Orthodontic vibration devices; a simple and brilliant “nail in the coffin”. A new systematic review
Orthodontic vibration devices aim to reduce the length of orthodontic treatment. This new systematic review looks at whether this is true.
I have posted a lot about AcceleDent. So, I hope that this is one of the last times that we need to devote time to this “intervention”. This is a vibratory device that orthodontists sell to their patients with the promise of speeding up the rate of tooth movement. They sell this appliance for $ 800.00. They ask their patients to use this for 20 minutes a day, and the vibrations are supposed to stimulate tooth movement. While the marketing makes these claims; recent trials have not been supportive. This systematic review is very timely. A team from Saudi Arabia and Seattle, USA did this study. The AJO-DDO published it.
Effects of vibrational devices on orthodontic tooth movement: A systematic review
Aljazi Aljabaa, Khalid Almoammar, Abdullah Aldrees, and Greg Huang
Am J Orthod Dentofacial Orthop 2018;154:768-79. https://doi.org/10.1016/j.ajodo.2018.07.012
They did a good literature review. It was interesting to see that they felt that the animal studies that were done on orthodontic vibration were not as “clear-cut” as we were given to believe.
As a result, they decided to carry out this new review to answer the following question;
“What is the ability of vibrational devices to increase the rate of tooth movement or reduce pain associated with tooth movement”?
What did they do?
They followed Cochrane methods for doing a systematic review. As a result, they only included randomised controlled trials. The PICO was:
Participants: Orthodontic patients
Intervention: Orthodontic vibration device
Control: No intervention or sham
Outcome: Rate of tooth movement and reduction in pain.
They did an electronic and hand search. Two reviewers identified the papers, agreed on their inclusion and carried out data extraction. They evaluated the risk of bias using the Cochrane Risk of Bias tool. They intended to do a meta-analysis of the data.
What did they find?
They found 5 studies. I have reviewed all these before in other posts. When they evaluated the risk of bias. They concluded that two of the studies were at high risk of bias and the remaining three were at unclear risk. The main reasons for this assessment were issues with blinding, conflict of interest and sponsorship by OrthoAccel. Importantly, they found that there were differences in the methodology and devices that were used. This meant that they could not carry out a meta-analysis. As a result, they decided to carry out a narrative review.
They pointed out that four of the trials concluded that the application of vibration did not have an effect on the rate of tooth movement. The only study that reported this effect was the poor research carried out by Pavlin et al. Seminars in Orthodontics, a non refereed journal published this paper and there were several conflicts of interest.
Their final conclusion was:
“There is no advantage from using vibrational devices during orthodontic treatment”.
What did I think?
I thought that this was an excellent systematic review that a high impact journal published. The authors carried out the study well. They also did an overview of the research and the relative merits of the research. I was unsure about their decision to classify a trial as being of unclear risk of bias because of commercial sponsorship of a study. While this may lead to conflict and influence, this may be reduced to a degree by open declaration of the possible conflict. This is particularly relevant for these papers, as they concluded that the vibration device did not have an effect.
Finally, there have now been several trials of orthodontic vibrators, and the overwhelming conclusion is that there is no evidence that they are useful. I think that this just about sums it up. Perhaps, it is time for orthodontists to stop selling this type of device.
Emeritus Professor of Orthodontics, University of Manchester, UK.
Thanks Kevin. I do not use this type of device in practice because whenever I have discussed the little we know about these products with my patients they do not justify the additional cost to explore something that may or not make a difference. Lately the argument is actually that most evidence does not support its use to consistently and meaningfully accelerate orthodontic tooth movement. We need more research regarding settling aligners.
Where I want to suggest to keep our eyes open to is the possibility that similar approaches but using higher frequencies of vibration and maybe with different usage times may report different responses.
What should happen in this regard is that companies need to accumulate enough supportive non-biased evidence before offering this type of products to the market. And we should expect that before jumping into the sea without a support line.
In summary, this specific device at this frequency and for this usage time does not seem to be a clinical dealbreaker but we should not close this chapter completely as there is still much to be explored.
It is amazing that false manufacturer claims can continue so long and the companies keep showing up on the trade show floor while the lectures question their presence. Thank you for your attention to these topics. Hopefully you will find the studies on ultrasound orthodontics (claims of quicker and safer treatment) to be trustworthy.
As Carlos points out, this holds for 30Hz/0.2N with AcceleDent and my paper in the Aust Orth J 2012; 28: 213–218 found no difference for ~110Hz with brackets/wires (only slightly less than the 120Hz for V-Pro5). However, some may then counter that they are the incorrect frequency and/or force level and we have innumerable possible permutations! Unfortunately those that are true ‘believers’ will always find a flaw in the study or an excuse. Bottom line is the companies should have well designed research prior to making it available for sale but then they risk selling less units or, heaven forbid (sarcasm intended), not even making it to the marketplace! As a profession it behooves us to be wary of such claims of accelerated treatment and inform/protect our patients where there is a lack of evidence so they can make an informed choice.
Be prepared for the return of “electric braces.” This time, rather than constant-current battery packs, how about a magnet in one arch and a coil in the other? It should take a decade or so to disprove the florid claims that would made about whatever the resulting currents are supposed to do (speed tooth movement, signal the right/wrong jaw position, etc.). Such a gizmo would sound good, and apparently that’s all that’s necessary in today’s orthodontic marketplace.
can I suggest that the problem is not that manufacturers bring these devices to market but that clinicians convince their uninformed patients to spend money on them. As (supposed) professionals we have the responsibility to guide and inform patients. We have the evidence base to work from, we should not offer these devices until the evidence of effectiveness exists. I do not think it will be long before a dental law company will run a recruiting campaign along the lines of “have you been mis-sold a vibrating device to speed orthodontic tooth movement”
I agree with Carlos that different usage times may elicit different responses. A device needs to be in the mouth for 8hrs to produce a clinical effect – 20 minutes is not enough. In addition, since the sole parameter is tooth movement, other (beneficial) changes reported in animal studies might have been ignored clinically.
I also support the views of Dr Johnston; we have the technology for smart devices that might be pre-programmed for generic changes (factory settings) based on 3D predictive modeling of previous successful cases –