What adjunctive methods can accelerate tooth movement with clear aligners or fixed braces, and what are their long‑term risks?

Accelerating Tooth Movement with Clear Aligners or Braces

Modern Methods Available

Based on current evidence, corticotomy is the most effective intervention to accelerate orthodontic tooth movement, supported by low-quality evidence showing significant short-term acceleration (1-3 months), though it requires surgical intervention. 1, 2

Surgical Approaches

Corticotomy is the most evidence-supported method for accelerating tooth movement:

• Involves selective cutting of cortical bone around teeth to induce regional acceleratory phenomenon (RAP) 3, 1
• Demonstrates effectiveness and safety in accelerating orthodontic tooth movement 1
• Shows predictable outcomes but has limited application due to its invasive nature 3

Piezocision represents a minimally invasive alternative:

• Considered one of the best surgical approaches with good periodontal tissue response and excellent aesthetic outcomes 3
• Less aggressive than traditional corticotomy while maintaining acceleration benefits 3

Non-Surgical Approaches

High-Frequency Vibration (HFV) shows promise specifically for clear aligner treatment:

• Appears effective in accelerating tooth movement and reducing the exchange interval of aligners 4
• More effective than low-frequency vibration in patients treated with clear aligners 4
• Based on low level of certainty from available evidence 4

Low-Level Laser Therapy (LLLT) has mixed evidence:

• Doses of 5 and 8 J/cm² supported by low-quality evidence for short-term (1-3 months) acceleration 2
• One systematic review found LLLT unable to accelerate orthodontic tooth movement 1
• Requires further investigation to determine optimal energy and duration 3

Ineffective or Insufficient Evidence:

• Electrical current: current evidence does not reveal effectiveness 1
• Pulsed electromagnetic fields: lacks convincing evidence 1, 2
• Relaxin injections: reported to have no impact on tooth movement 2
• Extracorporeal shock waves: no impact according to very low-quality evidence 2

Long-Term Effects and Safety Considerations

Risks of Accelerated Treatment

Root resorption remains a primary concern:

• Long orthodontic treatment duration already poses higher risk of root resorption 5, 3
• Limited data available on whether HFV reduces or increases root resorption risk 4
• Further investigation necessary to clarify effects of vibration on root resorption 4

Periodontal complications:

• Extended treatment time increases predisposition to gingival recession 3
• Corticotomy shows good periodontal tissue response when performed correctly 3
• Piezocision demonstrates excellent periodontal outcomes 3

Dental caries risk:

• Longer orthodontic treatment poses higher predisposition to caries 3
• Accelerating treatment theoretically reduces this exposure time 5

Evidence Quality Limitations

Critical gap in long-term data:

• Quality of evidence for most interventions ranges from very low to low 2
• Short-term effects (1-3 months) are better documented than long-term outcomes 2
• Future high-quality trials required to determine long-term effects before warranting routine clinical recommendations 2

Animal vs. human studies:

• High amount of research on biological methods (cytokines, PTH, vitamin D, RANKL/RANK/OPG) done primarily on animals 3
• Limited human clinical trial data for many promising biological approaches 3

Clinical Decision Algorithm

For patients seeking accelerated treatment:

1. If patient accepts surgical intervention: Corticotomy or piezocision offers most predictable acceleration with documented safety profile 3, 1

2. For clear aligner patients preferring non-surgical approach: High-frequency vibration devices show promise for reducing aligner exchange intervals 4

3. For fixed braces with non-surgical preference: LLLT at 5-8 J/cm² may provide short-term acceleration, though evidence quality is low and conflicting 1, 2

4. Avoid: Relaxin injections, extracorporeal shock waves, and electrical current lack evidence of effectiveness 1, 2

Common Pitfalls

Do not promise definitive acceleration with non-surgical methods, as evidence quality remains low and long-term effects are unknown 2

Avoid aggressive surgical approaches without proper training, as periodontal complications can occur; piezocision offers safer alternative to traditional corticotomy 3

Do not neglect monitoring for complications including root resorption, periodontal health, and caries during accelerated treatment 4, 3

Recognize that no intervention is widely accepted as routine practice in orthodontic clinics due to limitations in evidence quality and potential disadvantages 5