Effects of mechanical vibrations on maxillary canine retraction and perceived pain: a pilot, single-center, randomized-controlled clinical trial

Effective mechanical vibration frequency in canine tooth movement acceleration: a systematic review and network meta-analysis of randomized controlled trial studies

OBJECTIVE

This study aims to evaluate the effectiveness of various supplementary vibrational frequencies with orthodontic force on the rate of canine movement.

MATERIALS AND METHODS

A literature search was conducted in PubMed, Embase, Cochrane, Scopus, ClinicalTrials.gov, and Google Scholar, with the final search on February 17, 2025. Randomized controlled trials (RCTs) involving participants undergoing orthodontic treatment with upper first premolar extraction, assessed the effect of different vibration frequencies on canine movement rate were included. Study quality was assessed using the Risk of Bias (RoB) 2. A random-effects model (DerSimonian and Laird method) for pairwise meta-analysis (PMA) and a frequentist-based network meta-analysis (NMA) estimated relative effects, with mean difference (MD) and 95% confidence interval (CI) calculated for all comparisons. The certainty of evidence was assessed using the Confidence in Network Meta-Analysis tool.

RESULTS

Ten RCTs examined the effects of five vibration frequencies. The RoB ranged from low to high. The PMA found vibrations significantly increased tooth movement (MD = 0.084 mm, 95% CI [0.004, 0.164]). Conversely, NMA showed no significant differences across all comparisons. The Surface Under the Cumulative Ranking Curve ranked 125 Hz as the most effective, followed by 100, 60, 30, and 0 Hz. The confidence in evidence ranged from low to moderate.

CONCLUSIONS

The use of supplementary vibration in conjunction with orthodontic force statistically effectively accelerates tooth movement, with higher frequencies showing a tendency to yield better acceleration results.

CLINICAL RELEVANCE

While vibration therapy demonstrated a statistically significant effect on canine movement, the magnitude of this effect was not sufficient to be considered clinically significant for orthodontic treatment. Further research is required to optimize the effectiveness.

Effect of applying intermittent force with and without vibration on orthodontic tooth movement

PURPOSE

This study aimed to determine whether orthodontic tooth movement could be accelerated by applying an intermittent force protocol. It also examined the effect of applying additional vibrational forces on orthodontic tooth movement and root resorption rates.

METHODS

This study included 24 patients (16 males and 8 females) who underwent orthodontic treatment involving first premolar extraction and distal movement of the canines in the maxilla. A Hycon device (Adenta GmbH, Gilching, Germany) was used for canine distalization in all patients. The patients were randomly divided into two groups: one group received 20 min of vibration per day using the AcceleDent device (OrthoAccel Technologies, Inc., Bellaire, TX, USA), while the other group received no vibration. In addition, a split-mouth design was used: an activation-only force protocol was applied on one side, and an intermittent activation-deactivation-activation (ADA) protocol was applied on the other. The duration required for complete canine tooth distalization on each side was calculated. In addition, the effect of vibration on the orthodontically induced root resorption was examined.

RESULTS

The intermittent ADA protocol significantly accelerated orthodontic tooth movement compared to the activation-only protocol (p < 0.05). The application of additional vibration did not affect the orthodontic tooth movement rate (p > 0.05).

CONCLUSIONS

Using a Hycon device and following an ADA protocol provided significantly faster canine distalization than the activation-only protocol (p < 0.05). This intermittent force method proved very effective in closing the spaces. However, vibration did not significantly affect the orthodontic tooth movement rate (p > 0.05).

Effects of Vibration on Accelerating Orthodontic Tooth Movement in Clinical and In Vivo Studies: A Systematic Review

This systematic review aims to assess the impact of high (>30 Hz) and low (≤30 Hz) frequency vibrations on orthodontic tooth movement (OTM). Several articles were collected through a systematic search in the databases MEDLINE and SCOPUS, following PRISMA methodology and using a PICO question. Relevant information on selected articles was extracted, and the quality of each study was assessed by the quality assessment tools EPHPP, ROBINS-1 and STAIR. Out of 350 articles, 30 were chosen. Low-frequency vibrations did not seem to accelerate OTM with aligners or fixed appliances, despite some positive outcomes in certain studies. Conversely, high-frequency vibrations were linked to increased aligner change, tooth movement, and space closure with fixed appliances. In vivo studies reported favourable results with high-frequency vibrations (60 Hz to 120 Hz), which stimulate bone biomarkers, facilitating alveolar bone remodelling. The results suggest that high-frequency vibration effectively speeds up orthodontic tooth movement, showing promise in both in vivo and clinical studies. Larger-scale research is needed to strengthen its potential in orthodontics.

Bibliometric and visualized analysis of randomized controlled trials in orthodontics between 1991 and 2022

INTRODUCTION

In many evidence-based approaches to orthodontic research, randomized controlled trials (RCTs) represent authoritative evidence to identify rational therapeutics. This study aimed to perform mappings of bibliometric networks on orthodontic RCTs and summarize visual characteristics between 1991 and 2022.

METHODS

The articles were retrieved from the Web of Science Core Collection in October 2022 without an initial time limit. Only orthodontic RCTs were eligible. Some bibliometric tools (HistCite, VOSviewer, SCImago Graphica, and CiteSpace) were applied for visualized analysis. Data such as geography, productive institutions, hot articles, journals, authors, references, and keywords were extracted and summarized for analysis.

RESULTS

A total of 1122 orthodontic RCTs were searched. A total of 3841 authors from 1157 institutions in 65 countries published orthodontic RCTs. The United States (149) was the most prolific country, and the University of Sao Paulo (35) was the most productive institution. The American Journal of Orthodontics and Dentofacial Orthopedics (206) was the most popular journal for scholars. The visualization results of keyword co-occurrence identified 5 clusters: (1) tooth movement and auxiliary measures, (2) appliances and oral health, (3) orthodontic discomfort and symptomatic therapy, (4) periodontal disease in orthodontics and health maintenance, and (5) retention and relapse.

CONCLUSIONS

Over the past 31 years, publications and citations on orthodontic RCTs from the Web of Science Core Collection have increased notably across many countries, authors, and institutions. Recently, there has been a significant increase in the attention to orthodontic RCTs that focus on accelerating tooth movement.

Comparison of GUMMETAL® and stainless steel alloy during canine retraction: A pilot split-mouth randomized controlled trial

OBJECTIVES

A TiNb alloy wire (GUMMETAL® [GM], Toyota Central R&D Labs, Inc., Nagakute, Japan) was recently developed with unique properties for orthodontic applications. This pilot split-mouth randomized controlled trial compared maxillary canine retraction during space closure using sliding mechanics on GM vs. stainless steel (SS) archwires.

METHODS

Subjects who met the inclusion criteria were treated with fixed appliances and maxillary first-premolar extractions between September 2020 and March 2022. After leveling and aligning, maxillary archwires, fabricated by crimping together segments of 0.016×0.022" GM and SS archwires, were placed and canine retraction initiated using nickel-titanium coil springs. Digital models of the maxillary arch were superimposed at 0, 4, 8 and 12 weeks and the amount of canine movement (mm), rate of movement (mm/month), and 3-dimensional changes (rotational, vertical extrusion, tip) were measured and compared statistically.

RESULTS

Of the 12 subjects recruited, only six completed the study with a median age of 15.8 years (12.0-17.4 years). At 12 weeks, the median canine retraction was 3.41mm (IQR: 2.10, 4.76) with GM versus 3.71mm (IQR: 1.62, 6.45) with SS. The retraction rate was 1.14mm/month (IQR: 0.69, 1.59) with GM, versus 1.24mm/month (IQR: 0.54, 2.15) with SS. The median rotational, vertical and tip changes of the canine were 7.90̊, 0.59mm and 6.15̊ with GM, and 7.25̊, 0.29mm and 2.05̊ with SS. Intergroup differences with all measurements were not statistically significant.

CONCLUSION

No significant differences were found between GM and SS during maxillary canine retraction. GM demonstrated clinical potential for space closure mechanics, however, future larger studies are needed.

Vibrational Force on Accelerating Orthodontic Tooth Movement: A Systematic Review and Meta-Analysis

This study aimed to systematically gather and analyze the current level of evidence for the effectiveness of the vibrational force in accelerating orthodontic tooth movement (OTM). This systematic review was conducted using three electronic databases: Scopus, PubMed, and Google Scholar until March 2022. The search was done through the following journals: European Journal of Orthodontics, American Journal of Orthodontics and Dentofacial Orthopedics, The Angle Orthodontist, Progress in Orthodontics, and Seminars in Orthodontics. Human or animal studies that have evaluated the effect of vibrational force on the rate of OTM were selected. A meta-analysis was performed for the rate of canine movement per month. Database research, elimination of duplicate studies, data extraction, and risk of bias assessment were performed by authors independently and in duplication. A fixed and random-effect meta-analysis was performed to evaluate the effect of vibrational forces. A total of 19 studies (6 animal and 13 human studies) that met the inclusion criteria were included. Meta-analysis was performed based on four human clinical trials. Three out of four studies showed no significant difference in the rate of canine movement between vibrational force and control groups. The limitation of this study was the small sample size and significant heterogeneity among the studies. Although vibrational forces have been shown to accelerate OTM in experimental studies, the results are inconsistent in clinical studies. The inability to apply desired peak load to the targeted teeth may be the main factor in inconsistent clinical outcomes.

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

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.

Pain Relief in Dental Local Anaesthesia with Vibrational Devices: Much Ado about Nothing? A Scoping Review

In recent years, vibrational devices have been introduced in order to reduce patient discomfort in some situations such as orofacial pain, orthodontic therapy, and injection of local anaesthetics. This article aims to review the clinical experience given by the use of these devices in local anaesthesia. The literature search was carried out on the main scientific databases for articles up to November 2022. Eligibility criteria were established, and pertinent articles selected. The results were classified by author, year, type of study, sample size and characteristics, purpose of use, type of vibrational device used, protocol used, and outcomes. Nine relevant articles were found. These are split mouth randomized clinical trials which evaluate the reduction in pain perception with different devices and different protocols of use in children, during procedures which require local analgesia by injection, compared with traditional local anaesthesia with premedication based on anaesthetic gels. Different objective and subjective scales of pain and discomfort perception were used. Although results are promising, some data, such as those relating to vibrational intensity and frequency, are not clear. Evaluations on samples varying by age and context of use are necessary to fully define the indications for this type of aid during oral rehabilitation procedures.

Duration of canine retraction with fixed appliances: A systematic review and meta-analysis

INTRODUCTION

Space closure is a challenging and time-consuming phase of orthodontic treatment with fixed appliances. This systematic review evaluated canine retraction duration using fixed appliances after maxillary first premolar extraction.

METHODS

Unrestricted systematic literature searches were conducted in 8 databases for randomized clinical trials, assessing the duration and rate of maxillary canine retraction using fixed appliances with or without treatment adjuncts published up to July 2021. Study selection, data extraction, and risk of bias evaluation were conducted independently and in duplicate. Random-effects meta-analyses of average rates or mean differences (MD) and 95% confidence intervals (CI) were conducted at α = 5%, followed by sensitivity and Grading of Recommendations Assessment, Development, and Evaluation analysis.

RESULTS

Fifty randomized clinical trials (6 parallel and 44 split-mouth designs) covering 811 participants (mean age 19.9 years; 34% male) were included. The estimated average pooled duration to achieve complete canine retraction was 4.98 months (2 trials; 95% CI, -2.9 to 12.88 months). Pooled average canine retraction was 0.97 mm at months 0-1 (23 trials; 95% CI, 0.79-1.16), 1.83 mm at months 0-2 (20 trials; 95% CI, 1.52-2.14), 2.44 mm at months 0-3 (23 trials; 95% CI, 2.10-2.79), 3.49 mm at months 0-4 (6 trials; 95% CI, 1.81-5.17) and 4.25 mm at months 0-5 (2 trials; 95% CI, 0.36-8.14). Surgically-assisted orthodontics was associated with greater canine retraction at all time points: months 0-1 (10 trials; MD, 0.52 mm; P = 0.004), months 0-2 (8 trials; MD, 0.53 mm; P = 0.04), months 0-3 (8 trials; MD, 0.67 mm; P = 0.01), and months 0-4 (3 trials; MD, 1.13 mm; P = 0.01), whereas subgroup analyses indicated significant effects of anchorage reinforcement method and bracket slot size on canine retraction.

CONCLUSIONS

The average time to achieve complete retraction of the maxillary canine using fixed appliances was around 5.0 months. Most studies used split-mouth randomization to investigate canine retraction for around 1-3 months, with substantial heterogeneity across studies. At 3 months of treatment, high-quality evidence supported greater canine retraction with surgically-assisted orthodontics.

Human Interleukin-1β Profile and Self-Reported Pain Monitoring Using Clear Aligners with or without Acceleration Techniques: A Case Report and Investigational Study

INTRODUCTION

There is a growing demand for more aesthetic, comfortable, and faster orthodontic treatments, and clear aligners emerged as a solution to fulfill this need. However, the effectiveness of clear aligners to treat complex malocclusions is yet contentious. The use of acceleration methods could improve the efficacy of clear aligners by stimulating cells' mechanobiology through numerous pathways, but this hypothesis is still poorly explored.

OBJECTIVE

We aimed to monitor the release profile of an inflammatory marker-the interleukin-1β-and to evaluate its relationship with self-reported pain scores with and without the use of acceleration techniques during an orthodontic treatment requiring difficult tooth movements with clear aligners. Case Report. Here, we report a case of a 46-year-old female patient who presented functional and aesthetic complaints. Intraoral examination revealed a diminished overjet and overbite, rotation of teeth 45 and 24, absence of teeth 25, 35, and 36, buccolingual dislocation of tooth 21, a tendency to a Class III malocclusion, and a 2 mm left deviation of the lower midline. This study is divided into three stimulation phases: no stimulation, mechanical vibration stimulation, and photobiomodulation. Interleukin-1β levels in gingival crevicular fluid samples from the pressure side of six selected teeth were evaluated at four time points after the orthodontic treatment onset. Pain monitoring in those teeth was performed using a visual analogue scale at the same time points.

RESULTS

Interleukin-1β protein production peaked 24 h after treatment onset. Complex movements were associated with increased self-reported pain.

CONCLUSION

Clear aligners show limitations in solving complex tooth movements, even when combined with acceleration. The development of customized and programmable stimulation microdevices integrated into "smart aligners," which could be designed to specifically stimulate the direction of movement and stimulation parameters and could constitute a solution to optimize the orthodontic tooth movement with clear aligners.

Effect of customized vibratory device on orthodontic tooth movement: A prospective randomized control trial

AIMS:

The primary purpose of the present trial was to evaluate the effect of low-frequency (30Hz) vibrations on the rate of canine retraction.

SETTING AND DESIGN:

Single-center, split mouth prospective randomized controlled clinical trial

METHODS AND MATERIAL:

100 screened subjects (aged18–25 years) were selected; out of which 30 subjects having Class I bimaxillary protrusion or Class II div 1 malocclusion, requiring upper 1^st premolar therapeutic extractions, were selected for the study. A split-mouth study design was prepared for the maxillary arch of each selected individual and was randomly allocated into vibration and nonvibration side (control) groups. A customized vibratory device was fabricated for each subject to deliver low-frequency vibrations (30 Hz). Scanned 3D models were prepared sequentially to assess the amount of tooth movement from baseline (T0),(T1), (T2), (T3), and (T4)-4^th month of canine retraction.

STATISTICAL ANALYSIS USED:

Independent “t” test.

RESULTS:

There was no statistically significant differencein the rate of individual canine retraction among the experimental and control groups when the intergroup comparison was done using independent “t” test at T1-T0, (P = 0.954), T2-T1 (P = 0.244), T3-T2 (P = 0.357), and T4-T3 (P = 0.189).

CONCLUSION:

The low-frequency vibratory stimulation of 30 Hz using a customized vibratory device did not significantly accelerate the rate of orthodontic tooth movement.

TRIAL REGISTRATION:

Registered at ctri.nic.in (CTRI/2019/05/019043).

Evaluation of the effects of diode laser application on experimental orthodontic tooth movements in rats. Histopathological analysis

Purpose:

To evaluate the effect of diode laser use on experimental orthodontic tooth movements.

Methods:

Thirty Rattus norvegicus albinus Wistar were divided into three equal groups (n = 10), two experimentals and one control. Applying 20 g orthodontic force were attached to the maxillary incisors of the rats in all groups. Low dose laser was applied to the surrounding tissues of the maxillary incisors of the rats in the experimental groups. Two exposure times for laser irradiation were used for seven days: t = 12 min (energy dose = 72 J) and t = 9 min (energy dose = 54 J) by a 0.1 W DEKA brand diode laser with wavelength of 980 nm.

Results:

Osteoclastic activation increased in the 72 J group when compared to control group and decreased in comparison to the 54 J group. Osteoblastic activation was decreased in the 72 J group when compared to the control group and increased in comparison to the 54 J group.

Conclusions:

Applying 54 J laser energy has been found effective to accelerate the orthodontic tooth movement.

Performance comparison of vibration devices on orthodontic tooth movement - A systematic review and meta-analysis

Background

To evaluate the efficiency of vibratory devices in altering rate of orthodontic tooth movement.

Methods

A literature search up to January 31, 2020 was conducted in three electronic databases: PubMed, Cochrane Central Register of Controlled Trials (CENTRAL) and Science Direct, to identify studies on vibratory devices reporting any alteration in tooth movement as a primary outcome. Only articles published in English language were included. A meta-analysis was done to compare the amount of tooth movement (in mm) in patients treated with vibratory devices compared to control groups, to quantify weighted treatment effects.

Results

A total of two split mouth studies, six parallel arm randomized control trials (RCT) one split mouth RCT, and three regular RCTs were assessed qualitatively. Quantitative assessment was done for 8 randomized trials using a forest plot (310 patients). Pooled data showed increase in the amount of tooth movement by 0.34 ​mm (95% CI:0.25,0.42). There was a statistically significant difference noted for this result at p ​< ​0.00001.

Conclusion

Current evidence suggests a moderate to high level of certainty in regard to included studies in this systematic review and meta-analysis. Vibratory devices when used in conjunction with fixed orthodontic appliances show significant increase in the rate of tooth movement. These devices can be used by clinicians to reduce treatment duration and patient discomfort.

PROSPERO registration

CRD42020169675.

Comparative assessment of the rate of orthodontic tooth movement in adolescent patients undergoing treatment by first bicuspid extraction and en mass retraction, associated with low-frequency mechanical vibrations in passive self-ligating and conventional brackets: A randomized controlled trial

BACKGROUND

Low-frequency vibrations are one of the many non-surgical modalities aimed at increasing the rate of orthodontic tooth movement.

OBJECTIVE

The present trial was conducted to assess the efficacy of low-frequency vibrations in increasing the rate of orthodontic tooth movement in adolescent patients undergoing fixed mechanotherapy with passive self-ligating brackets and conventional brackets.

MATERIALS AND METHODS

Setting and sample population: department of orthodontics and dentofacial orthopaedics in a nationally accredited dental college. Participants, study design and methods: 65 patients were randomly allocated to three groups. Two experimental groups consisted of passive self-ligating and conventionally ligated appliances received low-frequency vibrations. The control group did not receive any vibrations. Allocation ratio was 1:1:1.32. Eligibility criteria: adolescent patients with sound and healthy dentition, incisor irregularity<5mm.

PRIMARY OUTCOME

rate of orthodontic tooth movement in mm/month. Randomization and blinding: computer-generated random allocation sequencing was done and data assessor was blinded.

STATISTICS

the Q-Q plot and Shapiro-Wilks test judged the normality of the data. The parametric test included ANCOVA and post-hoc analysis.

RESULTS

No statistically significant enhancement of tooth movement was seen in the experimental groups, when comparison was done with the control group P>0.05. Comparison between the two experimental groups did not reveal any significant difference either.

CONCLUSION

No statistically significant increase of orthodontic tooth movement was seen with low-frequency vibrations and the mode of ligation did not have any effect in increasing the rate of tooth movement either.

Effectiveness of vibrational forces on orthodontic treatment : A randomized, controlled clinical trial

AIM

AcceleDent® Aura (OrthoAccel® Technologies, Bellaire, TX, USA) is a class II medical device with U.S. Food and Drug Administration approval that uses SoftPulse Technology™ to increase the speed of tooth movement. The aim of this study was to evaluate the application of vibrational forces on the rate of canine distalization.

METHODS

A total of 20 patients (10 boys and 10 girls) who had class II division 1 malocclusion or severe crowding and indicated first premolar extractions for treatment were included in the study. The patients were divided into two groups: 8 in the control group and 12 in the study group. Three-dimensional digital models were taken just before canine distalization and after space closure using the 3Shape TRIOS® R700 (3Shape Inc., Copenhagen, Denmark) device. Linear measurements between molars and canines were evaluated. The results were assessed with SPSS 23.0 program (IBM, Armonk, NY, USA).

RESULTS

One subject was excluded from the study group due to insufficient oral hygiene and poor patient compliance. Tooth movement rates were 1.06 mm/month for mandibular and maxillary canine teeth in the control group. In the study group, tooth movement rates were 1.24 mm/month for maxillary canines and 1.09 mm/month for mandibular canines. These differences were not statistically significant (p > 0.05).

CONCLUSION

AcceleDent® Aura is an easy-to-use device; however, in our study its application did not have any positive effects on canine retraction rates.

The Effect of High-Frequency Vibration on Tooth Movement and Alveolar Bone in Non-Growing Skeletal Class II High Angle Orthodontic Patients: Case Series

This study presents a novel technique utilizing high-frequency vibration to shorten treatment time and preserve alveolar bone in challenging orthodontic cases that have been treated with Invisalign^® clear aligners. Four non-growing orthodontic patients (age range 14–47 years old) with Class II skeletal patterns (convex profiles with retrognathic mandibles) who sought correction of their crowded teeth and non-surgical correction of their convex profiles were included in this study. These patients were treated using Invisalign clear aligners together with high-frequency vibration (HFV) devices (120 Hz) (VPro5™) that were used by all patients for five minutes per day during active orthodontic treatment. Vertical control and forward rotation of the mandible for each patient was achieved through pre-programming the Invisalign to produce posterior teeth intrusion. Successful forward rotation of the mandibles achieved in all patients led to improvement of their facial convex profiles (apical base relationship (ANB) improved 2.1 ± 0.5 degrees; FMA (Frankfurt mandibular plane angle) improved 1.2 + 1.1 degrees). Dental decompensation was achieved by lingual tipping of the lower incisors and palatal root torque of upper incisors. The use of HFV together with Invisalign facilitated achieving these results within a 12 ± 6 months period. In addition, more bone labial to the lower incisors after their lingual movement was noted. In conclusion, the use of HFV concurrent with SmartTrack Invisalign aligners allowed complex tooth movement and forward mandibular projection without surgery in non-growing patients with skeletal Class II relationships. The clinical impact and implications of this case series are: (1) the use of HFV facilitates complex orthodontic tooth movement including posterior teeth intrusion and incisor decompensation; (2) forward mandibular projection of the mandible and increased bone formation labial to lower incisors can be achieved in non-growing patients that may minimize the need for surgical intervention in similar cases or gum recession due to lower incisors labial inclination.

The Use of High Frequency Vibration and Clear Aligners in Management of an Adult Patient with Class III Skeletal Malocclusion with Open Bite and Severe Bimaxillary Protrusion: Case Report

Adult orthodontic patients with skeletal Class III malocclusion, open bite and bimaxillary dentoalveolar protrusion are complex problems that normally require surgical intervention to correct. This is a report of an adult female with a skeletal Class III jaw relationship; in addition, the patient had anterior open bite and bimaxillary dentoalveolar protrusion. The patient also had three premolars in the lower left quadrant. Treatment involved extracting the extra premolar distal to lower left canine, retraction of lower anterior teeth, closing extraction space and anterior open bite utilizing Invisalign clear aligners. The patient initially changed aligners every week before this was changed to 3–5 days after starting to use a high frequency vibration (HFV = 120 Hz) device. Satisfactory results were achieved in a relatively shorter period. Comparing before and after treatment cone beam computed tomography revealed that new bone has been formed labial to the lower incisors after their retraction/correction of their initial proclined position and the use of HFV and myofunctional therapy without gingival graft. The present case report shows the comprehensive multidisciplinary team approach in treatment for such cases and the advantage of using HFV to improve bone formation.