TY - JOUR
AU - Zou,, Shujuan
AB - Summary Background and objectives The results from the literature regarding the influence of supplemental vibrational forces (SVFs) on orthodontic treatment are controversial. Therefore, this systematic review aimed to evaluate whether SVFs have positive effects, such as in accelerating tooth movement, alleviating pain, and preventing root resorption, in orthodontic patients. Search methods Searches through five electronic databases (PubMed, MEDLINE, EMBASE, Web of Science, and Cochrane Central) were complemented by hand searches up to January, 2019. Selection criteria Randomized controlled trials and controlled clinical trials reporting on the effects of SVFs in orthodontic patients in English were included. Data collection and analysis Study selection, data extraction, and a risk of bias assessment were independently performed by two reviewers. Study characteristics and outcomes were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A qualitative analysis of the effects of SVFs on orthodontic tooth movement, pain experience, and root resorption was conducted. Results Thirteen studies, including nine clinical trials, were eligible for inclusion in the systematic review. There was no significant evidence to support the positive effects of SVFs in orthodontic patients, neither in accelerating tooth movement nor in alleviating pain experience. According to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria, the quality of the evidence was very low for all the outcomes in the qualitative analysis. Limitations The results of this systematic review are based on a limited number of studies and the methodological heterogeneity and non-comparability of original outcomes made it difficult to conduct a meta-analysis. Conclusions There is insufficient evidence to support the claim that SVFs have positive clinical advantages in the alignment of the anterior teeth. The potential positive effects of vibrational forces on space closure, pain experience, and root resorption in orthodontic patients are inconclusive with no sufficient information at present. High-quality clinical trials with larger sample sizes are needed to find more comprehensive evidence of the potential positive effects of vibrational forces. Registration The protocol for this systematic review was registered on PROSPERO (CRD42018098788). Funding This study has not received any contributions from private or public funding agencies. Conflict of Interest None. Introduction Orthodontic treatment duration often lasts 2 or more years with fixed appliances, although it can vary widely (1, 2). However, the longer the treatment time is, the higher the risk of common negative effects of orthodontic treatment on dental hard tissues and periodontium such as white spot lesions, periodontal disease, and root resorption (3–5). In addition, longer treatment times may affect the patient compliance, resulting in a negative effect on the overall outcome (6). Therefore, both patients and orthodontists want to accelerate the rate of tooth movement in orthodontic treatment. To meet this demand, there are several appliances and techniques, both surgical and non-surgical, that can be used, for example, low-intensity laser irradiation, resonance vibration, pharmacological approaches, and corticotomies (7, 8). Pain is common in orthodontic treatment, especially during the early stages after appliance placement and then gradually goes away (9–15). During orthodontic treatment, pain can affect many kinds of activities in daily life, such as eating and sleeping, and may have a negative effect on the compliance or overall outcome of orthodontic treatment (6, 16). Therefore, a painkiller is sometimes necessary (9, 17). Although they are effective in reducing orthodontic pain, medications can be associated with side effects (18) and some patients may be allergic to them. For these reasons, some non-pharmacological interventions have emerged to alleviate pain during the orthodontic treatment, such as chewing gum, low–level laser therapy ,and vibratory stimulation (19). Supplemental vibrational force has been recognized to have an anabolic effect on bones, and early studies demonstrated promising results with vibrational appliances to accelerate orthodontic tooth movement (20, 21). In addition, there is evidence in previous studies that vibrational stimulation can effectively reduce various types of musculoskeletal and dental pain (22, 23). As it is portable, convenient and non-invasive, supplemental vibrational stimulus has already been commercial and advocated as a method to accelerate orthodontic tooth movement and alleviate orthodontic pain. Recently, the potential positive influence of supplemental vibrational forces on orthodontic treatment, such as accelerating tooth movement, alleviating pain, and preventing root resorption, has been investigated in several randomized controlled trials (RCTs) and other kinds of clinical studies (24–26).There have been two systematic reviews recognizing the effectiveness of vibration, but they did not pay enough attention to the potential effects on orthodontic pain and root resorption (27, 28). As the potential positive effect of vibrational devices on orthodontic treatment involves not only accelerating orthodontic tooth movement, and several new studies of the effect vibrational forces on orthodontic treatment have emerged, there is a demand for a new, comprehensive systematic review to determine whether there is enough evidence that the supplemental vibrational forces have a positive effect on orthodontic treatment, which is important in clinical practice to inform orthodontists’ decisions in relation to the choice of whether to use supplemental vibrational forces. The purpose of this study was to systematically review the available literature, including RCTs and controlled clinical trials (CCTs), to evaluate the potential positive effects of supplemental vibrational forces on orthodontic treatment in a scientific evidence-based way. The potential effects on orthodontic treatment, the rate of tooth movement, orthodontic pain, and root resorption were evaluated. Materials and methods Protocol This systematic review was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement Guidelines (29). The protocol for this systematic review was registered on PROSPERO (https://www.crd.york.ac.uk/PROSPERO/) (CRD42018098788). Focus question The effectiveness of supplemental vibrational force on enhancing orthodontic treatment. Search strategy Five electronic databases (Pubmed, Medline via Ovid, Embase via Ovid, Web of Science, and Cochrane Library databases) were searched until 31st January 2019 independently by two reviewers (C.L., L.Z.) to acquire potentially eligible studies, and only articles in English were reviewed. The keywords were searched in Medical Subject Headings (MeSH) and in the related published articles. The following terms were used: (vibration) AND (Orthodontic, Corrective). Search strategies used in each database is presented on Supplementary Materials. A manual searching of the reference lists of the retrieved full text articles was also conducted. The judgment of eligibility, data extraction, and risk of bias assessment were performed independently and in duplicate by two reviewers (C.L., L.Z.), whereas disagreements were solved through discussion and after consultation with a third reviewer (S.Z.). Selection Eligibility criteria: The following selection criteria were applied for this systematic review: Study design: RCTs or CCTs, both parallel group and split-mouth were considered. Participants: Orthodontic patients with fixed orthodontic brackets or clear aligners. Interventions: Fixed brackets or clear aligners with an intraoral vibrational appliance. Outcome measures: The comparison of the rate of tooth movement, pain experience, and the condition of orthodontically induced inflammatory root resorption (OIIRR) between orthodontic patients treated with and without supplemental vibrational forces. The rate of tooth movement could be measured with different methods, such as the rate of space closure, the rate of molar distalization, and changes in Little’s irregularity index (millimetre). Pain experience was measured by a 100-mm visual analogue scale (VAS). Root resorption was measured from the maxillary right central incisor. Exclusion Criteria: (a) Studies involving participants with systematic diseases or other diseases undergoing orthodontic treatment. (b) Orthodontic patients with functional appliances. Data extraction and management Data extraction was performed by two independently working reviewers (C.L., L.Z.) who were not blinded to author identity and study origin. Titles and abstracts were examined first and then the full text of the articles was screened for potential inclusion. Disagreements between the reviewers were resolved through discussion. We did not contact the study authors. Data were recorded according to guidelines outlined by the Cochrane Collaboration (30). For the present evaluation, the information that was extracted from each article included the study design, participants, interventions, observation period and methods, comparators, and outcomes. Risk of bias within studies For both RCTs and CCTs, the risk of bias in individual clinical trials was evaluated according to the Cochrane Risk of Bias tool (31). In particular, the following domains were considered: (1). Random sequence generation. (2). Allocation concealment. (3). Blinding of participants and personnel involved in the study. (4). Blinding of outcome assessment. (5). Incomplete outcome data reporting. (6). Selective reporting of outcomes. (7). Other sources of bias, for example, the unclear but potential carry-over effect in cross-over trials (split-mouth designs) and the positive results when a research was funded by a relevant appliance company. Studies with one or more characteristics designated to have a high risk of bias were regarded as having an overall high risk of bias. Trials with an unclear risk of bias for one or more key domains were categorized having an unclear risk of bias, and studies with a low risk of bias in all domains were considered as having a low risk of bias. Summary measures and data synthesis The clinical heterogeneity of the included studies was assessed by the evaluating the individual trial settings, the eligibility criteria, the characteristics and specifications of vibration devices, the frequency of the use of supplemental vibrational forces, and the data collection methods. Statistical heterogeneity was examined through a chi-square test, and a P-value below the level of 10 per cent (P < 0.1) was considered indicative of significant heterogeneity (32). A visual inspection of the confidence intervals (CIs) on forest plots for the assessed treatment effects was also used to evaluate the heterogeneity, and the heterogeneity was quantified based on an I2 test (33). A meta-analysis was to be performed if sufficient studies of high or moderate methodological quality with clinical homogeneity existed. Quality of the evidence The Grading of Recommendations Assessment, Development and Evaluation (GRADE) (34) approach was used to assess the overall quality of the evidence as demonstrated by the interventions and the outcomes under study. Results Results of the study selection A total of 366 studies were initially identified from the electronic databases, and 2 additional records were found through a hand search (Figure 1). After removing the duplicates, 173 publications were screened based on the examination of the title and the abstract. Subsequently, 24 studies were left for full text assessment. Finally, 13 studies were qualified for this qualitative synthesis. Figure 1. Open in new tabDownload slide Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram of study selection. From: Moher et al. (35). Figure 1. Open in new tabDownload slide Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram of study selection. From: Moher et al. (35). Description of the included studies Of the thirteen studies, all except one (36) were regarded as RCTs (Table 1). Among the RCTs, two studies were of a split-mouth design (37, 38) whereas the others were parallel-group studies (24–26, 39–45). Two publications were from the same clinical trial (42, 43). Another four publications (26, 39, 40, 45) were different parts of the same clinical trial that was a multicentre, three-arm parallel design study that included an experimental group, a sham group, and a control group with no vibrational forces. A total of 409 participants were included in this review, among which 209 subjects underwent supplemental vibrational stimulus and 228 patients were assigned to the sham/control group (28 patients were involved in the split-mouth design). Participants from one study were treated with clear aligners (44), whereas the others were treated with fixed appliance. Table 1. Study characteristics of included studies. C, control group; T, experiment group; TTest, time of data collection; TTotal, total duration of a trial. CCT, controlled clinical trial; RCT, randomized clinical trial; VAS, visual analogue scale Study, country Study design Participants Group Follow-up Vibration device Outcome Katchooi et al. (44), Canada RCT N = 26 Age: 33.0 ± 11.8 years Female: 14 Male: 12 Clear aligners T: AcceleDent Aura device (13) C: Non-functional (sham) AcceleDent (13) TTotal: < 25 weeks TTest: T0: Start T1: After treatment AcceleDent (30Hz, 0.25N) 20 min/day • Tooth movement (alignment of anterior teeth): Little’s irregularity index (mm) (maxillary and mandibular) • Pain: VAS DiBiase et al.*(45), UK RCT N = 81 Age: 13.5 ± 1.5 years Fixed appliances T: AcceleDent Aura device (29) C1: Non-functional (sham) AcceleDent (25) C2: No vibration device (27) T1-T2: 68 ± 28 days T1-T3: 172 ± 79 days TTest: T1: Start of space closure T2: First visit after initiation T3: End of space closure T4: Completion of treatment AcceleDent (30Hz, 0.2N) 20 min/day • Tooth movement: initial and overall rate of space closure (mm/month) • (Mandibular arch) Miles et al.**(43), Australia RCT N = 40 Age: 12.84 ± 1.34 years Female: 26 Male: 14 Full fixed appliances T: AcceleDent Aura appliance (20) C: No vibration appliance (20) TTotal: 10 weeks TTest: T1: Start T2: Just before complete space closure AcceleDent (30Hz, 0.2N) 20 min/day • Tooth movement: the rate of space closure (mm/month) (maxillary premolar extraction) Liao et al. (38), Australia Split-mouth design RCT N = 13 Mean age: 13.6 years Fixed appliances T: Vibration appliance on canine C: No vibration appliance TTotal: 12 weeks, vibration for 28 days TTest: T0: Start (baseline) T1: 4 weeks T2: 8 weeks T3: 12 weeks Oral B (USA) Humming Bird Vibrating Unit (50Hz, 0.2N) 10 min/day • Tooth movement: total maxillary space closure and canine retraction (mm) Lobre et al. (41), USA RCT N = 58 Fixed appliances T: Vibration appliance (29) C: No vibration appliance (29) TTotal: 4 months TTest: T1: The first 7 days of each month after the adjustment T2: Once weekly for the remainder of the month AcceleDent (30Hz, 0.25N) 20 min/day • Pain: VAS Bowman (36), USA CCT N = 65 Age: 13 ± 1.2 years Fixed appliances T: Vibration appliance (34) C: No vibration appliance (31) TTotal: About 200 days AcceleDent (30Hz, 0.25N) 20 min/day • Tooth movement: rate of distalization of maxillary first molar (mm/ month) Leethanakul et al. (37), Thailand Split-mouth design RCT N = 15 Mean age: 22.9 years Female: 11 Male: 4 Fixed appliances T: Vibration appliance C: No vibration appliance TTotal: 3 months TTest: T0: Start T1: 1 month T2: 2 months T3: 3 months Colgate Motion-Multi Action electric toothbrush (125 Hz) 5 min, three times a day • Tooth movement: maxillary space closure (canine distalization) (mm) Miles et al.**(42), Australia RCT N = 40 Age: 12.8 ± 1.3 years Female: 26 Male: 14 Full fixed appliances T: AcceleDent Aura appliance (20) C: No vibration appliance (20) TTotal: 10 weeks. TTest (tooth movement): Start; 5 weeks; 8 weeks; 10 weeks TTest (pain): Start; 6–8 hours; 24 hours; 3 days; 7 days AcceleDent (30Hz, 0.2N) 20 min/day • Tooth movement (alignment of anterior teeth) Little’s irregularity index (mm) (mandibular) • Pain: VAS (mm) DiBiase et al.*(26), UK RCT N = 81 Age: 12–19 years Fixed appliances T: AcceleDent Aura device (29) C1: Non-functional (sham) AcceleDent (25) C2: No vibration device (27) TTotal: 188.6–214.6 days TTest: T1: Start T3: End of alignment AcceleDent (30Hz, 0.2N) 20 min/day • Orthodontically induced inflammatory root resorption (OIIRR) of maxillary right central incisor (mm) Woodhouse et al.*(39), UK RCT N = 81 Age: 14.1 ± 1.7 years Female: 41 Male: 40 Fixed appliances T: AcceleDent Aura device (29) C1: Non-functional (sham) AcceleDent (25) C2: No vibration device (27) TTest (tooth movement): T1: Insertion of the initial 0.014-inch nickel- titanium archwire T2: Insertion of the initial 0.018-inch nickel- titanium archwire TTest (pain): 4 hours; 24 hours; 3 days; 1 weeks AcceleDent (30Hz, 0.2N) 20 min/day • Tooth movement (alignment of anterior teeth) Little’s irregularity index (mm) (mandibular) • Pain: VAS Woodhouse et al.*(40), UK RCT N = 81 Age: 14.06 ± 1.7 years Female: 41 Male: 40 Fixed appliances T: AcceleDent Aura device (29) C1: Non-functional (sham) AcceleDent (25) C2: No vibration device (27) TTest: T1: Baseline (placement of 0.014-inch nickel- titanium archwire) T2: Initial alignment (placement of insertion of the 0.018-inch nickel-titanium archwire) T3: Final alignment (complete engagement of 0.019 × 0.025-inch stainless steel achwire) AcceleDent (30Hz, 0.2N) 20 min/day • Tooth movement (alignment of anterior teeth) • Little’s irregularity index (mm) (mandibular) Pavlin et al. (25), USA RCT N = 45 Age: 12–40 years Full fixed appliances T: AcceleDent (23) C: Disabled vibration appliance (22) TTest: T0: Start T1: After treatment AcceleDent (30Hz, 0.25N) 20 min/day • Tooth movement: average rate of maxillary canine retraction or en masse retraction (mm/month) Miles et al. (24), USA RCT N = 66 Age: 13 ± 0.18 years Female: 40 Male: 26 Fixed appliances T: Vibration appliance (33) C: No vibration appliance (33) TTotal: 10 w TTest (tooth movement): Start; 5 weeks; 8 weeks; 10 weeks TTest (pain): Immediately after initial bracket and wire placement; 6–8 hours; 1 day; 3 days; 7 days Tooth Masseuse (111Hz, 0.06N) 20 min/day • Tooth movement (alignment of anterior teeth) Little’s irregularity index (mm) (mandibular) • Pain: VAS Study, country Study design Participants Group Follow-up Vibration device Outcome Katchooi et al. (44), Canada RCT N = 26 Age: 33.0 ± 11.8 years Female: 14 Male: 12 Clear aligners T: AcceleDent Aura device (13) C: Non-functional (sham) AcceleDent (13) TTotal: < 25 weeks TTest: T0: Start T1: After treatment AcceleDent (30Hz, 0.25N) 20 min/day • Tooth movement (alignment of anterior teeth): Little’s irregularity index (mm) (maxillary and mandibular) • Pain: VAS DiBiase et al.*(45), UK RCT N = 81 Age: 13.5 ± 1.5 years Fixed appliances T: AcceleDent Aura device (29) C1: Non-functional (sham) AcceleDent (25) C2: No vibration device (27) T1-T2: 68 ± 28 days T1-T3: 172 ± 79 days TTest: T1: Start of space closure T2: First visit after initiation T3: End of space closure T4: Completion of treatment AcceleDent (30Hz, 0.2N) 20 min/day • Tooth movement: initial and overall rate of space closure (mm/month) • (Mandibular arch) Miles et al.**(43), Australia RCT N = 40 Age: 12.84 ± 1.34 years Female: 26 Male: 14 Full fixed appliances T: AcceleDent Aura appliance (20) C: No vibration appliance (20) TTotal: 10 weeks TTest: T1: Start T2: Just before complete space closure AcceleDent (30Hz, 0.2N) 20 min/day • Tooth movement: the rate of space closure (mm/month) (maxillary premolar extraction) Liao et al. (38), Australia Split-mouth design RCT N = 13 Mean age: 13.6 years Fixed appliances T: Vibration appliance on canine C: No vibration appliance TTotal: 12 weeks, vibration for 28 days TTest: T0: Start (baseline) T1: 4 weeks T2: 8 weeks T3: 12 weeks Oral B (USA) Humming Bird Vibrating Unit (50Hz, 0.2N) 10 min/day • Tooth movement: total maxillary space closure and canine retraction (mm) Lobre et al. (41), USA RCT N = 58 Fixed appliances T: Vibration appliance (29) C: No vibration appliance (29) TTotal: 4 months TTest: T1: The first 7 days of each month after the adjustment T2: Once weekly for the remainder of the month AcceleDent (30Hz, 0.25N) 20 min/day • Pain: VAS Bowman (36), USA CCT N = 65 Age: 13 ± 1.2 years Fixed appliances T: Vibration appliance (34) C: No vibration appliance (31) TTotal: About 200 days AcceleDent (30Hz, 0.25N) 20 min/day • Tooth movement: rate of distalization of maxillary first molar (mm/ month) Leethanakul et al. (37), Thailand Split-mouth design RCT N = 15 Mean age: 22.9 years Female: 11 Male: 4 Fixed appliances T: Vibration appliance C: No vibration appliance TTotal: 3 months TTest: T0: Start T1: 1 month T2: 2 months T3: 3 months Colgate Motion-Multi Action electric toothbrush (125 Hz) 5 min, three times a day • Tooth movement: maxillary space closure (canine distalization) (mm) Miles et al.**(42), Australia RCT N = 40 Age: 12.8 ± 1.3 years Female: 26 Male: 14 Full fixed appliances T: AcceleDent Aura appliance (20) C: No vibration appliance (20) TTotal: 10 weeks. TTest (tooth movement): Start; 5 weeks; 8 weeks; 10 weeks TTest (pain): Start; 6–8 hours; 24 hours; 3 days; 7 days AcceleDent (30Hz, 0.2N) 20 min/day • Tooth movement (alignment of anterior teeth) Little’s irregularity index (mm) (mandibular) • Pain: VAS (mm) DiBiase et al.*(26), UK RCT N = 81 Age: 12–19 years Fixed appliances T: AcceleDent Aura device (29) C1: Non-functional (sham) AcceleDent (25) C2: No vibration device (27) TTotal: 188.6–214.6 days TTest: T1: Start T3: End of alignment AcceleDent (30Hz, 0.2N) 20 min/day • Orthodontically induced inflammatory root resorption (OIIRR) of maxillary right central incisor (mm) Woodhouse et al.*(39), UK RCT N = 81 Age: 14.1 ± 1.7 years Female: 41 Male: 40 Fixed appliances T: AcceleDent Aura device (29) C1: Non-functional (sham) AcceleDent (25) C2: No vibration device (27) TTest (tooth movement): T1: Insertion of the initial 0.014-inch nickel- titanium archwire T2: Insertion of the initial 0.018-inch nickel- titanium archwire TTest (pain): 4 hours; 24 hours; 3 days; 1 weeks AcceleDent (30Hz, 0.2N) 20 min/day • Tooth movement (alignment of anterior teeth) Little’s irregularity index (mm) (mandibular) • Pain: VAS Woodhouse et al.*(40), UK RCT N = 81 Age: 14.06 ± 1.7 years Female: 41 Male: 40 Fixed appliances T: AcceleDent Aura device (29) C1: Non-functional (sham) AcceleDent (25) C2: No vibration device (27) TTest: T1: Baseline (placement of 0.014-inch nickel- titanium archwire) T2: Initial alignment (placement of insertion of the 0.018-inch nickel-titanium archwire) T3: Final alignment (complete engagement of 0.019 × 0.025-inch stainless steel achwire) AcceleDent (30Hz, 0.2N) 20 min/day • Tooth movement (alignment of anterior teeth) • Little’s irregularity index (mm) (mandibular) Pavlin et al. (25), USA RCT N = 45 Age: 12–40 years Full fixed appliances T: AcceleDent (23) C: Disabled vibration appliance (22) TTest: T0: Start T1: After treatment AcceleDent (30Hz, 0.25N) 20 min/day • Tooth movement: average rate of maxillary canine retraction or en masse retraction (mm/month) Miles et al. (24), USA RCT N = 66 Age: 13 ± 0.18 years Female: 40 Male: 26 Fixed appliances T: Vibration appliance (33) C: No vibration appliance (33) TTotal: 10 w TTest (tooth movement): Start; 5 weeks; 8 weeks; 10 weeks TTest (pain): Immediately after initial bracket and wire placement; 6–8 hours; 1 day; 3 days; 7 days Tooth Masseuse (111Hz, 0.06N) 20 min/day • Tooth movement (alignment of anterior teeth) Little’s irregularity index (mm) (mandibular) • Pain: VAS *The four studies are different parts of an identical clinical trial. **The two studies are from the same one clinical trial. Open in new tab Table 1. Study characteristics of included studies. C, control group; T, experiment group; TTest, time of data collection; TTotal, total duration of a trial. CCT, controlled clinical trial; RCT, randomized clinical trial; VAS, visual analogue scale Study, country Study design Participants Group Follow-up Vibration device Outcome Katchooi et al. (44), Canada RCT N = 26 Age: 33.0 ± 11.8 years Female: 14 Male: 12 Clear aligners T: AcceleDent Aura device (13) C: Non-functional (sham) AcceleDent (13) TTotal: < 25 weeks TTest: T0: Start T1: After treatment AcceleDent (30Hz, 0.25N) 20 min/day • Tooth movement (alignment of anterior teeth): Little’s irregularity index (mm) (maxillary and mandibular) • Pain: VAS DiBiase et al.*(45), UK RCT N = 81 Age: 13.5 ± 1.5 years Fixed appliances T: AcceleDent Aura device (29) C1: Non-functional (sham) AcceleDent (25) C2: No vibration device (27) T1-T2: 68 ± 28 days T1-T3: 172 ± 79 days TTest: T1: Start of space closure T2: First visit after initiation T3: End of space closure T4: Completion of treatment AcceleDent (30Hz, 0.2N) 20 min/day • Tooth movement: initial and overall rate of space closure (mm/month) • (Mandibular arch) Miles et al.**(43), Australia RCT N = 40 Age: 12.84 ± 1.34 years Female: 26 Male: 14 Full fixed appliances T: AcceleDent Aura appliance (20) C: No vibration appliance (20) TTotal: 10 weeks TTest: T1: Start T2: Just before complete space closure AcceleDent (30Hz, 0.2N) 20 min/day • Tooth movement: the rate of space closure (mm/month) (maxillary premolar extraction) Liao et al. (38), Australia Split-mouth design RCT N = 13 Mean age: 13.6 years Fixed appliances T: Vibration appliance on canine C: No vibration appliance TTotal: 12 weeks, vibration for 28 days TTest: T0: Start (baseline) T1: 4 weeks T2: 8 weeks T3: 12 weeks Oral B (USA) Humming Bird Vibrating Unit (50Hz, 0.2N) 10 min/day • Tooth movement: total maxillary space closure and canine retraction (mm) Lobre et al. (41), USA RCT N = 58 Fixed appliances T: Vibration appliance (29) C: No vibration appliance (29) TTotal: 4 months TTest: T1: The first 7 days of each month after the adjustment T2: Once weekly for the remainder of the month AcceleDent (30Hz, 0.25N) 20 min/day • Pain: VAS Bowman (36), USA CCT N = 65 Age: 13 ± 1.2 years Fixed appliances T: Vibration appliance (34) C: No vibration appliance (31) TTotal: About 200 days AcceleDent (30Hz, 0.25N) 20 min/day • Tooth movement: rate of distalization of maxillary first molar (mm/ month) Leethanakul et al. (37), Thailand Split-mouth design RCT N = 15 Mean age: 22.9 years Female: 11 Male: 4 Fixed appliances T: Vibration appliance C: No vibration appliance TTotal: 3 months TTest: T0: Start T1: 1 month T2: 2 months T3: 3 months Colgate Motion-Multi Action electric toothbrush (125 Hz) 5 min, three times a day • Tooth movement: maxillary space closure (canine distalization) (mm) Miles et al.**(42), Australia RCT N = 40 Age: 12.8 ± 1.3 years Female: 26 Male: 14 Full fixed appliances T: AcceleDent Aura appliance (20) C: No vibration appliance (20) TTotal: 10 weeks. TTest (tooth movement): Start; 5 weeks; 8 weeks; 10 weeks TTest (pain): Start; 6–8 hours; 24 hours; 3 days; 7 days AcceleDent (30Hz, 0.2N) 20 min/day • Tooth movement (alignment of anterior teeth) Little’s irregularity index (mm) (mandibular) • Pain: VAS (mm) DiBiase et al.*(26), UK RCT N = 81 Age: 12–19 years Fixed appliances T: AcceleDent Aura device (29) C1: Non-functional (sham) AcceleDent (25) C2: No vibration device (27) TTotal: 188.6–214.6 days TTest: T1: Start T3: End of alignment AcceleDent (30Hz, 0.2N) 20 min/day • Orthodontically induced inflammatory root resorption (OIIRR) of maxillary right central incisor (mm) Woodhouse et al.*(39), UK RCT N = 81 Age: 14.1 ± 1.7 years Female: 41 Male: 40 Fixed appliances T: AcceleDent Aura device (29) C1: Non-functional (sham) AcceleDent (25) C2: No vibration device (27) TTest (tooth movement): T1: Insertion of the initial 0.014-inch nickel- titanium archwire T2: Insertion of the initial 0.018-inch nickel- titanium archwire TTest (pain): 4 hours; 24 hours; 3 days; 1 weeks AcceleDent (30Hz, 0.2N) 20 min/day • Tooth movement (alignment of anterior teeth) Little’s irregularity index (mm) (mandibular) • Pain: VAS Woodhouse et al.*(40), UK RCT N = 81 Age: 14.06 ± 1.7 years Female: 41 Male: 40 Fixed appliances T: AcceleDent Aura device (29) C1: Non-functional (sham) AcceleDent (25) C2: No vibration device (27) TTest: T1: Baseline (placement of 0.014-inch nickel- titanium archwire) T2: Initial alignment (placement of insertion of the 0.018-inch nickel-titanium archwire) T3: Final alignment (complete engagement of 0.019 × 0.025-inch stainless steel achwire) AcceleDent (30Hz, 0.2N) 20 min/day • Tooth movement (alignment of anterior teeth) • Little’s irregularity index (mm) (mandibular) Pavlin et al. (25), USA RCT N = 45 Age: 12–40 years Full fixed appliances T: AcceleDent (23) C: Disabled vibration appliance (22) TTest: T0: Start T1: After treatment AcceleDent (30Hz, 0.25N) 20 min/day • Tooth movement: average rate of maxillary canine retraction or en masse retraction (mm/month) Miles et al. (24), USA RCT N = 66 Age: 13 ± 0.18 years Female: 40 Male: 26 Fixed appliances T: Vibration appliance (33) C: No vibration appliance (33) TTotal: 10 w TTest (tooth movement): Start; 5 weeks; 8 weeks; 10 weeks TTest (pain): Immediately after initial bracket and wire placement; 6–8 hours; 1 day; 3 days; 7 days Tooth Masseuse (111Hz, 0.06N) 20 min/day • Tooth movement (alignment of anterior teeth) Little’s irregularity index (mm) (mandibular) • Pain: VAS Study, country Study design Participants Group Follow-up Vibration device Outcome Katchooi et al. (44), Canada RCT N = 26 Age: 33.0 ± 11.8 years Female: 14 Male: 12 Clear aligners T: AcceleDent Aura device (13) C: Non-functional (sham) AcceleDent (13) TTotal: < 25 weeks TTest: T0: Start T1: After treatment AcceleDent (30Hz, 0.25N) 20 min/day • Tooth movement (alignment of anterior teeth): Little’s irregularity index (mm) (maxillary and mandibular) • Pain: VAS DiBiase et al.*(45), UK RCT N = 81 Age: 13.5 ± 1.5 years Fixed appliances T: AcceleDent Aura device (29) C1: Non-functional (sham) AcceleDent (25) C2: No vibration device (27) T1-T2: 68 ± 28 days T1-T3: 172 ± 79 days TTest: T1: Start of space closure T2: First visit after initiation T3: End of space closure T4: Completion of treatment AcceleDent (30Hz, 0.2N) 20 min/day • Tooth movement: initial and overall rate of space closure (mm/month) • (Mandibular arch) Miles et al.**(43), Australia RCT N = 40 Age: 12.84 ± 1.34 years Female: 26 Male: 14 Full fixed appliances T: AcceleDent Aura appliance (20) C: No vibration appliance (20) TTotal: 10 weeks TTest: T1: Start T2: Just before complete space closure AcceleDent (30Hz, 0.2N) 20 min/day • Tooth movement: the rate of space closure (mm/month) (maxillary premolar extraction) Liao et al. (38), Australia Split-mouth design RCT N = 13 Mean age: 13.6 years Fixed appliances T: Vibration appliance on canine C: No vibration appliance TTotal: 12 weeks, vibration for 28 days TTest: T0: Start (baseline) T1: 4 weeks T2: 8 weeks T3: 12 weeks Oral B (USA) Humming Bird Vibrating Unit (50Hz, 0.2N) 10 min/day • Tooth movement: total maxillary space closure and canine retraction (mm) Lobre et al. (41), USA RCT N = 58 Fixed appliances T: Vibration appliance (29) C: No vibration appliance (29) TTotal: 4 months TTest: T1: The first 7 days of each month after the adjustment T2: Once weekly for the remainder of the month AcceleDent (30Hz, 0.25N) 20 min/day • Pain: VAS Bowman (36), USA CCT N = 65 Age: 13 ± 1.2 years Fixed appliances T: Vibration appliance (34) C: No vibration appliance (31) TTotal: About 200 days AcceleDent (30Hz, 0.25N) 20 min/day • Tooth movement: rate of distalization of maxillary first molar (mm/ month) Leethanakul et al. (37), Thailand Split-mouth design RCT N = 15 Mean age: 22.9 years Female: 11 Male: 4 Fixed appliances T: Vibration appliance C: No vibration appliance TTotal: 3 months TTest: T0: Start T1: 1 month T2: 2 months T3: 3 months Colgate Motion-Multi Action electric toothbrush (125 Hz) 5 min, three times a day • Tooth movement: maxillary space closure (canine distalization) (mm) Miles et al.**(42), Australia RCT N = 40 Age: 12.8 ± 1.3 years Female: 26 Male: 14 Full fixed appliances T: AcceleDent Aura appliance (20) C: No vibration appliance (20) TTotal: 10 weeks. TTest (tooth movement): Start; 5 weeks; 8 weeks; 10 weeks TTest (pain): Start; 6–8 hours; 24 hours; 3 days; 7 days AcceleDent (30Hz, 0.2N) 20 min/day • Tooth movement (alignment of anterior teeth) Little’s irregularity index (mm) (mandibular) • Pain: VAS (mm) DiBiase et al.*(26), UK RCT N = 81 Age: 12–19 years Fixed appliances T: AcceleDent Aura device (29) C1: Non-functional (sham) AcceleDent (25) C2: No vibration device (27) TTotal: 188.6–214.6 days TTest: T1: Start T3: End of alignment AcceleDent (30Hz, 0.2N) 20 min/day • Orthodontically induced inflammatory root resorption (OIIRR) of maxillary right central incisor (mm) Woodhouse et al.*(39), UK RCT N = 81 Age: 14.1 ± 1.7 years Female: 41 Male: 40 Fixed appliances T: AcceleDent Aura device (29) C1: Non-functional (sham) AcceleDent (25) C2: No vibration device (27) TTest (tooth movement): T1: Insertion of the initial 0.014-inch nickel- titanium archwire T2: Insertion of the initial 0.018-inch nickel- titanium archwire TTest (pain): 4 hours; 24 hours; 3 days; 1 weeks AcceleDent (30Hz, 0.2N) 20 min/day • Tooth movement (alignment of anterior teeth) Little’s irregularity index (mm) (mandibular) • Pain: VAS Woodhouse et al.*(40), UK RCT N = 81 Age: 14.06 ± 1.7 years Female: 41 Male: 40 Fixed appliances T: AcceleDent Aura device (29) C1: Non-functional (sham) AcceleDent (25) C2: No vibration device (27) TTest: T1: Baseline (placement of 0.014-inch nickel- titanium archwire) T2: Initial alignment (placement of insertion of the 0.018-inch nickel-titanium archwire) T3: Final alignment (complete engagement of 0.019 × 0.025-inch stainless steel achwire) AcceleDent (30Hz, 0.2N) 20 min/day • Tooth movement (alignment of anterior teeth) • Little’s irregularity index (mm) (mandibular) Pavlin et al. (25), USA RCT N = 45 Age: 12–40 years Full fixed appliances T: AcceleDent (23) C: Disabled vibration appliance (22) TTest: T0: Start T1: After treatment AcceleDent (30Hz, 0.25N) 20 min/day • Tooth movement: average rate of maxillary canine retraction or en masse retraction (mm/month) Miles et al. (24), USA RCT N = 66 Age: 13 ± 0.18 years Female: 40 Male: 26 Fixed appliances T: Vibration appliance (33) C: No vibration appliance (33) TTotal: 10 w TTest (tooth movement): Start; 5 weeks; 8 weeks; 10 weeks TTest (pain): Immediately after initial bracket and wire placement; 6–8 hours; 1 day; 3 days; 7 days Tooth Masseuse (111Hz, 0.06N) 20 min/day • Tooth movement (alignment of anterior teeth) Little’s irregularity index (mm) (mandibular) • Pain: VAS *The four studies are different parts of an identical clinical trial. **The two studies are from the same one clinical trial. Open in new tab Eleven studies reported on the effect of supplemental vibrational forces on the rate of tooth movement (24, 25, 36–40, 42–45), six studies reported on the pain experience (24, 26, 39, 41, 42, 44), and only one study focused on root resorption (26). As presented in Table 1, 10 studies (25, 26, 36, 39–45) used AcceleDent (OrthoAccel Technologies, Houston, Texas, USA) to offer supplemental vibrational forces for 20 minutes/day with a frequency of 30 Hz; the force in 6 (26, 39, 40, 42, 43, 45) of these studies was set to 0.2 N, and the force in the other 4 studies (25, 36, 41, 44) was set to 0.25 N. Liao et al. (38) adopted the Oral-B Humming Bird Vibrating Unit (50 Hz, 0.2 N) for 10 minutes/day for supplemental vibration for the maxillary canine. Miles et al. (24) chose the Tooth Masseuse 20 minutes/day to provide a vibrational force of 111 Hz at 0.06 N. Leethanakul et al. (37) used an electric toothbrush on the experimental canine for a minimum of 5 minutes three times a day, which produced a vibration frequency of 125 Hz vibration. Tooth movement There were three ways of measuring the rate of tooth movement (Table 2). Five studies measured the rate of space closure (25, 37, 38, 43, 45), another five studies used the irregularity index to measure the rate of alignment of the anterior teeth (24, 39, 40, 42, 44), and one study measured the molar-distalization rates (36). Table 2. Results of tooth movement in included studies. C, control group with no vibrational devices; T, experiment group with vibrational devices; S: sham group with non-functional vibrational devices Study, country Space closure (mm/month, mean (SD)) Alignment of anterior teeth (irregularity index, mm) Distalization of molar (mm/month) T C S T C S T C S DiBiase et al.*(45), UK Initial (68 ± 28 days) 0.82 0.95 0.89 Final (172 ± 79 days) 0.82 0.76 0.68 Miles et al.**(43), Australia Right side 1.41 (0.50) 1.30 (0.61) Left side 1.25 (0.51) 1.25 (0.46) Liao et al. (38), Australia Model (total space closure) 1.4233 (0.7212) 1.1667 (0.6377) Intraoral (total space closure) 1.9606 (1.2699) 1.6914 (1.0135) Model (canine retraction) 1.2367 (0.9597) 0.8167 (0.9606) Intraoral (canine retraction) 0.9400 (0.7871) 0.6367 (0.5763) Leethanakul et al. (37), Thailand Baseline 0.63 (0.06) 0.63 (0.06) 1–2 months 1.26 (0.27) 0.83 (0.17) 2–3 months 0.96 (0.19) 0.61 (0.13) Pavlin et al (25), USA 1.25 0.89 Katchooi et al. (44), Canada Changes in maxilla 3.56 (0.9) 3.36 (1.8) Changes in mandible 3.56 (2.2) 3.74 (2.1) Miles et al.**(42), Australia Baseline 3.9 4.4 5 weeks 2.0 2.0 8 weeks 1.8 1.7 10 weeks 1.7 1.5 Woodhouse et al.*(39), UK Baseline 8.3 8.9 8.1 Initial alignment 2.8 3.3 2.2 Woodhouse et al.*(40), UK Baseline-initial alignment 5.5 5.7 5.9 Initial-final alignment 2.8 3.0 2.2 Baseline-final alignment 8.4 8.6 7.6 Miles et al. (24), USA Initial-8 weeks 3.4 (2.7) 3.1 (2.4) Initial-10 weeks 4.0 (3.3) 3.4 (2.4) Bowman (36), USA Crown 1.1 (0.5) 0.9 (0.4) Apex 2.9 (1.6) 1.7 (2.4) Study, country Space closure (mm/month, mean (SD)) Alignment of anterior teeth (irregularity index, mm) Distalization of molar (mm/month) T C S T C S T C S DiBiase et al.*(45), UK Initial (68 ± 28 days) 0.82 0.95 0.89 Final (172 ± 79 days) 0.82 0.76 0.68 Miles et al.**(43), Australia Right side 1.41 (0.50) 1.30 (0.61) Left side 1.25 (0.51) 1.25 (0.46) Liao et al. (38), Australia Model (total space closure) 1.4233 (0.7212) 1.1667 (0.6377) Intraoral (total space closure) 1.9606 (1.2699) 1.6914 (1.0135) Model (canine retraction) 1.2367 (0.9597) 0.8167 (0.9606) Intraoral (canine retraction) 0.9400 (0.7871) 0.6367 (0.5763) Leethanakul et al. (37), Thailand Baseline 0.63 (0.06) 0.63 (0.06) 1–2 months 1.26 (0.27) 0.83 (0.17) 2–3 months 0.96 (0.19) 0.61 (0.13) Pavlin et al (25), USA 1.25 0.89 Katchooi et al. (44), Canada Changes in maxilla 3.56 (0.9) 3.36 (1.8) Changes in mandible 3.56 (2.2) 3.74 (2.1) Miles et al.**(42), Australia Baseline 3.9 4.4 5 weeks 2.0 2.0 8 weeks 1.8 1.7 10 weeks 1.7 1.5 Woodhouse et al.*(39), UK Baseline 8.3 8.9 8.1 Initial alignment 2.8 3.3 2.2 Woodhouse et al.*(40), UK Baseline-initial alignment 5.5 5.7 5.9 Initial-final alignment 2.8 3.0 2.2 Baseline-final alignment 8.4 8.6 7.6 Miles et al. (24), USA Initial-8 weeks 3.4 (2.7) 3.1 (2.4) Initial-10 weeks 4.0 (3.3) 3.4 (2.4) Bowman (36), USA Crown 1.1 (0.5) 0.9 (0.4) Apex 2.9 (1.6) 1.7 (2.4) *The three studies are different parts of an identical clinical trial. **The two studies are from the same one clinical trial. Open in new tab Table 2. Results of tooth movement in included studies. C, control group with no vibrational devices; T, experiment group with vibrational devices; S: sham group with non-functional vibrational devices Study, country Space closure (mm/month, mean (SD)) Alignment of anterior teeth (irregularity index, mm) Distalization of molar (mm/month) T C S T C S T C S DiBiase et al.*(45), UK Initial (68 ± 28 days) 0.82 0.95 0.89 Final (172 ± 79 days) 0.82 0.76 0.68 Miles et al.**(43), Australia Right side 1.41 (0.50) 1.30 (0.61) Left side 1.25 (0.51) 1.25 (0.46) Liao et al. (38), Australia Model (total space closure) 1.4233 (0.7212) 1.1667 (0.6377) Intraoral (total space closure) 1.9606 (1.2699) 1.6914 (1.0135) Model (canine retraction) 1.2367 (0.9597) 0.8167 (0.9606) Intraoral (canine retraction) 0.9400 (0.7871) 0.6367 (0.5763) Leethanakul et al. (37), Thailand Baseline 0.63 (0.06) 0.63 (0.06) 1–2 months 1.26 (0.27) 0.83 (0.17) 2–3 months 0.96 (0.19) 0.61 (0.13) Pavlin et al (25), USA 1.25 0.89 Katchooi et al. (44), Canada Changes in maxilla 3.56 (0.9) 3.36 (1.8) Changes in mandible 3.56 (2.2) 3.74 (2.1) Miles et al.**(42), Australia Baseline 3.9 4.4 5 weeks 2.0 2.0 8 weeks 1.8 1.7 10 weeks 1.7 1.5 Woodhouse et al.*(39), UK Baseline 8.3 8.9 8.1 Initial alignment 2.8 3.3 2.2 Woodhouse et al.*(40), UK Baseline-initial alignment 5.5 5.7 5.9 Initial-final alignment 2.8 3.0 2.2 Baseline-final alignment 8.4 8.6 7.6 Miles et al. (24), USA Initial-8 weeks 3.4 (2.7) 3.1 (2.4) Initial-10 weeks 4.0 (3.3) 3.4 (2.4) Bowman (36), USA Crown 1.1 (0.5) 0.9 (0.4) Apex 2.9 (1.6) 1.7 (2.4) Study, country Space closure (mm/month, mean (SD)) Alignment of anterior teeth (irregularity index, mm) Distalization of molar (mm/month) T C S T C S T C S DiBiase et al.*(45), UK Initial (68 ± 28 days) 0.82 0.95 0.89 Final (172 ± 79 days) 0.82 0.76 0.68 Miles et al.**(43), Australia Right side 1.41 (0.50) 1.30 (0.61) Left side 1.25 (0.51) 1.25 (0.46) Liao et al. (38), Australia Model (total space closure) 1.4233 (0.7212) 1.1667 (0.6377) Intraoral (total space closure) 1.9606 (1.2699) 1.6914 (1.0135) Model (canine retraction) 1.2367 (0.9597) 0.8167 (0.9606) Intraoral (canine retraction) 0.9400 (0.7871) 0.6367 (0.5763) Leethanakul et al. (37), Thailand Baseline 0.63 (0.06) 0.63 (0.06) 1–2 months 1.26 (0.27) 0.83 (0.17) 2–3 months 0.96 (0.19) 0.61 (0.13) Pavlin et al (25), USA 1.25 0.89 Katchooi et al. (44), Canada Changes in maxilla 3.56 (0.9) 3.36 (1.8) Changes in mandible 3.56 (2.2) 3.74 (2.1) Miles et al.**(42), Australia Baseline 3.9 4.4 5 weeks 2.0 2.0 8 weeks 1.8 1.7 10 weeks 1.7 1.5 Woodhouse et al.*(39), UK Baseline 8.3 8.9 8.1 Initial alignment 2.8 3.3 2.2 Woodhouse et al.*(40), UK Baseline-initial alignment 5.5 5.7 5.9 Initial-final alignment 2.8 3.0 2.2 Baseline-final alignment 8.4 8.6 7.6 Miles et al. (24), USA Initial-8 weeks 3.4 (2.7) 3.1 (2.4) Initial-10 weeks 4.0 (3.3) 3.4 (2.4) Bowman (36), USA Crown 1.1 (0.5) 0.9 (0.4) Apex 2.9 (1.6) 1.7 (2.4) *The three studies are different parts of an identical clinical trial. **The two studies are from the same one clinical trial. Open in new tab Three (25, 37, 38) of the five studies found that supplemental vibrational forces could accelerate the rate of space closure. Liao et al. (38) reported that both the amount of total space closure and the amount of canine distalization were higher on the vibration side than on the non-vibration side (amount of total space closure: 4.2700 ± 0.7212 versus 3.5000 ± 0.6377 mm, respectively, P = 0.022; amount of canine distalization: 3.7100 ± 0.9597 versus 2.4500 ± 0.9606 mm, P = 0.041). Pavlin et al. (25) showed that the average monthly rate of tooth movement in the group receiving vibrational forces was significantly faster compared to the control group (1.16 mm/month, 95% CI: 0.86–1.46 versus 0.79 mm/month, 95% CI: 0.49–1.09, respectively). Leethanakul et al. (37) found that the cumulative amount of canine movement was greater on the vibration side than on the non-vibration side (2.85 ± 0.17 versus 1.77 ± 0.11 mm, respectively, P < 0.001). Bowman et al. (36) carried out a CCT examining the effect of vibrational forces on molar distalization, and the results suggested a higher rate of molar distalization in the group receiving vibrational forces compared to the control group, both at the crown (1.1 ± 0.5 versus 0.9 ± 0.4 mm/month, respectively, P = 0.053) and at the root apex (2.9 ± 1.6 versus 1.7 ± 2.4 mm/month, respectively, P = 0.03). Regarding the rate of alignment of the anterior teeth, all five studies found insufficient evidence that supplemental vibrational force could significantly accelerate tooth movement. Pain experience Six studies (24, 26, 39, 41, 42, 44) reported the effects of vibrational stimulus on pain intensity using a VAS (Table 3). All except one (41) showed no significant effect on reducing orthodontic pain. Lobre et al. (41) found that vibrational forces significantly lowered the pain scores for overall pain (P = 0.002) and biting pain (P = 0.003) during the 4-month study period. Table 3. Results of pain experience in included studies (VAS, mean (SD), mm). C, control group with no vibration appliance; T, experiment group; S, sham group with non-functional vibration appliance Study, country Ttest T C S Katchooi et al. (44), Canada Baseline (sum of daily pain scores) 15.3 (9.2) 21.6 (14.1) Midpoint (sum of daily pain scores) 10.8 (11.4) 13.0 (13.1) Lobre et al. (41), USA 1 month 8.78 17.20 2 months 4.62 13.11 3 months 3.83 9.22 4 months 2.54 8.80 Miles et al. (42), Australia Baseline 8.0 9.5 6 hours 46.3 46.0 24 hours 50.5 54.0 3 days 21.5 22.1 7 days 2.6 2.1 DiBiase et al.* (26), UK Maximum pain during alignment 76.5 (19.6) 75.7 (22.6) 67.0 (24.7) Woodhouse et al.*(39), UK Maximum pain across all time-points 76.28 (18.86) 74.63 (21.95) 67.32 (23.81) Miles et al. (24), USA Baseline 12.4 (13.3) 8.1 (12.3) 6–8 hours 40.4 (20.8) 39.6 (25.8) 1 day 41.5 (27.2) 47.6 (24.5) 2 days 18.8 (18.5) 19.9 (15.5) 3 days 4.0 (6.3) 5.5 (7.8) Study, country Ttest T C S Katchooi et al. (44), Canada Baseline (sum of daily pain scores) 15.3 (9.2) 21.6 (14.1) Midpoint (sum of daily pain scores) 10.8 (11.4) 13.0 (13.1) Lobre et al. (41), USA 1 month 8.78 17.20 2 months 4.62 13.11 3 months 3.83 9.22 4 months 2.54 8.80 Miles et al. (42), Australia Baseline 8.0 9.5 6 hours 46.3 46.0 24 hours 50.5 54.0 3 days 21.5 22.1 7 days 2.6 2.1 DiBiase et al.* (26), UK Maximum pain during alignment 76.5 (19.6) 75.7 (22.6) 67.0 (24.7) Woodhouse et al.*(39), UK Maximum pain across all time-points 76.28 (18.86) 74.63 (21.95) 67.32 (23.81) Miles et al. (24), USA Baseline 12.4 (13.3) 8.1 (12.3) 6–8 hours 40.4 (20.8) 39.6 (25.8) 1 day 41.5 (27.2) 47.6 (24.5) 2 days 18.8 (18.5) 19.9 (15.5) 3 days 4.0 (6.3) 5.5 (7.8) *The two studies are from the same clinical trial. Open in new tab Table 3. Results of pain experience in included studies (VAS, mean (SD), mm). C, control group with no vibration appliance; T, experiment group; S, sham group with non-functional vibration appliance Study, country Ttest T C S Katchooi et al. (44), Canada Baseline (sum of daily pain scores) 15.3 (9.2) 21.6 (14.1) Midpoint (sum of daily pain scores) 10.8 (11.4) 13.0 (13.1) Lobre et al. (41), USA 1 month 8.78 17.20 2 months 4.62 13.11 3 months 3.83 9.22 4 months 2.54 8.80 Miles et al. (42), Australia Baseline 8.0 9.5 6 hours 46.3 46.0 24 hours 50.5 54.0 3 days 21.5 22.1 7 days 2.6 2.1 DiBiase et al.* (26), UK Maximum pain during alignment 76.5 (19.6) 75.7 (22.6) 67.0 (24.7) Woodhouse et al.*(39), UK Maximum pain across all time-points 76.28 (18.86) 74.63 (21.95) 67.32 (23.81) Miles et al. (24), USA Baseline 12.4 (13.3) 8.1 (12.3) 6–8 hours 40.4 (20.8) 39.6 (25.8) 1 day 41.5 (27.2) 47.6 (24.5) 2 days 18.8 (18.5) 19.9 (15.5) 3 days 4.0 (6.3) 5.5 (7.8) Study, country Ttest T C S Katchooi et al. (44), Canada Baseline (sum of daily pain scores) 15.3 (9.2) 21.6 (14.1) Midpoint (sum of daily pain scores) 10.8 (11.4) 13.0 (13.1) Lobre et al. (41), USA 1 month 8.78 17.20 2 months 4.62 13.11 3 months 3.83 9.22 4 months 2.54 8.80 Miles et al. (42), Australia Baseline 8.0 9.5 6 hours 46.3 46.0 24 hours 50.5 54.0 3 days 21.5 22.1 7 days 2.6 2.1 DiBiase et al.* (26), UK Maximum pain during alignment 76.5 (19.6) 75.7 (22.6) 67.0 (24.7) Woodhouse et al.*(39), UK Maximum pain across all time-points 76.28 (18.86) 74.63 (21.95) 67.32 (23.81) Miles et al. (24), USA Baseline 12.4 (13.3) 8.1 (12.3) 6–8 hours 40.4 (20.8) 39.6 (25.8) 1 day 41.5 (27.2) 47.6 (24.5) 2 days 18.8 (18.5) 19.9 (15.5) 3 days 4.0 (6.3) 5.5 (7.8) *The two studies are from the same clinical trial. Open in new tab Root resorption One study (26) focused on the effect of supplemental vibrational forces on OIIRR (Table 4), and the results indicated that vibrational force during the alignment phase did not affect OIIRR associated with the maxillary central incisor (P = 0.794) Table 4. GRADE assessment for quality of evidence on the effect of vibrational forces on OTM. CI, confidence interval; GRADE, Grading of Recommendations Assessment, Development and Evaluation; OTM, orthodontic tooth movement Vibrational stimulus compared to Control for rate of OTM Patient or population: patients with rate of OTM Settings: Outpatient Intervention: Vibrational stimulus Comparison: Control Illustrative comparative risks* (95% CI) Assumed risk Corresponding risk Outcomes Control Vibrational stimulus Relative effect(95% CI) No of Participants (studies) Quality of the evidence (GRADE) Comments rate of OTM in alignment See comment See comment Not estimable 213 (4 studies) ⊕⊝⊝⊝ very low**,***,**** vibrational stimulus cannot increase the rate of OTM rate of OTM in canine retraction See comment See comment Not estimable 222 (5 studies) ⊕⊝⊝⊝ very low**,***,***** vibrational stimulus may increase the rate of canine retraction Vibrational stimulus compared to Control for rate of OTM Patient or population: patients with rate of OTM Settings: Outpatient Intervention: Vibrational stimulus Comparison: Control Illustrative comparative risks* (95% CI) Assumed risk Corresponding risk Outcomes Control Vibrational stimulus Relative effect(95% CI) No of Participants (studies) Quality of the evidence (GRADE) Comments rate of OTM in alignment See comment See comment Not estimable 213 (4 studies) ⊕⊝⊝⊝ very low**,***,**** vibrational stimulus cannot increase the rate of OTM rate of OTM in canine retraction See comment See comment Not estimable 222 (5 studies) ⊕⊝⊝⊝ very low**,***,***** vibrational stimulus may increase the rate of canine retraction *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). **Unclear risk of bias in several domains ***The treatment procedure, the vibrational force and the follow-up period are varied. ****Only four studies with a small sample size (N=213). *****Only five studies with a small sample size (N=222). Open in new tab Table 4. GRADE assessment for quality of evidence on the effect of vibrational forces on OTM. CI, confidence interval; GRADE, Grading of Recommendations Assessment, Development and Evaluation; OTM, orthodontic tooth movement Vibrational stimulus compared to Control for rate of OTM Patient or population: patients with rate of OTM Settings: Outpatient Intervention: Vibrational stimulus Comparison: Control Illustrative comparative risks* (95% CI) Assumed risk Corresponding risk Outcomes Control Vibrational stimulus Relative effect(95% CI) No of Participants (studies) Quality of the evidence (GRADE) Comments rate of OTM in alignment See comment See comment Not estimable 213 (4 studies) ⊕⊝⊝⊝ very low**,***,**** vibrational stimulus cannot increase the rate of OTM rate of OTM in canine retraction See comment See comment Not estimable 222 (5 studies) ⊕⊝⊝⊝ very low**,***,***** vibrational stimulus may increase the rate of canine retraction Vibrational stimulus compared to Control for rate of OTM Patient or population: patients with rate of OTM Settings: Outpatient Intervention: Vibrational stimulus Comparison: Control Illustrative comparative risks* (95% CI) Assumed risk Corresponding risk Outcomes Control Vibrational stimulus Relative effect(95% CI) No of Participants (studies) Quality of the evidence (GRADE) Comments rate of OTM in alignment See comment See comment Not estimable 213 (4 studies) ⊕⊝⊝⊝ very low**,***,**** vibrational stimulus cannot increase the rate of OTM rate of OTM in canine retraction See comment See comment Not estimable 222 (5 studies) ⊕⊝⊝⊝ very low**,***,***** vibrational stimulus may increase the rate of canine retraction *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). **Unclear risk of bias in several domains ***The treatment procedure, the vibrational force and the follow-up period are varied. ****Only four studies with a small sample size (N=213). *****Only five studies with a small sample size (N=222). Open in new tab However, because only one study focused on root resorption, it should be, and only could be, regarded as insufficient evidence. Risk of bias within studies For quality assessment, RCTs were rated as having a high risk of selection bias, including the studies that used random sequence generation and allocation concealment. There was insufficient information to permit an exact judgement of selection bias in four studies, so they were assessed as having an unclear risk (Figure 2). Unlike the rate of tooth movement, which is an objective measurement, pain experience is a relatively subjective evaluation, so blinding of participants was of particular importance for the VAS score. Therefore, when considering pain experience, three studies in which there was no sham group (24, 41, 42) were evaluated as having a high risk of performance bias; these studies were evaluated as having a low risk of bias for the rate of tooth movement. Because of insufficient information, three studies and four studies were considered to have an unclear risk of detection bias and attrition bias, respectively. All 13 studies presented a low risk of reporting bias. Given that the compliance of patients might affect the outcomes, four studies were assessed as having an unclear risk for other biases. Two studies presented a high risk of other bias because of the split-mouth design. Three studies received sponsorship from the manufacturer of vibrational devices, but only one was considered to have a high risk of other bias as the other two showed an ineffective result. Figure 2. Open in new tabDownload slide Risk of bias of the studies included. (Red frame: detection bias was assessed as high risk for pain experience, while evaluated as low risk for the rate of orthodontic tooth movement. Figure 2. Open in new tabDownload slide Risk of bias of the studies included. (Red frame: detection bias was assessed as high risk for pain experience, while evaluated as low risk for the rate of orthodontic tooth movement. After assessing the risk of bias and testing heterogeneity, no study was included in the quantitative analysis. Quality of the evidence The quality of the evidence, based on the GRADE approach, of the positive effect of vibrational forces on orthodontic patients was determined in a sub-assessment. The quality of the evidence was classified as very low for the subgroup assessment of the rate of alignment of the anterior teeth, the rate of space closure, and pain experience; this result implies very low evidence of the positive effects of vibrational forces (Tables 4 and 5). Table 5. GRADE assessment for quality of evidence on the effect of vibrational forces on orthodontic pain experience. CI, confidence interval; GRADE, Grading of Recommendations Assessment, Development and Evaluation; RCT, randomized clinical trial; VAS, visual analogue scale Vibrational stimulus compared to Control for Pain in orthodontic treatment Patient or population: patients with Pain in orthodontic treatment Settings: RCTs Intervention: Vibrational stimulus Comparison: Control Illustrative comparative risks* (95% CI) Assumed risk Corresponding risk Outcomes Control Vibrational stimulus Relative effect (95% CI) No. of Participants (studies) Quality of the evidence (GRADE) Comments Pain in orthodontic treatment VAS See comment See comment Not estimable 271 (5 studies) ⊕⊝⊝⊝ very low**,***,**** Vibrational stimulus does not affect significantly high pain experience. Vibrational stimulus compared to Control for Pain in orthodontic treatment Patient or population: patients with Pain in orthodontic treatment Settings: RCTs Intervention: Vibrational stimulus Comparison: Control Illustrative comparative risks* (95% CI) Assumed risk Corresponding risk Outcomes Control Vibrational stimulus Relative effect (95% CI) No. of Participants (studies) Quality of the evidence (GRADE) Comments Pain in orthodontic treatment VAS See comment See comment Not estimable 271 (5 studies) ⊕⊝⊝⊝ very low**,***,**** Vibrational stimulus does not affect significantly high pain experience. *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). **Unclear risk in several domains. ***The treatment procedure, the vibrational force and the follow-up period are varied. ****Only five studies with a small sample size (N=271). Open in new tab Table 5. GRADE assessment for quality of evidence on the effect of vibrational forces on orthodontic pain experience. CI, confidence interval; GRADE, Grading of Recommendations Assessment, Development and Evaluation; RCT, randomized clinical trial; VAS, visual analogue scale Vibrational stimulus compared to Control for Pain in orthodontic treatment Patient or population: patients with Pain in orthodontic treatment Settings: RCTs Intervention: Vibrational stimulus Comparison: Control Illustrative comparative risks* (95% CI) Assumed risk Corresponding risk Outcomes Control Vibrational stimulus Relative effect (95% CI) No. of Participants (studies) Quality of the evidence (GRADE) Comments Pain in orthodontic treatment VAS See comment See comment Not estimable 271 (5 studies) ⊕⊝⊝⊝ very low**,***,**** Vibrational stimulus does not affect significantly high pain experience. Vibrational stimulus compared to Control for Pain in orthodontic treatment Patient or population: patients with Pain in orthodontic treatment Settings: RCTs Intervention: Vibrational stimulus Comparison: Control Illustrative comparative risks* (95% CI) Assumed risk Corresponding risk Outcomes Control Vibrational stimulus Relative effect (95% CI) No. of Participants (studies) Quality of the evidence (GRADE) Comments Pain in orthodontic treatment VAS See comment See comment Not estimable 271 (5 studies) ⊕⊝⊝⊝ very low**,***,**** Vibrational stimulus does not affect significantly high pain experience. *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). **Unclear risk in several domains. ***The treatment procedure, the vibrational force and the follow-up period are varied. ****Only five studies with a small sample size (N=271). Open in new tab Discussion A long period of treatment time and orthodontic pain are common problems bothering orthodontists and patients. It has been claimed that supplemental vibrational forces enhance orthodontic treatment, such as accelerating orthodontic tooth movement and alleviating orthodontic pain; however, the results from animal experiments to clinical trials vary. Given the evidence of optimism bias in newly introduced treatments and the heterogeneity in the methodology of different studies (46), a systematic review is needed to determine the facts. The present review performed an overall qualitative assessment on the current available studies. Three ways of measuring tooth movement were noted in studies that were included in this systematic review, and eight studies (four trials) indicated no significant evidence that vibrational forces accelerate tooth movement. The present systematic review included more studies, especially researches evaluated as low risk of bias, focused on the effect of vibrational forces on orthodontic space closure than the previous review (27), and they had controversial results. Three studies showed that vibrational forces could accelerate the rate of space closure in orthodontic treatment. However, all of these studies were assessed as high risk of bias and there was not sufficient information available on important domains. As the outcomes from one of the two studies with a low risk of bias were not normally distributed (45), no data could be directly synthesized in a meta-analysis. Consequently, different from the conclusion from a previous review (27), the present systematic review was more objective and more comprehensive. On the basis of assessment of risk of bias, no conclusion could be drawn with the limited current literature and more high-quality studies are needed to reach a more reliable conclusion. Another way of measuring tooth movement in the studies was the rate of tooth alignment. Of the five studies, Miles et al. (42) used medians rather than means to report the results of one study and applied a vibrational device with 111 Hz and 0.06 N in another study (24), which was quite different from other vibrational forces in other trials. Because of the heterogeneity of methodology across the included studies (different types of orthodontic appliances), meta-analysis could not be performed. All the studies assessed with a low risk of bias showed no significant evidence supporting a positive effect of supplemental vibrational forces on the alignment of the anterior teeth, neither with fixed appliances nor with clear aligners. Interestingly, there was a recent study on the effect of vibrational forces on clear aligners (47). It was excluded in this review because of there were no extractable data of interest. In contrast to Katchooi et al. (44), the authors used ‘accuracy’ to evaluate the effect of vibrational forces and found greater accuracy in upper incisor rotation when vibrational forces were applied (P = 0.016). To some extent, greater accuracy of the aligners could be explained as accelerated tooth movement. However, a non-functional vibrational device is necessary for evaluating the influence on tooth movement when the orthodontic appliance used are clear aligners, due to the potential seating effect obtained by biting on the device. We hope that this point will help in future research directions and designs. Among the six studies measuring the effects of vibrational stimulus on orthodontic pain intensities, only one study (41) reported that vibrational forces could significantly alleviate orthodontic pain experience. However, these controversial results should be interpreted with caution as pain experience is a relatively subjective feeling; thus blinding of participants was indispensable. Only three studies (26, 39, 44) were free of this bias via a non-functional vibration group (sham group) and showed no significant positive effect on reducing orthodontic pain. Nevertheless, a quantitative analysis could not be performed as the outcome they measured had a significant heterogeneity. Therefore, no conclusion of the potential effect of supplemental vibrational forces on orthodontic pain could be drawn based on the current literature, although there was a trend that vibrational forces might not have the ability to alleviate orthodontic pain. Only one study (26), involving 81 patients measured the influence of vibrational forces on OIIRR through long-cone periapical radiographs. Given the limited information in the literature, more trials are needed to reach a reliable result. Given the limited literature and given that some studies included in this systematic review displayed methodological limitations, additional high-quality RCTs with larger sample sizes are needed, on one hand to confirm the findings that supplemental vibrational forces do not have advantages on alignment of anterior teeth in orthodontic treatment, on the other hand to explore the fact whether supplemental vibrational forces have a positive effect on space closure, pain experience, and OIIRR in orthodontic treatment. This systematic review was carefully implemented following normalized procedures. However, it also has limitations. First, more high-quality clinical trials with larger sample sizes are needed as only 13 studies are included in the present review. For the potentially positive effect of accelerating tooth movement, the split-mouth design may bias the outcome as the vibrational force could be transmitted from one side of the mouth to the other. In addition, in the present review, two studies used a split-mouth design and their results were different from those in the parallel-group trials, which were estimated as low risk of bias. These results might give us indirect evidence that the split-mouth design is inappropriate for these investigations. For the influence of vibrational forces on orthodontic pain experience, it is necessary for future studies to ensure the blinding of patients; for example, a credible sham appliance should be an option for patients. Second, the methodological heterogeneity and non-comparability of original outcomes could keep them from a quantitative summarization. For studies measuring orthodontic space closure, when the original outcomes were not normally distributed, a transformation of the original outcome data to reduce the skewness may be a valid method to facilitate the quantitative analysis. Third, language restriction might bring bias related to ethnicity, whereas exclusion of unpublished clinical trials might have rendered the results vulnerable to publication bias. Conclusions On the basis of systematically analysed current literature, there is insufficient evidence to support the claim that supplemental vibrational forces have positive clinical advantages in the alignment of the anterior teeth and insufficient information to draw a conclusion on the influence of vibrational forces on space closure and root resorption during orthodontic treatment. In addition, there is a non-significant trend showing that supplemental vibrational forces cannot alleviate orthodontic pain. Vibrational forces may not as effective as advertised, and orthodontists should be careful making decisions on whether to apply supplement vibrational forces to accelerate tooth movement or to alleviate pain and prevent root resorption. 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First published on January 11, 2019, https://doi.org/10.1093/ejo/cjy084 . WorldCat © The Author(s) 2019. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)
TI - The effectiveness of supplemental vibrational force on enhancing orthodontic treatment. A systematic review
JF - The European Journal of Orthodontics
DO - 10.1093/ejo/cjz018
DA - 2019-09-21
UR - https://www.deepdyve.com/lp/oxford-university-press/the-effectiveness-of-supplemental-vibrational-force-on-enhancing-3EClbaHuj0
SP - 502
VL - 41
IS - 5
DP - DeepDyve
ER -