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. 2023 Jun 20;6(6):CD010887.
doi: 10.1002/14651858.CD010887.pub3.

Non-surgical adjunctive interventions for accelerating tooth movement in patients undergoing orthodontic treatment

Ahmed El-Angbawi  1 , Grant McIntyre  2 , Padhraig S Fleming  3 , David Bearn  2
Affiliations

Non-surgical adjunctive interventions for accelerating tooth movement in patients undergoing orthodontic treatment

Ahmed El-Angbawi et al. Cochrane Database Syst Rev. .

Abstract

Background: Deviation from a normal bite can be defined as malocclusion. Orthodontic treatment takes 20 months on average to correct malocclusion. Accelerating the rate of tooth movement may help to reduce the duration of orthodontic treatment and associated unwanted effects including orthodontically induced inflammatory root resorption (OIIRR), demineralisation and reduced patient motivation and compliance. Several non-surgical adjuncts have been advocated with the aim of accelerating the rate of orthodontic tooth movement (OTM). OBJECTIVES: To assess the effect of non-surgical adjunctive interventions on the rate of orthodontic tooth movement and the overall duration of treatment.

Search methods: An information specialist searched five bibliographic databases up to 6 September 2022 and used additional search methods to identify published, unpublished and ongoing studies.

Selection criteria: We included randomised controlled trials (RCTs) of people receiving orthodontic treatment using fixed or removable appliances along with non-surgical adjunctive interventions to accelerate tooth movement. We excluded split-mouth studies and studies that involved people who were treated with orthognathic surgery, or who had cleft lip or palate, or other craniofacial syndromes or deformities.

Data collection and analysis: Two review authors were responsible for study selection, risk of bias assessment and data extraction; they carried out these tasks independently. Disagreements were resolved by discussion amongst the review team to reach consensus. MAIN RESULTS: We included 23 studies, none of which were rated as low risk of bias overall. We categorised the included studies as testing light vibrational forces or photobiomodulation, the latter including low level laser therapy and light emitting diode. The studies assessed non-surgical interventions added to fixed or removable orthodontic appliances compared to treatment without the adjunct. A total of 1027 participants (children and adults) were recruited with loss to follow-up ranging from 0% to 27% of the original samples. Certainty of the evidence For all comparisons and outcomes presented below, the certainty of the evidence is low to very low. Light vibrational forces Eleven studies assessed how applying light vibrational forces (LVF) affected orthodontic tooth movement (OTM). There was no evidence of a difference between the intervention and control groups for duration of orthodontic treatment (MD -0.61 months, 95% confidence interval (CI) -2.44 to 1.22; 2 studies, 77 participants); total number of orthodontic appliance adjustment visits (MD -0.32 visits, 95% CI -1.69 to 1.05; 2 studies, 77 participants); orthodontic tooth movement during the early alignment stage (reduction of lower incisor irregularity (LII)) at 4-6 weeks (MD 0.12 mm, 95% CI -1.77 to 2.01; 3 studies, 144 participants), or 10-16 weeks (MD -0.18 mm, 95% CI -1.20 to 0.83; 4 studies, 175 participants); rate of canine distalisation (MD -0.01 mm/month, 95% CI -0.20 to 0.18; 2 studies, 40 participants); or rate of OTM during en masse space closure (MD 0.10 mm per month, 95% CI -0.08 to 0.29; 2 studies, 81 participants). No evidence of a difference was found between LVF and control groups in rate of OTM when using removable orthodontic aligners. Nor did the studies show evidence of a difference between groups for our secondary outcomes, including patient perception of pain, patient-reported need for analgesics at different stages of treatment and harms or side effects. Photobiomodulation Ten studies assessed the effect of applying low level laser therapy (LLLT) on rate of OTM. We found that participants in the LLLT group had a statistically significantly shorter length of time for the teeth to align in the early stages of treatment (MD -50 days, 95% CI -58 to -42; 2 studies, 62 participants) and required fewer appointments (-2.3, 95% CI -2.5 to -2.0; 2 studies, 125 participants). There was no evidence of a difference between the LLLT and control groups in OTM when assessed as percentage reduction in LII in the first month of alignment (1.63%, 95% CI -2.60 to 5.86; 2 studies, 56 participants) or in the second month (percentage reduction MD 3.75%, 95% CI -1.74 to 9.24; 2 studies, 56 participants). However, LLLT resulted in an increase in OTM during the space closure stage in the maxillary arch (MD 0.18 mm/month, 95% CI 0.05 to 0.33; 1 study; 65 participants; very low level of certainty) and the mandibular arch (right side MD 0.16 mm/month, 95% CI 0.12 to 0.19; 1 study; 65 participants). In addition, LLLT resulted in an increased rate of OTM during maxillary canine retraction (MD 0.01 mm/month, 95% CI 0 to 0.02; 1 study, 37 participants). These findings were not clinically significant. The studies showed no evidence of a difference between groups for our secondary outcomes, including OIIRR, periodontal health and patient perception of pain at early stages of treatment. Two studies assessed the influence of applying light-emitting diode (LED) on OTM. Participants in the LED group required a significantly shorter time to align the mandibular arch compared to the control group (MD -24.50 days, 95% CI -42.45 to -6.55, 1 study, 34 participants). There is no evidence that LED application increased the rate of OTM during maxillary canine retraction (MD 0.01 mm/month, 95% CI 0 to 0.02; P = 0.28; 1 study, 39 participants ). In terms of secondary outcomes, one study assessed patient perception of pain and found no evidence of a difference between groups. AUTHORS' CONCLUSIONS: The evidence from randomised controlled trials concerning the effectiveness of non-surgical interventions to accelerate orthodontic treatment is of low to very low certainty. It suggests that there is no additional benefit of light vibrational forces or photobiomodulation for reducing the duration of orthodontic treatment. Although there may be a limited benefit from photobiomodulation application for accelerating discrete treatment phases, these results have to be interpreted with caution due to their questionable clinical significance. Further well-designed, rigorous RCTs with longer follow-up periods spanning from start to completion of orthodontic treatment are required to determine whether non-surgical interventions may reduce the duration of orthodontic treatment by a clinically significant amount, with minimal adverse effects.

Trial registration: ClinicalTrials.gov NCT00830947.

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Conflict of interest statement

There are no financial conflicts of interest; the review authors declare that they do not have any association with any parties who may have vested interests in the results of this review.

Figures

1
1
Study flow diagram
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study
3
3
Risk of bias summary: each domain for all included studies
1.1
1.1. Analysis
Comparison 1: Effect of light vibrational forces as an adjunct to orthodontic fixed appliance treatment versus conventional orthodontic fixed appliance treatment (control), Outcome 1: Overall total orthodontic treatment duration: light vibrational forces vs control
1.2
1.2. Analysis
Comparison 1: Effect of light vibrational forces as an adjunct to orthodontic fixed appliance treatment versus conventional orthodontic fixed appliance treatment (control), Outcome 2: Total number of orthodontic appliance adjustment appointments: light vibrational forces vs control
1.3
1.3. Analysis
Comparison 1: Effect of light vibrational forces as an adjunct to orthodontic fixed appliance treatment versus conventional orthodontic fixed appliance treatment (control), Outcome 3: OTM early alignment (4‐6 weeks) in the form of the reduction in the LII index: light vibrational forces vs control
1.4
1.4. Analysis
Comparison 1: Effect of light vibrational forces as an adjunct to orthodontic fixed appliance treatment versus conventional orthodontic fixed appliance treatment (control), Outcome 4: OTM mid alignment (10‐16 weeks) in the form of the reduction in the LII index: light vibrational forces vs control
1.5
1.5. Analysis
Comparison 1: Effect of light vibrational forces as an adjunct to orthodontic fixed appliance treatment versus conventional orthodontic fixed appliance treatment (control), Outcome 5: OTM full alignment in the form of the reduction in the LII index: light vibrational forces vs control
1.6
1.6. Analysis
Comparison 1: Effect of light vibrational forces as an adjunct to orthodontic fixed appliance treatment versus conventional orthodontic fixed appliance treatment (control), Outcome 6: Rate of OTM during space closure en‐masse (maxillary and mandibular arches): light vibrational forces vs control
1.7
1.7. Analysis
Comparison 1: Effect of light vibrational forces as an adjunct to orthodontic fixed appliance treatment versus conventional orthodontic fixed appliance treatment (control), Outcome 7: Rate of OTM during space closure en‐masse (maxillary arch only): light vibrational forces vs control
1.8
1.8. Analysis
Comparison 1: Effect of light vibrational forces as an adjunct to orthodontic fixed appliance treatment versus conventional orthodontic fixed appliance treatment (control), Outcome 8: Rate of OTM during space closure en‐masse (mandibular arch only): light vibrational forces vs control
1.9
1.9. Analysis
Comparison 1: Effect of light vibrational forces as an adjunct to orthodontic fixed appliance treatment versus conventional orthodontic fixed appliance treatment (control), Outcome 9: Rate of OTM during maxillary canine distalisation space closure: light vibrational forces vs control
1.10
1.10. Analysis
Comparison 1: Effect of light vibrational forces as an adjunct to orthodontic fixed appliance treatment versus conventional orthodontic fixed appliance treatment (control), Outcome 10: Patient perception of pain immediately after initial wire ligation: light vibrational forces vs control
1.11
1.11. Analysis
Comparison 1: Effect of light vibrational forces as an adjunct to orthodontic fixed appliance treatment versus conventional orthodontic fixed appliance treatment (control), Outcome 11: Patient perception of pain after 4‐8 hours from the initial archwire ligation: light vibrational forces vs control
1.12
1.12. Analysis
Comparison 1: Effect of light vibrational forces as an adjunct to orthodontic fixed appliance treatment versus conventional orthodontic fixed appliance treatment (control), Outcome 12: Patient perception of pain after 1 day from the initial archwire ligation: light vibrational forces vs control
1.13
1.13. Analysis
Comparison 1: Effect of light vibrational forces as an adjunct to orthodontic fixed appliance treatment versus conventional orthodontic fixed appliance treatment (control), Outcome 13: Patient perception of pain after 3 days from the initial archwire ligation: light vibrational forces vs control
1.14
1.14. Analysis
Comparison 1: Effect of light vibrational forces as an adjunct to orthodontic fixed appliance treatment versus conventional orthodontic fixed appliance treatment (control), Outcome 14: Patient perception of pain after 7 days from the initial archwire ligation: light vibrational forces vs control
1.15
1.15. Analysis
Comparison 1: Effect of light vibrational forces as an adjunct to orthodontic fixed appliance treatment versus conventional orthodontic fixed appliance treatment (control), Outcome 15: Patients' reported need for analgesics during the first week of the initial aligning archwire: light vibrational forces vs control
1.16
1.16. Analysis
Comparison 1: Effect of light vibrational forces as an adjunct to orthodontic fixed appliance treatment versus conventional orthodontic fixed appliance treatment (control), Outcome 16: Patient perception of pain and discomfort immediately after ligation of the second aligning archwire: light vibrational forces vs control
1.17
1.17. Analysis
Comparison 1: Effect of light vibrational forces as an adjunct to orthodontic fixed appliance treatment versus conventional orthodontic fixed appliance treatment (control), Outcome 17: Patient perception of pain after 4‐8 hours from the second aligning archwire ligation: Light vibrational forces vs control
1.18
1.18. Analysis
Comparison 1: Effect of light vibrational forces as an adjunct to orthodontic fixed appliance treatment versus conventional orthodontic fixed appliance treatment (control), Outcome 18: Patient perception of pain after 1 day from the second aligning archwire ligation: light vibrational forces vs control
1.19
1.19. Analysis
Comparison 1: Effect of light vibrational forces as an adjunct to orthodontic fixed appliance treatment versus conventional orthodontic fixed appliance treatment (control), Outcome 19: Patient perception of pain after 3 days from the second aligning archwire ligation: light vibrational forces vs control
1.20
1.20. Analysis
Comparison 1: Effect of light vibrational forces as an adjunct to orthodontic fixed appliance treatment versus conventional orthodontic fixed appliance treatment (control), Outcome 20: Patient perception of pain after 7 days from the second aligning archwire ligation: light vibrational forces vs control
1.21
1.21. Analysis
Comparison 1: Effect of light vibrational forces as an adjunct to orthodontic fixed appliance treatment versus conventional orthodontic fixed appliance treatment (control), Outcome 21: Patients' reported need for analgesics during the first week of the second aligning archwire: light vibrational forces vs control
1.22
1.22. Analysis
Comparison 1: Effect of light vibrational forces as an adjunct to orthodontic fixed appliance treatment versus conventional orthodontic fixed appliance treatment (control), Outcome 22: Orthodontically induced inflammatory root resorption: light vibrational forces vs control
2.1
2.1. Analysis
Comparison 2: Effect of low level laser therapy (LLLT) as an adjunct to orthodontic appliance treatment on OTM versus conventional orthodontic appliance treatment (control), Outcome 1: Orthodontic alignment duration: LLLT vs control
2.2
2.2. Analysis
Comparison 2: Effect of low level laser therapy (LLLT) as an adjunct to orthodontic appliance treatment on OTM versus conventional orthodontic appliance treatment (control), Outcome 2: Number of orthodontic appliance adjustment appointments during the alignment stage: LLLT vs control
2.3
2.3. Analysis
Comparison 2: Effect of low level laser therapy (LLLT) as an adjunct to orthodontic appliance treatment on OTM versus conventional orthodontic appliance treatment (control), Outcome 3: OTM early alignment  (4 weeks)  percentage reduction in the LII: LLLT vs control
2.4
2.4. Analysis
Comparison 2: Effect of low level laser therapy (LLLT) as an adjunct to orthodontic appliance treatment on OTM versus conventional orthodontic appliance treatment (control), Outcome 4: OTM early alignment  (8 weeks) percentage reduction in the LII: LLLT vs control
2.5
2.5. Analysis
Comparison 2: Effect of low level laser therapy (LLLT) as an adjunct to orthodontic appliance treatment on OTM versus conventional orthodontic appliance treatment (control), Outcome 5: Patient perception of pain during maxillary canine retraction:  LLLT vs control
3.1
3.1. Analysis
Comparison 3: Effect of light emiting diode (LED) as an adjunct to orthodontic appliance treatment on OTM versus conventional orthodontic appliance treatment (control), Outcome 1: Duration of orthodontic alignment stage mandibular arch: LED vs control
3.2
3.2. Analysis
Comparison 3: Effect of light emiting diode (LED) as an adjunct to orthodontic appliance treatment on OTM versus conventional orthodontic appliance treatment (control), Outcome 2: OTM space closure canine distalisation/space closure: LED vs control
3.3
3.3. Analysis
Comparison 3: Effect of light emiting diode (LED) as an adjunct to orthodontic appliance treatment on OTM versus conventional orthodontic appliance treatment (control), Outcome 3: Patient perception of pain: LED vs control
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Update of

References

References to studies included in this review

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Caccianiga 2017 {published data only}
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Katchooi 2018 {published data only}
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Kumar 2020 {published data only}
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Lalnunpuii 2020 {published data only}
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Lo Giudice 2020 {published data only}
    1. Lo Giudice A, Nucera R, Leonardi R, Paiusco A, Baldoni M, Caccianiga G. A comparative assessment of the efficiency of orthodontic treatment with and without photobiomodulation during mandibular decrowding in young subjects: a single-center, single-blind randomized controlled trial. Photobiomodulation, Photomedicine and Laser Surgery 2020;38(5):272-9. - PMC - PubMed
Lombardo 2018 {published data only}
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    1. Lombardo L, Arreghini A, Ghislanzoni LTH, Siciliani G. Does low-frequency vibration have an effect on aligner treatment? A single-centre, randomized controlled trial. European Journal of Orthodontics 2019;1(10):1-10. - PubMed
Miles 2012 {published data only}
    1. Miles P, Smith H, Weyant R, Rinchuse DJ. The effects of a vibrational appliance on tooth movement and patient discomfort: a prospective randomised clinical trial. Australian Orthodontic Journal 2012;28(2):213-8. [PMID: ] - PubMed
Miles 2016 {published data only}
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Nahas 2017 {published data only}
    1. Nahas AZ, Samara SA, Rastegar-Lari TA. Decrowding of lower anterior segment with and without photobiomodulation: a single center, randomized clinical trial. Lasers in Medical Science 2017;32(1):129-35. - PubMed
NCT02868554 {published data only}
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Pavlin 2015 {published data only}
    1. NCT00830947. The OrthoAccel (OATI) Celerect Device Pivotal Study - effect of cyclic loading (vibration) on orthodontic tooth movement. clinicaltrials.gov/ct2/show/NCT00830947 (first received 28 January 2009).
    1. Pavlin D, Anthony R, Raj V, Gakunga PT. Cyclic loading (vibration) accelerates tooth movement in orthodontic patients: a double-blind, randomized controlled trial. Seminars in Orthodontics 2015;21(3):187-94.
Reiss 2020 {published data only}
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Siriphan 2019 {published data only}
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Taha 2020 {published data only}
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Telatar 2020 {published data only}
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Woodhouse 2015 {published data only}
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References to studies excluded from this review

Abd 2019 {published data only}
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Abellan 2016 {published data only}
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ACTRN12616000829415 {published data only}
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ACTRN12619001237178 {published data only}
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Al‐Jundi 2018 {published data only}
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AlShahrani 2019 {published data only}
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Celebi 2019 {published data only}
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Cronshaw 2019 {published data only}
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CTRI201804013228 {published data only}
    1. CTRI201804013228. A study to compare the amount of backward movement of teeth between newer lockable kind ofdental brackets and ordinary dental brackets using laser. www.ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=23871 (first received 12 April 2018).
CTRI201804013520 {published data only}
    1. Effect of low-level laser therapy on external root resorption during orthodontic tooth movement- a randomized controlled trial. www.ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=24328 (first received 27 April 2018).
Dalaie 2015 {published data only}
    1. CTRI201707009153. Effect of low level laser therapy on rate of orthodontic tooth movement: a clinical investigation. www.ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=17194 (first received 28 July 2017).
    1. Dalaie K, Hamedi R, Kharazifard MJ, Mahdian M, Bayat M. Effect of low-level laser therapy on orthodontic tooth movement: a clinical investigation. Journal of Dentistry (Tehran University of Medical Science and Health Services) 2015;12(4):249-56. - PMC - PubMed
Elmotaleb 2019 {published data only}
    1. Elmotaleb MAA, Elnamrawy MM, El Sharaby F, Elbeialy AR, ElDakroury A. Effectiveness of using a vibrating device in accelerating orthodontic tooth movement: a systematic review and meta-analysis. Journal of International Society of Preventive & Community Dentistry 2019;9(1):5-12. - PMC - PubMed
Fernandes 2019 {published data only}
    1. Fernandes MRU, Suzuki SS, Suzuki H, Martinez EF, Garcez AS. Photobiomodulation increases intrusion tooth movement and modulates IL-6, IL-8 and IL-1 beta expression during orthodontically bone remodeling. Journal of Biophotonics 2019;12(10):10. - PubMed
Goymen 2020 {published data only}
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References to other published versions of this review

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Publication types

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