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ePaper created 2018-03-13, 09:28:55 | version 1.38.0
technique | on the rate of tooth movement, the inconclusive and sometimes conflicting results, compounded by meth- odological heterogeneity, have made it difficult to criti- cally assess the evidence. It is of critical importance to recognise this, in order to avoid misleading practitioners into promoting clinical outcomes to their patients that are specious. The paucity of high-quality randomised clini- cal trials is problematic. Moreover, this challenge is com- pounded by the trend of manufacturers directing patients to their orthodontic products rather than through ortho- dontic practitioners, as well as to selected clinicians that promote these products.10 An emergent scientific observation, for it to become an objective fact, whether or not it is accepted, requires more than a handful of selective scientific research. It requires a whole system of research all pointing in the same direction and towards the same consequences. In the absence of a body of science-based evidence, there, nevertheless, remains an increasing volume of clinical reports that illustrate the potential value of these accelerated modalities. Precise aligner seating is not only integral to the clinician’s anticipated treatment schedule, but it also prevents teeth from moving in an undesired or unanti- cipated direction within the aligner, due to a less than adequate fit. Successful tracking is fundamental to accelerated aligner exchange. HFV pulse vibration devices such as the VPro5, have clinically demonstrated the capacity to enhance tracking and tooth movement,1 assuming appropriate diagnosis, treatment planning and Clincheck design. An especially particular benefit of this HFV device is that patients only need to use it for five minutes per day, which is conducive to patient compliance. Moreover, it appears to be of benefit with tracking in patients that are less than compliant with the mandated 20 hours per day aligner wear protocol. A recent study demon- strated a significant 99.6% patient compliance rate with the five-minute HFV device.11 My own experience with a low-frequency vibration device wherein the manufac- turer designated a mandatory 20 consecutive minutes of use, resulted in a compliance rate of only 10%, which led me to abandon its use. During the first few hours or days of aligner exchange, some discomfort is expected. The HFV device has elic- ited a positive response from a majority of patients, with some patients claiming that its use immediately following aligner exchange, results in complete resolution of dis- comfort. Congruently, a recent study using the device in aligner therapy demonstrated a statistically significant immediate reduction in recorded pain scores, versus controls within five minutes of aligner exchange, as well as over a seven-day period following aligner exchange.11 Accordingly, it appears that many patients benefit from use of the device in discomfort modification. Because the MOP procedure is entirely clinician- directed, it does not rely on patient compliance outside of the office to generate its effects. It therefore provides an opportunity to more readily appreciate its capacity to accelerate aligner treatment, and consequently remains the gold standard for acceleration in our practice. More- over, based upon clinical experience, it appears that the combination of MOP and HFV devices provides a possible synergistic effect, where the capacity to exchange aligners every three days is extended over a greater period of time, as opposed to instances where MOP alone is used. The benefits of decreased treatment time with enhanced pre- dictability and clinical outcomes are of importance to clini- cians and patients alike. Within the past two years, we have experienced patients who have presented for treatment through patient referral, proactively requesting the MOP procedure as an adjunct to their aligner treatment. The use of these accelerated devices in clinical practice has the potential to augment the quality of care, patient accep- tance of, and satisfaction with orthodontic treatment. Sev- eral years ago, these acceleration modalities had signifi- cantly influenced my practice. Now, they have defined it. Acknowledgement The Excellerator is the first and only device cleared by the US Food and Drug Administration (FDA) for micro- osteoperforation in orthodontic and dental operative pro- cedures. Propel Orthodontics markets the VPro5, the first and only high-frequency vibration aligner seater. Propel Orthodontics provided financial support to the author. Editorial note: A list of references is available from the publisher. about Dr Gary Brigham is a Top 1% Super Elite provider of Invisalign and has been an Elite provid- er since its inception. He has lectured across the US to doctors on all aspects of Invisalign treatment since 2004. In addition to his Doctor of Dental Surgery degree and Orthodontic Specialty Cer- tifi cation, Dr Brigham earned a Master of Science degree in Immunology at Case Western Reserve University in Cleveland, Ohio, in the US. For his research, he was presented with the Harry Sicher Research Award by the American Association of Orthodontists. A former Assistant Pro- fessor of Paediatric Medicine at the University of Illinois Medical Center in Chicago in the US, Dr Brigham currently serves as an adjunct professor and is the dedicated Invisalign and Propel instructor in the Graduate Orthodontics Program at A.T. Still University in Mesa, Arizona, in the US. In addition, he practises in Scottsdale and Cave Creek in Arizona, where he has treated 1,967 patients (including over 672 teens) with Invisalign. ortho 1 2018 37