August 05, 2019

Is orthodontic vibration the air guitar of orthodontics?

One of the recent developments to make teeth move faster is AcceleDent/orthodontic vibration. This is an orthodontic vibrator which is supposed to reduce treatment time and discomfort.  A new systematic review does not support these claims. This is my last post on orthodontic vibration, we have all wasted too much time on this.

I have posted about AcceleDent/orthodontic vibrators several times. Most of the studies that I have reviewed have suggested that these devices are not useful. Yet, it is still heavily promoted by the OrthoAccel company and its paid Key Opinion Leaders.  I decided to post about this new paper, so that our knowledge remains current.

The EJO published this systematic review of the effects of orthodontic vibration. I realise that you may know the direction that this blog post is going to take, but here we go…

A team from China did this systematic review.

The effectiveness of supplemental vibrational force on enhancing orthodontic treatment. A systematic review

Chunxiao Lyu, Li Zhang and Shujuan Zou

EJO doi:10.1093/ejo/cjz018

What did they ask?

They did this systematic review to answer this question:

“What are the potential effects of supplemental vibrational force on the rate of tooth movement, orthodontic pain and root resorption”?

What did they do?

They used the standard Cochrane methodology of electronic and relevant hand searches for Randomised Controlled and Controlled Clinical Trials.  The PICO was

Participants: Orthodontic patients with fixed appliances or clear aligners.

Intervention:Intral-oral orthodontic vibration device.

Control: Treatment as usual.

Outcome: Rate of tooth movement, pain experience and root resorption.

Two independent examiners identified the papers and carried out data extraction.  They evaluated Risk of Bias with the Cochrane Risk of Bias tool and measured the strength of evidence using the GRADE approach.  Finally, they did a meta-analysis to identify the effect size.

What did they find?

They obtained a final sample of 13 studies. Of these, 12 were RCTs, and 1 was a CCT.  Two of the RCTs were split-mouth, and the remainder were parallel-group designs.  Two publications were from the same trial, and four were different parts of the same clinical trial.  They obtained data from a total of 409 participants, and 209 subjects were assigned supplemental vibration, and 228 were allocated to a control/sham group.

There was a large amount of variation across the studies in measurement, study design and outcomes.  As a result, they could not carry out a meta-analysis of the data, and they outlined their general findings.  I do not have sufficient space to go through all their results here.  However, their overall conclusion was:

“There is insufficient information to support the claims that supplemental vibrational force has a positive clinical advantage in tooth movement, reduction of orthodontic pain and root resorption”.

What did I think?

Earlier this year, I outlined a previous systematic review that came to similar conclusions. However, this review was confined to tooth movement. The authors of the present paper did their study to consider the other claimed effects of vibration.  It is, therefore, relevant to find that we now have two systematic reviews that have come to similar conclusions.  The overall conclusion is:

“There is an absence of evidence that orthodontic vibration has any effect”.

I cannot help feeling that we now have reached the end of the line in analysing the claims that are made for the effects of orthodontic vibration.  There is absolutely no reason for orthodontists to promote and sell this appliance to their patients.  Yet, the AcceleDent Key Opinion Leaders happily ignore all this research and continue to support the claims.  Have a look at the KOL page on the AcceleDent website.

Here are some quotes

Straty Righellis…

“AcceleDent works! I’ve found that AcceleDent’s innovative technology accelerates tooth movement at a faster rate than previously experienced”.

Stuart Frost….

“My patients say that by using AcceleDent, they have reduced the soreness after their ortho visits by 50%. Who wouldn’t want that? I don’t think we have seen all the benefits of AcceleDent yet”.

I think that everyone who reads the literature must disagree and I wonder if these KOLs are now beginning to look rather foolish. I wonder why they make these claims in the face of overwhelming evidence?

Final summary

Finally, the title of this post is not mine.  There was a discussion about orthodontic vibration on one of the Facebook groups that I follow and Kliff Kapus (a USA based orthodontist) stated

“Orthodontic vibration is the air guitar of orthodontics”.

I think that this sums it up correctly, and this is why I used this title for my post.  This is my last post on this subject. It is time to stop and consign orthodontic vibration to the rubbish bin. Once again, many people were taken in by the advertising hype…

 

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Have your say!

  1. Avatar

    I agree that there is no evidence that it works. I have used it in my practice and it seems to help some people and others not so much. I sent a proposal for a study for your imput but I didn’t hear from you. I would love to at least be a part of a study such as this. Any advice regarding getting it done would be appreciated.

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    The KOLs are out of tune. They have lost the last string of of their air guitar. Perhaps now we can stop listening to them. It won’t stop their strumming. It won’t stop the vibrators being sold and the public being deceived.

    Can we now all play The Last Post, on our air bugle.

  3. Avatar

    I believe the protocol used in these studies may have been inappropriate for human clinical trials. There are several studies in the orthodontic literature that describe the basis for this effect, but the phenomenon is not about tooth movement – it’s about bone volume.

  4. Avatar

    Acceledent can work as a PLACEBO this a time tested fact. This can bring in a positive energy in patient for what he is seeking for.
    That is why different drugs works differently from person to person.

    • Avatar

      Interesting idea. How do you measure positive energy? Where is this time tested fact? I would love to read the study.

      Instead of using AcceleDent for a placebo treatment, why not use a placebo device? Would be cheaper. Lol

      Would you expect the AcceleDent to be better than a placebo device?

  5. Avatar

    Are you serious ?

    Why would true scientists limit their opinion to the study of single-mark devices using a single frequency and study only the consequences on the speed of tooth movement?
    Other frequencies, other protocols, other benefits, other objective effects … So many interesting questions that you seem not to be interested in.
    And then an attack on the KOLs which seems to me very debatable on a deontological level. Who does the crime benefit from?
    Would you benefit to decredibilize them to attract colleagues on your blog!
    Strange strategy, strange mentality.
    It’s time to grow up and stop making a fool of yourself. (I am not KOL for any brand of vibrating device but I have 31 years of orthodontic practice including 25 academic)

    • Avatar

      Interesting comments Philippe. Are you serious?

      I’m sorry, I didn’t understand anything you said, apart from you being a clinician.

      You’re suggesting that we should believe KOLs, who are being financially rewarded for their opinions, when there is no scientific backing for their ideas, or any biological mechanism that could explain their beliefs?

      Why would any rational clinician believe such nonsense? Why would any scientist waste any more time researching a placebo device? There are many more valuable topics to research.

      The crime is that AcceleDent has no evidence to back their claims and the KOLs are happy to take the money. I know who the fool in the reflection is.

      The profession and the public are being deceived. If you don’t understand that, then I have some magic chewing gum that moves teeth faster. You only need to chew it for 20 minutes per day.

  6. Avatar

    What is the consensus regarding the different effect of high frequency-vs-low frequency vibration. I don’t see this addressed in this review.

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