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.
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.
|Paper||Type of study||Outcome||Result||Paper quality|
|Woodhouse||RCT||Rate of alignment||No difference||High|
|Miles||RCT||Rate of alignment||No difference||High|
|Lobre||RCT||Pain||Less pain in short term with AcceleDent (no placebo)||low|
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;
- There was no sample size calculation.
- The sample size was very low. This means that the effect size may be subject to individual variation.
- The investigator “chose” the canines for the intervention/control. This does not appear to be an RCT.
- There was no allocation concealment.
- They provided limited information on the method of measurement and no information on how they carried out an error analysis.
- 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…
I have put together a summary table of the evidence from my posts on this subject.
|مجموعة المراقبة||1.77 (95% CI 1.71-1.8)||1.15 (95% CI 1.00-1.2)|
|مجموعة فرشاة الاهتزاز||2.85 (95% CI 2.7-2.9)|
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?