Accelerated orthodontic tooth movement: surgical techniques and the regional acceleratory phenomenon

Abstract

Background: Techniques to accelerate tooth movement have been a topic of interest in orthodontics over the past decade. As orthodontic treatment time is linked to potential detrimental effects, such as increased decalcification, dental caries, root resorption, and gingival inflammation, the possibility of reducing treatment time in orthodontics may provide multiple benefits to the patient. Another reason for the surge in interest in accelerated tooth movement has been the increased interest in adult orthodontics.

Review: This review summarizes the different methods for surgical acceleration of orthodontic tooth movement. It also describes the advantages and limitations of these techniques, including guidance for future investigations.

Conclusions: Optimization of the described techniques is still required, but some of the techniques appear to offer the potential for accelerating orthodontic tooth movement and improving outcomes in well-selected cases.

Keywords: Corticision; Microosteoperforations; Periodontally accelerated osteogenic orthodontics (PAOO); Piezocision; Regional acceleratory phenomenon.

Fig. 1

Schematic representation of the surgical procedure for rapid canine distraction (redrawn from Liou, 1998)

Fig. 2

A rapid canine distraction device was designed by Drs. Keser and Pober (patent pending) to overcome some of the disadvantages of the dental distractors

Fig. 3

Application of the Canine distractor. Activation begins immediately after the surgical procedure and activation is at a rate of 0.35 mm twice per day. Power chain is placed on the lingual aspect to prevent rotation during the movement

Fig. 4

Wilcko and Wilcko PAOO. a Corticotomies, vertical lines and dots. b DFDBA placement

Fig. 5

a Minimal vertical interproximal incisions on the buccal aspect to provide access to the piezosurgical knife. b Corticotomies are performed with a Piezoelectrical surgical knife (BS1 insert, Piezotome, Satelec Acteon Group, Merignac, France) through the gingival incision in the bone, with a depth of 3 mm to pass the cortical plate. c Where bone grafting is needed a small periosteal elevator is used to create a tunnel which will accommodate the bone graft

Fig. 6

Propel device by Propel Orthodontics, USA. It has a surgical tip 1.6 mm in diameter and a usable length of up to 7.0 mm

Fig. 7

Propel handheld disposable device used for MOPs (Alikhani, 2013)

Fig. 8

Case report (Dibart, 2009). a Pretreatment frontal view. b Post-treatment frontal view. c Tunnelling of areas to be grafted with bone. d Bone grafting. e Sutures in place

Fig. 9

a Piezocision surgical guide planning, showing the ideal angulation/insertion of the piezoelectric knife (design by Dr. Keser). b Application of the surgical guide digitally created to guide piezocision surgery for a patient being treated by clear aligners

Fig. 10

Percentage of bone demineralization over time in the three experimental groups: piezocision alone (PS), piezocision and tooth movement (PS+TM), tooth movement alone (TM) (from Dibart et al. [54].)