CLINICAL INSIGHT
In my practice: aligner therapy with added high-frequency vibration Dr. David R. Boschken discusses a combination of therapies that can lead to more efficient orthodontic treatment
D
uring my 20-year orthodontic career, it has been my experience that tooth movement can lead to discomfort and pain. It has been reported that orthodontic pain has a prevalence of 72%–100%, perceived as feelings of soreness, pressure, or tension in the affected teeth.1 Even though our mechanics over the past decade have evolved to using more light wires and slow continuous movements, as opposed to steel wires and punctuated movements, patients still complain of discomfort caused by the inflammatory response created when teeth move within bone. In recent years, a majority of my patients have been treated with clear aligner therapy with Invisalign®. Seventy-five percent of my patients, ages 7 years old to 70 years old, are involved in aligner therapy, and within the next 12 to 18 months, that number should rise to 90 percent of patients. With the opportunity to treat these patients more quickly, I felt the necessity to implement a way to make tooth movement less painful as well.
About 6 years ago, I began using the manual osteoperforations (MOPs) technique (Propel), a procedure I use to allow a more targeted planning of tooth movements, as well as speed treatment. MOPs is a process of creating small holes in the bone around the teeth to accelerate tooth movement. I found that this treatment translated to greater efficiency in moving teeth in less time. A few years later, Propel developed an option for orthodontists that patients could use at home — VPro5™, a high-frequency vibration (HFV) aligner seater. In my practice, this device was offered to patients either as an alternative or in addition to MOPs. The device, which was used for 5 minutes each night as per instructions for use was designed to facilitate better aligner seating. When the aligners fit more snugly to the teeth, the result was more efficient tooth movement. Over time, Invisalign developed a new material — SmartTrack — that improved
the process of tooth movement and represented a massive advancement in the technology of plastic and aligner therapy. According to Align Technology, SmartTrack material is a “highly elastic material that delivers gentle, more constant force to improve control of tooth movements.”2,3 The material “conforms more precisely to tooth morphology, attachments, and interproximal spaces, which delivers improved control.”3 VPro5 allowed those aligners to fit even better. Over time, my patients began giving me feedback about a reduction in discomfort and pain in conjunction with VPro5 use. Anecdotally speaking, hundreds of my patients who have used the VPro5 comment that they either feel less discomfort or don’t feel pain when switching aligners every 5 to 7 days.4 I believe that HFV with VPro5 helped us offer that protocol to a greater range of patients with a wide range of clinical issues and compliance levels.
Figures 1 and 2: Patient 1 — Peter. Diagnosis: Class I crowding. Treatment plan: 32 upper and lower aligners, 5-day exchange with HFV each day. Expected treatment time: 12-14 months. Actual treatment time: 5 months Dr. David R. Boschken, DMD, graduated from the University of California, Berkeley, with a double major in Biology and Anthropology. He received his DMD from the University of Pennsylvania Dental School. He completed a Guy’s and St. Thomas Hospital Residency in London, England, and an Orthodontic certification from the University of Pennsylvania Dental School. Dr. Boschken is recognized as an Elite Invisalign® Top 1% provider and has been on Align Technology Speaker’s Bureau for 17 years training Primary Care Dentists (PCD) and Orthodontists throughout North and South America, Europe, and Asia. He owns two orthodontic offices, Los Altos and San Jose, California, offering comprehensive orthodontic treatment to children and adults. Disclosure: Dr. Boschken has served on the Clinical Advisory Board (CAB) and has been a KOL member for Propel Orthodontics since the company’s inception.
20 Orthodontic practice
Volume 8 Number 6