Throughout the world, orthodontic treatment is used to correct the position of teeth in adolescents and adults when they experience problems. Braces are orthodontic appliances made up of brackets glued to the teeth and then connected by wires in order to exert pressure on the teeth to move them and improve their positioning. Depending on the problem, the length of time for treatment may range from several months to several years. However, on average, most treatments take around 24 months. Accelerating the rate of tooth movement may help to reduce the length of time needed for a course of treatment and may reduce the unwanted effects of orthodontic treatment that can sometimes occur, such as tooth decay and the shortening of the tooth root. Several methods, including surgical and non-surgical treatments, have been suggested to accelerate orthodontic tooth movement. The evidence relating to non-surgical procedures to accelerate orthodontic tooth movement is assessed in this review.
What was the research?
A systematic review of the evidence to find what effect do non-surgical adjuncts have on the length of time it takes for teeth to move when treated with fixed braces, and the overall time required for orthodontic treatment.
Who conducted the research?
The research was conducted by a team led by Ahmed El-Angbawi from the School of Dentistry at the University of Dundee, on behalf of the Cochrane Oral Health Group. Grant T. McIntyre, Padraig S. Fleming and David R. Bearn were also on the team.
What evidence was included in the review?
Data was extracted from two randomised controlled trials, with 111 participants in total. In one study, the age of participants ranged from 11 to 15 years old, and in the second, the average age of participants was 21 years. The studies evaluated the additional use of two devices that use light vibrational forces – Tooth Masseuse in people receiving conventional fixed appliance treatment during the tooth alignment stage and OrthoAccel for those receiving conventional fixed appliance treatment for the space closure stage in orthodontic treatment. Participants receiving additional treatment with the devices were compared to those receiving only the conventional treatment. The trials evaluated different aspects of orthodontic tooth movement and side effects.
What did the evidence say?
The studies evaluated three outcomes: rate of tooth movement; patient perception of pain and discomfort, and unwanted side effects. There were substantial differences between the studies, which meant that we were unable to combine the results.
From the limited evidence available, it is not possible to establish if the use of vibrational forces during treatment with fixed orthodontic appliances has a significant beneficial or harmful effect on either the rate of orthodontic tooth movement or the duration of treatment.
How good was the evidence?
The quality of evidence was very low.
What are the implications for dentists and the general public?
There is insufficient evidence to conclude whether or not there is a positive effect of non-surgical adjunctive methods to accelerate tooth movement. Although there have been claims that there may be a positive effect of light vibrational forces, the results of the current studies do not reach either statistical or clinical significance and are at high risk of bias.
What should researchers look at in the future?
There is a clear need for well-designed and reported randomised clinical studies of the proposed non-surgical adjunctive methods to accelerate tooth movement. Future studies need to have sufficient number of participants to detect any clinically and statistically significant differences.
El-Angbawi A, McIntyre GT, Fleming PS, Bearn DR. Non-surgical adjunctive interventions for accelerating tooth movement in patients undergoing fixed orthodontic treatment. Cochrane Database of Systematic Reviews 2015, Issue 11. Art. No.: CD010887. DOI: 10.1002/14651858.CD010887.pub2.