Unfortunately long orthodontic treatment time poses several disadvantages like higher predisposition to caries gingival recession and root resorption This increases the demand to find the best method to increase tooth movement with the least possibl ID: 12030
Download Pdf The PPT/PDF document "REVIEW Open Access Acceleration of tooth..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Accelerationoftoothmovementduring orthodontictreatment-afrontierinOrthodontics GhadaNimeri,ChungHKau * ,NadiaSAbou-KheirandRachelCorona Abstract Nowadays,thereisanincreasedtendencyforresearchestofocusonacceleratingmethodsfortoothmovement duetothehugedemandforadultsforashorterorthodontictreatmenttime.Unfortunately,longorthodontic treatmenttimeposesseveraldisadvantageslikehigherpredispositiontocaries,gingivalrecession,androot resorption.Thisincreasesthedemandtofindthebestmethodtoincreasetoothmovementwiththeleastpossible disadvantages.Thepurposeofthisstudyistoviewthesuccessfulapproachesintoothmovementandtohighlight thenewesttechniqueintoothmovement.Atotalof74articleswerereviewedintoothmovementandrelated disciplinefrom1959to2013.Thereisahighamountofresearchesdoneonthebiologicalmethodfortooth movement;unfortunately,themajorityofthemweredoneonanimals.Cytokine,PTH,vitaminD,andRANKL/RANK/ OPGshowpromisingresults;ontheotherhand,relaxindoesnotacceleratetoothmovement,butincreasesthe toothmobility.Low-levellasertherapyhasshownpositiveoutcome,butfurtherinvestigationshouldbedonefor thebestenergyanddurationtoachievethehighestsuccessrate.Surgicalapproachhasthemostpredictable outcomesbutwithlimitedapplicationduetoitsaggressiveness.Piezocisiontechniqueisconsideredoneofthe bestsurgicalapproachesbecauseitposesgoodperiodontaltissueresponseandexcellentaestheticoutcome.Due totheadvantagesanddisadvantagesofeachapproach,furtherinvestigationsshouldbedonetodeterminethe bestmethodtoacceleratetoothmovement. Keywords: Acceleratingtoothmovement;Biology;Photobiomodulation Review Introduction Orthodonticshasbeendevelopinggreatlyinachieving thedesiredresultsbothclinicallyandtechnically.Thisis especiallysobyusingnewtechnologies,likestimulation lationalproducts.Inaddition,continuousmodification ofwiresandbracketsasaresultofthebiomechanical efficienciesinorthodonticshasgreatlyimproved.How- ever,thesebiomechanicalsystemsmayhavereached theirlimitandthereisaneedtodevelopnewmethods toaccelerateteethmovement. Today,itisstillverychallengingtoreducethedur- ationoforthodontictreatments.Itisoneofthecommon deterentsthatfacesorthodontistandcausesirritation amongadultsplusincreasingrisksofcaries,gingivalre- cession,androotresorption. Anumberofattemptshavebeenmadetocreatedif- ferentapproachesbothpreclinicallyandclinicallyin ordertoachievequickerresults,butstilltherearealot ofuncertaintiesandunansweredquestionstowardsmost ofthesetechniques.Mostattemptscanbroadlybecate- gorizedintobiological,physical,biomechanical,andsur- gicalapproaches.Beforegoingintodetailsofthese attempts,weneedtounderstandthebasicsoforthodon- tictoothmovementsandthefactorsthatinitiateinhib- itionanddelayedtoothmovement. Orthodontictoothmovementoccursinthepresence ofamechanicalstimulisequencedbyremodelingofthe alveolarboneandperiodontalligament(PDL).Bonere- modelingisaprocessofbothboneresorptiononthe pressuresiteandboneformationonthetensionsite[1]. Orthodontictoothmovementcanbecontrolledbythe sizeoftheappliedforceandthebiologicalresponses fromthePDL[2].Theforceappliedontheteethwill causechangesinthemicroenvironmentaroundthePDL duetoalterationsofbloodflow,leadingtothesecretion *Correspondence: ckau@uab.edu Building,19197thAvenuesouth,Birmingham,AL35294-0007,USA ©2013Nimerietal.;licenseeSpringer.ThisisanopenaccessarticledistributedunderthetermsoftheCreativeCommons AttributionLicense(http://creativecommons.org/licenses/by/2.0),whichpermitsunrestricteduse,distribution,andreproduction inanymedium,providedtheoriginalworkisproperlycited. Nimeri etal.ProgressinOrthodontics 2013, 14 :42 http://www.progressinorthodontics.com/content/14/1/42 ofdifferentinflammatorymediatorssuchascytokines,growthfactors,neurotransmitters,colony-stimulatingfactors,andarachidonicacidmetabolites.Asaresultofthesesecretions,remodelingoftheboneoccurs[3,4].MethodsofacceleratingtoothmovementTherearethreephasesoftoothmovement:theinitialphase,whichischaracterizedbyrapidmovementaftertheapplicationofforce;followedbyalagperiod,wherelittleornomovement,andthelastphase,wheregradualorsuddenincreaseofmovementoccurs[5].Theearlyphaseoftoothmovementinvolvesacutein-flammatoryresponsescharacterizedbyleucocytesmi-gratingoutofbloodcapillariesandproducingcytokines,whichstimulatestheexcretionofprostaglandinsandgrowthfactors[6].Theacutephaseisfollowedbythechronicphasethatinvolvestheproliferationoffibro-blast,endothelialcells,osteoblasts,andalveolarbonemarrowcellsremodelingprocess[4].BiologicalapproachExperimentshavebeendoneusingthesemoleculesexogenouslytoenhancetoothmovementbothinanimalexperimentsandhumans.ExampleofthesemoleculesareprostaglandinE(PGE),cytokinesthatincludelymphocytesandmonocytes-derivedfactors,receptoractivatorofnuclearfactorkappaBligand(RANKL),andmacrophagecolony-stimulatingfactor(MCSF)[7-9](Table1).EffectofcytokinesontoothmovementHighconcen-trationofcytokinessuchasinterleukinsIL-1,IL-2,IL-3IL-6,IL-8,andtumornecrosisfactoralpha(TNF)werefoundtoplayamajorroleinboneremodeling;more-over,interleukin-1(IL-1)stimulatesosteoclastfunctionthroughitsreceptoronosteoclasts[3].Itwasalsofoundthatmechanicalstressduetoorthodontictreatmentin-creasedtheproductionofprostaglandinPGEandIL-1betaintheperiodontalligaments.Theseexperimentsweredoneoncatswhereonecaninewastippeddistallyby80gofforcefromhourstodays,thenimmunohisto-chemistryandmicrophotometryexperimentswheredonetomeasuretheintensityofPGEandIL-1betawhichwasfoundtobehighestonthetension[9].Othercytokineswhicharealsoinvolvedintheacceler-ationoftoothmovementareRANKL,whichisamembrane-boundproteinontheosteoblaststhatbindtotheRANKontheosteoclastsandcausesosteoclasto-genesis[23-25].Ontheotherhand,osteoprotegerin(OPG)competeswithRANKLinbindingtoosteoclasttoinhibitosteoclastogenesis.Theprocessofboneremodelingisabalancebetween(RANKL-RANK)sys-temandOPGcompound[26,27].Inrelationtothis,usingbiologicalmoleculesintheaccelerationoftoothmovement[14]hasbeenshownintwouniqueexperi-mentsinwhichitwasdemonstratedthatthetransferofRANKLgenetotheperiodontaltissueinducedpro-longedgeneexpressionfortheenhancementofosteo-clastogenesisandaccelerationoftoothmovementsinrats.Ontheotherhand,thetransferofOPGgene Table1BiologicalapproachestoenhancetoothmovementAuthorsBiologicalmoleculestestedAnimalorhumansDurationAccelerationSaitoetal.[]PGsandIL-1CatsWeeksYesYamasakietal.[]PGsRatsWeeksYesYamasakietal.[]PGsMonkeysWeeksYesLeikeretal.[]PGsRatsWeeksYesYamasakietal.[]PGsHumanMonthsYesSeifietal.[]PGs+CaRatsWeeksYesandstabilizerootresorptionSeifietal.[]PGsCaRatsWeeksYesKanzakietal.[]RANKL/RANKAnimalsWeeksYesOPGAnimalsWeeksYesNishijimaetal.[]RANKL/RANK/OPGandrootresorptionHumanMonthsRelationwithrootresorptionCollinsetal.[]VitaminDCatsWeeksYesKaleetal.[]VitaminDandPGsRatsWeeksYesSomaetal.[]PTHRatsWeeksYesSomaetal.[]PTHRatsWeeksYesLiuZietal.[]RelaxinRatsWeeksYesMadanetal.[]RelaxinRatsWeeksEffectoncollagefibersMcgorrayetal.[]RelaxinHumanWeeksNoPGs,prostaglandins;RANKL,receptoractivatorofnuclearfactorkappaBligand;PTH,parathyroidhormone;Ca,Calcium.etal.ProgressinOrthodonticsPage2of8http://www.progressinorthodontics.com/content/14/1/42 inhibitedorthodontictoothmovements[28].Inanotherstudyitwasfoundthatjuvenileteethmovefasterthanadults,whichisduetotheloweramountofRANKL/OPGratiointhegingivalcrevicularfluid(GCF)inadultpatientsmeasuredbytheenzyme-linkedimmunosorbentassaymethod.AlsoacorrelationwasfoundamongRANK,OPG,androotresorptionduringorthodonticteethmovement,andpatientswithrootresorptionproducedalargeamountofRANKLinthecompressedsite[15,29].ProstaglandineffectontoothmovementProstaglan-dins(PGs)areinflammatorymediatorandaparacrinehormonethatactsonnearbycells;itstimulatesbonere-sorptionbyincreasingdirectlythenumberofosteo-clasts.InvivoandinvitroexperimentswereconductedtoshowclearlytherelationbetweenPGs,appliedforces,andtheaccelerationoftoothmovement.Yamasaki[10,11]wasamongthefirsttoinvestigatetheeffectoflocaladministrationofprostaglandinonratsandmon-keys.Inaddition,experimentsdonein[7]haveshownthatinjectionsofexogenousPGE2overanextendedperiodoftimecausedaccelerationoftoothmovementsinrats.Furthermore,theaccelerationratewasnotaffectedbysingleormultipleinjectionsorbetweendif-ferentconcentrationsoftheinjectedPGE2.However,rootresorptionwasveryclearlyrelatedtothedifferentconcentrationsandnumberofinjectionsgiven.IthasalsobeenshownthattheadministrationofPGE2inthepresenceofcalciumstabilizesrootresorptionwhileac-celeratingtoothmovement[13].Furthermore,chemicallyproducedPGE2hasbeenstudiedinhumantrialswithsplit-mouthexperimentsinthefirstpremolarextractioncases.Intheseexperimentstherateofdistalretractionofcanineswas1.6-foldfasterthanthecontrolside[12].EffectofVitaminD3ontoothmovementVitaminD3hasalsoattractedtheattentionofsomescientisttoitsroleintheaccelerationoftoothmovement;1,25dihy-droxycholecalciferolisahormonalformofvitaminDandplaysanimportantroleincalciumhomeostasiswithcalcitoninandparathyroidhormone(PTH).Anothersetofinvestigators[16]hasmadeanexperi-mentwheretheyhaveinjectedvitaminDmetaboliteonthePDLofcatsforseveralweeks;itwasfoundthatvita-minDhadacceleratedtoothmovementat60%morethanthecontrolgroupduetotheincreasementofoste-oclastsonthepressuresiteasdetectedhistologically.AcomparisonbetweenlocalinjectionofvitaminDandPGEsontwodifferentgroupsofratswasalsoinvesti-gated.Itwasfoundthatthereisnosignificantdifferenceinaccelerationbetweenthetwogroups.However,thenumberofosteoblastsonthepressuresidewhichwasinjectedbyvitaminDwasgreaterthanonthePGE2side.ThisindicatesthatvitaminDmaybemoreeffectiveinboneturnover[17].PTHeffectontoothmovementPTHhasbeenshowntoaccelerateorthodontictoothmovementonrats,whichwasstudiedbycontinuousinfusionofPTH(1tog/100gofbodyweight/day)implantationinthedorsocervicalregion,andthemolarsweremoved2-to3-foldfastermesiallybyorthodonticcoilspring[18].SomestudieshaveshownthatlocallyinjectedPTHin-duceslocalboneresorption,anditismoreadvantageoustogivePTHlocallyratherthansystemically[30].Thedevelopmentofaslow-releaseapplicationthatkeepsthelocalconcentrationofPTHforalongtimewasveryeffi-cientasshownlaterin[19]wherethedailyinjectionofPTHdissolvedingelmediumallowedaslowreleasewhichcaused1.6-foldfasteraccelerationofteethcom-paredtodailyinjectionofPTHdissolvedinsalinesolu-tionwhichdidnotcauseanyacceleration.RelaxineffectontoothmovementRelaxineffecthasalsobeeninvestigated.RelaxinisahormonethathelpsduringchildbirthbywideningofthepubicligamentsinfemalesandissuggestedtobepresentincranialsutureandPDL[31].Theroleofrelaxinisknowninthere-modelingofsofttissueratherthanremodelingofbone.Ithasbeenshownthatitincreasescollagenintheten-sionsiteanddecreasesitincompressionsiteduringorthodonticmovement[32,33].Also,theadministrationofhumanrelaxinmayacceleratetheearlystagesoforthodontictoothmovementinratexperiments[20].However,anotherstudyshowedthathumanrelaxindoesnotaccelerateorthodontictoothmovementinrats,butcanreducethelevelofPDLorganizationandmechan-icalstrengthofPDLandincreasetoothmobility[21].Intheseexperimentsinvitrostudieswerealsoper-formedtotestthePDLmechanicalstrengthandtoothmobilityusingtissuefromadditional20ratsthathadpreviouslyreceivedthesamerelaxintreatmentforsev-eraldays[21].TheremodelingofPDLbyrelaxinmightreducetherateofrelapseafterorthodontictreatmentassuggestedbyothers[34].Recently,randomizedclinicaltrialsonhumansweredonebyweeklyinjectionsof50gofre-laxinorplacebocontrolfor8weeks.Toothmovementwasmeasuredweeklyonpolyvinylsiloxaneimpressionswhichwerescanneddigitally.Therewasnosignificantdifferencebetweentherelaxinandtheplacebocontrolgroupregardingtheaccelerationandrelapse[22].How-ever,themechanismofhowrelaxinacceleratestoothmovementisnotyetfullyunderstood.etal.ProgressinOrthodonticsPage3of8http://www.progressinorthodontics.com/content/14/1/42 Device-assistedtreatmentAnotherapproachinacceleratingtoothmovementisbyusingdevice-assistedtherapy(Table2).Thistechniqueincludesdirectelectriccurrents,pulsedelectromagneticfield,staticmagneticfield,resonancevibration,andlow-levellaserwhichwasmostlyinvestigatedandgavethemostpromisingresults.Theconceptofusingphysicalapproachescamefromtheideathatapplyingorthodonticforcescausesbonebending(bonebendingtheory)andbioelectricalpoten-tialdevelops.TheconcavesitewillbenegativelychargedattractingosteoblastsandtheconvexsitewillbepositivelychargedattractingosteoclastsasdetectedbyZengo[43]inhismeasurementsondogalveolarbone.Thebioelectricalpotentialiscreatedwhenthereisap-plicationofdiscontinuousforces,whichleadstotheideaoftryingcyclicforcesandvibrations.Ithasbeenfoundthatapplyingvibrationsfordifferentdurationperdayacceleratedtoothmovementsbetween15%and30%inanimalexperiments[35,44].Cyclicalforcedeviceeffectontoothmovementhavealsousedthisconceptbyusingthecyclicalforcedevicewithpatientsandachieved2to3mm/monthoftoothmovement.Thevibrationratewas20to30Hzandusedfor20min/day[36].FurtherresultsneededtobeinvestigatedtoclearlyidentifytherangeofHertzthatcanbeusedintheseexperimentstogetthemaximumdesiredresults.DirectelectriccurrenteffectontoothmovementAn-otherapproachistousedirectelectriccurrent.Thistechniquewastestedonlyonanimalsbyapplyingdirectcurrenttotheanodeatthepressuresitesandcathodeatthetensionsites(by7V),thus,generatinglocalre-sponsesandaccelerationofboneremodelingasshownbygroupofinvestigators[37].Theirstudiesweremoresuccessfulthanthepreviousattemptsbecauseelectrodeswereplacedascloseaspossibletothemovingtooth.Thebulkinessofthedevicesandthesourceofelectricitymadeitdifficulttobetestedclinically.Severalattemptsweremadetodevelopbiocatalyticfuelcellstogenerateelectricityintraorallybytheuseofenzymesandglucoseasfuel[45,46].Furtherdevelopmentofthedirectelectricdeviceandthebiocatalyticfuelcellsisneededtobedonesothatthesecanbetestedclinically.Low-levellasertherapyPhotobiomodulationorlow-levellasertherapy(LLLT)isoneofthemostpromisingapproachestoday.Laserhasabiostimulatoryeffectonboneregeneration,whichhasbeenshowninthemidpa-latalsutureduringrapidpalatalexpansion[47],andalsostimulatesboneregenerationafterbonefracturesandextractionsite[48,49].Ithasbeenfoundthatlaserlightstimulatestheproliferationofosteoclast,osteoblast,andfibroblasts,andtherebyaffectsboneremodelingandac-celeratestoothmovement.ThemechanisminvolvedintheaccelerationoftoothmovementisbytheproductionofATPandactivationofcytochromeC,asshownin[38,50,51]thatlow-energylaserirradiationenhancedthevelocityoftoothmovementviaRANK/RANKLandthemacrophagecolony-stimulatingfactoranditsreceptorexpression.Animalexperimentshaveshownthatlow-levellasercanacceleratetoothmovement.Furthermore,clinicaltrialattemptsweremadeinwhichdifferentintensitiesoflaserwereusedanddifferentresultswereobtained[40,42].Low-levellasertherapycanbeaveryusefultechniqueforaccelerationoftoothmovementsinceitincreasesboneremodelingwithoutsideeffectstotheperiodontium.Laserwavelengthof800nmandoutputpowerof0.25mWhaveindicatedsignificantstimulationofbonemetabolism,rapidossification[39,49],andalsoaccelerationoftoothmovementto1.5-foldinratexperi-ments.Latelyinaclinicaltrialstudy,thelaserwave-lengththeyhaveusedinacontinuouswavemodeat800nm,withanoutputof0.25mW,andexposureof10swasfoundtoacceleratetoothmovementat1.3-foldhigherthanthecontrol[42].InanotherstudydonebyKau[41]on90subjects(73testsubjectsand17con-trols),therewas1.12-mmchangeperweekinthetestsubjectsversus0.49mminthecontrolgroup.Having Table2Device-assistedtreatmenttechniquesandtheireffectontoothmovementAuthorPhysicalapproachusedRateAnimalhumanAccelerationNishimura[]Vibrationalstimulation60Hz,1.0m/s(2/8min/day)RatsYesKauetal.[]Resonancevibration20to30Hz/20min/dayHumanYesDavidovitch[]Directelectricalcurrent7VAnimalYesFujitaetal.2008[]Low-levellaser810-nmGa-Al-Asdiodelaserandcontinuouswavesat100mWRatsYesKawasaki[]Low-levellaser830-nmGa-Al-Asdiodelaserandcontinuouswavesat100mWRatsYesLimpanichkul[]Low-levellaser860-nmGa-Al-Asdiodeandcontinuouswavesat100mWHumanNoKau[]Low-levellaser850-nmLEDandcontinuouswave60mWHumanYesDoshi-MehtaG[]Low-levellaser800-nmGa-Al-Asdiodelaserandcontinuouswave0.25mWHumanYesLED,Light-EmittingDiodeetal.ProgressinOrthodonticsPage4of8http://www.progressinorthodontics.com/content/14/1/42 saidthis,therearealotofcontradictoryresultsrelatedtotheLLLT.Therefore,moreexperimentsareneededtodifferentiatetheoptimumenergy,wavelength,andtheoptimumdurationforusage.SurgicalapproachThesurgicaltechniquehasbeendocumentedinmanycasereports.Itisaclinicallyeffectivetechniqueusedforadultpatients,wheredurationoforthodontictreatmentmaybecriticalinselectedgroupsofpatients.ThePDLandalveolarboneremodelingaretheimportantparame-tersintoothmovement,andboneturnoverisknowntoincreaseafterbonegrafting,fracture,andosteotomy.Severalsurgicalapproachesthathavebeentriedinordertoacceleratetoothmovementwereinterseptalalveolarsurgery,osteotomy,corticotomy,andPiezoci-siontechnique(Table3).InterseptalalveolarsurgeryInterseptalalveolarsurgeryordistractionosteogenesisisdividedintodistractionofPDLordistractionofthedentoalveolarbone;exampleofbothistherapidcaninedistraction.Theconceptofdistractionosteogenesiscamefromtheearlystudies[66]oflimblengthening.Alsofromsurgicaltreatmentsofcraniofacialskeletaldysplasia,thisconceptwaslateradaptedinrelationtotherapidtoothmovement.IntherapidcaninedistractionofPDL,theinterseptalbonedistaltothecanineisunderminedsurgicallyatthesametimeofextractionofthefirstpremolars,thus,thiswillreducetheresistanceonthepressuresite.Inthisconceptthecompactboneisreplacedbythewovenbone,andtoothmovementiseasierandquickerduetore-ducedresistanceofthebone[52].Itwasfoundthattheserapidmovementsareduringtheinitialphasesoftoothmovementespeciallyinthefirstweekasshowin[53].Inthistechniquetheinterseptalboneisundermined1to1.5mminthicknessdistaltothecanineaftertheex-tractionofthefirstpremolar,andthesocketisdeepenedbyaroundburtothelengthofthecanine.Theretrac-tionofthecanineisdonebytheactivationofanintraoraldevicedirectlyafterthesurgery.Ithasbeenshownthatittook3weekstoachieve6to7mmoffullretractionofthecaninetothesocketoftheextractedfirstpremolars[52].RapidcaninedistractionofthedentoalveolarboneisdonebythesameprincipleofthedistractionofPDL,withtheadditionofmoredissectionandosteotomiesperformedatthevestibuleasshownin[54-57,63].Inallthestudiesdone,bothtechniquesacceleratedtoothmovementwithnoevidenceofsignificantrootresorption,ankylosis,androotfracture.However,therewerecontradictoryresultsregardingoftheelectricalvitalitytestoftheretractedcanines.Liou[52]reported9outof26teethshowedpositivevitality,whileSukurica[54]reportedthat7outof20showedpositivevitalityafterthesixthmonthofretraction.Sotherearestillsomeuncertaintiesregardingthistechnique.CorticotomyandosteotomyOsteotomyandcorticot-omyarealsosurgicaltechniquesthathavebeenclinic-allyusedformanyyears.Osteotomyiswhenasegmentoftheboneiscutintothemedullaryboneandissepa-ratedandthenmovedasaunitasshownin[58,67].Corticotomyisoneofthesurgicalproceduresthatiscommonlyusedinwhichonlythecorticalboneiscutandperforatedbutnotthemedullarybone,suggesting Table3SurgicalapproachestoenhancetoothmovementAuthorSurgicalapproachusedAnimalHumanAccelerationLiou[]DistractionofthePDLaidedbyalveolarsurgeryunderminingtheinterseptalboneHumanYesRen[]IntraseptalalveolarsurgeryDogYesSukuricaetal.2007[]RapidcaninedistalizationbysegmentalalveolardistractionHumanYesKisnisci[]RapidcaninedistalizationbysegmentalalveolardistractionHumanYesIseri[]RapidcaninedistalizationbysegmentalalveolardistractionHumanYesSayin[]RapidcaninedistalizationbysegmentalalveolardistractionHumanYesLee[]Corticotomy-assistedtoothmovementRatsNotstatisticallysignificantWilckoetal.2001[]AcceleratedosteogenicorthodonticsHumanYesBaloul[]CorticotomyRatsYesAbouletal.2011[]CorticotomyHumanYesHan[]IntraseptalalveolarsurgeryDogYesDibart[]PiezocisiontechniqueHumanYesHassan[]PiezocisiontechniqueHumanYesKeserandDibart2011[]Piezocision-assistedInvisaligntreatmentHumanYesetal.ProgressinOrthodonticsPage5of8http://www.progressinorthodontics.com/content/14/1/42 thatthiswillreducetheresistanceofthecorticalboneandacceleratetoothmovements.Itwasfirsttriedinor-thodonticsbyKole[68],wheretoothmovementswereachievedbetween6and12months.Thetechniquewasfurtherusedbyothers,forexample,Grenerson[69]whousedthisforopenbitestreatments,andothersin[70-72].In2001Wilcko[59]reportedthattheaccelerationoftoothmovementisnotduetothebonyblockmovementaspostulatedbyKole[68];itwasratheraprocessofboneremodelingatthesurgicalsite,whichwascalledregionalacceleratoryphenomenon(RAP).Hedevelopedpatenttechniqueswhichwerecalledacceleratedosteo-genicorthodontics(AOO)andperiodontalacceleratedosteogenicorthodontics.Also,modificationofRAPwasdonebyaddingbioabsorbablegraftingmaterialovertheinjuredbonetoenhancehealing.Thistechniqueisreportedtohavepostoperativesta-bilityandimprovedretentionasshownin[73],butmorestudiesarestillneededtobedone.Thenegativityofthesesurgicaltechniquesistheirinvasivenessandtheaccelerationwasonlyinthefirst3to4monthsanditdeclineswithtimetothesamelevelofthecontrols,asshownbyothers[60-62].PiezocisiontechniqueOneofthelatesttechniquesinacceleratingtoothmovementisthePiezocisiontech-nique.Dibart[63]wasamongthefirsttoapplythePiezocisiontechniquewhichstartswithprimaryincisionplacedonthebuccalgingivafollowedbyincisionsbyPiezosurgicalknifetothebuccalcortex[74].Piezocisiontechniquedidnotcauseanyperiodontaldamageasre-portedbyHassan[64].AnotherbenefitofthistechniqueisthatitcanbeusedwithInvisalign,whichleadstoabetteraestheticappearanceandlesstreatmenttimeasreportedbyKeser[65].Piezocisionisapromisingtoothaccelerationtechniquebecauseofitsvariousadvantagesontheperiodontal,aesthetic,andorthodonticaspects.ClinicalapplicationforthefutureTheadministrationofexogenousbiologicalmoleculestoacceleratetoothmovementduringorthodontictreat-mentshasbeenintensivelytestedonanimalexperi-ments.However,clinicaltrialsonhumansarelimitedsincetheymustbeadministeredoccasionallybylocalin-jectionsthatcanbepainfulandcausediscomforttothepatientsavoidingsystemicapplications,plustheirsideeffectwasnottestedforlongperiodsoftime.However,administrationofcertainmoleculeshasshownpromis-ingresults;forexample,cytokine,PTH,vitaminD,andRANKL/RANK/OPGsystemplayanimportantroleinboneremodelingandtoothmovement.Humanrelaxindoesnotacceleratetoothmovementinrats,butin-creasestoothmobilitybydecreasingtheorganizationandmechanicalstrengthofthePDL.However,alotofthesemechanismsarenotfullyunderstoodandthedose-dependentmechanismsshouldalsobefurtherinvestigated.Inthephysicalapproach,thelowlevellasertherapyisthemostpromisingmethod;however,contradictoryre-sultswereshown.Thisisduetothedifferentenergies,duration,andexperimentaldesign.Furthermore,mostoftheseexperimentsweredoneinonlyfewweeks,whichisaveryshorttimetonoticeanysideeffects.Thesurgicalapproachisthemostclinicallyusedandmosttestedwithknownpredictionsandstableresults.However,itisinvasive,aggressive,andcostly,andpa-tientsarenotopentotheideasinvolvingsurgeryunlessitistheonlyoptionthatisneededtohaveagoodocclu-sion.Piezocisiontechniqueisoneofthenewesttech-niquesinacceleratingtoothmovement,andithasgoodclinicaloutcomeandisconsideredtheleastinvasiveinthesurgicalapproach.ConclusionsIngeneral,allthesetechniqueshaddrawbacksandun-certaintiesthatmadethemnotcommonlyusedclinic-ally.However,therehasbeenarapidincreaseintheinterestlevelsofproductcompaniestoenhancetheeffectsofbiologyinorthodontics.Thesenewapproacheshavethepotentialtobethenextfrontierfororthodon-ticsanditsresources.CompetinginterestsTheauthorsdeclarethattheyhavenocompetinginterests.GNwrotethebiological,physicalandsurgicalparts.CKdesigned,revised,editedandcheckedtheinformationonthearticle.NSA-Kwrotethepeizocisiontechnique&andcontributedintheformationofthetables.RCcontributedinthefinallayoutofthepaper.AllauthorsreadandapprovedthefinalmanuscriptReceived:6June2013Accepted:26September2013Published:29October20131.DavidovitchZ.Toothmovement.CritRevOralBiolMed.2.MeikleMC.Thetissue,cellular,andmolecularregulationoforthodontictoothmovement:100yearsafterCarlSandstedt.EurJOrthod.3.DavidovitchZ,NicolayOF,NganPW,ShanfeldJL.cytokines,andthecontrolofalveolarboneremodelinginorthodontics.DentClinNorthAm.4.KrishnanV,DavidovitchZ.Cellular,molecular,andtissue-levelreactionstoorthodonticforce.AmJOrthodDentofacialOrthop.2006;129(4):469.e461-432.5.BurstoneCJ,TanneK.Biomechanicalbasisoftoothmovement.NipponKyoseiShikaGakkaiZasshi.6.GarletTP,CoelhoU,SilvaJS,GarletGP.Cytokineexpressionpatternincompressionandtensionsidesoftheperiodontalligamentduringorthodontictoothmovementinhumans.EurJOralSci.2007;115(5):35562.7.LeikerBJ,NandaRS,CurrierGF,HowesRI,SinhaPK.Theeffectsofexogenousprostaglandinsonorthodontictoothmovementinrats.AmJOrthodDentofacialOrthop.8.KrishnanV,DavidovitchZ.TheeffectofdrugsonorthodontictoothOrthodCraniofacRes.9.SaitoM,SaitoS,NganPW,ShanfeldJ,DavidovitchZ.Interleukin1betaandprostaglandinEareinvolvedintheresponseofperiodontalcellstoetal.ProgressinOrthodonticsPage6of8http://www.progressinorthodontics.com/content/14/1/42 mechanicalstressinvivoinvitroAmJOrthodDentofacialOrthop.10.YamasakiK,MiuraF,SudaT.Prostaglandinasamediatorofboneresorptioninducedbyexperimentaltoothmovementinrats.JDentRes.11.YamasakiK,ShibataY,FukuharaT.Theeffectofprostaglandinsonexperimentaltoothmovementinmonkeys(MacacafuscataJDentRes.12.YamasakiK,ShibataY,ImaiS,TaniY,ShibasakiY,FukuharaT.applicationofprostaglandinE1(PGE1)uponorthodontictoothAmJOrthod.13.SeifiM,EslamiB,SaffarAS.TheeffectofprostaglandinE2andcalciumgluconateonorthodontictoothmovementandrootresorptioninrats.EurJOrthod.14.KanzakiH,ChibaM,AraiK,TakahashiI,HaruyamaN,NishimuraM,MitaniH.LocalRANKLgenetransfertotheperiodontaltissueacceleratesorthodontictoothmovement.GeneTher.15.NishijimaY,YamaguchiM,KojimaT,AiharaN,NakajimaR,KasaiK.LevelsofRANKLandOPGingingivalcrevicularfluidduringorthodontictoothmovementandeffectofcompressionforceonreleasesfromperiodontalligamentcellsinvitro.OrthodCraniofacRes.16.CollinsMK,SinclairPM.ThelocaluseofvitaminDtoincreasetherateoforthodontictoothmovement.AmJOrthodDentofacialOrthop.17.KaleS,KocadereliI,AtillaP,AsanE.Comparisonoftheeffectsof1,25dihydroxycholecalciferolandprostaglandinE2onorthodontictoothAmJOrthodDentofacialOrthop.18.SomaS,IwamotoM,HiguchiY,KurisuK.EffectsofcontinuousinfusionofPTHonexperimentaltoothmovementinrats.JBoneMinerRes.19.SomaS,MatsumotoS,HiguchiY,Takano-YamamotoT,YamashitaK,KurisuK,IwamotoM.LocalandchronicapplicationofPTHacceleratestoothmovementinrats.JDentRes.20.LiuZJ,KingGJ,GuGM,ShinJY,StewartDR.Doeshumanrelaxinaccelerateorthodontictoothmovementinrats?AnnNYAcadSci.21.MadanMS,LiuZJ,GuGM,KingGJ.Effectsofhumanrelaxinonorthodontictoothmovementandperiodontalligamentsinrats.AmJOrthodDentofacialOrthop.8.e1-10.22.McGorraySP,DolceC,KramerS,StewartD,WheelerTT.Arandomized,placebo-controlledclinicaltrialontheeffectsofrecombinanthumanrelaxinontoothmovementandshort-termstability.AmJOrthodDentofacialOrthop.23.UdagawaN,TakahashiN,JimiE,MatsuzakiK,TsurukaiT,ItohK,NakagawaN,YasudaH,GotoM,TsudaE,HigashioK,GillespieMT,MartinTJ,SudaT.Osteoblasts/stromalcellsstimulateosteoclastactivationthroughexpressionofosteoclastdifferentiationfactor/RANKLbutnotmacrophagecolony-stimulatingfactor:receptoractivatorofNF-kappaB24.DrugarinDDM,NegruS,CioaceR.RANKL/RANK/OPGmolecularcomplex-controlfactorsinboneremodeling.25.KimSJ,KangYG,ParkJH,KimEC,ParkYG.Effectsoflow-intensitylasertherapyonperiodontaltissueremodelingduringrelapseandretentionoforthodonticallymovedteeth.LasersMedSci.26.SimonetWS,LaceyDL,DunstanCR,KelleyM,ChangMS,LuthyR,NguyenHQ,WoodenS,BennettL,BooneT,ShimamotoG,DeRoseM,ElliottR,ColomberoA,TanHL,TrailG,SullivanJ,DavyE,BucayN,Renshaw-GeggL,HughesTM,HillD,PattisonW,CampbellP,SanderS,VanG,TarpleyJ,DerbyP,LeeR,BoyleWJ.Osteoprotegerin:anovelsecretedproteininvolvedintheregulationofbonedensity.27.OshiroT,ShiotaniA,ShibasakiY,SasakiT.Osteoclastinductioninperiodontaltissueduringexperimentalmovementofincisorsinosteoprotegerin-deficientmice.AnatRec.28.KanzakiH,ChibaM,TakahashiI,HaruyamaN,NishimuraM,MitaniH.OPGgenetransfertoperiodontaltissueinhibitsorthodontictoothJDentRes.29.YamaguchiM.RANK/RANKL/OPGduringorthodontictoothmovement.OrthodCraniofacRes.30.Takano-YamamotoT,RodanGA.Amodelforinvestigatingthelocalactionofbone-actingagentsinvivo:effectsofhPTH(134)onthesecondaryspongiosaintherat.CalcifTissueInt.31.NicozisisJL,Nah-CederquistHD,TuncayOC.Relaxinaffectsthedentofacialsuturaltissues.ClinOrthodRes.32.HanGL,HeH,HuaXM,WangSZ,ZengXL.ExpressionofcathepsinKandIL-6mRNAinroot-resorbingtissueduringtoothmovementinrats.ZhonghuaKouQiangYiXueZaZhi.33.BumannA,CarvalhoRS,SchwarzerCL,YenEH.CollagensynthesisfromhumanPDLcellsfollowingorthodontictoothmovement.EurJOrthod.34.MasellaRS,MeisterM.Currentconceptsinthebiologyoforthodontictoothmovement.AmJOrthodDentofacialOrthop.35.NishimuraM,ChibaM,OhashiT,SatoM,ShimizuY,IgarashiK,MitaniH.Periodontaltissueactivationbyvibration:intermittentstimulationbyresonancevibrationacceleratesexperimentaltoothmovementinrats.AmJOrthodDentofacialOrthop.36.KauCH.Aradiographicanalysisoftoothmorphologyfollowingtheuseofanovelcyclicalforcedeviceinorthodontics.HeadFaceMed.37.DavidovitchZ,FinkelsonMD,SteigmanS,ShanfeldJL,MontgomeryPC,KorostoffE.Electriccurrents,boneremodeling,andorthodontictoothmovement.II.Increaseinrateoftoothmovementandperiodontalcyclicnucleotidelevelsbycombinedforceandelectriccurrent.AmJOrthod.38.FujitaS,YamaguchiM,UtsunomiyaT,YamamotoH,KasaiK.laserstimulatestoothmovementvelocityviaexpressionofRANKandOrthodCraniofacRes.39.KawasakiK,ShimizuN.Effectsoflow-energylaserirradiationonboneremodelingduringexperimentaltoothmovementinrats.LasersSurg40.LimpanichkulW,GodfreyK,SrisukN,RattanayatikulC.Effectsoflow-levellasertherapyontherateoforthodontictoothmovement.OrthodCraniofacRes.41.KauCH,KantarciA,ShaughnessyT,VachiramonA,SantiwongP,dala-FuenteA,etal.Extra-oralphotobiomodulationinthealignmentphaseoforthodontics.ProgOrthod..inpressarticledoiandyear42.Doshi-MehtaG,Bhad-PatilWA.Efficacyoflow-intensitylasertherapyinreducingtreatmenttimeandorthodonticpain:aclinicalinvestigation.AmJOrthodDentofacialOrthop.43.ZengoAN,BassettCA,PawlukRJ,PrountzosG.Invivopetentialsinthedentoalveolarcomplex.AmJOrthod.44.ShimizuY.MovementofthelateralincisorsinMacacafuscataasloadedbyavibratingforce.NipponKyoseiShikaGakkaiZasshi.45.KakehiN,YamazakiT,TsugawaW,SodeK.Anovelwirelessglucosesensoremployingdirectelectrontransferprinciplebasedenzymefuelcell.BiosensBioelectron.46.KolahiJ,AbrishamiM,DavidovitchZ.Microfabricatedbiocatalyticfuelcells:anewapproachtoacceleratingtheorthodontictoothmovement.MedHypotheses.47.SaitoS,ShimizuN.Stimulatoryeffectsoflow-powerlaserirradiationonboneregenerationinmidpalatalsutureduringexpansionintherat.AmJOrthodDentofacialOrthop.48.TrellesMA,MayayoE.Bonefractureconsolidatesfasterwithlow-powerLasersSurgMed.49.TakedaY.Irradiationeffectoflow-energylaseronalveolarboneaftertoothextraction.Experimentalstudyinrats.IntJOralMaxillofacSurg.50.KaruTI.Mitochondrialsignalinginmammaliancellsactivatedbyredandnear-IRradiation.PhotochemPhotobiol.51.EellsJT,HenryMM,SummerfeltP,Wong-RileyMT,BuchmannEV,KaneM,WhelanNT,WhelanHT.Therapeuticphotobiomodulationformethanol-inducedretinaltoxicity.ProcNatlAcadSciUSA.52.LiouEJ,HuangCS.Rapidcanineretractionthroughdistractionoftheperiodontalligament.AmJOrthodDentofacialOrthop.1998;114(4):37282.53.RenA,LvT,KangN,ZhaoB,ChenY,BaiD.Rapidorthodontictoothmovementaidedbyalveolarsurgeryinbeagles.AmJOrthodDentofacialOrthop.160.e161-110.54.SukuricaY,KaramanA,GurelHG,DolanmazD.Rapidcaninedistalizationthroughsegmentalalveolardistractionosteogenesis.AngleOrthod.55.KisnisciRS,IseriH,TuzHH,AltugAT.Dentoalveolardistractionosteogenesisforrapidorthodonticcanineretraction.JOralMaxillofacSurg.etal.ProgressinOrthodonticsPage7of8http://www.progressinorthodontics.com/content/14/1/42 56.IseriH,KisnisciR,BziziN,TuzH. Rapidcanineretractionandorthodontic treatmentwithdentoalveolardistractionosteogenesis. AmJOrthod DentofacialOrthop. 2005; 127(5): 533 41.quiz625. 57.SayinS,BengiAO,GurtonAU,OrtakogluK. Rapidcaninedistalization usingdistractionoftheperiodontalligament:apreliminaryclinical validationoftheoriginaltechnique. AngleOrthod. 2004; 74(3): 304 15. 58.LeeW,KarapetyanG,MoatsR,YamashitaDD,MoonHB,FergusonDJ,Yen S. Corticotomy-/osteotomy-assistedtoothmovementmicroCTsdiffer. JDentRes. 2008; 87(9): 861 7. 59.WilckoWM,WilckoT,BouquotJE,FergusonDJ. Rapidorthodonticswith alveolarreshaping:twocasereportsofdecrowding. IntJPeriodontics RestorativeDent. 2001; 21(1): 9 19. 60.BaloulSS,GerstenfeldLC,MorganEF,CarvalhoRS,Van-DykeTE,KantarciA. Mechanismofactionandmorphologicchangesinthealveolarbonein responsetoselectivealveolardecortication-facilitatedtoothmovement. AmJOrthodDentofacialOrthop. 2011; 139(4Suppl): S83 101. 61.Aboul-ElaSM,El-BeialyAR,El-SayedKM,SelimEM,El-MangouryNH,Mostafa YA. Miniscrewimplant-supportedmaxillarycanineretractionwithand withoutcorticotomy-facilitatedorthodontics. AmJOrthodDentofacial Orthop. 2011; 139(2): 252 9. 62.HanXL,MengY,KangN,LvT,BaiD. Expressionofosteocalcinduring surgicallyassistedrapidorthodontictoothmovementinbeagledogs. JOralMaxillofacSurg. 2008; 66(12): 2467 75. 63.DibartS,SurmenianJ,SebaounJD,MontesaniL. RapidtreatmentofClass IImalocclusionwithpiezocision:twocasereports. IntJPeriodontics RestorativeDent. 2010; 30(5): 487 93. 64.HassanNHANE,SaIT. Theeffectofusingpiezocisiontechniquein orthodontictoothmovementontheperiodontalcondition. EgyptDentJ. 2011; 57: 3047. 65.KeserEI,DibartS. Piezocision-assistedInvisaligntreatment. CompendContinEducDent. 2011; 32(2): 46 8.50 41. 66.IlizarovGA. Thepossibilitiesofferedbyourmethodforlengthening varioussegmentsinupperandlowerlimbs. BasicLifeSci. 1988; 48: 323 4. 67.WangL,LeeW,LeiDL,LiuYP,YamashitaDD,YenSL. Tisssueresponsesin corticotomy-andosteotomy-assistedtoothmovementsinrats:histology andimmunostaining. AmJOrthodDentofacialOrthop. 2009; 136(6): 770. e771-711;discussion770 771. 68.KoleH. Surgicaloperationsonthealveolarridgetocorrectocclusal abnormalities. OralSurgOralMedOralPathol. 1959; 12(5): 515 29.concl. 69.GenersonRM,PorterJM,ZellA,StratigosGT. Combinedsurgicaland orthodonticmanagementofanterioropenbiteusingcorticotomy. JOralSurg. 1978; 36(3): 216 9. 70.AnholmJM,CritesDA,HoffR,RathbunWE. Corticotomy-facilitated orthodontics. CDAJ. 1986; 14(12): 7 11. 71.GantesB,RathbunE,AnholmM. Effectsontheperiodontiumfollowing corticotomy-facilitatedorthodontics.Casereports. JPeriodontol. 1990; 61(4): 234 8. 72.SuyaH. Corticotomyinorthodontics. In:HoslE,BaldaufA,editors. Mechanicalandbiologicalbasisinorthodontictherapy .Heidelberg,Germany: HuthigBuchVerlag;1991:p.207 26. 73.NazarovAD,FergusonD,WilckoWM,WilckoMT. Improvedretention followingcorticotomyusingABOobjectivegradingsystem. JDentRes. 2004; 83: 2644. 74.MittalSKS,SinglaA. Piezocisionassistedorthodontics:anewapproachto acceleratedorthodontictoothmovement. InnovativeDentistry. 2011; 1: 1. doi:10.1186/2196-1042-14-42 Citethisarticleas: Nimeri etal. : Accelerationoftoothmovementduring orthodontictreatment-afrontierinOrthodontics. Progressin Orthodontics 2013 14 :42. Submit your manuscript to a journal and bene t from: 7 Convenient online submission 7 Rigorous peer review 7 Immediate publication on acceptance 7 Open access: articles freely available online 7 High visibility within the eld 7 Retaining the copyright to your article Submit your next manuscript at 7 springeropen.com Nimeri etal.ProgressinOrthodontics 2013, 14 :42 Page8of8 http://www.progressinorthodontics.com/content/14/1/42