Are interventions for accelerating orthodontic tooth movement effective?

DATA SOURCES

Pubmed, Embase, Sciences Citation Index, Cochrane Central Register of Controlled Trials (CENTRAL) and grey literature database of SIGLE were searched from January 1, 1990 to August 20, 2011 with no language restrictions.

STUDY SELECTION

Randomised controlled trials (RCTs) or quasi-RCTs in which the participants were healthy and received additional interventions to conventional orthodontic treatment for accelerating tooth movements were included. Subjects with defects in oral and maxillofacial regions (ie, cleft lip/palate), dental pathologies and medical conditions were excluded.

DATA EXTRACTION AND SYNTHESIS

Studies were selected by two independent reviewers and disagreements were resolved by discussion with a third reviewer. The primary outcomes included accumulative moved distance (AMD) or movement rate (MR) and time required to move the tooth to its destination. Secondary outcomes were pain improvement, anchorage loss, periodontal health, orthodontic caries, pulp vitality and root resorption. The reviewers performed statistical pooling, where possible, according to a priori criteria on the basis of comparability of patient type, treatments and outcomes measured and risk of bias. The reviewers tested for heterogeneity, publication bias and sensitivity. A quality assessment test was conducted to evaluate the method used to measure AMD.

RESULTS

The authors selected seven RCTs and two quasi-RCTs, which included a total of 101 patients with an age range of 12-26.3 years. Eight studies compared four intervention methods to no intervention group (control group). From them, four studies assessed low laser therapy (LLL), two evaluated corticotomy (CC), one assessed electrical current therapy (EC) and one evaluated pulsed electromagnetic field (PEF). Another study compared dentoalveolar distraction (DAD) vs periodontal distraction (PDD).Quality assessment scores showed that only two studies were of high quality, five studies were of medium quality, while two studies were of low quality. All studies, except one, compared left and right sides of the same participant (split mouth design), and measured the AMD.The method for measuring AMD was reliable in three studies, relatively reliable in one study and unreliable in four studies. The authors only performed pooled AMD mean meta-analysis for the LLL studies. The meta-analysis showed pooled mean AMD of 0.32 (95% confidence interval (CI), 20.04, 0.68), 0.76 (95% CI, 20.14, 1.65), and 0.73 (95% CI, 20.68, 2.14) for one month, two months and three months, respectively. Two LLL studies showed no differences regarding periodontal health and two LLL studies showed no differences in root resorption between LLL intervention and control groups. Compared to control group, one study reported that CS had significantly higher MR and another study showed that CS exhibited larger AMD for one month, two months, three months and four months. Two studies revealed that CS did not show any difference in the periodontal health status. One study reported the EC showed significantly larger AMD for one month, whereas another study reported that PEF induced larger AMD for five + 0.6 months. DAD showed faster MR and less anchorage loss compared to PDD. Teeth remained vital in both DAD and PDD interventions and one out of six cases presented root resorption in the PDD group.

CONCLUSIONS

Among the five interventions corticotomy is effective and safe to accelerate orthodontic tooth movement, low-level laser therapy was unable to accelerate orthodontic tooth movement. The level of evidence does not support whether electrical current and pulsed electromagnetic fields are effective in accelerating orthodontic tooth movement and dentoalveolar or periodontal distraction is promising in accelerating orthodontic tooth movement.