A massive summary of the best of my blog for 2017

In this post I have made a list of the most popular blog posts from this year. If you have time you can look back and re-read them or have a look at some that you missed.

I have been doing this blog for three years now and the readership has grown dramatically. Over the past few months my posts have been read over 45,000 a month. I think that, with luck, this may increase 50,000 this month. This graph shows how readership has increased per year.

The posts are now translated into several languages and we have a high level of hits in Brazil, China and Russia. A group of French orthodontists recently joined the translation team and this is great news.

Changes this year

I introduced an app in September and this has been downloaded 1200 times. It is completely free and I think that it is the best way to read the posts.

I also managed to persuade several other people to write guest posts and they were very popular. I will repeat this again next year.

We hope that everyone finds this to be a useful resource. It is a bit of work but I really enjoying doing it.

Anyway, thanks for reading my blog and here are the top 10 most popular posts from 2017 in reverse order.

The top 10 posts

Another nail in the coffin of the non-extraction obsession: a new study

This post was about a study that looked at the effect of extractions on facial profile. It caused a lot of discussion and a lot of this was objections to the title!

Careful with that cone-beam: It does not seem to make a difference?

The development and evaluation of new technology is an important role for research. This post was based on a paper that showed that the use of routine CBCT views did not make a real difference to treatment decisions. The discussion again was wide ranging. It also gave me a chance to reference a classic Pink Floyd track.

Which is better a bonded or vacuum formed retainer? Here is a new trial.

I wrote this post to have a close look at a new trial into retention methods. A team from the North of England did this study and I thought that it provided very useful information. I have referenced the North of England several times and people have asked is it similar to the North in Game of Thrones. Yes, it is but we do not have dragons…

The end of self ligation: or is it?

This was a review of another study on self ligation. It still surprises me that people claim that self ligation speeds up treatment. The answer is simple “it does not”.

I have decided to invent a new form of treatment: 24 month braces revisited

I revisited one of my earlier posts and posted this. It still managed to cause controversy and there were many comments.

Which is better Invisalign or fixed appliances? Does this study help?

I do not usually write about retrospective studies, but I thought that this was interesting. It is also a reflection of the lack of high quality research that has been done into Invisalign.

Lets talk about FastBraces

This post was about FastBraces. I got 38 comments that I could publish. There were about another 20 that were not publishable. Have a look at the comments. They tell a good story.

We need to talk about Myofunctional orthodontics..

We had a good chat about this one. There were 82 comments. They provided a great insight into this type of treatment. Again, these were the publishable ones. The comments from  Director of search of Myofunctional Research were very interesting…

Let’s talk about Acceledent

This was an old post from 2015 and it is still being read many times a week. I think that it has been picked up some patient groups. It is my most read post and has been read over 30,000 times.

The most popular post this year was

What’s going on with Invisalign?

I wrote this in early December and it has been read 18,000 times. In this post I discussed the new Invisalign store.

I feel that this has been a good year for my blog and I hope that it can continue to grow and provide information to you. I hope that you have a good holiday season. In the UK we have a very long Christmas/New Year break and I will post again in early January.

AcceleDent increases tooth movement by up to 50%…

Does AcceleDent increase tooth movement by up to 50%?

The other day I was looking at an online edition of the AJO-DDO.  There was a pop-up from Acceledent that drew attention to their new clinical evidence.  I thought that I should have a look at this again….

 

 

 

 

This is the link to their page. You will see that they specifically mention three RCTs that support AcceleDent.

I decided to look at these trials. I have reviewed two of these before.  The first I did was the AcceleDent sponsored study run by an AcceleDent consultant published in  Seminars in Orthodontics.  In my post, I pointed out that, in my opinion, this study was significantly flawed and I still cannot understand why the journal editor agreed to publish this paper. Another paper investigated pain.  Again, I felt that this was significantly flawed, as the study did not include a placebo.

I have also posted on other studies by Miles and Woodhouse.  These were much better studies that showed no effect of AcceleDent. However, AcceleDent and their Key Opinion Leaders do not appear to quote them..

The study they mentioned was published in the Angle Orthodontist and I must have missed it last year.

Vibratory stimulation increases interleukin-1 beta secretion during orthodontic tooth movement

Chidchanok Leethanakul et al

The Angle Orthodontist: January 2016, Vol. 86, No. 1, pp. 74-80.

They did this study to investigate the levels of pro-inflammatory molecules in the gingival crevicular fluid after the application of a vibratory force.

What did they do?

They did a split mouth randomised trial. The PICO was;

Participants:  15 patients (11females, 4 males) aged 19-25 years having orthodontic treatment that needed canine retraction.  The operators retracted the canines using a power arm and elastics.

Intervention:  They selected the right or left canine to have vibratory stimulation from a powered toothbrush (NOT ACCELEDENT).

Comparison:  Split mouth.  Toothbrush vs no intervention.

Outcome:  Tooth movement

They gave no information on method of randomisation apart from saying that the right or left canine was selected by the operator.  They also did not provide any information on allocation concealment or sample size calculation.  These are fundamental problems in the reporting of a trial.

When I looked at their method of measurement this was not clear.  They stated that the accuracy of their measurement was 0.01mm but did not let us know how they calculated this.

What did they find?

I will only look at the tooth movement data.  I have put this in this table along with the 95% CIs.

Tooth movement

 Tooth movementDifference
Control1.77 (95% CI 1.71-1.8)1.15 (95% CI 1.00-1.2)
Vibrating toothbrush2.85 (95% CI 2.7-2.9)

Therefore, within the severe limitations of this study, they found a significant difference in the amount of tooth movement. This was 1.15mm over three months or 0.38mm/month.

What did I think?

In my academic opinion, I felt that this study was significantly flawed, for the following reasons;

  1. There was no sample size calculation.
  2. The sample size was very low. This means that the effect size may be subject to individual variation.
  3. The investigator “chose” the canines for the intervention/control. This does not appear to be an RCT.
  4. There was no allocation concealment.
  5. They provided limited information on the method of measurement and no information on how they carried out an error analysis.
  6. We also need to consider the effect size.  This was 1.15 mm over three months, that is 0.38mm/month. I am not sure if this is really “speeding up” tooth movement.

Finally, they did not use AccelDent (cost $800-1000) they used a tooth brush (cost $80).  I know what I would use…

Summary

I have put together a summary table of the evidence from my posts on this subject.

PaperType of studyOutcomeResultPaper quality
WoodhouseRCTRate of alignmentNo differenceHigh
MilesRCTRate of alignmentNo differenceHigh
PavlinRCTCanine movement0.37mm/monthv.low
Leethanakul?Canine movement0.38mm/monthv.low
LobreRCTPainLess pain in short term with AcceleDent (no placebo)low

Nature of the evidence

I can only conclude that we do not know if AcceleDent has an effect on tooth movement.  However, AcceleDent are correct in their claim of an increase of “up to 50%”. My broadband provider claims up to 200Mb/s…but I get much less. However, you need to decide on the effect size and the strength of evidence and then decide if you want to recommend (sell) this device to your patients.

I have now posted on this subject several times.  I think that one of the most interesting features of the papers that I have analysed is that the higher quality studies published in the AJO-DDO and Journal of Dental Research do not show an effect. Whereas, those that show a small effect are significantly flawed and published in lower impact journals.  However, this is clearly an editorial decision and I am not going to comment.

Finally, I can fully understand why AcceleDent do not quote the evidence that does not support their product. It is the role of the salesman to sell their product and it is our role as clinician scientists to evaluate their claims.  However, the silence from the clinicians selling AcceleDent to their patients and the Key Opinion Leaders is deafening.

I also wonder if it is time that the specialist societies made a statement on the various methods of “moving teeth faster”.  The AAO did this for self-ligation and took a lead in carrying out this type of work.   Is there anybody out there?