Orthotown May 2018 - 29
While many mechanical aspects of treatment available today
facilitate tooth movement, historically the only option for
speeding up the process involved surgical intervention such as
osteogenesis, corticotomy or osteotomy.1 To enable greater
tooth movement in less time, I prefer minimally invasive
options, such as micro-osteoperforation (MOP), in
conjunction with both traditional orthodontics
and clear aligner therapy. I also incorporate high
frequency vibration (HFV) into my practice
to improve patient aligner seating, which
may translate to more predictable tooth
movement-and reduced pain when
switching aligners.
MOP was shown in one study to accelerate the rate of tooth movement 2.3 times
faster than without the treatment. 2 In my
experience, this procedure is especially helpful
for effective tooth movements, as well as for patients
who need a combination of orthodontic and restorative treatments
that could take 12-24 months before they even begin their restorative phase.
This waiting period can be discouraging and can also result in the patient
forgoing necessary treatment.
MOP produces little to no discomfort or swelling. Before treatment, the
patient can be treated with an effective topical anesthetic gel, or with minimal
infiltration and a chlorhexidine rinse for 60 seconds before and after treatment.
If patients need analgesic for minor discomfort after MOPs, they should be
advised to take acetaminophen; NSAIDs such as aspirin and ibuprofen should
be avoided because they inhibit the inflammatory effect of MOP and reduce
its effectiveness.3
MOP: Getting teeth back on track
For patients who have challenging orthodontic issues, MOP has successfully
affected their treatment goals. For example, one patient who came to my office
after previous orthodontic treatment presented with an anterior 3mm open
bite from first molar to first molar with posterior occlusion only on the second
molars, a bilateral posterior crossbite and an anterior maxillary cant up on the
right side (Fig. 1). While he wanted a cosmetic solution to his issues, he did
not want wires and brackets or surgical intervention. This posed a common
clear aligner challenge clinicians face with open bites. The relative extrusions
required were beyond the 2mm aligners can typically deliver, and the goal was
to close the posterior open bite and land him on a more functional position to
eliminate the edge-to-edge bite.
Fig. 1: Initial photos. Malocclusion: canted edge-to-edge
posterior open bite, anterior open bite greater than 3mm
and a midmaxillary facial deficiency. Patient was treated with
reactive micro-osteoperforation (MOP) treatments at month
4 and month 8. Expected treatment time: 22 months. Actual
treatment time with MOP: 13 months.
Fig. 2: Day of and immediately after second MOP treatment.
orthotown.com \\ MAY 2018
29
http://www.orthotown.com
Table of Contents for the Digital Edition of Orthotown May 2018
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