Why shorter is better (with Dr. Shivam Mehta)
Dr. Shivam Mehta, B.D.S., M.D.S., is a longtime orthodontic expert and researcher in the areas of rapid palatal expansion (RPE), 3D imaging, randomized clinical trials, bone biology, and accelerated orthodontic tooth movement, which is the topic we’ll be discussing in today’s article.
He is also currently an assistant professor of Developmental Sciences/Orthodontics at the Marquette University School of Dentistry.
Dr. Mehta agreed to give Artvoice an exclusive look at accelerated orthodontic tooth movement.
Why should you care? Dr. Mehta’s research and clinical successes indicate that there is a long list of benefits associated with accelerated orthodontic tooth movement, one of the biggest being reduced time for successful treatment. Such a progression could very well be the dawn of a new era in orthodontics.
According to Dr. Mehta, patients very frequently ask about the total length of treatment.
Patients, of course, want the entire process to take as little time as possible. At times, orthodontic treatment can be uncomfortable for the patient, and treatment is frequently expensive as well.
The typical timeline for treatment is between two and three years, but that span can be affected by any number of different factors, including the patient’s individual needs and their response to treatment.
Speeding up an inherently time-consuming processes
As Dr. Mehta noted, one of the most influential factors behind treatment time is the collection of biological processes that occur during orthodontic tooth movement, and which lead to bone modeling and remodeling.
“Orthodontic tooth movement is a highly orchestrated process that occurs due to bone modeling and remodeling after an externally applied force. When an orthodontic force is applied to a tooth, alveolar bone remodeling occurs as resorption of bone in the direction of the force and deposition on the opposite side.”
The total duration of orthodontic treatment is also used as a way to judge the overall success of that treatment.
This is because longer terms of treatment can potentially lead to multiple issues and side effects, as Dr. Mehta explains here.
“Increased duration of orthodontic treatment has been implicated in the development of adverse side effects such as the development of white spot lesions and root resorption. Thus, my focus is on decoding the biology of orthodontic tooth movement and whether we can reduce the duration of orthodontic tooth movement.”
Taking a closer look at the biology behind tooth movement in this context gets right to the root of the problem, so to speak.
A thorough understanding of orthodontic tooth movement and its causes and effects could greatly enhance current orthodontic treatment, especially in terms of safety and efficiency.
This understanding could also greatly benefit the treatment of patients with osteogenesis imperfecta, a condition wherein bone structure is defective, which can lead to multiple fractures and bone deformities.
Dr. Mehta has been hard at work researching both osteogenesis imperfecta and accelerated orthodontic tooth movement.
Let’s take a look at some of this research.
Surgical and non-surgical solutions
When orthodontists and researchers are looking to accelerate orthodontic tooth movement, the methods for achieving this fall into two different categories: surgical and non-surgical.
Dr. Mehta has extensively researched both surgical and non-surgical models for tooth movement.
Here are some simplified findings:
Dr. Mehta’s research with animal models has shown that using heavy force in treatment can constitute a substantial increase in the rate of orthodontic tooth movement (OTM).
In addition to this, Dr. Mehta has found that the use of light force, along with minimal surgical intervention, is optimal for OTM acceleration, sort of a best-of-both-worlds approach.
Unfortunately, this research has also revealed a major downside to surgical interventions that use a specific technique known as alveolar decortications, which is that it increases root resorption.
Root resorption can be serious, and (to explain simply) involves an uncommon process during which the body begins to dissolve a tooth’s structure
While root resorption is a natural and healthy process in children, as part of making room for permanent, adult teeth, it’s a serious problem for adults.
Dr. Mehta explains his attempts to refine these processes in order to achieve the best possible results while avoiding serious drawbacks.
“By using light force, root resorption can be reduced as compared to heavy force. The next question that arose in my mind was can we accelerate tooth movement without an increase in root resorption? To answer this question, we undertook a research project on surgical intervention at different distances from the teeth to identify the location which can enable acceleration of orthodontic tooth movement without an increase in root resorption.”
As is probably clear by this point, research into OTM, or indeed any specific aspect of orthodontic treatment, is a complicated process, and every potential solution can come with its own set of potential issues, even if only for specific patients.
But there’s another player in this game, another treatment method that could potentially accelerate tooth movement and which is certainly worth looking into.
It’s called photobiomodulation.
To put it simply, photobiomodulation is potentially another viable method for accelerating OTM.
But as for what photobiomodulation actually involves, well, that’s a bit more difficult to explain.
At a basic level, photobiomodulation is a non-surgical method that has the goal of accelerating OTM. It has also been referred to as low-level laser therapy (LLLT) since it involves the use of infrared or red light to execute therapeutic effects on tissue.
Dr. Mehta also noted that this method has been called a “cold laser” because the local temperature is only raised by about one degree Celsius (roughly 33.8 degrees Fahrenheit).
Using low levels of light energy, photobiomodulation stimulates the bone surrounding the roots of teeth in order to facilitate tooth movement.
Dr. Mehta has taken a special interest in the photobiomodulation method, believing that it could represent a viable orthodontic method. But first, the method needs to be studied in great detail.
“My motivation to conduct this clinical trial is to determine the molecular changes associated with the use of photobiomodulation and to measure its validity, if any, in reducing overall treatment time.”
Dr. Mehta explained that, as far as he and his team know, this clinical trial is the first randomized control clinical trial on humans using photobiomodulation.
This research also aims to study the effects of photobiomodulation on the density of the mandibular bone and evaluate the role of this method on markers of bone modeling and remodeling.
To put this more simply, Dr. Mehta and his team are doing everything they can to make sure that this research is as safe and precise as possible, gathering highly useful data which could support or deter widespread use of photobiomodulation in the future.
“We have taken utmost care to generate the highest level of evidence by paying attention to each step leading to an appropriate study design, an adequate sample size, proper randomization, blinding, and variable samples processed at both the micro and macro level. I believe this study will provide strong evidence about photobiomodulation usage and whether it is effective in the acceleration of orthodontic tooth movement and reduction in overall treatment time.”
Of course, Dr. Mehta didn’t have the results of this study to share with us, but it’s certainly an exciting moment in his research, and one that could have a major impact on the methodologies of orthodontic treatment.
OTM and Osteogenesis Imperfecta
Somewhat removed from the discussion thus far is the question of how best to manage the acceleration of OTM in patients with a condition known as Osteogenesis Imperfecta.
Osteogenesis Imperfecta usually results in what are colloquially referred to as brittle bones, which can translate to bone fractures in each patient, though the number of fractures can vary.
This condition affects one in every 15,000 people, and frequently, individuals with Osteogenesis Imperfecta have a more serious need for orthodontic treatment than those without.
Methods for accelerating OTM in patients with this condition require special care, especially given the common use of bisphosphonate therapy on patients with Osteogenesis Imperfecta.
This has created a gap in accelerated OTM research in reference to such patients, which has led to Dr. Mehta’s special interest in this particular area of research.
“It is my determination to improve the health, wellbeing, and oral health-related quality of life of patients with Osteogenesis Imperfecta. It is with this goal and research funding and grant support from institutions such as the American Association of Orthodontists Foundation (AAOF) and Northeastern society of orthodontists (NESO) that I am leading first-of-its-kind research on the effects of Alendronate on orthodontic tooth movement in Osteogenesis Imperfecta.”
Dr. Mehta notes that, in addition to the conducting of research in this area, dissemination of that research is also incredibly important for the advancement of orthodontia and continuing research.
Specifically, Dr. Mehta highlighted the role that institutions such as the National Institute of Health, the Association of Orthodontists Singapore, the European Orthodontic Society, and the International Association for Dental Research have provided excellent platforms for sharing this research.
Dr. Mehta himself has over 27 publications in peer-reviewed journals and has received four grants and delivered fifteen scientific presentations alongside world-renowned researchers.
But ultimately, all this research has the goal of improving the treatment of specific individuals, based on their orthodontic needs.
“I am continually working on aspects of acceleration of orthodontic tooth movement and finding a solution to decrease orthodontic treatment duration below the current average of 24 months. The goal of this research is to find repeatable, reliable, and consistent ways to accelerate orthodontic tooth movement.”
When finalized, this research may very well lead to tangible benefits for real people who require treatment, and we hope that Dr. Mehta will continue his work in earnest to bring about those benefits.