Barts and The Royal London Dental Hospital, Queen Mary University, William Harvey Hospital, East Kent University Hospitals, 4 Newark Street London E1 2AT, England, UKUnited Kingdom
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Every clinician will always aim for providing effective treatment, this can be accomplished by delivering the planned treatment goals over the shortest time possible, with minimal biological side effects and high levels of patient satisfaction. Unlike most of the dental specialities, orthodontic treatment tends to take relatively longer duration; this can range from as short as a several months to as long as several years (representative average 24 months).1 This can be explained by the conservative nature of orthodontic treatment that mainly depends on the dento-alveolar response to gentle orthodontic forces
DENTISTRY ISSN 2377-1623 http://dx.doi.org/10.17140/DOJ-2-118 Open Journal Opinion Accelerating Orthodontic Treatment: A * *Corresponding author Continuous Challenge Ahmed M. F. El-Angbawi, BDS, MSc, PhD, MOrth (RCS Ed), FHEA Barts and The Royal London * Dental Hospital Ahmed M. F. El-Angbawi Queen Mary University William Harvey Hospital Barts and The Royal London Dental Hospital, Queen Mary University, William Harvey Hospital, East Kent University Hospitals East Kent University Hospitals, 4 Newark Street London E1 2AT, England, UK 4 Newark Street London E1 2AT England, UK E-mail: aelangbawi@outlook.com Every clinician will always aim for providing effective treatment, this can be accom- plished by delivering the planned treatment goals over the shortest time possible, with minimal Volume 2 : Issue 3 biological side effects and high levels of patient satisfaction. Unlike most of the dental speciali- Article Ref. #: 1000DOJ2118 ties, orthodontic treatment tends to take relatively longer duration; this can range from as short as a several months to as long as several years (representative average 24 months).1 This can Article History be explained by the conservative nature of orthodontic treatment that mainly depends on the th Received: September 15th, 2015 dento-alveolar response to gentle orthodontic forces.
th Accepted: October 6th, 2015 th Published: October 7th, 2015 It is not surprising that patient satisfaction with fixed orthodontic treatment outcome is generally high.2 However, according to an interesting survey, the majority of orthodontic Citation patients expressed that their duration of treatment was considered too long and that they wish El-Angbawi AMF. Accelerating orth- if the duration of orthodontic treatment could be less than 12 months i.e. reduced to half.3 odontic treatment: A continuous chal- Nowadays, there seem to be voices in the dental field claiming this is achievable. One must be lenge. Dent Open J. 2015; 2(3): 98- wondering if this is true?
99. doi: 10.17140/DOJ-2-118 Let us first agree that this unresolved challenge is not new. Since Edward Angle in- troduced the edgewise fixed orthodontic in the early 1900’s and hundreds of studies were con- ducted to identify factors influencing the duration of orthodontic treatment. Interestingly, most studies agreed that these factors can be categorised into: patient-related and treatment-related factors.4 As it was assumed that the patient-related factors are difficult to change, it was not a surprise to know that the main focus during the last few decades was to develop the mechan- ics around the fixed orthodontic appliance system. This included advanced technologies in the archwires (e.g. Nickel titanium), bracket design (e.g. self-ligation) and force application (e.g. elastomerics and NiTi coils). Although, these advances might have been useful in different as- pects, none were found to significantly shorten the duration of orthodontic treatment.3 This had confirmed to the clinician that there is no such thing called “fast brace systems”.
It then became obvious that new approaches had to be considered. Approaches that are mainly focused on influencing patient response to orthodontic forces leading to accelerated tooth movement. This includes surgical and non-surgical interventions.
Adjunctive surgical interventions geared towards reducing orthodontic treatment times have been collectively described as ’surgically assisted orthodontics’. These methods are based on the principle of initiating inflammation after the bone is irritated surgically. This Copyright usually leads to increased rate of bone remodelling and in turn accelerates tooth movement.
©2015 El-Angbawi AMF. This is an Although there is some evidence from several studies that these interventions can accelerate open access article distributed un- 5 tooth movement, the results should be considered with caition. This is mainly because the der the Creative Commons Attribu- tion 4.0 International License (CC effect of the intervention was evaluated for few months (e.g. space closure stage) and not the BY 4.0), which permits unrestricted whole duration of treatment; which may question the clinical significance of the intervention. use, distribution, and reproduction It is also worth mentioning that the effect of the surgical intervention was found to decay after in any medium, provided the origi- 7 few months. This may suggest that repeated surgical intervention may be required through the nal work is properly cited.
DENTISTRY ISSN 2377-1623 http://dx.doi.org/10.17140/DOJ-2-118 Open Journal treatment; which in turn may affect the popularity of the intervention among patients who already prefer non-invasive orthodontics.3 Recently, less invasive surgical methods were proposed e.g. piezosurgery and microosteoperforation. Non-surgical mechanical or physical stimulation of the dento-alveolar process has also been used in conjunction with conventional braces to increase the speed of alveolar bone remodelling. These non-surgical adjunctive interventions include Pho- tobiostimulation (e.g. lasers), cyclic vibration and direct electric current. The popularity of these interventions has grown in the orthodontic field due to their non-invasive nature and the influence from marketing companies. Interestingly, some of these compa- nies promote devices by claiming that they can reduce the orthodontic treatment time to half. However, currently there is no sound evidence to support these claims.1 There are currently several ongoing research projects in this field and hopefully the future will tell us more about these interventions.
Unfortunately, accelerating orthodontic treatment is still an ongoing challenge. The evidence available regarding the ad- junctive interventions is not supportive, but can be promising. Obviously, there is a rapid increase in the research around the non- invasive adjunctive interventions. It is important to remember that effective orthodontic treatment is not solely about the duration. I trust that patients expectations will continue to drive proper research for the continuous development of our speciality.