Pacific Coast Society of Orthodontists Bulletin Summer 2019 - 31

Let's Talk About That

Accelerated Orthodontic Tooth
Movement:
Dr. Patrick Turley Interviews
Dr. Jae Hyun Park
1. A generation ago, there were few articles in
the orthodontic literature on accelerating
orthodontic tooth movement. Today, however, it is one of the most widely discussed
topics. Why such a change? What factors are
driving this interest in speeding up orthodontic treatment?
Dr. Patrick K. Turley
Editor, Let's Talk About That
Manhattan Beach, CA

Jae Hyun Park,
DMD, MSD, MS, PhD
Professor and Chair, Postgraduate
Orthodontic Program
Arizona School of Dentistry & Oral
Health
Mesa, AZ

Recently, the number of adult patients seeking
orthodontic treatment has increased significantly. Patients are pursuing more esthetic orthodontic appliances and shorter treatment time.
Usually, comprehensive orthodontic treatment
takes less than two years to complete, but now
patients are expecting treatment times to be
just six to 12 months.1 Subsequently, substantial
advancements such as the application of lasers,
corticotomy, vibration, and pharmacological
agents have been shown to accelerate orthodontic tooth movement. However, when prescribing
an accelerated modality for our patients, we must
consider factors such as cost-benefit, patient
expectations, and the risk for long-term morbidity
associated with the procedures.
2. The surgical procedure commonly referred to
as Wilckodontics has been used to accelerate
orthodontic tooth movement and to increase
the periodontal support of the involved teeth.
Has this procedure been proven to be a "reliable method" for these purposes?
Periodontally accelerated osteogenic orthodontics (PAOO) or accelerated osteogenic orthodontics (AOO), otherwise known as Wilckodontics, is
a combination of conventional corticotomy plus
the use of bone graft material. Accelerated tooth
movement with PAOO is the result of a regional
acceleratory phenomenon, characterized by an
increase in cortical bone porosity and trabecular
bone surface turnover due to augmented osteoclastic activity. This localized burst of hard-tissue
remodeling begins within a few days of surgery,

Summer 2019

PCSO Bulletin

typically peaking at one to two months, and is
reversible. Meanwhile, alveolar bone grafting
increases alveolar bone width after treatment,
which may contribute to improved long-term
stability.2 Thus, PAOO has been shown to speed
up tooth movement and broaden the orthodontic envelope of tooth movement in borderline
surgical cases.3 Further, recent systematic reviews
have concluded that corticotomy-facilitated orthodontics decreases treatment time with fewer
complications and lower morbidity. However,
the certainty of these treatment effects ranged
from very low to low level when GRADE assessments were conducted. Also, PAOO is not only an
invasive but also an expensive surgical procedure from the patient's perspective. Apparently,
further clinical studies with higher quality are
required.
3. Micro-osteoperforation (MOP) has become
a popular method used by orthodontists to
accelerate tooth movement. Alikhani et al.4
are commonly cited as having demonstrated
the effectiveness of this procedure. In your
opinion, what are the convincing and less
than convincing aspects of these studies?
MOP has gained popularity as a method of accelerated orthodontic movement, which involves
puncturing cortical bone through the soft tissue
without raising a flap and is commonly known
under system names such as PROPEL Orthodontics. While still aggressive as far as orthodontic
treatment is concerned, MOP is far less invasive
with less cost than the alveolar corticotomy
technique.
In animal studies, MOP increased cytokines, the
numbers of osteoclasts, and bone-remodeling
activity accompanied by generalized osteoporosity and an increased rate of tooth movement.5
Clinically, MOP significantly increased the rate
of tooth movement by two- to threefold with a

Pacific Coast Society of Orthodontists Bulletin Summer 2019

Table of Contents for the Digital Edition of Pacific Coast Society of Orthodontists Bulletin Summer 2019