anyone tried an acceledent?

[DrJasonKTam]

I wrote a blog entry regarding the recent research regarding AcceleDent. I do agree that independent but WELL-DESIGNED studies need to be put together. That being said, we have seen anecdotally a very nice response in our Invisalign patients.

http://markhamortho.blogspot.ca/2015/07 ... udies.html

We have also had many units go down. There has been no issue with getting OrthoAccel to send us units to replace them, as long as we have everything to send back to them. That being said, it has been a bit of an annoyance to our office and our patients to need to process these claims, and leave our patients without a unit for a short time.

[metalliKa]

< response to metalliKa >
Hmm, chewing gum? An orthodontist said that? There is more science and empirical research behind an AcceleDent device than chewing gum, and the biomechanics and forces delivered are not the same. The science behind the AcceleDent is not "stimulating gums to promote good blood flow", as you wrote. The way resonance vibration accelerates tooth movement is through enhanced RANKL expression in the periodontal ligament (basically, these are cytokines -- substances that are inflammatory that are released by our bodies, and, in this case, remodel tooth ligaments).

A 50% reduced treatment time is not a common outcome in the studies. At best, it would constitute an outlier in the data, however, in my case, it is pretty close to what has occurred. Although the treatment periods for people vary by a lot, I usually read that the average length of time spent in braces is anywhere between 2 and 3 years. I will have spent 12 months (I will update as my treatment progresses and if this changes) total. That is roughly 50% of the time I was told to expect.

Still, any reduction, even one of 10-20% would be quite meaningful for many people who wish for a shorter treatment time. I think the cost, though, is prohibitive for many, but was not for me due to the reasons stated in my post.

As for those who think more studies are needed, well, there are already many as you would see through a PubMed search. Some of them are better than others, however. The methodology of the first controlled study had patients using the device for only 6 months, and all of the study subjects had only a Class I malocclusion. In addition, this study measured only root resorption, a common problem when accelerating tooth movement. It did not study how quickly the subjects' teeth actually responded to orthodontic treatment. (Head Face Med. 2011; 7: 14.) There was a study that measured the rate of movement per week on a small group of patients using AcceleDent, but I noticed there was no control group for baseline comparison.

Perhaps higher degrees of malocclusion, like mine, respond more favorably to the device.

Other studies:
-- Am J Orthod Dentofacial Orthop. 2008 Apr;133(4):572-83. doi: 10.1016/j.ajodo.2006.01.046.
-- World J Methodol. 2014 Sep 26; 4(3): 151–162. Dental movement acceleration: Literature review by an alternative scientific evidence method

Giovanna, as simple as chewing gum sounds...it has worked wonders for me. Perhaps, like you mentioned, patients with a more severe case do respond better to AcceleDent.

[newbite]

My ortho has been using Acceledent since it first was developed and is a big proponent of it. Lucky for me, that means he sells them at a very low price ($500). It seems very sketchy that some orthos charge $1000+, but perhaps they have to pay a lot more (maybe there are big bulk discounts?).

Anyway, if it weren't for my gum graft messing up my treatment I'd be out of braces soon. I'll have had them a year on the 14th. My case was fairly severe-- class 3, crowding, cross bite, bruxism. By 10 months all but the bruxism has been fixed (of course, bruxism is likely going to be a lifelong "friend").

I had a wire change nearly every month because of the Acceledent. Without it I wouldn't even be in finishing wires yet. As for pain, yes I DO still have pain! Significant pain after the 1st rectangular wire and 1st finishing wires (for days), especially, and of course the first 10 days. The ortho seemed surprised at the amount of pain I've had, but in my mind it could have been worse so I don't care. I just wanted to put that out there so people don't think it's a miracle device and you'll never have any pain. Maybe you will, maybe you won't.

I missed an entire month of treatment because of my gum graft, my next adjustment is the end of this month. They have to pull back my overjet a bit (me, an overjet!) but other than that I'm done as far as I know. If I can get these off by December (16 months) I will be extremely happy and it will have been more than worth the extra $500.

[Giovanna911]

Hi Newbite. Your experiences mimic mine. First, please allow me to say that I am sorry you had to endure a gum graft. I know it is for the best, but ouch! The cessation in your treatment due to the graft was not that long, fortunately.

Regarding the variability of cost for an AcceleDent, when I queried my ortho about this months ago, he responded that it does matter how many units a practice can afford to buy at once, and he bought a LOT. Like you, I don't know why someone would charge $1,000 for this device.

As for your pain, there are studies to suggest, and my ortho confirms this from his 26 years of practice, that individual pain tolerances are extremely variable. Some people's genotypes and inherent responses to pain are much more acute than others. In addition, it is also variable not only between individuals but within a single individual during a course of treatment. Sometimes, my pain would be quite high and steady for two weeks, usually following a change to a higher tensile finishing wire, but usually, my pain subsides within two days following a re-tie. In the beginning of my treatment phase, the pain tended to be higher and of a longer duration.

I smiled when I read that you had an overjet after starting out Class 3 prognathic. It just goes to show you that the manipulation of alveolar bone is amazing.

[DrJasonKTam]

Units cost doctors around $1000 USD. For us in Canada, that now means over $1300 CAD.

With bulk discounts, the price can get down into the $650 USD range with a rebate, but doctors pay for that list price up front. We're talking about ordering 40 units at a time, so $40,000 USD in dead stock with no promise of someone using it.

[Giovanna911]

Today, at my daughter's RPE fitting, I spoke with my orthodontist about the cost of AcceleDent (among other topics), and he confirmed what DrJasonKTam wrote. They are indeed $1,000 per unit, and my ortho purchases 40 at a time, as well. He said that when AcceleDents first came out, the purchasing unit amounts were smaller, and he would buy only around six at a time, not certain whether or not he could "move" them through his office quickly enough.

Today, his staff educate the patients about them at initial consultation and charge $400 per unit. He said he takes a small loss, even though a rebate he has negotiated with his rep has helped a lot. So, he doesn't make money off them, but once his patients learn that the units shorten response time and make treatment more comfortable, most people add them to their treatment plans and use them regularly.

His patients universally report positive experiences with AcceleDent, and he has been wanting to report his findings from his practice but has not had the time. We discussed the published science, and he agreed that more studies are needed.

When I looked at a review (Evid Based Dent. 2014 Dec;15(4):116-7.) of eight RCTs (randomized controlled trials) comparing the effectiveness of four interventions for accelerating orthodontic tooth movement, only two of the studies were deemed to be of high quality. In none of the eight studies were any of the subjects older than 26 years of age. I would imagine that the majority of AcceleDent users who utilize the devices with highest compliance are older (>30 yrs) orthodontic patients, and I'd like to see an RCT done on that age population.

[DrJasonKTam]

Interesting development. Results of an RCT have been released and will be published in a peer-reviewed journal. However, it was funded by OrthoAccel and does not appear to be a great study either... jury is still out.

AcceleDent Study http://www.semortho.com/article/S1073-8 ... 5/abstract:

[metalliKa]

I'll keep on chewing sugarless gums. The technology behind AcceleDent may far exceed that of gum chewing...but the science is the same...exerting a small amount of force to agitate the teeth. Or in my ortho's own words, "All you're really doing is just jiggling your teeth around." LOL

[jfriend33]

I'll keep on chewing sugarless gums. The technology behind AcceleDent may far exceed that of gum chewing...but the science is the same...exerting a small amount of force to agitate the teeth. Or in my ortho's own words, "All you're really doing is just jiggling your teeth around." LOL

well said. not to mention chewing gum can help with orthodontic discomfort.

Chewing is a very important part of jaw development too. Faces in the USA are becoming longer with weaker jaws because we eat so much soft crap and processed food.

I would like to see more research on acceledents... not to mention their use with traditional braces. Also I would like to see how effective they are with molar intrusion as well.

[Vive18]

Are there any risks associated with moving the teeth too quickly?

I have condylar resorption of my TMJs. I may need to be in braces for 2 years, so would definitely love to cut the treatment time down. However, one Oral Medicine Specialist I saw said that I want to move the teeth slowly and not to risk any root resorption ontop of what I'm currently dealing with.

I will ask the orthodontist, but I suspect, being in the business of making money, they will say Acceledent is perfectly fine.

[djspeece]

Are there any risks associated with moving the teeth too quickly?

I have condylar resorption of my TMJs. I may need to be in braces for 2 years, so would definitely love to cut the treatment time down. However, one Oral Medicine Specialist I saw said that I want to move the teeth slowly and not to risk any root resorption ontop of what I'm currently dealing with.

I will ask the orthodontist, but I suspect, being in the business of making money, they will say Acceledent is perfectly fine.

Yes of course there are risks with teeth moving too quickly. Ask your ortho.
Most of us are in business to make money. I don't work for free. However I would not be too quick to imply that this is the main motivation for orthodontists, if that is what you were meaning. When I asked my ortho about Acceledent, he indicated that it was not really a new approach and didn't seem to have strong feelings one way or the other. Drs. Freyman and Tam have commented here about Acceledent's pros and cons, and you may want to search for their thoughts. I would think if treatment could be hastened, it might allow a practice to intake more patients and increase revenues, but that is just speculation on my part. I don't think orthodontists would expose their patients to additional risk just to make a few more dollars with Acceledent if they had any reservations.

[metalliKa]

I find it very interesting that not one single Board of Directors for OrthoAccel has any dental or orthodontic background. All of them are high powered executives with various marketing and finance background.

I don't doubt the efficacy of the appliance. I just don't believe that the appliance itself is worth the cost it's currently being sold for.

[Vive18]

[quote="djspeece"][quote="Vive18"]Are there any risks associated with moving the teeth too quickly?

I have condylar resorption of my TMJs. I may need to be in braces for 2 years, so would definitely love to cut the treatment time down. However, one Oral Medicine Specialist I saw said that I want to move the teeth slowly and not to risk any root resorption ontop of what I'm currently dealing with.

I will ask the orthodontist, but I suspect, being in the business of making money, they will say Acceledent is perfectly fine.[/quote]

Yes of course there are risks with teeth moving too quickly. Ask your ortho.
Most of us are in business to make money. I don't work for free. However I would not be too quick to imply that this is the main motivation for orthodontists, if that is what you were meaning. When I asked my ortho about Acceledent, he indicated that it was not really a new approach and didn't seem to have strong feelings one way or the other. Drs. Freyman and Tam have commented here about Acceledent's pros and cons, and you may want to search for their thoughts. I would think if treatment could be hastened, it might allow a practice to intake more patients and increase revenues, but that is just speculation on my part. I don't think orthodontists would expose their patients to additional risk just to make a few more dollars with Acceledent if they had any reservations.[/quote]
The orthodontists I had an initial consult with, implied that Acceledent was universally safe for everyone (they were very sell, sell, sell! it felt like just a sales pitch - at least when it came to Invisalign & Acceledent - not just to me, but felt like that to the two others I was with too) but I am curious if they will change their mind given my new circumstances.
I don't think all orthodontists are like that - I know they aren't - but my most recent experience has left me a bit wary.

I actually hope I will be able to use Acceledent though, so we shall see.

[newbite]

It's not the Acceledent that will hurt your bone, it's how aggressive your ortho is with wire changes. Acceledent is supposed to allow for quicker/more aggressive wire changes since it's supposed to encourage faster bone remodeling. The quicker the wire changes the shorter your time in braces (assuming your teeth cooperate). My ortho changed my wire every month since I was using Acceledent but he didn't skip any wires-- he went through almost every wire size to avoid pushing my teeth too quickly.

[jfriend33]

Actually orthos are transitioning in their archwire changes. It used to be they would go up one at a time. But now, they skip and put in the largest one that can fit.

Anyway, I have not seen anyone here with traditional braces post about an acceledent. Its only people with invisalign. I just want to talk to a few people with traditional braces, especially someone who had teeth intruded....