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 Chapter 3

Accelerated Orthodontics

Anand K. Patil and Amrit Singh Maan

K. Patil Singh Maan

Additional information
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available at
at the
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http://dx.doi.org/10.5772/intechopen.80915

Abstract
Clinical orthodontics is ever dynamic branch of Dentistry. Traditionally orthodontics
was always considered as aesthetic treatment of face & also needed for proper oral oral
function. This treatment may take up 2–3 years of total duration. The chapter describes
changing trends in this aspect wherein we speed up the treatment by various methods
thus reducing the overall time duration. These modalities include alteration in bio
mechanics, pharmacological, chemical & by biological means. It is also cautioned here
that the clinician has to take up these changing trends based on sound clinical knowledge
& evidence based applicability.

Keywords: biology of tooth movement, acceleration of tooth movement, prostaglandins,

regional acceleration phenomena, corticotomy

1. Accelerated orthodontics

Orthodontic treatment in the present day does not just require to meet the demands of creat-
ing the functional harmony in occlusion and improving the aesthetic outlook of but is should
also be completed in the most efficient duration that is accepted by the patient and the ortho-
dontist. We live in a fast-paced world where the treatment duration has clearly made the field
of orthodontic treatment to revolve around it. Accelerated orthodontic tooth movement is
not something that has recently emerged; it has been studied and tried out for many years.
In an attempt of producing faster tooth movement during orthodontic treatment, there are
numerous methods of accelerating tooth movements that have been introduced over the years
which range from surgical means to the use of laser therapy. Now let us look at each method
explained in this chapter.

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons
© 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative
Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use,
Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use,
distribution, and reproduction in any medium, provided the original work is properly cited.
distribution, and reproduction in any medium, provided the original work is properly cited.
24 Current Approaches in Orthodontics

2. Methods of accelerated tooth movements

We can categorise the methods of accelerated tooth movement into the following categories:
A. Pharmacological methods
B. Surgical methods
C. Physical methods

2.1. Pharmacological methods

Orthodontic forces cause a fluid movement in the periodontal ligament space and distor-
tion of the matrix and cells. There is release of molecules which initiate bone remodelling
for tooth movement [1]. There are a number of researches on pharmacological agents that
act as biomodulators for increased orthodontic tooth movement. These are examples of such
biomodulators:

• Prostaglandin E2 and Prostaglandin E1

• Misoprostol
• 1,25-Dihydroxycholecalciferol
• Parathyroid hormones
• Intravenous immunoglobulins

Prostaglandin E2 (PGE2) is an arachidonic acid metabolite is an often-tested substance to

increase orthodontic tooth movement [2]. Animal studies have shown PGE2 to increase tooth
movement and facilitate bone resorption [3–6]. Camacho and Velásquez Cujar conducted a
study that showed that it required repeated injections due to its short half-life [7]. Particular
synthases that are required for the synthesis of PGE2 could be targeted to control the produc-
tion of the prostaglandins [8].
Another prostaglandin that has been reported to speed up orthodontic tooth movement
is Prostaglandin E1 (PGE1). Prostaglandin E1 (PGE1) has also been seen to be induced by
mechanical stress and cause bone remodelling, Patil and his co-workers had shown that even
minimal amounts of PGE1 injection had significant increase in tooth movement [9]. Due to
the hyperalgesia that accompanies with the local injection of PGE1, an analogue of it which
is misoprostol was tried out. It was seen that it was effective in increasing orthodontic tooth
movement (Figure 1) [10].
The parathyroid hormone (PTH) acts directly on osteoblasts and on osteoclasts indirectly by
binding to the PTH type 1 receptor on osteoblasts. This causes the expression of insulin like
growth factor 1. There is promotion of osteoblast survival, osteoblastogenesis and receptor
activator for nuclear factor κ B ligand (RANKL) which induces osteoclast activation [2]. PTH
facilitates bone remodelling in intermittent treatment by enhancing activities of osteoblasts
and osteoclasts [11].
 Accelerated Orthodontics 25
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Figure 1. Injection of a biomodulator in the periodontium.

Calcitriol or 1,25-dihydroxycholecalciferol which is the most active metabolite of vitamin D

acts in a similar fashion to PTH by facilitating osteoblastic proliferation and function [12].
Calcitriol facilitates alveolar bone remodelling which leads to increase in tooth movement
while force application [6, 13].
Recently intravenous immunoglobulin (IVIg) preparations which are used in immunodefi-
cient patients as replacement therapy. These preparations have been shown to induce COX-2
mediated PGE2 and cytokine production [14, 15]. Future potential of these preparations could
be used to modulate orthodontic movement via PGE2 synthesis.

2.2. Surgical methods

Bichmalyr in 1931, put forward a surgical technique with orthodontic appliances for rapid
correction of severe maxillary protrusion. First, wedges of bone were removed to reduce the
volume for which the roots of the maxillary anterior teeth would require for retraction. Kӧle
further looked into this technique in 1959 by including special movements like crossbite cor-
rection and space closure. He believed that he was able to move bony blocks using the crowns
of teeth as handles as the blocks were connected by only less-dense medullary bone [16].
Currently there are few surgical methods being practiced, they are:

• Periodontally accelerated osteogenic orthodontics

• Piezocision

• Micro-osteoperforations

In 2001, Wilcko et al. had introduced a method which combines corticotomy surgery and
alveolar bone grafting which is referred to as accelerated osteogenic orthodontics or recently
26 Current Approaches in Orthodontics

termed as periodontally accelerated osteogenic orthodontics (PAOO) [16]. This procedure

which enables rapid tooth movement is due to a healing event that was described by Frost
[17] and termed as regional acceleratory phenomenon (RAP).

RAP is the acceleration of the normal regional healing process from the original injury. It usu-
ally occurs after osteotomy, bone-grafting procedure, arthrodesis and fractures and there might
be involvement and activation of precursor cells required for healing at the injury site. RAP can
increase both soft and hard tissue healing processes by two- to tenfold [17]. It usually starts in
the first few days of injury, peaks at the first or second month and may last for 3–4 months [16].

Orthodontic treatment can be started 1 week before or within 2 weeks after the surgery.
Surgery begins with flap reflection and decortication with low-speed round burs. Bone graft
is then laid over these areas of corticotomies. The flaps are then closed and sutured [18].
Several studies have been done related to corticotomies, an example is one by Uzuner and her
co-workers where they showed that canine retraction assisted by corticotomy had reduced
duration of retraction by 20% ratio [19]. PAOO has shown to have reduced treatment time,
produce lower cortical bone resistance leading to reduced root resorption, enhancement of
post-orthodontic stability, increased bone support since there is supplementation of the bone
graft. However, PAOO still has risks since it is an invasive procedure and is expensive [20–24].

Since the corticotomy procedure is still invasive, Dibart et al. introduced a new minimally
invasive method called piezocision. Piezocision involves microincisions which are confined
to the buccal side that allows the use of piezoelectric knife and selective tunnelling which
enables hard and soft tissue grafting [25]. Piezocision is usually done a week after orthodon-
tic appliance placement. The procedure involves vertical incisions made buccally and inter-
proximally. The mid portion of the incision between the roots enables the piezoelectric knife
to be inserted. A piezotome is then inserted in the gingival openings that were made and
piezoelectrical corticotomy of 3 mm is made. Hard or soft tissue grafts can then be added via
a tunnelling procedure (Figure 2) [26].

Figure 2. Piezocision.
 Accelerated Orthodontics 27
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Piezocision can be used as an adjunct to treat a number of malocclusions and aid in rapid
orthodontic treatment in adults. Since it is much more minimally invasive than corticotomy,
it is having high degree of patient acceptance, short surgical time and has less postoperative
discomfort [25, 26]. Dibart and coworkers in 2013 showed that there was an increase in the
rate of tooth movement in their animal study and preliminary human studies are being con-
ducted to correlate with the animal studies [26, 27].

To further reduce the amount of invasive nature of surgical intervention, a method called
micro-osteoperforation (MOP). It is procedure in which small pinhole-sized perforations are
created within the alveolar bone surrounding the dentition. This initiates cytokine release to
call in osteoclasts to increase bone resorption. Thus, acceleration of tooth movement occurs
during orthodontic treatment. The site of perforation is within the attached gingiva and close
to the target teeth on the mesial and distal aspect of the roots of the teeth which will be moved.
The most favourable place for placement of the perforation is the buccal cortical plate but
lingual plate can also be approached with a contra-angled appliance. Two to four perforations
are ideal amounts with depths of 3–7 mm into the bone [28].
In 2013, Alikhani et al. showed that MOP increased expression of cytokines for osteoclast
differentiation, increased canine retraction, reduced orthodontic treatment by 62% with
mild discomfort in patients [29]. In an animal study, Alikhani and co-workers found that the
expression of inflammatory markers and bone resorption was significant. Their human clini-
cal trial found distalisation was twice as much with MOP than the forces alone [30].

2.3. Physical methods

Despite all the attempts in making surgical methods being minimally invasive, they still
remain as an invasive procedure. This had led to discoveries in other tools that can acceler-
ate tooth movement during orthodontic treatment. The two most common physical methods
used in the present day are:

• Vibratory stimulus

• Low level laser therapy

• Low-intensity pulsed ultrasound

Bone has the ability to respond to the mechanical stimuli that is applied to it as a mechanism
to withstand functional activity. Rubin et al. showed the rate of remodelling in mechanically
loaded long bones have been increased following vibrations or low level mechanical oscilla-
tory signals [31]. In 2008, Nishimura et al. did an animal study which gave an insight on how
resonance vibration could be able to accelerate tooth movement through the expression of
RANKL in the periodontal ligament [32].

A novel device that was introduced by OrthoAccel Technologies is the AcceleDent device. The
device has an activator and a mouthpiece. The patient bites on the mouthpiece component
when in use. The activator which is extraorally positioned generates and transmits vibrations
28 Current Approaches in Orthodontics

to the teeth. It can provide 0.2 N of vibration at 30 Hz for 20 minutes. It was fabricated to
work in tandem with existing bracket systems and not replace them. The device produces
cyclic forces to move teeth within the alveolus via accelerated bone remodelling [33]. Pavlin
and co-workers in 2015 showed low-level cyclic loading with AcceleDent increased the rate of
orthodontic movement (Figure 3) [34].
Another treatment modality to speed up orthodontic tooth movement is by the use of low-level
laser therapy (LLLT). Laser irradiation on tissues has a biostimulating effect with not more
than 1°C rise in local temperature. Biostimulation potency of laser irradiation utilised by treat-
ment are called low-level laser therapy [35]. Other than accelerating tooth movement, LLLT
can enhance stability of orthodontic mini-implants [36], reduce post-adjustment pain [37], and
induce bone growth in midpalatal suture area following rapid maxillary expansion [38].
Studies done by Fujita et al. and Yamaguchi et al. showed that LLLT enhances osteoclasto-
genesis on the compressed side of teeth being moved. There was stimulation of RANKL and
macrophage colony-stimulating factor [39, 40]. Coordination of bone remodelling had been
facilitated by RANKL and osteoprotegerin following orthodontic force with LLLT. LLLT stim-
ulates bone formation on the tension side [41]. Kim et al. observed osteopontin localisation in
the periodontal tissue in their study subjects, indicating LLLT may stimulate osteogenesis as
well in orthodontic treatment [42]. Although much findings show LLLT stimulates osteoblast
and osteoclast function, further studies are still required to optimise the effect of LLLT on
tooth movement (Figure 4) [43].

Figure 3. AcceleDent device.

 Accelerated Orthodontics 29
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Figure 4. Low-level laser therapy.

Apart from physical agents, low-intensity pulsed ultrasound (LIPUS) has also been suggested.
It uses mechanical energy which passes through the tissues as acoustic pressure waves [44].
This leads to biochemical changes at molecular and cellular levels. It can increase the healing
of both soft tissue and hard tissue [45]. LIPUS is usually used at frequency pulses of 1.5 MHz
with 200 μs pulse width, which is repeated at 1KHz a for 20 minutes a day with an intensity
of 30 mW/cm2 [46].
Recent studies on LIPUS using animal models by Xue et al. showed that there is induction of
alveolar bone remodelling. The remodelling occurred due to an increase in the gene expres-
sion of HGF/Runx2/BMP-2 signalling pathway with LIPUS. This led to an increase in the
velocity of tooth movement during orthodontic treatment [47]. El-Bialy et al. observed that
LIPUS may reduce the root resorption that was orthodontically-induced by deposition of den-
tin and cementum to create a preventive layer from root resorption [48].

3. Conclusion

Over the years, the methods of reducing treatment time has risen along with its’ demand.
The options that are available on the orthodontist’s plate are numerous ranging from surgical
means to photostimulation. Much studies will still need to be done for newer methods to
emerge and obtaining a clearer understanding on the methods that already exist. At present,
the clinician should use all the knowledge obtained for deciding which treatment option is
best for the patient to meet the healthcare needs of the patient and achieving an optimum
treatment outcome.
30 Current Approaches in Orthodontics

Author details

Anand K. Patil1* and Amrit Singh Maan2

*Address all correspondence to: [email protected]

1 Department of Orthodontics and Dentofacial Orthodontics, SDM College of Dental

Sciences and Hospital, Karnataka, India

2 SDM College of Dental Sciences and Hospital, Dharwad, Karnataka, India

References

[1] Krishnan V, Davidovitch ZE. Cellular, molecular, and tissue-level reactions to orthodon-
tic force. American Journal of Orthodontics and Dentofacial Orthopedics. 2006;129(4):469,
e1-e32
[2] Kouskoura T, Katsaros C, Gunten SV. The potential use of pharmacological agents to
modulate orthodontic tooth movement (OTM). Frontiers in Physiology. 2017;8:67
[3] Yamasaki K, Shibata Y, Fukuhara T. The effect of prostaglandins on experimental tooth
movement in monkeys (Macaca fuscata). Journal of Dental Research. 1982;61(12):1444-1446
[4] Yamasaki K, Shibata Y, Imai S, Tani Y, Shibasaki Y, Fukuhara T. Clinical application
of prostaglandin E1 (PGE1) upon orthodontic tooth movement. American Journal of
Orthodontics and Dentofacial Orthopedics. 1984;85(6):508-518
[5] Kale S, Kocadereli I, Atilla P, Aşan E. Comparison of the effects of 1,25 dihydroxycho-
lecalciferol and prostaglandin E2 on orthodontic tooth movement. American Journal of
Orthodontics and Dentofacial Orthopedics. 2004;125(5):607-614
[6] Leiker BJ, Nanda RS, Currier G, Howes RI, Sinha PK. The effects of exogenous prosta-
glandins on orthodontic tooth movement in rats. American Journal of Orthodontics and
Dentofacial Orthopedics. 1995;108(4):380-388
[7] Camacho AD, Velásquez Cujar SA. Dental movement acceleration: Literature review
by an alternative scientific evidence method. World Journal of Methodology. 2014;4(3):
151-162
[8] Forsberg L, Leeb L, Thorén S, Morgenstern R, Jakobsson P-J. Human glutathione depen-
dent prostaglandin E synthase: Gene structure and regulation. FEBS Letters. 2000;471(1):
78-82
[9] Patil AK, Keluskar KM, Gaitonde SD. The clinical application of prostaglandin E1 on
orthodontic tooth movement. Journal of Indian Orthodontic Society. 2005;38:91-98
[10] Sekhavat AR, Mousavizadeh K, Pakshir HR, Aslani FS. Effect of misoprostol, a pros-
taglandin E1 analog, on orthodontic tooth movement in rats. American Journal of
Orthodontics and Dentofacial Orthopedics. 2002;122(5):542-547
 Accelerated Orthodontics 31
http://dx.doi.org/10.5772/intechopen.80915

[11] Li F, Li G, Hu H, Liu R, Chen J, Zou S. Effect of parathyroid hormone on experimental

tooth movement in rats. American Journal of Orthodontics and Dentofacial Orthopedics.
2013;144(4):523-532

[12] Reichel H, Koeffler HP, Norman AW. The role of the vitamin D endocrine system in
health and disease. The New England Journal of Medicine. 1989;320(15):980-991

[13] Takano-Yamamoto T, Kawakami M, Kobayashi Y, Yamashiro T, Sakuda M. The effect of

local application of 1,25-dihydroxycholecalciferol on osteoclast numbers in orthodonti-
cally treated rats. Journal of Dental Research. 1992;71(1):53-59

[14] Trinath J, Hegde P, Sharma M, Maddur MS, Rabin M, Vallat J-M, et al. Intravenous immu-
noglobulin expands regulatory T cells via induction of cyclooxygenase-2-dependent
prostaglandin E2 in human dendritic cells. Blood. 2013;122(8):1419-1427

[15] Djoumerska-Alexieva I, Roumenina L. Intravenous immunoglobulin with enhanced

polyspecificity improves survival in experimental sepsis and aseptic systemic inflam-
matory response syndromes. Molecular Medicine. 2015;21(1):1

[16] Wilcko WM, Wilcko T, Bouquot JE, Ferguson DJ. Rapid orthodontics with alveolar
reshaping: Two case reports of decrowding. The International Journal of Periodontics &
Restorative Dentistry. 2001;21(1):9-19

[17] Frost HM. The regional acceleratory phenomenon: A review. Henry Ford Hospital
Medical Journal. 1983;31(1):3-9

[18] Goyal A, Kalra JPS, Bhatiya P, Singla S, Bansal P. Periodontally accelerated osteogenic
orthodontics (PAOO)—A review. Journal of Clinical and Experimental Dentistry. 2012;
4(5):e292-e296

[19] Uzuner FD, Yücel E, Göfteci B, Gülsen A. The effect of corticotomy on tooth movements
during canine retraction. Journal of Orthodontic Research. 2015;3:181-187

[20] Ferguson DJ, Makki L, Stapelberg R, Wilcko MT, Wilcko WM. Stability of the mandibu-
lar dental arch following periodontally accelerated osteogenic orthodontics therapy:
Preliminary studies. Seminars in Orthodontics. 2014;20(3):239-246

[21] Wilcko MT, Wilcko WM, Pulver JJ, Bissada NF, Bouquot JE. Accelerated osteogenic
orthodontics technique: A 1-stage surgically facilitated rapid orthodontic technique with
alveolar augmentation. Journal of Oral and Maxillofacial Surgery. 2009;67(10):2149-2159

[22] Yalamanchi L, Yalamanchili P, Adusumilli S. Periodontally accelerated osteogenic ortho-

dontics: An interdisciplinary approach for faster orthodontic therapy. Journal of Pharmacy
& Bioallied Sciences. 2014;6(5):2

[23] Andrade IJ, Sousa AB, da Silva GG. New therapeutic modalities to modulate orthodon-
tic tooth movement. Dental Press Journal of Orthodontics. 2014;19(6):123-133

[24] Uzuner FD, Darendeliler N. Dentoalveolar surgery techniques combined with orth-
odontic treatment: A literature review. European Journal of Dentistry. 2013;7:257-265
32 Current Approaches in Orthodontics

[25] Dibart S, Dibart J-P. Practical Osseous Surgery in Periodontics and Implant Dentistry.
Chichester, West Sussex, UK: Wiley-Blackwell; 2011. pp. 195-197

[26] Dibart S, Keser E, Nelson D. Piezocision™-assisted orthodontics: Past, present, and

future. Seminars in Orthodontics. 2015;21:170-175
[27] Dibart S, Yee C, Surmenian J, Sebaoun JD, Baloul S, Goguet-Surmenian E, et al. Tissue
response during piezocision-assisted tooth movement: A histological study in rats.
European Journal of Orthodontics. 2013;36(4):457-464

[28] Sangsuwon C, Alansari S, Nervina J, Teixeira CC, Alikhani M. Micro-osteoperforations

in accelerated orthodontics. Clinical Dentistry Reviewed. 2018;2:4

[29] Alikhani M, Raptis M, Zoldan B, Sangsuwon C, Lee YB, Alyami B, et al. Effect of micro-
osteoperforations on the rate of tooth movement. American Journal of Orthodontics and
Dentofacial Orthopedics. 2013;144(5):639-648

[30] Alikhani M, Alansari S, Sangsuwon C, Alikhani M, Chou MY, Alyami B, et al. Micro-
osteoperforations: Minimally invasive accelerated tooth movement. Seminars in
Orthodontics. 2015;21(3):162-169
[31] Rubin C, Turner AS, Müller R, Mittra E, Mcleod K, Lin W, et al. Quantity and quality of
trabecular bone in the femur are enhanced by a strongly anabolic, noninvasive mechani-
cal intervention. Journal of Bone and Mineral Research. 2002;17(2):349-357

[32] Nishimura M, Chiba M, Ohashi T, Sato M, Shimizu Y, Igarashi K, et al. Periodontal tis-
sue activation by vibration: Intermittent stimulation by resonance vibration accelerates
experimental tooth movement in rats. American Journal of Orthodontics and Dentofacial
Orthopedics. 2008;133(4):572-583

[33] Kau CH, Nguyen JT, English JD. The clinical evaluation of a novel cyclical force generat-
ing device in orthodontics. Orthodontic Practice US. 2010;1:10-15

[34] Pavlin D, Anthony R, Raj V, Gakunga PT. Cyclic loading (vibration) accelerates tooth
movement in orthodontic patients: A double-blind, randomized controlled trial. Seminars
in Orthodontics. 2015;21(3):187-194

[35] Walsh LJ. The current status of low level laser therapy in dentistry, part 1. Soft tissue
applications. Australian Dental Journal. 1997;42(4):247-254

[36] Omasa S, Motoyoshi M, Arai Y, Ejima K-I, Shimizu N. Low-level laser therapy enhances
the stability of orthodontic mini-implants via bone formation related to BMP-2 expres-
sion in a rat model. Photomedicine and Laser Surgery. 2012;30(5):255-261
[37] Bicakci AA, Kocoglu-Altan B, Toker H, Mutaf I, Sumer Z. Efficiency of low-level laser
therapy in reducing pain induced by orthodontic forces. Photomedicine and Laser
Surgery. 2012;30(8):460-465

[38] Cepera F, Torres FC, Scanavini MA, Paranhos LR, Filho LC, Cardoso MA, et al. Effect
of a low-level laser on bone regeneration after rapid maxillary expansion. American
Journal of Orthodontics and Dentofacial Orthopedics. 2012;141(4):444-450
 Accelerated Orthodontics 33
http://dx.doi.org/10.5772/intechopen.80915

[39] Fujita S, Yamaguchi M, Utsunomiya T, Yamamoto H, Kasai K. Low-energy laser stimu-

lates tooth movement velocity via expression of RANK and RANKL. Orthodontics &
Craniofacial Research. 2008;11(3):143-155
[40] Yamaguchi M, Fujita S, Yoshida T, Oikawa K, Utsunomiya T, Yamamoto H, et al. Low-
energy laser irradiation stimulates the tooth movement velocity via expression of M-CSF
and c-fms. Orthodontic Waves. 2007;66(4):139-148

[41] Yoshida T, Yamaguchi M, Utsunomiya T, Kato M, Arai Y, Kaneda T, et al. Low-energy

laser irradiation accelerates the velocity of tooth movement via stimulation of the alveo-
lar bone remodeling. Orthodontics & Craniofacial Research. 2009;12(4):289-298
[42] Kim J-Y, Kim B-I, Jue S-S, Park JH, Shin J-W. Localization of osteopontin and osterix in
periodontal tissue during orthodontic tooth movement in rats. The Angle Orthodontist.
2012;82(1):107-114

[43] Kasai K, Chou MY, Yamaguchi M. Molecular effects of low-energy laser irradiation dur-
ing orthodontic tooth movement. Seminars in Orthodontics. 2015;21(3):203-209

[44] Buckley MJ, Banes AJ, Levin LG, Sumpio BE, Sato M, Jordan R, et al. Osteoblasts increase
their rate of division and align in response to cyclic, mechanical tension in vitro. Bone
and Mineral. 1988;4(3):225-236

[45] Claes L, Willie B. The enhancement of bone regeneration by ultrasound. Progress in

Biophysics and Molecular Biology. 2007;93(1-3):384-398

[46] Xue H, Zheng J, Chou MY, Zhou H, Duan Y. The effects of low-intensity pulsed
ultrasound on the rate of orthodontic tooth movement. Seminars in Orthodontics.
2015;21(3):219-223
[47] Xue H, Zheng J, Cui Z, Bai X, Li G, Zhang C, et al. Low-intensity pulsed ultrasound
accelerates tooth movement via activation of the BMP-2 signaling pathway. PLoS One.
2013;8(7)

[48] El-Bialy T, Lam B, Aldaghreer S, Sloan A. The effect of low intensity pulsed ultrasound
in a 3D ex vivo orthodontic model. Journal of Dentistry. 2011;39(10):693-699