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This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4687287
 Efficacy of non-surgical methods to accelerate orthodontic tooth movement: a

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systematic review.

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Bendahan Z1, Escobar LM1, Colorado C1, González MC1, Díaz-Báez D3, Chambrone L2,3

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1Unidad de Manejo Integral de Malformaciones Craneofaciales (UMIMC), Facultad de

Odontología, Universidad El Bosque

2Evidence-Based

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Hub, Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas

Moniz-Cooperativa de Ensino Superior, Caparica, Almada, Portugal;

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3Unit of Basic Oral Investigation (UIBO), Universidad El Bosque, Bogota, Colombia, and

Department of Periodontics, School of Dental MedicineThe University of Pennsylvania,

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Philadelphia, PA, USA

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Correspondence to:
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Zita Carolina Bendahan Álvarez. Av. Cra 9 # 131 A – 02. Ed. Fundadores School of Dentistry.

Universidad El Bosque, Bogotá, Colombia

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Cellphone: 57-3214577512 Fax number: 57 1 6489000, Ext. 1244-1253[A2]

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E-mail: zbendahana@unbosque.edu.co
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This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4687287
 d
HIGHLIGHTS

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- First systematic review that analyzed the efficacy of low-level laser therapy in terms of

treatment time.

- LLLT speeds-up 25 days the canine retraction compared to fixed orthodontics.

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ABSTRACT

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Long-term orthodontic treatment may be associated with increased risk of bone necrosis, root

resorption, caries, and loss of patient motivation. Accelerating orthodontic tooth movement
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(OTM) is desirable for patients and dentists. Recent investigations focused on accelerating

OTM by physical, chemical or surgical techniques. Corticotomy and osteotomy accelerates

OTM while non-surgical methods showed variable rate of success. The purpose of this
p

systematic review is to evaluate the efficacy of non-surgical methods to accelerate OTM.

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Materials and methods

Literature search was performed on MEDLINE, EMBASE and CENTRAL databases up to

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January 2023. Inclusion criteria were randomized clinical trials (RCT); fixed orthodontics and

non-surgical methods used to accelerate OTM. Cochrane Collaboration’s tool Version 2 was
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used for assessing risk of bias of RCT. The primary outcomes evaluated were time, amount,

and rate of displacement. Adverse effects were evaluated as secondary outcomes. Prospero

registration number CRD42018117564.

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Results
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Literature research identified 883 articles; after screening of titles, abstracts, and full-text

studies; 30 fulfilled the inclusion criteria and were included. 16 of the 30 studies investigated

This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4687287
 the effect of LLLT; ten studies investigated SW; one study reviewed the influence of VitD3, and

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one study analyzed the effects of Platelet-rich plasma (PRP) and Platelet-rich fibrin (PRF).

LLLT speeds-up 25 days the canine retraction and local administration of VitD3 potentiate

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OTM. No difference in efficacy was found between the use of PRP and PRF or shock waves

(SW). None reported adverse effects related to the therapies.

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Conclusions

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Based on current information from individual studies outcomes and the pooled estimates,

weak evidence suggests that intraoral LLLT speeds-up 25 days the canine retraction and that

local administration of VitD3 potentiate OTM, compared to conventional orthodontics. The use

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of PRP and SW showed inconsistent results accelerating the OTM.
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Keywords: orthodontics; tooth movement techniques; orthodontic appliances, fixed; low-level
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light therapy; high-energy shock waves
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INTRODUCTION
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Orthodontic treatment aims to correct dental malocclusion, restoring teeth alignment, function,

and aesthetics.1 It is well-defined in the literature that orthodontic tooth movement (OTM) is
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characterized by the formation of tension and compression zones in the periodontal ligament

and bone deposition, or resorption guided by molecules that induce cellular responses.2,3
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It has been identified that a long orthodontic treatment may increase the risk of bone necrosis,

root resorption, pulp reactions, caries, and loss of patient motivation.4 Therefore, surgical, and

non-surgical orthodontic procedures have been evaluated to accelerate OTM. Corticotomy

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has been successfully used to accelerate OTM; however, few patients accept its use due to

its invasive nature.5 It has been demonstrated that non-surgical methods such as low-level

This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4687287
 laser therapy, vitamins intake, and shock wave therapy, among others, have shown a variable

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rate of success. To date, to the best of our knowledge, these non-surgical treatment modalities

have not been systematically compared so far. Therefore, the purpose of this systematic

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review is to evaluate the efficacy of non-surgical methods to accelerate OTM, by answering

the following focused question: “What is the most effective non-surgical method to accelerate

tooth movement in patients with malocclusion treated with fixed orthodontics?”.

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MATERIALS AND METHODS

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The protocol of this review was registered at the National Institute for Health Research

PROSPERO (registration number CRD42018117564). The study was conducted according to

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the PRISMA Statement6 and the Cochrane Handbook of Systematic Reviews of Interventions.7
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Inclusion criteria
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Only randomized clinical trials (RCT) performed with fixed orthodontics were considered

eligible for inclusion in the review. The interventions of interest were Low-level laser therapy
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(LLLT), shock waves therapy (SW), Vitamin D3 (VitD3), platelet-rich plasma (PRP) and platelet

rich fibrin (PRF).

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Outcome measures
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Primary outcomes were changes in treatment duration measured in days, rates of tooth

movement measured in millimeters per week (mm/week) and amount of tooth movement
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measured in millimeters (mm). Therapy adverse effects and additional results were evaluated

as secondary outcomes.

This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4687287
 d
Search strategy

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An electronic search was conducted on MEDLINE, EMBASE, and Central databases for

articles published in the English language up to January 2023. The search strategy included

terms related to orthodontics, orthodontic tooth movement, malocclusion, and acceleration

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orthodontic.

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Search strategy developed for MEDLINE (via Pubmed) was:

1) (Orthodontic treatment) OR (orthodontic tooth movement) OR (orthodontic

movement).

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2) (Tooth movement acceleration) OR (acceleration orthodontic) OR (accelerated

orthodontics) OR (accelerated orthodontic tooth movement).

3) 1 AND 2.
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Validity assessment and data extraction

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Four independent reviewers (ZCB, MCG, LME, and CCO) assessed each of the articles

considered eligible. After reviewing titles and abstracts, those not fulfilling the inclusion criteria
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were excluded, and the full text of others was evaluated. Disagreements among reviewers

were resolved by consensus, or if agreement could not be reached another reviewer (LC) was

consulted.
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The following data were extracted (in duplicate) from each included study. 1) citation,

publication year, and publication status; 2) location of the trial (private practice or
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university/hospital); 3) type of study (RCT); 4) type of participants; 5) types of interventions; 6)

This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4687287
 outcome measures and quality assessment; 7) conclusions; 8) source of funding, and 9)

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conflict of interest.

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Quality of the included studies

The quality of included studies was evaluated using Version 2 of the Cochrane risk-of-bias

tool for randomized trials (RoB 2) for assessing the risk of bias by Sterne et al.8 The

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randomization, allocation methods, follow-up period, blinding of examiners, selective reporting

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and other sources of bias were analyzed, and based on the results, the risk of bias was

categorized in (1) a low risk of bias if all criteria were met (i.e., adequate methods of

randomization and allocation concealment and a yes answer to all questions on completeness

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of follow-up questions and masking of examiners); (2) an unclear risk of bias if one or more

criteria were partially met (i.e., unclear criteria were set); or (3) a high risk of bias if one or
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more criteria were not met.9
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Data synthesis
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Data were grouped into evidence tables and reported as descriptive summaries. This allowed

us to assess the quantity of data and study variations in terms of study characteristics and
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results. Random effects meta-analysis was performed in subgroups by treatment therapy and

outcome. Heterogeneity between studies was assessed using Cochran Q-statistics and the I2
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measure. I2-values of 25%–49% were considered to indicate low, 50%–74% moderate, and

≥75% high levels of heterogeneity.

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This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4687287
 RESULTS

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Study selection

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The electronic and manual search identified 883 articles. After examining titles and abstracts,

37 potentially relevant studies were identified and analyzed in full text. Six studies did not fulfill

the criteria and were excluded (Table 1). A total of 30 studies were included in the systematic

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review (Figure 1).

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Table 1. Excluded studies

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Author, year Title Reason of
of publication exclusion

Wu et al. A pilot clinical study of Class III surgical patients facilitated by Surgical
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(2015) improved accelerated osteogenic orthodontic treatments. method.

Genc et al. Effect of low-level laser therapy (LLLT) on orthodontic tooth No

(2013) movement. randomizat
ion
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Youssef et al. The effect of low-level laser therapy during orthodontic movement: No
(2018) a preliminary study. randomizat
ion
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Domínguez et Effects of low-level laser therapy on orthodontics: rate of tooth No

al. (2018) movement, pain, and release of RANKL and OPG in GCF. randomizat
ion
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Ilknur et al. Assessment of the effects of local platelet-rich fibrin injection and Surgical
(2021) piezocision on orthodontic tooth movement during canine method.
distalization.
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Gui and Qu Clinical application of low energy laser in acceleration of Article in

(2008) orthodontic tooth movement chinese
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 Included studies

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Sixteen of the thirty studies investigated the effect of LLLT;10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25 ten

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studies investigated SW;26,27,28,29,30,31,32,33,34,35 one study reviews the influence of VitD3,36 and

three studies analyzed the effects of PRP o PRF.37,38,39

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Quality of the included studies

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Based on Version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB 2) for

assessing risks of bias, twelve studies were judged to be of high risk;14,16,20,21,22,26,28,29,33,36,39

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sixteen with some concerns10,11,13,15,17,19,23,24,25,27,30,32,34,35,37,38 and two of them were low risk.12,31

(Table 2).
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Table 2. Quality of the included studies
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Type of intervention Autor, year of publication Overall risk of bias

Low level laser
therapy Pérignon, et al. (2021) Some concerns
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Farhadian, et al. (2021) Some concerns

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Qamruddin et al. (2021) Low

Zheng and Yang (2021) Some concerns

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Jivrajani and Bhad (2020) High

Varella et al. (2018) Some concerns

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AlSayed et al. (2017) High

Nahas et al. (2017) Some concerns

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Üretürk et al. (2017) High

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 Chung et al. (2015) Some concerns

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Heravi et al. (2014) High

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Kau et al. (2013) High

Doshi-Mehta and Bhad-Patil High

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(2012)

Sousa et al. (2011) Some concerns

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Limpanichkul et al. (2006) Some concerns

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Cruz, et al. (2004) Some concerns
Shock wave
therapy Bhad Patil (2022 High
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Mayama et al. (2022) Some concerns

El-Bialy et al. (2020) High

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Taha et al. (2020) High

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Leethanakul et al. (2016) Some concerns

Dubravko et al. (2015) Low

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Woodhouse et al. (2015) Some concerns

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Falkensammer et al. (2014) High

Miles et al. (2012) Some concerns

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Showkatbakhsh et al. (2010) Some concerns

Vitamin D3 therapy Al-Hassani et al. (2011) High

PRP/ PRF
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Zeitounlouian et al. (2021) Some concerns

Erdur et al. (2021) Some concerns

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 El-Timamy et al. (2020) High

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PRP: Platelet-rich plasma, PRF: Platelet rich fibrin

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Effects of interventions

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According to intervention therapy, studies were divided into four groups: LLLT, SW, VitD3, and

PRP. Intervention effects were assessed according to the outcomes of individual studies in

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each treatment group (Tables 3, 4, 5, 6).

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1. Low-level laser therapy (LLLT)
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Primary outcomes

- Time of displacement
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Four studies evaluated the treatment time as an outcome10,14,16,17 finding a difference for time

displacement of 25,96 days for canine retraction in favor of LLLT10,14 and 23,75 days for teeth
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alignment also in favor for LLLT.16,17 Nevertheless, Perignon et al. evaluated the treatment

time for canine retraction in a clinical study during a following time of 180 days, finding no
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differences between LLLT and placebo.10

Given the high heterogeneity between the protocols, as well as due to the lack of data available
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for the analysis from some studies, in this subgroup of analysis it was only possible to combine

the results of the studies by Alsayed and Nahas, who evaluated the efficacy of LLLT with
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respect to conventional orthodontic treatment for dental alignment.16,17 The pooled estimation

showed a statistically significant effect in favor of the experimental group with a treatment time

difference of 25 days compared to the control (95% CI: 15.94-34.66) (Table 3) (Figure 2).
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Table 3. Effects of interventions: LLLT

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 Author, Sample Age of Orthodo Applied Treatm Treatment Locatio Conclusions

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year of size participa ntic therapy ent time n of
publicatio (patient nts treatmen dose (days) trial
n s) (years) t (light

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intensit
y)
(J/cm2)

Pérignon, 42 10-18 Canine LLLT Vs. 30 180 Univer Cannot

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et al. retractio Placebo sity conclude that
(2021) n the use of a
diode laser
reduces the

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time to obtain
Class I status
in patients
wearing Class

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II elastics
during
orthodontic
treatment.
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Farhadian 60 15-30 Canine LLLT Vs. LED: 60 Univer LLLT
, et al. retractio LED Vs. 10 sity appeared to be
(2021) n Conventi LLLT: effective in
onal 4 accelerating
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orthodon OTM by 60%,

tic but the LED
could not
increase the
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rate of OTM
significantly.
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Qamruddi 22 12-30 Canine LLLT Vs. 7.5 21 Univer Application of

n et al. retractio Placebo sity LLLT at
(2021) n regular
orthodontic
visits (3 weeks
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intervals)
accelerates
OTM and
decreases the
pain
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significantly.
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 Zheng 12 18-28 Canine LLLT Vs. 6.29 28 Univer LLLT could

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and Yang retractio Conventi sity have clinical
(2021) n onal utility in
orthodon accelerating

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tic OTM, due to
its
biostimulatory
effects, which
elicited an

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enhanced
biological
response in
the

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periodontium
adjacent to the
tooth.

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Jivrajani 10 14-24 Canine LLLT Vs. 9 135,6 Univer LLLT
and Bhad retractio Placebo sity increases the
(2020) n rate of
orthodontic
ee
tooth
movement by
38%.

Varella et 10 17,7 Canine LLLT Vs. 8 60 Univer LLLT-

p

al. (2018) retractio Conventi sity facilitated

n onal orthodontics
orthodon is
tic approximately
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2 times faster
than
conventional
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orthodontics
and can be
used to
provide
physical
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stimuli
resulting in
accelerated
tooth
movement
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AlSayed 26 20,07 Aligment LLLT Vs. 2,25 Laser: Univer LLLT is an

et al. Conventi 81.23 +/- sity effective
(2017) onal 15.29 method for
orthodon Control: accelerating
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tic 109.23+/- orthodontic

14.18 tooth
movement.

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 Nahas et 40 21,4 Aligment LLLT Vs. 12 Laser: Univer The use of

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al. (2017) Conventi 68.3 sity photobiomodu
onal Control: lation for 20
orthodon 87.8 minutes daily

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tic at 850 nm
wavelength
might reduce
the time
required to

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resolve lower
anterior
crowding.

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Üretürk et 15 16,2 Canine LLLT Vs. 5 90 Univer LLL
al. (2017) ±1,32 retractio Conventi sity application
n onal significantly
orthodon accelerates

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tic tooth
movement in
humans with a
healthy tissue
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response and
increased
levels of IL-1β
and TGF-β1 in
the gingival
p

crevicular fluid

Chung et 13 (17 16,07 Canine LED Vs. 0.92- 70 Univer Unilateral

al. (2015) arches) retractio Conventi 6.92 sity application of
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n onal extra-orally
orthodon derived,
tic transdermal
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LED
phototherapy
did not result
in any
statistical
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difference in
the rate of
OTM over a 3-
month period
of bilaterally
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symmetrical
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This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4687287
 Heravi et 20 22.1 ±5.3 Canine LLLT Vs. 21,4 56 Private LLLT neither

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al. (2014) retractio Conventi practic accelerated
n onal e orthodontic
orthodon tooth

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tic movement nor
affected the
degree of
mesiodistal
inclination of

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canines over
retraction.

Kau et 90 18 Aligment LED Vs. 72-216 Not Univer Photobiomodu

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al.(2013) Conventi declared sity lation
onal produced
orthodon clinically
tic significant

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changes to the
rates of tooth
movement as
compared to a
ee
control group
during the
alignment
phase of
orthodontic
p

treatment,
regardless of
maxillary or
mandibular
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arch.

Doshi- 20 (30 12-23 Canine LLLT Vs. 8 90 Not The mean

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Mehta and quadra retractio Placebo declare increase in the

Bhad-Patil nts n d rates of tooth
(2012) each movement at 3
group) months was
54% in the
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maxillary arch
and 58% in the
mandibular
arch.
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Sousa et 10 (26 13,1 Canine LLLT Vs. 5 90 Univer LLLT

al. (2011) canine retractio Conventi sity statistically
s) n onal speeded the
orthodon orthodontic
tic movement of
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canines during
the initial

This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4687287
 retraction
period.

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Limpanich 12 20.11 Canine LLLT Vs. 25 30-90 Univer LLLT at the
kul et al. ±3.4 retractio Placebo sity parameter
(2006) n settings in this

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study had no
effect on the
rate of OTM

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for any time
periods,
between one
and three

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months.

Cruz, et 11 12-18 Canine LLLT Vs. 5 60 Private LLLT

al. (2004) retractio Conventi practic significantly
n onal e accelerates
ee
orthodon orthodontic
tic movement in
humans with a
healthy
p
response from
periodontal
tissues.
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LLLT: low-level laser therapy, OTM: orthodontic tooth movement, IL-1β: Interleukin 1 β, TGF-β1: transforming

growth factor
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- Rate of displacement

Seven studies evaluated this outcome with this treatment10.11,12,14,21,22,25, and concluded that
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LLLT increases the rate of orthodontic tooth movement by 38-60% for canine

retraction.11,12,14,22,25, Qamruddin et al. and Fharadian et al. found that the mean rate of OTM
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was statistically significant between the experimental and control side.11,12 Also with a small

sample, Jivrajani and Bhad concluded that LLLT increases OTM rate by 38% in the maxillary

arch.14
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This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4687287
 Photobiomodulation also produced clinically significant changes to the rates of tooth

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movement as compared to a control group during the alignment phase of orthodontic

treatment, regardless of maxillary or mandibular arch.21

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On the other hand, Pérignon, et al., cannot conclude that the use of a diode laser reduces the

time to obtain Class I status in patients wearing Class II elastics during canine retraction.10

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In this subgroup, the results of Cruz et al., (2004), Jivrajani and Bhad (2020), Fharadian et al.,

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(2021) and Pérignon, et al., (2021) who evaluated the use of LLLT for canine retraction were

combined, the results of the random effects meta-analysis did not show significant differences

between the groups evaluated (MD 0.23 mm/week, CI 95 %: -0.60-1.06) during a follow-up

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time between 60-180 days.10,11,14,25 (Figure 3)
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- Amount of displacement
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Seven of the studies analyzed the amount of displacement. According to Cruz et al., (2004),

the canine retraction movement after 60 days were 4.39 mm ±0.27 and 3.30mm ±0.24 from
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the laser and control group respectively, showing a statistically significant difference between

treatments (p<0.001).25 Sousa et al. (2011), determined that canine movement increased from
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1.6 mm in the non-laser-irradiated group to 3.06 mm in the laser-irradiated group after 90 days

of treatment23 and another author found the average cuspid displacement in the experimental
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and placebo groups was 1.55 ± 0.25 mm and 0.94 ± 0.25 mm, respectively.12 At the end of 4

weeks of retraction, Zheng and Yang (2021) concluded that canines were retracted 1.15±0.29

mm on the laser side and 0.85±0.23 mm on the control side.13 Additionally, Üretürk et al. found
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a canine distalization amount of 3.9 ±1.41 mm and 2.77 ±1.49 mm in laser and control groups,

respectively and statistically significant (p<0.01).18 Despite the small sample, Varella et al.
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(2018), found an amount of tooth movement two times faster in the experimental group.15

This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4687287
 On the contrary, studies using the highest doses of Gallium-aluminum-arsenide diodes

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(GaAlAs) diode laser for canine retraction, did not find a positive effect.10,19,20,24

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The pooled estimate of studies evaluating displacement for canine retraction using

LLLT10.13,19,23,12,15, showed a trend toward improvement in favor of LLLT (MD 0.54 mm, 95%

CI: 0.13 to 0.94) over a period of follow-up time between 21-180 days (Figure 4).

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Secondary outcomes

LLLT decreased pain on the third day of treatment, according to Doshi-Mehta and Bhad-

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Patil.22 Nevertheless, Farhadian, et al. (2021) and Heravi et al. (2014), did not find significant

differences in pain perception between the laser and control group when they bit a plastic
ee
block (p>0.05).11,20

Levels of interleukin 1β (IL-1β) in the experimental canine group were higher compared with
p

the control canines group at all times evaluated,15 and Zheng and Yang found the same results

on days 21 and 28 of treatment.13 Üretürk found significant differences at 24 hours between

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laser and control group of IL-1β concentrations (p <0.05) only at the compression site, there

were no significant differences in IL-1β concentrations between laser and control groups at
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the tension site (p>0.05). A negative correlation was found between the amount of tooth

movement and L-1β levels on the compression site (day 21).18 LLLT application increases the
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matrix metallopeptidase 9 (MMP-9) concentration in gingival crevicular fluid in the initial period

of orthodontic tooth movement.12,14 RANKL level was significantly higher on the laser side on

days 7, 14, and 21 than control.13

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Sousa et al. did not find statistically significant differences in evaluating root or alveolar bone

ridge resorption between groups.23 In addition, other studies have not reported adverse or
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secondary effects.

This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4687287
 2. Shock waves therapy

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Primary outcomes

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The protocols were highly heterogeneous; different devices were used, and the SW

application varied between a single application until ten weeks, and wave frequency was

between 1-1.500.000 Hz. (Table 4)

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Table 4. Effects of interventions: shock waves

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Author, Samp Age of Orthod Applied Treat Treatm Location of Conclusions
year of le participants ontic therapy ment ent trial
publicatio size (years) treatme dose time

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n (patie nt (Hz) (days)
nts)

Bhad 19 18-24 Canine Shock 1 150 University PEMF therapy

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Patil retracti wave Vs. increases the
(2022) on Conventi rate of
onal orthodontic
orthodon tooth
tic movement in a
p

physiological
manner.

Mayama 23 20.2 ±7.0 Canine Shock 102.2 Not University Static

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et al. retracti wave Vs. ±2.6 declare orthodontic

(2022) on Conventi d force with
onal supplementary
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orthodon vibration of
tic 102.2±2.6 Hz
for 3 min
accelerated
tooth
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movement in
canine
retraction and
reduced the
number of
ep

visits

El-Bialy et 20 19.7 ±6.63 Canine Shock 15000 168 University/ LIPUS

al. (2020) retracti wave Vs. 00 Private increased the
on Placebo practice rate of tooth
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movement and
decreased
orthodontically

This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4687287
 induce root
resorption.

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Taha et al. 21 Control: Canine Shock 30 84 Private No statistically
(2020) 15.09 ±1.7 retracti wave Vs. practice significant
Experiment on Conventi differences
al:15.9 onal between the

ie
±1.29 orthodon experimental
tic and control
groups in the

ev
rate of canine
retraction.

Leethana 15 22.9 Canine Shock 125 60 University The

rr
kul et al. retracti wave Vs. accumulative
(2016) on Conventi amount of
onal tooth
orthodon movement was
tic greater for the
ee
experimental
canine
than for the
control canine
p
(mean, 2.85 6
0.17 mm vs
1.77 6 0.11
mm,
ot

respectively,
P<.001).

Dubravko 45 12-40 Canine Shock 30 Not Not Significantly

tn

et al. retracti wave Vs. declare declared increases the

(2015) on Placebo d rate of
orthodontic
tooth
rin

movement

Woodhou 81 14.1 Aligme Shock 30 Not University Overall, mean

se et al. nt wave Vs. declare time from
(2015) Conventi d initial to final
ep

onal alignment was

orthodon 150 ±62.5 d
tic Vs (95% CI, 136-
Placebo 165) and from
baseline to
Pr

final
alignment, 209
±65 d (95% CI,
195-224); there

This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4687287
 were no
significant

d
differences
among groups
for either

we
period (p=0.41,
0.49,
respectively).

ie
Falkensa 26 31.5 Second Shock 0.19– Single University Single

ev
mmer et molar wave Vs. 0.23 appplic application of
al. (2014) retracti Placebo mJ/m ation shock wave
on m2 treatment did
not statistically
and

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significantly
accelerate
tooth
movement.
ee
Showkatb 10 23 ±3.3 Canine Shock 1 Not University Successful in
akhsh et retracti wave Vs. declare increasing the
al. (2010) on Conventi d rate of or
onal thodontic
p

orthodon tooth
tic movement
ot

Miles et 66 13 Aligme Shock 111 70 days Private No advantage

al. (2012) nt wave Vs. practice for the early
Conventi resolution of
onal crowding
tn

orthodon
tic
PEMF: Pulsed electromagnetic field therapy
rin

- Time of displacement
ep

Only two studies evaluated the time of displacement. Woodhouse et al. (2015), using a

vibration of 0.25 N and 30 Hz by 20 minutes/day with AcceleDent device (OrthoAccel

Pr

Technologies), reported that the device did not accelerate the rate of initial tooth alignment or

reduce the treatment time.32 On the contrary, static orthodontic force with supplementary

This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4687287
 vibration of 102.2±2.6 Hz for three minutes accelerated tooth movement in canine retraction

d
and reduced the number of visits.27 The analysis of random effects meta-analysis could not be

performed given the heterogeneity between the protocols. (Figure 1)

we
- Rate of displacement

ie
Four studies evaluated the rate of displacement as an outcome.26,28,29,31

ev
Dubravko (2015), used a vibration of 0.25 N and 30 Hz by 20 minutes/day with AcceleDent

device (OrthoAccel Technologies) and determined that the average monthly rates of tooth

rr
movement were 48.1% above the baseline value, which demonstrates a significant clinical

benefit.31 El-Bialy et al. (2020) increased the rate of tooth movement applying the highest
ee
waves frequency (1500000 Hz) with the low-intensity pulsed ultrasound (LIPUS) (Ultrasonic

Treatment) for 20 minutes/day for 24 weeks or until the closure of the extraction space on
p
either side.28 Pulsed electric fields (PEMF) therapy increases the rate of OTM in a physiological

manner.26
ot

On the contrary, Taha et al. (2020) did not find statistically significant differences in the rate of

canine retraction between groups29 using the same device and similar protocol used by
tn

Woodhouse et al. (2015)32 and Dubravko (2015).31

Regarding the analysis of random effects meta-analysis, the rate of tooth movement is -0.08
rin

mm/week (95% CI: -0.21 to 0.05), finding no clinical changes or statistically differences. during

a treatment time of 60-168 days.26,28,30,31 (Figure 3)

ep

- Amount of displacement
Pr

Five studies analyzed the amount of displacement.26,27,30,33,35

This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4687287
 Showkatbakhsh et al. (2010) recorded statistically significant differences in the distance

d
between maxillary canine and first molar (p<0.001). Pre and post-treatment distances on each

side were 5 ±1.3 mm and 3.5 ±1.6 mm for the experimental and control groups, respectively

we
applying 1 Hz during 8 hours/day with a self-design circuit with magnets and PEMFs.35

Leethanakul et al. (2016) showed that canine retraction with Colgate H Motion-Multi Action

electric toothbrush (125 Hz, 5 minutes, three times per day during 60 days) was most

ie
significant for the experimental group (mean 2.85 +/-0.17 mm vs. 1.77 +/-0.11 mm,

ev
respectively, p<0.001).30

After ten weeks of alignment using Tooth Masseuse (111 Hz, 20 minutes/day), Miles et al.

rr
(2012) demonstrated a 65% reduction in irregularity index, while the control group

demonstrated a 69% reduction, showing no advantage for early crowding resolution.34 Using
ee
a single application with Orthogold 100 (MTS/TNT Konstanz), Falkensammer et al. (2014)

reported no significant acceleration of second mandibular molar retraction in the experimental

group compared to the control group.33

p

Regarding the results, the rate of tooth movement ranged from 29-100%,26,28,30,31 and the
ot

amount of tooth movement was 0.32-1.5 mm higher in the experimental group compared with

the control group.27,35 The other studies did not find differences between groups29,32,33,34 (Table
tn

4).

The findings for the meta-analysis of this subgroup showed an amount of movement of -0.31
rin

mm (95% CI: -1.77 to 1.15) in favor of SW therapy during 150 days of treatment, therefore no

statistically significant differences were found between the use of SW with different

instruments and conventional orthodontics. (Figure 4)

ep
Pr

This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4687287
 Secondary outcomes

d
Less orthodontically-induced root resorption was found in patients treated with LIPUS.28 IL-

we
1β levels in gingival crevicular fluid (GCF) increased after the application of vibratory stimuli

combined with orthodontic force.30 No statistically significant differences in perceived pain

during canine retraction helped with the AcceleDent Aura device29 and another vibration

ie
generator.27

ev
3. Vitamin D3

Primary outcomes

rr
ee
The 25 pg of VitD3, also known as calcitriol, produced about 51% faster rate of experimental

canine movement compared to control, while 15 pg and 40 pg resulted in about 10%

accelerated OTM; however, differences were not statistically significant due possibly to the
p

small sample size (n=15).36 (Table 5).

ot

Table 5. Effects of interventions: Vitamin D3

Author, Sample Age of Orthodo Applie Treatm Treatm Locati Conclusions

tn

year of size participa ntic d ent ent on of

publicati (patien nts treatmen therap dose time trial
on ts) (years) t y (days)

Al- 15 17-28 Canine Vitami 15-40 21 Univer Local administration of

rin

Hassani retractio n D3 pg sity calcitriol, in a dose

et al. n Vs dependent pattern, is
(2011) Placeb clinical and cost
o effective in
accelerating OTM in
ep

humans
OTM: orthodontic tooth movement
Pr

This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4687287
 Secondary outcomes

d
Although there was an increase in GCF volume 1.0-1.5 hours after injections in all groups, no

we
statistical differences were reported for these values compared to the pre-injection period.

Thus, the application of calcitriol did not cause tissue damage in any of the patients

evaluated.36

ie
ev
4. Platelet-rich plasma (PRP) and Platelet-rich fibrin (PRF)

Platelet-rich plasma (PRP) and Platelet-rich fibrin (PRF) are the two major autologous platelet

rr
concentrations. PRF is an autologous fibrin matrix, without the addition of anticoagulants and

additives at lower centrifugation speeds; PRP must be activated with calcium chloride and
ee
thrombin.38 (Table 6)

Table 6. Effects of interventions: PRF-PRP

p

Author, Sampl Age of Orthodo Appli Treatm Treatm Location of Conclusions

year of e size particip ntic ed ent ent trial
ot

publicati (patie ants treatme thera dose time

on nts) (years) nt py (mL) (days)

Zeitounlo 21 20.85 ± Canine PRF 2 150 University/ The rates of canine

tn

uian et al. 3.85 retracti Vs. Hospital retraction did not

(2021) years on Cont differ significantly
rol between
experimental and
control sides except
rin

at the second month

over a period of 5
months.

Erdur et 20 21,4 Canine PRF 4 84 University/ PRF-facilitated

ep

al. (2021) ±2,9 retracti Vs. Hospital orthodontics is an

on Place effective alternative
bo treatment method for
shortening the
Pr

treatment duration
required for tooth
movement by
stimulating the

This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4687287
 expression of
inflammatory

d
cytokines.

we
El- 16 18 ±3 Canine PRP 0.25 120 University/ Despite the
Timamy retracti Vs. Hospital statistically
et al. on Place significant increase

ie
(2020) bo in the rate of canine
retraction during the
early stages of tooth

ev
movement
concomitant with
PRP injections, PRP
did not exhibit long-

rr
term acceleration
effects.
ee
PRF: platelet rich fibrin; PRP: platelet rich plasma
p

Primary outcomes
ot

- Amount of displacement

Results showed a 15% faster rate of canine retraction on the intervention side in the first month
tn

and 5% in the second month. However, after the injections, in the third month of treatment,

the rate of canine retraction was 40% lower on the experimental side.39 (Table 5).
rin

PRF effect is not conclusive, Erdur et al. (2021) concluded that it is an effective alternative

treatment method for shortening the treatment duration required for tooth movement by
ep

stimulating the expression of inflammatory cytokines,38 but according to Zeitounlouian et al.

(2021), the rates and overall time of canine retraction did not differ significantly between

experimental and control sides except at the second month over a period of 5 months.39
Pr

This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4687287
 Of the 3 articles studied, we only could make the comparison between 2 articles38,39 for canine

d
retraction and no difference in efficacy was found between the use of plasma and placebo

(MD 1.15mm; 95% CI: - 0.94 to 3.23). (Figure 4)

we
Secondary outcomes

ie
Pain scores showed no difference between the intervention and control sides assessed using

ev
a visual analog scale questionnaire completed by patients until the seventh week of

treatment.39

rr
ee
DISCUSSION
p

Summary of main findings.

ot

This systematic review included 30 studies divided according to the acceleration method:

LLLT, SW, VitD3, and PRP-PRF.

tn

In summary, intraoral LLLT applied with continuous doses between 4-30 J/cm2 of GaAlAs, and

wavelengths between 780-980 nm helps to accelerate teeth alignment with a treatment time
rin

difference of 25 days compared to the control (95% CI: 15.94 to 34.66) (Figure 2)16,17 and the

amount of displacement showed a trend toward improvement in favor of LLLT (MD 0.54 mm,

95% CI: 0.13 to 0.94) over a period of follow-up time between 21-180 days.10.12,13,18,23, (Figure
ep

4)

SW showed no clinical changes or statistically differences in the rate of movement of retracted

Pr

canines (MD -0.08 mm/week; 95% CI: -0.21 to 0.05 during a treatment time of 60-168

This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4687287
 days).26,28,29,31 or the amount of canines movement (MD -0.31 mm; 95% CI: -1.77 to 1.15 in

d
favor of SW therapy during 150 days of treatment).26,27,35

we
25 pg of VitD3 demonstrated a 51% increase in OTM; nevertheless, the highest and lowest

dose promotes a lower rate of canine movement.36

PRP injections demonstrated no difference in accelerating canines retraction (MD 1.15mm;

ie
95% CI: - 0.94 to 3.23) with conventional orthodontics.38,39

ev
Quality of evidence

rr
Nevertheless, only randomized clinical trials were included, the quality of synthesized
ee
evidence is low, mainly due to the lack of high-quality primary studies and methodological

heterogeneity. In some studies, participants,16,26,39 or people delivering the

interventions14,16,20,22,26,29,33,39 were aware of the assigned intervention during the trial that could
p

affected the outcome. According to the results, some investigations did not report data for all

the randomized participants, and this could bias the results.28,36

ot

A substantial degree of heterogeneity was detected in five of the six meta-analyses (Figures
tn

3 and 4). Increasing methodological rigor of the future studies may influence positively the

quality of evidence, so the shortage of high-quality clinical trials is evident.

rin

Limitations and potential biases in the review process.

ep

The present review only included articles in English, which could generate a significant loss of

results.
Pr

In addition, some authors did not find differences between groups, probably because of the

This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4687287
 small sample sizes19,20,24,29 and poor device compliance rate experienced by patients that

d
could contributed to reduce the mean tooth movement in the experimental group.29

we
Another limitation was the elevated heterogeneity in terms of study design and protocols that

avoid establishing conclusions about efficacy and benefits of techniques.

Also, there is limited research-based evidence to conclude the efficacy of the methods that

ie
could accelerate OTM. Results should be taken with caution because the greater part of

ev
studies have high19,20,22,23,29,32,34,35,39 or unclear risk of bias.13,15,18,21,25,28,31,36,37,38

rr
Agreements and disagreements with other systematic reviews.
ee
1. Low-level laser therapy (LLLT)

As far as we know, there is no previous systematic review that analyzed the efficacy of LLLT

in terms of treatment time. This meta-analysis found that LLLT speeds-up 25 days the canine
p

retraction compared to conventional orthodontics. This 25 days of gain during canine

ot

retraction, could result in higher gain in full treatment time.

A recent meta-analysis did not find benefits in the amount of displacement of OTM helped with
tn

LLLT,40 in agreement with this review that found an amount of displacement of 0.54 mm (95%

CI: 0.13 to 0.94) over a period of follow-up time between 21-180 days.10,12,13,18,23,
rin

2. Shock waves therapy (SW)

ep

Based on this meta-analysis no significant differences were found between the use of SW with

different instruments and conventional orthodontics, reinforcing the information from a

Pr

previous systematic review that found weak evidence to support the efficacy of vibrational

stimulus for accelerating canine retraction but not in the alignment phase.4

This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4687287
 3. Vitamin D3.

d
Weak evidence suggests that local administration of VitD3 potentiates OTM, but there is a

we
need for well-designed RCT to obtain more reliable results. A previous systematic review

concluded that the heterogeneous results on the effect of VitD3 might be attributed to the fact

that studies utilized different concentrations for VitD3, and its effect may be depending on the

ie
dose.41

ev
4. Platelet-rich plasma (PRP) and Platelet-rich fibrin (PRF)

rr
These results agree with other systematic reviews that concluded that the use of PRP and its

derivatives showed inconsistent results on the rate of OTM41 and the rate of canine movement
ee
at different intervals; in the 1st (MD 0.12 mm, 95% -5.01 to 5.24) and 3rd month (MD 0.54 mm,

-1.38 to 2.47) did not significantly affect OTM; but in the 2nd month, PRF (MD 0.66 mm, 0.60
p
to 0.73) significantly increased the OTM.42
ot

CONCLUSIONS
tn

Based on current information from individual studies outcomes and the pooled estimates,

weak evidence suggests that intraoral LLLT speeds-up 25 days the canine retraction and that
rin

local administration of VitD3 potentiate OTM, compared to conventional orthodontics. The use

of PRP and SW showed inconsistent results accelerating the OTM.

ep

Implications for practice

Pr

These findings allow practitioners to offer to their patients the opportunity to accelerate a few

days the OTM with LLLT.

This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4687287
 d
Implications for research

we
Long-term case-control studies are needed to support the findings of this review. Future

investigations should use comparable protocols and bigger samples.

ie
ev
FUNDING

This systematic review was financed by Universidad El Bosque.

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37. Zeitounlouian TS, Zeno KG, Brad BA, Haddad RA. Effect of injectable platelet-rich

fibrin (i-PRF) in accelerating orthodontic tooth movement: A randomized split-mouth-

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controlled trial. J Orofac Orthop. 2021;82(4):268-77. doi: 10.1007/s00056-020-00275-x.

38. Erdur EA, Karakaslı K, Oncu E, Ozturk B, Hakkı S. Effect of injectable platelet-rich
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fibrin (i-PRF) on the rate of tooth movement. Angle Orthod. 2021;91(3):285-92. doi:

10.2319/060320-508.1.
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39. El-Timamy A, El Sharaby F, Eid F, El Dakroury A, Mostafa Y, Shaker O. Effect of

platelet-rich plasma on the rate of orthodontic tooth movement. Angle Orthod.

tn

2020;90(3):354-361. doi: 10.2319/072119-483.1.

40. Olmedo-Hernández OL, Mota-Rodríguez AN, Torres-Rosas R, Argueta-Figueroa L.

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Effect of the photobiomodulation for acceleration of the orthodontic tooth movement: a

systematic review and meta-analysis. Lasers Med Sci. 2022;37(5):2323-41. doi:

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10.1007/s10103-022-03538-8.

41. Arqub SA, Gandhi V, Iverson MG, Ahmed M, Kuo CL, Mu J, Dutra E, Uribe F. The
Pr

effect of the local administration of biological substances on the rate of orthodontic tooth

This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4687287
 movement: a systematic review of human studies. Prog Orthod. 2021;22(1):5. doi:

d
10.1186/s40510-021-00349-5.

we
42. Farshidfar N, Amiri MA, Firoozi P, Hamedani S, Ajami S, Tayebi L. The adjunctive

effect of autologous platelet concentrates on orthodontic tooth movement: A systematic

review and meta-analysis of current randomized controlled trials. Int Orthod.

ie
2022;20(1):100596. doi: 10.1016/j.ortho.2021.10.004.

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FIGURE CAPTIONS

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Figure 1. Study selection. A total of 30 studies were included in the systematic review.
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Figure 2. Fore splot: Outcome time of displacement. The pooled estimation showed a

statistically significant effect in favor of the low-level laser therapy (LLLT) with a treatment time
p

difference of 25 days compared to the fixed orthodontics (control).

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Figure 3. Fore splot: Outcome rate of displacement. The results of the random effects

meta-analysis did not show significant differences between low-level laser therapy (LLLT) and
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fixed orthodontics (control) during a follow-up time between 60-180 days.

Figure 4. Fore splot: Outcome amount of displacement. Random effects meta-analysis

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evaluating the amount of displacement for canine retraction using LLLT showed a trend toward

improvement in favor of LLLT over a period of follow-up time between 21-180 days. Also
ep

showed an amount of movement of -0.31 mm in favor of shock waves (SW) therapy during

150 days of treatment, therefore no statistically significant differences were found between the

use of SW with different instruments and conventional orthodontics (control). No difference

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was found for canine retraction between the use of plasma and placebo.

This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4687287