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RAPID ORTHODONTICS :A CRITICAL REVIEW

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Journal of
Dental Science

RAPID ORTHODONTICS- Review

Article
A CRITICAL REVIEW

1
Sandhya Maheshwari, 2Sanjeev Kumar Verma, 3Mohd. Tariq, 4Aditi Gaur
1,2
Professor, 3 Associate Professor, 4 Junior Resident
Department of Orthodontics and Dentofacial Orthopaedics,
Dr. Z. A. Dental College, Aligarh Muslim University, Aligarh, India.

Abstract - Due to increased demand of orthodontic treatment amongst adult patients there has
been a rise in the development of methods to accelerate the orthodontic tooth movement and Keywords -
reduce the overall treatment time. Various methods have been introduced to enhance the rate accelerated orthodontic,
of tooth movement which include the use of low-level laser therapy, pulsed electromagnetic corticotomy, low level laser
fields, electrical currents, Surgical means like corticotomy, dentoalveolar distraction, therapy, RANKL, prostaglandins
periodontal distraction, peizocision and molecular therapies. Amongst these methods the best
results have been obtained through Surgical procedures. Most of these procedures are still in Source of support - Nil
the experimental phase and greater number of clinical trials are required to reinforce these Conflict of interest - Nil
techniques in the clinical practice.

Introduction the cortex, connected with horizontal osteotomy cuts resulted

In today's era there is an increased demand for orthodontic
treatment especially among adult patients. The greatest
concern amongst the patients undergoing orthodontic
treatment is the increased treatment time. Fixed orthodontic
treatment lasts up to 2 to 3 years which further increases the
risk of complications associated with the treatment such as
external root resorption, periodontal problems and patient
compliance. Clinicians are constantly striving towards
developing strategies to enhance the rate of orthodontic tooth
movement. Recently, numerous methods have been proposed
to enhance the rate of orthodontic tooth movement so that
faster and better treatment options can be provided to the
patients. The present article aims to review the different
Surgical and non Surgical techniques which have been
proposed to fasten the rate of orthodontic tooth movement.
Surgical methods :
Over the years various Surgical procedures have been tested
to enhance the rate of tooth movement. Amongst the
numerous modalities Surgical techniques have been found to
be highly effective in reducing the treatment time for
orthodontic therapy. These Surgical procedures can be
performed routinely, but have the limitations of increased
discomfort to the patient and the risk for morbidity. The
commonly used Surgical techniques have been enumerated.
Corticotomy:
Kole et al in the year 1959 gave the concept of corticotomy
combined with orthodontics as a means of reducing treatment
time. Interproximal corticotomy cuts made extending through
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in bony blocks which were considered by Kole to be
responsible for quicker tooth movement.1 Similar attempts
were made by Gantes et al in five adult patients in whom
space closing was attempted with orthodontic forces
following alveolar corticotomy. The mean treatment time for
these patients was 14.8 months, compared with the traditional
treatment time of 28.3 months.2
Wilckodontics - periodontally accelerated osteogenic
orthodontics
Wilcko et al introduced a corticotomy facilitated technique
involving alveolar augmentation. The technique includes
labial and lingual alveolar flaps accompanied with limited
selective corticotomy.(Figure 1). According to Wilcko et al
the accelerated tooth movement in case of corticotomy is due
to increased bone turnover and deccreased bone density.3
When a tooth moves through a healing Surgical site , the
tensional stress on the teeth act in a synergistic manner with
growth factors to redefine local bone mass. This mechanism
was explained by Harold frost as Regional Acceleratory
Phenomenon.4 The corticotomy Surgery elicits a profound
accelerated response in a limited area because of the
demineralization. Sebaoun et al explained the histological
mechanism following corticotomy using a rat model.5 He
suggested that there was a rapid Sciee in the catabolic and
anabolic activity in the alveolar bone and periodontium three
weeks after the corticotomy procedure. The induced increase
in bone turnover and decrease in mineral content of the bone
(demineralization) are conducive to accelerated tooth
movement.
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blood flow. The teeth move in the alveolar bone without any
damage to the periodontal tissues.9

Non Surgical methods :

In contrast to the invasive Surgical procedures a number of
non Surgical methods such as use of devices, vibratory
methods, electromagnetic fields and biological methods
using gene therapy have been developed to provide a rapid
rate of tooth movements. These modalities are limited to the
Figure 1 : Corticotomy for correction of lower anterior few case reports and have not been supported by clinical
crowding trials, thus limiting their application in the present scenario.

Corticision: Periodontal tissue activation by vibration:

Park et al introduced a technique named corticision which
involved cutting the bone using scalpel and mallet through the
gingiva without reflection of a Surgical flap. The trauma to
the bone induced regional acceleratory phenomenon leading
to rapid tooth movement. But this method had its
shortcomings involving dizziness in the patients due to
repeated malleting.6
Peizocision
Peizocision was introduced by Dibart et al in 2010. It involves
peizoelectric microincisions with selective tunneling for
alveolar bone grafting. The bone is Surgically stimulated
followed by placement of grafts which results in a rapid
orthodontic response.7
Nishimura et al evaluated the effect of vibratory forces on rate
of orthodontic tooth movement in maxillary molars of wistar
rats. They observed greater tooth movement in experimental
groups as compared to conventional groups. They also
studied root resorption and concluded that this procedure did
not lead to additional damage to periodontal tissues such as
root resorption.10 On the basis of effect of vibratory cyclical
forces a device has been developed to accelerate tooth
movement which enhances the rate of bone
remodelling(Figure 3).11

Periodontal distraction
Liou et al suggested that rapid orthodontic tooth movement is
a form of distraction osteogenesis of the periodontal ligament.
In 1998, they conducted a clinical experiment and
demonstrated the rapid distalization of 26 canine teeth in
humans using distraction of the periodontal ligament. This
technique was referred to as dental distraction.8 This
procedure is performed in patients requiring premolar
extractions, during which the interseptal bone distal to the
canine is undermined with a bur. Customized distracters are
used to retract the canines into the extraction space.(Figure 2).
Canines can be distalized upto 6mm into the extraction space
during a short period of 3 weeks using this procedure.
Figure 2: Periodontal distractor for canine distalisation after
premolar extraction
Dentoalveolar distraction :
This method is based on the principle of distraction
osteogenesis. The procedure involves corticotomy only on
the alveolar side sparing the palatal side to maintain adequate
Figure 3 : Device with vibratory forces for accelerating tooth
movement
Electrical currents and Pulsed electromagnetic fields:
Electrical currents have been tested experimentally on animal
models and have been found to show accelerated tooth
movement response. Electrical currents generated
peizoelectrically or direct currents have been shown to
enhance the rate of tooth movement. According to
Davidovitch mechanical stress induced electrical potentials in
bone may be the signal activating the cells that participate in
the remodeling process. Also, the electrical stimulation in
conjunction with mechanical force can increases the rate of
tooth movement.12 Pulsed electromagnetic fields are
produced by an integrated circuit embedded in a removable
denture (0.5 mt and 1 hz,V8 hours per day overnight). The
bulkiness of the devices used to generate electric currents is a
major shortcoming of these procedures resulting in their lack
of application during routine practice. 13
Photobiomodulation
A low level light therapy also referred to as
photobiomodulation has been used in the form of near
infrared light with specific wavelength and intensity.(Figure
4) The low intensity light leads an increase in ATP at a

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localized site which induces the cells to undergo a remodeling
process due to an elevated metabolic activity. Cytochrome
oxidase c which is upregulated by infra red light, mediates
ATP production. During the tooth movement , higher ATP
availability leads to rapid turnover of cellsthus resulting in
accelerated tooth movement. Low level light theray also
increases the vascular activity, which would also contribute to
the rapid turnover of the bone and is amenable to light A
clinical trial was conducted by Cruz et al using this therapy in
which low intensity was directed at the cheeks of orthodontic
patients. The results showed better tooth movement response
measured in the form of little's irregularity index.14 A number
of human trials have also been conducted using low intensity
diode lasers during orthodontic treatment. These studies have
shown an increased rate of tooth movement along with
reduced pain when orthodontic forces were applied.15, 16
Figure 4: Device for low level laser therapy for accelerating
orthodontic treatment
Molecular methods:
Biological factors like prostaglandins, RANKL, vascular
endothelial factors etc have been tested in various
experimental models as non invasive means of enhancing
tooth movement. An increased rate of tooth movement has
been shown in animals on exogenous administration of
prostaglandin highlighting its role in bone resorption during
alveolar bone remodelling.17 Prostaglandin has a direct
action on osteoclasts in increasing their numbers and their
capacity to form a ruffled border and effect bone resorption. It
also stimulates PGE2 also stimulates osteoblastic cell
differentiation and new bone formation, coupling bone
resorption in vitro. Prostaglandins couple bone resorption and
formation, increasing the turnover of bone cells and thus
accelerating the orthodontic tooth movement. Recently
human trials have been conducted showing greater tooth
movement in extraction cases when prostaglandin was
administered.18 Gene therapy has also been proved to be
useful during orthodontic treatment. RANKL is a membrane-
bound protein on the osteoblasts that bind to the RANK on the
osteoclasts and causes osteoclastogenesis. On the other hand,
OPG is a decoy receptor produced by osteoblastic cells, which
compete with RANK for RANKL binding. The biologic
effects of OPG on bone cells include inhibition of terminal
stages of osteoclast differentiation, suppression of activation
of matrix osteoclasts, and induction of apoptosis. Thus, bone
remodeling is controlled by a balance between RANK-
RANKL binding and OPG production.19 It was
demonstrated that the transfer of RANKL gene to the
periodontal tissue induced prolonged gene expression for the
37
enhancement of osteoclastic activity and acceleration of tooth
movements in rats.20Similar experiments were performed
using OPG gene transfer into the periodontium, which
showed significant reduction in the tooth movement. Thus a
balanced delivery of genes such as RANKL and OPG, to the
oral tissues can prove to be beneficial in managing the rate of
the orthodontic treatment.
Conclusion:
Rapid orthodontics is still in its initial phase of development
and requires further research in the form of clinical trials. Of
the various methods Surgical means provide better results but
have the drawback of being invasive in nature. The scope for
the non - invasive methods including molecular therapies is
vast and further explorations in this field would prove to be
beneficial for both the clinicians and the patients.
References:
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correct occlusal abnormalities. Oral Scie Oral Med Oral
Pathol. 1959; 12(5):515-29.
2. Gantes B, Rathbun E, Anholm M: Effects on the
periodontium following corticotomy-facilitated
orthodontics: case reports. J Periodontol 1990;61:234-
238.
3. Wilcko WM, Wilcko T, Bouquot JE, Ferguson DJ. Rapid
orthodontics with alveolar reshaping: two case reports of
decrowding. Int J Periodontics Restorative Dent. 2001;
21(1):9-19.
4. Frost, H.M. The regional acceleratory phenomenon: a
review. Henry Ford Hosp. Med. J. 1983. 31, 3-9.
5. Sebaoun J-D, Ferguson DJ, Wilcko MT, et al:
Corticotomie. Alvolaire et traitements orthodontiques
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paradigm. Kinki Tokai Kyosei Shika Gakkai Gakujyutsu
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Correspondence :
Dr. Aditi Gaur
Department of Orthodontics and Dentofacial Orthopaedics,
Dr. Z. A. Dental College, Aligarh Muslim University,
Aligarh, India.
E mail : aditigaur2289@gmail.com

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