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MECHANICAL METHODS IN ACCELARATING ORTHODONTICS.pptx

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MECHANICAL METHODS IN ACCELARATING ORTHODONTICS.pptx

  1. 1. MECHANICAL METHODS IN ACCELARATING ORTHODONTICS Dr. Genoey George
  2. 2. INTRODUCTION • Orthodontic treatment is a dental procedure which generally requires several months to years. • Unfortunately, long orthodontic treatment time poses several disadvantages like higher predisposition to caries, gingival recession, and root resorption • Several approaches have been advocated to accelerate orthodontic tooth movement. They can be broadly classified into surgical and non-surgical.
  3. 3. PHYSICAL / MECHANICAL METHODS All surgical methods are invasive in one way or the other and so have their related complications and side effects. Therefor device assisted approach, which is far less invasive has come into use to accelerate orthodontic tooth movement. • Direct electric currents • Pulsed electromagnetic field • Static magnetic field • Resonance vibration • Low level laser
  4. 4. BONE BENDING THEORY FARRAR(1888) Zengo AN, Bassett CAL, Pawluk RJ, Prountzos G. In vivo bioelectric potentials in the dentoalveolar complex. Am J Orthod. 1974;66(2):130–9.
  5. 5. BONE BENDING THEORY FARRAR(1888) Zengo AN, Bassett CAL, Pawluk RJ, Prountzos G. In vivo bioelectric potentials in the dentoalveolar complex. Am J Orthod. 1974;66(2):130–9. “Application of discontinuous forces cause the bioelectrical potential to be created and so the idea of using cyclic forces and vibrations were considered”
  6. 6. ELECTRIC CURRENT & ELECTRO MAGNETIC FIELD (1980) Zeev Davidovitch, D.M.D., Mathew D. Finkelson, B.S., Shulamit Steigman, D.M.D., Joseph L. Shanfeld, Ph.D., Paul C. Montgomery, Ph.D., and Edward Korostoff PD. Electric currents, bone remodeling, and orthodontic tooth movement. II. Increase in rate of tooth movement and periodontal cyclic nucleotide levels by combined force and electric current. Am J Orthod. 1980
  7. 7. ELECTRIC CURRENT & ELECTRO MAGNETIC FIELD Zeev Davidovitch, D.M.D., Mathew D. Finkelson, B.S., Shulamit Steigman, D.M.D., Joseph L. Shanfeld, Ph.D., Paul C. Montgomery, Ph.D., and Edward Korostoff PD. Electric currents, bone remodeling, and orthodontic tooth movement. II. Increase in rate of tooth movement and periodontal cyclic nucleotide levels by combined force and electric current. Am J Orthod. 1980 • Effect of D.C Current Into Periodontal Tissues • Direct effect of rate of tooth movement by application of electric current in alveolar bone. • It can accelerate orthodontic tooth movement by 2.42mm/month. In case of canines, the current should be applied 5 hours a day
  8. 8. PHOTO-STIMULATION: LED AND LOW LEVEL LASER • Wound healing, • Control inflammation • Reduce pain • Improve blood circulation Photo-bio-stimulation may be used therapeutically through lasers and light emitting diodes. Both uses near infrared wavelength of around 600 to 1000 nm. The ideal and recommended range is 730 to 850 nm which being relatively narrow allows more response from the tissue. Yoshida T, Yamaguchi M, Utsunomiya T, Kato M, Arai Y, Kaneda T, et al. Low-energy laser irradiation accelerates the velocity of tooth movement via stimulation of the alveolar bone remodeling. Orthod Craniofacial Res. 2009;12(4):289–98.
  9. 9. PHOTOBIOSTIMULATION : cellular and molecular level • Single Oxygen Hypothesis – Porphyrins and flavoproteins • Redox properties alteration Hypothesis – • Effect On RNA & DNA Chung S, Milligan M, Gong SG. Photobiostimulation as a modality to accelerate orthodontic tooth movement. Semin Orthod [Internet]. 2015;21(3):195–202. REDOX POTENTIAL ALTERED FOR OXIDATION INCREASE IN CELLULAR METABOLISM INCREASE Na+/K+ PUMP ACTIVITY AND INTRACELLULAR Ca2+
  10. 10. LOW LEVEL LASER THERAPY • THE BIOSTIMULATORY EFFECT OF LASER - ACCELERATING TOOTH MOVEMENT. Yuhan DM, Shetty S, Nambiar S, Philip N, Ashith MV. Accelerated orthodontics-surgical, mechanical and pharmacological methods. Eur J Mol Clin Med. 2020;7(10):1293-306. APPLICATION OF LASER PROLIFERATION OF OSTEOBLAST, OSTEOCLAST & FIBROBLAST INCREASE IN BONE REMODELLING ACCELARATES TOOTH MOVEMENT
  11. 11. LOW LEVEL LASER THERAPY • Tooth movement is accelerated by the production of ATP and activation of cytochrome-C. • In 2004, Cruz et al was the first to carry out a human study on the effect of low-intensity laser therapy on orthodontic tooth movement. They showed that : “irradiated canines were retracted at a rate 34% greater than the control canines over 60 days.” Cruz DR, Kohara EK, Ribeiro MS, Wetter NU. Effects of low-intensity laser therapy on the orthodontic movement velocity of human teeth: A preliminary study. Lasers Surg Med. 2004;35(2):117–20
  12. 12. LOW LEVEL LASER THERAPY Kochar GD, Londhe SM, Varghese B, Jayan B,Kohli S, Kohli VS. Effect of low-level laser therapy on orthodontic tooth movement. J Indian Orthod Soc 2017;51:81-6.
  13. 13. LOW LEVEL LASER THERAPY Kochar GD, Londhe SM, Varghese B, Jayan B,Kohli S, Kohli VS. Effect of low-level laser therapy on orthodontic tooth movement. J Indian Orthod Soc 2017;51:81-6. Infrared spectrum (810 nm wavelength) Aluminum Gallium Arsenide Power of 100 mW, dose of 5.0 J/cm2
  14. 14. LOW LEVEL LASER THERAPY Total time required for canine retraction - 67% lesser than the time required on control site. There was about 1.7 folds increase in retraction rate. Kochar GD, Londhe SM, Varghese B, Jayan B,Kohli S, Kohli VS. Effect of low-level laser therapy on orthodontic tooth movement. J Indian Orthod Soc 2017;51:81-6.
  15. 15. LOW LEVEL LASER THERAPY • Sousa et al. - 5.0 J/cm² and found 2 folds increase • Youssef et al. - 8.0 J/cm² and found 2 folds increase • Al Sayed Hasan et al. - Increase in OTM by applying 2.25 J/cm². • Dalaie et al. in their study found no significant difference in OTM between controlled and lased side. AlSayed Hasan MM, Sultan K, Hamadah O. Low-level laser therapy effectiveness in accelerating orthodontic tooth movement: A randomized controlled clinical trial. Angle Orthod 2016.
  16. 16. VIBRATION AIDED ORTHODONTIC TOOTH MOVEMENT ALVEOLAR BONE BENDS DEFORMATION OF CRYSTALLINE STRUCTURES CHANGE IN BONE METABOLISM CELLULAR DIFFERENTIATION TOOTH MOVEMENT Asiry MA. Biological aspects of orthodontic tooth movement: A review of literature. Saudi journal of biological sciences. 2018 Sep 1;25(6):1027-32.
  17. 17. VIBRATION AIDED ORTHODONTIC TOOTH MOVEMENT Shapiro et al - orthodontic force aid in tooth movement should not be continuous. intermittent force applied by the vibrational force help tooth movement in two ways. Shapiro E, Roeber FW, Klempner LS. Orthodontic movement using pulsating force-induced piezoelectricity. Am J Orthod. 1979;76(1):59–66. DECREASE FRICTIONAL RESISTANCE INDUCE BONE REMODELLING
  18. 18. VIBRATION AIDED ORTHODONTIC TOOTH MOVEMENT 0.2N at 30 Hz 0.06N at 111 Hz
  19. 19. VIBRATION AIDED ORTHODONTIC TOOTH MOVEMENT Aljabaa A, Almoammar K, Aldrees A, Huang G. Effects of vibrational devices on orthodontic tooth movement: A systematic review. American Journal of Orthodontics and Dentofacial Orthopedics. 2018
  20. 20. VIBRATION AIDED ORTHODONTIC TOOTH MOVEMENT Aljabaa A, Almoammar K, Aldrees A, Huang G. Effects of vibrational devices on orthodontic tooth movement: A systematic review. American Journal of Orthodontics and Dentofacial Orthopedics. 2018 The best evidence on vibration and orthodontic therapy consists of the 5 RCTs identified in this systematic review. One RCT reported increased tooth movement, but 5 reports from 4 RCTs reported no difference.
  21. 21. VIBRATION AIDED ORTHODONTIC TOOTH MOVEMENT Pavlin D, Anthony R, Raj V, Gakunga PT. Cyclic loading (vibration) accelerates tooth movement in orthodontic patients: a doubleblind, randomized controlled trial. Semin Orthod 2015;21:187-94. The application of cyclic loading (vibration) of 0.25 N (25 g) at the frequency of 30 Hz, significantly increases the rate of orthodontic tooth movement.
  22. 22. LOW INTENSITY PULSED ULTRASOUND – (LIPU) • Mechanical energy passed through the living tissue creating biochemical changes at the cellular and molecular level. • Acoustic Wave therapy • Bio stimulatory Effect Kochar GD, Londhe SM, Varghese B, Jayan B,Kohli S, Kohli VS. Effect of low-level laser therapy on orthodontic tooth movement. J Indian Orthod Soc 2017;51:81-6.
  23. 23. LOW INTENSITY PULSED ULTRASOUND – (LIPU) El-Bialy T, Lam B, Aldaghreer S, Sloan AJ. The effect of low intensity pulsed ultrasound in a 3D ex vivo orthodontic model. J Dent FASTER TOOTH MOVEMENT PREVENTS RESORPTION OF ROOT INDUCE PERIODONTAL REGENERATION El-Bialy et al anti-root resorptive action of LIPUS is due to the induced deposition of cementum and dentin which acts as a preventive layer against root resorption
  24. 24. LOW INTENSITY PULSED ULTRASOUND – (LIPUS) El-Bialy T, Farouk K, Carlyle TD, Wiltshire W, Drummond R, Dumore T, Knowlton K, Tompson B. Effect of low intensity pulsed ultrasound (LIPUS) on tooth movement and root resorption: a prospective multi-center randomized controlled trial. Journal of Clinical Medicine. 2020 Mar 16;9(3):804.
  25. 25. LOW INTENSITY PULSED ULTRASOUND – (LIPUS) El-Bialy T, Farouk K, Carlyle TD, Wiltshire W, Drummond R, Dumore T, Knowlton K, Tompson B. Effect of low intensity pulsed ultrasound (LIPUS) on tooth movement and root resorption: a prospective multi-center randomized controlled trial. Journal of Clinical Medicine. 2020 Mar 16;9(3):804. LIPUS output: Frequency - 1.5 MHz, Output intensity - 30 mW/cm²
  26. 26. LOW INTENSITY PULSED ULTRASOUND – (LIPUS) El-Bialy T, Farouk K, Carlyle TD, Wiltshire W, Drummond R, Dumore T, Knowlton K, Tompson B. Effect of low intensity pulsed ultrasound (LIPUS) on tooth movement and root resorption: a prospective multi-center randomized controlled trial. Journal of Clinical Medicine. 2020 Mar 16;9(3):804.
  27. 27. LOW INTENSITY PULSED ULTRASOUND – (LIPUS) Akagi, H.; Nakanishi, Y.; Nakanishi, K.; Matsubara, H.; Hirose, Y.; Wang, P.L.; Ochi, M. Influence of low-intensity pulsed ultrasound stimulation on expression of bone-related genes in rat bone marrow cells. J. Hard Tissue Biol. 2016, 25, 1–5. LIPUS increases RANK-L protein expression in the osteoclasts to accelerate bone Resorption,while in osteoblasts LIPUS increases bone-forming proteins RUNX2 ,OPG and ALP Akagi, H.et al (2016) LIPUS increased the rate of tooth movement and decreased orthodontically induce root resorption when applied for 20 min per day for up to six months.
  28. 28. CONCLUSSION • All these developments provide us with a wide array of techniques that are being put forward by treatment needs of patients. • Further possibilities are still being explored by various peoples from within and outside the orthodontic fraternity. These efforts will help us get better and faster results expanding the reach and possibilities of orthodontic treatment.
  29. 29. REFERENCES • Zengo AN, Bassett CAL, Pawluk RJ, Prountzos G. In vivo bioelectric potentials in the dentoalveolar complex. Am J Orthod. 1974;66(2):130–9. • Zeev Davidovitch, D.M.D., Mathew D. Finkelson, B.S., Shulamit Steigman, D.M.D., Joseph L. Shanfeld, Ph.D., Paul C. Montgomery, Ph.D., and Edward Korostoff PD. Electric currents, bone remodeling, and orthodontic tooth movement. II. Increase in rate of tooth movement and periodontal cyclic nucleotide levels by combined force and electric current. Am J Orthod. 1980 • Yoshida T, Yamaguchi M, Utsunomiya T, Kato M, Arai Y, Kaneda T, et al. Low-energy laser irradiation accelerates the velocity of tooth movement via stimulation of the alveolar bone remodeling. Orthod Craniofacial Res. 2009;12(4):289–98. • Hamblin MR, Demidova TN. Mechanisms of low level light therapy. Mech Low-Light Ther. 2006;6140:614001. • Chung S, Milligan M, Gong SG. Photobiostimulation as a modality to accelerate orthodontic tooth movement. Semin Orthod [Internet]. 2015;21(3):195–202. • Yuhan DM, Shetty S, Nambiar S, Philip N, Ashith MV. Accelerated orthodontics-surgical, mechanical and pharmacological methods. Eur J Mol Clin Med. 2020;7(10):1293-306.
  30. 30. REFERENCES • Cruz DR, Kohara EK, Ribeiro MS, Wetter NU. Effects of low-intensity laser therapy on the orthodontic movement velocity of human teeth: A preliminary study. Lasers Surg Med. 2004;35(2):117–20 • Kochar GD, Londhe SM, Varghese B, Jayan B,Kohli S, Kohli VS. Effect of low-level laser therapy on orthodontic tooth movement. J Indian Orthod Soc 2017;51:81-6. • Kochar GD, Londhe SM, Varghese B, Jayan B,Kohli S, Kohli VS. Effect of low-level laser therapy on orthodontic tooth movement. J Indian Orthod Soc 2017;51:81-6. • Asiry MA. Biological aspects of orthodontic tooth movement: A review of literature. Saudi journal of biological sciences. 2018 Sep 1;25(6):1027-32. • Shapiro E, Roeber FW, Klempner LS. Orthodontic movement using pulsating force-induced piezoelectricity. Am J Orthod. 1979;76(1):59–66. • Aljabaa A, Almoammar K, Aldrees A, Huang G. Effects of vibrational devices on orthodontic tooth movement: A systematic review. American Journal of Orthodontics and Dentofacial Orthopedics. 2018
  31. 31. REFERENCES • Pavlin D, Anthony R, Raj V, Gakunga PT. Cyclic loading (vibration) accelerates tooth movement in orthodontic patients: a doubleblind, randomized controlled trial. Semin Orthod 2015;21:187-94. • Buckley MJ, Banes AJ, Levin LG et al. Osteoblasts increase their rate of division and align in response to cyclic, mechanical tension in vitro. Bone Min. • Kochar GD, Londhe SM, Varghese B, Jayan B,Kohli S, Kohli VS. Effect of low-level laser therapy on orthodontic tooth movement. J Indian Orthod Soc 2017;51:81-6. • El-Bialy T, Lam B, Aldaghreer S, Sloan AJ. The effect of low intensity pulsed ultrasound in a 3D ex vivo orthodontic model. J Dent • El-Bialy T, Farouk K, Carlyle TD, Wiltshire W, Drummond R, Dumore T, Knowlton K, Tompson B. Effect of low intensity pulsed ultrasound (LIPUS) on tooth movement and root resorption: a prospective multi-center randomized controlled trial. Journal of Clinical Medicine. 2020 Mar 16;9(3):804. • Akagi, H.; Nakanishi, Y.; Nakanishi, K.; Matsubara, H.; Hirose, Y.; Wang, P.L.; Ochi, M. Influence oflow-intensity pulsed ultrasound stimulation on expression of bone-related genes in rat bone marrow cells.J. Hard Tissue Biol. 2016, 25, 1–5.

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