Effect of extracorporeal shockwave therapy (ESWT) on pulpal blood flow after orthodontic treatment: a randomized clinical trial

Translational Applications of Extracorporeal Shock Waves in Dental Medicine: A Literature Review

Extracorporeal shock wave therapy (ESWT) has been studied and applied extensively in medical practice for various applications including musculoskeletal, dermal, vascular, and cardiac indications. These indications have emerged from primary ESWT use in treating urolithiasis and cholelithiasis. Likewise, dental medicine has had its share of utilizing ESWT in various investigations. This review aimed to provide an up-to-date summary of ESWT use in preclinical and clinical dental medicine. There is growing interest in ESWT use stemming from its non-invasiveness, low cost, and safe qualities in addition to its proven regenerative biostimulating aspects. Targeted tissue and parameters of ESWT delivery continue to be an integral part of successful ESWT treatment to attain the clinical value of the anticipated dose’s effect.

Orthodontic force and extracorporeal shock wave therapy: Assessment of orthodontic tooth movement and bone morphometry in a rat model

OBJECTIVE

The objective was to investigate the effect of extracorporeal shock wave therapy (ESWT) on the magnitude of orthodontic tooth movement, in a rat model, based on a previously established treatment protocol.

DESIGN

In conjunction with orthodontic force commencement, rats underwent ESWT. The amount of tooth movement along with different microarchitectural parameters were measured after three weeks by means of microcomputed tomography. In addition, the percentage of cells expressing vascular endothelial growth factor, the number of tartrate-resistant acid phosphatase (TRAP) positive cells/area and blood vessel density were evaluated both for the pressure and tension sides.

RESULTS

The addition of ESWT to the orthodontic force after three weeks more than doubled the average tooth movement. The addition of ESWT on the pressure side induced a significant decrease in volumetric bone mineral density. Blood vessel density and the number of TRAP positive cells were higher after the application of ESWT.

CONCLUSION

The induction of ESWT during orthodontic tooth movement in a rat model increases the rate of tooth movement by accelerating bone resorption on the pressure side and possibly enhances bone formation on the tension side.

Dose-related effects of extracorporeal shock waves on orthodontic tooth movement in rabbits

The purpose of this animal study is to investigate the quantitative effects of extracorporeal shock waves applied at two different impulses and with two different applicators on orthodontic tooth movement. Thirty-five New Zealand rabbits were randomly divided into five groups (n = 7): the four experimental extracorporeal shock wave groups-focused/500 impulses, focused/1000 impulses, unfocused/500 impulses, and unfocused/1000 impulses-and the control group. Orthodontic tooth movement was achieved by application of reciprocal force between two maxillary incisors. In the experimental groups, animals received 500 or 1000 impulses of extracorporeal shock waves at 0.19 mJ/mm² with focused or unfocused applicators depending on the group to which they belonged. These experiments were conducted on days 0, 7, and 14. Orthodontic tooth movement was measured with 0.01 mm accuracy at one-week intervals. On days 7 and 21, the bone-specific alkaline phosphatase levels were measured from blood samples. After 21 days, the animals were sacrificed and the area between the two maxillary incisors was stereologically examined. Orthodontic tooth movement in the focused/500 impulses and focused/1000 impulses groups was significantly increased compared to the control group. A significant difference in bone-specific alkaline phosphatase levels between the unfocused/500 impulses and control groups was found at 21st day. Stereological analysis showed that there were significant increases of the formation of new bone, connective tissue, and vessels in the experimental groups. The application of extracorporeal shock waves, especially with a focused applicator, could accelerate orthodontic tooth movement.

Extracorporeal shock wave therapy (ESWT) may be helpful in the osseointegration of dental implants: A hypothesis

In recent decades, with the rapid development of dental implant technology, dental implants have been widely used in clinical practice. Various complications, including a lack of osseointegration, may occur after dental implantation. However, the occurrence of osteointegration failure after dental implantation is often complicated and unpredictable, and existing treatment methods cannot reverse osteointegration failure to achieve the optimum condition. A noninvasive, easy-to-operate, low-cost, fast-acting mechanotherapy is expected to solve this problem. Extracorporeal shock wave therapy (ESWT) is widely used to treat delayed healing, bone nonunion fractures, femoral head necrosis and other orthopedic diseases and plays a significant role in promoting bone regeneration. Studies have shown that ESWT can promote bone formation and osseointegration of titanium devices in vivo. In previous experiments, ESWT was found to regulate the activity of inflammatory cells, osteoblasts and mesenchymal stem cells. Studies have also mentioned the role of ESWT in promoting angiogenesis and bactericidal activity. Therefore, our hypothesis is that extracorporeal shock wave therapy can facilitate the realization of osteointegration by regulating the immune response, inducing regeneration of the jaw and alveolar bone, and promoting angiogenesis and bactericidal efficacy.

Coupling between Osseointegration and Mechanotransduction to Maintain Foreign Body Equilibrium in the Long-Term: A Comprehensive Overview

The permanent interaction between bone tissue and the immune system shows us the complex biology of the tissue in which we insert oral implants. At the same time, new knowledge in relation to the interaction of materials and the host, reveals to us the true nature of osseointegration. So, to achieve clinical success or perhaps most importantly, to understand why we sometimes fail, the study of oral implantology should consider the following advice equally important: a correct clinical protocol, the study of the immunomodulatory capacity of the device and the osteoimmunobiology of the host. Although osseointegration may seem adequate from the clinical point of view, a deeper vision shows us that a Foreign Body Equilibrium could be susceptible to environmental conditions. This is why maintaining this cellular balance should become our therapeutic target and, more specifically, the understanding of the main cell involved, the macrophage. The advent of new information, the development of new implant surfaces and the introduction of new therapeutic proposals such as therapeutic mechanotransduction, will allow us to maintain a healthy host-implant relationship long-term.