teeth yourself!  Your orthodontist will do his part in the office. If patients do their part at home, treatment time will be as short as it can be.