This document provides an overview of methods used to accelerate orthodontic tooth movement. It begins with an introduction to the topic and discusses the main concerns with traditional orthodontic treatment duration. It then outlines several methods to speed up tooth movement, including pharmacological methods using agents like prostaglandins, surgical methods like corticotomy and piezocision, and physical methods employing vibratory stimulation or low-level laser therapy. For each method, the document discusses the procedure, indications, advantages, disadvantages and relevant studies. It primarily serves to educate on the various techniques available to reduce the length of orthodontic treatment.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Bioprogressive therapy /certified fixed orthodontic courses by Indian dental ...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Maxillomandibular elastics (or intermaxillary elastics) are commonly used because of their simplicity; however, a lack of understanding of their force system can lead to many serious problems.
Elastics are usually classified by the direction of the force (eg, Class II or Class III elastics).
Sometimes force magnitude is considered, but point of force application is left out. Therefore, many different types of Class II elastics can be applied. There are short or long elastics.
Often too many elastics are used when a single resultant elastic at the correct location would work better. However, sometimes more than a single elastic is needed when the attachment point is not directly accessible.
All maxillomandibular elastics and their actions should be analyzed in three dimensions.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Bioprogressive therapy /certified fixed orthodontic courses by Indian dental ...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Maxillomandibular elastics (or intermaxillary elastics) are commonly used because of their simplicity; however, a lack of understanding of their force system can lead to many serious problems.
Elastics are usually classified by the direction of the force (eg, Class II or Class III elastics).
Sometimes force magnitude is considered, but point of force application is left out. Therefore, many different types of Class II elastics can be applied. There are short or long elastics.
Often too many elastics are used when a single resultant elastic at the correct location would work better. However, sometimes more than a single elastic is needed when the attachment point is not directly accessible.
All maxillomandibular elastics and their actions should be analyzed in three dimensions.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
management of vertical maxillary excess /certified fixed orthodontic courses ...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
00919248678078
K- Sir loop /certified fixed orthodontic courses by Indian dental academy Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
Tweed merrifield philosophy /certified fixed orthodontic courses by Indian ...Indian dental academy
The Indian Dental Academy is the Leader in
continuing dental education , training dentists
in all aspects of dentistry and offering a wide
range of dental certified courses in different
formats.
Indian dental academy provides dental crown &
Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit
www.indiandentalacademy.com ,or call
0091-9248678078
Orthodontics has been developing greatly in achieving the desired results both clinically and technically.
Today, it is still very challenging to reduce the duration of orthodontic treatments.
It is one of the common deterents that the orthodontist faces and it causes irritation among adults plus increasing risks of caries, gingival recession, and root resorption.
A number of attempts have been made to create different approaches both preclinically and clinically in order to achieve quicker results, but still there are a lot of uncertainties and unanswered questions towards most of these techniques.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
management of vertical maxillary excess /certified fixed orthodontic courses ...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
00919248678078
K- Sir loop /certified fixed orthodontic courses by Indian dental academy Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
Tweed merrifield philosophy /certified fixed orthodontic courses by Indian ...Indian dental academy
The Indian Dental Academy is the Leader in
continuing dental education , training dentists
in all aspects of dentistry and offering a wide
range of dental certified courses in different
formats.
Indian dental academy provides dental crown &
Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit
www.indiandentalacademy.com ,or call
0091-9248678078
Orthodontics has been developing greatly in achieving the desired results both clinically and technically.
Today, it is still very challenging to reduce the duration of orthodontic treatments.
It is one of the common deterents that the orthodontist faces and it causes irritation among adults plus increasing risks of caries, gingival recession, and root resorption.
A number of attempts have been made to create different approaches both preclinically and clinically in order to achieve quicker results, but still there are a lot of uncertainties and unanswered questions towards most of these techniques.
Quinidine, Albino rats, Pentylenetetrazole, Gap junctionsiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Periodontally Accelerated Osteogenic Orthodontics: A Surgical Technique and C...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Abstract: Corticotomy-assisted orthodontic treatment is an established and efficient orthodontic technique that has recently been studied in a number of publications. Corticotomy facilitated orthodontics have been employed in various forms over speed up orthodontic treatment It involves selective alveolar decortication in the form of decortication lines and dots performed around the teeth that are to be moved. It is done to induce a state of increased tissue turnover and a transient osteopenia, which is followed by a faster rate of orthodontic tooth movement. This technique has several advantages, including faster tooth movement, shorter treatment time, safer expansion of constricted arches, enhanced post-orthodontic treatment stability and extended envelope of tooth movement. The aim of this article is to present a comprehensive review of the literature, including historical background, contemporary clinical techniques, indications, contraindications, complications and side effects. Keywords: Corticotomy, decortication, review, orthodontic treatment
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Periodontally Accelerated Osteogenic Orthodontics with Piezoelectric Surgery...Abu-Hussein Muhamad
Piezosurgery has been applied in dentistry for many years. This paper reviews specifically the treatment applications that have been used in surgically assisted orthodontic treatment since the last decade. Periodontally Accelerated Osteogenic Orthodontics (PAOO) is a surgical technique which results in an increase in alveolar bone width, shorter treatment time, increase post-treatment stability, and decrease amount of apical root resorption. The aim of this case report is to compare the use of micro-motor and piezoelectric surgery unit during decortication in Periodontally Accelerated Osteogenic Orthodontics technique.
Key words: Piezoelectric surgery, piezosurgery, Periodontal regeneration , accelerated tooth movement
Periodontally accelerated osteogenic orthodontics: A perio-ortho ambidextrous...Dr. Anuj S Parihar
The interdisciplinary collaboration of periodontics and orthodontics has allowed teeth to be moved 2–3 times faster, reducing the time required for traditional orthodontic therapy considerably. Periodontally accelerated osteogenic orthodontics (PAOO), also known as Wilckodontics, is a combination of a selective decortication facilitated orthodontics and alveolar augmentation. With this technique, there is no dependence on the pre‑existing alveolar volume. This case report describes the treatment of permanent mandibular molar protraction in a 14‑year‑old patient undergoing orthodontic therapy using PAOO with piezosurgery.
A presentation on inter-relationship between periodontal and orthodontic events. Helpful for dental graduates and perio and ortho post graduate students.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
2. Outline
• Introduction
• Theories of tooth movement
• Overview of the biology of tooth movement
• Methods of accelerated tooth movements
• Pharmacological methods
• Surgical methods
• Physical methods
• Conclusion
• References
2
3. Introduction
Orthodontic treatment
involves the
reorganization of
skeletal and dental
tissues. Treatment
duration however, is one
of the main concerns of
patients undergoing
fixed orthodontics
treatment.
01
This period orthodontic
treatment (usually 2-3
years) in such cases
has several drawbacks
to the patients such as
increased predisposition
to root resorption, dental
caries and gingival
hyperplasia, etc.
02
Consequently,
researchers have
therefore introduced few
methods to accelerate
the velocity of the tooth
movement without any
drawbacks.
03
3
4. • These kinds of methods used in orthodontics are
known as accelerated orthodontics.
• Accelerated orthodontics could be possible by
mechanical stimulation or device assisted therapy,
surgical therapy and by the use of pharmacological
agents.
4
5. Theories of tooth movement
• Alveolar bone resorption and deposition during orthodontic tooth movement is a
cell mediated process regulated by various factors.
• However, the mechanisms involved in conversion of Orthodontic force into biologic
activity are not completely understood
• And the two possible control elements that form two major theories of orthodontic
tooth are:
1. Bio-electric theory
2. Pressure tension theory (PDL)
5
6. Overview of the biology of tooth
movement
Prolonged pressure to a tooth resulting in tooth movement due to bone remodeling
around the tooth.
This bone remodeling is a highly regulated process that is coordinated by bone
resorption by osteoclasts and new bone formation by osteoblasts.
6
Mechanism involved in OTM include, sterile inflammation-mediated osteoclasto-
genesis on the compression side and tensile force-induced osteogenesis on the
tension side.
7. Key cell types that participate in mediating the response to OTM include periodontal ligament
fibroblasts, mesenchymal stem cells, osteoblasts, osteocytes, and osteoclasts.
Intercellular signals that stimulate cellular processes needed for orthodontic tooth movement include
receptor activator of nuclear factor- κB ligand (RANKL), tumor necrosis factor-α (TNF-
α),transforming growth factor beta (TGF-β), and bone morphogenetic proteins.
7
Several intracellular signaling pathways and mechanosensors including ion channels transduce
mechanical force into biochemical signals that stimulate formation of osteoclasts or osteoblasts.
8. Methods of
accelerate
d tooth
movement
s
8
We can categorise the
methods of
accelerated tooth
movement into the
following categories:
Pharmacolo
gical
methods
Surgical
methods
Physical
methods
8
9. Pharmacologic
al methods
There are a number of researches on pharmacological
agents that act as biomodulators for increased
orthodontic tooth movement. These are examples of
such include:
• Prostaglandin E2 and Prostaglandin E1
• Misoprostol
• 1,25-Dihydroxycholecalciferol
• Parathyroid hormones
• Intravenous immunoglobulins
9
Orthodontic forces cause fluid movement in the
periodontal ligament space and distortion of the bone
matrix and cells. There is release of molecules which
initiate bone remodelling for tooth movement.
10. Prostaglandin
s
Prostaglandins (PGs) are inflammatory mediator and a
paracrine hormone that acts on nearby cells; it stimulates
bone resorption by increasing directly the number of
osteoclasts.
Animal studies have shown that both PGE1 and PGE2
increase tooth movement and facilitate bone resorption.
Camacho and Velásquez Cujar conducted a study that
showed that it required repeated injections due to its short
half-life.
10
11. It is usually administered submucosally with injections
given into the gingiva near the first molar
Following L.A administration 0.1ml of PGE1 solution in
saline is injected submucosally.
Various experiments have shown that injections of
exogenous PGE2 over an extended period of time caused
accelerated tooth movements.
Furthermore, the acceleration rate was not affected by
single or multiple injections or between different
concentrations of the injected PGE2.
11
12. However, root resorption was very clearly related to the
different concentrations and number of injections given.
It has also been shown that the administration of PGE2 in
the presence of calcium stabilizes root resorption while
accelerating tooth movement.
Furthermore, chemically produced PGE2 has been
studied in human trials with split-mouth experiments in the
first premolar extraction cases. In these experiments the
rate of distal retraction of canines was 1.6-fold faster than
the control side.
12
13. Disadvantages
• Injections are given at weekly intervals.
• Severe pain after injections.
• To minimise this, local injection of PGE1 an analogue misoprostol was tried out
and It was seen that it was effective in increasing orthodontic tooth movement
with less pain.
13
14. Figure 1. Injection of a
biomodulator in the
periodontium.
Photo credits: google 14
15. Calcitriol or 1,25-dihydroxycholecalciferol which is the most active metabolite of
vitamin D acts in a similar fashion to parathyroid hormones by facilitating
osteoblastic proliferation and function.
Route of administration: Intraligamentry injections of calcitriol increases the number
of osteoclasts and amount of tooth movement during canine retraction with light
forces.
15
Calcitriol
16. 16
It acts directly on osteoblasts and on osteoclasts indirectly by binding to the PTH type 1
receptor on osteoblast that causes the expression of insulin like growth factor 1.
There is promotion of osteoblastogenesis and receptor activator for nuclear factor κ B ligand
(RANKL) which induces osteoclast activation.
PTH facilitates bone remodelling in intermittent treatment by enhancing activities of osteoblasts
and osteoclasts.
May be administered locally at the subperiosteum and systemically
Parathyroid hormone (PTH)
17. Surgical
methods
17
• Bichlmayr in 1931, put forward a surgical technique with
orthodontic appliances for rapid correction of severe maxillary
protrusion.
• First, wedges of bone were removed to reduce the volume for
which the roots of the maxillary anterior teeth would require for
retraction.
• Kӧle further looked into this technique in 1959 by including
special movements for crossbite correction and space closure.
• He believed that he was able to move bony blocks using the
crowns of teeth as handles as the blocks were connected by
only less-dense medullary bone.
18. • Regional acceleratory phenomenon
• Corticotomy
• Intraseptal alveolar surgery
• Corticision
• Piezocision
• Microosteoperforations(MOP)
18
Various surgical methods exist, and they include:
19. Regional acceleratory phenomenon (RAP).
• The basis for surgical acceleration came to being
following the introduction of regional acceleratory
phenomenon (RAP).
• This procedure which enables rapid tooth movement is
due to a healing event that was described by Frost
and termed as regional acceleratory phenomenon
(RAP).
• It is the acceleration of the normal regional healing
process from the original injury.
• It usually occurs after osteotomy, fractures,
arthrodesis and bone-grafting procedures. There might
be involvement and activation of precursor cells
required for healing at the injury site.
19
20. • RAP can increase both soft and hard tissue healing
processes by two- to tenfold. It usually starts in the first
few days of injury, peaks at the first or second month
and may last for 3–4 months.
• The concept ot RAP would prevail for several years
until 2001 when Wilcko et al. introduced a method that
increases the alveolar bone volume after orthodontic
treatment by using bone grafts consisting of
decalcified freeze-dried bone allograft (DFDBA).
• It combines corticotomy surgery and alveolar bone
grafting and was referred to as accelerated osteogenic
orthodontics or recently termed as periodontally
accelerated osteogenic orthodontics (PAOO).
20
21. • The PAOO is an amalgamation of selective
decortications and facilitated orthodontic techniques
along with alveolar augmentation.
• This technique decreases the treatment time to 33%
the time of conventional treatment duration in
orthodontics. This concept was based on a technique
that’s similar to that of the preveiously described
regional acceleratory phenomena (RAP).
21
22. Figure 2. The modified periodontally accelerated osteogenic orthodontics (PAOO) augmented
corticotomy in the lower anterior alveolar region
22
Photo credits: google
23. 23
A corticotomy is defined as a surgical procedure whereby only the cortical bone is cut,
perforated, or mechanically altered without any alteration in the medullary bone.
Procedure:
• Elevation of full thickness of buccal and/or lingual mucoperiosteal flaps.
• Positioning the corticotomy cuts using piezosurgical aurnamenterium or micromotor under
irrigation and it is followed by placement of a graft material, in required sites to enhance the
thickness of the bone
Corticotomy
24. Indications
1. Resolve Crowding and Shorten Treatment Time
• Several authors have described cases in which moderate
and severe crowding was treated without extraction by
corticotomy within shorter periods of time.
2. Accelerate Canine Retraction after Premolar Extraction
• Canine retraction after premolar extraction is a lengthy
step during the extraction stage of orthodontic treatment.
Corticotomy accelerated canine retraction in animal
studies resulting in a faster retraction when compared to
conventional orthodontic retraction.
3. Enhance Post-Orthodontic Stability
• Stability after orthodontic treatment may be a challenge.
Corticotomy-assisted orthodontics favours stability due to
the increased turnover of tissues adjacent to the surgical
site.
24
25. Contraindications
• Patients with active periodontal disease or gingival
recession are not good candidates for corticotomy-
assisted orthodontic treatments.
• Patients with severe class III maloclussion
25
26. Advantages
• Corticotomy procedure causes minimal changes in the periodontal attachment apparatus
• It has been proven successfully by many authors to accelerate tooth movement.
• Bone can be augmented; thereby preventing periodontal defects.
26
27. Disadvantages
• Expensive and invasive procedure.
• Chances of damage to adjacent vital structures.
• Presence of postoperative pain and swelling.
• Chances of infection or avascularnecrosis.
• Low acceptance by the patient.
27
28. 28
Corticocision is a procedure in which a reinforced scalpel is used to make a vertical incision in
the interdental region that penetrates the cortical bone. In this way, the regional acceleratory
phenomenon would be induced in a manner similar to corticotomy in a less invasive way
Procedure:
• The surgical technique consists of infiltrative anesthesia followed by incision with a blade
number 15, which has the necessary stiffness to allow penetration into the vestibular
cortical.
• The inclination of 900 should be maintained relative to the alveolus and the extent of the
incision ranges from below the interdental papilla to 1mm above the mucogingival junction
of each dentition.
Corticocision
29. 29
As the cervical incision is extended the blade is forced into the medullary bone and must be
withdrawn without pivoting to prevent injury to the lips.
The original technique recommends the incision could also be done palatally or linguall, in this,
even greater care should be taken regarding the tongue. case
Indications: to resolve anterior crowding and open bite.
30. 30
Is defined as a flapless, minimally invasive surgical procedure designed to help achieve rapid
orthodontic tooth movement.
Procedure:
• Involves microincisions which are confined to the buccal side that allows the use of
piezoelectric knife and selective tunnelling which enables hard and soft tissue grafting.
Piezocision is usually done a week after orthodontic appliance placement and it involves
vertical incisions made buccally and interproximally.
Piezocision
31. 31
The mid portion of the incision between the roots enables the piezoelectric knife to be inserted.
A piezotome is then inserted in the gingival openings that were made and piezoelectrical
corticotomy of 3 mm is made. Hard or soft tissue grafts can then be added via a tunnelling
procedure.
Since it is much more minimally invasive than corticotomy, it is having high degree of patient
acceptance, short surgical time and has less postoperative discomfort.
32. Indications
1. Correction of deep bite
2. Correction of Open bite
3. Prevention of Mucogingival defects
4. Rapid adult orthodontic treatment
5. Simultaneous correction of osseous and mucogingival
defects
32
33. Advantages
• It is minimally invasive hence more tolerated by patients
• May be used to correct both hard and soft tissue defects.
• Minimal post operative swelling and pain.
33
34. Contraindications
• Medically compromised patients
• Mixed Dentition
• Non-Compliant patients
• Ankylosed teeth
• Piezocision must not be used if the patient has a
pacemaker or any other active implants.
34
36. 36
Is a procedure used to further reduce the amount of invasive nature of surgical intervention. It
involves the creation of small pinhole-sized perforations are created within the alveolar bone
surrounding the dentition.
This initiates cytokine release to call in osteoclasts to increase bone resorption. Thus,
acceleration of tooth movement occurs during orthodontic treatment.
Procedure:
• The site of perforation is within the attached gingiva and close to the target teeth on the
mesial and distal aspect of the roots of the teeth which will be moved.
• Involves microincisions which are confined to the buccal side that allows the use of
piezoelectric knife and selective tunnelling which enables hard and soft tissue grafting.
Micro-osteoperforation
37. 37
The most favourable place for placement of the perforation is the buccal cortical plate but
lingual plate can also be approached with a contra-angled appliance.
Two to four perforations of about 0.025mm are made with depths of 3–7 mm into the bone
using a round bur and a handpiece.
In 2013, Alikhani et al. showed that MOP increased expression of cytokines for osteoclast
differentiation, increased canine retraction, reduced orthodontic treatment by 62% with mild
discomfort in patients.
Their human clinical trial found distalisation was twice as much with MOP than the forces alone.
38. Advantages
• Studies are still being carried out to assess its effects in the long term, as well as
investigations on the MOPs method such as number of perforations required.
38
Limitation
• Reduced post-op pain.
• Increased patient compliance as the procedure is minimally invasive, comfortable, and
safe.
• Capable of reducing orthodontic treatment time by 62%.
41. Physical
methods
Despite all the attempts in making surgical methods being
minimally invasive, they still remain as an invasive procedure.
This had led to discoveries in other tools that can accelerate
tooth movement during orthodontic treatment.
The concept of using physical approaches came from the idea
that applying orthodontic forces causes bone bending (bone
bending theory) and bioelectrical potential develops.
The concave site will be negatively charged attracting
osteoblasts and the convex site will be positively charged
attracting osteoclasts.
The most common physical methods used in the present day
are:
• Vibratory stimulus
• Low level laser therapy
• Low-intensity pulsed ultrasound
• Direct electric current
• Pulsed electromagnetic field
41
42. 42
Bone has the ability to respond to the mechanical stimuli that is applied to it as a mechanism to
withstand functional activity.
Ortho Accel Technologies introduced a novel device named AcceleDenttm device. The device
has an activator and a mouthpiece.
Procedure:
• The patient bites on the mouthpiece component when in use and the activator which is
extraorally positioned generates and transmits vibrations to the teeth.
Vibratory stimulus
43. 43
It can provide 0.2 N of vibration at 30 Hz for 20 minutes. It was fabricated to work in tandem
with existing bracket systems and not replace them.
The device produces cyclic forces to move teeth within the alveolus via accelerated bone
remodelling.
Pavlin et al in 2015 showed low-level cyclic loading with AcceleDent increased the rate of
orthodontic movement
45. 45
Photo biomodulation or low-level laser therapy (LLLT) is one of the most promising approaches
today. Laser light stimulates the proliferation of osteoclast, osteoblast and fibroblasts, and
thereby affects bone remodeling and accelerates tooth movement.
The mechanism involved in the acceleration of tooth movement is by the production of ATP
and activation of cytochrome C [48] and improve the velocity of tooth movement via
RANK/RANKL and the macrophage colony-stimulating factor and its receptor expression.
Other than accelerating tooth movement, LLLT can enhance stability of orthodontic mini-
implants, reduce post-adjustment pain, and induce bone growth in midpalatal suture area
following rapid maxillary expansion.
Studies done by Fujita et al. and Yamaguchi et al. showed that LLLT enhances
osteoclastogenesis on the compressed side of teeth being moved.
Low-level laser therapy
46. 46
LLLT stimulates bone formation on the tension side. Kim et al. observed osteopontin
localisation in the periodontal tissue in their study subjects, indicating LLLT may stimulate
osteogenesis as well in orthodontic treatment.
Although several findings show LLLT stimulates osteoblast and osteoclast function, further
studies are still required to optimise the effect of LLLT on tooth movement.
48. 48
Apart from physical agents, low-intensity pulsed ultrasound (LIPUS) has also been suggested.
It uses mechanical energy which passes through the tissues as acoustic pressure waves
Procedure:
• An electric appliance that provides direct electric current placed in the extracted tooth
region, bio electric potentials are generated, causing local responses and acceleration of
bone modelling.
This procedure was performed by some researchers on living animals and found to be effective
in tooth movement.
Subsequently, Kim et al performed a clinical trial on humans and found 30% acceleration of
tooth movement when compared to conventional technique.
Low-intensity pulsed
ultrasound(LIPUS)
49. 49
Recent studies on LIPUS using animal models by Xue et al. showed that there is induction of
alveolar bone remodelling.
The remodelling occurred due to an increase in the gene expression of HGF/Runx2/BMP-2
signalling pathway with LIPUS.
This led to an increase in the velocity of tooth movement during orthodontic treatment.
El-Bialy et al. observed that LIPUS may reduce the root resorption that was orthodontically-
induced by deposition of dentin and cementum to create a preventive layer from root
resorption.
51. 51
Electrical current have been tested experimentally on the animal models and have shown
ATOM. Direct current or electrical currents generated piezoelectrically thereby enhance the
OTM.
This leads to biochemical changes at molecular and cellular levels. It can increase the healing
of both soft tissue and hard tissue.
LIPUS is usually used at frequency pulses of 1.5 MHz with 200 μs pulse width, which is
repeated at 1KHz for 20 minutes a day with an intensity of 30 mW/cm2
Direct electric current
52. Conclusion
Over the years, the methods of reducing treatment time has risen along with its’ demand.
The options that are available on the orthodontist’s plate are numerous ranging from
surgical means to device assisted methods.
However, more studies still need to be done particularly for newly emerging methods and
also to obtain a clearer understanding on the methods that already exist.
At present, the clinician should use all the knowledge available at present, for deciding
which treatment option is best for the patient, to meet the healthcare needs of the patient
and achieving an optimum treatment outcome.
52
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