Accelerated orthodontics: Perspectives by Seattle orthodontist, Keith B. Wong

Over the last century, numerous orthodontists have continued to improve the efficiency of the technology employed.  One focus has been to increase the effectiveness of tooth movement in a given amount of time, sometimes referred to as “accelerated orthodontics.”  In the 20th century, most of the breakthroughs in making orthodontic treatment shorter had to do with improvements in either materials (e.g. better alloys for wires) or appliance design (e.g. reducing friction).  More recently, technologies that more directly address the body’s ability to respond to orthodontic force have been available.  Following is a summary of these technologies and comments on their clinical use and effectiveness (based upon both scientific studies and the impressions of Seattle orthodontist, Keith B Wong, DDS, MS):

AcceleDent  (Vibration)

AcceleDent was the first FDA-approved appliance to make orthodontic treatment faster.  The explanation of how it works is that AcceleDent “applies precisely calibrated vibrations called micropulses that transmit through the roots of your teeth to the surrounding bone. This gentle vibration helps increase the cellular activity and speeds the rate in which your teeth can move.”  AcceleDent also claims that there is less discomfort associated with orthodontics when using the device.  My experience with AcceleDent is that it can help Invisalign patients move through their aligners somewhat quicker (due to the vibrational seating of the aligners, thereby making them more active) and it does reduce discomfort, however, the bulk of scientific studies into AcceleDent do not support its ability to accelerate orthodontic movement per se.  For this reason, I do not recommend AcceleDent currently.

OrthoPulse (Photobiomodulation)

OrthoPulse is the first FDA-approved appliance to use light (near-infrared, nIR) to achieve accelerated orthodontics.  The explanation of how it works is that OrthoPulse delivers energy via photons of nIR light to the mitochondria of the bone and tissues  to help create more energy (in the form of ATP) to supply the biological processes involved in orthodontic tooth movement.  It also is claimed to reduce discomfort associated with orthodontics.  In the case of OrthoPulse, studies do consistently show statistically significant and clinically significant increases in the rate of orthodontic tooth movement with both Invisalign and traditional orthodontic appliances.  I have seen this clinically along with apparent reduction of orthodontic discomfort.  I do make OrthoPulse an option for patients that choose to reduce treatment length, however, it is important to note that appliance-based acceleration necessitates consistent daily use (typically 5 minutes per arch with OrthoPulse).  While OrthoPulse works well to move teeth faster in simple, routine, and somewhat challenging cases, when extremely challenging tooth movements are required, I would not depend on OrthoPulse alone.

Periodontally Accelerated Osteogenic Orthodontics (PAOO or aka “Wilckodontics”)

PAOO is a procedure, rather than an appliance, which achieves accelerated orthodontics, although I tend to employ PAOO for its significant effect in improving the volume of bone supporting teeth and the long-term health of the periodontium.  In short, PAOO is a periodontal/oral surgery (done by a periodontist or oral surgeon) to effect biochemical responses from the local tissues that result in significantly accelerating the process of bone remodeling (which is the primary process associated with orthodontics).  During the procedure, plentiful amounts of mineralized matrix is placed where the bone is not currently sufficient to support teeth, then teeth are orthodontically moved into that matrix, which has the effect of transforming it into robust, living bone that supports the newly positioned teeth.  As I mentioned, I use PAOO primarily to augment the periodontal support in order to move teeth into areas that do not have enough bone (for example, cases where facial aestheics prohibit the extraction of teeth but straightening the crowded teeth alone would push them OUTSIDE the existing bone).  In unique cases, we have recommended PAOO for accelatory reasons, but the procedure is more invasive than using an appliance and should be considered thoroughly.

Propel (Microosteoperforation, MOP)

Propel refers to procedure that is performed by the orthodontist (or another practitioner) with a specific device.  It is a localized relative of the PAOO, but on a much smaller scale.  Very small perforations are made through anesthetized gum tissue into the outer plate of the bone that holds the teeth.  The act of perforating the bone results in biochemical response that enhances bone remodeling around each site (to one centimeter in diameter).  The perforation procedure is quick (approximately one minute per perforation) and no stitches are required, thus it is much less invasive than the PAOO.  This enhanced bone remodeling makes tooth movement faster but I prescribe it generally to make large or challenging tooth movements more reliable and predictable.   Especially in adult patients, using the Propel procedure often means the difference between successfully moving the tooth orthodontically versus needing to consider surgical movement of the teeth and bone.

VPro5 (Vibration)

VPro5 is a vibrational accelerating appliance made by Propel.  It vibrates at a higher frequency than AcceleDent, which studies suggest may accelerate tooth movement more effectively, however, Propel markets the VPro5 for aligner seating, discomfort reduction, and to help extend the effective life of the Propel procedure, which is usually 4-6 months.  I have found that the VPro5 does seat aligners and reduce discomfort.  We are now giving them to some patients post-Propel to see if they do seem to extend the effects.  I have not seen any studies addressing this use.

As one can see, there are significant differences between the various approaches to “accelerated orthodontics” and communication with an experienced clinician that has used them is recommended before opting to utilize them.

For more information from the manufacturers/proponents: