ACCELERATED

ORTHODONTICS

1
CONTENTS
2  Introduction
 Biological principles behind accelerated tooth movement
 Methods Of Accelerating Tooth Movement
 Biological approach
 Cytokines
 Prostaglandin
 Vitamin D3
 PTH
 Surgical approach
 Interseptal alveolar surgery
 Osteotomy and Corticotomy
 Micro-osteoperforation
 Piezocision technique
3

 Device-assisted treatment
 Cyclical force device effect on tooth movement.
 Direct electric current effect on tooth movement.
 Photobiostimulation
 LIPUS
• Conclusion
• References
4
Introduction
 The dream of a beautiful smile is currently not
difficult to fulfill, as interdisciplinary treatment
makes successful esthetic effects possible in the
majority of cases.
 However, orthodontics have a  fundamental
disadvantage: prolonged therapy time.
 Comprehensive orthodontic treatment lasts on
average close to 2 years.

Alicja Kacprzak, Adrian Strzecki. Methods of accelerating orthodontic tooth movement:

A review of contemporary literature. Dent Med Probl. 2018;55(2):197–206
5

 This has a negative impact on the patient’s

compliance.
 On the clinical level, long-term therapy may lead
to iatrogenic complications.

Alicja Kacprzak, Adrian Strzecki. Methods of accelerating orthodontic tooth movement:

A review of contemporary literature. Dent Med Probl. 2018;55(2):197–206
6

 In light of contemporary literature, using increased

force to accelerate the movement of teeth is
discouraged.
 It is therefore necessary to affect the surroundings of the
tooth that ensure its stable position in the neutral zone −
the alveolar bone.

Alicja Kacprzak, Adrian Strzecki. Methods of accelerating orthodontic tooth movement:

A review of contemporary literature. Dent Med Probl. 2018;55(2):197–206
7

 Methods of accelerating tooth movement are based on

stimulating biological tissue response, i.e., enhanced
metabolism and accelerated bone remodeling.
 A number of attempts have been made to create different
approaches.
 Most attempts can broadly be categorized into biological,
biomechanical, and surgical approaches.

Nimeri et al. Acceleration of tooth movement during orthodontic treatment - a frontier in

Orthodontics. Progress in Orthodontics 2013,14:42-50
8

 Before going into details of these attempts, we need to

understand the basics of orthodontic tooth movement and
the factors controlling it.

Nimeri et al. Acceleration of tooth movement during orthodontic treatment - a frontier in

Orthodontics. Progress in Orthodontics 2013,14:42-50
9 BIOLOGICAL PRINCIPLES BEHIND
ACCELERATED TOOTH MOVEMENT
10
 Orthodontic tooth movement occurs in the presence
of a mechanical stimuli.
 The force applied on the teeth will cause changes in
the microenvironment around the PDL.
 Orthodontic appliances are not intentionally built to
activate or inhibit specific remodeling pathways in
specific cells.
 Rather, they are built to generate biomechanical force
systems that produce the desired tooth and jaw
movements.

Alansari, Sarah et al. Biological principles behind accelerated tooth movement.

Seminars in Orthodontics 2015,21(3):151 - 161
11
 Orthodontists are now designing innovative appliances
and treatments.
 By identifying and harnessing reactions of the target
cells, two different approaches to accelerate the rate of
tooth movement :
 directly stimulate the target cells by artificial,
physical, or chemical means to increase their
numbers and their activity,
 or indirectly stimulate the body to recruit and activate
more target cells.
 In either scenario, identifying the target cells and
understanding how they are activated is crucial.

Alansari, Sarah et al. Biological principles behind accelerated tooth movement.

Seminars in Orthodontics;21(3):151 - 161
 METHODS OF ACCELERATING TOOTH
12 MOVEMENT

• BIOLOGICAL

• SURGICAL

• DEVICE ASSISTED
13
BIOLOGICAL

 Cytokines
 Prostaglandins
 Vitamin D3
 PTH
 CYTOKINES
14
• Cytokines family includes IL, Tumor necrosis
factors, colony stimulating factors and Growth
factors.
• Prominent cytokines that show demonstrated
effects on bone remodeling are IL-1α, IL - 1β, IL-
6, TNF-alpha.
• These cytokines have been shown to stimulate
bone resorption and induce osteoclast proliferation.

Krishnan V, Davidovitch Z. Cellular, molecular, and tissue-level reactions to orthodontic force. Am J Orthod
Dentofacial Orthop. 2006;129:469.e1–32
15

 These cytokines stimulates osteoclast function through its

receptor on osteoclasts.
 Other cytokines which are also involved in the
acceleration of tooth movement are RANKL.

Nimeri et al. Acceleration of tooth movement during orthodontic treatment - a frontier in Orthodontics.
Progress in Orthodontics 2013, 14:42
16
 On the other hand, osteoprotegerin (OPG) competes with
RANKL in binding to osteoclast to inhibit
osteoclastogenesis.

 The process of bone remodeling is a balance between

(RANKL-RANK) system and OPG compound.

Nimeri et al. Acceleration of tooth movement during orthodontic treatment - a frontier in Orthodontics.
Progress in Orthodontics 2013, 14:42
17
18
 Juvenile teeth move faster than adults, which is due to
the lower amount of RANKL/ OPG ratio in the
gingival crevicular fluid (GCF) in adult patients
measured by the enzyme-linked immunosorbent assay
method.

Yamaguchi M. RANK/RANKL/OPG during orthodontic tooth movement. Orthod Craniofac Res.

2009; 12(2):113–9.
 PROSTAGLANDIN EFFECT ON TOOTH
19
MOVEMENT
 Prostaglandins (PGs) are inflammatory mediator and a
paracrine hormone that acts on nearby cells;
 It stimulates bone resorption by increasing directly the
number of osteoclasts.
 Drugs that effect PG activity falls into two categories :
 Corticosteroids and NSAIDS
 Agents that have mixed agonistic and anatagonistic effect on
PGs.

Proffit
20

 Corticosteroids inhibit the formation of

arachidonic acid.
 NSAIDs inhibit the conversion of arachidonic
acid into PG.

Proffit
21

 Injecting PGs into the PDL in rodents increases

the number of osteoclasts and the rate of tooth
movement.
 Systemic application of misoprostol, a PGE1
analog, to rats undergoing tooth movement for 2
weeks, significantly increased the rate of tooth
movement.

Alansari, Sarah et al. Biological principles behind accelerated tooth movement. Seminars
in Orthodontics 2015;21(3):151 - 161
22

 Injection of PGs to increase the rate of tooth

movement has limitations.
 First, due to their very short half-life, PGs must
be delivered repeatedly.
 Second, local PGs injections can cause
hyperalgesia.

Alansari, Sarah et al. Biological principles behind accelerated tooth movement. Seminars
in Orthodontics 2015;21(3):151 - 161
23 EFFECT OF VITAMIN D3 ON
TOOTH MOVEMENT
 1,25 dihydroxycholecalciferol is a hormonal form of
vitamin D.
 Vitamin D metabolite was injected on the PDL of
cats for several weeks; Collins et al founded that
vitamin D had accelerated tooth movement at 60%
more than the control group.
 Due to the increase of osteoclasts on the pressure
site as detected histologically.

Collins MK, Sinclair PM. The local use of vitamin D to increase the rate of  orthodontic tooth
movement. Am J Orthod Dentofacial Orthop. 1988;94:278–284.
24
 A comparison between local injection of vitamin D and
PGEs on two different groups of rats was also
investigated.
 It was found that there is no significant difference in
acceleration between the two groups.
 However, the number of osteoblasts on the pressure side
which was injected by vitamin D was greater than on the
PGE2 side.
 This indicates that vitamin D may be more effective in
bone turnover.

Kale S, Kocadereli I, Atilla P, Asan E. Comparison of the effects of 1,25 dihydroxycholecalciferol and
prostaglandin E2 on orthodontic tooth movement. Am J Orthod Dentofacial Orthop. 2004; 125(5):607–14
 PTH EFFECT ON TOOTH
25
MOVEMENT
 PTH has been shown to accelerate orthodontic
tooth movement on rats, which was studied by
continuous infusion and the molars were moved
2 to 3 fold faster.
 Some studies have shown that locally injected
PTH induces local bone resorption.
 Therfore, it is more advantageous to give PTH
locally rather than systemically.

Soma S, Matsumoto S, Higuchi Y, et al. Local and chronic application of PTH

accelerates tooth movement in rats. J Dent Res. 2000;79(9):1717-24.
26

SURGICAL APPROACH
27

INTERSEPTAL OSTEOTOMY and

ALVEOLAR SURGERY CORTICOTOMY
SURGICAL
APPROACH
MICRO- PIEZOCISION
OSTEOPERFORATION TECHNIQUE
S
28
INTERSEPTAL
ALVEOLAR
SURGERY

DISTRACTION
DISTRACTION
OF
OF ALVEOLAR
PERIODONTAL
BONE
LIGAMENT

Nimeri et al. Acceleration of tooth movement during orthodontic treatment - a frontier in Orthodontics.
Progress in Orthodontics 2013, 14:42
 DISTRACTION OF PDL
29

 In the rapid canine distraction of PDL, the interseptal bone distal

to the canine is undermined surgically at the same time of
extraction of the first premolars.

 Thus, this will reduce the resistance on the pressure site.

 In this concept the compact bone is replaced by the woven bone,

and tooth movement is easier and quicker due to reduced
resistance of the bone.

Liou and Huang. Rapid canine retraction through distraction of the periodontal ligament. Am J
Orthod Dentofacial Orthop 1998;114:372-82.
30
 In this technique, the interseptal bone is undermined 1 to 1.5
mm in thickness distal to the canine and the socket is
deepened by a round bur to the length of the canine.
 The retraction of the canine is done by the activation of an
intraoral device directly after the surgery.

Liou and Huang. Rapid canine retraction through distraction of the periodontal ligament. Am J Orthod
Dentofacial Orthop 1998;114:372-82.
31
 Activated 0.5 to 1 mm/day after the extraction until the
canine was distracted into the desired position and
amount.
 It took 3 weeks to achieve 6 to 7 mm of full retraction
of the canine to the socket of the extracted first
premolars.

Liou and Huang. Rapid canine retraction through distraction of the periodontal ligament. Am J Orthod Dentofacial
Orthop 1998;114:372-82.
 ALVEOLAR BONE DISTRACTION
32

 This procedure was used as early as 1905 by Codivilla and

later popularized by the clinical and research studies of
Ilizarov.

 Rapid canine distraction of the dentoalveolar bone is done by

the same principle of the distraction of PDL, with the addition
of more dissection and osteotomies performed at the
vestibule.

Sukurica Y, Karaman A, Gurel HG, Dolanmaz D. Rapid canine distalization through segmental alveolar distraction osteogenesis. Angle
Orthod. 2007; 77(2):226–36.
33

Sukurica Y, Karaman A, Gurel HG, Dolanmaz D. Rapid canine distalization through segmental alveolar distraction
osteogenesis. Angle Orthod. 2007; 77(2):226–36.
34

 A vertical osteotomy was made in a similar manner along the

posterior aspect of the canine tooth.
 The first premolar was extracted at this stage.
 The buccal bone was carefully removed through the
extraction socket using large, round burs between the bone
cut at the distal canine region anteriorly and the second
premolar posteriorly.

Sukurica Y, Karaman A, Gurel HG, Dolanmaz D. Rapid canine distalization through segmental alveolar distraction
osteogenesis. Angle Orthod. 2007; 77(2):226–36.
35

 The distraction device fitted and cemented to the first

molar and canine teeth at the end of the surgical
procedure.
 Dentoalveolar distraction was started on the day of the
surgery and continued at a rate of 0.4 mm twice a day.
36
 In all the studies done, both techniques accelerated tooth
movement with no evidence of significant root resorption,
ankylosis, and root fracture.

 But there are still some uncertainties regarding this

technique.

Sukurica Y, Karaman A, Gurel HG, Dolanmaz D. Rapid canine distalization through segmental alveolar distraction
osteogenesis. Angle Orthod. 2007; 77(2):226–36.
37

OSTEOTOMY
ASSOCIATED TOOTH
MOVEMENT
38

 Osteotomy is defined as a surgical cut through both the

cortical and trabecular bones.

 In orthodontics, osteotomies have been used to enhance

and accelerate tooth movement.

Almpani K,Kantarci A. Surgical Methods for the Acceleration of the Orthodontic Tooth Movement.Front Oral Biol 2016.
39
 Cunningham in 1893 used mesial and distal interseptal
osteotomies to reposition palatally inclined maxillary teeth
and stabilized them in correct occlusion with wire ligatures
or metal splints.
 It reduced the procedure time to one third that of
conventional treatment and allowed more predictable
treatment in older patients.
 In the 1950s, Kole introduced his ‘bony block’ technique.

Almpani K,Kantarci A. Surgical Methods for the Acceleration of the Orthodontic Tooth Movement.Front Oral Biol 2016.
40

 Vertical and horizontal osteotomies have had an

increased risk of postoperative tooth devitalization or
even bone necrosis, depending on the severity of injury
to the trabecular bone.

 There is also an increased risk of periodontal damage.

Almpani K,Kantarci A. Surgical Methods for the Acceleration of the Orthodontic Tooth Movement.Front Oral Biol 2016.
41
CORTICOTOMY ASSISTED
ORTHODONTIC TOOTH
MOVEMENT
42
 Commonly used.
 Only the cortical bone is cut and perforated but not the
medullary bone.
 Whereas in osteotomies both cortical and trabecular
bone material is removed.

Oliveira D, Oliveira B. F, Rodrigo VS. Alveolar corticotomies in orthodontics: Indications and effects on tooth movement.
Dental Press J Orthod 2010 July-Aug;15(4):144-57.
43 INDICATIONS

1. Accelerating corrective orthodontic treatment

2. Facilitating complex orthodontic movements
3. Intrusion of posterior teeth
4. Corticotomies combined with skeletal
anchorage devices
5. Enhancing the correction of skeletal
malocclusions.

Oliveira D, Oliveira B. F, Rodrigo VS. Alveolar corticotomies in orthodontics: Indications and effects on tooth movement.
Dental Press J Orthod 2010 July-Aug;15(4):144-57.
44 CONTRAINDICATIONS

1. Patients showing any sign of active periodontal

disease
2. Individuals with inadequately treated
endodontic problems
3. Patients making prolonged use of
corticosteroids
4. Persons who are taking any medications that
slow down bone metabolism, such as
bisphosphonates and NSAIDs.

Oliveira D, Oliveira B. F, Rodrigo VS. Alveolar corticotomies in orthodontics: Indications and effects on tooth movement.
Dental Press J Orthod 2010 July-Aug;15(4):144-57.
45

 However, Wilcko et al described an innovative strategy

of combining corticotomy alveolar surgery with
alveolar grafting in a technique.
 Referred to, initially, as accelerated osteogenic
orthodontics and, more recently, as periodontally
accelerated osteogenic orthodontics.

Oliveira D, Oliveira B. F, Rodrigo VS. Alveolar corticotomies in orthodontics: Indications and effects on tooth movement.
Dental Press J Orthod 2010 July-Aug;15(4):144-57.
46

 Grooves are made in the cortical bone, both on the buccal

and lingual surfaces.
 Followed by placement of lyophilized bone grafts before
repositioning and suturing the gingival flap.
 The bone augmentation has been proposed to
increase the volume of the alveolar process,
to facilitate arch development,
to prevent or even treat fenestrations.

Oliveira D, Oliveira B. F, Rodrigo VS. Alveolar corticotomies in orthodontics: Indications and effects on tooth movement.
Dental Press J Orthod 2010 July-Aug;15(4):144-57.
 HOW DOES CORTICOTOMY WORK ?
47
 Local injury to the alveolar process reduces resistance to
tooth movement and generates Rapid Acceleratory
Phenomenon.
• In 2001, Wilcko reported that the acceleration of tooth
movement is not due to the bony block movement as
postulated by Kole.
• It was rather a process of bone remodeling at the surgical site,
which was called regional acceleratory phenomenon.

Nimeri et al. Acceleration of tooth movement during orthodontic treatment - a frontier in Orthodontics.
Progress in Orthodontics 2013, 14:42
48
 The regional acceleratory phenomenon (RAP) is a
tissue reaction to a noxious stimulus that increases
the healing capacities of the affected tissues.

 It is typical not only of hard tissues such as bone

and cartilage, but also of soft tissues.

 At the tissue level, the RAP is characterized by the

production of woven bone, with the typical
unorganized pattern, that will be reorganized into
lamellar bone at a later stage.

Verna C. Regional Acceleratory Phenomenon. Front Oral Biol.2016;18:28-35. 

49
 Herald Frost collectively mentioned the events in
physiologic healing and called it as “The Regional
acceleratory phenomenon”.

 Following surgical injury in human bone, RAP begins

within a few hours, maximum action is usually reached
in 1-2 months and usually may take 6-24 months to
complete.

Nisha N. et al. Wilckodontics- A Magical Wand for Rapid Success-A Review. Annuals of International Medical and Dental
Research, Vol (1), Issue (3)
50

 Application of orthodontic force can stimulate or trigger

mild RAP activity.
 RAP can be maximized when selective decortication is
combined with tooth movement.

Nisha N. et al. Wilckodontics- A Magical Wand for Rapid Success-A Review. Annals of International
Medical and Dental Research, Vol (1), Issue (3)
 SURGICAL TECHNIQUE
51
1. Flap design
Full thickness flap is elevated towards the coronal aspect
and partial thickness towards the apical portion to
avoid tension at the time of closure.

Nisha N. et al. Wilckodontics- A Magical Wand for Rapid Success-A Review. Annals of International Medical and Dental
Research, Vol (1), Issue (3)
 2. Decortication
52 Corticotomies are done in mid interdental areas, using no 2
carbide bur.

Nisha N. et al. Wilckodontics- A Magical Wand for Rapid Success-A Review. Annuals of International Medical and
Dental Research, Vol (1), Issue (3)
 3. Bone Graft
53
Commonly de-proteinized bovine bone, decalcified free-
dried bone allograft and autogenous bone grafts are
used.

Nisha N. et al. Wilckodontics- A Magical Wand for Rapid Success-A Review. Annals of International Medical and
Dental Research, Vol (1), Issue (3)
 4. Primary closure
54
For predictable bone augmentation, flap should be closed
without excessive tension. Flap is usually sutured at the
mid line in the interproximal areas followed by other areas.

Nisha N. et al. Wilckodontics- A Magical Wand for Rapid Success-A Review. Annals of International
Medical and Dental Research, Vol (1), Issue (3)
55

 Advantages
1. Corticotomy procedure causes minimal changes in the
periodontal attachment apparatus.
2. It has been proven successfully by many authors to
accelerate tooth movement.
3. Bone can be augmented; thereby preventing periodontal
defects.
4. Nutritive function is also maintained.

Shrikanth B. et al. Methods of Accelerating orthodontic treatment – A Review. Journal of Applied Dental
and Medical Sciences. 2016;2 (1):15-20
56

 Disadvantages
1. Invasive procedure leading to high morbidity.
2. Chances of damage to adjacent vital
structures.
3. Postoperative pain and swelling.
4. Chances of infection or avascular necrosis.
5. Low acceptance by the patient.
57

PIEZOCISION TECHNIQUE
58

 Dibart in 2009 was among the first to apply the

Piezocision technique.
 It starts with primary incision placed on the buccal
gingiva by Piezo surgical knife to the buccal cortex and
initiate the regional acceleratory phenomenon.

Mittal S.K.,Sharma R, Singla A. Piezocision Assisted Orthodontics: A new approach to accelerated

orthodontic tooth movement. Journal of Innovative Dentistry 2011;Vol 1,(1):201-210
 Technique
59
 A small vertical incision is made buccally and
interproximally.

 This mid-level incision, between the roots of the teeth will

allow for the insertion of the piezoelectric knife.

 The tip of the Piezotome is inserted in the gingival openings

previously made and a 3 mm deep piezoelectrical
corticotomy is done.

Dibart, Serge et al. Piezocision™-assisted orthodontics: Past, present, and future. Seminars in Orthodontics , Volume 21 ,
Issue 3 , 170 - 175
60

 The decortication has to pass the cortical layer and reach

the medullary bone to get the full effect of the regional
acceleratory phenomenon (RAP).

Dibart, Serge et al. Piezocision™-assisted orthodontics: Past, present, and future. Seminars in Orthodontics , Volume 21 ,
Issue 3 , 170 - 175
61
 The patient is seen every one or two weeks after surgery
by the orthodontist.

 This results in faster tooth movement and early

completion of treatment.

 After the 3rd or 4th month of treatment, the tooth

movement appears to slow down.

Dibart, Serge et al. Piezocision™-assisted orthodontics: Past, present, and future. Seminars in Orthodontics , Volume 21 ,
Issue 3 , 170 - 175
 Clinical Applications
62

 Generalized: If the correction of the malocclusion requires

moving all of the teeth in both maxilla and mandible at the
same time.

 Localized: If the malocclusion affects only one part of the

dentition or one arch (i.e. An anterior crowding case with a
perfect posterior occlusion, single tooth extrusions intrusions,
etc.)

Dibart, Serge et al. Piezocision™-assisted orthodontics: Past, present, and future. Seminars in Orthodontics , Volume 21 ,
Issue 3 , 170 - 175
63

 Sequential: If the correction of the malocclusion

requires a “staged” approach, where selected
areas or segment of the arch are being
demineralized at different times during
orthodontic treatment to help achieve specific
results.
 Contra-Indications:
64

1. Medically compromised patients

2. Patients taking drugs modifying normal bone physiology
(i.e. biphosphonates)
3. Bone pathology
4. Ankylosed teeth
5. Non-compliant patients
6. Patient and/or operator having a pacemaker or any other
active implant.

Dibart, Serge et al. Piezocision™-assisted orthodontics: Past, present, and future. Seminars in Orthodontics , Volume 21 ,
Issue 3 , 170 - 175
65 MICRO-OSTEOPERFORATIONS
66

 Micro-trauma in the form of micro-osteoperforations

(MOPs) will amplify the expression of inflammatory
markers.
 In human subjects, MOPs increased the rate of canine
retraction concomitant with increased TNF and IL-1 levels
in gingival crevicular fluid.
 The device used during the treatment was designed by
Propel Orthodontics.

Alikhani, Mani et al. Micro-osteoperforations: Minimally invasive accelerated tooth movement

Seminars in Orthodontics 2015, Volume 21;(3):162 - 169
67 Advantages

 More efficient approach to accelerate tooth

movement.
 Less invasive than piezoincision or corticotomy
 Repeatable as needed by orthodontist
 Limited pain or discomfort
68

DEVICE-ASSISTED TREATMENT

 Cyclical force device effect on tooth movement.

 Direct electric current effect on tooth movement.
 Photobiostimulation
69 Cyclical force device effect on
tooth movement.

 Low-level mechanical oscillatory signals (vibrations) have been

shown to increase the rate of remodeling in mechanical loaded
long bones.

 Dynamic loading improves bone formation and increases

orthodontic tooth movement compared to a static force.

Pavlin, Dubravko et al. Cyclic loading (vibration) accelerates tooth movement in orthodontic patients: A double-blind,
randomized controlled trial. Seminars in Orthodontics , Volume 21 , Issue 3 , 187 - 194
70 AcceleDent® device

 AcceleDent is a  device
that uses soft pulse
technology and cyclic
forces to accelerate the
movement of teeth.

Pavlin, Dubravko et al.Cyclic loading (vibration) accelerates tooth movement in orthodontic patients: A double-blind, randomized controlled trial. Seminars in
Orthodontics 2015 Volume 21 , Issue 3 , 187 - 194
71

DIRECT ELECTRIC CURRENT

EFFECT ON TOOTH MOVEMENT
72
 Another approach is to use direct electric current.
 This technique was tested only on animals by applying
direct current to the anode at the pressure sites and
cathode at the tension sites (by 7 V).
 Generated local responses and acceleration of bone
remodeling.
 The bulk of the devices and the source of electricity
made it difficult to be tested clinically

Nimeri et al. Acceleration of tooth movement during orthodontic treatment - a frontier in Orthodontics. Progress in
Orthodontics 2013, 14:42
73 ENZYMATIC MICRO BATTERY

 Utilizes glucose as a fuel and

enzyme as a catalyst.

 Placed on the gingiva near the

alveolar bone.

Kolahi J, Abrishami M, Davidovitch Z. Microfabricated biocatalytic fuel cells: a new approach to accelerating the
orthodontic tooth movement. Med Hypotheses 2009 Sep;73(3):340-1
74

 A combined force–electric treatment may provide a

powerful and practical technique for enhancing the velocity
of orthodontic tooth movement, regardless the type of the
orthodontic appliance.

 DISADVANTAGES:
 Short life span
 Poor power density

Kolahi J, Abrishami M, Davidovitch Z. Microfabricated biocatalytic fuel cells: a new approach to accelerating the
orthodontic tooth movement. Med Hypotheses 2009 Sep;73(3):340-1
75

LOW LEVEL LASER

THERAPY
76
 Also known as photobiostimulation.
 Photobiostimulation refers to the alterations, produced by
relatively low levels of irradiation in target tissues with
little or no temperature changes.

Chung, Sean et al. Photobiostimulation as a modality to accelerate orthodontic tooth movement

Seminars in Orthodontics 2015 Volume 21 , Issue 3 , 195 – 202.
77

 Photobiomodulation or low level laser therapy

(LLLT) is one of the most promising approaches
today.

 Laser has a biostimulatory effect on bone

regeneration.

Nimeri et al. Acceleration of tooth movement during orthodontic treatment - a frontier in Orthodontics.
Progress in Orthodontics 2013, 14:42
  Two photobiostimulation modalities:
78

 LOW-LEVEL LASER THERPAY (LLLT)

 LIGHT EMITTING DIODES (LED)

 Both types of applications utilize a near-infrared

wavelength of approximately 600-1000 nm.

 The relatively narrow wavelength range allows for

greater absorption by target tissues.

Chung, Sean et al. Photobiostimulation as a modality to accelerate orthodontic tooth movement

Seminars in Orthodontics 2015 Volume 21 , Issue 3 , 195 – 202.
79

 Photobiostimulation is not associated with any

harmful effects on the periodontium and teeth.

 The apparent increase in tooth movement can be

significant in the clinic provided that more
rigorous research, in both animal models and
humans, is conducted to improve the consistency
and predictability of laser and LED therapy
usage.
Chung, Sean et al. Photobiostimulation as a modality to accelerate orthodontic tooth movement
Seminars in Orthodontics 2015 Volume 21 , Issue 3 , 195 – 202.
 Biolux OrthoPulse®
80

 OrthoPulse is a battery-
operated device designed
to promote accelerated
tooth movement using
near infrared light. The
therapy is delivered
through a soft mouthpiece
that is made for use with
both clear aligners or
braces

Kau CH, Kantarci A, Shaughnessy T et al. Photobiomodulation accelerates orthodontic alignment in the early phase of
treatment. Progress in Orthodontics 2013, 14:30 
81

LED Array provides safe, gentle 850nm of Infrared Wavelength

light.
82 LIPUS
 Recently, low-intensity pulsed ultrasound (LIPUS)
has been shown to increase the rate of tooth
movement in ex-vivo mandible slice organ culture
and in animals and decrease OITRR.
 Ultrasound is a form of mechanical energy that can
be transmitted through different tissues as pressure
waves.
 The frequency of these waves is above the limit of
human hearing.
 Ultrasound has been used in medicine in surgical
operation, therapeutic application, and diagnostic.
El-Bialy T et al. Effect of Low Intensity Pulsed Ultrasound (LIPUS) on Tooth Movement and Root Resorption: A
Prospective Multi-Center Randomized Controlled Trial. J Clin Med. 2020;9(3):e804
83
84

 According to Maurya et al, intermittent use of

LIPUS (at days 0, 3, 5, 7, 14, and every 15 days
afterward) had an increased rate of tooth
movement.

Maurya, R.K.; Singh, H.; Kapoor, P.; Jain, U.; Mitra, R. Effects of low-level laser and low-intensity
pulsed ultrasound therapy on treatment duration and pain perception. J. Clin. Orthod. 2019, 53, 154–162.
85 CONCLUSION

 Tooth acceleration phenomenon is still a relatively

new horizon and researchers have yet to seek a single
most ideal and prudent technique for the patient.

 The surgical techniques have most of the human trials

and also show very favorable and long term effects
adding to the stability and retention of the orthodontic
therapy. However the invasiveness and cost of these
might make it little less viable option for the patients.
86

 Microsteoperforation, Piezocision on the other

hand are the least discomforting among all the
surgical procedures.
 Yet at the same time any of these techniques
once adapted depending upon clinician’s choice
and patient’s preference; can prove to be
immensely beneficial in reducing orthodontic
treatment time.
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94

25. Maurya, R.K.; Singh, H.; Kapoor, P.; Jain, U.; Mitra,
R. Effects of low-level laser and low-intensity pulsed
ultrasound therapy on treatment duration and pain
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26 El-Bialy T et al. Effect of Low Intensity Pulsed
Ultrasound (LIPUS) on Tooth Movement and Root
Resorption: A Prospective Multi-Center Randomized
Controlled Trial. J Clin Med. 2020;9(3):e804
95

 Thank you