It is a very useful technique in orthodontics. I have treated many cases of constricted upper arches in adults, where non surgical expansion is questionable. It is also equally useful in unilateral constriction of the upper arch. The way I describe it is: a technique that augment tooth movement and expand the envelope of Tooth movement. It has many indications, which are doable but difficult and risky when done using conventional orthodontics

Thank you, dr. Hassan. Most interesting, indeed. From the articles I read, the risks and complications that I gathered seem the ones generally associated with surgery. Could you indicate any specific ones? Your opinion on controindications?

I agree that it is an invasive procedure. Among the complications that I noticed were: gingival recession, fibrous integration when importer graft material is used and the immediate post operative swelling that happens especially when buccal corticotomies are done.

I use a different technique for accelerating tooth movement called "Propel." In basic terms, I insert and remove TADs in the inter-dental space. This creates micro-fractues in the alveolus, promoting osteoclast / osteoblast activity which accelerates tooth movement. A recent randomized clinical trial found Propel makes tooth movement 2.3 x faster. (Alikhani et al. AJODO. 2013:144;639-48. Link to pubmed abstract below)

I've used the technique with great success for accelerating molars through edentulous space from congenitally missing 2nd bicuspids. But the technique can be used across the entire arch to create the same generalized accelerated effect as Wilkodontics.

The benefit of Propel is that it's MUCH less invasive (no flaps, no bone drilling, no grafting). so does not require referral to a periodontist. It's very easy procedure for an orthodontist to perform themselves, and is substantially more cost effective for the patient.

The draw back of Propel is that (unlike Wilko) it does NOT increase the envelope of tooth movement; it only accelerates tooth movement. Increasing the envelope is a distinct advantage of Wilko.

http://www.ncbi.nlm.nih.gov/pubmed/?term=Alikhani+et+al.+AJODO.+2013%3A144%3B639-48

Thank you for your most interesting answer, dr. Major. It is a technique unknown to me, so I shall study it carefully. I am glad for the good results.

I would like to add one element to my question. I recently listened a lecture upon the misterious connections between occlusion and posture. One of the studies presented regarded the distraction of the maxilla. They followed up a small number of patients for one year only, in order to detect anomalies in the balance between posture and occlusion. They found none after this one year. Nonetheless, the authors remain reserved upon the effects of these accelerated changes of the skeleton and occlusion. The researcher told us that this field, that tries to consider the body as a whole, is still looking for a mathematical model that could integrate all variables and make scientifically valid their opinions.

Do you have observations or opinions on the discussed tecniques, from this point of view? Thank you.

Dr Jane, I am aware individuals who advocate what you accurately describe as a "mysterious connection between occlusion and posture." Despite all the talk, I am unaware of any concrete, high quality evidence that can predictably and repeatedly demonstrate the link between occlusion and posture. While I will not dismiss the possible link, I have not found any evidence that would alter my clinical practice.

More specific to your question, I don't think accelerated orthodontics would affect an occlusion / posture relationship any more than standard orthodontic tooth movement.

Thank you again, dr. Major. It is indeed a misterious field, very challenging, in which the future may bring interesting news.

I have to be correct, I am only a dentistry student. Doctorship pending... :)

Periodontally accelerated orthodontic and osteogenic techniqueswill speed up tooth movement but will always remain additional invasive techniques. Treatment time can be much faster when you are able to avoid round tripping in using sound biomechanics and in improving time schedules.

1. Beckwith FR, Ackerman RJ, Cobb CM, Tira DE. An evaluation of factors affecting duration of orthodontic treatment. Am J Orthod Dentofac Orthop. 1999;115(4):439–47.

2. Sanon M, Taylor DC a, Parthan A, Coombs J, Paolantonio M, Sasane M. Effectiveness and duration of orthodontic treatment in adults and adolescents. J Med Econ. 2012 Jul 4;383–6.

3. Skidmore KJ, Brook KJ, Thomson WM, Harding WJ. Factors influencing treatment time in orthodontic patients. Am J Orthod Dentofacial Orthop. 2006 Mar;129(2):230–8.