A topic of great interest to our readers this year is the use of surgical techniques to allow faster tooth movement and shorter treatment times. With this in mind, we have selected a series of original research studies related to this topic for publication in the “2014 Supplement and Product Guide.” The most significant article in this issue of the Journal is “Surgically facilitated orthodontic treatment: A systematic review,” by Hoogeveen, Jansma, and Ren, from University Medical Center Groningen, The Netherlands. To the best of my knowledge, this is the first systematic review on this topic and one that you will want to spend time reading.
A total of 18 studies met the inclusion criteria for this systematic review. Seven were clinical trials with small sample sizes. The aims of the study were to answer the following questions. (1) Does surgically facilitated treatment significantly increase the velocity of tooth movement and shorten treatment duration, compared with conventional orthodontics? (2) Are there differences in the incidence of tooth vitality loss, periodontial problems, and root resorption? (3) Do the designs of the cortical cuts and the gingival flaps influence the efficiency of tooth movement and the incidence of complications?
Before rushing to any conclusions, it must be acknowledged that the quality of the available studies was moderate or low, resulting in several risks of bias. However, the outcomes of the studies were consistent: both corticotomy-facilitated orthodontics and distraction temporarily enhanced tooth displacement, with few complications. The procedures were not associated with loss of tooth vitality, periodontal problems, or severe root resorption. It was clear that surgically facilitated orthodontics is characterized by a temporary phase of accelerated tooth movement, and this might shorten the duration of treatment. But careful treatment planning, early activation of appliances, and short intervals between checkups are recommended. The authors end with their best advice: “Well-conducted, prospective research is still needed to draw valid conclusions.”
This topic raises a number of other questions that must be considered. Do patients really care how long treatment takes? Are they willing to pay more for treatment if it takes less time? Uribe et al addressed those questions in their article, “Patients’, parents’, and orthodontists’ perceptions of the need for and costs of additional procedures to reduce treatment time.” Their purpose was to evaluate patients’, parents’, and orthodontists’ perspectives on treatment duration and various techniques for accelerating the rate of tooth movement. Two hundred adolescent patients and their parents and 50 adult patients were surveyed regarding treatment duration and the acceptance of techniques to possibly enhance the speed of treatment. They were also asked to consider how much of an increase in fees they would be willing to pay for these new technologies. The findings will not surprise you. Although treatment generally takes about 2 years, parents want treatment to be finished in 12 to 18 months; adult patients want treatment to be completed within 6 to 12 months; and adolescents want treatment finished in 6 months or less. Their willingness to pay extra for techniques or appliances so that treatment could be finished within these time frames varies, but in general all groups were more willing to pay more for noninvasive techniques to speed treatment compared with surgical techniques, and adolescents were the most willing of all. The findings magnified a difference between the children and their parents regarding treatment time.
Members of the AAO were also interviewed electronically, and 70% were interested in changing clinical procedures if it would reduce treatment times. However, many were satisfied with treatment times, especially when considering the reality of patients’ payment schedules.
Whether the use of surgically facilitated orthodontic treatment is efficient depends on the value received relative to the cost of the treatment—in terms of time saved and money spent. Until more high-level studies are completed, only the patient and the orthodontist can determine whether sufficient value would be achieved in each clinical situation.