ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Osteoperforations Such As Propel Orthodontics Micro-Osteoperforation Appliance Accelerate Orthodontic Tooth Movement With Minimal Surgical Intervention
Clinical Question Do orthodontic patients undergoing osteoperforations into the alveolar bone have an accelerated tooth movement with minimal discomfort as opposed to traditional orthodontic treatment without an osteoperforation technique?
Clinical Bottom Line Corticotomies and Propel Orthodontic micro-osteoperforation (MOP) appliance accelerated the treatment time for orthodontics by doubling the rate of tooth movement during canine retraction. Furthermore, the Propel appliance MOPs showed no post-recovery time difference or any statistical difference in pain between the control and experimental group; on the other hand, the corticotomy method is a much more invasive surgical procedure with post-recovery time and pain.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 24182579Alikhani/201320 adults with Class II Division 1 malocclusionRandomized Controlled Trial
Key resultsTwenty patients with an average age of 24.7 years received similar orthodontic treatment until the initiation of canine retraction. Patients received 3 small MOPs between the canine and second premolar randomly on one side, and the opposite side remained the control. After 28 days, canine retraction in the experimental side was 1.1 ± 0.47 mm compared to 0.5 ± 0.2 mm in the control (P<0.05). Pain and discomfort levels were assessed using a self-rating 1-10 system and the results showed there was no significant difference between the two groups (P<0.5).
#2) 25072362Gkantidis/20143 StudiesSystematic review of randomized trials
Key resultsTwo trials with 23 patients monitored the effect of a corticotomy on canine retraction in a first premolar extraction space. The studies suggested a weighted mean difference of 0.73 mm/month (95% CI, 0.28 to 1.19 mm) and p-value < 0.01. A third study demonstrated that the acceleration in tooth movement appears to be time dependent, and the corticotomy effect is similar to the control group during the fourth month.
Evidence Search (rate[All Fields] AND orthodontic[All Fields] AND ("tooth movement"[MeSH Terms] OR ("tooth"[All Fields] AND "movement"[All Fields]) OR "tooth movement"[All Fields])) AND (systematic[sb] OR Randomized Controlled Trial[ptyp])
Comments on
The Evidence
Validity: The randomized control study used a homogenous group to limit confounding variables. Subjects had no periodontal or systemic issues and had fully erupted maxillary canines with a Class II Division 1 malocclusion that required the removal of both maxillary first premolars. Subjects randomly received MOPs on the left or right side to eliminate bias. Subjects were not blinded to the experiment; however, the investigators performing the measurements were blinded. All subjects were referred to the same surgeon for extraction to reduce variability. Comparison between groups was assessed by analysis of variance (ANOVA). The systematic review only included similar randomized controlled trials; however, a wide range for effect size on tooth movement (0.28 mm/month to 1.19 mm/month) illustrated moderate variance amongst the studies (I2 = 46.9%). Although the randomized controlled trials included within the study showed some heterogeneity, the results still indicate osteoperforations as a method to accelerate tooth movement. Perspective: Orthodontic treatment time can be accelerated by increasing canine retraction through osteoperforations. Although the Propel appliance study for micro-osteoperforations does a good job controlling confounding variables by blinding the investigators, it is a manufacturer-funded study. Therefore, studies by other groups using Propel’s appliance would increase confidence. Also, only a few studies included in the systematic review addressed corticotomies; thus, more homogenous studies would enhance the data and help give more accurate and precise results for corticotomies.
Applicability Duration of orthodontic treatment is a common reason for patients to refuse treatment; however, osetoperforations allow adults and teens with busy schedules to reduce the number of appointments as well as provide a quicker treatment plan for orthodontics. The Propel system can be used with multiple appliances and aligner system treatment; moreover, both general dentists and specialists can perform the treatment. Furthermore, Propel’s micro-osteoperforations simplifies the corticotomy technique by making minimal, shallow MOPs in the alveolar bone without the need for any soft tissue flaps, bone grafting, or any suturing. Lastly, a main concern associated with accelerating tooth movement for orthodontics has been the risk of root resorption; however, both these studies failed to observe any root resorption using the osteoperforations as a way to accelerate tooth movement. Nonetheless, these studies were of short duration and longer studies are necessary to have a better understanding of the possible risks associated with root resorption.
Specialty/Discipline (General Dentistry) (Orthodontics)
Keywords Osteoperforations, Accelerated Orthodontics, Propel
ID# 2771
Date of submission: 10/21/2014spacer
E-mail tibbitts@livemail.uthscsa.edu
Author Luke Tibbitts
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Robert Lemke, DDS, MD
Faculty mentor/Co-author e-mail robertlemke@mac.com
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