Spending money to “finish faster” increase capacity or even to “get a better result” does not make sense in this day and age. We have plenty of time. What the modern orthodontic practice needs to spend money on is attracting new patients and opening up new markets. Honestly whether or not one of these acceleration products works or not is secondary…
Kevin O’Brien looks at the latest AJO-DO study:
Another trial suggests that AcceleDent may not be effective…
After reviewing the methods in this study, I honestly would not have expected the results to be any different than reported. I don’t think any acceleration device would have shown any clinical difference, since the biomechanics and arch wire sequence used was exactly the same in both groups. To see Accelerated tooth movement, the patient needs to refrain from the use of any NSAIDs, which was recommended but not measured or enforced. Example: All Pt’s who would have taken any NSAID’s would have been excluded from the group. In my clinical experience with accelerated treatment, it is important to adjust biomechanics, whether you are changing wires more frequently or switching aligners in a shorter time interval to see a reduction in treatment time or increased rate of tooth movement (which was conveniently not looked at in this study). In order to take advantage of the enhanced biological response (osseous modulation), one must change the treatment sequence to see any significant difference, which was not done. By maintaining a standard protocol without shortening the follow-up interval or changing wires within the evaluation period, one would not expect an increased expression of the prescribed mechanics. A small diameter wire like 014 Niti will not fully express the prescription of the bracket nor will it affect the arch width, thus what was measured did not account for the changes in vertical position of the teeth. The body responded to the biomechanics faster in the vibration group but was limited by its expression based on the limited mechanics. Thus both groups showed about the same change in Littles irregularity Index. Creating a clinical scenario that the only variable is the use of pulsatile forces would not by itself show an accelerated result. That is the misunderstanding of the study and for all those who think just adding a device will increase the rate of tooth movement or decrease treatment time. Osseous modulation in conjunction with smart biomechanics is where we see a reduction in treatment time. Even more important to me is increased predictability of the intended outcome in less time.
Furthermore, I question why the investigators evaluated patients for only 10 weeks. A short time creates statistically significant results, but it’s not clinically significant, since orthodontics is never a 10 week process and we don’t end with a 014 Niti wire. Aside from their limitations in assessing orthodontic tooth movement, clinically significant differences in arch expansion and crowding are not to be expected between groups in such a short period, especially with a light 014 Niti wire. It may have been more appropriate to at least evaluate the effect of pulsatile forces on total treatment time vs. a 10 week time frame. Because of these limitations, I can’t say that this study disproves the effect of AcceleDent. I think this study was not set up to show the effect, but to show that there is no effect. The bias is inherent in the way the study was set up.