Orthotown May 2018 - 30

Fig. 3: Progress and final photos.

Fig. 4: Before high-frequency vibration treatment
(HFV), aligner does not seat properly. Malocclusion:
Class III clinical bite. Treatment plan: IPR on the
lower anterior arch region, expand and procline
upper to finish in 1mm overjet overbite on anterior
coupling.

Halfway through the treatment, it was evident that the teeth were no longer
tracking. At that point, four months into the treatment, we treated the patient
reactively with MOP and then again at month 8 (Fig. 2). We gained much
better tracking and movements of teeth, including the projected goal of better
anterior coupling finishing 1mm overjet overbite. In just under a year, he had
a better smile line, and his open bite was getting closed.
We got the anterior bite closed and landed the posterior bite, and the patient
could even close his teeth and "chew his food better." The results were positive
because MOP targets osteoclast activation, the main rate-controlling factor in
orthodontic tooth movement.4 Introduction of a controlled microtrauma, without
affecting the integrity and architecture of hard and soft tissue, stimulates the
inflammatory defense mechanism in the body, which then creates a synergy with
the effects of orthodontic forces to accelerate the bone remodeling response.4
Temporary reductions in bone density for 12-14 weeks allowed the difficult
tooth movements to translate, and the teeth to move as predicted and planned
on the aligner software.
After initially falling off track, this patient was thrilled to complete treatment
ahead of schedule and achieved an aesthetic final solution in less than two years
(Fig. 3). Typically this patient's treatment time would have been 22 months,
but including MOP truncated treatment time down to 13 months. This patient
would have been a candidate for orthognathic surgery because of his maxillary
deficiencies, airway and upper-vs.-lower arch discrepancies, but we were able to
avoid surgery and achieve excellent results with the much less invasive MOPs.

HFV: Facilitating the seating of clear aligners
Fig. 5: Patient used HFV for five minutes daily to
seat the aligner.

30

MAY 2018 // orthotown.com

I have encountered aligner tracking issues that could significantly affect
patient treatment time. During aligner therapy, if teeth are not tracking well
in the aligners, teeth will stop moving or even move in an undesired direction.
In these cases, I introduce the VPro5 high-frequency vibration aligner seater
(Propel Orthodontics) to get the treatment back on track and reduce or eliminate
pain attributed to the aligner therapy.5 In my practice, patient compliance is
high because this HFV device delivers vibration in five minutes while the
patient is at home each night. A recent study has reported a 99.6 percent daily
compliance rate with at-home use as well as a "clinically meaningful, immediate,
and extended reduction in orthodontic pain."5
Another study that evaluated the effect of HFV devices on clear aligner
exchange intervals and treatment time has shown the beneficial aspects of
HFV with clear-aligner therapy. Besides reducing pain, the study noted that
"accelerated and more predictable tooth movement was achieved using adjunctive
HFV treatment with aligner therapy." In fact, using the HFV device allowed
64 percent faster aligner exchanges than the control in the study. The study
subjects required fewer refinements than control subjects and fewer aligners to
complete treatment than in the control groups.6
http://www.orthotown.com
Table of Contents for the Digital Edition of Orthotown May 2018
