It was refreshing to read the article “Effect of micro-osteoperforations on the rate of tooth movement” in the November issue (Alikhani M, Raptis M, Zoldan B, Sangsuwon C, Lee YB, Alyami B, et al. Am J Orthod Dentofacial Orthop 2013;144:639-48). Duration of orthodontic treatment is a factor preventing many adults from seeking the benefits treatment has to offer. Historically, investigators have applied additional stimuli in various forms to augment the effects of mechanical loading to activate bone cells and speed up tooth movement. The complexity of surgical manipulation to increase the velocity of tooth movement has ranged from plain transmucosal corticision and decortications of different degrees to therapeutic fractures of the anterior alveolus. In their attempt to expedite orthodontic treatment time, the authors here have focused on the concomitant use of surgical assistance to enhance the rate of tooth movement.

In this seminal article, the authors have presented interesting preliminary findings using an innovative, minimally invasive surgical technique. They used a novel surgical method sans raising a flap or placing graft material and showed accelerated canine retraction. However, we wish to express some of our concerns pertaining to the report.

In a clinical practice setting when treating patients with dentoalveolar protrusion, extractions for the purpose of creating space are delayed by most practitioners, often until the completion of leveling and aligning. Anecdotal evidence shows that when the teeth are extracted just before commencing space closure, then space closure tends to be faster, possibly owing to the reduced bony resistance offered by the freshly healed extraction site to tooth movement. A similar phenomenon is observed when teeth are moved through new bone regenerate soon after interdental distraction osteogenesis. In our opinion, the utility of the procedure outlined by the authors in routine extraction space closure is limited, since the extent of the inflammatory responses generated by micro-osteoperforations and that of delayed orthodontic premolar extractions just before space closure might not differ greatly. However, the micro-osteoperforation technique presented by the authors might hold promise, especially in sites that need reactivation of dormant bone biology, like atrophic extraction areas, making it an excellent choice in adjunctive adult orthodontic treatment.

Second, there is doubt regarding the suitability of the lateral incisors as stable reference points for the canine retraction measurements.

Finally, the basis on which the authors concluded that micro-osteoperforation–assisted orthodontics could shorten treatment duration by 62% is unclear. Nevertheless, it certainly is a laudable effort from the team at the Consortium for Translational Orthodontic Research. We hope this article will set the ball rolling for more studies that will ultimately provide unequivocal evidence regarding surgically assisted accelerated tooth movement.