Unclear if non-surgical adjuncts accelerate orthodontic treatment

Data sourcesCochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, LILACS, the metaRegister of Controlled Trials, the US National Institutes of Health Trials Register and the WHO International Clinical Trials Registry Platform.Study selectionRandomised controlled trials of orthodontic treatment using fixed appliances along with non-surgical adjunctive interventions to accelerate tooth movement.Data extraction and synthesisTwo reviewers independently selected studies, abstracted data and assessed risk of bias. Meta-analysis was not possible.ResultsTwo studies involving a total of 111 patients were included, both were at high risk of bias. The studies compared the use of Tooth Masseuse and OrthoAccel with conventional treatment mechanics. Using OrthoAccel with 30 Hz at 0.25 N for 20 minutes daily produced a higher rate of maxillary canine distalisation in comparison to the control group (MD 0.37 mm/month; 95% CI -0.07 to 0.81; P = 0.05). Whilst this difference suggested 50% faster tooth movement using the vibrational appliance, the absolute differences were marginal and deemed clinically unimportant. Similar levels of non-serious adverse effects were reported in the intervention and control groups with a risk ratio of 0.96 (95% CI 0.32 to 2.85). Overall, the quality of the evidence was very low and therefore we cannot rely on the findings.ConclusionsThere is very little clinical research concerning the effectiveness of non-surgical interventions to accelerate orthodontic treatment. The available evidence is of very low quality and so it is not possible to determine if there is a positive effect of non-surgical adjunctive interventions to accelerate tooth movement. Although there have been claims that there may be a positive effect of light vibrational forces, results of the current studies do not reach either statistical or clinical significance. Further well-designed and rigorous RCTs with longer follow-up periods are required to determine whether non-surgical interventions may result in a clinically important reduction in the duration of orthodontic treatment, without any adverse effects.