An occasionally irregular blog about orthodontics

AcceleDent vibration reduces orthodontic pain? A new trial

By on November 23, 2015 in Clinical Research, Recent posts with 5 Comments
AcceleDent vibration reduces orthodontic pain? A new trial

Vibration reduces orthodontic pain: A new trial

This post is a follow-up from previous posts in which I have reviewed the recent research on AcceleDent.  I have concluded that, at present,  AcceleDent does not appear to have an effect on orthodontic tooth movement. This newly published  study  evaluates whether the use of AcceleDent reduces orthodontic related pain.If you did not read my last post on “how to read a randomised controlled trial” I suggest that you have a quick look at it, as I hope that it provides a basis for my discussion of this and other papers over the next few weeks.

IMG_3845Pain control in orthodontics using a micropulse vibration device : A randomized clinical trial

Dunn W et al. Angle orthodontist advanced access DOI: 10.2319/072115-492.1  OPEN ACCESS

 

 

The authors did a nice introduction that outlined the various methods of reducing orthodontic related pain and I would recommend that you read this, I found it very useful and interesting. These methods include analgesics, acupuncture, laser therapy, viscoelastic bite wafers and chewing gum.  They pointed out that the last three methods may reduce compression of the periodontal ligament to eliminate oedema, inflammation and pain. This led them to introduce the concept that vibration may have a similar effect and this led to the present study.

What did they ask?

They investigated whether the use of AcceleDent reduced orthodontic pain in comparison to a control group of no treatment, during the first four months of orthodontic treatment.

What did they do?

This was a randomised controlled trial in which patients were randomly allocated to AcceleDent or no intervention for pain. They carried out a sample size calculation and enrolled a sample of 70 adult and child participants. The randomisation concealment and enrolments were satisfactory.

The participants in the study recorded their pain using visual analogue scales for the first seven days following adjustment and then weekly for the remainder of the month for four months. Importantly, they asked all the patient not to take analgesics.

What did they find?

In each group 29/35 (83%) completed the study. Six patients from each group were excluded. Four in each group were excluded because they used analgesics and two did not complete their pain diary.

They found that the use of Acceledent resulted in a statistically significant reduction in reported pain for  both biting and overall pain. They represented this graphically and I have done a screen grab for overall pain. This illustrates their finding very clearly.

Visual analogue scale pain for overall pain

Visual analogue scale pain for overall pain

The discussion was very balanced and they suggested that the vibratory stimulation may increase blood flow to the PBL and reduce pain producing substance.

What did I think?

Firstly, I would like to discuss a major problem with this study which the authors also mentioned  in their discussion.  This was that they did not use a placebo. This is very relevant because there may be a placebo effect as the patients may have believed that they were doing something to reduce their pain. As a result, they perceived or recorded less pain. This is well recognised in all studies involving any form of pain reduction.

The authors felt that they could not have used a sham device because  this may have influenced the reporting of pain. However, I cannot help feeling that this is exactly what a placebo should do.

My other concern is with the choice of no intervention as a control. This may be somewhat philosophical, but I wonder if it would have been a better study if they had compared the vibrating device with an analgesic (or other method of pain reduction). This would avoid the comparison of the potentially active intervention against nothing and make the study more “real-world”. I would also have ethical concerns in asking my patients not to take an analgesic after their appointments.

Finally, the authors  point out that vibration may be safer than using analgesics. This may be the case, however, they did not address the considerable additional cost of Acceledent when compared to over-the-counter medication, bite wafers and chewing gum. I also had a look at some of the other papers reporting pain reduction and they reported pain reduction with both bite wafers and chewing gum.  These would be far more economical than the Acceledent device.

As a result, I feel that this study is no more than an interesting exploratory study and their conclusions are not really supported by the data, particularly with respect to an evaluation of the placebo effect. Nevertheless, there needs to be a further study carried out making a comparison between the effect of vibratory force and analgesics or other methods of pain relief.

You may think that I am becoming rather cynical about AcceleDent. I can assure you that this is not the case, I would clearly like to provide my patients with a method of speeding up their treatment and reducing pain. Unfortunately, the current research base needs improving, before I buy into this new technology.  It would be great if AcceleDent was shown to  increase the speed of tooth movement!

ResearchBlogging.org
Lobre, W., Callegari, B., Gardner, G., Marsh, C., Bush, A., & Dunn, W. (2015). Pain control in orthodontics using a micropulse vibration device:

The Angle Orthodontist DOI: 10.2319/072115-492.1

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  1. How do i purchase this in india?

  2. Jayaram Mailankody says:

    From the two trials of AccelDent, one thing is obvious, the industry is very good in identifying problems in orthodontics, namely (i)speed of tooth movement and (ii) pain and discomfort associated with loading of orthodontic forces. Now it is upto the clinical researchers to innovate, easy, effective economical and conservative methods of enhancing tooth movement and reducing pain and discomfort. Refining existing methods or innovating newer approaches needs to be explored ?

  3. Dr Sharanya Sabrish says:

    Dear Sir,
    I love reading your blog. It is insightful and very relevant, especially to academicians like myself.

  4. Invisalign User says:

    I’m currently using Acceledent for the purpose of having a shorter Invisalign treatment. I didn’t know that it would lessen pain but from my personal experience, it absolutely has. I had Invisalign 10 years ago but didn’t complete my treatment and my teeth moved back to their original position. Back then, I had noticeable pain for the first 3 days every time I changed trays. It wasn’t anything I couldn’t handle but I did dread changing trays. Fast forward to now. I’m on tray 8 and have felt virtually no pain, which is surprising to me. Surprising enough that I googled Acceledent lessens pain and found your blog. You say it doesn’t speed tooth movement, but I’ve been instructed to change my trays every 3 days and each new tray fits without problem. I’ve yet to find anyone talking about wearing their trays for this short of period of time, even with Acceledent. But so far it’s working!

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