Cochrane · intervention · CD010887
Non‐surgical adjunctive interventions for accelerating tooth movement in patients undergoing orthodontic treatment
El-Angbawi, A, McIntyre, G, Fleming, PS, et al. · Cochrane Database of Systematic Reviews · 2023 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
33
current version
GRADE rated
15
No studies
8
Included studies
23
as reported
No studies 8 · 24.2%Ungraded 10 · 30.3%Very low 8 · 24.2%Low 7 · 21.2%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Individuals of any age receiving orthodontic treatment with fixed or removable appliances incorporating non-surgical adjunctive interventions; patients treated with orthognathic surgery, cleft lip/palate or other craniofacial syndromes/deformities excluded | 1027 participants, children and adults (age range 8 to 50 years), various malocclusions; fixed appliances in most studies and removable aligners in 3 studies (n=23) |
| Intervention | Any fixed or removable orthodontic appliance treatment incorporating non-surgical adjunctive interventions to accelerate orthodontic tooth movement | Light vibrational forces (Acceledent, Tooth Masseuse, electric toothbrush, custom device) (n=12); Low level laser therapy (n=10); Light-emitting diode (n=2) (n=23) |
| Comparison | Any fixed or removable orthodontic appliance treatment without non-surgical adjunctive interventions, or with a different type of non-surgical adjunctive intervention | Conventional fixed or removable appliance treatment without adjunct; sham device in 4 studies (n=23) |
| Outcomes | Duration of active orthodontic treatment (primary); Number of visits for appliance activation; Rate of reduction of malalignment (Little's irregularity index); Rate of OTM (mm/week or month); Improvement in occlusion (PAR); Patient-centred outcomes (daily life, quality of life, pain); Harms; Cost of treatment | Duration of treatment/alignment stage; Number of adjustment visits; Rate of OTM during alignment and space closure; Pain and discomfort VAS (n=9); Need for analgesics (n=3); OIIRR (n=2); Occlusal outcome PAR (n=1); Quality of life (n=1); Harms (n>=5) (n=23) |
| Study designs | Randomised controlled trials (RCTs); split-mouth designs excluded | Parallel-group randomised controlled trial (n=23) |
| Timing | No restriction on length of follow-up | Variable; discrete treatment stages (alignment, space closure) through to full treatment duration (n=23) |
Search date: 2022-09. Databases: Cochrane Oral Health's Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE Ovid; Embase Ovid; LILACS BIREME Virtual Health Library; ClinicalTrials.gov; WHO ICTRP
Questions and results
Show all 3 versionsLight vibrational forces (LVF) vs Conventional orthodontic appliance treatment (placebo or no adjunct)
Population: Adolescents and adults with malocclusion undergoing orthodontic treatment with fixed or removable appliances
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Change in angulation of teeth adjacent to the space (molar and canine tipping/rotation) | Siriphan 2019 (lateral cephalometric radiographs): rate of molar movement and tipping, and canine rotation and tipping were not significantly different between groups (P>0.05). | 1 study | Ungraded |
Harms and side effects: orthodontically-induced inflammatory root resorption (OIIRR), mm | MD 0.09 [-0.35, 0.53] 0.09 [-0.35, 0.53] mm (higher) | 1 study · 50 participants | Low Downgraded: imprecision, indirectness |
Harms: serious adverse effects | No serious adverse effects were reported across five studies that assessed harms (Katchooi 2018; Lombardo 2018; Pavlin 2015; Reiss 2020; Taha 2020). | 5 studies | Ungraded |
Rate of orthodontic tooth movement (OTM) during space closure stage (en masse, mm/month) Space closure stage | MD 0.10 [-0.08, 0.29] 0.10 [-0.08, 0.29] mm/month (higher) | 2 studies · 81 participants | Low Downgraded: risk of bias, imprecision |
Oral health-related quality of life (OHRQoL) | Katchooi 2018 (unclear risk of bias): light vibrational forces had no statistically significant (P>0.05) effect on OHRQoL when used with orthodontic aligners. | 1 study · 27 participants | Ungraded |
Cost of treatment | Cost of treatment was not investigated in any of the included studies. | NR | No studies |
Patient-reported need for analgesics during first week of initial aligning archwire First week of initial aligning archwire | OR 1.64 [0.60, 4.53] 76.08% (percentage of control patients reporting need for analgesics) vs 7.59% lower in intervention groups | 2 studies · 76 participants | Low Downgraded: risk of bias, imprecision, indirectness |
Patient perception of pain and discomfort (VAS 0 to 100 mm), immediately after ligation of initial archwire Immediately after ligation of initial archwire (also 4-8h, 1, 3, 7 days) | MD 2.56 [-2.35, 7.47] 2.56 [-2.35, 7.47] mm on VAS (higher) | 3 studies · 153 participants | Low Downgraded: risk of bias, imprecision |
Improvement in occlusion / orthodontic treatment occlusal outcome (Peer Assessment Rating, PAR) | Woodhouse 2015 (81 participants, 22 dropouts): PAR reduction intervention median 28.0 (IQR 21.0-38.0), control median 29.0 (IQR 24.0-31.0), placebo median 27.0 (IQR 20.0-35.0); percentage improvement medians 88.9 /… | 1 study · 59 participants | Ungraded |
Rate of orthodontic tooth movement with removable orthodontic aligners Full aligner treatment duration | MD 0.2 [-1.51, 1.10] | 1 study · 27 participants | Ungraded |
Orthodontic tooth movement (OTM) during alignment stage (reduction in Little's Irregularity Index, mm) Full alignment stage (also 4-6 weeks; 10-16 weeks) | MD -0.20 [-7.02, 6.62] -0.20 [-7.02, 6.62] mm (LII reduction, less) | 1 study · 54 participants | Low Downgraded: imprecision |
Harms: non-serious adverse effects (headache, discomfort, loosening of temporary anchorage devices) | RR 0.96 [0.32, 2.85] | 1 study · 45 participants | Ungraded |
Duration of orthodontic treatment | MD -0.61 [-2.44, 1.22] -0.61 [-2.44, 1.22] months (fewer) | 2 studies · 77 participants | Low Downgraded: risk of bias, imprecision |
Total number of orthodontic appliance adjustment appointments during treatment | MD -0.32 [-1.69, 1.05] -0.32 [-1.69, 1.05] visits (fewer) | 2 studies · 77 participants | Low Downgraded: risk of bias, imprecision |
Low level laser therapy (LLLT) vs Conventional orthodontic appliance treatment
Population: Adolescents and adults with malocclusion undergoing fixed orthodontic appliance treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Harms and side effects arising during treatment | SoF states harms/side effects Not reported; Ghaffer 2022 (the only LLLT study to assess harms) reported no serious harms other than gingivitis associated with plaque accumulation. | 1 study | Ungraded |
Patient perception of pain and discomfort (VAS 0 to 100 mm) Space closure / first visit | MD -0.4 [-1.87, 1.07] -0.4 [-1.87, 1.07] mm on VAS (lower) | 1 study · 37 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Total number of orthodontic appliance adjustment visits during overall treatment | No study reported on the influence of LLLT on the total number of orthodontic appliance adjustment visits to complete a course of treatment. | NR | No studies |
Duration of total overall orthodontic treatment | No study reported on the influence of LLLT on the total overall orthodontic treatment duration. | NR | No studies |
Rate of maxillary molar intrusion for correction of anterior open bite 3 and 6 months | Two studies (62 participants), not pooled. Abellan 2021: no significant difference in molar intrusion at 3 months (1.25 vs 1.72 mm) or 6 months (1.09 vs 1.28 mm), nor rate per month. Hasan 2022: increased intrusion… | 2 studies · 62 participants | Ungraded |
Periodontal health during molar intrusion | Abellan 2021 assessed periodontal health (plaque index, pocket depth, bleeding on probing) after intrusion of maxillary molars; no evidence of significant difference with LLLT. Statistical test results not published. | 1 study | Ungraded |
Rate of orthodontic tooth movement during alignment stage (percentage reduction in LII), first month First month of alignment (also second month) | MD 1.63 [-2.60, 5.86] 1.63 [-2.60, 5.86] % reduction in LII (greater) | 2 studies · 56 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Rate of orthodontic tooth movement during space closure stage (maxillary arch), mm/month Space closure stage | MD 0.18 [0.10, 0.26] 0.18 [0.10, 0.26] mm/month (higher) | 1 study · 45 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Duration of orthodontic treatment during alignment stage Alignment stage | MD -48.87 [-56.48, -41.26] -48.87 [-56.48, -41.26] days (fewer) | 3 studies · 92 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Total number of orthodontic appliance adjustment appointments during alignment stage Alignment stage | MD -2.25 [-2.52, -1.97] -2.25 [-2.52, -1.97] visits (median, fewer) | 2 studies · 125 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Patient-reported need for analgesics | Patient-reported need for analgesics | Not reported | NR | No studies |
Orthodontically-induced inflammatory root resorption (OIIRR) during molar intrusion | Abellan 2021 assessed OIIRR using CBCT after intrusion of maxillary molars; no evidence of significant increase or reduction with LLLT. Statistical test results not published. | 1 study | Ungraded |
Light-emitting diode (LED) photobiomodulation vs Conventional orthodontic appliance treatment
Population: Adolescents and adults with malocclusion undergoing fixed orthodontic appliance treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Orthodontic tooth movement (OTM) during alignment stage | Orthodontic tooth movement (OTM) during alignment stage | Not reported | NR | No studies |
Patient perception of pain and discomfort (VAS 0 to 100 mm) First visit | MD -0.80 [-2.20, 0.62] -0.80 [-2.20, 0.62] mm on VAS (lower) | 1 study · 39 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Patient-reported need for analgesics | Patient-reported need for analgesics | Not reported | NR | No studies |
Total number of orthodontic appliance adjustment appointments during treatment | Total number of orthodontic appliance adjustment appointments required during treatment stage | Not reported | NR | No studies |
Rate of orthodontic tooth movement during space closure stage (maxillary canine distalisation), mm/day Space closure (canine retraction) | MD 0.006 [0, 0.02] 0.006 [0, 0.02] mm/day (higher) | 1 study · 39 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Harms and side effects arising during treatment | Harms and side effects | Not reported. None of the included studies assessed harms arising during the LED intervention. | NR | No studies |
Duration of orthodontic treatment: alignment stage (mandibular arch) Alignment stage | MD -24.5 [-42.45, -6.55] -24.5 [-42.45, -6.55] days (fewer) | 1 study · 34 participants | Very low Downgraded: risk of bias, imprecision, indirectness |